How UCSF Nurses are Strengthening Maternal and Perinatal Health
Despite advances in medicine, maternal morbidity and death rates in the United States continue to rise. In addition, pregnant individuals and their infants, especially in underserved communities, struggle with access to quality care.
Experts at the UCSF School of Nursing are leading innovative projects to address disparities and identify ways to improve health. Here is just some of the work they are leading to strengthen maternal and perinatal health.
Addressing Black Maternal and Infant Health Disparities
Studies show that breastfeeding is linked to physiological, psychological and immunological benefits for both birthing people and infants. This includes a lower risk of heart disease, cancer and diabetes for those who breastfeed, and a reduced risk of gastrointestinal infections, ear infection and sudden infant death syndrome for babies.
Yet Black infants in the U.S. are nine times more likely than white infants to be formula-fed in the hospital after birth.
Associate professor Ifeyinwa Asiodu, PhD ’14, IBCLC, FAAN, a national leader in maternal and infant health disparities, cites inequitable access to skilled lactation support providers, racism and inaccessible maternity care practices as some of the factors that have led to a lack of breastfeeding in Black communities.
Asiodu leads the MILK Research Lab that is responding to these factors directly. Through innovative research on human milk feeding and lactation, and policy and advocacy efforts, the MILK Lab seeks to improve maternal health outcomes of Black birthing people across the life course.
As part of its work, the MILK Research Lab has released two toolkits to support Black families navigating the neonatal intensive care unit (NICU).
“These toolkits were a collaborative community effort created to improve Black families’ NICU experience and advance health equity, access to human milk and reproductive justice,” explains Asiodu.
Are Antenatal Corticosteroids Detrimental in the Long Term?
Antenatal corticosteroids, synthetic hormones that accelerate fetal organ development, are commonly administered to women at risk of preterm delivery to improve birth outcomes.
But there is growing concern that fetal exposure to corticosteroids may result in adverse, long-term health outcomes.
In 2015, UCSF School of Nursing professor Sandra Weiss, PhD, RN, FAAN, found that these hormones can suppress the infant’s ability to regulate cortisol, a key stress-related hormone. Recently, she demonstrated that cortisol suppression persists across the first year of life.
Weiss is also studying the effect of antenatal corticosteroids on development of the infant microbiome. At the 2022 conference of the Western Institute for Nursing Research, she presented results implicating antenatal corticosteroids in microbial depletion and an unusual composition of the infant’s gut microbiome.
These findings have major significance for later management of stress symptoms since both cortisol regulation and microbial composition have a strong influence on stress-related adaptive functions that are critical to the child’s long-term health.
In collaboration with Susan Lynch, PhD, professor at the School of Medicine, Weiss is building on these findings to examine antenatal corticosteroids’ effect on glucocorticoid genes and gene pathways of the microbiome in a current study funded by the National Institute of Health.
Racism as a Motivator and Barrier to Midwifery for People of Color
Severe maternal morbidities in the U.S. have increased by 200% since the 1990s. Black and Native American or Alaska Native birthing people are at least 2.5 times more likely to die during pregnancy, birth and postpartum than white birthing people.
Midwifery care is an effective way to improve maternal health outcomes. In the U.S., 86% of midwives are white. Because studies have shown that racially concordant care leads to improved health outcomes, diversifying the midwifery workforce is critical to improving the health of birthing people of color.
Renee Mehra, PhD, a postdoctoral scholar with the Abortion Care Training Incubator for Outstanding Nurse Scholars at UCSF, co-led a study to better understand the barriers and motivators for people of color in becoming midwives.
The study found that structural and interpersonal racism was both a motivator and barrier for people of color pursuing careers as midwives. The top motivating factors were an interest in providing racially concordant care and reducing racial disparities in health, while barriers were cost of midwifery education and a lack of racial diversity in midwifery training programs and the profession.
To diversify the midwifery workforce and improve the health of birthing people of color, these barriers must be addressed. More funding should be provided to support midwifery students of color and to facilitate culturally competent midwifery education, she said. In addition, Mehra and her colleagues recommend opening more midwifery education programs nationwide.
“We need a national imperative to diversify the perinatal workforce that includes addressing the financial and educational barriers to midwifery education for people of color,” says Mehra.
Delirium and Circadian Rhythm Disturbances in Pediatric Cardiac Surgery Patients, a First-of-Its-Kind Study
Delirium, a condition defined by psychomotor symptoms like apathy, emotional withdrawal and agitation, is common in pediatric critical care settings. Pediatric delirium can extend a patient’s time in critical care and is associated with higher mortality rates.
Children recovering from cardiac surgery are nearly twice as likely to exhibit delirium as children cared for in general pediatric intensive care units. Children ages 6 to 48 months of age are most at risk.
In a first-of-its-kind study, Sandra Staveski, PhD, CPNP-AC, FAAN, assistant professor, is studying the association between delirium and circadian rhythm disturbances – a key contributor to delirium development in adults – in 30 children under the age of 4 who are recovering from cardiac surgery at UCSF Benioff Children’s Hospital.
Staveski hopes her study, which is expected to be completed this year, will inform and improve hospital protocols nationwide to prevent pediatric delirium and improve outcomes for children after cardiac surgery.
Improving Person-Centered Maternity Care Globally
Maternal care that respects a birthing person’s needs and values is central to encouraging pregnant individuals to come to hospitals for childbirth and reducing maternal deaths and newborn complications.
Jerry John Nutor, PhD, MS, RN, assistant professor, is studying factors that will help advance person-centered maternity care globally. “It is my hope that our research will stimulate conversation on the importance of person-centered maternity care in improving maternal and child health outcomes in low-and-middle income countries,” says Nutor.
After identifying provider burnout as a key driver of poor care in Kenya and Ghana, Nutor led a study exploring predictors of burnout and stress among health care providers in Northern Ghana.
An overcommitment to work and disrespect in the workplace were key predictors of provider burnout and stress. These findings suggest that training additional staff to share the workload and fostering a supportive work environment are two ways to tackle provider burnout and advance person-centered maternity care, Nutor said.
UCSF School of Nursing Team Leading the First Ronald McDonald House Charities Research Center
In the U.S. alone, over 5 million children are hospitalized annually, a troubling statistic given the adverse impacts of hospitalization on children’s health and development, and on the well-being of the entire family.
Many hospitals use a family-centered care philosophy to combat these challenges. This framework engages patient’s families as partners in care delivery and has been shown to improve patient health outcomes and decrease health care costs.
The UCSF School of Nursing and Ronald McDonald House Charities® (RMHC®) have launched what may be the first research center worldwide to advance family-centered care for children.
Professor Linda Franck, PhD, RN, FAAN, an internationally recognized expert in family-centered care, is leading the center. Based at UCSF, the center seeks to advance the awareness, knowledge, understanding and adoption of family-centered care principles and practices in the care and support of pediatric patients globally.
Under Franck’s leadership, the center team – which includes Renee Mehra, PhD, postdoctoral scholar, Christine Hodgson, PhD, MSN, postdoctoral scholar, Caryl Gay, PhD, research specialist, Thomas Hoffman, PhD, associate professor, and Michelle Pavlik, MPH, project analyst – will conduct research to assess what is being done globally to deliver family-centered care, identify areas of opportunity to address social determinants of health impacting families before and after a hospital stay, and explore innovative solutions to close the current gaps in family-centered care practices worldwide.
