Audrey Lyndon

Faculty

Audrey Lyndon Headshot

Audrey Lyndon

FAAN PhD RNC

Vernice D. Ferguson Professor in Health Equity
Assistant Dean for Clinical Research

1 212 922 5940

433 First Ave
New York, NY 10010
United States

Accepting PhD students

Audrey Lyndon's additional information

Dr. Lyndon is the Vernice D. Ferguson Professor in Health Equity and assistant dean for clinical research at NYU Rory Meyers College of Nursing. Her equity work is focused in two areas: maternal health equity and diversifying the nursing science and healthcare workforce. Dr. Lyndon’s maternal health work has focused on patient safety and quality in maternity and neonatal care, including improving communication and teamwork among clinicians; identifying parents’ perspectives on safety during labor, birth, and neonatal care; developing nurse-sensitive outcomes for labor and birth; and research on severe maternal morbidity and maternal mortality. Her team has conducted groundbreaking research on differences in clinicians’ and parents’ perspective on speaking up about safety concerns and developing an understanding of how women and parents conceptualize safety during childbirth and neonatal intensive care. Dr. Lyndon co-chaired the development of the CMQCC Obstetric Hemorrhage Toolkit, which became a national and international model for maternal safety bundles and collaborative quality improvement. Dr. Lyndon recently completed a study funded by the Agency for Healthcare Research and Quality examining relationships between nursing care during labor and patient outcomes. She is currently focused on understanding the experiences of Black and Latinx survivors of severe maternal morbidity to better identify their support needs, research priorities, and community-driven prevention targets for severe maternal morbidity. Dr. Lyndon’s work on diversifying the nursing science and healthcare workforce includes mentoring and sponsorship of historically excluded clinicians and scientists and efforts to build effective pathways programs for historically excluded individuals into nursing, nursing science, and clinical specialties.

PhD - University of California, San Francisco
MS - University of California, San Francisco
BA - University of California, Santa Cruz

Women's health
Health Services Research

American Academy of Nursing
American College of Obstetricians and Gynecologists (ACOG), Educational Affiliate
American Nurses Association
Association of Women’s Health Obstetric and Neonatal Nurses
International Family Nursing Association

Faculty Honors Awards

Reviewer of the Year, Journal of Obstetric, Gynecologic, and Neonatal Nursing (2017)
Irving Harris Visiting Professor, University of Illinois, Chicago College of Nursing (2015)
Distinguished Professional Service Award, Association of Women's Health, Obstetric and Neonatal Nurses (2013)
Fellow, American Academy of Nursing (2012)
Award of Excellence in Research, Association of Women's Health, Obstetric and Neonatal Nurses (2011)

Publications

A Qualitative Study of Breastfeeding Experiences Among Mothers Who Used Galactagogues to Increase Their Milk Supply

Ryan, R. A., Hepworth, A. D., Bihuniak, J. D., & Lyndon, A. (2024). Journal of Nutrition Education and Behavior, 56(3), 122-132. 10.1016/j.jneb.2023.12.002
Abstract
Abstract
Objective: To qualitatively describe breastfeeding experiences among mothers who used galactagogues to increase their milk supply. Design: One-time, semistructured phone interviews. Setting: US. Participants: Breastfeeding mothers (n = 19) who reported ever consuming foods, beverages, or herbal supplements to increase their milk supply in a cross-sectional online survey were purposefully sampled to participate in this qualitative study. Participants were diverse in terms of race and ethnicity, education, income, infant age (0–18 months), and prior breastfeeding experience (32% first-time breastfeeding). Phenomenon of Interest: Reasons for trying to increase milk supply, sources of information about increasing milk supply, and strategies tried to increase milk supply. Analysis: Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. Results: Participants expressed determination and commitment to breastfeeding but unexpectedly struggled to breastfeed and increase their milk supply. They sought information from multiple sources and used individualized approaches to address milk supply concerns on the basis of recommendations from others, as well as the perceived convenience, cost, palatability, and safety of potential strategies. Conclusions and Implications: Results suggest a need to expand breastfeeding education and support so that lactating parents anticipate common breastfeeding challenges and are aware of evidence-based strategies for increasing their milk supply.

