Alexis Dunn Amore

Abstract

Community-based birth supported by midwives and nurses is increasing in the United States amid stark racial disparities in maternal outcomes and worsening access to pregnancy care. Although studies examining prenatal confidence have shown that persons with higher confidence are more likely to give birth vaginally, reporting less pain, anxiety, and dissatisfaction, existing measurement tools have focused on hospital births. Accordingly, we adapted the previously validated Preparation for Labor and Birth (P-LAB) instrument, which measures third-trimester confidence for physiologic birth, for community-based births, centering the perspectives of Black populations.

Abstract

PhD Doctoral student manuscript on P-lab adaptation

Abstract

PhD Doctoral student manuscript on P-lab adaptation

Abstract

~

Abstract

~

Abstract

~

Abstract

Conference Abstract submitted for podium presentation -submitted February 2025

Abstract

The CHOICES Black Midwifery Fellowship Program is an exemplar of a transformative postgraduate model in midwifery education that extends beyond traditional training frameworks. The program is designed around 5 core pillars: full-scope reproductive health services education and training, Black feminist thought, leadership and mentorship, neonatal and postnatal care, and community and patient-centered care. By embedding these frameworks into the curriculum, the fellowship challenges the prevailing medicalized approach to birth that often neglects the unique needs of marginalized communities. This perspective equips fellows with a critical understanding of the social, political, and economic factors that influence health outcomes, enabling them to advocate effectively for their patients and communities. In addition to improving clinical outcomes, the fellowship has also played a crucial role in restoring trust between Black birthing people and the health care system. Historical injustices and ongoing systemic racism have led to deep-seated mistrust of mainstream health care institutions among many Black communities. By training Black midwives who understand and share the cultural and lived experiences of their patients, the CHOICES fellowship helps to bridge this trust gap. Fellows are taught to adopt a patient-centered approach that prioritizes informed consent, shared-decision-making, and respect for cultural practices. In this article we outline the structure, curriculum, and training activities of the CHOICES Black Midwifery Fellowship. Additionally, we review the challenges encountered and lessons learned during the implementation process.

Abstract

Background: Health disparities in maternal health outcomes persist among Black birthing populations in the United States. Given the historical harms experienced by Black populations in research, culturally tailored approaches to ensure ethical research are needed. Community-engaged research strategies have been found to be effective in a variety of investigations; however, little has been documented regarding their use within biologically focused research among pregnant populations. Objective: The purpose of this paper is to describe the process of engaging with a community advisory board of a biologically focused research study focused on reducing perinatal health disparities and promoting health equity. Specifically, we outline the methods followed to meaningfully involve the community in each step of the research process. Methods: The research team utilized intentional team-building activities and feedback methods to relay information between the community and research partners regarding study protocols and community-led dissemination strategies. Online sessions with community partners were created utilizing community-engaged research principles to guide the sessions. Information obtained from the community advisory board (CAB) during these sessions was used to modify and optimize this study’s data collection protocol, recruitment strategies, and dissemination efforts. A quantitative and qualitative survey was conducted during the process to gather feedback from CAB members about their experiences. Results: The CAB (n = 8 community members) shared in the operation of the project and collaborated on everything from study onset, recruitment/retention strategies, informed consent processes, and dissemination to data sharing. Scores from the quantitative questionnaire (n = 5) about their experiences demonstrated that members overall reported good or excellent experiences as participants in the CAB. Additionally, feedback from community members about how they felt working within a research team included feeling that they were (a) making the research study better, (b) learning about research, (c) providing voice for the community, and (d) building a community of trust. Detailed feedback on each session resulted in changes in study protocols, recruitment practices, and dissemination activities. Discussion: Safety is a crucial tenant of all research investigations. When research focuses on populations who have experienced perpetual harm, utilization of community expertise is necessary to ensure just and equitable research experiences.

Abstract

Manuscript submitted January 2024; revise and resubmitResubmitted Summer 2024; Not accepted February 2025