Rachel Blankstein Breman

Pregnant woman with nurse

Rachel BremanResearcher:

Rachel Blankstein Breman, PhD ’18, MPH, RN, assistant professor

Areas of Expertise:

Breman specializes in maternal health, intrapartum care, shared decision-making, implementation and dissemination research, and outcomes research.

The BIG Idea:

Breman’s work is aimed at improving care for individuals throughout pregnancy, labor, and birth via improved communication and respectful maternal care and by using a lens of reproductive justice as a guide.

Breman is a University of Maryland, Baltimore Institute of Clinical Translational Research KL2 Scholar, and when her original study exploring the feasibility of a shared decision-making tool for birth was put on hold due to the COVID-19 pandemic, she turned to pregnancy-tracking apps to investigate the experience of pregnant people during pregnancy and after childbirth.

In September, she published with colleagues “Pregnant Women’s Reports of the Impact of COVID-19 on Pregnancy, Prenatal Care, and Infant Feeding Plans” in MCN, The American Journal of Maternal/Child Nursing. This publication was informed by surveys conducted March 1 - May 27, 2020, of women who were pregnant during the COVID-19 pandemic. 

In a separate survey of people who gave birth between March 1 and June 11, 2020, Breman found that our health care systems need to identify better ways to support the birthing and postpartum population. In this survey, women reported getting discharged early because of COVID-19, some as early as 24 hours after vaginal birth or 48 hours after a cesarian delivery. And many of these women then found themselves at home with a new baby, often with other children to care for and without assistance from partners who had to return to work. Many survey respondents indicated that grandparents couldn’t offer support due to pandemic-related health risks.

Why does the research matter?

The United States has one of the worst maternal mortality ratios in the world for developed countries, and the outcomes are far worse for women of color, according to research published by Obstet Gynecol. “There’s no reason for it, and it shouldn’t happen,” Breman says. “Black women shouldn’t be dying more. Indigenous women shouldn’t be dying more. We should have a system that is based on justice and equity, where we listen to the birthing population.” 

Breman’s research is focused on communication. She explains that providers need to listen to their patients and then adjust health care plans accordingly, after considering what the individual needs and wants. 

“I don’t want to read another story that there was a maternal death and that the health care staff didn’t listen to the woman,” Breman says.

And with the COVID-19 pandemic comes a new set of challenges, including those related to isolation. In the two surveys conducted by Breman, women reported being worried about testing positive for COVID-19, having COVID-19 and passing it to their baby, and being separated at birth (which is not a World Health Organization recommendation). One mother in Georgia reported being separated from her twins after birth and being forbidden from seeing them in the neonatal intensive care unit (NICU) for two weeks, missing important opportunities for bonding and breastfeeding. 

“We need to be sure hospitals are very clear about what their policies are and what will be happening during labor and after birth,” Breman explains.

Who does the research matter to?

As Breman puts it, none of us would be here without safe motherhood. “We should all care deeply about maternal health and reproductive justice at all levels,” she says.

Her research is important to health care providers, to birthing populations, and to the families that are being created.

“I hope that we can improve communication to address the needs of the patient, to provide care that is patient centered, respectful, and that could theoretically save costs,” Breman says. “There is a huge population of women who do not want a lot of interventions during birth. Yet, we have created a system that supports more birthing interventions.”

What are the clinical applications of the research?

“These women are isolated,” Breman says of the women surveyed who gave birth during the pandemic. “Many reported feeling anxiety, stress, loneliness, lack of support, and they talked about how they were unable to have help." 

Although patients say they understand that the pandemic necessitates different approaches, health care providers still need to ensure each patient’s needs are being addressed, Breman explains. “A lot of it is about communication,” she says. “Making people aware of what the hospital policies are, finding out what these families need, and figuring out how can we be creative in achieving that during the COVID-19 pandemic.”

Breman says providers need to offer clear guidelines to new mothers. “Who is safe to come over and provide support to these new parents? They need it. They are already at risk for postpartum depression,” Breman explains. This support could include a postpartum doula, a family member, or both if everyone follows COVID-19 prevention guidelines. New parent groups have also moved to online formats and could provide additional support as well.

Breman’s work also considers how virtual visits can be improved. “Can we intervene earlier for postpartum support? If a new mother gets discharged early, can providers do a Zoom call on day three instead of waiting six weeks?” she asks. And she recognizes the need for balance between keeping everyone safe during the pandemic and also providing patient-centered care that is really family-centered care. She indicates that family-centered care should involve both parents, such as including partners during prenatal care, during birth, in the NICU, and even at pediatric appointments for the newborns.

The next step for Breman’s research is exploring birth preferences, communication, and shared decision-making through the perinatal continuum. This work deepens the focus on supporting and advocating for pregnant people’s voices in their care during birth.

Read Breman's article "Giving birth during the COVID-19 pandemic, perspectives from a sample of the United States birthing persons during the first wave: March - June 2020," published in Birth: Issues in Prenatal Care in June 2021.