Assessing the relationship between census tract rurality and severe maternal morbidity in California (1997-2018)

Berkowitz, R. L., Kan, P., Gao, X., Hailu, E. M., Board, C., Lyndon, A., Mujahid, M., & Carmichael, S. L. (2023). Journal of Rural Health. 10.1111/jrh.12814
Abstract
Abstract
Purpose: Recent studies have demonstrated an increased risk of severe maternal morbidity (SMM) for people living in rural versus urban counties. Studies have not considered rurality at the more nuanced subcounty census-tract level. This study assessed the relationship between census-tract-level rurality and SMM for birthing people in California. Methods: We used linked vital statistics and hospital discharge records for births between 1997 and 2018 in California. SMM was defined by at least 1 of 21 potentially fatal conditions and lifesaving procedures. Rural-Urban Commuting Area codes were used to characterize census tract rurality dichotomously (2-category) and at 4 levels (4-category). Covariates included sociocultural-demographic, pregnancy-related, and neighborhood-level factors. We ran a series of mixed-effects logistic regression models with tract-level clustering, reporting risk ratios and 95% confidence intervals (CIs). We used the STROBE reporting guidelines. Findings: Of 10,091,415 births, 1.1% had SMM. Overall, 94.3% of participants resided in urban/metropolitan and 5.7% in rural tracts (3.9% micropolitan, 0.9% small town, 0.8% rural). In 2-category models, the risk of SMM was 10% higher for birthing people in rural versus urban tracts (95% CI: 6%, 13%). In 4-category models, the risk of SMM was 16% higher in micropolitan versus metropolitan tracts (95% CI: 12%, 21%). Conclusion: The observed rurality and SMM relationship was driven by living in a micropolitan versus metropolitan tract. Increased risk may result from resource access inequities within suburban areas. Our findings demonstrate the importance of considering rurality at a subcounty level to understand locality-related inequities in the risk of SMM.

Emotional safety is patient safety

Lyndon, A., Davis, D. A., Sharma, A. E., & Scott, K. A. (2023). BMJ Quality and Safety, 32(7), 369-372. 10.1136/bmjqs-2022-015573

Examining respect, autonomy, and mistreatment in childbirth in the US: do provider type and place of birth matter?

Niles, P. M., Baumont, M., Malhotra, N., Stoll, K., Strauss, N., Lyndon, A., & Vedam, S. (2023). Reproductive Health, 20(1). 10.1186/s12978-023-01584-1
Abstract
Abstract
Background: Analyses of factors that determine quality of perinatal care consistently rely on clinical markers, while failing to assess experiential outcomes. Understanding how model of care and birth setting influence experiences of respect, autonomy, and decision making, is essential for comprehensive assessment of quality. Methods: We examined responses (n = 1771) to an online cross-sectional national survey capturing experiences of perinatal care in the United States. We used validated patient-oriented measures and scales to assess four domains of experience: (1) decision-making, (2) respect, (3) mistreatment, and (4) time spent during visits. We categorized the provider type and birth setting into three groups: midwife at community birth, midwife at hospital-birth, and physician at hospital-birth. For each group, we used multivariate logistic regression, adjusted for demographic and clinical characteristics, to estimate the odds of experiential outcomes in all the four domains. Results: Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy (aOR: 5.22, 95% CI: 3.65–7.45), higher respect (aOR: 5.39, 95% CI: 3.72–7.82) and lower odds of mistreatment (aOR: 0.16, 95% CI: 0.10–0.26). We found significant differences across birth settings: participants cared for by midwives in the community settings had significantly better experiential outcomes than those in the hospital settings: high- autonomy (aOR: 2.97, 95% CI: 2.66–4.27), respect (aOR: 4.15, 95% CI: 2.81–6.14), mistreatment (aOR: 0.20, 95% CI: 0.11–0.34), time spent (aOR: 8.06, 95% CI: 4.26–15.28). Conclusion: Participants reported better experiential outcomes when cared for by midwives than by physicians. And for those receiving midwifery care, the quality of experiential outcomes was significantly higher in community settings than in hospital settings. Care settings matter and structures of hospital-based care may impair implementation of the person-centered midwifery care model.

Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients

Simpson, K. R., Spetz, J., Gay, C. L., Fletcher, J., Landstrom, G. L., & Lyndon, A. (2023). Nursing Outlook, 71(3). 10.1016/j.outlook.2023.101960
Abstract
Abstract
Background: Evidence is limited on nurse staffing in maternity units. Purpose: To estimate the relationship between hospital characteristics and adherence with Association of Women's Health, Obstetric and Neonatal Nurses nurse staffing guidelines. Methods: We enrolled 3,471 registered nurses in a cross-sectional survey and obtained hospital characteristics from the 2018 American Hospital Association Annual Survey. We used mixed-effects linear regression models to estimate associations between hospital characteristics and staffing guideline adherence. Findings: Overall, nurses reported strong adherence to AWHONN staffing guidelines (rated frequently or always met by ≥80% of respondents) in their hospitals. Higher birth volume, having a neonatal intensive care unit, teaching status, and higher percentage of births paid by Medicaid were all associated with lower mean guideline adherence scores. Discussion and Conclusions: Important gaps in staffing were reported more frequently at hospitals serving patients more likely to have medical or obstetric complications, leaving the most vulnerable patients at risk.

Linking Patient Safety Climate with Missed Nursing Care in Labor and Delivery Units: Findings from the LaborRNs Survey

Zhong, J., Simpson, K. R., Spetz, J., Gay, C. L., Fletcher, J., Landstrom, G. L., & Lyndon, A. (2023). Journal of Patient Safety, 19(3), 166-172. 10.1097/PTS.0000000000001106
Abstract
Abstract
Objective This study aimed to explore the association of nurses' perceptions of patient safety climate with missed nursing care in labor and delivery (L&D) units. Methods We recruited nurse respondents via email distribution of an electronic survey between February 2018 and July 2019. Hospitals with L&D units were recruited from states with projected availability of 2018 state inpatient data in the United States. Measures included the Safety Attitudes Questionnaire Safety Climate Subscale and the Perinatal Missed Care Survey. We estimated the relationship between safety climate and missed care using Kruskal-Wallis tests and mixed-effects linear regression. Results The analytic sample included 3429 L&D registered nurses from 253 hospitals (response rate, 35%). A majority of respondents (65.7%) reported a perception of good safety climate in their units, with a mean score of 4.12 (±0.73) out of 5. The mean number of aspects of care occasionally, frequently, or always missed on respondents' units was 11.04 (±6.99) out of 25. χ2 Tests showed that six mostly commonly missed aspects of care (e.g., timely documentation) and three reasons for missed care (communications, material resources, and labor resources) were associated with safety climate groups (P < 0.001). The adjusted mixed-effects model identified a significant association between better nurse-perceived safety climate and less missed care (β = -2.65; 95% confidence interval, -2.97 to -2.34; P < 0.001) after controlling for years of experience and highest nursing education. Conclusions Our findings suggest that improving safety climate - for example, through better teamwork and communication - may improve nursing care quality during labor and birth through decreasing missed nursing care. Conversely, it is also possible that strategies to reduce missed care - such as staffing improvements - may improve safety climate.

Neighborhood disinvestment and severe maternal morbidity in the state of California

