Search

PURPOSE Currently, 40% of counties in the United States do not have an obstetrician or midwife, and in rural areas the likelihood of childbirth being attended to by a family medicine (FM) physician is increasing. We sought to characterize the effect of the FM presence on unit culture and a key perinatal quality metric in Iowa hospital intrapartum units. METHODS Using a cross-sectional design, we surveyed Iowa physicians, nurses, and midwives delivering intrapartum care at hospitals participating in a quality improvement initiative to decrease the incidence of cesarean delivery. We linked respondents with their hospital characteristics and outcomes data. The primary outcome was the association between FM physician, obstetrician (OB), or both disciplines' presence on labor and delivery and hospital low-risk, primary cesarean delivery rate. Unit culture was compared by hospital type (FM-only, OB-only, or Both). RESULTS A total of 849 clinicians from 39 hospitals completed the survey; 13 FM- only, 11 OB-only, and 15 hospitals with both. FM-only hospitals were all rural, with CONCLUSIONS Birthing hospitals staffed exclusively by FM physicians were more likely to have lower cesarean rates and stronger nursing-rated safety culture. Both access and quality of care provide strong arguments for reinforcing the pipeline of FM physicians training in intrapartum care. Key words: family medicine; cesarean birth; organizational culture, https://doi.org/10.1370/afm.3157 INTRODUCTION The United States is facing multiple maternal health crises including increasing severe maternal morbidity (SMM) and mortality, racial inequities in SMM, and a shrinking footprint of pregnancy care [...]

BackgroundPerinatal quality improvement lacks valid tools to measure adverse hospital experiences disproportionately impacting Black mothers and birthing people. Measuring and mitigating harm requires using a framework that centers the lived experiences of Black birthing people in evaluating inequitable care, namely, obstetric racism. We sought to develop a valid patient-reported experience measure (PREM) of Obstetric Racism© in hospital-based intrapartum care designed for, by, and with Black women as patient, community, and content experts.MethodsPROMIS© instrument development standards adapted with cultural rigor methodology. Phase 1 included item pool generation, modified Delphi method, and cognitive interviews. Phase 2 evaluated the item pool using factor analysis and item response theory.ResultsItems were identified or written to cover 7 previously identified theoretical domains. 806 Black mothers and birthing people completed the pilot test. Factor analysis concluded a 3 factor structure with good fit indices (CFI = 0.931-0.977, RMSEA = 0.087-0.10, R2  > .3, residual correlation

Context: The consequences of continued loss of family physicians(FMs) practicing obstetrics in the United States has been characterized in terms of loss of access to care, particularly for rural patients; however, the impact on quality of care needs further study. Reducing the low-risk, primary cesarean rate is a national quality goal. Iowa is a state with a strong FM obstetrics presence where many rural hospitals are staffed exclusively by FMs with general surgery on call for cesarean deliveries. Objective: To characterize the FM impact on cesarean delivery in Iowa birthing hospitals. Study Design: Survey linked with administrative hospital data. Dataset: Hospital characteristics were obtained from the Iowa Department of Public Health or self-reported. Population Studied: Iowa clinicians delivering intrapartum care at hospitals participating in an initiative to reduce cesarean. Instrument: The Labor Culture Survey is a valid measure of individual attitudes, beliefs, and unit culture on intrapartum units. Outcome Measures: Primary outcome was the association between FM, obstetrician, or both disciplines' presence on labor and delivery and hospital low-risk, primary cesarean delivery rate. Unit culture was compared by hospital type (FM-only, OB-only, or both). Results: 849 clinicians from 39 hospitals completed the survey; 12 FM-only, 12 OB-only, and 15 hospitals with both. FM-only hospitals were all rural with less than 1,000 annual births. FMs practicing at FM-only hospitals had been practicing maternity care for longer than FMs at hospitals with both (13 vs 4 years, p=.02). Among hospitals with less than 1,000 annual births, compared to hospitals with both, births at FM-only hospitals had an adjusted 39% lower risk of cesarean (95% CI -0.16 to -0.62%; p, Presenters Emily White VanGompel, MD, MPH, Stephanie Radke, Lavisha Singh, MPH, Francesca Carlock, [...]

The article presents a case study of a 35-year-old healthy woman without a history of high-grade precancerous cervical lesions, immunodeficiency, or exposure to diethylstilbestrol presents to office for her routine health visit. It mentions that USPSTF emphasized that screening alone is not sufficient for the prevention of cervical cancer and that efforts should be made to create equitable access t follow-up of abnormal results and the provision of appropriate treatment.

Background: In order to evaluate interventions aimed at reducing cesarean births, care practitioners' attitudes are important to measure. The Labor Culture Survey (LCS) is a scale that measures individual and unit attitudes towards supporting vaginal birth. As no equivalent scale exists in Sweden, the aim was to translate, adapt, and validate the LCS and to investigate whether there were differences in attitudes toward supporting vaginal birth between maternity care practitioners., Methods: A cross-sectional study including midwives, physicians, and nurse assistants working with intrapartum care in five labor wards in Sweden. The original LCS was translated into Swedish, and six context-specific items were developed for the Swedish setting (SLCS). The translation was tested for face validity. Psychometric analysis was conducted using exploratory factor analysis with principal component analysis, parallel analysis, and principal axis factoring. Reliability was estimated using Cronbach's alpha. One-way ANOVA and Tukey HSD were calculated to analyze differences in attitudes between professions on the subscales of the S-LCS., Results: A total of 539 midwives, physicians, and nurse assistants participated. The final S-LCS showed a five-factor solution with the following subscales: Best Practices to reduce cesarean overuse, Unpredictability of vaginal birth, Unit Microculture, Maternal Agency, and Organizational Oversight. Chronbach alpha values varied from 0.60 to 0.83. Midwives were more supportive towards vaginal birth and less fearful of potential consequences of vaginal birth compared with physicians., Conclusions: The S-LCS demonstrated satisfactory psychometric properties for use in Swedish maternity care. Further work to improve the scale should include additional items reflecting the subscale Maternal Agency., (© 2023 The Authors. Birth published by Wiley Periodicals LLC.)

Women ages 30 to 65 years now have a third cervical cancer screening option.