Projects
The Birth Place Lab (BPL), in the Faculty of Medicine at the University of British Columbia facilitates community-based participatory research and knowledge translation around equitable access to high quality maternity health care. The BPL team has convened numerous transdisciplinary teams, to address wicked problems in perinatal care. Lead Investigators, Dr. Saraswathi Vedam and Dr. Kathrin Stoll have extensive expertise in community-led design and implementation of quality improvement measures. In response to findings from their patient-oriented research, the BPL has engaged community members to co-develop instruments and accountability tools that they can use to report on their experiences of autonomy, respect and mistreatment when interacting with the healthcare system. These acclaimed tools have been applied in research and quality monitoring programs in more than 60 countries. The BPL utilize both traditional and novel digital and arts-based knowledge translation modes that are accessible, pragmatic and relevant to marginalized families, community health workers, clinicians, and policymakers.
Respectful Maternity Care Research
(Canadian Institutes of Health Research, 2018-2023)
Our multidisciplinary team has launched a national survey examining the quality of pregnancy and childbirth care in Canada, including experiences of respect, support, discrimination, and/or mistreatment. This is the first project of its kind that asked community members to select the research questions that can improve the quality of care for childbearing families in Canada. The community-based participatory approach aims to reach those who whose stories are seldom told - including people with historically under-represented identities, circumstances, or backgrounds.
(Vancouver Foundation, 2013-2015, Michael Smith Foundation for Health Research, 2017-2022)
Changing Childbirth in BC was the first study in the province to examine person-centred outcomes for pregnancy and birth. Over 4000 service users participated in the study, from all across the province. The focus of the study was to understand the experience of maternity care in BC, especially women and pregnant people from communities that are typically under-represented in research.
Learn more about Changing Childbirth in British Columbia here
(American Institute of Research)
Global implementation of the Mothers Autonomy in Decision Making Scale (MADM) and the Mothers on Respect (MORi) index, and the Mistreatment (MIST) index across diverse populations, and contexts for pregnancy and birth care.
Learn more about MADM and MORi here
Learn more about application to research and implementation for accountability here.
(Transforming Birth Fund 2014-2018, Groundswell Fund, 2018-present)
This participatory action study in the US used indicators developed and validated by service users to examine how planned place of birth, race and ethnicity affect pregnancy and birth care, experiences with respect, discrimination, or mistreatment, and access to options for care.
(UBC-UW Collaborative Research Mobility Award, Royalty Research Fund)
In development via collaboration with multidisciplinary stakeholders and Dr. Molly Altman.
(BC Support Unit - Patient Centred Measurement Cluster, CIHR IRSC)
This study aims to develop person-centered measures of respect, disrespect, racism and/or mistreatment as experienced by Indigenous families during pregnancy and childbirth. The project is led by Indigenous researchers, Dr. Rachel Olson, Co-Director of the Firelight Group and Hon. Wanda Phillips-Beck, Seven Generations Scholar, First Nations Health and Social Secretariat of Manitoba, and with the support of Elder Roberta Price and Dr. Saraswathi Vedam, Principal of the Birth Place Lab. We acknowledge that Indigenous Knowledge Keepers and Elders are integral to our project and will provide leadership throughout the community engagement phases, to ensure that Indigenous ways of knowing drive Indigenous ways of doing.
We will co-develop a roadmap and strategy for Indigenous communities to lead or meaningfully participate in maternity care research that promotes autonomy, cultural safety, and decolonizes birth research.
To find out more about the Firelight Group, please go to https://firelight.ca/.
(Canadian Institutes of Health Research, 2018-2023)
An international panel of multidisciplinary experts and Canadian service users participated in a Delphi process to select and prioritize indicators of respect, disrespect, and mistreatment that were developed, and/or validated, by service users. The Respectful Maternity Care Registry includes more than 200 indicators across 12 domains of experience of care during childbearing.
Implementation: Person-Centred Decision Making and Care
The Mothers Autonomy in Decision Making Scale (MADM) and the Mothers on Respect (MORi) index, and the Mistreatment (MIST) index have been implemented in research and quality improvement initiatives across diverse populations, and contexts for pregnancy and birth care.
MADM
The Mothers Autonomy in Decision Making scale (MADM) is a scale developed to assess women’s experiences with maternity care.
MADM
It is a reliable and valid instrument, and has been translated and validated into several languages.
MOR
The Mothers on Respect index (MOR) is a scale developed to assess the nature of respectful patient-provider interactions and their impact on a person’s sense of comfort, behavior, and perceptions of racism or discrimination.
MOR
The MOR index is a reliable, patient-informed quality and safety indicator that can be applied across jurisdictions to assess the nature of provider-patient relationships, and access to person-centered care.
MIST
The Mistreatment Index (MIST) is a set of patient designed indicators of mistreatment that align with the seven dimensions of mistreatment identified by the Bohren typology.
MIST
These were applied in a national study in the US, and have been translated into 8 languages. Pregnant persons can use this index to identify which, if any, of the dimensions of mistreatment they may have experienced in their maternity care.
(UBC Teaching and Learning Enhancement Fund)
This course includes 5 online interactive modules on person-centred decision making, inter-professional teamwork, communication, and conflict transformation in maternity care.
