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Reproducing Race, an ethnography of pregnancy and birth at a large New York City public hospital, explores the role of race in the medical setting. Khiara M. Bridges investigates how race--commonly seen as biological in the medical world--is socially constructed among women dependent on the public healthcare system for prenatal care and childbirth. Bridges argues that race carries powerful material consequences for these women even when it is not explicitly named, showing how they are marginalized by the practices and assumptions of the clinic staff. Deftly weaving ethnographic evidence into broader discussions of Medicaid and racial disparities in infant and maternal mortality, Bridges shines new light on the politics of healthcare for the poor, demonstrating how the \"medicalization\" of social problems reproduces racial stereotypes and governs the bodies of poor women of color.

globally, the rate of maternal mortality is unacceptably high with Kenya recording a rate of 362 maternal death per 100,000 live births. Even so, only 62% of women deliver under skilled health care. The government of Kenya introduced Free Maternity Services (FMS) to all women delivering in public health facilities as a way of increasing facility-based deliveries. Despite this, intervention, health facility deliveries in Machakos County are still low. This study aimed to identify hindrances and enablers of the FMS program in Machakos County.INTRODUCTIONglobally, the rate of maternal mortality is unacceptably high with Kenya recording a rate of 362 maternal death per 100,000 live births. Even so, only 62% of women deliver under skilled health care. The government of Kenya introduced Free Maternity Services (FMS) to all women delivering in public health facilities as a way of increasing facility-based deliveries. Despite this, intervention, health facility deliveries in Machakos County are still low. This study aimed to identify hindrances and enablers of the FMS program in Machakos County.it was a cross-sectional study conducted among postnatal women who delivered between September 2018 and September 2019 in Machakos County. A total of 394 women were enrolled. Data was collected using questionnaires and focus group discussions. Key informant interviews were conducted using nursing officer in charge of selected health facilities. Qualitative data was analyzed using chi-square and fishers exact. Multivariate logistic regression was used to determine predictors of utilization of FMS. Statistical significance was set at p < 0.05.METHODSit was a cross-sectional study conducted among postnatal women who delivered between September 2018 and September 2019 in Machakos County. A total of 394 women were enrolled. Data was collected using questionnaires and focus group discussions. Key informant interviews were conducted using nursing officer in charge of selected health facilities. Qualitative data was analyzed using chi-square and fishers exact. Multivariate logistic regression was used to determine predictors of utilization of FMS. Statistical significance was set at p < 0.05.utilization of FMS in Machakos County was 75.6%. Factors that were associated with utilization of FMS included marital status (p = 0.006), parity (p = 0.038), distance from health facility (p = 0.000), services offered during labour (p = 0.000), treatment of mothers by healthcare workers during labour (p = 0.000), provision of adequate food (p = 0.005), quality of service (p = 0.000) and cleanliness of the maternity ward (p = 0.000).RESULTSutilization of FMS in Machakos County was 75.6%. Factors that were associated with utilization of FMS included marital status (p = 0.006), parity (p = 0.038), distance from health facility (p = 0.000), services offered during labour (p = 0.000), treatment of mothers by healthcare workers during labour (p = 0.000), provision of adequate food (p = 0.005), quality of service (p = 0.000) and cleanliness of the maternity ward (p = 0.000).utilization of FMS in Machakos County is optimal. Health facilities should be supported to offer FMS by providing them with necessary supplies.CONCLUSIONutilization of FMS in Machakos County is optimal. Health facilities should be supported to offer FMS by providing them with necessary supplies.

Kenya introduced free maternity services in June 2013. The main study objective was to investigate the effect of this intervention on maternal and newborn health and specifically to determine differences in 4th antenatal care visits, facility deliveries, post-abortion care, and occurrence of facility-based maternal and neonatal deaths two years pre-and-post intervention. The study site was Gem Sub-County, Kenya. The study design was an interrupted time series (ITS). Longitudinal data from the District Health Information Software (DHIS2) were analyzed by the Chow test and segmented linear regression. In the post-intervention period, 4th antenatal care visits decreased by .6% (p = .839); facility deliveries decreased by 1.6% (p = .616); post-abortion care uptake increased by 54.4% (p = .000); maternal deaths increased by 10.1% (p = .192) whereas neonatal deaths decreased by .1% (p = .466). The intervention had a significant influence on the uptake of post-abortion care.

