"An extra layer of pressure to be my best self”: Healthcare provider perspectives on how doulas foster accountability and bridge gaps in pregnancy-related care

This analysis contributes to the broader literature on doula care by describing mechanisms through which doulas improve pregnancy-related care. Doulas may be critical for birthing people who are most likely to experience mistreatment due to racism and other dimensions of oppression.

"We were left to our own devices": Midwives' experiences of providing maternity care to Ukrainian women in Poland after the outbreak of the full-scale war in Ukraine

This qualitative study aimed to explore the challenges and strategies of midwives offering maternity care to Ukrainian migrants. The findings revealed barriers at individual and interpersonal levels, such as fear for life and well-being due to the war, depleting resources, post-pandemic fatigue, language barriers, and lack of knowledge in caring for war-affected women. At the management and organizational level, midwives faced a lack of organizational support and interpreting services. The study concluded that systemic solutions, jointly prepared by state and local authorities and considering midwives' insights, are essential to provide high-quality care to the migrant population.

A Cost-Benefit Analysis of Doula Care from a Public Health Framework

This report seeks to present a broad cost-benefit analysis of public reimbursement for doula services nationally with a public health and Reproductive Justice lens. It summarizes the cost of recent maternal and infant morbidity and mortality; outlines the cost savings from doula support; describes the health benefits of doulas across the pregnancy, birth, and postpartum continuum; and provides recommendations/conclusions for allies and advocates across disciplines.

A History Of The Impacts Of Discriminatory Policies On Housing And Maternal And Infant Health In An Ohio Neighborhood

Community-level disinvestment and de facto segregation rooted in decades of discriminatory race-based policies and racism have resulted in unacceptably large infant mortality rates in racial minority neighborhoods across the US. This research article details how state and local policies have affected the Linden neighborhood in Columbus, OH, and shaped neighborhood-level demographics and resources during the past 100 years.

A Visit to the Pediatrician as a Part of Comprehensive Prenatal Care?

The study examines the underutilization of pediatric prenatal visits (PPV) recommended by medical associations during the prenatal period. While research supports the effectiveness of these visits in improving child health, only 22% of expectant parents utilize them (with racial and income disparities). Educating providers about the benefits, insurance coverage, and guidelines could help reduce disparities and increase overall PPV utilization.

A systematic review of clinical psychological guidance for perinatal mental health

Guidelines on psychological and/or psychosocial assessment and intervention in the perinatal period can provide benefcial practice guidance for healthcare professions to reduce maternal distress and potential mortality. As little is known about the similarities in recommendations across guidelines, which could impact the quality of therapeutic intervention women receive, this systematic review was conducted to draw out the consistent guidance for perinatal psychological and/or psychosocial therapeutic input

Addressing anti-black racism in an academic preterm birth initiative: Perspectives from a mixed methods case study

The case study evaluates the California Preterm Birth Initiative's (PTBi) Anti-Racism Action Plan, established in response to growing awareness of racism in academic settings. The study aimed to gauge perspectives on anti-racism competencies, identifying areas of success and potential improvements within the initiative, ultimately focusing on achieving racial equity. Qualitative data from interviews and surveys were analyzed, highlighting common themes across various assessment domains.

Advancing Clinical Research with Pregnant and Lactating Populations

Congress called on the National Academies to convene a committee to examine the real and perceived risks of liability arising from research conducted with pregnant and lactating women. The resulting report, Clinical Research with Pregnant and Lactating Populations: Overcoming Real and Perceived Liability Risks, explores and finds limited evidence of legal liability for inclusion of pregnant and lactating women in clinical research, contradicting perceptions of heightened liability. The committee also makes recommendations that could lead to a more robust evidence base about the safety and efficacy of medications for pregnant and lactating women that would facilitate more informed decision making regarding care while mitigating liability.

Adverse childhood experiences and prescription opioid use during pregnancy: an analysis of the North and South Dakota PRAMS, 2019–2020

Utilizing data from 2,999 individuals in the 2019 and 2020 Pregnancy Risk Assessment Monitoring System from two US states, researchers examined the association between adverse childhood experiences (ACEs) and prescription opioid use during pregnancy. This study highlights the negative effects that adverse childhood experiences can have on the health of individuals over their lifetime, especially during the vulnerable period of pregnancy.

Aligning Pregnancy-Related Medicaid Coverage Extensions and Medicaid Doula Coverage to Improve Maternal Health

Medicaid plays a crucial role in ensuring access to care during and after pregnancy. States can help alleviate maternal mortality and severe morbidity by putting in place both Medicaid pregnancy related extensions and Medicaid coverage for doula care. This issue brief shares an update of current state implementation efforts around pregnancy related Medicaid coverage extensions and Medicaid coverage for doula care. The brief analyses how these two efforts address maternal and infant mortality and why aligning twelve month pregnancy related Medicaid extensions and Medicaid coverage for doula care can improve maternal health.

Analysis of Heat Exposure During Pregnancy and Severe Maternal Morbidity

In this cohort study with 403 602 pregnancies from 2008 to 2018 in Southern California, statistically significant associations were observed between both long- and short-term maternal heat exposure during pregnancy and increased risks of severe maternal morbidity.

Analysis of research on interventions for the prevention of safety accidents involving infants: a scoping review

This study aimed to conduct a scoping review of studies on interventions for the prevention of safety accidents involving infants.

Association Between Publicly Funded Contraceptive Services and the Abortion Rate in Texas, 2010-2015

This study researches how the availability of contraceptive services was associated with a change in the abortion rate before and after Texas' legislative changes to the family planning budget in 2011 and abortion access in 2013.

Association between adverse childhood experiences and perinatal depressive symptoms: a cross-sectional analysis of 16,831 women in Iceland

Using data on 16,831 female participants from the Stress-And-Gene-Analysis (SAGA) cohort in Iceland, researchers sought to examine whether women with any out of 13 different types of adverse childhood experiences (ACEs) were more likely to experience depressive symptoms during their pregnancy and/or postpartum. This cross-sectional analysis indicated a positive association between the accumulative number of ACEs and perinatal depression (PND) symptoms in a dose–response manner. This study provides additional evidence of the relationship between ACE history and risk of perinatal depression.

