Jennifer Bute
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COVID-19 Birth Stories
In this year-long project, Professor Bute and her research partner, Professor Maria Brann, first conducted focus groups with women across the country who had given birth during a time when their state or local governments had issued stay-at-home orders because of the COVID pandemic. Then, they followed up a year later by interviewing the same women individually to learn more about raising a newborn during a pandemic.
The researchers found that the isolation of stay-at-home orders and changes in health care policies, such as limitations on hospital visitors and in-person appointments, had a profound effect on women. Women discussed in detail the mental health challenges they faced, such as postpartum depression and anxiety, that they felt were heightened because of the pandemic. Women also discussed the challenges of navigating who had access to visit or hold their newborn, which involved keeping their babies safe while contending with family expectations about seeing the baby. The women who participated in the study were grateful for the opportunity to connect with other women with similar experiences to know that they are not alone. They provided recommendations for helping pregnant women and new moms who are navigating motherhood in an unprecedented time, and even spoke to the media about this project so that other women would feel supported.
Professor Bute's translation of research into supportive groups for new mothers is another excellent example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.
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Recent Submissions
Item “I’m Not Comfortable With COVID, But …”: Dilemmas and Decision-Making to Mitigate Risks Among Mothers Who Gave Birth During the COVID-19 Pandemic(Sage, 2024) Johnson, Nicole L.; Brann, Maria; Scott, Susanna F.; Bute, Jennifer J.; Communication Studies, School of Liberal ArtsIndividuals have faced unprecedented uncertainty and risk surrounding the COVID-19 pandemic, and decision-making dilemmas have been complicated by quickly evolving and often contradictory recommendations for staying healthy. Using tenets of problematic integration theory and risk orders theory, we analyzed interview data from 50 mothers who gave birth during the pandemic to understand how uncertainty and risk perceptions shaped their decision-making about keeping themselves and their infants healthy in the first year after birth. Results describe how some mothers in our sample made sense of their decision-making to prioritize first-order risks to their own and their family’s physical health, and other mothers prioritized second-order risks to their relationships and identities. We also discuss the social nature of mitigating risk during the COVID-19 pandemic and the catalysts for shifting risk perceptions. Theoretical and practical implications include improving public health messaging and clinical conversations to enable individuals to effectively manage social and identity needs alongside serious threats to physical health.Item Narrative Sense-Making During COVID-19: Using Stories to Understand Birth in a Global Pandemic(Taylor & Francis, 2024) Brann, Maria; Bute, Jennifer J.; Foxworthy Scott, Susanna; Johnson, Nicole L.; Communication Studies, School of Liberal ArtsWomen who gave birth in the spring and summer of 2020 contended with a host of challenging factors. In addition to facing pregnancy, labor, and delivery during an emerging global pandemic, women grappled with health care restrictions that altered their birth experience. To explore how women made sense of their birth during COVID-19, we analyzed written narratives from 71 women who gave birth in the United States from March to July 2020. Based on tenets of communicated narrative sense-making, the themes that emerged from our data suggest that women framed the role of the pandemic as either completely overshadowing their birth experience or as an inconvenience. Women also wrote about threats to their agency as patients, mothers, and caregivers, as well as the evolving emotional toll of the pandemic that often prompted feelings of fear and sadness, along with self-identified anxiety and depression. We discuss these findings in light of the literature on birth stories as essential sites of narrative sense-making for women and their families.Item Expectancy violations and boundary management when giving birth during a pandemic: implications for supporting women(Taylor & Francis, 2024) Bute, Jennifer J.; Brann, Maria; Scott, Susanna; Johnson, Nicole; Communication Studies, School of Liberal ArtsBackground: Few life events are as profound as the birth of a child. Yet for those who gave birth during the COVID-19 pandemic, the birth experience and the care of their newborn child were altered in significant ways. Method: In this study, we examined the stories of women who gave birth during the COVID-19 pandemic using expectations violations theory and communication privacy management