Two 天美影视传媒 nursing and midwife experts in maternal health have provided the following quotes on the issue of restricting abortion or making it illegal 鈥� seen as increasingly likely due to the Supreme Court draft opinion, leaked to Politico on Monday.

is an assistant professor in the UW School of Nursing and nurse midwife, whose scientific research focuses on respectful and equitable care during pregnancy and childbirth.

is associate professor and Director of Nursing at UW Bothell School of Nursing and Health Studies. Eagen-Torkko a nurse midwife with a continuing practice at Public Health Seattle-King County, where her practice specializes in family planning and women鈥檚 health.

鈥淩estricting, and in many states, making abortion illegal will not change the need for abortion, but not having safe and accessible abortion services available will have tremendous impact. In fact, lack of access to abortion services has been shown to increase the risk of maternal mortality, both through restricted funds to family planning and through abortion restriction legislation, with the highest impact seen with racially minoritized communities,鈥� said Altman.

鈥淥utside of maternal mortality, the impacts on health care will be enormous: We can expect to see mismanagement of miscarriage and complicated pregnancies due to provider fear of being accused of providing abortions. We will see people not accessing necessary care for early pregnancy complications due to fear that providers will report them. We will see significant negative mental health impacts from people being forced to carry unwanted pregnancies,鈥� said Eagen-Torkko.

Said Altman: 鈥淲e will also see increased birth rates and associated increased poverty given our country does not provide adequate resources for childbearing families. Bottom line is that abortion is necessary health care. Abortion is public health. And the impacts of removing this crucial health care service will be monumental.鈥�

With a lethal, airborne virus spreading fast, hospitals had to change how they treated patients and policies for how caregivers provided that treatment. But for maternity patients and nurses some of those changes had negative outcomes, according to a new .

鈥淲e found that visitor restrictions and separation policies were harming families and nurses. The effects for patients included loneliness, isolation and mistrust, while nurses described mistrust and low morale,鈥� said , lead author of the study and assistant professor in the UW School of Nursing.

Importantly, Altman added, both nurses and patients described how COVID 鈥渁mplified existing racially biased and disrespectful care experiences for Black women and birthing people, in part due to loss of protection and advocacy that support people provide.鈥�

The study, published March 31 in Global Qualitative Nursing Research, involved in-depth interviews with 15 patients from Washington state and 14 nurses from Washington, New York, Georgia and Michigan. Nearly half of participants in both groups self-identified as BIPOC and for slightly more than half this was their first birth.

Under COVID-19 restrictions, patients experienced a shift from in-person visits, a source of social and emotional support, to virtual conversations or telehealth and more perfunctory exchanges in offices with physical distancing. Pregnancy education and group classes all moved online, while family and friends were excluded from patient care when in the hospital or clinic. Meanwhile, nurses experienced shifting policies and procedures that led to a collective mistrust of management and administration.

In the interviews, researchers wrote, patient responses focused on how hospital adaptations 鈥渨ere inadequate to meet their needs鈥� and, in addition to mistrust, nurse responses focused on how inconsistencies in policies and policy implementation affected their ability to 鈥渟afely care for patients.鈥�

Here are a few verbatim transcriptions of statements patients gave researchers (with minor edits):

About telehealth 鈥�

I want to be able to actually have a check-in and actually have a doctor be able to check everything鈥檚 fine and make sure the baby鈥檚 heartbeat is still okay or see how my uterus is measuring and things like that that are more concrete. 鈥� I see the phone conversation just more being like, 鈥淚s everything okay,鈥� and me saying 鈥淵es鈥� and then that kind of being it.

Communication with providers 鈥�

We don鈥檛 talk about how this is affecting us or what it means for the future. It鈥檚 just they leave you hanging like, 鈥淥kay, well I鈥檓 guessing everything鈥檚 okay so I鈥檓 just going to walk on out of here.鈥� But if you could just say something nice, concise and brief but meaty it would be perfect.

Education and nursing support 鈥�

I lost … the classes that we were supposed to need. I was so excited to join those classes because I could get a chance to meet with other mothers that we may build connections, right? But because of COVID we just don鈥檛 have the chance of doing that.

People were there [in labor] to support me and to make sure I was okay and then I felt like postpartum everyone disappeared.

