Integrating Holistic Services for Birthing People into a Hospital Setting

Thesis (Master's)--University of Washington, 2020Perinatal mood disorders, experienced by over one in ten pregnant people in high-income nations, are considered the number one concern impacting the health and well being of the pregnant person and their child during birth (Milgrom & Gemmill, 2014). The vulnerability to mood disorders pregnant and birthing people face, compounded by discrimination and obstetric violence in the birthing space along with racial disproportionality in maternal health outcomes, invites the question of how to improve the mental health and birth outcomes of pregnant and birthing people in the United States. Methods. This exploratory, cross-sectional, qualitative study included 30-60 minute interviews with 18 maternity providers in the United States, including behavioral health specialists, doulas, midwives, Obstetrician-Gynecologists (OBGYNs)/family physicians, health researchers, and labor & delivery registered nurses (RNs). The interview questions investigate provider opinions on the accessibility of maternal health services in a hospital setting, the integration of behavioral health and doula services, knowledge of culturally-responsive care, and racial disproportionality in maternal health outcomes. Results. Key findings of this study include a unanimous participant belief that inclusion on inter-professional teams and culturally-relevant patient-centered care are essential for successful integration of holistic maternity services into a hospital setting. The majority of participants indicated the impact of racial bias and discrimination in birth outcomes, some speaking more explicitly about racism and white supremacy than others. There is an overall indication from participant interviews that integrating holistic services can work, but it is complex and multi-faceted. Conclusions. This study implies the need for future research, further investigating the integration of holistic services into hospital settings and expanding the definition of culturally-relative mental health treatment/interventions. Future studies must also explore the lack of diversity among maternity providers and how the current academic system may not be meeting the needs of non-white individuals