DISCUSSION BOARD- RESPOND TO IT Title: The

DISCUSSION BOARD- RESPOND TO IT Title: The title Effects of CenteringPregnancy group prenatal care on breastfeeding outcomes describes the article well. In this article, the authors compare the outcomes of breastfeeding pregnant people who received prenatal education through a CenteringPregnancy prenatal group or traditional 1-on-1 prenatal care. The title is clear and decisive. It also describes what CenteringPregnancy is (prenatal groups) for those who don’t know. Tanner-Smith, E. E., Steinka-Fry, K. T., & Lipsey, M. W. (2013). Effects of centering pregnancy group prenatal care on breastfeeding outcomes. Journal of Midwifery & Women’s Health, 58(4), 389-395. https://doi.org/10.1111/jmwh.12008 Abstract: The abstract contains an introduction, methods, results, and discussion sections that include the purpose of the study, how it was carried out, the data gathered, and the main findings. It was a structured abstract with section headings, making it clear and easy to understand. However, there were some details missing from the methods that I think could have been beneficial to the reader, including: (1) how the information was gathered (i.e., interviews, survey, chart review, etc.) and (2) the timeline for the postpartum follow-up data point (i.e., 6-week postpartum follow-up visit). If this information had been included in the methodology section of the abstract, it would have been clearer that this was a retrospective chart review with the main data points being captured at hospital discharge and 6-weeks postpartum. Problem, purpose, research question(s) & hypothesis(es): The authors clearly state what the problem is. In the introduction, the authors describe the CenteringPregnancy model for prenatal care in contrast to the traditional individual format. The problem is presented in the sentence, “Only a handful of studies have examined whether CenteringPregnancy Group prenatal care has an effect on breastfeeding, and the result has been inconsistent.” The authors stated the purpose of the study in the statement, “The objective of this study is to examine the effects of group-delivered (CenteringPregnancy) versus individual prenatal care on breastfeeding outcomes among women receiving prenatal care at four sites in Tennessee”. The purpose of the study is also stated in the discussion section: “The purpose of this study was to compare breastfeeding outcomes for women who received two formats of prenatal care at four sites in Tennessee. The purpose is realistic since they focus on a specific population, four sites in Tennessee. The focus is also direct and attainable because it centers on the effects on breastfeeding outcomes of these two different methods of prenatal care delivery. The problem statement does not contain a general description of the population. The authors mention that the group comprises women receiving prenatal care at four sites in Tennessee. The authors did not explicitly state the research question. Instead, the authors implied the research question. In the last paragraph of the introduction, just before the statement of the study’s purpose says, “To contribute further evidence to this unresolved question,” Therefore, it disguises the question. The reader can infer the question: What are the effects of group delivered versus individually-delivered prenatal care on breastfeeding outcomes? I understand that the question relates to the research’s purpose since it is implied one is connected to the other. In the method section, the authors described that the study was a quasi-experimental research design with propensity score matching to compare breastfeeding outcomes for women receiving prenatal care delivered in a group (CenteringPregnancy) versus individual format. The significance or importance of the study is immense as it’s looking to evaluate the effectiveness between two types of prenatal visits on breastfeeding outcomes, and the benefits of breastfeeding are well documented. The discussion also states,” This topic deserves more study to understand better the institutional factors that may inhibit or enhance the effects of group prenatal care on breastfeeding outcomes. ” This statement addresses the need to investigate further and study this issue. Variables, operational definitions, assumptions, limitations: This is a quantitative study, so the independent variable was the type of prenatal visits, and the dependent variables were breastfeeding outcomes. There weren’t any operational definitions; everything was explained throughout the text. The assumptions were not listed, but we can assume that Centering will have an effect on breastfeeding outcomes. But the limitations were. The limitations addressed are high-risk pregnancies weren’t able to enroll in CenteringPregnancy, so they were not represented in this study, breastfeeding data was only collected up to the 6-week postpartum visit as opposed to 3,6,12 months, data collection on breastfeeding at the different sites may have been “conservative estimates” on the effect of centering, lastly, it wasn’t clear what facilities were lactation friendly. Review of the literature & conceptual frameworks/model: All of the referenced literature was relevant and current for the study. The authors used a classical article Breast-feeding and cognitive development: a meta-analysis, written in 1999. There are a lot of secondary sources as the titles describe “meta-analysis” or “systematic review,” but the majority were primary as “doctoral dissertations,” government reports, and “scholarly journal articles.” Most of the references were used in the introduction to give background knowledge to further support their assumptions. Sample: The methods section clearly outlines the type of study to be a quasi-experimental research design with propensity score matching to compare breastfeeding outcomes for women receiving prenatal care delivered in a group (CenteringPregnancy) versus individual format. Since this was a retrospective chart review, they could not assign participants to specific prenatal visit formats. To try and reduce bias in the sample selection between the study and control groups, the researchers used propensity score matching to create statistically matched groups. The propensity matching utilized the following variables: demographic characteristics, pregnancy and childbirth history, and risk factors for adverse pregnancy outcomes. The researchers could not incorporate breastfeeding history into this matching, and thus this could introduce a potential bias in the sample. If participants had a previous breastfeeding experience, this could have influenced, either positively or negatively, their subsequent breastfeeding journey and, thus, the outcome being analyzed in this study. To increase the total sample size and hence statistical power, the researchers aggregated the sites and conducted statistical analysis on this combined dataset. With this, they were able to include a large sample size. Ethical considerations: The author did not specifically address the protection of the participants of the study; however, the data pulled were