Publications by Year: 2026

OBJECTIVE: To measure clinician continuity during pregnancy care and contextualize the findings with patient experiences of clinician continuity and their influence on trust-building.

METHODS: We conducted a convergent mixed methods study that examined the number of clinicians seen for all patients who gave birth at a large academic medical center between June 2023 and May 2024. Statistical analyses were performed across demographic subgroups with number of clinicians seen during pregnancy care as the primary outcome and the proportion of visits with the most frequently seen clinician as the secondary outcome. Multivariable Poisson regression models were used to control for covariates. Purposive sampling was used to select a subset of English- and Spanish-speaking patients for semi-structured interviews. Participants completed a short sociodemographic survey and interviews exploring perceptions of clinical continuity, factors that build or erode trust, and patients' recommendations for pregnancy care. Interviews were transcribed and analyzed using content analysis. Two researchers met to iteratively refine the codebook, discuss discrepancies, and reach consensus.

RESULTS: We identified 2395 patients with eligible visits for the retrospective cohort. Total visits ranged from two to 38 (median 13, interquartile range [IQR] 10-15) with a median of 4 clinicians seen during pregnancy (IQR 3-5). Participants in the resident practice and hospital-based maternal-fetal medicine practice saw more clinicians (7, IQR 6-9 and 5, IQR 3-7, respectively; p < 0.001). Overall, 21.0% of patients had one or more visit with the obstetrician who was present at delivery. The qualitative phase included 14 participants with a median age of 31 years (IQR 28-35). Most participants valued continuity of care; discontinuity of care was a driving factor of patient-clinician trust erosion. Participants recommended clinical continuity as a strategy to improve pregnancy care.

CONCLUSION: Clinician continuity during outpatient pregnancy care varied by clinician type, practice, clinical site, and patient factors. Participants highly valued continuity of care, which was associated with greater trust and improved care experiences.

OBJECTIVE: This study examines whether hospitals with stronger patient safety culture more consistently follow essential birth practices and have fewer adverse outcomes for mothers and newborns and whether this evidence can guide maternity care priorities in patient safety policy.

METHODS: We conducted a multicenter cross-sectional study in six public maternity hospitals in Brazil (November 2022 to February 2024). In each hospital, we measured patient safety culture using the Brazilian version of the Hospital Survey on Patient Safety Culture. From a systematic sample of 2183 births (approximately 360 per hospital), we reviewed charts to record eight essential obstetric and neonatal practices and 10 adverse outcomes. We created hospital-level composites for the practice bundle and adverse outcomes and correlated them with culture scores using Spearman coefficients (one-sided exact P-values).

RESULTS: A total of 686 professionals responded to the survey, with a mean overall culture score of 43.6% (range: 29.5%-56.4%). "Perception of safety" and "non-punitive response to errors" were consistently low, while "management expectations," "organizational learning," and "teamwork within units" were relative strengths. Adherence was high for postpartum oxytocin (93.4%), vitamin K (95.9%), and newborn identification (91.1%), and low for partogram initiation (36.4%), birth companion (48.1%), and breastfeeding within the first hour (47.5%). Culture scores aligned positively with the practice bundle (ρ = 0.77; P = 0.072) and inversely with adverse outcomes-maternal (ρ = -0.77; P = 0.072), neonatal (ρ = -0.89; P = 0.019), and total (ρ = -0.94; P = 0.005).

CONCLUSION: Findings support pairing culture-strengthening actions with clinical bundles to promote safer childbirth and prioritize maternity services in safety policy.