Browsing by Author "Bode, Leah"
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Item Analysis of Factors Contributing to Antenatal Corticosteroid Administration in Threatened Preterm Labor(Wolters Kluwer Health, Inc., 2023-05) Bode, Leah; McKinzie, Alexandra; Gidia, Nadia; Ibrahim, Sherrine; Haas, DavidINTRODUCTION: Antenatal corticosteroids (ACS) are recommended for pregnant persons at risk for imminent preterm delivery within 7 days. Many diagnosed with threatened preterm labor (tPTL) are given ACS but do not deliver until term. The objective of this study was to analyze characteristics of those seen for tPTL who receive ACS to better understand clinical decision-making. METHODS: This retrospective cohort study consisted of patients seen in triage at an urban hospital caring for underserved patients in 2021 for tPTL during pregnancy. Demographic variables (maternal age, race and ethnicity, prior preterm delivery) and obstetric variables (cervical dilation, effacement, membrane rupture, tocolytic administration) were evaluated against the primary outcome of ACS administration. RESULTS: Two hundred ninety pregnant people with 372 unique encounters for tPTL were identified. The mean gestational age at presentation was 33.5 weeks. 107 patients in 111 encounters received ACS, which was associated with lower body mass index (BMI), greater cervical dilation and effacement, membrane rupture, and more frequent contractions (all P<.01). Logistic regression, limited to first encounter in triage, found that BMI (odds ratio 0.91, 95% CI 0.87–0.95), cervical dilation 2 cm or greater (2.49, 1.12–5.35), and cervical effacement 50% or higher (4.80, 2.25–10.24) were significantly associated with patients receiving ACS. Forty-four percent of those receiving ACS delivered within 7 days, compared to 11% of those who did not receive ACS (P<.001). CONCLUSION: Greater cervical dilation and effacement and a lower BMI were associated with ACS administration, although most patients receiving ACS did not deliver within 7 days. These findings will contribute to developing a clinical decision model for administering ACS.Item Analysis of Factors Contributing to Antenatal Corticosteroid Administration in Threatened Preterm Labor(2022-07) Bode, Leah; McKinzie, Alexandra; Gidia, Nadia; Ibrahim, Sherrine; Haas, DavidIntroduction: Antenatal corticosteroids (ACS) are recommended for pregnant persons who are between 24 and 36+6/7 weeks’ gestational age (GA) and at risk for imminent delivery within 7 days. Many individuals diagnosed as having threatened preterm labor (tPTL) are given ACS but do not deliver until they reach term. This study aimed to describe characteristics of those seen for tPTL who receive ACS to better understand clinical decision-making. Methods: This retrospective cohort study consisted of mothers seen in triage at Eskenazi Hospital in 2021 for tPTL during pregnancy. Multiple demographic variables were evaluated against the primary outcome of ACS administration including maternal age, race/ethnicity, and prior preterm delivery, as well as obstetrical variables such as cervical dilation, effacement, membrane rupture, and tocolytic administration. Results: After exclusions, a cohort of 290 pregnant people with 372 unique encounters remained. The average maternal age was 26.7, and 15.6% of patients had a history of prior preterm birth. 107 patients in 111 encounters received ACS, which were associated with lower BMI, greater cervical dilation, greater effacement, membrane rupture, and more frequent contractions (all p<0.01). The mean GA at triage was 33.5 weeks. Logistic regression, adjusting for significant factors in the univariable analysis, found that BMI (OR 0.93, 0.89-0.97), cervical dilation (OR 1.34, 1.07-1.71), and cervical effacement (OR 1.02, 1.01-1.03) were significantly associated with giving ACS. 44% of those receiving ACS delivered within 7 days, compared to 11% of those who did not receive ACS (p<0.001). Conclusion: Greater cervical dilation and effacement and a lower BMI were associated with ACS administration, though most patients receiving ACS still did not deliver within 7 days. These findings will be further categorized and used to develop a clinical decisional model for administering ACS in those likely to imminently deliver preterm. Presentation recording available online: https://media.dlib.indiana.edu/media_objects/3b5922009Item Benefits of Hobbies for Self-Care(2022-04) Bode, LeahItem Cerebral Vein Thrombosis in Concomitant Combination Oral Contraceptive Pill Use and COVID-19(2023-03) Owusu, Raiven; Bode, Leah; Jansen, Nicole; Libke, Megan; Mehta, RakeshCase Description: Patient is a 27-year-old female who presented with confusion, fever, and chills and was found to have a cerebral vein thrombosis (CVT) on MRI. She had a seven-year history of combination oral contraceptive pill (OCP) use and prior to onset of symptoms tested positive for COVID-19. After CVT diagnosis, she started apixaban, which was discontinued 6 months later. She decided to discontinue her OCP and had a copper intrauterine device (IUD) placed. Clinical Significance: CVT is a rare form of stroke that most commonly affects young women. Pregnancy, puerperium, and OCP all use induce a hypercoagulable state which increases risk for CVT. Estrogen causes increased