deidentified, which protected the participants. All sites that participated agreed to participate as part of their grant requirement. Since the data collected was not considered to be human subject research, the researchers received exempt research status from the institutional review board at Vanderbilt University. Methodology (design): This study was a retrospective chart review, with four variables under analysis: (1) any breastfeeding at hospital discharge, (2) exclusive breastfeeding at hospital discharge, (3) any breastfeeding at a 6-week postpartum follow-up visit and (4) exclusive breastfeeding at a 6-week postpartum follow-up visit. The study group was those who participated in the CenteringPregnancy group prenatal visits, and the control was a propensity-matched group who only attended individual prenatal visits. The researchers mentioned ‘history of breastfeeding’, which should have been an extraneous variable; however, this data was not available to the researchers, and thus they could not control it. This could impact the findings associated with the design. This study could be replicated since the researchers provided enough detail regarding the methodology, especially the propensity-matching process. Methodology (instrumentation and data collection procedures): Since the study methodology utilized a retrospective chart review, there was no specific instrument for this study. The researchers did, however, explain how missing data were handled in their sample selection process. The details provided would allow other researchers to replicate the study’s procedures. The researchers did comment on the reliability and validity in the discussion section, citing that the availability of breastfeeding data in patient charts varied and was more common in the patient charts associated with those who participated in CenteringPregnancy. They provided a thorough explanation of how missing data were handled, including the outcomes of interest and the data utilized in the propensity matching. Researchers also noted that generalizability is limited given the matching procedure where those with rare medical conditions and those who attend less than five prenatal care sessions throughout their pregnancy were excluded. Results: The results section flows nicely from the methods section, starting first with a brief recap of the sample size and analysis process. The results are presented as odds ratios (ORs_ measuring the difference in the odds of breastfeeding at two-time points (discharge or follow-up) for women in CenteringPregnancy versus individual prenatal care. The results included both any breastfeeding as well as exclusive breastfeeding at these two-time points. Researchers only found a statistical difference in the aggregated dataset for any breastfeeding at discharge. Women in CenteringPregnancy were significantly more likely to report any breastfeeding at discharge, more than twice the odds of a woman in individual prenatal care breastfeeding at discharge. The researchers also showed the results broken down between the four sites included in the study; however, the sample size for these sites varied. The results confirmed the hypothesis that CenterPregnancy improves the likelihood of breastfeeding at discharge but failed to confirm the hypothesis that CenteringPregnancy enhances the likelihood of breastfeeding at 6-week follow-up when compared with those who only attended individual prenatal visits. Also, within the results section, researchers provided a demographics table for the participants included in the study from the four sites. It would have been nice to have an additional demographic column for the aggregate sample across all four sites. Data analysis: The statistics used were to identify the current stance on breastfeeding in the US and specifically in Tennessee. “Multilevel mixed-effects logistic regression models” were used for data analysis. This was to avoid and reduce any propensities of the scores, clustering within sites, and human biases. This helps the reader put the results found into perspective. The results are explained but also shown in many charts. This is helpful to see the data together and organized. The charts are easy to understand and descriptive. Summary and conclusions: I learned from this study that CenteringPregnancy was piloted in the early 1990s by a nurse-midwife, Sharon Schindler Rising, who initiated centering groups in a hospital clinic, a community health center, and a private office in Waterbury, Conn. There are sites in almost all 50 states and some foreign countries. The claim is that these groups promote better birth outcomes, more provider and patient interaction, patient empowerment and learning, patient self-care, and encourage and support friendship among group members. This is possible since the environment and setting could promote and improve the outcomes. The authors provided convincing arguments about the importance of the People 2020 goals for breastfeeding, which are 82% of infants ever being breastfed. They noted that the gap between actual and recommended practice is 15% for CenteringPregnancy prenatal care. In contrast, the gap for traditional prenatal care participants is 30%. These numbers show that humans are social beings, and they thrive in groups. Significance for your study problem: This study does relate to my proposed study because it is about postpartum. My proposal study is not directly associated with breastfeeding outcomes. It also resonates with my proposal research because it focuses on improving the outcome. Although the effects are different, the ultimate goal is the person’s well-being. I can, however, utilize similar data collection methods, retrospective patient chart analysis. The authors proposed ways this article can impact the practice or future research. First, the limitations are well established, with plenty of details indicating why the limitations were a problem with the accuracy of the results. This information will help to prevent similar restrictions in future studies. An example of a critical constriction stated in this study is the need for more information regarding the validity and reliability of the breastfeeding outcome of interest. Another essential factor to highlight regarding this study is that the authors emphasized that the beneficial effects of group prenatal care could be partly a result of the delivery of care and additional support provided by CNMs, versus traditional prenatal care that physicians may primarily deliver. Additional Areas to Critique: Although the limitations were significant, there were still some useful findings from the study. The study was trying to demonstrate that breastfeeding outcomes are greater for group prenatal care than individual prenatal care. The group prenatal care is closer to People 2020 goals for breastfeeding, which is 82% of infants ever being breastfed. The results for the group prenatal care shown in this study are encouraging if compared to the individual prenatal care delivery. Other areas of critique are listed in the respective sections above. Reply to Thread

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