Mujahid, M. S., Wall-Wieler, E., Hailu, E. M., Berkowitz, R. L., Gao, X., Morris, C. M., Abrams, B., Lyndon, A., & Carmichael, S. L. (2023). American Journal of Obstetrics and Gynecology MFM, 5(6). 10.1016/j.ajogmf.2023.100916
Abstract
Abstract
BACKGROUND: Social determinants of health, including neighborhood context, may be a key driver of severe maternal morbidity and its related racial and ethnic inequities; however, investigations remain limited. OBJECTIVE: This study aimed to examine the associations between neighborhood socioeconomic characteristics and severe maternal morbidity, as well as whether the associations between neighborhood socioeconomic characteristics and severe maternal morbidity were modified by race and ethnicity. STUDY DESIGN: This study leveraged a California statewide data resource on all hospital births at ≥20 weeks of gestation (1997–2018). Severe maternal morbidity was defined as having at least 1 of 21 diagnoses and procedures (eg, blood transfusion or hysterectomy) as outlined by the Centers for Disease Control and Prevention. Neighborhoods were defined as residential census tracts (n=8022; an average of 1295 births per neighborhood), and the neighborhood deprivation index was a summary measure of 8 census indicators (eg, percentage of poverty, unemployment, and public assistance). Mixed-effects logistic regression models (individuals nested within neighborhoods) were used to compare odds of severe maternal morbidity across quartiles (quartile 1 [the least deprived] to quartile 4 [the most deprived]) of the neighborhood deprivation index before and after adjustments for maternal sociodemographic and pregnancy-related factors and comorbidities. Moreover, cross-product terms were created to determine whether associations were modified by race and ethnicity. RESULTS: Of 10,384,976 births, the prevalence of severe maternal morbidity was 1.2% (N=120,487). In fully adjusted mixed-effects models, the odds of severe maternal morbidity increased with increasing neighborhood deprivation index (odds ratios: quartile 1, reference; quartile 4, 1.23 [95% confidence interval, 1.20–1.26]; quartile 3, 1.13 [95% confidence interval, 1.10–1.16]; quartile 2, 1.06 [95% confidence interval, 1.03–1.08]). The associations were modified by race and ethnicity such that associations (quartile 4 vs quartile 1) were the strongest among individuals in the “other” racial and ethnic category (1.39; 95% confidence interval, 1.03–1.86) and the weakest among Black individuals (1.07; 95% confidence interval, 0.98–1.16). CONCLUSION: Study findings suggest that neighborhood deprivation contributes to an increased risk of severe maternal morbidity. Future research should examine which aspects of neighborhood environments matter most across racial and ethnic groups.

Sources of stress and coping mechanisms: Experiences of maternal health care providers in Western Kenya

Getahun, M., Oboke, E. N., Ogolla, B. A., Kinyua, J., Ongeri, L., Sterling, M., Oluoch, I., Lyndon, A., & Afulani, P. A. (2023). PLOS Global Public Health, 3(2), e0001341. 10.1371/journal.pgph.0001341
Abstract
Abstract
The dynamic and complex nature of care provision predisposes healthcare workers to stress, including physical, emotional, or psychological fatigue due to individual, interpersonal, or organizational factors. We conducted a convergent mixed-methods study with maternity providers to understand their sources of stress and coping mechanisms they adopt. Data were collected in Migori County in western Kenya utilizing quantitative surveys with n = 101 maternity providers and in-depth interviews with a subset of n = 31 providers. We conducted descriptive analyses for the quantitative data. For qualitative data, we conducted thematic analysis, where codes were deductively developed from interview guides, iteratively refined based on emergent data, and applied by a team of five researchers using Dedoose software. Code queries were then analysed to identify themes and organized using the socioecological (SE) framework to present findings at the individual, interpersonal, and organizational levels. Providers reported stress due to high workloads (61%); lack of supplies (37%), poor salary (32%), attitudes of colleagues and superiors (25%), attitudes of patients (21%), and adverse outcomes (16%). Themes from the qualitative analysis mirrored the quantitative analysis with more detailed information on the factors contributing to each and how these sources of stress affect providers and patient outcomes. Coping mechanisms adopted by providers are captured under three themes: addressing stress by oneself, reaching out to others, and seeking help from a higher power. Findings underscore the need to address organizational, interpersonal, and individual level stressors. Strategies are needed to support staff retention, provide adequate resources and incentives for providers, and ultimately improve patient outcomes. Interventions should support and leverage the positive coping mechanisms identified.

