Medicine and Health Sciences Commons^™

Circumcision For The Male Infant: Patient Education And Cultural Humility, Grace E. Eisenbiegler

Family Medicine Clerkship Student Projects

Male circumcision is a religious and cultural decision that has become increasingly medicalized. Many families make decisions about circumcision based on culture and family without true informed consent. There is a need for unbiased information, prior to delivery, about circumcision, so that families may make an informed decision that is right for them. A one page document was created as an addition to the clinic's pregnancy guide with information on risks and benefits of circumcision, complications associated with the uncircumcised penis, cultural significance, and care of the uncircumcised penis.

Increasing Vaccination Rates In Pregnancy Using A Multifaceted Approach Including Patient Education And Reminder/Recall Interventions, Jas Tiara Mcgee

Evidence-Based Practice Project Reports

Given the global tragedy that this most recent pandemic has caused, more attention has been given to the devastating outcomes that the spread of infectious disease outbreaks can have. Similar to those with comorbid conditions, pregnant women are also extremely vulnerable to infectious diseases, as disease manifestation does not only affect the mother, but the fetus as well. Thus, the prevention of both the influenza virus and pertussis are two major goals when providing care for this population. Preventing both of these disease processes during the intrapartum period helps to ensure optimal wellness for both mother and baby and overall …

Perinatal Maternal Mood Disorders, Sarah Elizabeth Hirsh Cokenakes, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

1. To identify the spectrum of peripartum mood disorders, their features, diagnostic criteria, and treatments.
2. To review FDA pregnancy safety categories and lactation categories for commonly prescribed mood medications.
3. To identify the role of family physicians in identifying and treating peripartum mood disorders.

Community Resources Addressing Peripartum Depression, Tiffany L. Lao

Family Medicine Clerkship Student Projects

Peripartum mood disorders affect a large proportion of new mothers as well as their families, partners, and support systems. This project aims to provide patients with information about peripartum mood disorders as part of their initial prenatal packet. Also included are a list of local community resources specifically addressing peripartum mood disorders for patients seeking additional support outside of their primary care office.

Resource To Address Pandemic-Related Anxiety And Depression For Pregnant Patients In Vermont, Mohammed Wali

Family Medicine Clerkship Student Projects

The 2019 novel coronavirus (COVID-19) has led to patient deaths, strained health care systems, and economic uncertainty. Distress during pregnancy can lead to adverse outcomes for both parent and baby. A patient-friendly handout was created for pregnant patients to offer reassurance, incorporate mind-body recommendations to address stress, and offer screening tools to empower them to address mood concerns with their obstetric providers in the COVID-era.

Emerging Themes In Food Security: Environmental Justice, Extended Families And The Multiple Roles Of Grandmothers., Ethel Alderete, Lauren Sonderegger, Eliseo J Pérez-Stable

Articles, Abstracts, and Reports

BACKGROUND: Pre- and perinatal nutritional status defines the development of adult metabolism and energy balance in humans. Young children in poor households are disproportionately more vulnerable to food insecurity given the cumulative impact of chronic stress on susceptibility to chronic diseases as an adult. Qualitative studies focusing on the experience of food insecurity in Latin America are scarce. In Argentina, although socioeconomic indicators improved in the aftermath of the 2001ecomomic crisis, the disadvantaged provinces in the north continue to bear the burden of historical inequities. The study was conducted among Primary Health Care patients in the city of San Salvador …

Postpartum Contraception Education, Erin E. Hunt

Family Medicine Clerkship Student Projects

The current standard of practice for postpartum contraception in Plattsburgh, NY, as well as much of the United States, is initiation of contraception at the standard 6 week postpartum visit. However, many women may be better suited for immediate postpartum contraception while still hospitalized in labor and delivery. Long acting reversible birth control (LARC), including hormonal IUDs, copper IUDs, and progesterone implants, were the contraception types focused on in this project. Family medicine residents at CVPH reported low confidence in postpartum contraception as a whole. Furthermore, they reported limited knowledge on immediate postpartum contraception. The primary aim of this project …

Establishing A Pediatric Prenatal Visit At The Health Center (Thc) In Plainfield, Vt, Katherine Price

Family Medicine Clerkship Student Projects

The AAP has long recommended a prenatal visit as part of the continuum of well-child care. However, this visit is underutilized by new families. Most prenatal education focuses on labor and childbirth with little to no information about parenting and the postpartum period. The PRAMS VT Survey 2012-2014 identified “a class for new parents (parenting, not childbirth)” as a requested resource by respondents. The pediatric prenatal visit provides infant care guidance and can connect families with community organizations that provide postpartum education. The Health Center (THC) does not currently have an established pediatric prenatal visit for expecting parents.

