Kellie Thiessen

Experiences of violence before and during pregnancy and adverse pregnancy outcomes: An analysis of the Canadian Maternity Experiences Survey

BackgroundAbuse and violence against women constitute a global public health problem and are particularly important among women of reproductive age. The literature is not conclusive regarding the impact of violence against pregnant women on adverse pregnancy outcomes, such as preterm birth, small for gestational age and postpartum depression. Most studies have been conducted on relatively small samples of high-risk women. Our objective was to investigate what dimensions of violence against pregnant women were associated with preterm birth, small for gestational age and postpartum depression in a nationally representative sample of Canadian women.MethodsWe analysed data of the Maternity Experiences Survey, a nationally representative survey of Canadian women giving birth in 2006. The comprehensive questionnaire included a 19-item section to collect information on different dimensions of abuse and violence, such as type, frequency, timing and perpetrator of violence. The survey design is a stratified simple random sample from the 2006 Canadian Census sampling frame. Participants were 6,421 biological mothers (78% response rate) 15 years and older who gave birth to a singleton live birth and lived with their infant at the time of the survey. Logistic regression was used to compute Odds Ratios. Survey weights were used to obtain point estimates and 95% confidence intervals were obtained with the jacknife method of variance estimation. Covariate control was informed by use of directed acyclic graphs.ResultsNo statistically significant associations were found for preterm birth or small for gestational age, after adjustment. Most dimensions of violence were associated with postpartum depression, particularly the combination of threats and physical violence starting before and continuing during pregnancy (Adjusted Odds Ratio = 4.1, 95% confidence interval: 1.9, 8.9) and perpetrated by the partner (4.3: 2.1, 8.7).ConclusionsOur findings provide weak evidence of an association between experiences of abuse before and during pregnancy and preterm birth and small for gestational age but they indicate that several dimensions of abuse and violence are consistently associated with postpartum depression.

Prevalence of abuse and violence before, during, and after pregnancy in a national sample of Canadian women

OBJECTIVES We describe the prevalence of abuse before, during, and after pregnancy among a national population-based sample of Canadian new mothers. METHODS We estimated prevalence, frequency, and timing of physical and sexual abuse, identified category of perpetrator, and examined the distribution of abuse by social and demographic characteristics in a weighted sample of 76,500 (unweighted sample = 6421) Canadian mothers interviewed postpartum for the Maternity Experiences Survey (2006-2007). RESULTS Prevalence of any abuse in the 2 years before the interviews was 10.9% (6% before pregnancy only, 1.4% during pregnancy only, 1% postpartum only, and 2.5% in any combination of these times). The prevalence of any abuse was higher among low-income mothers (21.2%), lone mothers (35.3%), and Aboriginal mothers (30.6%). In 52% of the cases, abuse was perpetrated by an intimate partner. Receiving information on what to do was reported by 61% of the abused mothers. CONCLUSIONS Large population-based studies on abuse around pregnancy can facilitate the identification of patterns of abuse and women at high risk for abuse. Before and after pregnancy may be particularly important times to monitor risk of abuse.

Risk factors for postpartum depression among abused and nonabused women

OBJECTIVE The objective of the study was to compare risk factors for postpartum depression among women exposed vs not exposed to intimate partner violence and to assess the timing of abuse in relation to postpartum depression. STUDY DESIGN This was a retrospective cohort study utilizing data from the Canadian Maternity Experiences Survey, a telephone survey at 5-10 months postpartum. Survey questions were adapted from the Canadian Violence Against Women Survey and the Edinburgh Post-Natal Depression Scale. RESULTS Among abused women, younger (15-19 years), and older (35 years old and older), age was associated with postpartum depression, adjusted odds ratio (aOR, 2.29; 95% confidence interval [CI], 1.17-4.51) and (aOR, 2.33; 95% CI, 1.02-5.34) as was unemployment (aOR, 1.41; 95% CI, 1.06-1.84), foreign birth (aOR, 2.04; 95% CI, 1.35-3.09], and low income (aOR, 1.68; 95% CI, 1.25-2.25) among nonabused women. Postpartum depression was significantly associated with abuse occurring only prior to pregnancy (aOR, 3.28; 95% CI, 1.86-5.81), starting postpartum (aOR, 4.76; 95% CI, 1.41-16.02), and resuming postpartum (aOR, 3.81; 95% CI, 1.22-11.88). CONCLUSION Among pregnant women, subgroups defined by abuse exposure differ in their risk profile for postpartum depression.