Click here to see a 40 second animation of our person-centred decision tool
(Vancouver Coastal Health Research Institute)
In collaboration with Dr. Sarah Munro, this project led to the development and piloting of a patient decision aid for choice of model of maternity care and place of birth for BC service users.
(Transforming Birth Fund)
The Undisturbed Labour Birth Index (ULab) is a quality care measure, based on evidence-based indicators, that can be implemented to assess pregnancy and birth care in institutions and at the clinical practice level.
(Transforming Birth Fund, Professional Organizations, sponsors)
The Birth Place Lab convened a multi-stakeholder group of leaders to develop a strategic implementation plan for emerging evidence, tools, and models of care that can eliminate inequities, and enhance quality of care across all communities.
As healthcare systems seek to reorganize and redeploy resources to protect the quality, safety, rights and dignity of pregnant people during periods of crisis, we are marshalling the collective wisdom, expertise and lived experiences of members of the Global Perinatal Task Force on Quality Perinatal Care during COVID-19. We are co-creating an accessible virtual platform to bring critical, evidence-based guidance and pragmatic information to communities globally. Together we are designing, developing, and disseminating the Quality Perinatal Services Hub (QPS Hub), an interactive, digital repository of resources and a mapping tool of culture-matched strategies that are immediately accessible to a wide range of stakeholders across multiple levels of service and connectivity.
Place of Birth and Provider
(Transforming Birth Fund)
In collaboration with colleagues at the University of Technology Sydney and a global Delphi panel of multidisciplinary experts we developed a, reliable and practical tool that can be used to rate the quality of research that examines the effects of birth place on health outcomes.
(Transforming Birth Fund)
The AIMM Study, explores the relationships between access, integration, and density of midwives in the United States with key pregnancy, birth, and newborn outcomes. Findings are now informing policy initiatives and activities at the state and regional levels.
Best Practice Guidelines: Transfer from Planned Home Birth to Hospital
What are the guidelines?
These guidelines were designed to facilitate the safe and mutually respectful transfer of care from planned home birth to a hospital.
How can I apply the guidelines?
Three model transfer forms: Maternal, Infant and Nurse are available for individual practitioners and institutions to support the implementation of the guidelines.
Best Practice Guidelines for Interprofessional Collaboration Between Community Midwives and Specialist Providers
Why do we need Interprofessional Collaboration?
Collaborative care throughout the antepartum, intrapartum, and postpartum periods is crucial to safety in all birth settings, including hospital, birth center, and home. It improves health outcomes and meets the diverse needs and preferences of families.
Details
Addressing the various levels of interactions between care providers from discussion, through consultation, collaboration, up to transfer of care from one provider to another. Best practices for community midwives and collaborating providers and system level requirements for collaborative care are identified.
The Home Birth Summits brought a cross-section of the maternity care system into one room to discuss improved integration of services for all women and families in the United States. In 2011, 2013, and 2014 the Home Birth Summits convened a multidisciplinary group of leaders, representing all stakeholder perspectives, to address their shared responsibility for care of women who plan home births in the United States.
Midwifery Workforce
(Transforming Birth Fund)
The AIMM Study, explores the relationships between access, integration, and density of midwives in the United States with key pregnancy, birth, and newborn outcomes. Findings are now informing policy initiatives and activities at the state and regional levels.
Scaling up access to patient-centered, high quality models of health care delivery is a provincial priority, yet only a small proportion of families can access midwifery care and the profession is facing numerous challenges that threaten its growth and sustainability. A study conducted by Stoll & Gallagher (2018) revealed that 40% of BC midwives have seriously considered leaving the profession in the 12 months preceding data collection and 1 in 10 were actively making plans to leave.
Informed by two years of data collection with BC midwives and midwifery leaders across the country, the Sustainable Midwifery Practice Taskforce used an appreciative inquiry framework to identify solutions to occupational stress and burnout among BC midwives. The report includes actionable recommendations at all levels, from government to the individual midwife, to help improve the sustainability of midwifery as a career in BC and enhance the wellbeing of BC midwives.
The International Confederation of Midwives recommends that all pregnant people should have access to midwifery care.
The benefits of midwifery-led care for women with complex needs are well-documented. McRae et al. (2016) published a scoping review that showed women with low socio-economic position (SEP) who had antenatal midwifery care had reduced odds of preterm births (PTB), low and very low birthweight babies (LBW) and their babies spent fewer days in the NICU, compared to women under the care of physicians. Using BC perinatal date, McRae et al. (2018 a,b) were able to demonstrate that women with low SEP, and those affected by substance use and mental illness had lower odds of small for gestational age babies, PTB and LBW.
More research is needed about the changing profile of midwifery clients over time and the lived experience of midwives caring for this population, to advocate for better supports for midwives.
Attitudes About and Preferences for Birth
An often-neglected consequence of the institutionalization of childbirth is that children have no or few opportunities to observe and learn about birth. Childbirth is something that happens at the hospital, behind closed doors. Over the past ten years Dr. Stoll has worked with a team of midwifery and nursing researchers from eight countries, to understand the attitudes of young people towards birth. We demonstrated empirically what we already knew anecdotally: lack of exposure to and lack of knowledge of birth is linked to increased fear. Fear, in turn, is linked to preferences for Cesarean section and other interventions.