Contingency Management For Smoking Cessation In Pregnancy, Jacob Miller, Brady Reynolds, Courtney Crain, Hisham Keblawi, Lynne J. Goebel

Marshall Journal of Medicine

This pilot study examined the feasibility of applying Contingency Management (CM), where the woman receives financial compensation for abstinence from smoking. Eleven subjects were recruited from Marshall’s OB clinic for the program. CO levels were measured daily using online video recording. Quit rates were determined at the end of pregnancy. Birth outcomes were measured at delivery. 21 pregnant smokers from Marshall’s OB clinic were used as the control group. The results demonstrated a trend toward improved rates of smoking abstinence in CM participants as compared with the control group. Our study also showed a trend towards improved birth outcomes in …

Counseling Pregnant Women On Marijuana Use, Theresa B. Flanagan

Family Medicine Clerkship Student Projects

Marijuana is the most commonly used illicit substance for pregnant women nationwide, with rates of use trending upward. Marijuana use in Penobscot County is elevated well above the national average, and is likely to continue to rise with the legalization of recreational marijuana in the state of Maine. Though the American Congress of Obstetricians and Gynecologists (ACOG) discourages marijuana use during pregnancy and breastfeeding, studies have shown that providers do not emphasize counseling pregnant patients on marijuana use. This project looked at provider practices and perceptions regarding marijuana use during pregnancy at the Center for Family Medicine at Eastern Maine …

Talking To Your Teens About Pregnancy, Sergio Andres Munoz

Family Medicine Clerkship Student Projects

Teen parents are at risk for a variety of adverse life outcomes. The rate of low birth weight and premature delivery is higher among teen mothers than the average population. Teen pregnancy and birth are major contributors to lower educational achievement and income as they are less likely to graduate High school and college, leading to increased rates of poverty among teen mothers. This project aims to educate parents of at risk teens on how to approach the topic with their kids and to provide them with a list of online sources to aid in the process.

Marijuana Use Counseling During Pregnancy, Adam Petchers

Family Medicine Clerkship Student Projects

Penobscot County, Maine has among the highest rates of marijuana use in the country, and Maine has recently voted to legalize recreational use of marijuana. Research has shown that pregnant women frequently seek out and are dissatisfied with information regarding the safety of marijuana use during pregnancy. We surveyed Family Medicine providers at the Center for Family Medicine at Eastern Maine Medical Center in Bangor Maine regarding their counseling of pregnant patients on the topic of marijuana use. From the results, we created an information sheet to aid providers in marijuana use counseling with pregnant women.

Resources For Moms: Opiate Use In Pregnancy, Amy Schumer

Family Medicine Clerkship Student Projects

Substance use in pregnancy is not uncommon and the use of substances increases the risk of complications during pregnancy. In Vermont, opiate use in pregnancy is increasing as well as the number of people seeking treatment for opiate misuse. This project was designed to give pregnant mothers using opiates an idea of what to expect during their pregnancy as well as the resources that are available to them in the Springfield, VT area.

Patient Awareness And Understanding Of Intrauterine Devices, Lindsey Marie Eastman

Family Medicine Clerkship Student Projects

Unintended pregnancy rates in the United States are near 50%, but use of safe and effective long-acting reversible contraception methods, such as intrauterine devices, remain low compared to worldwide rates. Common misconceptions about intrauterine devices likely contribute to this stark contrast in use prevalence. This project aimed to assess patient understanding, awareness, and perception of intrauterine devices at a Family Medicine office in Connecticut. A pamphlet that includes a summary of contraception methods was produced and distributed with the goal of increasing knowledge of intrauterine devices as well as other contraception methods for patients in the primary care setting.

Tdap Vaccination In Pregnancy, Melissa N. Rafferty

Family Medicine Clerkship Student Projects

Since Maine's incidence of pertussis is higher than the national average, primary prevention through vaccination is important to protect vulnerable populations such as newborns in the state. Maternal Tdap vaccination between 27 to 36 weeks of pregnancy is recommended by ACIP to boost placental IgG transmission to the fetus and prevent newborn morbidity and mortality. For quality improvement, maternal Tdap vaccination rates were examined at Eastern Maine Medical Center Family Medicine Center and Residency and an educational handout was developed.

