IntroductionBreastfeeding-friendly worksites are associated with longer breastfeeding durations, yet currently there is a dearth of research exploring women's experiences of workplace-based wellness programs designed to support continued lactation.MethodUsing semi-structured interviews with a voluntary sample of participants from one rural New England town (N = 18), we examined women's experiences of returning to work at worksites with the Centers for Disease Control and Prevention (CDC)'s Worksite Health ScoreCard (HSC) “breastfeeding-friendly” designation.ResultsFive key themes emerged from participants' narratives; three policy and workplace climate-related themes are described.DiscussionCollectively, findings indicate areas where HSC lactation-support questions might be modified to more precisely identify the psychosocial, structural, and sociocultural needs of breastfeeding employees.
Objective: Hair cortisol is a noninvasive, long-term biomarker of human stress. Strengths and weaknesses of this biomarker as a proxy measure of perinatal stress are not yet well understood. Hair cortisol data were collected from pregnant women in Puerto Rico to investigate maternal cortisol level variance across pregnancy. Methods: In 2017, we recruited 86 pregnant women planning to birth at a large urban hospital. We aimed to collect four hair samples from each participant, one in each trimester and one in the postpartum period.Results: Median cortisol in the first trimester (n = 82) was 5.7 picograms/ milligram (pg/mg) (range: 1.0-62.4). In the second, third, and postpartum periods, the medians were 6.8 pg/mg (1.0-69.5), (n = 46), 20.1 pg/mg (5.6-89.0), (n = 30), and 14.1 pg/mg (1.7-39.8), (n = 9), respectively. These medians disguise a 10-fold and 50-fold variability for two participants. Our sample sizes declined sharply when Hurricane Maria caused major disruptions in services and participants' lives.
Conclusion:Maternal hair cortisol concentrations were lower in the first and second trimester than the third trimester and early postpartum period. We also observed a wide range of variation in cortisol levels throughout pregnancy and in the postpartum period.
IntroductionMaintaining lactation after returning to work is imperative for overall breastfeeding success, yet mothers who return to full-time employment outside the home are unlikely to meet their breastfeeding goals. Breastfeeding-friendly worksites are one potential solution.MethodUsing semi-structured interviews with employees in one rural New England town (N = 18), we aimed to better understand the barriers and supports to continued lactation at “breastfeeding-friendly” worksites.ResultsFive key themes emerged from participants' narratives; two built environment-focused themes are discussed here.DiscussionFindings expose the disproportionate burden placed on women when care- and wage-work are combined, even in worksites at least theoretically committed to supporting lactation following a return to work.
BackgroundThe interprofessional education collaborative (IPEC) core competencies (CCs) describe standards for effective interprofessional health care practice and education; these standards are updated periodically based on stakeholder feedback. The purpose of this project was to use a qualitative case study approach to describe one multiparous birth trauma survivor's fifth birth experience with an interprofessional birth care team (IBCT) and to juxtapose her experiences and perspectives with the IPEC core competencies (IPEC CCs). This approach enabled us to identify strengths and gaps in the standards for interprofessional health care education and practice specific to perinatal care.MethodsOne in‐depth, open‐ended, semi‐structured interview was conducted to elicit the participant's fifth birth experience. Information from her previous births and the IPEC CCs was used to design the interview guide, and we used independent, deductive, consensus coding to identify themes from verbatim transcripts.ResultsThree themes were identified: (a) Establishing a therapeutic patient‐provider relationship; (b) Prioritizing communication, respect, and knowledge in person‐centered care; and (c) Shared decision‐making as the crux of collaborative care. The participant's narrative elevated person‐centered, trauma‐informed care (TIC) principles as critical to effective interprofessional birth care and as essential threads for the IPEC CCs.ConclusionsOne survivor's positive experience after prior birth trauma illustrates the critical role IPEC CCs may play in collaborative perinatal care provided by IBCTs. In our analysis, we also identify the need to explicitly incorporate TIC principles and person‐centered language in health care competencies that support the standards for perinatal health care education and practice.
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of breastfeeding while employed and commentaries on reviews focused on mammography test characteristics and sexual health for gynecologic cancer survivors. It also includes a quick update on a USPSTF review for aspirin as pre-eclampsia prophylaxis.
Women with disabilities share similar risks for breast cancer as other women yet experience a lack of access to cancer screening and are less likely to receive screening mammograms in accordance with recommended guidelines. The present study evaluated mammography centers across the state of Montana in response to the Centers for Disease Control and Prevention's Right to Know campaign, which focused on addressing barriers to breast cancer screening. Mammography centers were originally evaluated in 2009 and were reassessed in 2011 and 2015 after being given action plans to address accessibility barriers. The current study examined changes in accessibility across time in four priority areas: 1) van and standard parking, 2) exterior and interior routes, 3) mammography rooms, and 4) restrooms. Results indicate all mammography centers had a least one mammography machine that lowered for patients in a seated position and that accessibility of the four priority areas improved over time; however, improvements were still needed to encourage health equity for women with disabilities.
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