Objective: To explore the motivation and ability of midwives in Victoria to contribute to maternity service reform recommendations, specifically expansion and promotion of midwifery continuity of care models. Background: Since the inception of the National Maternity Services Plan in Australia in 2010, midwifery continuity of care has been a key priority area for maternity service reform. It is known that midwifery continuity of care models improves outcomes for mothers and babies, and that midwives’ value and support working in these models. What is not known, is the motivating factors and ability of midwives in Victoria to contribute to Maternity Services Reform, through promotion of the initiation and expansion of midwifery continuity models.    Study design and methods: A cross-sectional, qualitative descriptive design was used. Ten midwives participated, resulting in six semi-structured individual interviews and one focus group of four midwives. Interview and focus group data was analysed using thematic analysis. Results: Midwives in this study were generally supportive of maternity service reform, especially midwifery continuity of care models, but many felt powerless to contribute to reform agenda. Midwives described limited knowledge of maternity service reform and lack of exposure to midwifery continuity of care models. Systemic issues like medical dominance and lack of institutional support further hindered midwives' ability to enact change. Despite these challenges, many midwives expressed a desire to work to their full scope, suggesting that with adequate education, mentorship, and leadership, they could become more active agents of reform. Conclusion: Midwives within this study are motivated to contribute to Maternity Services Reform and support greater access to midwifery continuity of care models, however, the majority felt unable to make an appreciable contribution to the expansion and promotion of these models. Strategies identified to improve midwives' contribution to reform included: education on transforming maternity care, having access to supportive midwifery leaders, successful interdisciplinary collaboration, and fostering a strong midwifery professional identity.    Implications for research, policy, and practice: Participants in this study were motivated to contribute to maternity service reform and practice in midwifery continuity of care models. However, there were many aspects of their role as a midwife and the current maternity care system that did not enable them to contribute. Recommendations to improve midwives’ ability to contribute include education programs that focus on continuity of care experiences, successful and respectful interdisciplinary collaboration, identifying midwifery leaders with a strong vision for reform agenda, and strengthening midwifery as a profession. 

Background Policy informs the planning and delivery of rural and remote maternity services and influences the perinatal outcomes of the 30 per cent of Australian women and their babies who live outside the major cities. Currently however, there are no planning tools that identify the optimal level of birthing services for rural and remote communities in Australia. To address this, the Australian government has prioritised the development of a rigorous methodology in the Australian National Maternity Services Plan to inform the planning of rural and remote maternity services. Methods A review of the literature was undertaken to identify planning indexes with component variables as outlined in the Australian National Maternity Services Plan. The indexes were also relevant if they described need associated with a specific type and level of health service in rural and remote areas of high income countries. Only indexes that modelled a range of socioeconomic and or geographical variables, identified access or need for a specific service type in rural and remote communities were included in the review. Results Four indexes, two Australian and two Canadian met the inclusion criteria. They used combinations of variables including: geographical placement of services; isolation from services and socioeconomic vulnerability to identify access to a type and level of health service in rural and remote areas within 60 minutes. Where geographic isolation reduces access to services for high needs populations, additional measures of disadvantage including indigeneity could strengthen vulnerability scores. Conclusion Current planning indexes are applicable for the development of an Australian rural birthing index. The variables in each of the indexes were relevant, however use of flexible sized catchments to accurately account for population births and weighting for extreme geographic isolation needs to be considered. Additionally, socioeconomic variables are required that will reflect need for services particularly for isolated high needs populations. These variables could be used with Australian data and appropriate cut-off points to confirm applicability for maternity services. All of the indexes used similar types of variables and are relevant for the development of an Australian Rural Birth Index.

We use a detailed operational and clinical data set from a maternity hospital to investigate how workload affects decisions in gatekeeper-provider systems, where the servers act as gatekeepers to specialists but may also attempt to serve customers themselves, albeit with a probability of success that is decreasing in the complexity of the customers’ needs. We study the effect of workload during a service episode on gatekeepers’ service configuration decisions and the rate at which gatekeepers refer customers to a specialist. We find that gatekeeper-providers (midwives in our context) make substantial use of two levers to manage their workload (measured as patients per midwife): they ration resource-intensive discretionary services (epidural analgesia) for customers with noncomplex service needs (mothers with spontaneous onset of labor) and, at the same time, increase the rate of specialist referral (physician-led delivery) for customers with complex needs (mothers with pharmacologically induced labor). The workload effect in the study unit is surprisingly large and comparable in size to those for leading clinical risk factors: when workload increases from two standard deviations below to two standard deviations above the mean, noncomplex cases are 28.8% less likely to receive an epidural, leading to a cost reduction of 8.7%, while complex cases are 14.2% more likely to be referred for a physician-led delivery, leading to a cost increase of 2.6%. These observations are consistent with overtreatment at both high and low workload levels, albeit for different types of patients, and suggest that smoothing gatekeeper workload would reduce variability in customer service experience. This paper was accepted by Serguei Netessine, operations management .