The Effect Of Education On Folic Acid In Women On Childbearing Age And Low Socioeconomic Status, Macey I. Bentley, Anna R. Goetsch, Courtney L. Perpich

All Electronic Theses and Dissertations

The purpose of this study was to investigate the effect of education to women of lower socioeconomic status about the importance of folic acid use before and during pregnancy. Previous research has shown the significance of folic acid in preventing neural tube defects; however, research has shown that women of lower socioeconomic status are not equipped with proper education regarding folic acid usage periconceptionally. An educational session was provided to three women’s shelters regarding folic acid, and questionnaires were used to gauge knowledge on folic acid before and after the sessions. The statistical analysis was consistent with our hypothesis in …

Opioid Abuse Treatment In Pregnancy, Catherine A. Suppan

Family Medicine Clerkship Student Projects

Opioid abuse remains an enormous issue in the state of Vermont, including among women who are pregnant. Several regional groups exist to help, support and educate women who are newly pregnant and interested in addressing their drug addiction. Knowledge of these programs, however, remains minimal. My project aimed to address the lack awareness of one of these programs in the Rutland region, BAMBI.

Assessing Barriers To Meeting Weight Gain Goals In Obese Pregnant Women, Margo Seybolt

Family Medicine Clerkship Student Projects

Obesity is a known risk factor for complications during pregnancy and birth, as well as worse outcomes. This study looked at the health risks and outcomes of pregnancy in obese women (BMI>35) at the family medicine clinic in Bangor, ME as well as what interventions are being done know to encourage women to meet their weight gain goals. Interviews and literature searches were conducted to determine possible strategies to better get obese pregnant women to meet their weight gain goals.

Application Of One Key Question At Hinesburg Family Practice, Katherine Y. Wang

Family Medicine Clerkship Student Projects

About one half of pregnancies in the United States are unintended (mistimed or unwanted). Only 54% of pregnancies in Vermont are planned and only 29% of women in Vermont have talked to a health care worker about healthy pregnancies prior to conception. Physicians are equipped to provide the necessary information to women about preconception care and contraception, but do not regularly have these conversations with the majority of their patients. One Key Question is an initiative developed by the Oregon Foundation for Reproductive Health that allows providers to screen women patients for their pregnancy intention in the next year and …

Why African-American Women Are At Greater Risk For Pregnancy-Related Death, Margaret Harper, Elizabeth Dugan, Mark Espeland, Anibal Martinez-Borges, Cynthia Mcquellon

Elizabeth Dugan

PURPOSE: Our study aim was to identify factors that may contribute to the racial disparity in pregnancy-related mortality.

METHODS: We examined differences in severity of disease, comorbidities, and receipt of care among 608 (304 African-American and 304 white) consecutive patients of non-Hispanic ethnicity with one of three pregnancy-related morbidities (pregnancy-related hypertension, puerperal infection, and hemorrhage) from hospitals selected at random from a statewide region.

RESULTS: African-American women had more severe hypertension, lower hemoglobin concentrations preceding hemorrhage, more antepartum hospital admissions, and a higher rate of obesity. The rate of surgical intervention for hemorrhage was lower among African-Americans, although the severity …

Racial Disparity In Pregnancy-Related Mortality Following A Live Birth Outcome, Margaret Harper, Mark Espeland, Elizabeth Dugan, Robert Meyer, Kathy Lane, Sharon Williams

Elizabeth Dugan

PURPOSE: African-American women have a 2- to 4-fold increased risk of pregnancy-related death compared with Caucasian women. We conducted this study to determine if differences in a combination of socioeconomic and medical risk factors may explain this racial disparity in pregnancy-related death. METHODS: Pregnancy-related deaths of African-American (N=60) and Caucasian (N=47) women were identified from review of pregnancy-associated deaths (N=400) ascertained through cause of death on death certificates, electronic linkage of birth and death files, and review of the hospital discharge database for the State of North Carolina, during the period between 1992 and 1998. Controls (N=3404) were randomly selected …

Marijuana Use Among Pregnant Women In Buprenorphine Treatment For Opioid Dependence, Tara Higgins

Family Medicine Clerkship Student Projects

New program, "Closer to Home," will allow pregnant women in buprenorphine treatment for opioid dependence to get treatment closer to home and deliver at Copley Hospital instead of being required to go to Burlington. This requires local physicians to prescribe buprenorphine to pregnant women. In creating the program, prescribing physicians have to decide policies around non-opioid substance use.