circulating procoagulant factors in the plasma, and combined OCP users are often found to have an acquired resistance to activated protein C6, which both contribute to a hypercoagulable state. COVID-19-associated coagulopathy also induces concurrent hyper-inflammatory response, hypercoagulability, and vascular endothelial cell dysfunction. These pathologic mechanisms are believed to be linked to elevated plasma levels of coagulation factors and reduced fibrinolysis, resulting in prothrombotic events. COVID-19 infection is thought to exacerbate existing prothrombotic states like OCP use. Conclusion: Concomitant hypercoagulable states, such as combination OCP use and COVID-19 coagulopathy, increase overall risk for thrombotic events. Patients with risk factors for hypercoagulability presenting with headache, visual changes, and confusion should be evaluated for CVT. Following a thrombotic event in a patient on combined OCPs, finding an alternative contraceptive that meets the patient’s reproductive goals and lowers their risk of repeat thromboembolic events is important. Progesterone-only and non-hormonal contraceptive options, such as IUDs, have a decreased risk of thrombosis compared to combined OCPs and can provide alternative contraceptive methods.Item I’m supposed to be a helper: Spiritual distress of abortion providers after Dobbs v. Jackson(2024-04) Bode, Leah; Kumar, Komal; McQuillan, Josie; Scott, Nicole; Bernard, CaitlinOn June 24, 2022, the Supreme Court of the United States voted to overturn Roe v. Wade, the 1970 landmark case protecting abortion rights in America, in Dobbs v. Jackson Women’s Health Organization. The decision has the potential to affect the way that physicians and learners in the field of Obstetrics and Gynecology (OBGYN), and specifically abortion providers, practice their specialty by interacting with patients and making meaning from their work. Meaning making in one’s work has been shown to be integral in fostering spiritual well-being and preventing burnout in medicine. We sought to demonstrate the spectrum of spirituality of abortion providers and their subsequent spiritual distress in the aftermath of Dobbs. We conducted thirty-minute interviews on Zoom with 26 abortion providers from 17 states from November 2022 to February 2023. Demographics collected included age, racial identity, location of practice (by state), years in practice, fellowship training, and practice setting (community, academic, hybrid). States were then classified according to the Guttmacher Institute classifications of Most Restrictive, Restrictive, Some restrictions/protections, Protective, and Very protective as of December 2022. Interviews consisted of questions such as "What are the major tenants of your spiritual beliefs (if none, how you make meaning)?” and “Tell me about any spiritual distress or alienation from your religious or spiritual community as a result of the Dobbs decision.” Interviews were transcribed using the closed caption feature on Zoom and coded by LB, KK, and JM. After achieving consensus, interviews were analyzed using NVivo 14. Sixteen providers were fellowship trained (14 Complex Family Planning and 2 Maternal Fetal Medicine), one was a family medicine physician, and one was a Nurse Practitioner. Practice type was equally distributed amongst community (34.6%), academic (34.6%), and hybrid (30.8%). Location of practice (state) was well-distributed across the restrictive-protective spectrum: 7.7% Most Restrictive, 30.8% Restrictive, 15.4% Some restrictions/protections, 30.8% Protective, and 15.4% Very Protective. The majority of participants identified a personal spirituality, while less than half were tied to an organized religion, such as Christianity, Judaism, Hinduism, or Buddhism. Fifteen participants (57.7%) identified a concept of “good” in their spirituality, using words such as “greater good” or “common good”. Sixteen participants (61.5%) cited ethical principles of justice, non-maleficence, respect for human life, or autonomy as major tenets of their spirituality. The subject of abortion care as related to spirituality was brought up in a number of ways. Ten subjects (38.5%) felt spiritually called to provide abortion care; 11 others (42.3%) perceived abortion care as an obligation born from their spiritual beliefs. Twelve participants (46.2%) noted the act of providing an abortion as a spiritual act, for provider and/or patient. Most participants experienced spiritual distress relating to the Dobbs decision. Spiritual distress was related to conflict with differently minded community members (30%), the perceived inability to live out their calling by providing abortion care (38%), and their physical location (38%). Those who did not experience spiritual distress (26%) noted location and alignment with spiritual values as protective factors. 