Maternal and Child Health Commons^™

A Comparative Analysis Of Group Care: Trust, Professional Identity, And Health System Structure In The United Kingdom And The Netherlands, Samantha J. Kohlmann

Senior Theses

Group prenatal care (Group Care) has been associated with improved maternal experiences and select clinical outcomes, yet less is understood about how it functions within high-resource health systems and what mechanisms underlie its impact. This study examines how Group Care is implemented in the United Kingdom and the Netherlands, with particular attention to professional roles, relational dynamics, and health system context.

I employed a qualitative, comparative design and conducted four semi-structured interviews with midwife researchers involved in Group Care implementation in both countries. Data were analyzed thematically, with attention to cross-context similarities and differences.

Findings indicate that Group Care operates …

Knowledgable Births: Advancing Informed Consent In Maternal Healthcare, Ella A. Forrester

Senior Theses

Background:

Informed consent is both a legal requirement and an ethical cornerstone of healthcare, ensuring that patients understand and voluntarily agree to medical treatments. However, evidence suggests that the informed consent process is often inadequately implemented in maternal healthcare settings, particularly during childbirth. While giving birth, women retain full decision-making capacity but are not consistently provided with sufficient information or support to exercise this right. Contributing factors include ineffective patient–provider communication, limited health literacy, and insufficient access to culturally responsive educational resources.

Methods:

This study aimed to address gaps in accessible prenatal education by developing an online resource platform, Know …

Informed Consent In Childbirth: A Global Scoping Review Of Episiotomy Practices And The Gaps In U.S. Perinatal Care, Rachel Gulczinski

Senior Theses

Informed consent is a fundamental ethical and legal component of preoperative and perinatal care and forms the foundation of trust between patients and healthcare providers. Despite this, current evidence suggests that many childbirth interventions, including episiotomies, are often performed without explicit patient consent. Episiotomy remains one of the most commonly cited interventions associated with non-consented care and obstetric violence. Therefore, this global scoping review aimed to evaluate whether informed consent is obtained for episiotomy procedures during childbirth, understand documented experiences of disrespect and unnecessary procedures, and identify differences between international and U.S. practices. This thesis followed the PRISMA Scoping Review …

Spatiotemporal Modeling Of Maternal Mortality In South Carolina 2018-2023, Leah Wood, Ray Bai, Emily Mann

Senior Theses

Maternal death serves as a public health indicator due to fact that it is considered preventable with the availability of modern biomedicine, however, it persists broadly throughout the United States. Current literature outlines national trends in maternal mortality with complicating, preexisting conditions, and structural upstream factors often cited as being the largest contributors to increased risk. This study utilizes publicly available, county-level data for maternal death in addition to demographic and descriptive data in order to estimate maternal mortality rates in each of South Carolina’s 46 counties from 2018 to 2023. In order to address sparsity in the outcome variable …

"Health Gatekeepers": The Influence Of Women On Health Practices In Rural, Central Appalachia, Reese Lycan

Senior Theses

Women have historically assumed leadership roles in familial and community health promotion, intervention, and facilitation. While the role of women in family health is globally understood and the historical importance of female leadership has been documented, there remains a gap in knowledge regarding the role of women as “health gatekeepers”. Furthermore, when considering the Appalachian region, there are limited studies regarding women’s place in leadership as far as health is concerned. Therefore, this study employs a hermeneutic phenomenological framework to explore the lived experiences of women in relation to their family and community’s health in rural, Central Appalachia- a region …

Role Of Race And Ethnicity In The Development, Diagnosis, And Treatment Of Gestational Diabetes Mellitus, Gabrielle D. Shupard

Senior Theses

Gestational diabetes mellitus (GDM) is the most common metabolic disorder of pregnancy, and rates of this disease have been steadily increasing over the past ten years. GDM disproportionately impacts racial and ethnic minorities at higher rates than their Caucasian counterparts. In this study, the PRECEDE model framework was employed during a literature review to gain a greater understanding of the complex risk factors contributing to differences in the development, diagnosis, and treatment of GDM among these population subgroups. The second part of this study concentrated on reviewing the extent to which current literature evaluates the role of race and ethnicity …

The Impact Of Discretion On Human Service Workers Supporting The Health Of Unaccompanied Minors In Foster Care, Diana M. Clark