Association between exposure to antibiotics during pregnancy or early infancy and risk of autism spectrum disorder, intellectual disorder, language disorder, and epilepsy in children: population based cohort study

This nationwide cohort study from Korea aimed to assess the link between antibiotic use during pregnancy or early infancy and the risk of neurodevelopmental disorders in children. Analyzing data from 2009 to 2021, including over 1.9 million children for the pregnancy analysis and 1.6 million for early infancy, the study found that while antibiotic exposure during pregnancy was initially associated with increased risks of neurodevelopmental disorders, these associations were weakened in sibling analyses, suggesting familial factors may play a role.

Association between maternity care practitioner type and postpartum depression screening

The study investigated postpartum depression (PPD) screening among California residents who gave birth in 2016, using data from the Listening to Mothers in California 2018 dataset. The primary focus was on the type of maternity care professional provided during pregnancy and its association with PPD screening. Self-reported depression or anxiety during pregnancy and attendance at postpartum office visits were also examined. Results showed that participants cared for by midwives had 2.6 times higher odds of being screened for PPD compared to those cared for by obstetricians, after adjusting for covariates. No significant differences were found in PPD screening rates when comparing care from other practitioner types to obstetricians. Additionally, reporting depression or anxiety during pregnancy was associated with lower odds of attending a postpartum office visit. The study concludes that receiving care from a midwife during pregnancy increases the likelihood of PPD screening. Furthermore, it highlights that even with universal screening, there remains a vulnerable population at high risk for PPD who are less likely to attend postpartum care visits.

Association between placental location and cord insertion site with pre-eclampsia: a retrospective cohort study

This retrospective cohort study conducted at a single tertiary hospital between January 2019 and June 2022 aimed to investigate the relationship between placental location, abnormal cord insertion, and adverse pregnancy outcomes in nulliparous women. The study suggests that anterior placenta and marginal cord insertion may be linked to an elevated risk of pre-eclampsia in nulliparous women, emphasizing the need for further research in prospective cohorts to validate these findings.

Barriers and Facilitators to the Implementation of a Community Doula Program for Black and Pacific Islander Pregnant People in San Francisco: Findings from a Partnered Process Evaluation

Increasingly, community-based models of doula care are receiving attention as possible interventions to address racial inequities in maternal health care experiences and outcomes. In 2018, community-based organization SisterWeb launched to provide free culturally congruent community doula care to advance birth equity for Black and Pacific Islander pregnant people, with funding from the San Francisco Department of Public Health. We conducted a process evaluation of SisterWeb’s first 1.5 years of existence to identify multilevel barriers and facilitators to implementation of their programs. Guided by the Equitable Evaluation Framework™, this study conducted 46 in-depth interviews with individuals from 5 groups: SisterWeb leadership, doulas, doula mentors, and clients, and external stakeholders.

Benefits of maternally-administered infant massage for mothers of hospitalized preterm infants: a scoping review

Infant massage (IM) is a well-studied, safe intervention known to benefit infants born preterm. Less is known about the benefits of maternally-administrated infant massage for mothers of preterm infants who often experience increased rates of anxiety and depression in their infants’ first year of life. This scoping review summarizes the extent, nature, and type of evidence linking IM and parent-centered outcomes.

Benzylpenicillin concentrations in umbilical cord blood and plasma of premature neonates following intrapartum doses for group B streptococcal prophylaxis

Dutch obstetrics guideline suggest an initial maternal benzylpenicillin dose of 2,000,000 IU followed by 1,000,000 IU every 4 h for group-B-streptococci (GBS) prophylaxis. The objective of this study was to evaluate whether concentrations of benzylpenicillin reached concentrations above the minimal inhibitory concentrations (MIC) in umbilical cord blood (UCB) and neonatal plasma following the Dutch guideline.

Black Women's Maternal Health - A Multifaceted Approach to Addressing Persistent and Dire Health Disparities

Regardless of socioeconomic status, Black women and birthing individuals in the United States are three times more likely to die from pregnancy than their white counterparts. This disparity widens in various cities and states. Black women are also disproportionately affected by severe maternal morbidity– unexpected outcomes in labor and delivery (e.g., hypertension and anxiety) that result in significant short- or long-term consequences to the childbearing person’s health and well-being.

Braiding Medicaid Funds to Support Person-Centered Care: Lessons from Medi-Cal

This brief explores strategies for optimizing braided funding to enhance integrated, person-centered care for Medicaid enrollees, featuring profiles of three organizations that successfully implemented strategies to braid funds.

Breastfeeding Aversion Response (BAR): A Descriptive Study

Some women have reported negative sensations such as an overwhelming need to unlatch while breastfeeding. This phenomenon is known as breastfeeding aversion response (BAR). This study therefore aimed to expand the understanding of BAR using an online survey targeting those who have experienced feelings of aversion while breastfeeding.

Breastfeeding Report Card

CDC’s Breastfeeding Report Card, 2022 provides a compilation of data on breastfeeding practices and supports in all states, the District of Columbia, and Puerto Rico.

Breastfeeding duration and associations with prevention of accelerated growth among infants from low-income, racially, and ethnically diverse backgrounds

In this prospective cohort study involving 256 low-income, racially diverse mother-infant pairs in the Southeastern US, breastfeeding patterns and their impact on infant growth were investigated. Most participants were African American or Latina, with 81% enrolled in a nutritional program for women and infants. The study found that infants breastfed beyond 6 months had slower growth rates compared to those breastfed for shorter periods, indicating a link between extended breastfeeding and reduced rapid weight gain. Infants breastfed for 2 months or less were more likely to experience rapid weight gain than those breastfed for 6 months or more, suggesting that prolonged breastfeeding may contribute to more equitable health outcomes among diverse populations, potentially aiding in preventing accelerated growth and childhood obesity.

Brief of “An extra layer of pressure to be my best self”: Healthcare provider perspectives on Doula Care

To create opportunities for bidirectional feedback between doulas and healthcare providers, SisterWeb developed the Champion Dyad Initiative, which fosters the support of one or two staff “champions” at labor and delivery sites. As part of an evaluation of SisterWeb’s community doula programs, researchers at UC Berkeley interviewed physicians, midwives, and nurses who worked at hospitals and clinicswhere SisterWeb doula clients receive care.

