ABSTRACT Background In Colorado, suicide and accidental overdose are the two leading causes of death among pregnant and postpartum individuals. People with substance use disorders report mistreatment in hospital settings, yet there is limited understanding of healthcare providers' perspectives on this issue. The study aimed to investigate hospital staff perspectives on the treatment of patients in/around labor. Methods We surveyed 26 birthing hospitals in Colorado that are part of the Colorado Perinatal Care Quality Collaborative's substance use quality improvement initiative. 193 individuals from 19 frontier, rural, and urban hospitals responded. We collected quantitative data on attitudes and behaviors toward patients and conducted an exploratory qualitative analysis to further understand these attitudes and behaviors. Results Respondents reported that their colleagues, and to a lesser extent, themselves, exhibit negative attitudes and behaviors when caring for patients with substance use disorders. Common issues highlighted biases, stereotypes, and gaps in unit‐level management of these patients. The qualitative analysis revealed five themes: 1. Negative discussions about patients in professional settings, 2. Judgment and mistrust from staff, 3. Rudeness or dismissiveness from nurses, 4. Concerns about child custody, and 5. Inadequate clinical care. Respondents requested specific training in perinatal substance use care. Conclusions This study characterizes the attitudes and behaviors of birthing hospital staff toward patients with substance use disorders from the healthcare provider's perspective. The findings demonstrate persistent negative attitudes and behaviors and underscore the need for enhanced education to prepare obstetric/neonatal healthcare providers to better support this vulnerable patient population.
ABSTRACT Background Over the past decade, major legal and policy shifts have reconfigured the reproductive health landscape in the United States (US), renewing interest in reproductive and bodily autonomy. While much of this attention has focused on abortion access, autonomy during labor, delivery, and the immediate postpartum period remains underexamined. This review aimed to synthesize qualitative evidence on experiences of maternal autonomy in childbirth and the factors that influence perinatal care decision‐making. Methods We searched Ovid MEDLINE, EMBASE, Scopus, JSTOR, and ClinicalTrials.gov for studies published between 2014 and February 2025. Eligible studies were appraised using the COREQ framework, and findings were extracted, meta‐summarized, and thematically synthesized. Results 39 studies including 4919 participants were synthesized. Most were conducted in urban areas of the US South and Upper‐Midwest, with limited representation from rural or other regions. Participants frequently cited structural barriers as limiting autonomy and access to preferred care. Clinical power dynamics and racial inequities further constrained decision‐making. Mothers navigated these challenges using strategies such as hiring doulas, modifying the birthing environment, or pursuing alternative birth settings. Conclusion Maternal autonomy in childbirth and perinatal care is shaped by complex structural, relational, and experiential factors that extend beyond individual “choice.” Persistent barriers underscore the need to integrate reproductive and maternal autonomy across the full pregnancy continuum. Linking decisions about “whether” and “when” to have children with decisions about “how” to deliver them can support cross‐specialty approaches in obstetrics that better reflect the temporal, lived experience of decision‐making across fertility, pregnancy, and postpartum care.
ABSTRACT Objective This study applied the reproductive justice framework to analyze refugee women's access to sexual and reproductive healthcare, specifically their access to contraception in Switzerland and their experiences of parenthood. Design Based on 14 semi‐structured interviews, this qualitative study used a participatory approach. It incorporated an interpreter with a refugee background as a project team member and a group of six refugee women participated as co‐researchers. Setting and Participants A total of 14 refugees of reproductive age and with different immigration status were interviewed; none had lived longer than 8 years in Switzerland. Since the main researcher had knowledge of Arabic, preference was given to Arabic‐speakers to facilitate participation and improve interview techniques. Findings Three main themes were identified in relation to the living conditions in collective accommodation: (1) neglected sexual and reproductive health after forced migration, (2) shifting reproductive decision‐making upon arrival, and (3) delegitimized sexuality and motherhood. Key Conclusions The findings of this study provide insights into the reproductive injustice faced by refugee women living in collective accommodation in Switzerland. We argue that addressing sexual and reproductive health should not be limited to access and information about contraceptives but must be seen as an integral part of reproductive justice, which also addresses structural factors such as living conditions and power relations.
ABSTRACT Background The return to work after maternity leave is reported to be a stressful event for many mothers. Yet, little is known about their experience just before returning. This descriptive study explored mothers' evaluation of this period, their levels of anticipatory postpartum work resumption stress (APWRS), their caregiving decisions, and factors that could support them. Methods Self‐reported data were collected from 236 Dutch mothers of infants planning to return to work within the next month. Results One in five mothers in our sample assigned an unsatisfactory evaluation rating (five or below) to the period before the return. While mothers reported experiencing concerns about work–family imbalance and child separation, many mothers also expressed positive thoughts and emotions about their upcoming return. Two‐thirds made adjustments to infant care in preparation for their return to work, such as adjusting infant sleep routines, starting with bottle feeding, and weaning off or stopping breastfeeding. Mothers who made caregiving changes experienced greater APWRS. Social support, longer leave, gradual work re‐entry, better sleep, and improved health were identified to benefit mothers approaching the transition to postpartum employment. Additionally, mothers experiencing higher levels of both near‐environment and workplace support reported lower levels of APWRS and assigned a higher evaluation rating to the period before returning to work. Conclusion Our findings highlight the need for further research on the period prior to mothers' return to work, specifically regarding how they feel, the caregiving practices they consequently adopt, and how they can be supported.
ABSTRACT Background Circadian preference is associated with physical activity and cardiorespiratory fitness in nonpregnant populations, but little is known about these associations during pregnancy. This study examined whether maternal circadian preference was associated with cardiorespiratory fitness, compliance with a structured prenatal exercise intervention, and longitudinal changes in maternal lipid concentrations. Methods Pregnant women participating in two randomized controlled trials of prenatal exercise self‐classified as Morning, More Morning, More Evening, or Evening chronotypes. Associations between chronotype and cardiorespiratory fitness (VO 2 peak), exercise compliance, and longitudinal lipid adaptations during pregnancy were examined using appropriate multivariable statistical models. Results Greater Evening preference was associated with lower VO 2 peak after adjustment for age, BMI, and MVPA (B = −1.40 mL·kg −1 ·min −1 , standardized β = −0.25, p = 0.005). Exercise compliance differed across chronotype groups ( p < 0.001; partial η 2 = 0.185), with significantly lower compliance among Evening chronotypes than each of the other groups (all p < 0.001). In exploratory longitudinal analyses, a significant Time × Chronotype interaction was observed for HDL cholesterol ( p = 0.009). HDL cholesterol increased from 16 to 36 weeks' gestation among Morning‐oriented women but did not significantly change among evening‐oriented women. Conclusions Maternal circadian preference was associated with cardiorespiratory fitness and participation in a structured prenatal exercise program. The substantially lower session attendance among Evening chronotypes suggests that circadian preference may be a useful characteristic for understanding individual differences in participation in prenatal exercise. Exploratory findings regarding HDL trajectories warrant confirmation in larger longitudinal studies.
