Publications > Pregnancy and childbirth

The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States

These findings suggest that mistreatment is experienced more frequently by women of color, when birth occurs in hospitals, and among those with social, economic or health challenges.

  • Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, McLemore M, et al. Reproductive Health. June 2019. 

Costs associated with policies regarding alcohol use during pregnancy: results from 1972-2015 vital statistics

This study finds negative effects from policies including mandatory warning signs about drinking while pregnant; categorizing drinking while pregnant as child abuse/neglect; limiting criminal prosecution; and priority substance abuse treatment for pregnant women. They lead to thousands of babies being born low birthweight or preterm birth each year, and cost hundreds of millions of dollars annually.

  • Subbaraman MS, Roberts SCM. PLOS One. May 2019.

Person-centered maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana and India

This is the first known study to measure person-centered maternity care in more than one country with the same tool. Researchers surveyed women in Kenya, Ghana and India using a scale to measure their experience of care. The results showed that serious efforts are needed to improve person-centered maternity care.

  • Afulani PA, Phillips B, Aborigo RA, Moyer CA. The Lancet Global Health. January 2019.

Trajectories of women's physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study

This is the first study to look at year-long trajectories of physical and psychosocial health after fistula repair surgery in Uganda. Researchers found that most women reported dramatic improvements in their physical and psychosocial health, mostly within the first 6 months.

  • El Ayadi AM et al. Tropical Medicine and International Health. October 2018. 

Using index of concentration at the extremes as indicators of structural racism to evaluate the association with preterm birth and infant mortality-California, 2011-2012.

This study found that in zip codes with a higher concentrations of racially and/or economically disadvantaged groups, Black women had a higher odds of preterm birth and infant mortality. Women in the least privileged zip codes had a more than 25% higher chance of having a preterm birth compared with women who lived in the most privileged zip codes.

  • Chambers BD, Baer RJ, McLemore MR, Jelliffe-Pawlowski LL. Journal of Urban Health. April 2018.

Effect of Ebola virus disease on maternal and child health services in Guinea: A retrospective observational cohort study

In Guinea, the Ebola virus outbreak stunted—and, in some cases, reversed—progress that had recently been made on several maternal and reproductive health indicators, including prenatal care visits and in-facility deliveries.

  • Delamou A, El Ayadi AM, Sidibe S, et al. The Lancet Global Health. February 2017.

Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide

The Lancet Maternal Health Series included this review of the best evidence-based practices for prenatal, birth and postpartum care, as well as unsafe or unnecessary practices.

  • Miller S, Abalos E, Chamillard M, et al. The Lancet. September 2016.

Use of HIV pre-exposure prophylaxis during the preconception, antepartum and postpartum periods at two United States medical centers

US health care providers are missing opportunities to offer pre-exposure prophylaxis (PrEP) drugs to pregnant women facing increased risk of HIV.

  • Seidman DL, Weber S, Timoney MT, Oza KK, Mullins E, Cohan DL, Wright RL. American Journal of Obstetrics and Gynecology. July 2016.

Vital sign prediction of adverse maternal outcomes in women with hypovolemic shock: The role of shock index

New guidelines help health care workers in low-resource settings identify when a woman is going into shock due to blood loss after giving birth.

  • El Ayadi AM, Nathan HL, Seed PT, Butrick EA, Hezelgrave NL, Shennan AH, Miller S. PLOS One. February 2016.

Misoprostol for primary versus secondary prevention of postpartum hemorrhage: a cluster-randomized non-inferiority community trial

Secondary prevention of postpartum hemorrhage with misoprostol is non-inferior to universal prophylaxis based on the primary outcome of postpartum hemoglobin. 

  • Raghavan S, Geller S, Miller S, Goudar S, Anger H, Yadavannavar M, Dabash R, Bidri S, Gudadinni M, Udgiri R, Koch A, Bellad MB, Winikoff B. BJOG: An International Journal of Obstetrics & Gynaecology. September 2015.

Per-protocol effect of earlier non-pneumatic anti-shock garment application for obstetric hemorrhage

The results support using a non-pneumatic anti-shock garment at the primary health clinic level, within a continuum of care for obstetric hemorrhage.

  • El Ayadi A, Gibbons L, Bergel, E, Butrick, E, Huong MT, Mkumba G, Kaseba C, Magwali T, Merialdi M, Miller S. International Journal of Gynecology & Obstetrics. July 2014.

PRONTO low-tech obstetric simulation and team-training for obstetric and neonatal emergencies in Mexico leads to a decrease in cesarean delivery rates

Making a low-cost emergency obstetric simulation training accessible globally has the potential to save the lives of mothers and newborns, particularly in the most resource-limited settings.