Background In Ethiopia, approximately three-fourths of mothers do not deliver in health facilities. Disrespect and abuse during childbirth fallouts in underutilization of institutional delivery that upshots maternal morbidity and mortality. Thus, the ambition of this study was to assess respectful maternity care and associated factors in Harar hospitals, Eastern Ethiopia. Methods A facility-based cross-sectional study was conducted from April 01 to July 01, 2017. A total of 425 women, delivered at Harar town hospitals, were nominated using a systematic random sampling technique. A pretested and organized questionnaire was used to collect the data. After checking for completeness, the data were entered into EpiData version 3.1 and exported to SPSS version 22.0 for cleaning and analyses. Both bivariate and multivariable logistic regression was computed to identify factors associated with respectful maternity care. Statistical significance was declared at a P -value of < 0.05. Results Data were collected on 425 women. Overall, only 38.4% (95% CI: 33.7, 42.0%) of women received respectful maternity care. Delivering at private hospitals [AOR: 2.3, 95% CI: 1.25, 4.07], having ANC follow-up [AOR: 1.8, 95% CI: 1.10, 3.20], planned pregnancy [AOR: 3.0, 95% CI: 1.24, 7.34], labor attended by male provider [AOR: 1.8, 95% CI: 1.14, 2.77] and normal maternal outcome [AOR: 2.3, 95% CI: 1.13, 4.83] were significantly associated with respectful maternity care. Conclusions Only four out of ten women received respectful care during labor and delivery. Providing women-friendly, abusive free, timely and discriminative free care are the bases to improve the uptake of institutional delivery. Execution of respectful care advancement must be the business of all healthcare providers. Furthermore, to come up with a substantial reduction in maternal mortality, great emphasis should be given to make the service woman-centered.

To learn how hospital labor and delivery units can achieve effective and sustainable teamwork practices and how much such practices affect staff experiences and patient outcomes, RAND researchers studied five units as they implemented improvements in their teamwork practices over a one-year period. They identified some key factors required by any given strategy for teamwork improvement but no standard template for implementation.

Background Increasingly, women with high-risk pregnancies or previous traumatic birth experiences decline care recommendations or seek alternatives because they feel that current maternity care services do not align with their personal preferences or needs. In the Netherlands, a designated clinic was set up to support women who decline care recommendations in making well-informed health decisions and to prevent them from making a negative choice to birth outside the system. The objective of this study was to learn from parents’ experiences with the clinic: what made them choose for a hospital birth while initially being apprehensive about this idea? Methods A total of eight semi-structured interviews were conducted, which took place between May 2019 and August 2019 in Nijmegen, the Netherlands. Results After open, axial and selective coding of the transcripts following constructivist grounded theory approach, three themes were constructed from the data: ‘An unexpected positive experience’, ‘Mutual effort and flexibility’ and ‘Together but on my terms’. One overarching theme was identified: ‘A healing and empowering experience’. Conclusions Our findings reveal that the approach of the designated clinic can be successful in meeting parents’ needs such as trust and autonomy during pregnancy and birth, and in preventing women from making a negative choice to birth outside the system.

1. To assess the performance of an extended questionnaire in identifying cases of SARS-CoV-2 infection among obstetric patients. 2. To evaluate the rate of infection among healthcare workers involved in women's care. A prospective cohort study of obstetric patients admitted to MBBM Foundation and Buzzi Hospital (Lombardy, Northern Italy) from March 16.sup.th to May 22.sup.nd, 2020. Women were screened on admission by a questionnaire investigating major and minor symptoms of infection and high-risk contacts in the last 14 days. SARS-CoV-2 assessment was performed by RT-PCR on nasopharyngeal swabs. Till April 7.sup.th, a targeted SARS-CoV-2 testing triggered by a positive questionnaire was used; from April 8.sup.th, a universal testing approach was implemented. There were 1,177 women screened by the questionnaire, which yielded a positive result in 130 (11.0%) cases. SARS-CoV-2 RT-PCR was performed in 865 (73.5%) patients, identifying 51 (5.9%) infections. During the first period, there were 29 infected mothers, 4 (13.8%) of whom had a negative questionnaire. After universal testing implementation, there were 22 (3%, 95% CI 1.94% - 4.04%) infected mothers, 13 (59.1%) of whom had a negative questionnaire; rate of infection among asymptomatic women was 1.9%. Six of the 17 SARS-CoV-2-positive women with a negative questionnaire reported symptoms more than 14 but within 30 days before admission. Isolated olfactory or taste disorders were identified in 15.7% of infected patients. Rate of infection among healthcare workers was 5.8%. An exhaustive triage questionnaire can effectively discriminate women at low risk of SARS-CoV-2 infection in the context of a targeted and a universal viral testing approach. In 15.7% of infected women, correct classification as a suspected case of infection was due to investigation of olfactory and taste disorders. Extension of the assessed time-frame to 30 days may be worth considering to increase the questionnaire's performance.