Racial bias 鈥�

Being [a person] of color, you already kind of deal with the standoffish approach from certain people and so like 鈥� the virus kind of gives [them] that reason to, it鈥檚 just like that. It鈥檚 like even though I already feel this way, now I have a reason to act this way.

I鈥檓 an educated Black woman. I鈥檓 a nurse. I know what鈥檚 going on with my body and I know how this stuff works and I still feel like so inferior, like to my [birth] team. That鈥檚 crazy to me.

Following are a few verbatim transcriptions of statements nurses gave researchers (with minor edits):

Lack of planning 鈥�

I was disappointed to see that in the, at least a month, more like six weeks since we鈥檇 had just the one COVID patient, that not a lot had been done to prepare in the meantime, both on a national scale and just at our hospital. 听

Policy changes 鈥�

I felt like at times on my shift, policies would change literally every 15 to 30 minutes. You do something one way and you get an email within the hour that this now has changed and we鈥檙e doing this procedure this way and it was just constant like nobody knows what they鈥檙e doing so it was very stressful.

Morale problems 鈥�

I鈥檓 just doing everything for this patient and then I鈥檓 not thinking about my own family. Even if I [say] let whatever happen to me 鈥� I have responsibilities for my family too. I鈥檓 not just a nurse, right? I鈥檓 a mother. When I took the oath to be a nurse, before that maybe I took an oath to be a good mother.

[a patient complained and] that stung because I remember going to my manager鈥檚 room that day and asking for more supplies so that I could go into the room more frequently without having to break the gowns and reuse the gowns and she said, 鈥淵ou use what you have and I鈥檓 not giving you anything else.鈥�

Racial bias 鈥�

[obstetrical resident physician] went in to go talk to [a patient] about the need for induction and instead of including the father in the conversation or even introducing herself, she went in, completely turned her back on the dad 鈥� I鈥檝e been there 10 years and I have never seen that with any Caucasian couple.

鈥淲e need to really center the voices and experiences of marginalized people, especially BIPOC, in policy. We need to ensure that communication is transparent and that we are trustworthy to the groups we develop policies for 鈥� patients, nurses, the public, everyone,鈥� said , study co-author and assistant professor in UW Bothell School of Nursing and Health Studies. 鈥淲e have to stop thinking of policy as a top-down process, because Covid has shown us quite clearly that this doesn鈥檛 work.鈥�

Co-authors include , UW School of Social Work; , UW Bothell School of Nursing and Health Studies; , UW School of Nursing, Seattle; and , The Perfect Push, LLC in Redmond. This research was funded by UW School of Nursing.

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For more information, contact Altman at听mraltman@uw.edu.

As an experienced nurse midwife, whose scientific research focuses on respectful and equitable care during pregnancy and childbirth, the 天美影视传媒鈥檚 has been studying pregnancy and childbirth during the pandemic alongside colleagues across the UW and in affected communities.

While her work is being distilled into formal studies that will be submitted for peer review, Altman, an assistant professor in the UW School of Nursing, believes it is important to begin discussions for improving this area of health care during the ongoing crisis.

鈥淲e found that visitor restrictions and separation policies were harming families and nurses. The effects for patients included loneliness, isolation and mistrust, while nurses described mistrust and low morale. Importantly, both nurses and patients described how COVID amplified existing racially biased and disrespectful care experiences for Black women and birthing people, in part due to loss of protection and advocacy that support people provide,鈥� Altman said.

While hospitals and health care systems were vastly unprepared to respond to the COVID-19 pandemic, Altman heard from patients and nurses that the changes enacted in response to COVID-19 often adversely affected their care or ability to provide that care.

鈥淣urses described being expected to take additional risks that other providers were not, which increased the risks of exposure for themselves and their families. Overwhelmingly, nurses in our study lost trust that their workplace would support them and keep them safe while providing care to others, and that loss of trust impacted how patients saw the care they received,鈥� said Altman.

