Moving from Interprofessional Disarticulation to Transformative Dialogue and Action: Examining a Transdisciplinary Process to Address Equitable Access to High Quality Maternity Care in North America
Bibliographic record
Abstract
Maternity providers in North America are in conflict about birth place, debating issues related to safety, autonomy, and quality of care. Very little is known about how birth place interacts with experience and outcomes of maternity care, or about how to resolve these differences among provider disciplines within established health care systems. A multi-stakeholder group of leaders convened at a series of Home Birth Summits in the United States to delineate a Common Ground Agenda, including nine priority areas for action and research. The aim of this doctoral study was to examine how and why this transdisciplinary process generated new evidence and tools that can improve maternity services. Methods I synthesized the results of four original research studies using a range of methodologies as appropriate to the study topic. In the Canadian Birth Place Study, I examine mixed methods data on provider attitudes to place of birth. In the Changing Childbirth in British Colombia (BC) and Giving Voice to Mothers studies, psychometric analysis cross-sectional survey data led to development of four new person-centered measures of experience of maternity care. In the Access and Integration Maternity Care Mapping Study, a Delphi study created a scoring system (MISS) to assess midwifery integration. Correlation and regression analyses elicit linkages between integration and key maternal-newborn outcomes. Finally, I triangulated results of these studies within the Taming Wicked Problems Framework, to elicit an underlying and contributory factor for effective transdisciplinary action. Results Among maternity care providers (n=825), 84% of variance in attitudes to home birth was attributable to provider type alone. Women from diverse backgrounds (n=2051, 3586 pregnancies) reported reduced autonomy and respect when cared for by physicians and when 9 giving birth in institutional settings. Among women in the United States (US) (n=2700), disparities in experiences of care, including mistreatment, links to race, socioeconomic status, place of birth and type of provider. U.S. states with higher midwifery integration and greater access to home birth reported significantly fewer adverse maternal-newborn outcomes and significantly higher rates of physiologic birth. Discussion The participatory approach and synthesis of outcomes of these studies was essential to understand and address inequities in experience and access to quality maternity health services in the US. Person-centered care emerged as a hidden common value that informed a transdisciplinary research process, and community-responsive knowledge translation outputs. Conclusion Increasing knowledge among all types of providers about quality and safety of birth place, and person-centered care, could improve outcomes across birth settings. The Summit process of transdisciplinary engagement reduced interprofessional conflict and facilitated cocreation of evidence and tools that improve quality, safety, and accountability in North American maternity care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".