Publications by authors named "Elizabeth Darling"
Objective: Gestational diabetes mellitus (GDM) is a common medical complication of pregnancy that leads to adverse outcomes for both infants and pregnant people. Early detection and treatment can mitigate these negative outcomes. The COVID-19 pandemic strained healthcare and laboratory services, including GDM screening programs.
View Article and Find Full Text PDFArticle Synopsis
- The study aimed to evaluate Canadian midwifery research against the Quality of Maternal and Newborn Care (QMNC) framework established by the 2014 Lancet Series, focusing on strengths and gaps in the current research landscape.
- A scoping review was conducted, analyzing 590 articles from various databases to assess how well Canadian research aligns with global midwifery priorities.
- Findings indicated that while there is substantial research on care organization and clinical practices, notable gaps exist in areas like neonatal and postpartum outcomes, midwifery education, and understanding midwifery values and philosophy.
Purpose: We aimed to determine the incidence of mental health diagnoses and associated health and social risk factors among perinatal people in three different COVID-19 phases.
Methods: We conducted a population-based, retrospective cohort study using linked administrative datasets. We included persons with live, in-hospital births in Ontario, Canada from January 1 to March 31 in 2019, 2021, or 2022 (three phases relative to COVID-19 with different public health policy measures).
Background: Group B (GBS) significantly contributes to neonatal sepsis and meningitis, with varying disease rates reported globally and limited population-based data. We estimated infant GBS disease burden in Ontario, Canada and assessed the association of maternal GBS screening (35-37 weeks' gestation) and intrapartum antibiotic prophylaxis (IAP) provision with infant disease rates.
Methods: Our population-based cohort study included pregnant individuals and their offspring from April 2012 to March 2018, utilising the provincial birth registry linked to health administrative data.
Article Synopsis
- A study in Ontario analyzed maternal deaths related to childbirth over 20 years, finding a maternal mortality ratio of 17.5 per 100,000 live and stillbirths, with significant early and late death disparities.
- Among 485 maternal deaths, 45.8% occurred within 42 days post-birth, mostly due to complications like hemorrhage and infections, while the majority of late deaths from day 43 to 365 were linked to cancer and cardiac issues.
- The findings highlight that many maternal deaths are not caused by pregnancy-related factors, stressing the need for comprehensive examinations of late mortality to fully understand and prevent these occurrences.
Article Synopsis
- Legalization of cannabis has led to increased usage among pregnant and lactating women, requiring clinicians to address this topic even if they feel unprepared.
- The study involved interviews with 75 individuals, including 23 clinicians and 52 patients, to understand their perspectives on cannabis consumption during pregnancy and lactation.
- Both clinicians and patients desire a nonjudgmental, open dialogue about cannabis that includes information sharing, exploration of values, and informed decision-making about the benefits and risks involved.
Article Synopsis
- * A systematic review identified 19 studies revealing that medical evacuation costs range from CAD $7,714 to CAD $31,794, alongside indirect costs such as lost income and disrespect for cultural practices.
- * The study concludes that while the direct costs of obstetric evacuation are notably high, clarity on financing and funding is lacking, indicating a need for further research on the economic impact on Indigenous communities across Canada.
Background: Hesitancy about vaccination during pregnancy posed challenges to SARS-CoV-2 vaccination efforts. We aimed to examine rates of SARS-CoV-2 vaccination among Ontario residents who gave birth in early 2022, and to compare rates of SARS-CoV-2 vaccine uptake with rates of tetanus, diphtheria, and pertussis (Tdap) and influenza vaccination during pregnancy in 2019, 2021, and 2022.
Methods: We conducted a population-based retrospective cohort study to describe vaccination rates among pregnant and comparable nonpregnant populations in Ontario using linked administrative data.
Background: Lack of evidence about the long-term economic benefits of interventions targeting underserved perinatal populations can hamper decision making regarding funding. To optimize the quality of future research, we examined what methods and costs have been used to assess the value of interventions targeting pregnant people and/or new parents who have poor access to healthcare.
Methods: We conducted a scoping review using methods described by Arksey and O'Malley.
Background: Globally, midwifery-led birthing units are associated with favourable clinical outcomes and positive birth experiences. As part of our evaluation of Canada's first Alongside Midwifery Unit (AMU) at Markham Stouffville Hospital, we sought to explore and compare birth experiences and satisfaction among midwifery clients who gave birth on the AMU with midwifery clients who gave birth on the traditional obstetric unit prior to AMU implementation.
Methods: We conducted a structured, online, cross-sectional survey of midwifery clients in the six months before, and up to 18 months after, opening of the AMU at Markham Stouffville Hospital, Ontario Canada.
Objectives: We examined the length of postpartum hospitalization for live births during the COVID-19 pandemic and explored how pandemic circumstances influenced postpartum hospital experiences.
Methods: We conducted a cross-provincial, convergent parallel mixed-methods study in Ontario (ON) and British Columbia (BC), Canada. We included birthing persons (BPs) with an in-hospital birth in ON from 1 January to 31 March 2019, 2021, and 2022 (quantitative), and BPs (≥18 years) in ON or BC from 1 May 2020 to 1 December 2021 (qualitative).
