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Biomedical subjects

Lisa Kane Low

Publications and source records attributed to Lisa Kane Low.

12 recordsLinked to original sources
PubMed2006

Moving beyond the trickle-down approach: addressing the unique disparate health experiences of adolescents of color.

PURPOSE: Health disparities in adults have received significant attention and research, yet the healthcare experiences of adolescents of color have been ignored. The purpose of this paper is to identify the shortcomings of our state of knowledge regarding adolescent health disparities and argue for the use of an inter-sectional, contextually embedded understanding of healthcare experiences. CONCLUSIONS: To understand health disparities, deficit-based models should be replaced with the framework proposed in this paper. PRACTICE IMPLICATIONS: Using the proposed model in practice will aid in identifying and preventing the health disparities experienced by adolescents of color.

Adolescent↗
PubMed2005

Challenges for traditional birth attendants in northern rural Honduras.

OBJECTIVE: to explore the relationship between community-based parteras, the staff at the Centro Materno Infantil (Mother-Child Centre), and other public health facilities within the district of Morazán in northern rural Honduras during the transition to new models of maternity care. DESIGN: focus-group discussions with two groups composed of a convenience sample of community parteras. After verbatim translation of the interviews, the transcripts were analysed for content. SETTING: the Centro de Salud of Morazán, Yoro Honduras. PARTICIPANTS: 28 community-based parteras and one partero (male community midwife). FINDINGS: five themes emerged from the focus group data: the shared view that attending birth is connected to a religious calling; the desire for additional training; the desire for support from, and connection to, existing public-health services and infrastructure; the role of parteras in providing services to women who otherwise would not receive care; and the lack of new parteras to carry on this work in the future. KEY CONCLUSIONS: traditional birth attendants are still relied upon to serve more than half of the childbearing women in Honduras. The findings from the focus groups provide a foundation upon which to strengthen the relationship between community-based parteras and the government-funded systems of health care during this time of transition to new models of maternity care.

Adult↗
PubMed2004

Abuse-related post-traumatic stress during the childbearing year.

BACKGROUND: Women with abuse-related post-traumatic stress who are pregnant experience symptoms that nurses and midwives may not recognize or know how to respond to. AIM: The purpose of this article is to increase familiarity with the post-traumatic stress disorder diagnostic framework by illustrating the symptom categories and associated features with women's descriptions of the symptoms from qualitative interviews. METHODS: A secondary analysis was performed with data from a qualitative interview study of the maternity care experiences of 15 American women who had abuse-related post-traumatic stress during pregnancy. Content analysis was used to extract all participant statements describing how post-traumatic stress disorder symptoms and associated features manifested in pregnancy. These were then juxtaposed with the post-traumatic stress disorder diagnostic framework. RESULTS: Participants' interviews included a range of descriptions of the intrusive re-experiencing, avoidance and numbing, and hyperarousal core symptoms of post-traumatic stress disorder, as well as associated psychological features such as somatization, dissociation and interpersonal sensitivity, and associated behavioural features such as substance abuse, disordered eating, high-risk sexual behaviours, suicidality, and revictimization. CONCLUSIONS: Limitations of this study include that it is a secondary analysis, using a small North American sample, and focusing only on abuse-related post-traumatic stress disorder. Descriptive information from this qualitative study may bridge the gaps between psychiatric technical language, women's subjective experiences, and clinicians' perceptions of a woman's post-traumatic stress reactions.

Adolescent↗
PubMed2003

An exploratory metasynthesis of midwifery practice in the United States.

