Overview

My research examines how changes in health policy and clinical practice have an impact on outcomes for infants and mothers. I use quantitative methods, in particular analyzing population-based health administrative data such as routinely collected hospitalization records, physician billing claims records, and birth records. I work closely with clinicians, health policymakers, health system leaders, and patients to identify key research questions and conduct this research. Understanding how policy and practice impact health outcomes allows us to intervene at the right time and with the right solutions to improve these outcomes for infants and mothers.

Publications

Characteristics, determinants, and frequency of persistent use among prescription opioid episodes initiated postpartum: a population-based cohort study from British Columbia, Canada
L. Schummers and James Wilton and Amanda Yu and Jennifer A. Hutcheon and Jessica Liauw and Margo Pearce and Mei Chong and Stanley Wong and Younathan Abdia and Roy Purssell and Naveed Janjua Z and Jane Buxton A
DOI: 10.22541/au.169643010.04872404/v1
10/2023

Study Quality Must Be Considered When Evaluating Long-term Outcomes of Antenatal Corticosteroid Therapy in Children
JAMA Pediatrics
Schummers, L. and Hutcheon, J.A.
DOI: 10.1001/jamapediatrics.2022.2855
2022

Abortion Safety and Use with Normally Prescribed Mifepristone in Canada
New England Journal of Medicine
Schummers, L. and Darling, E.K. and Dunn, S. and McGrail, K. and Gayowsky, A. and Law, M.R. and Laba, T.-L. and Kaczorowski, J. and Norman, W.V.
DOI: 10.1056/NEJMsa2109779
2022

A more accurate approach to define abortion cohorts using linked administrative data: an application to Ontario, Canada
International Journal of Population Data Science
Schummers, L. and McGrail, K. and Darling, E.K. and Dunn, S. and Gayowsky, A. and Kaczorowski, J. and Norman, W.V.
DOI: 10.23889/ijpds.v7i1.1700
2022

Travel Time to Delivery, Antenatal Care, and Birth Outcomes: A Population-Based Cohort of Uncomplicated Pregnancies in British Columbia, 2012–2019
Journal of Obstetrics and Gynaecology Canada
Luke, S. and Hobbs, A. and Mak, S. and Der, K. and Pederson, A. and Schummers, L.
DOI: 10.1016/j.jogc.2022.04.009
2022

Short interpregnancy interval and pregnancy outcomes: How important is the timing of confounding variable ascertainment?
Paediatric and Perinatal Epidemiology
Laura Schummers and Jennifer A. Hutcheon and Wendy V. Norman and Jessica Liauw and Talshyn Bolatova and Katherine A. Ahrens
DOI: 10.1111/ppe.12716
07/2021

Long interpregnancy interval and hypertensive disorders of pregnancy: Difficulties in interpreting and translating data to clinical practice
Paediatric and Perinatal Epidemiology
Laura Schummers and Jessica Liauw
DOI: 10.1111/ppe.12795
07/2021

Early pregnancy loss incidence in high-income settings: a protocol for a systematic review and meta-analysis
Systematic Reviews
Schummers, L. and Oveisi, N. and Ohtsuka, M.S. and Hutcheon, J.A. and Ahrens, K.A. and Liauw, J. and Norman, W.V.
DOI: 10.1186/s13643-021-01815-1
2021

Birth Outcomes for Planned Home and Licensed Freestanding Birth Center Births in Washington State
Obstetrics and gynecology
Nethery, E. and Schummers, L. and Levine, A. and Caughey, A.B. and Souter, V. and Gordon, W.
DOI: 10.1097/AOG.0000000000004578
2021

Dispensing and practice use patterns, facilitators and barriers for uptake of ulipristal acetate emergency contraception in British Columbia: a mixed-methods study
CMAJ open
Chan, M.C. and Munro, S. and Schummers, L. and Albert, A. and Mackenzie, F. and Soon, J.A. and Ragsdale, P. and Fitzsimmons, B. and Renner, R.
DOI: 10.9778/cmajo.20200193
2021

Interpregnancy interval and severe maternal morbidity – What can we learn from vital records data?
Paediatric and Perinatal Epidemiology
Laura Schummers
DOI: 10.1111/ppe.12587
07/2020

Variation in relationships between maternal age at first birth and pregnancy outcomes by maternal race: A population-based cohort study in the United States
BMJ Open
Schummers, L. and Hacker, M.R. and Williams, P.L. and Hutcheon, J.A. and Vanderweele, T.J. and McElrath, T.F. and Hernandez-Diaz, S.
DOI: 10.1136/bmjopen-2019-033697
2019