Article Synopsis
- * Among women with HDP, there has been a slight increase in cesarean deliveries and acute renal failure, despite a decrease in other severe complications like early preterm delivery and maternal intensive care admissions.
- * The study highlights the need for continuous monitoring of HDP trends and their associated outcomes to understand the effectiveness of prevention and management strategies in place.
Article Synopsis
- Limited research exists on midwives’ adaptations during crises despite their key role in sexual and reproductive health care needs.
- Midwives modify their services in response to various emergencies like pandemics and natural disasters, influenced by their prior training and working in diverse settings.
- Findings highlight the need for more comprehensive research to better understand midwifery adaptations, particularly in non-maternal health contexts, to inform sustainable health care responses during crises.
Introduction: Globally, a shift is occurring to recognize the importance of young peoples' health and well-being, their unique health challenges, and the potential they hold as key drivers of change in their communities. In Haiti, one of the four leading causes of death for those 20-24 years old is pregnancy, childbirth, and the weeks after birth or at the end of a pregnancy. Important gaps remain in existing knowledge about youth perspectives of maternal health and well-being within their communities.
View Article and Find Full Text PDFBackground: Evidence suggests that for low-risk pregnancies, planned home births attended by a skilled health professional in settings where such services are well integrated are associated with lower risk of intrapartum interventions and no increase in adverse health outcomes. Monitoring and updating evidence on the safety of planned home births is necessary to inform ongoing clinical and policy decisions.
Methods: This protocol describes a population-based retrospective cohort study which aims to compare risk of (a) neonatal morbidity and mortality, and (b) maternal outcomes and birth interventions, between people at low obstetrical risk with a planned home birth with a midwife, a planned a hospital birth with a midwife, or a planned hospital birth with a physician.
Background: Contemporary estimates of diabetes mellitus (DM) rates in pregnancy are lacking in Canada. Accordingly, this study examined trends in the rates of type 1 (T1DM), type 2 (T2DM) and gestational (GDM) DM in Canada over a 15-year period, and selected adverse pregnancy outcomes.
Methods: This study used repeated cross-sectional data from the Canadian Institute of Health Information (CIHI) hospitalization discharge abstract database (DAD).
Importance: Emergency department (ED) use postpartum is a common and often-preventable event. Unlike traditional obstetrics models, the Ontario midwifery model offers early care postpartum.
Objective: To assess whether postpartum ED use differs between women who received perinatal care in midwifery-model care vs in traditional obstetrics-model care.
Problem: Burnout and the psychological co-morbidities stress, anxiety and depression have a significant impact on healthcare providers, including midwives. These conditions impact the quality of care provided to women, and midwives' ability to remain in the profession.
Background: There is growing concern regarding the retention of maternity care providers in Canada, particularly midwives.
Introduction: Point of Care Ultrasound (POCUS) is used globally in obstetrics to conduct real time bedside ultrasound scans to answer a clinical question, and it may be conducted by a non-sonography healthcare practitioner. The College of Midwives of Ontario expanded the scope of practice in 2018 to allow registered midwives to perform POCUS during clinical assessments. In response, a POCUS training curriculum for practicing midwives was developed.
View Article and Find Full Text PDFIntroduction: There are two main data sources for perinatal data in Ontario, Canada: the BORN BIS and CIHI-DAD. Such databases are used for perinatal health surveillance and research, and to guide health care related decisions.
Objectives: Our primary objective was to examine the level of agreement between the BIS and CIHI-DAD.
Gestational diabetes mellitus (GDM) is associated with adverse health outcomes for the pregnant individual and their baby. Screening approaches for GDM have undergone several iterations, introducing variability in practice among healthcare providers. As such, our study aimed to explore the views of antenatal providers regarding their practices of, and counseling experiences on the topic of, GDM screening in Ontario.
View Article and Find Full Text PDFBackground: Before the COVID-19 pandemic, access to prenatal care was lower among some socio-demographic groups. This pandemic caused disruptions to routine preventative care, which could have increased inequalities.
Objectives: To investigate if the COVID-19 pandemic increased inequalities in access to prenatal care among those who are younger, live in rural areas, have a lower socio-economic situation (SES) and are recent immigrants.
Introduction: Lyme disease is one of the most prevalent vector-borne disease in North America, yet its implications during pregnancy are poorly understood. Our knowledge of perinatal transmission of Lyme disease is limited due to the lack of robust epidemiological studies and longitudinal follow-up.
Objectives: This study aimed to understand the research priorities of people who have experienced Lyme disease in pregnancy and the feasibility of recruiting this population for future studies on perinatal transmission of Lyme disease.
Background: Evidence on the effectiveness of youth-led interventions for improving maternal-neonatal health and well-being of women and gender diverse childbearing people in low-income and middle-income countries (LMICs) is incomplete. We aimed to summarise the evidence on whether community level youth-led interventions can improve maternal and neonatal outcomes in LMICs.
Methods: We included experimental studies of youth-led interventions versus no intervention, standard care, or another intervention.