38% of participants identified some other form of distress (e.g., moral) but did not identify it as spiritual distress. Of note, 92% of participants described their spirituality as helpful in coping with the fall of Roe v. Wade. Sources of strength included advocacy (34.6%), agency (e.g., “I feel strength knowing that I’m still able to do this job”) (57.7%), legislative work (30.8%), and community (50%). Community strength was further broken down into the abortion provider community (57.7%), family and friends (53.8%), and a faith or spiritual community (26.9%). Eight participants (30.8%) identified a perceived conflict, discordance, or lack of discussion between spirituality and medicine. Five subjects (19.2%) acknowledged that their personal spirituality is underexplored. This qualitative study demonstrates that abortion providers are spiritual individuals. For many, the decision to be an abortion provider is motivated by this identity, or in some cases an obligation. Regarding the fall of Roe v. Wade, many abortion providers endorsed feelings of spiritual distress. Many reported being distressed due to not being able to comply with their moral and/or spiritual obligation of providing abortions secondary to new restrictions. Location played a large role in whether providers were experiencing this distress. It can be deduced that state restrictions on provision of abortions have directly impacted the spiritual well-being of abortion providers. As many laws pertaining to abortion are influenced by religious beliefs, it is important to recognize that abortion providers themselves are overwhelming spiritual.Item “I’m supposed to be a helper”: Spiritual distress of abortion providers after Dobbs v. Jackson(2024-04-26) Bode, Leah; Kumar, Komal; McQuillan, Josie; Scott, Nicole; Bernard, CaitlinINTRO On June 24, 2022, the U.S. Supreme Court voted to overturn Roe v. Wade, the 1970 landmark case protecting abortion rights in America, in Dobbs v. Jackson Women’s Health Organization. The decision has the potential to affect the way that abortion providers practice their specialty by interacting with patients and making meaning from their work. Meaning making in one’s work has been shown to be integral in fostering spiritual well-being and preventing burnout in medicine. We sought to demonstrate the spectrum of spirituality of abortion providers and their subsequent spiritual distress in the aftermath of Dobbs. METHODS We conducted thirty-minute interviews on Zoom with 26 abortion providers from 17 states from November 2022 to February 2023. Demographics collected included age, racial identity, location of practice (by state), years in practice, fellowship training, and practice setting (community, academic, hybrid). States were then classified according to the Guttmacher Institute classifications of Most restrictive, Restrictive, Some restrictions/protections, Protective, and Very protective as of December 2022. Interviews consisted of questions such as "What are the major tenants of your spiritual beliefs (if none, how you make meaning)?” and “Tell me about any spiritual distress or alienation from your religious or spiritual community as a result of the Dobbs decision.” Interviews were analyzed using NVivo 14. RESULTS Providers were equally distributed amongst community (34.6%), academic (34.6%), and hybrid (30.8%) settings. Location of practice (state) was well-distributed across the restrictive-protective spectrum: 7.7% Most restrictive, 30.8% Restrictive, 15.4% Some restrictions/protections, 30.8% Protective, and 15.4% Very protective. The majority of participants identified a personal spirituality, while less than half were tied to an organized religion. Sixteen participants (61.5%) cited ethical principles of justice, non-maleficence, respect for human life, or autonomy as major tenets of their spirituality. Ten subjects (38.5%) felt spiritually called to provide abortion care, 11 others (42.3%) perceived abortion care as a spiritual obligation, and 12 participants (46.2%) noted the act of providing an abortion as a spiritual act, for provider and/or patient. Most participants experienced spiritual distress relating to the Dobbs decision. Those who did not experience spiritual distress (26%) noted location and the alignment of their work with spiritual values as protective factors. Of note, 92% of participants described their spirituality as helpful in coping with the fall of Roe v. Wade. Sources of strength included advocacy, agency (e.g., “I feel strength knowing that I’m still able to do this job”), legislative work, and community; 57.7% specifically cited the abortion provider community. CONCLUSION The decision to be an abortion provider is often motivated by one’s spiritual identity. Many abortion providers endorsed feelings of spiritual distress related to not being able to comply with their moral and/or spiritual obligation of providing abortions secondary to new restrictions. Location factored heavily into whether providers were experiencing this distress, suggesting that state restrictions on abortions have directly impacted the spiritual well-being of abortion providers. As many laws pertaining to abortion are influenced by religious beliefs, it is important to recognize that abortion providers themselves are overwhelming spiritual.Item “I’m supposed to be a helper”: Spiritual distress of abortion providers after Dobbs v. Jackson(2024-04) Bode, Leah; Kumar, Komal; McQuillan, Josie; Scott, Nicole; Bernard, CaitlinINTRO On June 24, 2022, the Supreme Court of the United States voted to overturn Roe v. Wade, the 1970 landmark case protecting abortion rights in America, in Dobbs v. Jackson Women’s Health Organization. The decision has the potential to affect the way that abortion