Abstract

Background: Our recent research demonstrated racial disparities in cesarean section delivery rates among Veterans of color utilizing VA maternity care coordination (MCC) and delivering at community- based hospitals. Disparate birth outcomes likely result from various factors that impact the Veteran at multiple timepoints during the perinatal period; however, an in-depth examination of the social determinants of health that may contribute to these disparities has yet to be conducted among Veterans. This study will conduct an in-depth examination of the social and clinical factors leading to cesarean deliveries among Veterans of color and test the feasibility of doula services to enhance VA MCC in an effort to mitigate disparities in childbirth delivery outcomes among Veterans of color. Significance: This novel study intensely examines the impact of the social determinants of health on prenatal, labor & delivery, and postpartum care among Veterans of color in effort to mitigate disparities in childbirth outcomes. This is the first study to test the feasibility of an enhanced MCC model that incorporates doula services to improve pregnancy outcomes. The proposed study is directly responsive to several HSR&D priorities including health equity, women Veterans’ health, access to care, and care coordination. Innovation and Impact: This is the first VA study to examine social determinants of health among Veterans of color who have delivered babies using the VA Maternity Care benefit. It is also the first study to examine the feasibility of a doula program that complements VA MCC support for Veterans of color, who are at an increased risk for cesarean delivery. Specific Aim 1: Conduct an in-depth investigation with Veterans of color to better understand their recent cesarean deliveries, using semi-structured interviews and systematic obstetrical chart reviews. Specific Aim 2: Test the feasibility of an enhanced VA Maternity Care Coordination program which incorporates doula care to ensure Veterans of color are receiving continuous support throughout pregnancy, labor and delivery, and the postpartum period. Specific Aim 3: Share our study findings (Aims 1 & 2) with VA stakeholders, including Women’s Health Services leadership, through expert roundtable sessions. Utilize the qualitative data from these proceedings to further inform a larger intervention that will seek to reduce childbirth delivery disparities among Veterans of color. Methodology: This is a mixed methods study that will utilize existing survey data and obstetrical chart audits to augment qualitative interviews in an effort to better understand the impact of social determinants of health and the role continuous perinatal support has on Veterans. Next Steps/Implementation: We plan to disseminate findings among our key stakeholders through expert roundtable discussions. The findings from these sessions will promote and inform a larger VA intervention that will seek to further mitigate childbirth delivery disparities among Veterans. Our findings may result in (1) an improved understanding of the impact of the social determinants on the prenatal and childbirth labor and delivery outcomes among Veterans of color; (2) an understanding of the feasibility of collaborative teams comprised of VA Maternity Care Coordinators and doulas in providing continuous prenatal, labor and delivery, and postpartum support to Veterans; (3) a stakeholder informed intervention developed to address the social determinants of health in effort to improve the quality of care for racial and ethnic minority pregnant Veterans.

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DRA: Health Systems

DRE: TRL - Applied/Translational

Keywords: Disparities, Reproductive Care (Gynecological), Social Support

MeSH Terms: None at this time.