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Introduction Social determinants of health and adverse childhood experiences have been implicated as driving causes of maternal mortality but the empirical evidence to substantiate those relationships is lacking. We aimed to understand the prevalence and intersection of social determinants of health and adverse childhood experiences among maternal deaths in Colorado based on a review of records obtained for our state's maternal mortality review committee. Methods A 5-member interdisciplinary team adapted the Protocol for Responding to and Assessing Patients' Assets, Risk, and Experiences and the Adverse Childhood Experiences tools to create a data collection tool. The team reviewed records collected for the purpose of maternal mortality review for pregnancy-associated deaths that occurred in Colorado between 2014 and 2016 (N = 94). Results The review identified an overwhelming lack of information regarding social determinants of health or adverse childhood experiences in the records used to review maternal deaths. The most common finding of the social determinants of health was a lack of conclusive evidence in the record (35.1-94.7%). Similarly, the reviewers were unable to make a determination from the available records for 92.1% of adverse childhood experience indicators. Discussion The lack of social and contextual information in the records points to challenges of relying on medical records for identification of non-medical causes of maternal mortality. Maternal mortality review committees would be well served to invest in alternative data sources, such as community dashboards and informant interviews, to inform a more comprehensive understanding of causes of maternal mortality., Author(s): E. Brie Thumm [sup.1] [sup.2] , Rebecca Rees [sup.2] , Amy Nacht [sup.3] , Kent Heyborne [sup.4] , Bronwen Kahn [sup.5] Author Affiliations: (1) grid.430503.1, 0000 0001 0703 675X, [...]

Introduction: The coronavirus disease 2019 (COVID‐19) pandemic created disruption in health care delivery, including a sudden transition to telehealth use in mid‐March 2020. The purpose of this study was to examine changes in the mode of prenatal care visits and predictors of telehealth use (provider‐patient messaging, telephone visits, and video visits) during the COVID‐19 pandemic among those receiving care in a large, academic nurse‐midwifery service. Methods: We conducted a retrospective cohort study of those enrolled for prenatal care in 2 nurse‐midwifery clinics between 2019 and 2021 (n = 3172). Use outcomes included number and type of encounter: in‐person and telehealth (primary outcome). Comparisons were made in frequency and types of encounters before and during COVID‐19. A negative binomial regression was fit on the outcome of telehealth encounter count, with race/ethnicity, age, language, parity, hypertension, diabetes, and depression as predictors. Results: When comparing pre–COVID‐19 (before March 2020) with during COVID‐19 (after March 2020), overall encounters increased from 15.9 to 19.5 mean number of encounters per person (P <.001). The increase was driven by telehealth encounters; there were no significant differences for in‐person prenatal visit counts before and during the pandemic period. Direct patient‐provider messaging was the most common type of telehealth encounter. Predictors of telehealth encounters included English as primary language and diagnoses of diabetes or depression. Discussion: No differences in the frequency of in‐person prenatal care visits suggests that telehealth encounters led to more contact with midwives and did not replace in‐person encounters. Spanish‐speaking patients were least likely to use telehealth‐delivered prenatal care during the pandemic; a small, but significant, proportion of patients had no or few telehealth encounters, and a significant proportion had high use of telehealth. Integration of telehealth in future delivery of prenatal care should consider questions of equity, patient and provider satisfaction, access, redundancies, and provider workload. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to investigate the relationship between state regulation of the midwifery workforce, practice environment, and burnout. Background: Burnout threatens the US midwifery workforce, with over 40% of certified nurse-midwives meeting criteria. Burnout can lead to poorer physical and mental health and withdrawal from the workforce. Burnout in midwives has been associated with lack of control and autonomy. In the United States, midwives' autonomy is restricted through state-level regulation that limits scope of practice and professional independence. Methods: A mixed-methods study was conducted using an explanatory sequential approach. Quantitative and qualitative data were collected by online surveys and analyzed in a 2-stage process, followed by data integration. Results: State regulation was not found to be independently associated with burnout (n = 248; P = .250); however, mediation analysis showed a significant association between state regulation, practice environment, and burnout. Qualitative analysis mirrored the importance of practice environment and expanded on its features. Conclusion: For midwives, unrestrictive practice regulation may not translate to burnout prevention without supportive practice environments. Implications for practice and research: Interventions should focus on promoting job flexibility, realistic demands, and professional values.While midwives' commitment to patients and the profession can help bolster the workforce, it can also amplify negative experiences of the practice environment. [ABSTRACT FROM AUTHOR]

Introduction: Prior to the coronavirus disease 2019 (COVID‐19) pandemic, studies of innovative telehealth perinatal care models showed similar clinical outcomes and perceived quality of care between groups receiving a combination of virtual video and in‐person visits. However, these studies included primarily White, English‐speaking participants, excluding those who were economically disenfranchised or did not speak English. The purpose of this qualitative study was to describe perinatal patients' and providers' experiences with telehealth during and after the acute phase of the COVID‐19 pandemic to inform future utilization of telehealth to drive the delivery of high‐quality, accessible, and equitable perinatal care to diverse communities. Methods: This descriptive qualitative study included a purposive sample of 14 patients and 17 providers who received or provided perinatal care via telehealth in either a certified nurse‐midwifery practice or the nurse‐family partnership care model between March 2020 and April 2022. Maximum variation sampling offered a diverse population based on race, ethnicity, and rurality. Researchers conducted 2 rounds of semistructured interviews with a focus on understanding social and geographic context. Results: Six themes were identified through inductive analysis: (1) unexpected advantages of telehealth, (2) patient empowerment, (3) providers' fear of adverse outcomes, (4) concern for equitable care, (5) strategies to enhance the telehealth experience, and (6) strategies to address access to perinatal telehealth. Patients appreciated the increased ease and reduced cost of accessing visits, which led to fewer missed appointments. Health care providers saw great opportunity in telehealth but expressed concerns about accessibility for patients with language barriers or limited resources. Discussion: This study provides insight into priorities for continued telehealth utilization focused on providing equitable access to perinatal care. Rather than returning to practices from before the COVID‐19 pandemic formed from longstanding routines and perceived limitations, providers are encouraged to capitalize on the rapid innovations in telehealth to build a more effective, equitable, and patient‐centered approach to perinatal care. [ABSTRACT FROM AUTHOR]

Background and Purpose: Team-based care has been proposed as a means of improving maternity care in the United States. Methods: The study evaluated the individual and group-level psychometric properties of the Collaborative Practice Scale (CPS) among 108 midwives and physicians who provided team-based care in military hospitals. Results: Psychometric properties of the CPS included Cronbach's alpha of.98. Internal consistency was measured with item-to-total correlations from.83 to.94 and inter-item correlations from.71 to.88. Principal components analysis resulted in a single-factor loading, accounting for 80% of total variance. Properties of the scale at the group level; strong within team agreement (r wg(j) =.94) and between team variance (ICC1 =.15, ICC2 =.65). Conclusion: The CPS demonstrated reliability and validity of the instrument at the individual and group levels. The collaborative process can be measured among midwife-physician teams. [ABSTRACT FROM AUTHOR]