Building Capacity for Research on Community Doula Care: A Stakeholder-Engaged Process in California

The study focuses on addressing disparities in maternal and infant health by expanding access to doula care, particularly community-based models, which are essential for marginalized communities. Through stakeholder engagement, the study aims to build capacity for client-centered, community-informed research on doula care in California. The process involved establishing a Steering Committee representing various stakeholders, conducting a needs assessment, identifying research priorities, and offering training to increase community doulas' research engagement. The study highlights the importance of including diverse perspectives in research and provides valuable insights for policymakers, funders, and researchers interested in promoting equitable maternal and infant health outcomes through doula care.

CalAIM Experiences: Implementer Views After 18 Months of Reforms

CalAIM, the multiyear effort to reform the state’s Medi-Cal system, is now in its second year. To gain a clearer picture of how implementation is occurring on the ground, CHCF commissioned an online survey, which was conducted July 21 to September 12, 2023, among 1,196 people working at managed care plans, behavioral health organizations, community-based organizations, social services organizations, and other types of people to produce this report.

CalAIM Experiences: Southern California Implementers

To gain a sharper picture of how CalAIM implementation is playing out regionally, Goodwin Simon Strategic Research produced five regional reports from the original data. These reports explore the unique challenges and successes faced by implementers in specific parts of the state. The focus on regional experiences aims to reveal detailed insights that could help in developing focused strategies to improve the impact of CalAIM. CalAIM Experiences: Southern California Implementers focuses on findings from the counties of Imperial, Los Angeles, Orange, Riverside, San Bernardino, and San Diego.

CalAIM Explained: Caring for Californians Leaving Incarceration

This guide, developed by the Center for Health Care Strategies in partnership with Community Oriented Correctional Health Services and the California Health Care Foundation, can support California stakeholders looking to partner with the criminal legal system. While developed for the California context, the lessons within are applicable for health care professionals everywhere interested in learning the basics of the correctional system, the reentry process, and finding key partnership opportunities to serve and improve the health outcomes of this population.

Care plan for individuals at risk for preeclampsia: shared approach to education, strategies for prevention, surveillance, and follow-up (2023)

This report provides a groundbreaking approach to preeclampsia, one of the most pressing issues in maternal health today, and will translate the prediction of risk into prevention of disease.

Challenges and Opportunities for Clinician Implicit Bias Training: Insights from Perinatal Care Stakeholders

In response to health disparities, several U.S. states have explored mandating implicit bias training (IBT) for healthcare providers. California's 'Dignity in Pregnancy and Childbirth Act' requires IBT for perinatal clinicians to enhance outcomes for Black women and birthing individuals. However, the effectiveness of IBT remains unclear. Through a comprehensive community-based study involving Black women who recently gave birth and perinatal clinicians in the San Francisco Bay Area, significant challenges and recommendations emerged for successful IBT implementation. These findings provide essential guidance for policymakers, healthcare leaders, and curriculum developers aiming to advance antibias interventions in healthcare settings.

Childhood trauma and fear of childbirth: findings from a birth cohort study

This retrospective cohort study of 2556 women aimed to examine the relationship between childhood trauma and fear of childbirth (FOC). The study found that emotional abuse, emotional neglect, and a higher total burden of childhood trauma (as measured by the TADS total score) increased the risk of FOC. However, there was no evidence of a significant association between physical abuse, physical neglect, sexual abuse, and FOC.

Children with Trans Parents: Parent–Child Relationship Quality and Psychological Well-being

This exploratory study offers the first quantitative assessment of parent–child relationship quality and child socio-emotional and behavioral adjustment in families with a self-identified trans parent with school-aged children. The study concluded that parents and children in trans parent families had good quality relationships and children showed good psychological adjustment. The findings of this exploratory study challenge commonly held concerns about the potentially negative effects on children of growing up with a trans parent.

Chronic Hypertension in Pregnancy and Racial–Ethnic Disparities in Complications

In this study, women with chronic hypertension or antepartum anemia were more likely to experience severe maternal morbidity, which is defined as a life-threatening complication that occurs during pregnancy, childbirth, or the postpartum period. The study also found that Black and Hispanic women were disproportionately affected by these conditions.

Cognitive household labor: gender disparities and consequences for maternal mental health and wellbeing

The study investigates the division of cognitive household labor—tasks involving planning, anticipating, and delegating—and its impact on mothers' mental wellbeing. Involving 322 mothers of young children, the study used self-reported data to assess both cognitive ("planning") and physical ("execution") labor across 30 common household tasks. Results revealed that while mothers generally did more domestic work than their partners, the division of cognitive labor was significantly more gendered, with women shouldering a disproportionate share.

Comparison of maternal outcomes in caring by Doula, trained lay companion and routine midwifery care

This study compared maternal outcomes in labor and obstetric care provided by a doula, a trained lay companion, and routine midwifery care. It involved 150 low-risk pregnant women in Arak, Iran. The study suggests that doula care is more effective in reducing the duration of labor and enhancing maternal satisfaction, while lay companions may help reduce anxiety in mothers who cannot afford doula services. Further research on pain severity and different care models is recommended.

Complementary Feeding Interventions for Infants and Young Children Under Age 2: Scoping of Promising Interventions to Implement at the Community or State Level

In response to a request from the Centers for Disease Control and Prevention, the National Academies Health and Medicine Division convened the Committee on Complementary Feeding Interventions for Infants and Young Children under Age 2 to conduct a consensus study scoping review of peer-reviewed literature and other publicly available information on interventions addressing complementary feeding of infants and young children.

Complicating the dominant morality discourse: mothers and fathers’ constructions of substance use during pregnancy and early parenthood

This article examines the complex perceptions of substance use during pregnancy and the transition to parenthood. It highlights that while many mothers and fathers view abstinence as the ideal during this period, they also recognize the autonomy of women to make decisions about substance use for themselves. The study emphasizes the need for health and social service providers to understand and address these competing perspectives in order to effectively support vulnerable families and promote well-being within individual definitions of problematic substance use.