Household income and contraceptive methods among female youth: a cross-sectional study using the Canadian Community Health Survey (2009-2010 and 2013-2014)
CMAJ open
Nethery, E. and Schummers, L. and Maginley, K.S. and Dunn, S. and Norman, W.V.
DOI: 10.9778/cmajo.20190087
2019

Abortion services in Canada: Access and safety
CMAJ
Schummers, L. and Norman, W.V.
DOI: 10.1503/cmaj.190477
2019

The Giving Voice to Mothers study: Inequity and mistreatment during pregnancy and childbirth in the United States
Reproductive Health
Vedam, S. and Stoll, K. and Taiwo, T.K. and Rubashkin, N. and Cheyney, M. and Strauss, N. and McLemore, M. and Cadena, M. and Nethery, E. and Rushton, E. and Schummers, L. and Declercq, E.
DOI: 10.1186/s12978-019-0729-2
2019

Absolute risks of obstetric outcomes risks by maternal age at first birth: A population-based cohort
Epidemiology
Schummers, L. and Hutcheon, J.A. and Hacker, M.R. and Vanderweele, T.J. and Williams, P.L. and McElrath, T.F. and Hernandez-Diaz, S.
DOI: 10.1097/EDE.0000000000000818
2018

Association of Short Interpregnancy Interval with Pregnancy Outcomes According to Maternal Age
JAMA Internal Medicine
Schummers, L. and Hutcheon, J.A. and Hernandez-Diaz, S. and Williams, P.L. and Hacker, M.R. and Vanderweele, T.J. and Norman, W.V.
DOI: 10.1001/jamainternmed.2018.4696
2018

Inter-pregnancy interval and pregnancy outcomes among women with delayed childbearing: Protocol for a systematic review
Systematic Reviews
Asgharpour, M. and Villarreal, S. and Schummers, L. and Hutcheon, J. and Shaw, D. and Norman, W.V.
DOI: 10.1186/s13643-017-0464-0
2017

Predictor characteristics necessary for building a clinically useful risk prediction model: A simulation study
BMC Medical Research Methodology
Schummers, L. and Himes, K.P. and Bodnar, L.M. and Hutcheon, J.A.
DOI: 10.1186/s12874-016-0223-2
2016

Risk of adverse pregnancy outcomes by prepregnancy body mass index : A population-based study to inform prepregnancy weight loss counseling
Obstetrics and Gynecology
Schummers, L. and Hutcheon, J.A. and Bodnar, L.M. and Lieberman, E. and Himes, K.P.
DOI: 10.1097/AOG.0000000000000591
2015

The Canadian birth place study: Examining maternity care provider attitudes and interprofessional conflict around planned home birth
BMC Pregnancy and Childbirth
Vedam, S. and Stoll, K. and Schummers, L. and Fairbrother, N. and Klein, M.C and Thordarson, D. and Kornelsen, J. and Dharamsi, S. and Rogers, J. and Liston, R. and Kaczorowski, J.
DOI: 10.1186/1471-2393-14-353
2014

Home birth in north America: Attitudes and practice of US certified nurse-midwives and Canadian registered midwives
Journal of Midwifery and Women's Health
Vedam, S. and Stoll, K. and Schummers, L. and Rogers, J. and Paine, L.L.
DOI: 10.1111/jmwh.12076
2014

Assessment of the Midwifery Education Program at the University of British Columbia: A survey of the first 5 cohorts of graduates and midwife mentors.
Canadian Journal of Midwifery Research and Practice
01/2013

Obstetrician, Family Physician, or Midwife: University Students’ Birthing Preferences
Canadian Journal of Midwifery Research and Practice
04/2012

The Canadian Birth Place Study: Development, validation, and administration of a questionnaire to multi-disciplinary maternity care providers.
Canadian Journal of Midwifery Research & Practice
01/2012

The Canadian Birth Place Study: Describing maternity practice and providers' exposure to home birth
Midwifery
Vedam, S. and Schummers, L. and Stoll, K. and Rogers, J. and Klein, M.C. and Fairbrother, N. and Dharamsi, S. and Liston, R. and Chong, G.K. and Kaczorowski, J.
DOI: 10.1016/j.midw.2012.06.011
2012

Applying the “Three Delays Framework” to examine maternal mortality in Uganda.
International Journal of Childbirth
2011

Nurse-midwives' experiences with planned home birth: Impact on attitudes and practice
Birth
Vedam, S. and Stoll, K. and White, S. and Aaker, J. and Schummers, L.
DOI: 10.1111/j.1523-536X.2009.00354.x
2009

