May 2013

Making Women’s Health a Priority

Programs and Research Targeting Women’s and Maternal Health at CUSON Showcase a Diversity of Expertise

Maternal Health

Despite spending upwards of $98 billion a year on hospitalizations for pregnancy and childbirth, the US ranks 50th in the world for maternal mortality, meaning 49 countries are better at keeping new mothers alive. In fact, in the last 25 years, the maternal mortality rate in the US has doubled.

CUSON educates future nurses and nurse scholars to care for women at all stages in their lives from childhood, through their childbearing years, to menopause and beyond. Here are some selected programs and research at Columbia Nursing focusing on maternal and women’s health.

The Impact of Prison Nurseries on Mothers and Children

When Mary Byrne, PhD, Stone Foundation/Fish Professor in Clinical Health Care for the Underserved, began placing students in clinical rotations at the Bedford Hills and Taconic Correctional Facilities, in New York State, she discovered something unusual: Female inmates living alongside their infants in prison nurseries.

Statistics show that children of incarcerated mothers who live in temporary arrangements with relatives are more likely to have emotional and behavioral disorders, fail in school, and get into trouble with the law. Byrne wondered what the impact of prison nurseries would have on families. Only seven states have prison nurseries, but no one had formally studied the impact of prison nursery life on infant development as well as on their mother’s criminal recidivism after release.

In 2000, Byrne became among the first researchers to study incarcerated women and their babies living in prisons. After more than a decade, the study at the Bedford Hills and Taconic facility has shown infants who spend time in prison nurseries form secure attachments to their mothers at a rate comparable to those in healthy outside communities. She has also found that the re-incarceration rate for these mothers is lower than reported for the general population of imprisoned women.

Additional studies have grown out of her initial research including a survey of mother-child co-residential substance abuse treatment programs in the New York metropolitan area, and an intervention to improve shared parenting for children separated from their mothers. In addition to her own research, Byrne supports the clinical and research endeavors of other faculty members and students as the director of the School of Nursing Center for Children and Families.

Studying the Stressors of High Risk Mothers

The well-known “fight or flight” response is a physiological reaction to a perceived threat:  If there's a burglar at your door, you're going to have to take action.  In response, your body releases the stress hormones adrenaline and norepinephrine, causing increased heart rate and blood pressure, and a surge of the hormone cortisol to break down stored sugar for extra energy, all of which enable you to either confront the burglar or head for the nearest exit.

Less studied is “tend and befriend,” the female analog to the stereotypically male “fight or flight” stress response. It refers to the instinct of women to protect their offspring (tend) and seek support from peers (befriend) when faced with stressful situations.  The biological basis for this reaction is oxytocin—a hormone released as a response to stress.  Although both men and women release oxytocin in high-stress conditions, the reaction is much more dramatic in women.

Professor Nancy Reame, PhD, and Assistant Professor Joan Kearney, PhD, are co-investigators on a study researching whether oxytocin serves to reduce stress in high risk mothers exposed to domestic violence, many of whom also experienced abuse as children.

Their study centers on understanding the biology of social support interventions—specifically group therapy sessions for women attending mandatory parenting skills workshops. The research team plans to collect the women’s saliva—which contains biomarkers for oxytocin—both before and after the interventions as a measure of the potential influence the support group experience provided.

“People say they feel better when they talk to their friends and peers in stressful situations,” says Reame. “This is a wonderful, evidence-based opportunity to test the ‘tend and befriend’ response as an effective coping mechanism.”

Kearney is working on another study among these same high-risk mothers attending the mandatory workshops—this one measures their level of engagement during these sessions and support groups, which can subsequently predict the effectiveness of the treatment.

“Some women can’t wait to tell their stories, while others are more guarded,” says Kearney. Her research focus is on high risk caregivers. She has also examined Byrne’s data on women in prison nurseries for evidence of their “reflective functioning,” the capacity to consider their child's thoughts and feelings, which is associated with healthy relationships between mothers and their children.

Other research subjects Kearney has worked with include battered women and parents of dying children.

Says Kearney: “We hope to gain a better understanding of what women are facing on a psychological level not just as women, but as mothers.”

Offering an Alternative to High Intervention Births

Nearly 60 years after Columbia Nursing started the nation’s first graduate nurse midwifery program, this year’s graduates will join some 7,000 practicing certified nurse-midwives (CNMs) who work as professional specialists managing different phases of pregnancy and labor and care for newborns.

Although jobs as nurse midwives can be hard to find, CUSON alumni typically are employed within six months of graduation, according to Nurse Midwifery Program Director Laura Zeidenstein, DNP, CNM.   These experts in natural childbirth attend births in hospitals, birth centers and in private homes.

CUSON midwifery students are assigned clinical rotations in both hospital and birth center settings in New York City locations allowing them to work with patients from diverse cultures. “The students have opportunities to serve women and families from every country in the world and to become more culturally literate,” says Zeidenstein.

The midwifery program also has a strong global focus. Zeidenstein has been involved in a clinical research study about traditional birth attendants (TBAS) in Bangladesh since 2011.

Understanding Women’s Childbirth Preferences

Adriana Arcia, PhD is a post-doctoral research fellow at Columbia Nursing, whose research focus is on childbirth preferences and maternal health. She plans on using informatics in future research studies to develop web and app-based informational and decision-support tools for women related to their maternity care options.

Her recent study published in the journal Midwifery, found that women are more likely to prefer planned home birth and the care of a midwife when they perceive themselves as “active” participants in the delivery of their first child, choosing a collaborative role with their healthcare provider rather than a subordinate one.

“The care that pregnant women and infants receive has lifelong consequences,” says Arcia. “If a Cesarean section is medically necessary, then it’s the right choice.  Far too often, though, Cesareans are performed without medical need. These procedures can increase short-term risks including blood clots and wound infections for mothers, and respiratory difficulties for babies.”

Arcia notes that unnecessary Cesarean sections can also result in longer term consequences. For example, the breastfeeding relationship can be disrupted. Another is that children born by Cesarean section lack exposure to the beneficial intestinal flora that children born vaginally gain, says Arcia. This flora can protect children from some food and skin allergies.

Women’s Health throughout the Lifespan

Mary Jane McEneaney, MS, WHNP-BC, was always fascinated by pregnancy and childbirth and loved working as a nurse in both the neonatal intensive care unit and in antepartum and postpartum roles. When she decided she wanted to work on a wider range of issues relating to women’s health in 1996, she entered CUSON’s Women’s Health Nurse Practitioner Program. Today, she serves as the Program Director.

Graduates of the Women’s Health NP program provide primary care and tend to women throughout the lifespan, from adolescents to the elderly.  During their clinical rotations students  provide physicals, women’s wellness exams, offer advice on family planning and perform other gynecologic services in settings including Planned Parenthood, community health centers, and OB/GYN clinics at major hospitals. Advanced clinical placements are in areas including oncology.

“Their clinical experiences provide them with exposure to a broad range of women’s health issues,” says McEneaney, who recently took 13 of her students to a contraceptive technology conference in Washington, DC. which covered topics including family planning, menopause, and policies involving contraception. Working with patients across different cultures in invaluable to her students, she says, as different cultures view health and illness differently. For example, the use of anti-depressants can be stigmatized in certain communities such as the Hispanic one, and she advises her students to be culturally sensitive to these issues.