With this issue on Disparities and Access to Care, the Journal of Perinatal & Neonatal Nursing (JPNN) welcomes a new Contributing Editor for the Perinatal section. Rebecca L. Cypher, MSN, PNNP, is a perinatal consultant and owner and founder of Cypher, Maternal Fetal Solutions. Becky has a wealth of experience in fetal assessment, legal issues, and risk management in perinatal services. We welcome her to the leadership team of JPNN. Please take time to peruse her first column for JPNN with this issue.
In the aim to reduce and eliminate health disparities, we must keep asking “Who is missing? Who is underserved? Who is unheard?” Healthcare is complex, and reproductive and perinatal care with its close proximity to sexuality is no exception. The pressures of the larger society are exerted on reproductive health; women's bodies, as well as minds, have been shaped by these pressures, contributing to the chasm of health disparities in this country. So many individuals have been marginalized and have poor health outcomes as a result. This issue represents a call for actively, intentionally, seeking the underserved in the community and a commitment to “seeing” them as valued partners in healthcare.
African American women have poor perinatal outcomes at rates vastly higher than white women, with a death rate worse than that in many developing countries. Individuals who identify as LGBTQI do not receive adequate preventive healthcare and present with more advanced illnesses. Women with obesity often literally do not fit within offices and hospitals. These disparities have roots well beyond the walls of the clinic, but without the ethical introspection of continually asking who is missing, underserved, and unheard, disparities cannot begin to be ameliorated.
The variety of approaches and imperatives presented in this issue underscores the scope of the issue and the multiple opportunities for action. If the women and families receiving care in the practice settings do not match the population outside the clinic doors, the problem must be discerned. Using the approach of Morse et al in “Barriers to Reproductive Healthcare for Women With Opioid Use Disorder,” members of the community can be surveyed to identify barriers to care and then develop solutions. Kwarteng-Amaning et al describe an innovative prison nursery program designed to prompt maternal-child bonding, for a reminder that improvement in care isn't limited to just the inpatient and outpatient settings. Making sure all women have access to evidence-based care, as suggested by Jones in “Continued Disparities in Postpartum Follow-up and Screening Among Women With Gestational Diabetes and Hypertensive Disorders,” requires providers to create safe spaces where patient needs will be taken seriously. In “Obesity and Socioeconomic Disparities: Rethinking Causes and Perinatal Care,” Jevitt advises working with women to understand pathology and improve the overall environment, reinforcing the evidence that an individual's state of health is the result of many influences and not simply a personal victory or failing. Finally, McLemore et al prompt movement beyond just welcoming of patients in “The Ethics of Perinatal Care for Black Women: Dismantling the Structural Racism in Mother Blame Narratives,” urging a look at and within ourselves, as well as the discipline, to mentor, and then hire, diverse new healthcare professionals, so the care providers reflect and approximate the recipients of care.
The problems of healthcare are not easily solved. However, simple compassion can transform lives. The system for maternity care cannot be immediately fixed; yet, students from historically disenfranchised backgrounds can be welcomed as they enter the nursing workforce. Personal and institutional biases are not instantaneously shed, but patient history forms can be adjusted to allow more unstructured space for LGBTQI individuals. Mostly, we can be fully present in the moment with those we serve, and with our colleagues, to view them as whole individuals with valuable insight into their own health and needs. Hopefully, as individuals or providers, we have felt or witnessed the power of personalized, compassionate care, the positive impact of being “seen” and valued. We have experienced it, firsthand, in the outcomes of loved ones who are members of typically marginalized groups in healthcare.
With this issue, we encourage perinatal providers to start increasing access to care and decreasing disparities by actively “seeking” those who are missing or underserved, by “seeing” those who have been marginalized or stigmatized, and by “seeing” the reality of the individuals in front of them. Increasing access to decrease disparities is more than opening doors; it is creating safe and welcoming spaces. Compassion for patients, families, colleagues, and ourselves is not expensive but is more valuable and sensitive than the most coveted new equipment. We are all worth it.
This current issue is focused on disparities and access to care. There are an increasing number of health disparities and these can often complicate access to care for patients and families. Developing an improved understanding of the nature of disparities whether they be related to physical or mental health, sex or gender-role, or economic factors, will result in our collective ability to help patients and families overcome these issues and achieve the most optimal health outcomes possible. In the neonatal section of this issue of the Journal of Perinatal and Neonatal Nursing (JPNN), we feature 4 articles, each highlighting a unique health disparity within the field of neonatal nursing. Dr Toly and colleagues report on the maternal mental health issues associated with care of technology-dependent infants following discharge from the neonatal intensive care unit (NICU). This article is followed by Dr Lee and colleagues’ report on the effectiveness of an intervention program for fathers of hospitalized preterm infants. We learn about the influence of early neonatal discharge from the parental perspective from Dr Sweet and her authorship team. Finally, we focus on the stress response of NICU nurses and how a stress management program might mitigate some of the emotional health issues associated with caring for hospitalized infants.
Joan Smith, the expert neonatal columnist, has provided a column for thoughts and reflections on disparities in care as they relate to prematurity and the care infants receive within the NICU. There are some very important points in this column that we all need to consider as we work to improve health outcomes for premature infants and their families. In particular, as neonatal caregivers, we need to be aware of our own biases and performance in delivering equitable quality care. This will be Dr Smith's last column for JPNN. I want to thank Joan, who has served as our expert neonatal columnist for the past several years. Her expert perspective and outstanding contributions have enriched the journal—we are incredibly fortunate to have had Joan as our expert columnist and we wish her well in the many professional contributions she continues to juggle.
As always, thank you for reading JPNN. Please reach out to us with any thoughts or suggestions for the journal. We have several great topic areas planned for forthcoming issues of the journal: emergency and disaster readiness, intrapartum care and the birth experience, preterm labor and birth issues, and the microbiome. It is never too soon to begin preparation of a manuscript for one of these topics—we welcome your submissions!
—Julia C. Phillippi, PhD, CNM, FACNM, FAAN
—Betsy Babb Kennedy, PhD, RN, CNE
Perinatal Guest Editors
—Katherine E. Gregory, PhD, RN, FAAN