Research

Optimal pregnancy spacing for high-risk obstetric populations
Closely spaced pregnancies have poor maternal and infant outcomes. Existing guidelines recommend waiting from at least 18 to 24 months following previous childbirth until becoming pregnant again. It is not known, however, whether these guidelines suitable for all women. Women with a prior history of poor outcomes might have different optimal interpregnancy interval pertinent to them and waiting for 18 months might be associated with adverse outcomes. For example, among women who had pregnancy loss, current recommendations to wait 18 months before their next pregnancy may prolong their grief and emotional stress, whereas for women with a history of subfertility, waiting the recommended 18 months may increase their risk of infertility due to advancing maternal age.

In this project, we will study whether associations between short intervals and adverse outcomes are the same or different among women with poor outcomes in the first pregnancy (fetal or newborn death, history of infertility treatment, or preterm delivery) and among women with good outcomes in the first pregnancy. This will help us to create guidelines on optimal birth spacing for women with the poor outcomes in their first pregnancies. We will use a high-quality, population-based cohort including all pregnancies in British Columbia from 2004 to 2014 to examine relationships between pregnancy spacing interval and adverse outcomes (fetal or newborn mortality, poor fetal growth, preterm delivery) for women with a fetal or newborn death, infertility treatment, or preterm birth in the first pregnancy. Study findings will inform women’s and families’ pregnancy spacing decisions to achieve the best pregnancy outcomes they can. These findings will guide clinicians providing counselling on optimal pregnancy spacing for women in these high-risk groups. Optimal pregnancy spacing for these high-risk populations may enable prevention of recurrent complications (preterm delivery or fetal/neonatal death) and improve fetal and infant health outcomes in each of these groups.

Postpartum prescription opioid use
There are growing concerns that opioid prescriptions related to childbirth may be contributing to the opioid epidemic. In the US, over 50% of opioid-naive women are prescribed an opioid in the postpartum period, including 80% after cesarean delivery and 29% after vaginal delivery. Of these, 1-2% are still using an opioid 6 months postpartum. Postpartum opioid prescribing has been identified as a potential clinical area in which new opioid prescribing could be reduced, particularly to prevent new long-term or chronic opioid use in this population. To this end, the American College of Obstetricians and Gynecologists published clinical postpartum pain management guidelines in 2018, which recommend multimodal pain management approaches that reserve opioids for breakthrough pain relief. These recommendations emphasize the importance of postpartum pain treatment to reduce risks of postpartum depression and other adverse outcomes.

In Canada, however, our understanding of postpartum use of prescription opioids is limited. The frequency of opioid prescribing after cesarean or vaginal delivery in Canada is not known, nor how frequently initial postpartum opioid prescriptions progress to persistent opioid use. The Society of Obstetricians and Gynecologists of Canada (SOGC) has published guidelines on pregnancy care for women using opioids in pregnancy, but has no specific recommendations for postpartum pain management. Patterns of opioid prescribing after routine surgery (laparoscopic cholecystectomy, laparoscopic appendectomy, arthroscopic knee meniscectomy, and breast excision) are similar between the U.S. and Canada, at 76% and 79% respectively. However, there are many differences in obstetrical practice between the U.S. and Canada, so it is not clear whether postpartum pain management practices are similar or different between these jurisdictions.

The objectives of this study are to determine the frequency of postpartum prescription opioid dispensation and progression to long-term use in British Columbia, variation by obstetric and sociodemographic characteristics, and temporal trends. Optimal postpartum pain management (including judicious use of prescription opioids) may facilitate mother-infant bonding, breastfeeding success, and long-term health of the mother-infant dyad.

Health policy impacts on pregnancy timing and spacing
Inadequate and inequitable access to contraception services have limited the ability for populations across Canada to optimally time and space their pregnancies. For equity deserving populations, particularly rural and remote, adolescent, gender-diverse, and racialized groups, inadequate access to the most effective contraception is a barrier to preventing unplanned pregnancy – a key reproductive population health indicator. In these groups, mistimed or unwanted pregnancies continue to be frequent, leading to poor reproductive outcomes, exacerbating health inequity, and limiting economic gender equity.

The most effective forms of contraception are long-acting reversible contraception, which includes intrauterine contraceptive devices (IUDs) and sub-dermal contraceptive implants. To date, evidence on long-acting reversible contraception access and uptake in Canadian health systems is sparse. Existing evidence is limited to surveys conducted during time periods prior to implant availability, leaving wide knowledge gaps regarding contraception access in Canada. The consequence of this gap is that health system and policy leaders have little evidence to guide policy and care delivery improvements.

