Introduction Texas faces a critical shortage of maternity care clinicians in its rural communities, where nearly half of rural counties are maternity care deserts. This study aimed to characterize and compare rural and urban midwives across several domains and identify workforce and health care policy strategies to strengthen Texas's rural maternity workforce. Methods We conducted a secondary, comparative, cross‐sectional analysis using 2 parallel web‐based surveys in 2025 among rural and urban licensed midwives (LMs), certified professional midwives (CPMs), and certified nurse‐midwives (CNMs) practicing in Texas. Harmonized items across instruments allowed pooled comparisons of rural and urban participants. We used descriptive statistics and bivariate analyses to assess differences. Results Among practicing midwives (LMs/CPMs and CNMs) in Texas, 228 completed the survey and were eligible for the study. Compared with urban midwives (n = 184), rural midwives (n = 44) were more often self‐employed, reported lower incomes, were less likely to have liability insurance, and reported more barriers to physician consultation. Rural midwives were also less likely to offer the option for a vaginal birth after cesarean but reported greater physiologic birth support and legislative engagement. Among CNMs, prescriptive authority was significantly less common in rural areas. Discussion Despite workforce and practice barriers, rural Texas midwives demonstrate a strong commitment to physiologic birth and policy advocacy. Strengthening the integration of rural midwives into the health care systems through consultation and liability support as well as policy reform is essential to sustaining and expanding the Texas midwifery workforce.
Introduction Postpartum hemorrhage (PPH) is the fourth leading cause of pregnancy‐related death in the United States. Although there is extensive evidence on best practices for the clinical management of PPH, no previous US studies have described the experience of individuals who lived it. Methods Guided by a feminist theoretical framework and using a qualitative phenomenological research design, we explored the lived experiences of individuals with a PPH after childbirth within the context of the US health care system. The study was conducted in the Northeastern United States at one urban tertiary care hospital that has greater than 5000 births annually. Individuals who had a blood loss greater than 1000 mL were invited to participate. Semistructured interviews were conducted and analyzed according to the method of van Manen. Themes were identified using the 6 phases of inductive thematic analysis according to Braun and Clarke. Results Ten individuals participated in the study. Five themes were identified, including (1) lack of clinician communication, (2) traumatic birth experiences, (3) need for immediate emotional support, (4) extended postpartum needs and impact on future pregnancies, and (5) effective teamwork. Discussion The impact of PPH extends well beyond the acute clinical event, encompassing a complex array of physical, emotional, informational, and mental health needs. The findings underscore the critical importance of clear communication and ongoing emotional support for individuals who experience PPH. Addressing these multidimensional needs requires a coordinated response from health care systems, clinicians, and policymakers, with comprehensive postpartum care positioned as a priority in maternal health services.
Introduction Cannabis use during pregnancy and early parenthood is an increasing public health concern, particularly as high‐concentration cannabis (HCC) products have become more widely available. Although prior research has examined perinatal cannabis use and risk perceptions, less is known about cannabis knowledge, HCC use, and confidence in risk‐reduction behaviors across stages of early parenthood. This study compared these factors among parents at different stages of parenthood. Methods This cross‐sectional study analyzed data from an online survey panel of adults living in Colorado. Of 630 initial respondents, 564 completed at least 80% of survey items; 327 identified as parents and were included in this analysis. Analyses compared participants who were pregnant or parenting a child aged younger than 2 years, defined as the early parenthood group (n = 76), with parents of children aged older than 2 years, defined as the older parenthood group (n = 256). Survey items assessed cannabis or HCC use, product and health‐related knowledge, perceived harms, and self‐efficacy intentions. Group differences were examined using χ2 tests and analysis of variance. Results Current cannabis use was similar between groups. HCC use was higher in the early parenthood group than in the older parenthood group, but this difference was not statistically significant (22.4% vs 14.1%; P = .08). When compared with the older parenthood group, the early parenthood group had lower health‐related knowledge scores ( P = .01), lower overall knowledge scores ( P = .03), lower confidence in declining HCC ( P = .007), and lower confidence in choosing alternatives ( P = .009). Discussion The early parenthood group demonstrated lower cannabis knowledge and confidence in risk‐reduction behaviors than the older parenthood group. Findings highlight the need for counseling that addresses cannabis potency, perceived risks and benefits, and practical skills for reducing use during pregnancy and early parenthood.
Abstract The historical legacy of white supremacy in the United States has been institutionalized in ways that contribute to maternal health care inequities, including the treatment of race as a biological risk factor in health care. Race is a social construct with neither a genetic nor biological basis, and racism is the major contributor to adverse outcomes. Recently, medical specialties have identified and reduced the use of race in clinical tests and decision‐making. Identifying the use of race in antenatal care is essential to dismantling institutional racism and improving perinatal outcomes. We conducted a narrative review to describe the role of race in currently recommended antenatal care tests. We identified tests considered routine and gold standard for antenatal care in the United States based on the 2025 American College of Obstetricians and Gynecologists Clinical Consensus for Tailored Prenatal Care Delivery. We searched bibliographic databases and reference lists. Of the 18 tests found in routine antenatal care, 3 currently use race, 3 previously used race, and 12 do not and have not used race. Currently, Black race is considered a moderate risk factor for preeclampsia, and race‐specific adjustment factors remain embedded in the first‐trimester combined and second‐trimester quadruple aneuploidy screening for the interpretation of maternal serum markers. Historically, anemia diagnosis definitions included race‐specific thresholds, and race and ethnicity were considered alongside other risk factors when recommending screening for hemoglobinopathies and gestational diabetes. Although the inclusion of race was likely an attempt to address maternal health care inequities, it can perpetuate racist rhetoric that an individual's increased risk is attributable to inherent biological differences. These findings reinforce the need to review antenatal care practices and eliminate race‐based clinical guidelines to provide evidence‐based health care and advance perinatal health equity.
INTRODUCTION In Utah, a confluence of factors over the last 10 years has led to an increase in prehospital births attended by emergency medical system (EMS) providers. Utah is a rural and frontier state where a large segment of the population lives far from obstetric care and where transport times to a facility for birth can be long or hazardous because of seasonal weather. Before March 2024, Utah EMS protocol guidelines only allowed paramedics to administer oxytocin and then only for the treatment of postpartum hemorrhage (PPH). In many cases, a paramedic is not available (because rural fire agencies are often staffed by volunteers, tight budgets do not support full paramedic coverage, or paramedics are not required), and thus, advanced emergency medical technicians (AEMTs) are first on the scene. A community-based interprofessional quality improvement initiative was designed and implemented to expand state EMS protocol guidelines to address the timing, route and administrator of oxytocin. PROCESS Using stepwise processes from Powell's Expert Recommendations for Implementing Change implementation science taxonomy, we combined bottom-up and top-down strategies, including stakeholder and decision-maker interviews, community-level focus groups, partner surveys, and coalition building to foster change. OUTCOMES In April 2024, the Utah EMS protocol guidelines were successfully changed to include the administration of oxytocin by paramedics for the prevention of PPH and to AEMTs for intramuscular prevention and treatment of PPH. DISCUSSION This expansion of medication administration provides an additional tool to prevent PPH while increasing safety and equity of prehospital birth services. This may be particularly crucial in a rural and frontier state where maternity deserts, desire for community-based birth, and obstetric-care hurdles are increasing. It is hoped this quality improvement initiative can serve as a guide to others wanting to implement similar practice changes in their state.