Confronting Racism in Pediatric Care

In this essay, Ben Danielson, MD, clinical professor in the Department of Pediatrics at the University of Washington School of Medicine, recounts the painful story of a Black pediatric patient and his mother as they navigate a hospital stay. Tragically, the hospitalization ends with the child being temporarily placed in a medical foster home due to bias and racism that hospital staff did not see playing out before them.

Cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from low- and middle-income countries residing in high income countries: A systematic review

This systemic review sought to better understand how cultural food practices impact the nutrition status of pregnant and postpartum women from LMICs residing in HICs. A total of 17 studies comprising qualitative (n = 10) and quantitative (n = 7) approaches were included in the review.

Delays in the vaccination of infants between 2 and 18 months of age: associated factors in Chile

This study contained two parts. In Part One, a questionnaire was created by the research team and then validated by a committee of experts in the field and a group of parents. It included the following contents: sociodemographic variables, features of the vaccination services, history of vaccination, and attitudes and perceptions about vaccination. Part Two was a cross-sectional study, recruiting private and public healthcare centers to explore the psychometrics features of the instrument, performing exploratory factor analysis, and determining the associated factors with DTaP vaccination delay throughout multivariable regression models.

Developing Financially Sustainable Child Health Transformation: Lessons from Primary Care Innovators

This brief from the Center for Health Care Strategies describes existing payment barriers and opportunities for primary care providers serving children to work toward financially sustaining care transformation. It draws from interviews with pediatric practices and subject matter experts engaged in the national Accelerating Child Health Transformation initiative.

Disparities by race/ethnicity in unplanned cesarean birth among healthy nulliparas: a secondary analysis of the nuMoM2b dataset

In this study, researchers aimed to conduct a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) dataset to examine self-identification of race/ethnicity and unplanned cesarean birth. The results indicated that the unplanned cesarean birth rate in percentage was about 19.6%. The cesarean birth rate was significantly higher in Black and Hispanic mothers in comparison to those who self-identified as White, even after controlling for pertinent clinical factors associated with cesarean birth.

Disparities in Postpartum Care Visits: The Dynamics of Parental Leave Duration and Postpartum Care Attendance

The study aimed to explore disparities in postpartum care access related to parental leave duration across various sociodemographic and income groups. Utilizing data from six US states in the CDC's PRAMS study (2016-2019) with 12,442 participants, the analysis assessed demographics among different parental leave durations and estimated the prevalence of not accessing postpartum care by demographics, stratified by leave length. Results indicated significant disparities in care access based on leave duration and sociodemographic factors like race, ethnicity, and income.

Early Lessons from CalAIM Initiatives to Address Behavioral Health Needs

The California Department of Health Care Services has launched the CalAIM (California Advancing and Innovating Medi-Cal) program in 2022 to transform the fragmented delivery of Medi-Cal services, particularly for individuals with behavioral health needs. To better understand the early implementation and enhance care coordination for adult Medi-Cal members with serious behavioral health conditions, the Center for Health Care Strategies conducted interviews with stakeholders across five counties between December 2022 and March 2023. The interviews provided insights into improving processes for developing contracts, identifying eligible members, reducing duplication, and delivering Enhanced Care Management (ECM) and Community Supports to eligible members within the CalAIM framework.

Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study

Lower respiratory tract infections (LRTIs) in early childhood are known to influence lung development and lifelong lung health, but their link to premature adult death from respiratory disease is unclear. This study aimed to estimate the association between early childhood LRTI and the risk and burden of premature adult mortality from respiratory disease.

Early predictors for maltreatment-related injuries in infancy and long-term mortality- a population-based study

Incidence, health consequences, and social burden associated with child maltreatment appeared to be borne disproportionately by very young children. We conducted a population-based data linkage study to explore child- and family-level factors that affect receiving different diagnoses of maltreatment injuries and investigate excessive mortality throughout toddlerhood.

Effect of implementing a birth plan on maternal and neonatal outcomes: a randomized controlled trial

This study aimed to investigate the effect of birth plan on maternal and neonatal outcomes. This study was a randomized controlled clinical trial performed on 106 pregnant women, 32–36 weeks of pregnancy, referring to Taleghani educational hospital in Tabriz city-Iran.

Effect of maternal nutrition education on early initiation and exclusive breast-feeding practices in south Ethiopia: a cluster randomised control trial

Optimal breast-feeding practices make a major contribution to the promotion of healthy growth and development through much prevention of diarrheal and respiratory diseases which majorly cause morbidity and mortality in under-five children. However, breast-feeding practices remain suboptimality in Ethiopia. The study objective was to determine the effect of maternal nutrition education on early initiation and exclusive breast-feeding practice in the Hawela Tulla sub-city.

Effects of armed conflict on maternal and infant health: a mixed-methods study of Armenia and the 2020 Nagorno-Karabakh war

This mixed-methods study explored the effects of the 2020 armed conflict between Armenia and Azerbaijan on maternal and infant health. Relying on ecological data to evaluate health trends in conflict, as well as interviews with 10 key informants about unmet needs, maternal health-seeking behaviors and priorities during the war, researchers found that both maternal and infant health measures showed adverse trends during the 2020 Nagorno-Karabakh war, including increases in neonatal mortality and maternal morbidity in 2020 compared with 2019.

Effects of free maternal policies on quality and cost of care and outcomes: An integrative review

This article conducted an integrative review of the global-free maternity (FM) policies and evaluated the quality of care (QoC) and cost and cost implications to provide lessons for universal health coverage (UHC).

Engaging Communities of Color to Promote Health Equity: Five Lessons from New York-Based Health Care Organizations

This brief outlines considerations for healthcare organizations to improve partnership relationships with patients of color to inform program and policy design. This brief expands on how Partnering with patients and community members of color to understand needs and preferences is an important step in improving health outcomes and advancing health equity.

Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents

As a traditionally underserved population that faces numerous health disparities, youth who identify as transgender and gender diverse (TGD) and their families are increasingly presenting to pediatric providers for education, care, and referrals. The need for more formal training, standardized treatment, and research on safety and medical outcomes often leaves providers feeling ill equipped to support and care for patients that identify as TGD and families. In this policy statement, we review relevant concepts and challenges and provide suggestions for pediatric providers that are focused on promoting the health and positive development of youth that identify as TGD while eliminating discrimination and stigma

Epidural analgesia during labour and severe maternal morbidity: population based study

This population-based study in Scotland involving 567,216 women in labor aimed to assess the impact of labor epidural on severe maternal morbidity (SMM) and explore its effects in women with medical indications or preterm labor. Of these women, 22.0% received epidural analgesia. SMM occurred in 4.3 per 1000 births. Epidural analgesia was associated with a 35% reduction in SMM, with even greater risk reductions observed in women with medical indications or delivering preterm. Access to epidural analgesia during labor, especially for high-risk groups, could significantly improve maternal health outcomes.

Equity in CalAIM: How to Identify the Patients Who Will Benefit Most

The brief, developed by the Center for Health Care Strategies with Rachel Davis Consulting, draws on a literature review and interviews with national and local experts to outline strategies for identifying high-need populations. While geared toward the California landscape, this resource can inform stakeholders in other states seeking to develop nuanced and inclusive approaches for identifying individuals most in need of care and services.

Examination of maternal near-miss experiences in the hospital setting among Black women in the United States

The high rate of maternal mortality among Black women in the United States continues to gain attention; yet research has not yet fully illuminated the precursors to these events, most impactful among them being “maternal near misses.” Researchers have focused on reviewing patient medical records after sentinel maternal events to help determine major contributors to them; however, qualitative studies with near-miss survivors, especially among Black women, may be a more useful approach.

Examining the impact of a change in maternity leave policy in Canada on maternal mental health care visits to the physician

This study aimed to investigate the impact of an extended maternity leave policy on maternal use of mental health services and prescription drugs in a universal public healthcare system. Analyzing administrative medical records of 18,000 randomly selected women who gave birth three months before and after the policy extension, the research revealed that mothers with the extended maternity leave (50 weeks) had 0.12 fewer medical visits and incurred Can$5 less in mental health service costs compared to those with shorter leave (26 weeks). These differences were observed specifically during the extended maternity leave period. The findings suggest that the additional time away from work provided by an extended maternity leave policy may contribute to a better balance in new family dynamics, potentially resulting in decreased demand on the healthcare system.

Experiences of childbirth care among immigrant and non-immigrant women: a cross-sectional questionnaire study from a hospital in Norway

This cross sectional study of 680 women aimed to investigate the childbirth experiences of immigrant and non-immigrant women, specifically focusing on perceived quality of care and the fulfillment of healthcare needs. The findings highlight the importance of further research to assess immigrant women's childbirth experiences and the need for healthcare providers to deliver optimal care that is sensitive to cultural backgrounds and individual expectations.

Exploring the intersection between country context and priority setting to prevent maternal mortality: A multi-methods study comparing expected vs observed priorities in five countries to validate the obstetric transition model

In this mixed-methods study design, researchers aimed to validate the obstetric transition model using data from six diverse low- and middle-income countries representing self-identified priorities for improving maternal health and measurement compiled in a multi-stakeholder process. Using multiple data sources from Bangladesh, Cote d’Ivoire, India, Mexico, Nigeria, and Pakistan, the authors conducted a four-phased analysis: examining the country’s contextual profile, mapping the key themes and indicators to the model, exploring stakeholder prioritization, and examining reasons for divergence from the model. They found the obstetric transition model to be a useful guide to aid decision-makers in prioritizing attention towards addressing maternal mortality.

Facilitators and Barriers to Medicaid Doula Benefit Implementation in California: Perspectives From Managed Care Plans and Risk-Bearing Organizations

This study explores the implementation of Medicaid doula benefits in California, which began in 2023 to address maternal health inequities. By conducting 14 interviews with staff from managed care plans (MCPs) and risk-bearing organizations (RBOs), we identified 10 facilitators and 16 barriers to the effective rollout of these benefits. Key findings highlight the need for better familiarity with doula care, relationship building with doulas, and collaboration among plans. These insights can guide improvements in California and assist other states in planning and designing their Medicaid doula benefits. This publication is detailed, so to aid in understanding, Berkeley Public Health created a brief summarizing the study.

Factors associated with short birth interval in low- and middle-income countries: a systematic review

There is ample evidence of associations between short birth interval and adverse maternal and child health outcomes, including infant and maternal mortality. This is a systemic review to systematize evidence on risk factors for short birth interval in low- and middle-income countries.

Fathers, Breastfeeding, and Infant Sleep Practices: Findings From a State-Representative Survey

A study published in June 2023 affirmed that fathers are an important factor in whether breastfeeding is successful and whether babies sleep in safe environments. This study suggests that it may be important to focus on the education of fathers regarding the benefits of breastfeeding and safe sleep.

Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity

Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity analyzes how past and current federal policies may create, maintain, and/or amplify racial, ethnic, and tribal health inequities. This report identifies key features of policies that have served to reduce inequities and makes recommendations to help achieve racial, ethnic, and tribal health equity.

GDF15 linked to maternal risk of nausea and vomiting during pregnancy

Nausea and vomiting (NVP) affect approximately 70% of pregnancies and can be debilitating, sometimes resulting in risks to the health of both mother and baby. In this study, researchers share their findings that fetal production of GDF15, a hormone acting on the brainstem, and maternal sensitivity to it, both contribute substantially to the risk of Hyperemesis Gravidarum (HG), the most severe form of NVP. This landmark study provides concrete evidence of a cause of nausea and vomiting in pregnancy as well as a potential mechanism for treating and preventing HG.

Grandparental Support and Maternal Postpartum Mental Health

This narrative review and meta-analysis, the scientific evidence on the association between grandparental support and maternal perinatal mental health is reviewed.

Having Enough Milk to Sustain a Lactation Journey: A Call to Action

The rates of human milk feeding are suboptimal worldwide. Recommendations for healthy, term mother–infant dyads include early breastfeeding initiation, frequent skin-to-skin contact, and frequent breastfeeding. Given that the first 2 to 3 days postpartum are critical to achieving timely secretory activation and establishing an adequate volume of milk, a proactive approach to care can include building awareness of risk factors and development of protocols for the effective early initiation of lactation.