OBJECTIVES: To conduct a metasynthesis of six qualitative studies of midwifery care and process; identify common themes and metaphors among the six studies for further exploration and theory development; and create a framework for further metasynthesis of qualitative studies of midwifery practice in the USA. DESIGN: A qualitative metasynthesis to analyse, synthesise, and interpret six qualitative studies on the process and practice of midwifery care. SAMPLE AND SETTING: Hospital, birth centre, and home birth settings were represented across all of the studies. Participants included nurse- and direct-entry midwives who provided both childbearing and gynaecological care. Recipients of midwifery care also received both childbearing and gynaecological care. FINDINGS: Four overarching themes were identified: the midwife as an 'instrument' of care; the woman as a 'partner' in care; an 'alliance' between the woman and midwife; and the 'environment' of care. These were interpretively and conceptually arrayed into a helix model of midwifery care. KEY CONCLUSIONS: The findings from this exploratory metasynthesis clearly indicate that the practice of midwifery is a dynamic partnership between the midwife and the woman, and reflects an environmental perspective. In a country that has a standard of highly technical childbirth care, perhaps the most outstanding concept of this model is that of the midwife as an 'instrument' of care. The significance of the findings will be determined by their ability to guide further research efforts to support a standard of midwifery care for all women in the USA. IMPLICATIONS FOR PRACTICE: This model offers a benchmark and a structure for considering the dynamic elements of midwifery practice and key roles that the midwife plays in the health care of women and babies.

Anecdotes as Topic↗
PubMedDate not supplied

Cortisol level and perinatal outcome in pregnant women with posttraumatic stress disorder: a pilot study.

Posttraumatic stress disorder (PTSD) affects 12% of women in the United States and could affect childbearing via behavioral and neuroendocrine mechanisms. This pilot study collected preliminary data about the extent to which the low cortisol profile found in patients with PTSD also occurs in the hormonal context of pregnancy, as well as the association between PTSD and less optimal processes and outcomes of pregnancy. Standardized psychiatric diagnostic telephone interviews, salivary cortisol assays, and medical records review were evaluated in a community sample of 25 women pregnant with their first child. Higher PTSD symptom counts correlated with worse overall perinatal outcomes summarized by an Optimality Index Score (n = 22; r = -.725; P < .001). The women whose symptoms met diagnostic criteria for PTSD or partial PTSD had lower peak basal salivary cortisol concentrations (n = 14; mean = .4584 versus .8123; P = .010). Further research on the effects of PTSD on pregnancy processes and outcomes is warranted. Differences in cortisol levels were consistent with the pattern seen in nonpregnant women with PTSD. This finding suggests that salivary cortisol would be a useful biological measure to include in perinatal research on PTSD and childbearing.

Abortion, Spontaneous↗
PubMedDate not supplied

Doulas as childbirth paraprofessionals: results from a national survey.

Fourteen randomized trials have demonstrated that continuous caregiver support during childbirth can lead to shorter labors and decrease the need for intervention. In response, there has been a significant increase in the number and use of doulas as paraprofessionals who provide social and emotional support to women during labor/birth for a fee. We conducted a mailed survey of a nationally representative sample of certified and certification-in-process doulas in the United States (n = 626, 64.4% response rate) to gather some descriptive information on their sociodemographic backgrounds, practice characteristics, and beliefs/attitudes on a number of salient issues. The survey results suggest that, in 2003, doulas were primarily white, well-educated married women with children. The majority of certified doulas worked in solo practice and provided childbirth support services on average to nine clients per year. Very few doulas were earning more than 5,000 dollars per year from this work, and only 10% of certified doulas reported receiving third-party reimbursement for their services. Thus, while almost all doulas found their work emotionally satisfying, only one in three saw their work as financially rewarding. Doulas also reported challenges in getting support/respect from clinicians and in balancing doula work and family life. In addition, one in four doulas reported that they were preparing for a career in midwifery. Doulas can play an important and unique role in the childbirth process and reap many personal rewards engaging in this type of work. However, a number of financial, personal, and professional challenges present significant obstacles to the growth of doulas as childbirth paraprofessionals in the United States.

Adult↗
PubMedDate not supplied

Health outcomes of incarcerated pregnant women and their infants in a community-based program.

