How Researchers Can Support Safe and Respectful Childbirth
September 17th is World Patient Safety Day; an annual opportunity to increase awareness for advancing safety in health care, while encouraging policy and action initiatives that promote patient safety and reduce risk and harm. This year’s focus: ‘Safe Maternal and Newborn Care: Act Now for Safe and Respectful Childbirth’, highlights the significant burden of risks and harm pregnant individuals and newborns are exposed to during perinatal care (pregnancy, during and after birth), as well as the critical need for more equitable access to safe and high quality care. These issues can be especially prevalent in rural and remote communities, where birthing people can face increased access barriers. Additionally, individuals who experience systemic oppression and racism, such as Black and Indigenous peoples, people with disabilities, and people from the LGBTQIA2S+ community, generally encounter more issues accessing safe, high quality perinatal care.
Researchers have a critical role in improving access to services, reducing risk, and promoting safety, whether it’s through contributions to health scholarship or through policy and advocacy efforts. Both Kristen Bigelow-Talbert and Christina Cantin are two doctoral students at the School of Nursing and Health Quality Programs who are conducting research focused on how health care professionals can better support safe and respectful childbirth.
Centering mental health and wellness is critical to safe and respectful childbirth
Maternal suicide due to perinatal mood and anxiety disorders (PMADs) is the fourth leading cause of maternal death and the number one medical complication during pregnancy and postpartum in Canada. These are sobering statistics and the rates of PMADs across the country have only gone up during the pandemic. There is currently no national Canadian perinatal mental health strategy in place to directly address these issues either, though this summer legislation to develop one was introduced to Parliament.
“Nurse researchers can contribute to improving access to safe and respectful childbirth experiences through continuing to build knowledge in identified areas such as prevention and screening strategies” says Christina Cantin, a second year PhD student in the graduate nursing program. However, she adds that in addition to promoting and advancing this research agenda, “nurse researchers can contribute to advocacy efforts such as supporting and advancing the calls to action for a national perinatal mental health strategy.”
A registered nurse for over 20 years, Christina specializes in perinatal care. Her research interests focus on perinatal mental health and addictions, and her PhD dissertation examines outcomes among newborns who have been exposed to antidepressants. “I know that families are very concerned about the safety of taking medications during pregnancy and lactation. Health care providers have an important role in supporting families to make evidence-informed decisions. We need to provide effective support” says Christina, “It’s important for health professionals to help families weigh the risks and the benefits of various health care decisions according to each person’s unique circumstance, and congruent with the person’s values and beliefs.”
The role that nurses and nurse researchers play in improving access to safe and respectful childbirth experiences and closing the accessibility gaps in perinatal care cannot be understated. Like most places around the world, in Canada nurses and midwives constitute the largest group of maternity care providers. However, Christina stresses that it is important for all health professionals to be involved in addressing the gaps in birthing care and supporting perinatal families.
“In the interest of promoting safe patient care, and ensuring safe maternal and newborn care, I encourage interprofessional health teams to continue to reflect on how we can collaborate to ensure the provision of seamless, integrated care. Perinatal families depend on us to support them in identifying paths forward; they require acknowledgement and validation of their mental health concerns, information to make decisions, and options regarding available support services and interventions. Stigma surrounding mental health continues to represent a significant barrier to care and we need to be mindful of our language and response as we work to ensure equitable access to safe and high-quality care in each of our communities.”
Barriers to care are everywhere – and they have a critical impact on birth experiences
As a health researcher, first year PhD student Kristen Bigelow-Talbert has a unique perspective on the negative impact that lack of accessibility and other barriers to care can have on birth experiences. A Community Health Quality Manager in the United States, she provides training and technical assistance to Federally Qualified Health Centers in Vermont and New Hampshire on a variety of quality improvement techniques, methods, and measure sets. She has also been a childbirth educator in the United States for almost a decade. “The overarching goal in my research is to improve birth experiences for individuals and their families.” says Kristen. “Too often as a childbirth educator I would hear about women who came away from a “normal” birth experience with trauma. It wasn’t until I looked into it in more detail that I realized that there are many common themes in birth trauma, and that most of these could actually be prevented.”
How access to perinatal care affects not just the quality of care received, but the birthing experiences of the patients themselves, can often be overlooked in health care systems. “For example, for a variety of reasons significant numbers of obstetricians and midwives in the United States are moving locations and practises” says Kristen, referring to how numerous birth centers and units (independent and hospital-based) across the country are relocating or closing entirely especially in rural areas, creating ‘maternity care deserts.’ “This results in very few options for pregnant individuals and their families. They may be forced to choose between either a home birth—if that’s even an option in their state—and a hospital that they may not trust or be comfortable with. This mistrust can create an aura of fear around the pending birth. There is documented evidence that fear can result in negative outcomes in birth, including increased incidences of trauma.”
“While a significant amount of research has already been done around evidence-based practices, barriers to care, and maternity care in general, change is slow or even non-existent in some areas. Why? What are the barriers? What role does culture play? How does malpractice insurance (and expectations of the insurance provider) impact the care provided? If something doesn’t change in the trajectory of the state of perinatal care in the United States, what will the impact be on the mortality and morbidity? There are many unanswered questions that still need to be explored, and health quality research is an appropriate avenue in which to pursue these important questions,” she continued.
Like Christina, Kristen also stresses that interprofessional collaboration is critical to supporting safe and respectful childbirth. “There is no one-size-fits-all approach that will work in every environment and that will positively impact every culture. In fact, I would argue that true meaningful change in perinatal care cannot be achieved without interdisciplinary collaboration and trust, which includes collaborating with patient themselves!”