Trends and Disparities in Severe Maternal Morbidity Indicator Categories During Childbirth Hospitalization in California from 1997-2017

El Ayadi, A. M., Lyndon, A., Kan, P., Mujahid, M. S., Leonard, S. A., Main, E. K., & Carmichael, S. (2023). American Journal of Perinatology. 10.1055/a-2223-3520
Abstract
Abstract
Objective Severe maternal morbidity (SMM) is increasing and characterized by substantial racial and ethnic disparities. Analyzing trends and disparities across time by etiologic or organ system groups instead of an aggregated index may inform specific, actionable pathways to equitable care. We explored trends and racial and ethnic disparities in seven SMM categories at childbirth hospitalization. Study Design We analyzed California birth cohort data on all live and stillbirths ≥20 weeks gestation from 1997-2017 (n=10,580,096) using the Centers for Disease Control and Prevention's SMM index. Cases were categorized into seven non-mutually exclusive indicator categories (cardiac, renal, respiratory, hemorrhage, sepsis, other obstetric, and other medical SMM). We compared prevalence and trends in SMM indicator categories overall and by racial and ethnic group using logistic and linear regression. Results SMM occurred in 1.16% of births and non-transfusion SMM in 0.54%. Hemorrhage SMM occurred most frequently (27 per 10,000 births), followed by other obstetric (11), respiratory (7), and sepsis, cardiac, and renal SMM (5). Hemorrhage, renal, respiratory, and sepsis SMM increased over time for all racial and ethnic groups. The largest disparities were for Black individuals, including over three-fold increased odds of other medical SMM. Renal and sepsis morbidity had the largest relative increases over time (717% and 544%). Sepsis and hemorrhage SMM had the largest absolute changes over time (17 per 10,000 increase). Disparities increased over time for respiratory SMM among Black, US-born Hispanic, and non-US-born Hispanic individuals and for sepsis SMM among Asian or Pacific Islander individuals. Disparities decreased over time for sepsis SMM among Black individuals yet remained substantial. Conclusion Our research further supports the critical need to address SMM and disparities as a significant public health priority in the United States and suggests that examining SMM subgroups may reveal helpful nuance for understanding trends, disparities and potential needs for intervention.

Use of Galactagogues to Increase Milk Production Among Breastfeeding Mothers in the United States: A Descriptive Study

Ryan, R. A., Hepworth, A. D., Lyndon, A., & Bihuniak, J. D. (2023). Journal of the Academy of Nutrition and Dietetics, 123(9), 1329-1339. 10.1016/j.jand.2023.05.019
Abstract
Abstract
Background: Perceived insufficient milk is a primary reason for early breastfeeding cessation. Some breastfeeding mothers may use galactagogues (ie, foods, beverages, herbal supplements, and pharmaceuticals) to try to increase milk supply. However, milk production requires frequent and effective milk removal, and there is limited evidence on the safety and efficacy of galactagogues. Additional research on the use of galactagogues is needed to inform breastfeeding support. Objective: Describe the prevalence of use and perceived effects of galactagogues and compare galactagogue use by maternal characteristics. Design: Cross-sectional online survey. Participants/setting: A convenience sample of 1,294 adult women breastfeeding a singleton child and living in the United States were recruited using paid Facebook advertisements between December 2020 and February 2021. Main outcome measures: Self-reported current or previous use of galactagogues and their perceived effects on milk production. Statistical analyses performed: Frequencies and percentages described the use and perceived effects of galactagogues. The χ2 test of independence and independent t tests compared galactagogue use by select maternal characteristics. Results: More than half of participants (57.5%) reported using any galactagogues, 55.4% reported consuming foods or beverages, and 27.7% reported using herbal supplements. Few participants (1.4%) reported using pharmaceuticals. Participants reported varying effects of specific galactagogues on milk production. Reported galactagogue use was higher among participants who reported first-time breastfeeding (yes: 66.7% vs no: 49.3%; P < 0.001), breastfeeding pumped milk (yes: 63.1% vs no: 50.4%; P < 0.001), formula supplementation (yes: 66.8% vs no: 50.4%; P < 0.001), and perceived insufficient milk (yes: 78.8% vs no: 53.8%; P < 0.001). Conclusions: Breastfeeding mothers in the United States commonly reported using galactagogues to increase milk production, highlighting the need for research on the safety and efficacy of galactagogues and enhanced breastfeeding support.