Trends in Midwifery Use in Manitoba

OBJECTIVE To describe the trends in numbers of midwives and midwifery-attended births and the characteristics of women who used midwifery health care services in Manitoba from 2001-2002 to 2009-2010. METHODS We conducted a quantitative descriptive analysis using population-based, de-identified administrative data from the Population Health Research Data Repository at the Manitoba Centre for Health Policy in Winnipeg, Manitoba to study the use of midwifery care. Trends in the numbers of practising and non-practising midwives were based on data from the College of Midwives of Manitoba registries and its annual reports. RESULTS There were 132,123 births in Manitoba during this time frame. Of those births, 6326 (4.8%) were midwife-attended births. There was modest growth in the overall proportion of midwife-attended births and in the number of midwives over the 10-year time period. The number of midwife-attended hospital births increased from 308 to 612 between 2001-2002 and 2009-2010, while the number of home births increased from 97 to 127. Most women who received midwifery care were in the 20- to 34-year age group and were multiparous. CONCLUSION The volume and distribution of midwifery services in Manitoba has slowly increased. The proportion of births attended by midwives continues to fall short of the goals set by the original human resource strategy, which projected that by 2005, 14% of births would be attended by midwives. Further research is needed to analyze the factors that have influenced the growth and sustainability of the midwifery profession in this province.

Sepsis guidelines: Clinical practice implications.

The Surviving Sepsis Campaign 2012 Guidelines offer recommendations for the care of severely septic patients. These guidelines are appraised and summarized briefly in this article, and a case example illustrates the integration process. These guidelines are important for multidisciplinary team members working together toward the common goal of reducing sepsis mortality.

Barriers and facilitators related to implementation of regulated midwifery in Manitoba: a case study

BackgroundIn 2000, midwifery was regulated in the Canadian Province of Manitoba. Since the establishment of the midwifery program, little formal research has analyzed the utilization of regulated midwifery services. In Manitoba, the demand for midwifery services has exceeded the number of midwives in practice. The specific objective of this study was to explore factors influencing the implementation and utilization of regulated midwifery services in Manitoba.MethodsThe case study design incorporated qualitative exploratory descriptive methods, using data derived from two sources: interviews and public documents. Twenty-four key informants were purposefully selected to participate in semi-structured in-depth interviews. All documents analyzed were in the public domain. Content analysis was employed to analyze the documents and transcripts of the interviews.ResultsThe results of the study were informed by the Behavioral Model of Health Services Use. Three main topic areas were explored: facilitators, barriers, and future strategies and recommendations. The most common themes arising under facilitators were funding of midwifery services and strategies to integrate the profession. Power and conflict, and lack of a productive education program emerged as the most prominent themes under barriers. Finally, future strategies for sustaining the midwifery profession focused on ensuring avenues for registration and education, improving management strategies and accountability frameworks within the employment model, enhancing the work environment, and evaluating both the practice and employment models. Results of the document analysis supported the themes arising from the interviews.ConclusionThese findings on factors that influenced the implementation and integration of midwifery in Manitoba may provide useful information to key stakeholders in Manitoba, as well as other provinces as they work toward successful implementation of regulated midwifery practice. Funding for new positions and programs was consistently noted as a successful strategy. While barriers such as structures of power within Regional Health Authorities and inter and intra-professional conflict were identified, the lack of a productive midwifery education program emerged as the most prominent barrier. This new knowledge highlights issues that impact the ongoing growth and capacity of the midwifery profession and suggests directions for ensuring its sustainability.