theory. Results: Based on focus group interviews with 65 women from 19 states across the U.S., we found that policies imposed by institutions and visitation rules negotiated by women were prominent in women’s birth stories. Policies that affect territorial access to mothers and babies shaped communication to manage health and safety, resulted in intense emotional responses, and affected relationships with women’s partners and families. Conclusions: Our findings offer practical implications for both health care systems and health care providers. Systems must communicate proactively to offer compassionate patient care, and physicians should offer guidance to help new parents manage visitors.Item Jennifer Bute and Maria Brann Research Introduction(Center for Translating Research Into Practice, IU Indianapolis, 2021-09-24) Brann, Maria; Bute, JenniferProfessors Jennifer Bute and Maria Brann briefly discuss their translational research that deals with COVID-19 Birth Stories.Item “There's no time limit on grief:” Women's perspectives on a novel reproductive grief screening tool(Elsevier, 2023-12-04) Bute, Jennifer J.; Brann, Maria; Buskmiller, Cara; Fredenburg, Michaelene; Communication Studies, School of Liberal ArtsObjective: Women who have experienced reproductive loss (i.e., miscarriage, stillbirth, abortion) evaluated the usefulness of a novel screening tool, Reproductive Grief Screen (RGS), to identify patients struggling with ongoing, complicated grief. Methods: This mixed-methods study involved U.S. women who had experienced reproductive loss. Online data collection resulted in 27 interviews and 282 surveys completed. Perceptions of and preferences about RGS were thematically analyzed. Chi square analyses assessed relationships between demographics and tool preferences. Results: RGS validated women's experiences with grief after reproductive loss. Women noted their providers may be unaware of their loss(es). Participants requested periodic screening using RGS beginning shortly after a loss (or during new patient intake) and occurring regularly (e.g., annually). Overall, women preferred completing RGS online before an appointment, though preferences varied by demographics (i.e., age, time since loss). Participants want providers to compassionately discuss RGS results with them and offer appropriate resources. Conclusion: The RGS can help identify largely ignored grief after reproductive loss. Innovation: Findings from group and individual interviews and a survey of women who have coped with reproductive loss suggest that use of a brief RGS tool could reshape clinical practice to aid women who might be facing complicated grief. Moreover, women expressed clear preferences for how to implement use of the RGS in clinical contexts.Item The association of news media with anxiety in food allergic children and their parents(Wiley, 2022-01) Bute, Jennifer J.; Martins, Nicole; Communication Studies, School of Liberal ArtsItem Validation of a Brief Measure for Complicated Grief Specific to Reproductive Loss(Springer Nature, 2023-04-20) Buskmiller, Cara; Grauerholz, Kathryn R.; Bute, Jennifer; Brann, Maria; Fredenburg, Michaelene; Refuerzo, Jerrie S.; Communication Studies, School of Liberal ArtsObjective: Complicated grief reactions follow some pregnancy outcomes, like miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination of pregnancy. Stigma can delay treatment and worsen outcomes. Screening tools such as the Edinburgh Postnatal Depression Scale detect complicated grief poorly, and specific tools for prolonged or complicated grief after a reproductive loss are cumbersome. In this study, a five-item questionnaire to detect complicated grief after reproductive loss of any type was designed and preliminary validated. Methods: A questionnaire patterned after the extensively validated Brief Grief Questionnaire (BGQ) was created by a group of physicians and lay advocates to employ non-traumatic but specific language related to grief after miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination of pregnancy. One hundred and forty women at a large academic center were recruited in person and via social media to validate the questionnaire with well-studied instruments for anxiety (7-item Panic Disorder Severity Scale, PDSS), trauma (22-item Impact of Events Scale), and reproductive grief and depressive symptoms (33-item Perinatal Grief Scale [PGS]). Results: The response rate was 74.9%. Of the 140 participants, 18 (12.8%) experienced their loss during high-risk pregnancies, and 65 (46.4%) were recruited via social media. Seventy-one (51%) respondents had a score > 4, a positive screen for the BGQ. On average, women experienced their loss 2 years prior to participation (IQR 1-5 years). Cronbach's alpha was 0.77 (95% CI: 0.69-0.83). The goodness of fit indices of the model met Fornell and Larker criteria (RMSEA = 0.167, CFI = 0.89, SRMR = 0.06). The AVE was 0.42 and the CR 0.78. Conclusions: This investigator-created screening tool is internally consistent and meets preliminary