Health Disparities by Race and Ethnicity in California — 2024 Edition

As one of the most racially diverse states in the nation, California has a critical responsibility to address health disparities experienced by people of color. The report, Health Disparities by Race and Ethnicity: 2024 Edition, shows that people of color face barriers in accessing health care, often receive suboptimal treatment, and are most likely to experience poor outcomes in the health care system.

Health Policy Issues in Women’s Health

Health care is a central element of women’s lives, shaping their ability to care for themselves and their families, to be productive members of their communities, to contribute to the workforce, and to build a base of economic security. This primer focuses on some of the key areas disproportionately affecting women today that are shaped by national and state health policies. This includes health coverage and costs, reproductive health services, maternal health, mental health, and intimate partner violence.

Impact of extreme heat and heatwaves on children's health: A scoping review

Due to climate change, the frequency of heatwaves and extreme heat events (EHE) has increased over the last five decades and is expected to continue increasing. A scoping review found that extreme heat exposure during pregnancy significantly increases the risk of several unfavorable birth outcomes.

Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana

In this cluster randomized trial based in the Eastern Region of Ghana, researchers sought to determine the effect of group antenatal care (G-ANC) on increasing maternal health literacy. This study enrolled a total of 1761 participants over 5 years, and found that women enrolled in the group antenatal care intervention improved their health literacy scores significantly more than the control group, and were more likely to attend 8 or more ANC visits. This study provides promising findings of the potential benefits of implementing group antenatal care options for improving health literacy.

Inaugural Maternal Mental Health State Report Card (2023)

The inaugural Maternal Mental Health Report Card provides the first-ever comprehensive view into the state of maternal mental health in America. The report card grades states in three domains: 1) Providers and Programs, 2) Screening and Screening Reimbursement, 3) Insurance Coverage and Payment

Incorporating Racial Equity into Trauma-Informed Care

This brief offers practical considerations to help health systems and provider practices incorporate a focus on racial equity to enhance trauma-informed care efforts. It draws from the experiences of two federally qualified health centers - the Stephen and Sandra Sheller 11th Street Family Health Services in Philadelphia and Bread for the City in Washington, D.C.

Infant Feeding for Persons Living With and at Risk for HIV in the United States: Clinical Report

This clinical report discusses the role of pediatricians and pediatric health care professionals in guiding infant feeding practices for infants born to people living with and at risk for HIV infection, emphasizing the need for awareness of the HIV transmission risk from breastfeeding and the recommendations for feeding infants with perinatal HIV exposure in the United States. The risk of HIV transmission via breastfeeding from a parent on antiretroviral treatment (ART) and virally suppressed is estimated to be less than 1%. The American Academy of Pediatrics recommends avoiding breastfeeding as the only option with 0% transmission risk. However, some parents with HIV may wish to breastfeed, and pediatricians should provide a family-centered, nonjudgmental, harm reduction approach to support those on ART with sustained viral suppression. For those not on ART or without viral suppression, breastfeeding is strongly discouraged. This article provides insight for clinicians navigating these discussions and decisions with their patients.

Integrating Mental Health In Perinatal Care: Perspectives Of Interprofessional Clinicians

Key barriers for nurse-midwives and obstetricians include a lack of resources, time, and expertise, all underscored by diagnostic ambiguity in mental health, leading clinicians to fear that they might either fail to identify mental health issues or identify mental health issues they would not be able to adequately address.

Interpregnancy intervals and adverse birth outcomes in high-income countries: An international cohort study

Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women can address this issue.

Interventions to Improve Safer Sleep Practices in Families With Children Considered to Be at Increased Risk for Sudden Unexpected Death in Infancy: A Systematic Review

Advice to families to follow infant care practices known to reduce the risks of Sudden Unexpected Death in Infancy (SUDI) has led to a reduction in deaths across the world. This reduction has slowed in the last decade with most deaths now occurring in families experiencing social and economic deprivation. A systematic review of the literature covered three areas: interventions to improve engagement with support services, parental decision-making for the infant sleep environment, and interventions to improve safer sleep practices in families with infants considered to be at risk of SUDI.

Involving men in pregnancy: a cross-sectional analysis of the role of self-efficacy, gender-equitable attitudes, relationship dynamics and knowledge among men in Kinshasa

The study examines male involvement in maternal health during pregnancy in the Democratic Republic of the Congo, focusing on patterns and factors influencing their engagement. Using data from the 2018 Momentum baseline study, researchers assessed predictors such as pregnancy knowledge, gender-equitable attitudes, self-efficacy, and co-parental relationship dynamics among 1,674 male partners of nulliparous pregnant women.

Issue Brief: Black Maternal Mental Health

This brief discusses the prevalence and repercussions of maternal mental health disorders, specifically focusing on maternal depression and anxiety during the perinatal or postpartum period. Approximately 20% of women experience these disorders, leading to an estimated economic cost of $14.2 billion over five years for untreated cases. The societal impact extends to early childhood development, pediatric mental health, and overall family well-being. Women of color, particularly Black women, face heightened vulnerability due to increased rates of trauma exposure, reaching 87% during the perinatal period. Coupled with a higher likelihood of perilous birth complications, Black women are 3-4 times more susceptible to maternal mental health disorders, including birth trauma and post-traumatic stress disorder. Additional risk factors encompass exposure to adverse health determinants, chronic stress, and gendered racism throughout their lifespan.

Key Learnings from the Doula and Perinatal Community Health Worker in Medicaid Learning Series

The report aims to support the creation and strengthening of pathways for Medicaid agencies and health plans, provider groups, and professional associations to expand access to quality, respectful, and equitable maternity care.

March of Dimes Report Card (2023)

The 2023 March of Dimes Report Card highlights key indicators to describe the current state of maternal and infant health. It provides updated rates and grades for preterm birth and data on infant mortality and maternal health. New this year is the inclusion of maternal mortality, leading causes of infant death, and data describing selected risk factors for preterm birth. Indicators by maternal race/ethnicity are included to call attention to the need for addressing racism in our systems and communities in order to eliminate health disparities. Detailed analyses of these measures inform the development of policies and programs that move us towards improving health for birthing people and the millions of babies born each year in the U.S., D.C. and Puerto Rico. The Report Card presents policies like Medicaid extension and programs like Maternal Mortality Review Committees, which can help to achieve equity in maternal and infant health outcomes.