Senior Theses

Unaccompanied children (UCs) are a vulnerable population that enters government custody and accesses healthcare via the Office of Refugee Resettlement (ORR)'s system of care. While prior research has focused on generating policy recommendations to improve healthcare services available to UCs both in ORR custody and following release from custody, this thesis will instead expand upon the experiences of staff members working at ORR-contracted agencies. These workers make decisions that have short- and long-term implications on the health and wellbeing of UCs. Drawing from 65 in-depth interviews with human service workers in ORR-contracted voluntary agencies, this thesis uses street-level bureaucracy framework …

A Historical Analysis Of Infant Mortality In South Carolina From 1920-1970, Allison Ritchie

Senior Theses

This study uses Geographic Information Systems (GIS) to investigate racial and spatial inequalities in South Carolina infant mortality rates (IMR’s) between 1920-1970. In the 20th century, IMR’s declined throughout the United States, primarily due to economic growth, increased sanitation, and improved medical knowledge. Factors such as systemic racism and lack of healthcare access resulted in higher IMR’s for Black infants and infants living in rural areas. In 1920, South Carolina’s Black IMR was 1.5 times higher than the white IMR; by 1970 the difference expanded to 1.9, reflecting a 27% rise. The disparity between Black and white IMR’s increased in …

A Comparative Analysis Of Adolescent Pregnancy Patient Outcomes In The United States And United Kingdom Healthcare Systems, Liza Hopper

Senior Theses

Individuals all across the world should have equal access to healthcare. However, one’s ability to receive and afford quality care differs between countries. Comparing the differences in healthcare structures in both the UK and the US provides great insight into how certain welfare models affect patient outcomes. In this project, I discuss the functionality of the healthcare systems in the UK and the US. Then, by delving into how they relate to adolescent pregnancy patient outcomes, one can compare how the healthcare policies relate to the patient outcomes of a vulnerable population group. In both countries, adolescent mothers, those who …

Comparative Medicaid Policy Analysis Related To Maternal And Infant Birth Outcomes In South Carolina, Cassidy L. Lena

Senior Theses

The United States despite being one of the most industrialized and wealthiest nations in the world, has the worst maternal and child health outcomes of any industrialized nation. The rates of maternal morbidity, mortality, and infant mortality have been increasing within the past decade, when many causes of death for this population are preventable. This study conducted a literature review on Medicaid policies and associated programs between three states (South Carolina, North Carolina, and California) in order to gain background information. Secondly, a comparative Medicaid policy analysis was completed using the Centers for Disease Control and Prevention [CDC] framework, which …

The Intersectionality Of Race And Rurality In Polysubstance Use During Pregnancy In The United States: A Study Of National Survey On Drug Use And Health, Sophia Tavakol

Senior Theses

Importance: Though detrimental consequences, many pregnant individuals are still binging alcohol, smoking, and/or using illicit drug. Yet, little is known regarding variations in such behaviors across pregnant people in the United States.

Objective: To examine alcohol, tobacco, and drug use during pregnancy in 2015-2020 and assess their racial, ethnic, and rural disparities.

Design: This cross-sectional descriptive study derived maternal characteristics and self-reported prenatal substance use data from 2015 and 2020 National Survey on Drug Use and Health, considering the complex sampling weight per participant per year produced by NSDUH.

Setting: United States.

Participants: A scientific random sample of non-institutionalized residents …

“The Worst Part About My Pregnancy Was Stuff That Didn’T Have To Do With My Pregnancy”: Medicaid Beneficiaries’ Pregnancy Intentions & Experiences In South Carolina, Andrew Michael Chen

Senior Theses

Low-income women and women of color experience adverse birth outcomes at disproportionately higher rates in the United States than most people who give birth. This thesis examines individual interviews conducted with 30 low-income women whose most recent birth was covered by Medicaid, the United States’ largest means-tested public health insurance program. The aim of this thesis is to examine how the women in the study thought about pregnancy, and how they described their intentions to become or avoid becoming pregnant at various times in their life. While public health researchers often frame pregnancy as an event that is either intended …

Application Of The Precede-Proceed Planning Model In Designing An Infant Mortality Mitigation Strategy, Alexandria Hawkinson

Senior Theses

In this paper, I present a clinical intervention strategy aimed at mitigating infant mortality rates through application of the PRECEDE-PROCEED planning model. These steps involve analyzing the social implications of infant mortality among non-Hispanic black women in the state of South Carolina and identifying contributing factors of preterm birth via a thorough literature review. After concluding that adverse childhood experiences are linked to preterm birth and its contributing factors, I utilize the Health Belief Model to develop a health promotion program titled Empowered Mothers of South Carolina. This program works towards increasing acknowledgment of adverse childhood experiences and implementation of …

Relation Of Breastfeeding Duration With Blood Pressure And Arterial Stiffness, Lohita Kollipara, Abbi Lane-Cordova, Xuewen Wang

Senior Theses

Background: The purpose of this analysis was to investigate the effects of differing breastfeeding duration on vascular function.