criteria for discriminant validity. This tool can be refined prior to testing for sensitivity and specificity in screening for complicated grief after a reproductive loss.Item ‘Had I gone into the office, they would have caught it a little bit sooner’: Narrative problematics in U.S. pandemic birth stories(T&F, 2022) Scott, Susanna Foxworthy; Johnson, Nicole L.; Brann, Maria; Bute, Jennifer J.; Communication Studies, School of Liberal ArtsIndividuals who gave birth during the COVID-19 pandemic experienced an increased risk for premature births, stillbirths, depression, and lower access to care. Their stories provide valuable information that can inform clinical care, particularly due to loss of in-person support resulting from visitor restrictions in hospitals. Grounded in a theory of narrative problematics, we explored how elicited birth narratives were affected by COVID-19 and how stories can be used as material evidence to inform healthcare systems. We facilitated seven focus group discussions with 65 women from 19 states who had given birth between March and July 2020. Three themes emerged from our qualitative thematic analysis: (1) navigating disrupted access to healthcare; (2) experiencing loss of co-construction of birth experience; and (3) recognizing fissures in the mask-wearing master narrative. Practical implications for improving healthcare include developing spaces for individuals to process birth stories for cathartic benefit due to significant disruption, improving hospital policies about in-person support to avoid loss of co-construction of experience, and centering hospitals and the providers that work within them as audiences for interventions around preventive measures during a disease outbreak.Item Breaking Bad News: A Randomized Trial Assessing Resident Performance After Novel Video Instruction(Cureus, 2021-06-05) Shanks, Anthony L.; Brann, Maria; Bute, Jennifer J.; Borse, Vyvian; Tonismae, Tiffany; Scott, Nikki; Obstetrics and Gynecology, School of MedicineIntroduction; Delivering bad news to patients is an essential skill for physicians, which is often developed through patient encounters. Residents in our program participate in objective structured clinical examinations (OSCEs) on an annual basis to evaluate their skills in these scenarios. Our objectives were to develop an educational video and determine if an educational video provided to residents prior to OSCEs would improve performance. Methods: Previous OSCEs were reviewed to identify best practices and to create a four-minute video highlighting the "do's and don'ts" of delivering bad news. Residents in two post-graduate year (PGY) classes were randomized to watch the video prior to or after a standardized patient encounter. Three masked reviewers assessed resident empathy, attention, and understanding on 10 five-point Likert scales and assigned a total score (scale: 0-50). Hedges' g was used to assess mean scores and effect size. Results: A total of 17 residents participated in the evaluation: nine in the pre-OSCE video group and eight in the control group. Residents randomized to the video prior to the patient encounter had a mean score of 37.01 (SD=3.6). Residents randomized to the control group had a mean score of 35.38 (SD=4.85). Hedges' g was 0.37 (95% CI: -0.59 to 1.33). Conclusion: Residents randomized to the video group had a small increase in OSCE performance, which was not statistically significant. The novel video was helpful and addresses the need for a quick pre-assessment educational tool, though interns and graduating medical students may be a more appropriate target audience for instruction.Item Communicating to promote informed decisions in the context of early pregnancy loss(Elsevier, 2017) Brann, Maria; Bute, Jennifer J.; Communication Studies, School of Liberal ArtsObjective. To evaluate residents’ ability to engage standardized patients in informed decision making during a pregnancy loss scenario. Methods. Forty patient encounters between interns and standardized patients were coded to assess informed decision-making practices, exploration of unexpressed concerns, and support provision. Results. Interns engaged in minimum informed decision making but did not address all of the communicative elements necessary for informed decisions, and most elements were only partially addressed. Patients in this study did not receive information about all management options, their concerns were not addressed, and there was limited support communicated for their decision. Conclusion. This study offers an initial assessment of a communicative approach to evaluate and improve decision making during early pregnancy loss. A comprehensive approach to making informed decisions must include discussion of all management options, exploration of patient preferences and concerns, and support for the patient’s decision. Practice Implications. Healthcare providers could benefit from communication skills training to communicate more effectively with patients to help them make more informed decisions.