  • Walker D, Cohen S, Fritz J, Olvera M, Lamadrid H, Carranza L. Journal of Midwifery & Women’s Health. May 2014.​

Association between severe obstetric hemorrhage and HIV status

HIV might affect hemorrhage-related maternal mortality by increasing blood loss.

  • Curtis M, El Ayadi A, Mkumba G, Butrick E, Leech A, Geissler J, Miller S. International Journal of Gynecology & Obstetrics. January 2014.

Combined analysis of the non-pneumatic anti-shock garment on mortality from hypovolemic shock secondary to obstetric hemorrhage

Using a non-pneumatic anti-shock garment is associated with a reduced odds of death for women with hypovolemic shock secondary to obstetric hemorrhage.

  • El Ayadi A, Butrick E, Geissler J, Miller S. BMC Pregnancy & Childbirth. November 2013.

Advances in the treatment of postpartum hemorrhage

Broad global access to oxytocin, other uterotonics and oral misoprostol for postpartum hemorrhage prevention and treatment is an important strategy to reduce maternal deaths.

  • El Ayadi A, Robinson N, Geller S, Miller S. Expert Review of Obstetrics & Gynecology. November 2013.

PDF iconNon-Pneumatic Anti-Shock Garment (NASG), a first-aid device to decrease maternal mortality from obstetric hemorrhage: A cluster randomized trial

There might be treatment benefits from earlier application of the NASG for women experiencing delays obtaining definitive treatment for hypovolemic shock.

  • Miller S, Bergel EF, El Ayadi A, Gibbons L, Butrick E, Magwali T, Mkumba G, Kaseba C, My Huong NT, Geissler JD, Merialdi M. PLOS ONE. October 2013.

Are all skilled birth attendants created equal? A cluster randomized controlled study of non-physician based obstetric care in primary health care clinics in Mexico

This study demonstrates the fallacy of assuming that general physicians provide the highest quality obstetric care and emphasizes the importance of competency based definitions for skilled birth attendants.

  • Walker D, DeMaria L, Gonzalez-Hernandez D, Padron-Salas A, Romero-Alvarez M, Suarez L. Midwifery. October 2013.

Comorbidities and lack of blood transfusion may negatively affect maternal outcomes of women with obstetric hemorrhage treated with NASG

These results suggest certain maternal conditions, particularly the presence of another life-threatening co-morbidity or macerated stillbirth, conferred a higher risk of mortality from postpartum hemorhage.

  • El Ayadi A, Raifman S, Jega F, Butrick E, Ojo Y, Geller S, Miller S. PLOS ONE. August 2013.

PDF iconUse of the non-pneumatic anti-shock sarment (NASG) for life-threatening obstetric hemorrhage: A cost-effectiveness analysis in Egypt and Nigeria

Using a non-pneumatic anti-shock garment for women in severe shock resulted in markedly improved health outcomes, with 2 to 2.9 disability adjusted life years (DALYs) averted per woman. The cost per DALY averted was extremely low.

  • Sutherland T, Downing J, Miller S, Bishai D, Butrick E, Fathalla MF, Mourad-Youssif, M, Ojengbede O, Nsima D, Kahn JG. PLOS ONE. April 2013.

PDF iconA matched pair cluster randomized implementation trail to measure the effectiveness of an intervention package aiming to decrease perinatal mortality and increase institution-based obstetric care among indigenous women in Guatemala: study protocol

Three interventions will be implemented in indigenous, rural and poor populations: a simulation training program for emergency obstetric and perinatal care, increased participation of the professional midwife in strengthening the link between traditional birth attendants (TBA) and the formal health care system, and a social marketing campaign to promote institution-based deliveries.

  • Kestler E, Walker D, Bonvecchio A, de Tejada SS, Donner A. BMC Pregnancy & Childbirth. March 2013.

Promoting cultural humility during labor and birth: putting theory into action during PRONTO obstetric and neonatal emergency training

The experience of the PRONTO program in Guatemala indicates that interactive learning, including simulation, is an effective way to promote cultural fluency among healthcare providers.

  • Fahey JO, Cohen SR, Holme F, Buttrick ES, Dettinger JC, Kestler E, Walker DM. The Journal of Perinatal & Neonatal Nursing. January-March 2013.

PRONTO training for obstetric and neonatal emergencies in Mexico

PRONTO brings simulation training to low-resource settings and can empower inter-professional teams to respond more effectively within their institutional limitations to emergencies involving women and newborns.

  • Walker DM, Cohen SR, Estrada F, Monterroso ME, Jenny A, Fritz J, Fahey JO. International Journal of Gynecology & Obstetrics. February 2012.