Methods: A study was designed to explore the breastfeeding patterns of 79 participants who delivered a singleton fetus 6 months-3 years ago and were aged 18-45 years old. Participant breastfeeding and dietary habits were self-reported using surveys. Breastfeeding groups were established by following the American Association of Pediatric guidelines on breastfeeding duration: Women who did versus did not breastfeeding for 6 months continuously. Blood pressure was measured using a standard oscillometric cuff, while SphygmoCor® technology was used to measure pulse wave velocity. …

The Effects Of The Use Of Medical Interpreters Amongst The Latina Population In The Context Of Sexual And Reproductive Health, Carson Collins

Senior Theses

The Latino population in the United States is large and consistently growing. These individuals, due to cultural and systemic factors, are at greater risk for a variety of health problems, especially in the context of sexual and reproductive health. Many of these patients may not speak English as their first language and thus need to access interpretative services to receive care. This study sought to examine whether medical facilities using certified medical interpreters and requiring cultural competency training for their staff could reduce the cultural and communication barriers LEP Latinas experience when receiving sexual and reproductive health care services. An …

A Comparison Of The United States And Costa Rican Health Care Systems And Their Influence On Immigrant Women's Maternal And Child Health Outcomes, Tamera R. Sullivan

Senior Theses

Health is a fundamental right for all humans, and every nation has a unique system for health care delivery. While the United States and Costa Rica follow two different welfare state models, there is still value in comparing the two countries. This project was inspired by my public health-based study abroad experience in Costa Rica in May 2018, which sparked a desire to learn more about the structures that form the health care system of each country. The United States has a more privatized and fragmented health care system, while Costa Rica has a public, universal health care system. Although …

An Investigation Into The Relationship Between Academic Pressure And Non-Medical Prescription Stimulant Use Among University Of South Carolina Undergraduate Students, Arslan Valimohamed

Senior Theses

One hundred and six undergraduate students of the University of South Carolina were surveyed to understand misuse of prescription stimulants and how perceived academic pressure may play a role in this behavior. Overall, the survey revealed that 33.0% of participants reported illicit use of prescription stimulants in the last 30 days, and 52.8% reported illicitly using prescription stimulants at least once during their time in college. Data from the survey responses indicated that students perceiving academic pressure were more likely to have misused prescription stimulants at least once during their time in college, but only if these students also reported …

"Transforming Care Through Disruptive Design": Incorporating A Midwifery Model Of Care Into Obstetric Practices, Lauren Marsh

Senior Theses

Maternal and child health outcomes in the United States are far poorer than in other industrialized nations. To improve women’s experiences with the maternity care system, nurse-midwife Sharon Schindler-Rising developed the CenteringPregnancy (CP) group model of prenatal care (PNC). Research comparing CP with ‘traditional’ one-on-one PNC has found that implementing CP results in decreased rates of preterm birth and low birth weight, increased rates of breastfeeding, and improved outcomes for women who typically experience health disparities, including African Americans. Documented success of the model in the Greenville Health System convinced the South Carolina Department of Health and Human Services of …

Exploring Obstacles To Perinatal Care-Seeking Behavior In Women Of Rural Odisha, India Using A Community Based Participatory Research Approach, Sarah Law, Runjhun Bhatia

Senior Theses

This project resulted from collaboration between USC student organization GlobeMed and the Alternative for Rural Movement (ARM), a non-governmental organization in Odisha, India. Rajendra Rana, the head of ARM, expressed the need to delineate the factors underlying the tendency of rural Odishan women to deliver with unskilled birth attendants as opposed to institutionally. A literature review was conducted to explore possible economic, cultural, and social factors. During five weeks in Odisha, discussions with women's groups, community health workers, and ARM staff members built on the literature review. A preliminary survey and plan for its dissemination were developed. The community based …