Women taking charge of changing childbirth in BC

Childbearing women in Canada are speaking out about their desire for respectful maternity care. The Vancouver Foundation funded Phase 1 of our provincial, community-led participatory action research project entitled "Changing Childbirth in BC: Women exploring access to high quality maternity care". A steering group of women from different cultural and socioeconomic backgrounds worked with researchers and community agencies to study access to preferred models of maternity care and experiences of autonomy, respect, discrimination, or coercion when participating in a decision-making process. Community leaders developed an online survey and focus group questions including items targeted for marginalized populations: street-entrenched, formerly incarcerated, and immigrant and refugee groups. The response from women from all communities was overwhelming: 4,082 respondents (392 from vulnerable populations) provided survey data, and 135 women in 20 focus groups.

Our preliminary analysis of this rich mixed-methods dataset suggests it will reveal detailed information on how model of care and patient-provider communication affect women's experience of care. Some women say they have a trusting relationship with a maternity provider who involves them in decision-making, but others report being treated in an impersonal, condescending manner; receiving fragmented care and false information; and feeling lonely, disregarded, and abandoned by care providers. Marginalized and immigrant women seem to experience higher rates of disrespect and lack access to maternity care options. Now we must confirm our findings, decide how best to tell these stories, and effect change.

We will work with community members to interpret and translate our findings into practice and policy. We will complete our analysis and examine differences in needs and preferences among women from varied regional and cultural contexts. We will hold town meetings to discuss the findings and decide how the community wants to tell the stories. To make an effective multimedia knowledge translation plan, we will link community members with health professional educators, public information specialists, and parents who have relevant technical expertise. Our partners will help us to create multilingual, culturally appropriate multimedia dissemination tools. Together we will lead implementation activities targeted at institutions, clinicians, and policymakers.

Intimate partner violence intervention for pregnant women: effectiveness in improving health and pregnancy outcomes

Intimate partner violence, which includes psychological, physical and sexual abuse, is a serious social and public health issue. The problem is particularly critical in British Columbia, which consistently has one of the highest rates of abuse of women in Canada. A woman’s risk of partner violence increases during pregnancy, and is associated with increased chance of miscarriage, premature labour, and low birth weight, as well as posttraumatic stress disorder and depression. Health care providers ask all pregnant women about violence as a routine part of their health history. However, a major barrier for caregivers is their lack of knowledge about what action to take after a woman discloses abuse. Little research has been done to determine what steps can be taken to successfully stop the abuse. Dr. Sarah Desmarais is evaluating the effectiveness of a targeted intervention, delivered in the context of primary care, to reduce violence and improve health. She will follow pregnant women – receiving care in a Lower Mainland hospital – who indicate that they have experienced partner violence. The intervention program will be provided by community health nurses and will consist of a variety of information, referral, and resource services (e.g., providing women with telephone numbers for community agencies and assisting women in contacting a women’s shelter and negotiating admission). Following the initial intervention, Desmarais will track pregnancy complications and newborn health. She will also interview women post partum about their health, their intervention experiences, and the incidence of partner violence. This research will inform the development and delivery of partner violence intervention in primary care settings, with an ultimate goal of reducing partner violence and improving women’s and newborn health.

Perinatal outcomes in a provincial based cohort of HIV positive mother-infant pairs

Every year 2.4 million HIV positive women worldwide deliver infants. In Canada, increasingly complex highly active antiretroviral therapy (HAART) regimens are widely used by pregnant woman to improve maternal health and reduce transmission to fetuses. However, there are concerns about maternal and fetal complications with HAART. Oak Tree Clinic, British Columbia’s provincial referral centre for maternal-infant care of HIV positive women and their families, maintains a longstanding comprehensive perinatal database. Tessa Chaworth-Musters is investigating, updating and expanding this database to determine complication rates in HAART-exposed pregnancies. Chaworth-Musters is adding new data fields to reflect questions in the current literature, and where available, she is making comparisons to a provincial data set from the BC Reproductive Care Program and using statistical models to determine if specific variables impact outcomes. The findings will guide Oak Tree physicians in their treatment of pregnant HIV positive women and contribute to improvement of provincial and national antiretroviral therapy guidelines and pregnancy practices. Chaworth-Musters also aims to clarify inconsistencies in already published data. Her overall goal is for the research to facilitate understanding of optimal, safe, effective and non-toxic treatment during pregnancy of HIV positive women.