An experimental, community-based, residential program, focused on health promotion, was established in 1990 for incarcerated pregnant women with short-term sentences and histories of drug abuse in a large, midwestern metropolitan area in the United States. Infants resided with mothers after birth. Prenatal care, delivery, postpartum, and family-planning services were initiated and provided by a nurse-midwifery service. Community-based health care, job training, and drug rehabilitation were provided for women during pregnancy through the fourth postpartum month. Program participants' prenatal, delivery, postpartum, and neonatal health outcomes are presented and compared with those of incarcerated women in the same state prison system who experienced usual correctional facility care and support. Program participants represented a group of obstetrically high-risk women. Health outcomes for both groups of incarcerated women and their infants were similar and more optimal than would have been expected given their preexisting health conditions and risk factors.

Adult↗
PubMedDate not supplied

Abuse-related posttraumatic stress and desired maternity care practices: women's perspectives.

Qualitative research participants who self-identified as having a history of childhood sexual abuse and abuse-related posttraumatic stress during the childbearing year were interviewed for the purpose of determining what these women perceive as optimal maternity care. Using a process of narrative analysis, desired care practices were identified. With the exception of one woman, all of the study participants wanted their maternity care provider to be competent to address trauma-related needs. Three groups emerged from the data, providing a useful structure for informing providers on how best to respond to diverse abuse-survivor clients: 1) women far along in recovery, 2) women who were not safe, and 3) women who were not ready to "know." The first group had the best trauma-related and maternity outcomes and the best childbearing experiences. For these women, having a provider who was a "collaborative ally" seemed beneficial. The second group had safety needs that required a "compassionate authority figure" who offered referral and follow-up care. Women in the third group were not ready to address trauma-related symptoms or issues overtly and appeared to need a provider who was a "therapeutic mentor." Four assessment factors help providers determine how to respond.

Adult↗
PubMedDate not supplied

Adolescents' experiences of childbirth: contrasts with adults.

Most of what is known about the meaning women assign to the experience of childbirth in the United States is based primarily on studies of Euro American, highly educated, married women of middle to higher income levels. Yet almost half a million adolescents give birth annually. This exploratory, qualitative study was conducted with 25 adolescents in an alternative school, partnered with the juvenile justice system, who had given birth. An open-ended question format was used for the interviews, and analysis was conducted by using extended case methodology. The study revealed a number of differences between the existing literature reports about women's interpretations of birth and the meanings assigned to childbirth experiences by the adolescents in this study. A key difference was the relationship between the pain of childbirth and responsibility for their child. The results provide an entrée into understanding unique characteristics of giving birth as an adolescent and potential roles health care providers can play to promote a positive experience.

Adolescent↗
PubMedDate not supplied

Every labor is unique: but "call when your contractions are 3 minutes apart".

PURPOSE: To explore women's perceptions of transitioning to the birth facility when in labor. DESIGN: Qualitative. METHODS: Twenty-four nulliparous women were interviewed following their birth experiences. RESULTS: Pain was identified as the primary reason for transitioning to the hospital. Once arriving at the hospital, women often felt pressure to "get it right" and not make multiple trips. Three themes were identified: (a) Don't trust your body, trust us; (b) This is not right; and (c) This is too labor! CLINICAL IMPLICATIONS: The implications for nursing involve increased recognition of the range of normal experiences and acknowledgment that pain is a primary basis for women coming to the hospital as opposed to cervical dilation. Reevaluating the instruction the healthcare providers give to women is warranted.

Adaptation, Psychological↗
PubMedDate not supplied

A clinical evaluation of evidence-based maternity care using the Optimality Index.

The Optimality Index-US (OI-US) reflects the use of evidence-based practices in obstetrics. This paper's objective is to apply the OI-US to a "typical" nurse-midwifery service data set to demonstrate its use outside of a research context. The OI-US score for the sample practice was 80%. The OI-US can be used by obstetric and gynecologic nurse clinicians to demonstrate the relationship of various care practices to optimal outcomes.

Benchmarking↗