鈥淲hile we recognize the enormous challenges the COVID-19 pandemic brings to the health care system, hospitals and clinics need to take action to make policies more equitable for both patients and nurses.鈥�

Altman suggests the following actions:

• Administrators need to collaborate on policy changes, particularly with communities that are directly affected by these changes
• Consider extending visitor policies to include multiple support people for patients in labor, as a way to mitigate risk of disrespectful care for marginalized communities
• Create educational resources to help patients understand policies that affect them and provide avenues for getting support and reassurance
• Develop clear, organized and transparent communication pathways about policy changes at all levels: patient, nurse and management
• Increase mental health assessment, support and services for both patients and nurses to help support well-being amid crisis
• Include bedside nurses in decisions about care planning, risk management and patient care

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For more information, contact Altman at mraltman@uw.edu.

A new study finds that women of color perceive their interactions with doctors, nurses and midwives as being misleading, with information being 鈥減ackaged鈥� in such a way as to disempower them by limiting maternity health care choices for themselves and their children.

“Given the significant birth-related disparities faced by women of color, particularly black women, this study illuminates a previously undescribed aspect of the patient-provider interaction,鈥� said 天美影视传媒 assistant professor , lead author of the in the journal Social Science & Medicine.

“How providers shared or didn鈥檛 share appropriate information about options, risks and possible outcomes was perceived as biased and dependent on whether providers saw them as individuals capable of making good decisions,鈥� said Altman. Now at the , Altman conducted the research while a postdoctoral fellow at the University of California San Francisco as part of its .

The study participants said that while they wanted complete, truthful and comprehensive information about their care and options available, they felt information was “packaged” in a way that reflected what the provider thought the patient should do, based on bias, and was 鈥渄isrespectful.鈥�

One participant said she felt like her providers were 鈥渉arassing鈥� and 鈥渂ullying鈥� her to get tests she didn鈥檛 want. Another said she wanted to 鈥渄o a little bit more research鈥� into vaccinations before getting them for her children, and said her provider 鈥渨as like, 鈥榃ell, I thought that you cared about your children. But if that鈥檚 not the case, then feel free to go.鈥欌��

Researchers interviewed 22 self-identified women of color from the San Francisco Bay Area who had given birth within the previous year. The interviews were open-ended discussions of the participants鈥� experiences in pregnancy, birth and postpartum care and took place between September 2015 and December 2017. The researchers point out in their paper that they used a method of analysis that 鈥渁cknowledges the subjective and involved nature of the researcher in relation to the participant鈥� to account for the interpersonal nature of the research.

“The results of our study were not surprising in the sense that communities of color have long known that providers often use their power to influence health-related communication and decision-making,鈥� Altman said. However, she added, 鈥済iven existing evidence of the impacts of implicit bias and racism on birth outcomes, this study provides a potential mechanism for how this association occurs.”

The authors explain that while providers have to consider health literacy of patients and tailor information to make it understandable, there is a difference between providing information in understandable language and packaging information based on prejudice and assumptions, or not providing information at all.

One participant said that during a postpartum hemorrhage, she received no information about what was happening to her and was treated as if she were not part of the situation.

鈥淚t was scary because I didn’t know what was happening, and, I mean, it was obvious that it was a serious issue because of, like, the look on everyone’s face and, like, how 鈥� how no one was even talking to me,鈥� the participant said.

Another participant explained that when she told her health care providers she was a student at the University of California, Berkeley, they treated her differently.

“They’re like, ‘Oh, maybe she’s not a crazy black woman,’ or something, you know? 鈥� It just makes me feel weird because, one, I feel like I’m accessing on like a certain type of privilege. And I feel like a part of me does it on purpose because I know that they’re going to treat me better after I say that,鈥� the participant said.

The researchers hope the study provides evidence that will lead to improved provider training in power differentials, informed consent and providing respectful care.

鈥淥ur study is one of the first to evaluate how information and power are exchanged between providers and patients from the perspective of the people we serve,鈥� said Monica McLemore, the study鈥檚 co-author and an associate professor at the UCSF School of Nursing. 鈥淚 believe these data are critical in developing new models of partnership, specific to how black women and other people with the capacity for pregnancy want and need to receive information that is essential for their care and decision-making.鈥�

Co-authors are Talita Oseguera and Linda Franck at UCSF; , at the UW; and Audrey Lyndon at New York University.

This research was funded at the University of California, San Francisco, by Marc and Lynne Benioff and the Bill & Melinda Gates Foundation.

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For more information, contact Altman at mraltman@uw.edu.