Work, pregnancy & childbirth-related health care choices, patterns, and quality

工作、怀孕

• 批准号: 8509752
• 负责人: Katy Backes Kozhimannil
• 金额: $ 6.81万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8509752
• 关键词: Accounting; Address; Affect; Age; Analgesics; Attention; Attitude; Birth; Budgets; Caring; Cesarean section; Characteristics; Childbirth; Clinical; Communities; Conflict (Psychology); Data; Data Sources; Development; Discipline of obstetrics; Economic Recession; Employment; Episiotomy; Event; Family; Goals; Health; Health Care Costs; Health Insurance; Healthcare; Hospitalization; Joints; Light; Literature; Maternal and Child Health; Measurement; Measures; Mediation; Mediator of activation protein; Medical; Membrane; Methods; Mothers; Outcome; Oxytocin; Patients; Pattern; Policies; Population; Pregnancy; Pregnant Women; Probability; Quality of Care; Research; Resources; Risk; Role; Rupture; Sampling; Science; Scoring Method; Selection Bias; Services; State Hospitals; Surveys; Technology; Testing; Time; United States; Weight; Woman; Work; base; care delivery; data collection methodology; demographics; design; experience; improved; innovation; interest; prenatal; prenatal influence; primary outcome; sample collection; service utilization; trend; women employment

DESCRIPTION (provided by applicant): The overall aim of this study is to use innovative methodological approaches to estimate the role of prenatal employment in health care choices and services utilization during childbirth. Over the past 50 years in the United States, there have been profound changes in the workforce participation of pregnant women; during that same time, substantial advances in the science and technology of obstetric care have radically transformed childbirth and the available health care options related to the delivery of a baby. However, the substandard quality of maternity care is a troubling policy issue, and national attention has focused on increases in labor induction and cesarean delivery. Workforce participation may impact a pregnant woman's choices about childbirth care via health insurance and other factors related to work commitment and role conflict. The implications of employment during pregnancy for childbirth-related choices have not been well-characterized, and available research on maternal employment and health outcomes suffers known methodological limitations. The proposed project has two specific aims: 1) to improve upon the methods used to characterize impacts of prenatal employment on health outcomes and services use, and 2) to measure the impact of prenatal work on choices, quality, and patterns of childbirth care. The project will use data from a nationally-representative survey of women who gave birth in 2005 (Listening to Mothers II Survey, n=1573), which was commissioned by Childbirth Connection and conducted by Harris Interactive using rigorous sampling and data collection methodologies. The survey is distinctive in that is contains extensive and detailed information on choices and health care use in the context of childbirth as well as information on employment, which will allow us to examine the influence of prenatal work on choices around labor induction and delivery care, while also accounting for factors related to health insurance, pregnancy and medical care, and socio-demographics. This project will capitalize on a rich and unique data source and contribute to the literature by 1) improving upon prior estimation strategies by using propensity score methods to address known methodological issues, and 2) characterizing previously unexplored associations between prenatal employment and women's choices regarding childbirth care. Results from this study will provide input for future research using larger, community-based samples or administrative data as well as the development and implementation of health care and employment policies designed to facilitate better childbirth care and improved maternal and child health. Recent years have brought significant changes in the workforce participation of pregnant women and mothers. The extent to which varied employment experiences may contribute to known and growing problems with the quality of maternity care and troublesome trends in health costs and outcomes for mothers and babies is an urgent and important policy question, especially in light of current health reform efforts, stat and federal budget crises, and a national economic recession. The proposed project uses innovative methods to examine work during pregnancy as a key factor that may influence choices and health care use during childbirth, focusing on labor induction and cesarean delivery. Results from this study will provide input for the development and implementation of health care and employment policies designed to facilitate better childbirth care and improved maternal and child health.