This study will use BC’s population-based administrative health data to generate urgently needed evidence for health policymakers and system decision-makers. We will analyze a population-based cohort of contraception service providers and reproductive-aged females from 2016-2022 to:

1. Describe the geographic distribution and characteristics of the contraception workforce and trends over time.
2. Identify the frequency and characteristics of “contraception deserts”, i.e., geographic regions lacking adequate access to long-acting reversible contraception services.
3. Describe long-acting reversible contraception users, populations with lowest uptake, and trends over time in long-acting reversible contraception use.

This study will support policy implementation, development, and revision to target geographic regions, population groups, and clinician professional development to improve contraception access. This lays the foundation for a learning health system approach to further policy evaluation and adaptation to ensure equitable access to the most effective contraception. By improving access to effective contraception, this study will enable populations to plan their pregnancies and births, leading to improved fetal and infant outcomes.

Grants

CIHR Patient Oriented Research Transition to Leadership Award, Phase 2. Improving reproductive population health through patient-oriented health policy and epidemiological research. PI: L Schummers. $460,000. 2023-2027.

UBC Faculty of Pharmaceutical Sciences, Faculty start-up funding. Start-up funds: Improving reproductive population health through health policy and outcomes research. PI: L Schummers. $360,000. 2022-2024.

BC Children’s Hospital Research Institute Clinical and Translational Seed Grant. Interpregnancy Interval and Pregnancy Outcomes: Defining Optimal Intervals for High-Risk Populations. PI: L Schummers. CoI: J Liauw. $10,000. 2020-2022.

CIHR Operating Grant: Data Analysis Using Existing Databases and Cohorts. Interpregnancy Interval and Pregnancy Outcomes: Defining Optimal Intervals for High-Risk Populations. PI: L Schummers. CoIs: KA Ahrens, JA Hutcheon, E Karacabeyli, J Liauw, WV Norman. $75,000. 2020-2022.

CIHR Patient Oriented Research Transition to Leadership Postdoctoral Fellowship (Phase 1). Examining the effect of Canada's unique medical abortion drug policy on patient abortion access and outcomes. PI: L Schummers. CoIs: B Henry, S Bryan, E Darling, K McGrail, WV Norman. $155,000. 2020-2022.

CIHR Health System Impact Fellowship. Population-based epidemiological analyses to evaluate and inform reproductive health policies in British Columbia. PI: L Schummers. CoIs: B Henry, WV Norman. $155,000. 2018-2020.

Honours & Awards

2022 Labelle Lecturer, Nov 9 2022. Selected by the Labelle Committee to give the 31st Labelle Lecture for the Centre for Health Economics and Policy Analysis, McMaster University. This lectureship brings a prominent ‘rising star’ in health services research with emerging recognition and an inter-disciplinary approach to research to give a general interest lecture on a topic in the broadly defined areas of health economics and/or health policy. ($2000).

2022 Top 10 Articles of the Year (2021-2022), CIHR Institute for Health Services and Policy Research and the Canadian Association for Health Services and Policy Research. This award recognizes published research that has significantly contributed to the advancement of the field of health services and policy research (HSPR) in Canada. Articles were selected for their relevance to HSPR, as well as for the extent to which they showed a clear impact (or potential impact) on policy, practice, or health outcomes.

2021 Killam Postdoctoral Fellow Research Prize awarded by the Faculty of Graduate and Postdoctoral Studies from the University of British Columbia, March 2022. Each year, two postdoctoral fellows from across the University are awarded this prize in recognition of outstanding research and scholarly contributions while at UBC.

“Best of Three” Oral presentation winner, Annual Clinical and Scientific Conference of the Society of Obstetricians and Gynecologists of Canada, June 2021: Abortion utilization and safety when mifepristone is available without regulations restricting practice? A population-based study using linked health administrative data from Canada. Of the three top-rated abstracts, selected as the best oral presentation.

2021 Outstanding Achievement by a Postdoctoral Fellow award, BC Children’s Health Research Institute 2020/2021 The award recognizes the outstanding achievement of a postdoctoral fellow whose high academic achievements, personal leadership qualities and demonstrated research ability show promise of the individual becoming a future leader in health research. One achievement award is given per year in each career category (mid-career investigator, early career investigator, postdoctoral fellow, graduate student).

Research Group Members

Elizabeth Nethery, Midwife, Researcher
Victoria Paller