Maternal Health Edition: National Healthy Start Association Brief

The August Maternal Health Brief focuses on The Unique Mental Health Needs of Black Women and Birthing People.

Maternal Migration Background and Mortality Among Infants Born Extremely Preterm

This cross-sectional study of live births in the Netherlands examines the associations between migration background and infant mortality.

Maternal Obesity and Risk of Sudden Unexpected Infant Death

This study explored the link between maternal obesity and the risk of sudden unexpected infant death (SUID). There's a noted increase in maternal obesity rates in the US. The research, based on a nationwide cohort study utilizing data from the CDC's National Center for Health Statistics for birth cohorts from 2015 to 2019, revealed significant findings. After adjusting for confounders, it was found that infants born to mothers with obesity had a heightened SUID risk, which escalated with the severity of the mother's obesity.

Maternal and Perinatal Outcomes in Placenta Previa: A Comprehensive Review of Evidence

Placenta previa poses significant risks to maternal and perinatal health, yet its management remains challenging. This comprehensive review synthesizes current evidence on maternal and perinatal outcomes in placenta previa, addressing its epidemiology, pathophysiology, diagnosis, and management strategies.

Maternal childhood maltreatment and perinatal outcomes: A systematic review

This review explores the impact of MCM on four perinatal outcome domains: pregnancy and obstetric; maternal mental health; infant; and the quality of the care-giving environment. Mechanisms identified in the included studies are discussed in relation to the maternal programming hypothesis and directions for future research.

Maternal complications and risk factors associated with assisted vaginal delivery

This retrospective analysis of 3500 cases of vaginal delivery aimed to identify maternal complications and risk factors associated with assisted vaginal delivery. The study found that the most common complication in vaginal deliveries was postpartum hemorrhage, occurring in 7.3% of cases, and various factors were identified that increased the risk of this complication.

Maternal interventions to decrease stillbirths and neonatal mortality in Tanzania: evidence from the 2017-18 cross-sectional Tanzania verbal and social autopsy study

Using data from the 2015-2016 Demographic and Health Survey in Tanzania, researchers assessed causes and social factors contributing to stillbirths and neonatal deaths. The study highlighted the importance of quality antenatal care (ANC) and its association with hospital deliveries for mothers facing complications. The findings underscored the need for improved care quality, especially in urban and rural areas, emphasizing early detection and management of complications during pregnancy and childbirth, and emphasizing newborn resuscitation.

Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance?

This study aimed to assess if the high and rising rates of maternal mortality in the United States reflect changes in obstetrical factors, maternal medical conditions, or methods of maternal mortality surveillance. Using data on all deaths in the United States from 1999 to 2021, maternal death trends were identified using the National Vital Statistics System methodology, and a definition-based approach, which requires the mention of pregnancy among the multiple causes of death on the death certificate. The authors found that recent changes in maternal mortality surveillance, such as maternal death identification based solely on pregnancy checkbox information on death certificates, have led to an overestimation of maternal mortality. The definition-based approach shows lower, stable maternal mortality rates in the United States and a temporal decline in deaths due to direct obstetrical causes. This study provides new information for the ongoing efforts to lower maternal mortality, and highlights the importance of contextualizing and understanding surveillance methods in public health, particularly when surveillance methods change over time.

Maternity Care Experiences Data Book

High-quality maternity care experiences are critical to maternal and infant health and well-being. Positive communication with providers is an important component of high-quality maternity care. This data book examines whether Californians giving birth during 2021-2022 felt heard and listened to by their providers during delivery.

Maternity Care in California — 2019 Edition

This report provides an overview of maternity care in California, reviews the state’s performance by demographic groups, over time, and in comparison with national numbers.

Maternity Care in California — 2023 Edition

There were 420,000 births in California in 2021, accounting for about one in 10 of all births nationwide. The number of births in the state declined 26% between 2007 and 2021. Maternity Care in California: Delivering the Data provides an overview of the delivery of maternity care in California, using the most recent data. When available, comparisons of California data to national averages, as well as metrics by race/ethnicity and trend data, are provided.

Medi-Cal Access to Community Midwifery Care: Midwives' Perspectives

While low-income communities in California continue to be hardest hit by the recent wave of hospital maternity ward closures, community midwives say they face overwhelming barriers to becoming Medi-Cal providers, according to a study by researchers at the UCSF Osher Center for Integrative Health. Without increasing the number of midwives who are Medi-Cal providers, access to perinatal care will worsen in a state already grappling with a maternal mortality crisis. This policy brief summarizes the findings of the research study.

Mental Distress Among Female Individuals of Reproductive Age and Reported Barriers to Legal Abortion Following the US Supreme Court Decision to Overturn Roe v Wade

The Supreme Court of the US (SCOTUS) ruling in Dobbs v Jackson Women’s Health Organization (hereafter, the SCOTUS decision), issued on June 24, 2022, overturned Roe v Wade, allowing states to set their own abortion laws, including outright bans. The American Psychological Association expressed alarm that eliminating the constitutional right to abortion would harm women’s mental health and exacerbate the ongoing mental health crisis in the US. This report assessed whether the SCOTUS decision was associated with mental distress among female individuals of reproductive age and how this association varied by barrier to legal abortion.

Midwifery continuity of care, breastfeeding and neonatal hyperbilirubinemia: A retrospective cohort study

The retrospective cohort study aimed to investigate the association between Midwifery Continuity of Care (MCoC) and outcomes of exclusive breastfeeding at hospital discharge and neonatal hyperbilirubinemia.

Music Therapy in Preterm Infants Reduces Maternal Distress

Preterm delivery is often a stressful event for mothers, exposing them to a greater risk for post-traumatic stress reactions. This study examined the degree of depressive symptoms and the levels of post-traumatic stress in mothers of preterm infants born before 32 gestational weeks. Conclusions were based on whether the infant received music therapy in the neonatal intensive care unit (NICU) or not.

National Survey of Children’s Health Interactive Data Query

The National Survey of Children’s Health (NSCH) provides rich data on multiple, intersecting aspects of children’s lives—including physical and mental health, access to and quality of health care, and the child’s family, neighborhood, school, and social context. The National Survey of Children's Health is funded and directed by the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB).

