Browsing by keyword "obstetrics"
Now showing items 1-7 of 7
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A National CERA Study of the Use of Laborists in Family Medicine Residency TrainingBACKGROUND AND OBJECTIVES: Little is known about the impact of laborists (which we defined as "clinicians dedicated to providing LandD care services in the hospital environment for pregnant patients, regardless of who provided the prenatal care" for this survey) on family medicine residency training. We surveyed family medicine residency directors to assess characteristics about laborist services and their involvement in family medicine residency teaching. METHODS: Questions were included in the 2015 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency directors. Univariate statistics were used to describe programs, directors, and our questions on the use of laborists. Chi-square tests and Student's t tests were used to evaluate bivariate relationships using a a P RESULTS: A total of 250/473 (52.9%) of residency directors completed the laborist section of the CERA survey. Sixty-four percent of residency programs were community based/university affiliated, representing the expected range, size, and location of family medicine programs. Almost half of programs (44.4%) reported a laborist service in their main teaching hospital for L&D training. Of directors, 64.1 % viewed laborists as good/excellent educators; 54.3% reported little or no reduction in L&D teaching required of their faculty despite the presence of a laborist service. Fifteen percent reported that >30% of their graduates included L&D care in their first practice. CONCLUSIONS: Laborists have an important role in family medicine resident obstetrics training and education. More research is needed to explore how laborists and family medicine faculty can collaborate to promote enhanced efficiency and effectiveness as residency teachers.
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Clinician Perspectives on the Need for Training and Caring for Pregnant Women with Intellectual and Developmental Disabilities [poster]Background: Women with intellectual and developmental disabilities (IDD) experience disparities in obstetric care access and quality, in addition to communication gaps with healthcare providers. Many obstetric providers are untrained and uneducated about critical aspects of providing care to persons with IDD. Objectives: The present study was conducted (1) to describe obstetric clinicians’ training experiences related to providing obstetric care to women with IDD, (2) to assess obstetric clinicians’ perceived need for formalized training, and (3) to identify recommendations for training content and dissemination. Methods: This study involved qualitative individual interviews (n=9) and one focus group (n=8) with obstetric clinicians who self-reported experience caring for women with IDD during pregnancy. Descriptive coding and content analysis techniques were used to develop an iterative codebook related to education and training; codes were applied to the data. Coded data were analyzed for larger themes and relationships. Results: Analysis revealed three main themes: 1. Need for obstetric training and education: No participant reported receiving any training in caring for pregnant women with IDD. Participants expressed a need for formal education. 2. Recommendations for formal training: Participants noted a dearth of clinical practice guidelines, the need for pregnancy-specific training during residency and beyond, and all healthcare staff should be included in training opportunities. 3. Training outcomes should increase knowledge, enhance attitudes, and develop practical skills related to communication and care for pregnant women with IDD. Conclusion: Study results indicate a need for and interest in systematic training efforts regarding obstetric care for women with IDD. Improved training and education may decrease health inequities and improve the quality of obstetric care, and thus pregnancy outcomes, for women with IDD.
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Evaluation of the accessibility of structured exercise programs for pregnant women: An analysis of offerings at the YMCAs of MassachusettsThe American Congress of Obstetrics and Gynecology recommends that exercise should be encouraged in women with uncomplicated pregnancies. Potential benefits of exercise include a decreased incidence of medical complications of pregnancy, including gestational diabetes and preterm labor. Additional benefits include decreased incidence of excessive maternal weight gain, cesarean sections and low birthweight of the newborn. The Massachusetts' rate of gestational diabetes was 4.7% in 2015 with 7.8% babies being born at low birth weight and 8.6% born preterm statewide. The aim of this project was to evaluate the availability of structured exercise programs tailored specifically to pregnant women, as a lack of options may limit a woman's ability to benefit from the health-protective effects of exercise during pregnancy. A telephone survey was conducted in 2017 to gather information about exercise programs available to pregnant women at YMCAs across Massachusetts. YMCAs were chosen because of their accessibility, affordability and history of health-centered initiatives. Our analysis revealed that of the 73 Massachusetts YMCA facilities contacted; only three indicated a specific class for prenatal exercise. Two offered prenatal yoga and the other a stretching class. This study revealed that easily accessible options for exercise tailored to pregnant women are currently limited at YMCA facilities in Massachusetts. This may reflect an overall limitation of exercise options for pregnant women. Further investigation regarding the specific barriers women face when attempting to exercise during pregnancy may provide valuable insight into how community organizations can help maximize the number of women who partake in exercise during pregnancy.
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Obstetrical Ultrasound - Basics of First Trimester SonographyThis presentation is part of the PEER Liberia Radiology Lecture Series. It provides an overview for clinicians of the basics of obstetrical ultrasound and first trimester sonography.
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PRogram In Support of Moms (PRISM): a pilot group randomized controlled trial of two approaches to improving depression among perinatal womenPURPOSE: This pilot study was designed to inform a larger effectiveness trial by: (1) assessing the feasibility of the PRogram In Support of Moms (PRISM) and our study procedures; and, (2) determining the extent to which PRISM as compared to an active comparison group, the Massachusetts Child Access Psychiatry Program (MCPAP) for Moms alone, improves depression among perinatal women. METHODS: Four practices were randomized to either PRISM or MCPAP for Moms alone, a state-wide telephonic perinatal psychiatry program. PRISM includes MCPAP for Moms plus implementation assistance with local champions, training, and implementation of office prompts and procedures to enhance depression screening, assessment and treatment. Patients with Edinburgh Postnatal Depression Scales (EPDS) > /= 10 were recruited during pregnancy, and completed the EPDS and a structured interview at baseline and 3-12 weeks' postpartum. RESULTS: Among MCPAP for Moms alone practices, patients' (n = 9) EPDS scores improved from 15.22 to 10.11 (p = 0.010), whereas in PRISM practices patients' (n = 21) EPDS scores improved from 13.57 to 6.19 (p = 0.001); the between groups difference-of-differences was 2.27 (p = 0.341). CONCLUSIONS: PRISM was beneficial for patients, clinicians, and support staff. Both PRISM and MCPAP for Moms alone improve depression symptom severity and the percentage of women with an EPDS > 10. The improvement difference between groups was not statistically significant due to limited power associated with small sample size.
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Supporting Family Physician Maternity Care ProvidersMaternity care access in the United States is in crisis. The American Congress of Obstetrics and Gynecology projects that by 2030 there will be a nationwide shortage of 9,000 obstetrician-gynecologists (OB/GYNs). Midwives and OB/GYNs have been called upon to address this crisis, yet in underserved areas, family physicians are often providing a majority of this care. Family medicine maternity care, a natural fit for the discipline, has been on sharp decline in recent years for many reasons including difficulties cultivating interdisciplinary relationships, navigating privileging, developing and maintaining adequate volume/competency, and preventing burnout. In 2016 and 2017, workshops were held among family medicine educators with resultant recommendations for essential strategies to support family physician maternity care providers. This article summarizes these strategies, provides guidance, and highlights the role family physicians have in addressing maternity care access for the underserved as well as presenting innovative ideas to train and retain rural family physician maternity care providers.
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Why pregnant women with depression often slip through the cracksOne in seven women experience depression during pregnancy and after they give birth. This article explains how a model the authors created in Massachusetts to ensure that women with depression get the help they need is being implemented in other states.
