Browsing by Author "Bode, Leah M."

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    Duration of double balloon catheter for patients with prior cesarean: a before and after study
    (Elsevier, 2024-07-09) Tang, Rachel J.; Bode, Leah M.; Baugh, Kyle M.; Mosesso, Kelly M.; Daggy, Joanne K.; Guise, David M.; Teal, Evgenia; Christman, Megan A.; Tuskan, Britney N.; Haas, David M.; Obstetrics and Gynecology, School of Medicine
    Background: Previous studies that suggest a shorter time from cervical ripening balloon placement to delivery with shorter total balloon placement time have excluded patients with prior cesarean deliveries. Objective: To evaluate, in patients with a prior history of cesarean delivery undergoing cervical ripening with a double-balloon catheter, whether planned removal of device after 6 vs 12 hours would result in shorter time to vaginal delivery. Study design: A before-and-after study was performed after a practice change occurred November 2020, shortening the planned time of double-balloon catheter placement for cervical ripening from 12 to 6 hours. Data were collected via retrospective electronic chart review. Primary outcome was time from balloon placement to vaginal delivery. Secondary outcomes included rates of cesarean delivery, maternal intraamniotic infection, and uterine rupture. Kaplan-Meier curves compared median times to delivery between the groups. A Cox proportional-hazards model was used to adjust for time of balloon placement, number of previous vaginal deliveries, and co-medications used. Results: From November 2018 to November 2022, 189 analyzable patients with a prior history of cesarean delivery received a double-balloon catheter for cervical ripening during their trial of labor. Patients were separated into pre- and postpolicy change groups (n=91 and 98, respectively). The median time to vaginal delivery for the pregroup was 28 hours (95% CI: 26, 35) and 25 hours (95% CI: 23, 29) for those in the postgroup (P value .052). After adjusting for dilation at time of balloon placement, number of previous vaginal deliveries, and co-medication, the estimated hazard ratio for successful vaginal delivery postpolicy change was 1.89 (95% CI: 1.27, 2.81). There were no differences in rates of secondary outcomes. Conclusion: In patients with prior cesarean delivery undergoing mechanical cervical ripening with a double-balloon catheter, planned removal at 6 hours compared to 12 hours may result in higher chances of successful vaginal delivery and possibly a shorter time to delivery, without increasing rates of cesarean delivery and intraamniotic infection.
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    "I'm supposed to be a helper": Spiritual distress of abortion providers after the Dobbs decision
    (Elsevier, 2025-02-22) Bode, Leah M.; Kumar, Komal A.; McQuillan, Josie C.; Scott, Nicole P.; Bernard, Caitlin; Obstetrics and Gynecology, School of Medicine
    Background: The Dobbs v. Jackson Women's Health Organization decision has undoubtably affected the practice of abortion providers nationally. We hypothesized that Dobbs has also impacted the ways in which providers experience meaning and purpose through their work, which are elements of spirituality. Objective: We sought to describe the spectrum of spirituality of abortion providers and understand whether and how the Dobbs decision caused spiritual distress. Study design: For this qualitative study, we conducted video interviews with 26 abortion providers from 17 states between November 2022 and February 2023. States were classified according to the Guttmacher Institute classifications from most restrictive to very protective as of December 2022. Interviews included questions such as, "Can you describe your own sense of spirituality or spiritual identity?" and "How does your spiritual belief inform your response to the Dobbs decision?" Results: Participants' states of practice were well-distributed across the abortion restrictive-protective spectrum. The majority of participants were spiritual, while less than half identified as part of an organized religion. Many participants felt a spiritual call or obligation to provide abortion care and 46% described abortion as a spiritual act for provider and/or patient. Most participants experienced spiritual distress (74%), including those practicing in states across the restrictive-protective spectrum. Of note, 92% of participants described their spirituality as helpful in coping with the effects of the fall of Roe v. Wade. Sources of strength included advocacy, agency, legislative work, and community; over half specifically cited the abortion provider community. Conclusions: The Dobbs decision-and subsequent state-level abortion restrictions-impacts abortion providers by causing spiritual distress. While many abortion-restrictive laws are influenced by religious or spiritual beliefs, it is important to recognize that abortion providers are also spiritual individuals.