National Survey on Drug Use and Health (NSDUH) Annual Report (2023)

Read key findings from the 2023 National Survey on Drug Use and Health (NSDUH). This report highlights 2023 estimates of substance use, mental health, and treatment in the United States. These national indicators are measured among people aged 12 or older in the civilian, noninstitutionalized population. Estimates are presented by age group and by race/ethnicity for selected measures.

Along with the full report, which includes both figures and text descriptions, a set of slides is available which includes just the figures from the report.

Neighborhood Disadvantage, Race and Ethnicity, and Postpartum Depression

This study examined neighborhood effects on postpartum depression (PPD) among 122,995 individuals in California. It found that greater neighborhood disadvantage was linked to a higher risk of PPD, particularly pronounced among Black individuals. Interestingly, this association wasn't observed among Hispanic individuals. The study suggests that residing in more disadvantaged neighborhoods correlates with poorer postpartum mental health, indicating a need for targeted geographic interventions to reduce mental health disparities in the postpartum period.

Neighborhood gentrification, displacement, and severe maternal morbidity in California

This study examined the associations between neighborhood-level gentrification and severe maternal morbidity (SMM) using data from all live hospital births in California between 2006 and 2017. Using three separate metrics for gentrification exposure, they conducted mixed-effects logistic regression analysis to explore associations between gentrification and SMM. After adjustment, they found differing associations between gentrification type and SMM risk, with some indicating a protective relationship and others indicating a higher risk of SMM. The influence of gentrification on SMM was similar across racial and ethnic groups. This study explores a complex, under-researched area of maternal health.

Perceptions of Social Support from Pregnant and Parenting Teens Using Community-Based Doulas

This descriptive study was designed to explore and describe the perceptions of disadvantaged pregnant and parenting teens who received support from culturally matched, community-based doulas. Their reported perceptions included enhanced knowledge about childbearing, support during childbirth, self-care, and early attachment to the newborn. Participants concurred that the community-based doula intervention had a positive impact on their supportive networks. This innovative model can supplement perinatal programs through utilization of culturally sensitive, community-based doulas that provide comprehensive relationship-based caring.

Perinatal Mental Health Education and Screening Project Phase 1 Final Report

Maternal Mental Health Leadership Alliance is leading a multi-year, multi-disciplinary collaborative effort to ensure all pregnant and postpartum people are educated about and screened for perinatal mental health disorders and connected with resources for recovery. Phase 1 focused on developing a framework for when to provide patient education and screening. Roundtable discussions were convened with maternal mental health experts and advocates to ensure the voices of those with lived experience are centered in our research and recommendations. This report reviews the advancements made in Phase 1 of the project.

Perinatal Psychotherapy Use and Costs Before and After Federally Mandated Health Insurance Coverage

This study of US private insurance data showed that psychotherapy out-of-pocket costs exhibited seasonal variation that decreased after the passage of the Federal Mental Health Parity and Addiction Equity Act (MHPAEA) with an immediate, steady increase after passage of the Affordable Care Act (ACA). Among those with maternal mental health disorders, MHPAEA was associated with an immediate decrease then sustained increase in psychotherapy; the ACA was associated with immediate, sustained increases.

Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review

While childbirth appears to be a potent trigger of severe mood disorders, the precise mechanisms by which postpartum psychosis occurs are poorly understood. This review examines the current evidence with respect to potential aetiology and childbirth-related triggers of postpartum psychosis.

Physician Perspectives and Workforce Implications Following the Repeal of Roe v. Wade

The National Academies Standing Committee on Reproductive Health, Equity, and Society and the National Academy of Medicine, committed to equitable access to quality reproductive health, hosted a webinar, After Roe: Physician Perspectives and Workforce Implications, in May 2023. Discussions increased awareness and promoted dialogue in the medical, public health, societal, and general population. This proceedings document summarizes the discussions held during the webinar.

Postpartum haemorrhage and risk of cardiovascular disease in later life: A population-based record linkage cohort study

The study investigates the association between postpartum hemorrhage (PPH) and subsequent cardiovascular disease using a population-based retrospective cohort design. Data were linked between the Aberdeen Maternity and Neonatal Databank and Scottish healthcare datasets, focusing on 70,904 women who gave birth after 24 weeks of gestation between 1986 and 2016 in the Grampian region of Scotland.

Potential Epigenetic Effects of Human Milk on Infants’ Neurodevelopment

This narrative review provides an updated analysis of the relationship between breast milk feeding and infants’ neurodevelopment via epigenetics, pointing out how breast milk’s bioactive components could have an impact on the neurodevelopment of both full-term and preterm babies.

Pregnancy and Homelessness Brief

Little is known about pregnancy among people experiencing homelessness. To address this issue, UCSF researchers examined findings from the California Statewide Study of People Experiencing Homelessness, published last year. This brief reviews who experiences pregnancy during homelessness, their experiences during homelessness, and barriers to regaining housing. It includes strategies to help meet the needs of pregnant people.

Prenatal Stress and Externalizing Behaviors in Childhood and Adolescence:
A Systematic Review and Meta-Analysis

Children whose mothers are highly stressed, anxious or depressed during pregnancy may be at higher risk for mental health and behavior issues during their childhood and teen years, according to research published by the American Psychological Association.

Prenatal iron supplementation adjusted to maternal iron stores reduces behavioural problems in 4-year-old children

A study conducted in Tarragona, Spain, involving 230 non-anemic pregnant women and their children explored the impact of adjusting prenatal iron supplements based on maternal iron levels on children's behavior. The authors conclude that tailoring prenatal iron supplementation based on maternal iron levels and hemoglobin can help reduce behavioral problems in 4-year-old children.

Preterm Birth Risk and Maternal Nativity, Ethnicity, and Race

In this cohort study of over 34 million singleton live births using US birth certificate data, there was significant variation in the associations of maternal nativity, ethnicity, and race with gestational age categories of preterm birth. Findings of this study suggest that understanding population-wide patterns of preterm birth could aid in targeted interventions and policies, especially for birthing people underrepresented in research.