描述（由申请人提供）：本研究的总体目标是使用创新的方法来估计产前就业的作用，在分娩期间的医疗保健选择和服务利用。在过去的50年里，在美国， 在此期间，产科护理科学和技术的巨大进步从根本上改变了分娩和与分娩婴儿有关的现有保健选择。然而，产妇护理质量不合格是一个令人不安的政策问题，全国的注意力集中在引产和剖腹产的增加上。劳动力参与可能会影响孕妇的选择分娩护理通过医疗保险和其他因素有关的工作承诺和角色冲突。怀孕期间就业对与生育有关的选择的影响尚未得到很好的描述，关于产妇就业和健康结果的现有研究受到已知的方法上的限制。拟议的项目有两个具体目标：1）改进用于描述产前就业对健康结果和服务使用的影响的方法，2）衡量产前工作对分娩护理的选择、质量和模式的影响。该项目将使用2005年对分娩妇女进行的全国代表性调查（倾听母亲II调查，n= 1 573）的数据，该调查由分娩联系组织委托，哈里斯互动公司采用严格的抽样和数据收集方法进行。该调查的独特之处在于，它包含了广泛而详细的信息，关于分娩时的选择和医疗保健使用以及就业信息，这将使我们能够检查产前工作对引产和分娩护理选择的影响，同时还考虑到与健康保险，怀孕和医疗保健以及社会人口统计学相关的因素。该项目将利用丰富而独特的数据源，并通过以下方式为文献做出贡献：1）通过使用倾向评分方法来解决已知的方法学问题，从而改进先前的估计策略; 2）表征产前就业与妇女分娩护理选择之间先前未探索的关联。这项研究的结果将为未来的研究提供投入，使用更大的，以社区为基础的样本或行政数据，以及制定和实施旨在促进更好的分娩护理和改善孕产妇和儿童健康的医疗保健和就业政策。近年来，孕妇和母亲的劳动力参与发生了重大变化。不同的就业经历在多大程度上可能导致产妇护理质量方面已知的和日益严重的问题，以及母婴健康成本和结果方面令人不安的趋势，这是一个紧迫而重要的政策问题，特别是考虑到目前的卫生改革努力、国家和联邦预算危机以及全国经济衰退。拟议的项目采用创新方法，将怀孕期间的工作作为可能影响分娩期间选择和保健使用的关键因素，重点是引产和剖腹产。这项研究的结果将为制定和执行旨在促进更好的分娩护理和改善孕产妇和儿童健康的保健和就业政策提供投入。

项目成果

The impact of prenatal employment on breastfeeding intentions and breastfeeding status at 1 week postpartum.

• DOI: 10.1177/0890334413504149
• 发表时间: 2013-11
• 期刊: Journal of human lactation : official journal of International Lactation Consultant Association
• 作者: Attanasio L;Kozhimannil KB;McGovern P;Gjerdingen D;Johnson PJ
• 通讯作者: Johnson PJ

Reevaluating the relationship between prenatal employment and birth outcomes: a policy-relevant application of propensity score matching.

重新评估产前就业与出生结果之间的关系：倾向评分匹配的政策相关应用。

• DOI: 10.1016/j.whi.2012.11.004
• 发表时间: 2013
• 期刊: Women's health issues : official publication of the Jacobs Institute of Women's Health
• 作者: Kozhimannil,KatyB;Attanasio,LauraB;McGovern,PatriciaM;Gjerdingen,DwendaK;Johnson,PamelaJo
• 通讯作者: Johnson,PamelaJo

Medically complex pregnancies and early breastfeeding behaviors: a retrospective analysis.

• DOI: 10.1371/journal.pone.0104820
• 发表时间: 2014
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Kozhimannil KB;Jou J;Attanasio LB;Joarnt LK;McGovern P
• 通讯作者: McGovern P

Maternal depressive symptoms, employment, and social support.

• DOI: 10.3122/jabfm.2014.01.130126
• 发表时间: 2014-01
• 期刊: Journal of the American Board of Family Medicine : JABFM
• 作者: Gjerdingen D;McGovern P;Attanasio L;Johnson PJ;Kozhimannil KB
• 通讯作者: Kozhimannil KB

Positive childbirth experiences in U.S. hospitals: a mixed methods analysis.

• DOI: 10.1007/s10995-013-1363-1
• 发表时间: 2014-07
• 期刊: Maternal and child health journal
• 影响因子: 2.3
• 作者: Attanasio LB;McPherson ME;Kozhimannil KB
• 通讯作者: Kozhimannil KB