Nirvana Manning

Purpose: The purpose of this study was to gather information that can be used to help inform doula integration into the clinical care setting. Study Design and Methods: We conducted a convergent (parallel) mixed-methods online survey study to understand maternity care team members’ perceptions of doulas and their integration into the clinical setting. Results: One hundred and ten maternity care team members responded to the survey with both open-ended questions. The majority (90.0%) of respondents were nurses, female (94.5%), and White (90.0%). Three quarters (75.5%) reported prior experience working with a doula. Four primary themes related to barriers and facilitators were identified through thematic content analysis: Doula Support and Its Benefits; Uncertainty about Doulas’ Qualifications; Interference with the Maternity Care Team Member ; and Integration into the Health Care System . Respondents discussed the benefits of doulas and the valuable support that doulas offered to patients, including: 1a) emotional, physical, and educational support and 1b) advocacy and communication. They expressed concerns about the potential interference with the maternity team, including: 3a) role confusion and influence on clinical decision-making and 3b) disrupting the patient–maternity care team member relationship. Recommendations for successful integration of doulas into the health care system included 4a) clear roles and boundaries, 4b) building relationships of trust and respect, 4c) collaborative communication, and 4d) education of maternity care team members. Clinical Implications: The study will be used to develop a doula integration tool kit. Doulas and maternity care team members should work together to create clear guidelines about the role of doulas within the hospital. Collaborative development of doula-supportive hospital policies and formalized hospital–doula partnership agreements can help reduce role ambiguity and create a more supportive hospital environment.

Background/Objective: The preconception period serves as a time for patients to modify behaviors, pre-existing disease, and potential perinatal risk factors. The purpose of this review is to review preconception behavioral modification and its effect on pregnancy outcomes. Methods: Electronic databases (PUBMED, CINAHL, and Embase) were searched. The search terms used were “healthy lifestyle” OR “life style” AND “fertility” OR “preconception care” OR “pre-pregnancy care” OR “pregnancy preparation”. Years searched were 1990–2024. Papers had to be in English. Results: Of the 301 abstracts identified, 189 full articles were selected to form this review. Preconception care (weight management, nutrition, management of pre-existing conditions, cessation of substance use, limitation to harmful environmental exposures, optimization of maternal mental health) has been shown to improve perinatal outcomes. While the benefit of preconception care has been established, compliance among reproductive aged patients is low. Reasons for low compliance in optimal preconception behavior appear to be multifactorial. While some programs have demonstrated promise in improving preconception care, more research needs to be done to improve counseling from providers as well as compliance among patients with the ultimate goal of optimizing perinatal outcomes. Conclusions: A comprehensive approach to physical, emotional, nutritional, environmental, and social well-being is essential to preconception care.

Pacific Islander communities experience significant maternal and infant health disparities including high maternal and infant mortality. Contraception and reproductive life planning prevent approximately one-third of pregnancy-related deaths and neonatal deaths. We report the results of formative research devoted to understanding Marshallese mothers’ as well as their maternal healthcare providers’ practices and influences related to contraceptive use and reproductive life planning. This study used an exploratory, descriptive qualitative design to explore Marshallese mothers’ and maternal healthcare providers’ practices and influences of contraception use and reproductive life planning. Twenty participants were enrolled in the study, 15 Marshallese mothers and five Marshallese maternal healthcare providers. For the Marshallese mothers, two themes emerged: (1) Reproductive Life Planning Practices and Information; and (2) Reproductive Life Planning Influences. For the Marshallese maternal healthcare providers, two themes emerged: (1) Reproductive Life Planning Practices; and (2) Reproductive Life Planning Influences. This is the first study to document Marshallese mothers’ and maternal healthcare providers’ practices and influences with contraceptive use and reproductive life planning. Study results will inform the development of a culturally-adapted contraception and reproductive life planning tool with an educational program for Marshallese family units and maternal healthcare providers serving Marshallese women.

Purpose of review: Despite efforts to minimize patient barriers to equitable care, health disparities persist in gynecology. This paper seeks to highlight racial and ethnic disparities in gynecologic care as represented by recent literature. Recent findings: Disparities exist among many areas including preventive screenings, vaccination rates, contraception use, infertility, and oncologic care. These can be identified at the patient, physician, and institutional levels. Summary: As we identify these social disparities in healthcare, we gain valuable knowledge of where our efforts are lacking and where we can further improve the health of women. Future research should focus on identifying and combating such disparities with measurable changes in health outcomes.

The Department of Obstetrics and Gynecology (OB/GYN) at the University of Arkansas for Medical Sciences (UAMS) tested various, new system-restructuring ideas such as varying number of different types of nurses to reduce patient wait times for its outpatient clinic, often with little or no effect on waiting time. Witnessing little progress despite these time-intensive interventions, we sought an alternative way to intervene the clinic without affecting the normal clinic operations. The aim is to identify the optimal (1) time duration between appointments and (2) number of nurses to reduce wait time of patients in the clinic. We developed a discrete-event computer simulation model for the OB/GYN clinic. By using the patient tracker (PT) data, appropriate probability distributions of service times of staff were fitted to model different variability in staff service times. These distributions were used to fine-tune the simulation model. We then validated the model by comparing the simulated wait times with the actual wait times calculated from the PT data. The validated model was then used to carry out “what-if” analyses. The best scenario yielded 16 min between morning appointments, 19 min between afternoon appointments, and addition of one medical assistant. Besides removing all peak wait times and bottlenecks around noon and late in the afternoon, the best scenario yielded 39.84 % (p<.001), 30.31 % (p<.001), and 15.12 % (p<.001) improvement in patients’ average wait times for providers in the exam rooms, average total wait time at various locations and average total spent time in the clinic, respectively. This is achieved without any compromise in the utilization of the staff and in serving all patients by 5pm. A discrete-event simulation model is developed, validated, and used to carry out “what-if” scenarios to identify the optimal time between appointments and number of nurses. Using the model, we achieved a significant improvement in wait time of patients in the clinic, which the clinic management initially had difficulty achieving through manual interventions. The model provides a tool for the clinic management to test new ideas to improve the performance of other UAMS OB/GYN clinics.

The telephone has become an indispensable method of communication in the practice of obstetrics. The telephone is one of the primary methods by which the patient makes her appointments and contacts her health care provider for advice, reassurance, and referrals. Current methods of telephone triage include personal at the physicians' office, telephone answering services, labor and delivery nurses, and a dedicated telephone triage system using algorithms. Limitations of telephone triage include the inability of the provider to see the patient and receive visual clues from the interaction and the challenges of obtaining a complete history over the telephone. In addition, there are potential safety and legal issues with telephone triage. To date, there is insufficient evidence to either validate or refute the use of a dedicated telephone triage system compared with a traditional system using an answering service or nurses on labor and delivery. Obstetricians and gynecologists, family physicians. After completing this CME activity, physicians should be better able to analyze the scope of variation in telephone triage across health care providers and categorize the components that go into a successful triage system, assess the current scope of research in telephone triage in obstetrics, evaluate potential safety and legal issues with telephone triage in obstetrics, and identify issues that should be addressed in any institution that is using or implementing a system of telephone triage in obstetrics.