providers practice their specialty by interacting with patients and making meaning from their work. Meaning making in one’s work has been shown to be integral in fostering spiritual well-being and preventing burnout in medicine. We sought to demonstrate the spectrum of spirituality of abortion providers and their subsequent spiritual distress in the aftermath of Dobbs. METHODS We conducted thirty-minute interviews on Zoom with 26 abortion providers from 17 states from November 2022 to February 2023. Demographics collected included age, racial identity, location of practice (by state), years in practice, fellowship training, and practice setting (community, academic, hybrid). States were then classified according to the Guttmacher Institute classifications of Most restrictive, Restrictive, Some restrictions/protections, Protective, and Very protective as of December 2022. Interviews consisted of questions such as "What are the major tenants of your spiritual beliefs (if none, how you make meaning)?” and “Tell me about any spiritual distress or alienation from your religious or spiritual community as a result of the Dobbs decision.” Interviews were transcribed using the closed caption feature on Zoom and coded by LB, KK, and JM. After achieving consensus, interviews were analyzed using NVivo 14. RESULTS Providers’ practices were equally distributed amongst community (34.6%), academic (34.6%), and hybrid (30.8%) settings. Location of practice (state) was well-distributed across the restrictive-protective spectrum: 7.7% Most restrictive, 30.8% Restrictive, 15.4% Some restrictions/protections, 30.8% Protective, and 15.4% Very protective. The majority of participants identified a personal spirituality, while less than half were tied to an organized religion. Sixteen participants (61.5%) cited ethical principles of justice, non-maleficence, respect for human life, or autonomy as major tenets of their spirituality. Ten subjects (38.5%) felt spiritually called to provide abortion care, 11 others (42.3%) perceived abortion care as a spiritual obligation, and 12 participants (46.2%) noted the act of providing an abortion as a spiritual act, for provider and/or patient. Most participants experienced spiritual distress relating to the Dobbs decision. Those who did not experience spiritual distress (26%) noted location and the alignment of their work with spiritual values as protective factors. Of note, 92% of participants described their spirituality as helpful in coping with the fall of Roe v. Wade. Sources of strength included advocacy, agency (e.g., “I feel strength knowing that I’m still able to do this job”), legislative work, and community; 57.7% specifically cited the abortion provider community. CONCLUSION The decision to be an abortion provider is often motivated by one’s spiritual identity. Regarding the fall of Roe v. Wade, many abortion providers endorsed feelings of spiritual distress related to not being able to comply with their moral and/or spiritual obligation of providing abortions secondary to new restrictions. Location played a large role in whether providers were experiencing this distress, suggesting that state restrictions on abortions have directly impacted the spiritual well-being of abortion providers. As many laws pertaining to abortion are influenced by religious beliefs, it is important to recognize that abortion providers themselves are overwhelming spiritual.Item Perceptions of Options for Mode of Delivery in Periviable Decision-Making(2019-07) Bode, Leah; Tucker Edmonds, BrownsyneThis study sought to qualitatively evaluate women’s perspectives on shared decision-making for mode of delivery (MOD) in the setting of periviable delivery (22-25 weeks), including their understanding of alternatives, risks/benefits, and provider recommendations. Interviews were conducted with women hospitalized for a threatened periviable delivery. We explored decision-making prompts related to MOD. Participants were also prompted to discuss their understanding of MOD risks/benefits and provider recommendations. Interviews were coded and analyzed using NVivo 12. Two-thirds of participants explicitly acknowledged having the option of cesarean section (CS) or vaginal delivery (VD). Maternal comorbidities limited some to one option. Many expressed a particular MOD preference, but most ultimately wanted “whatever’s best for baby.” Conceptually, MOD preference and decision-making were distinct, but typically aligned. However, occasionally, women recognized a MOD choice, but did not perceive the decision to be theirs, and vice versa. Likewise, consent was a separate concept, as some gave consent but did not feel they made a/the MOD decision. Understanding of MOD risks was mostly limited to bleeding, infection or fetal harm. Nine participants did not discuss any risks/benefits. Most women did not describe classical cesarean or risk to future pregnancies as risks. Patients felt that physicians recommended CS for fetal distress and to avoid risk of VD, though both CS and VD were equally recommended overall. Findings revealed a need for providers to clarify options and decision-making roles; review risks more comprehensively; refine recommendations; and create shared MOD plans in periviable counseling to aid women in informed, shared MOD decision-making.