How do you improve the health of women and children during pregnancy, labour, and early motherhood?
Drawing on a clinical background in high-risk obstetrics, labour and delivery, and public health, the goal of Christine Kurtz Landy’s research is to improve the health of women during their reproductive years. Through her research, she hopes to inform good public policy decisions and promote high-quality healthcare that will support women and their families.
I’m interested in equity and social justice. Children are among the most vulnerable of our society, so to ensure their well-being, it’s critical that we look at the health of parents. The most vulnerable have the lowest incomes and are most often single-parent families led by women. In 1995, Statistics Canada published a study that found the number one reason women become poor is having children.
The health of children really depends on the health of the family.
I’m a member of a research team doing the process evaluation of the implementation of an intervention called “the Nurse Family Partnership” within the BC Health Beginnings Project. This intervention involves intensive home visits by a nurse from twenty-nine weeks of pregnancy until the child is two years old. It has been shown to improve both maternal and infant outcomes in low-income first-time mothers. It is expensive up front, but the evidence demonstrates that it is cost effective in the long run. Studies in the United States have shown that having intensive home visits improves short and long term outcomes in both the child and the mother, including shorter periods on social assistance, more spacing between babies and lower school attrition rates.
Another focus of my research is pain and labour. I’ve been working with an anesthesiologist for about 10 years to develop a high quality pain measurement tool to measure quality of pain relief during labour. One of the major problems with existing tools is that they there were not developed on laboring women. Although we haven’t proven it yet, we are starting to recognize patterns; we can almost predict who is going to end up having a Cesarean section by looking at laboring women’s pain patterns.
One of the things I’m proud of is a critical study that I did examining the social construction of health inequities in new mothers who are low income. I found that health inequities during early motherhood are in some ways entrenched in policy. The way the government has set up maternity benefits linked to unemployment insurance renders women on maternity leave, who have no other income, below the low-income cut off. They are often topped up by welfare. Our policies make the assumption that everyone has a partner, and everyone is middle class, when that is clearly not the case.
The rates of Cesarean section in Canada are well above the rates recommended by the World Health Organization. Many women with a previous Cesarean birth, although eligible for a trial of labour, are having elective, non-medically indicated, repeat Cesarean sections. This trend is contributing to the rise in Cesarean rates and puts mothers and their infants at unnecessary risk. It also burdens our already over-extended healthcare system and human resources. With funding from CIHR, I’m leading a province-wide study looking at the factors women consider when deciding whether to have an elective repeat Cesarean section or whether to do a trial of labour. I’m also looking at the factors maternity care providers – obstetricians, family doctors, and midwives – consider when counselling women on this important decision. If we can better understand how women decide on their delivery method, and how care providers advise them, we can use that knowledge to develop strategies to ensure Cesarean births are used appropriately to optimize maternal-newborn outcomes.