About

Ruth E. Zielinski is a Clinical Professor and Graduate Program Lead in the Department of Health Behavior and Clinical Sciences at the University of Michigan School of Nursing. Her scholarship advances equitable, evidence-based, and person-centered reproductive and perinatal care, integrating biophysical outcomes, lived experiences, and health systems innovation to improve the health and well-being of women and families both in the U.S. and globally. She has been actively involved in research projects related to maternal health, midwifery education, and respectful maternity care, including initiatives to promote healthy pregnancies and optimize maternal and newborn outcomes. Dr. Zielinski primarily teaches in the graduate nurse-midwifery program, mentors students, and guest lectures across nursing and healthcare disciplines. She has served as a research advisor for undergraduate and graduate students and has been a speaker at numerous national and international conferences on women’s health topics.

Research topics

• Psychology
• Computer Science
• Medicine
• Sociology
• Audiology
• Pediatrics
• Nursing
• Biology
• Medical education
• Geography

Selected publications

• Improving respectful maternity care through group antenatal care: Findings from a cluster randomized controlled trial

  Midwifery · 2025-05-10 · 1 citations

  article
  PublisherDOI

• Impact of group antenatal care on lactational amenorrhea method awareness and knowledge: A cluster randomized control trial

  PLoS ONE · 2025-10-15

  articleOpen accessCorresponding

  High fertility rates in low and middle-income countries (LMICs), especially in sub-Saharan Africa and Ghana, lead to closely spaced pregnancies and contribute to high maternal and infant morbidity and mortality. Family planning remains critical for reducing rapid repeat and unwanted pregnancies, thus improving the health and survival outcomes. Unfortunately, many women face significant unmet needs due to limited knowledge, misinformation, and limited access to modern family planning methods in particular. Breastfeeding plays a substantial role, and the lactational amenorrhea method (LAM) offers a practical, natural, readily available, and cost-efficient postpartum option when practiced correctly. However, many mothers lack sufficient awareness of LAM and the conditions necessary for its effectiveness. Antenatal care provides a strategic opportunity for targeted education and counselling on contraceptive choices, empowering women with the knowledge to adopt safe, informed, and sustainable practices. Group antenatal care (G-ANC), recommended by WHO for research in LMICs, offers a comprehensive and participatory platform for health education and behavioral change. This study examined G-ANC and its impact on creating awareness and improving knowledge of the lactational amenorrhea method among mothers. A cluster randomized control trial, registered at ClinicalTrials.gov on 25/07/2019 with RCT number NCT04033003, was conducted in Ghana at 14 health facilities with a total of 1761 participants. The study included pregnant women who were at least 15 years old, able to speak English or one of four local languages, and less than 20 weeks of gestation at enrollment. Women classified as high-risk by the midwife were excluded from participation in the study. Facilities were randomized using a matched pair method. Structured interviews were conducted at baseline and subsequent timepoints. The results found that group antenatal care increases maternal awareness and knowledge of the postpartum lactational amenorrhea method of family planning compared to individualized care. Subgroup analysis revealed that a mother's level of education and parity strongly predict maternal awareness of the lactational amenorrhea method. These findings support group antenatal care as an effective strategy to improve knowledge on the use of lactational amenorrhea as a family planning method.

  PublisherDOI

• Perspectives of Doulas of Color on their Role in Alleviating Racial Disparities in Birth Outcomes: A Qualitative Study

  UNC Libraries · 2025-06-24

  articleOpen access

  INTRODUCTION: The purpose of this study was to explore how doulas of color conceptualize both their work and how their racial and ethnic identities influence their work within the context of racial disparities in birth outcomes in the United States. METHODS: We conducted semistructured qualitative interviews with doulas of color who had attended at least 3 births as doulas. Participants were recruited from across the United States. The interviews were audio recorded and transcribed verbatim. Qualitative content analysis was used to derive themes from the transcribed interviews. RESULTS: Interviews were conducted with 8 doulas of color, ranging in age from 21 to 47 from across the United States. All participants were either current college students or had earned a college degree. Although many of the doulas identified as being of more than one racial or ethnic group, nearly all participants identified closely with being Black or African American first, and their other racial groups second. Four major themes emerged: relationship with the medical system, role of identity in the doulas' work, role of class, and divisions within the natural birth movement. DISCUSSION: The majority of doulas who participated in this study stated that their racial identity strongly influenced their work, particularly when working with women of the same race or ethnicity due to their shared identities. Several participants initially became doulas because of a desire to alleviate disparities in birth outcomes for women of color. This suggests a commitment on the part of the study participants to serving their communities and to bridging the gap between women of color and the health care system. Several participants also noted that they feel alienated by both the health care system and the mainstream natural birth community.

  PublisherDOI

• Impolite Birth: Provider Perspectives on Vocalization During Childbirth

  Birth · 2025-03-10 · 3 citations

  articleOpen accessSenior author

  BACKGROUND: Childbirth is a pivotal event marked by diverse vocalizations, yet scant research examines healthcare providers' perspectives on vocalization during birth. This study seeks to address this gap by exploring the attitudes and practices of various healthcare professionals regarding vocalization during labor and birth. METHODS: This study used a qualitative comparison approach, grounded in Organizational Cultural Phenomenon of Humanized Childbirth. Five discipline specific focus groups were conducted with doulas, nurses, community midwives, hospital midwives, and obstetricians to explore provider perceptions and experiences with vocalization during childbirth. RESULTS: Analysis of the focus groups indicated five overarching themes: (1) Shame and apologies, (2) Providers inhibiting or facilitating vocalization of gendered norms, (3) Affirmations or "Mantras," (4) Right and wrong sounds, and (5) Developing comfort with vocalization. DISCUSSION: The findings underscore the need for education on supporting vocalization during childbirth. The tension between provider expectations and birthing individuals' autonomy highlights broader issues of paternalism in Western childbirth practices. Addressing these dynamics can foster a more respectful and empowering birth environment, promoting positive birth experiences.

  PublisherOA PDFDOI

• The impact of group antenatal care on newborns: Results of a cluster randomized control trial in Eastern Region, Ghana

  BMC Pediatrics · 2024-11-18 · 3 citations

  articleOpen access

  BACKGROUND: Maternal recognition of neonatal danger signs following birth is a strong predictor of care-seeking for newborn illness, which increases the odds of newborn survival. However, research suggests that maternal knowledge of newborn danger signs is low. Similarly, maternal knowledge of optimal newborn care practices has also been shown to be low. Since both issues are typically addressed during antenatal care, this study sought to determine whether group antenatal care (G-ANC) could lead to improvements in maternal recognition of danger signs and knowledge of healthy newborn practices, as well as boosting postnatal care utilization. METHODS: This cluster randomized controlled trial of G-ANC compared to routine individual antenatal care (I-ANC) was conducted at 14 health facilities in Ghana, West Africa, from July 2019 to July 2023. Facilities were randomized to intervention or control, and pregnant participants at each facility were recruited into groups and followed for the duration of their pregnancies. 1761 participants were recruited: 877 into G-ANC; 884 into I-ANC. Data collection occurred at enrollment (T0), 34 weeks' gestation to 3 weeks postdelivery (T1) and 6-12 weeks postpartum (T2). Comparisons were made across groups and over time using logistic regression adjusted for clustering. RESULTS: Overall, knowledge of newborn danger signs was significantly higher for women in G-ANC, both in aggregate (13-point scale) and for many of the individual items over time. Likewise, knowledge of what is needed to keep a newborn healthy was higher among women in G-ANC compared to I-ANC over time for the aggregate (7-point scale) and for many of the individual items. Women in G-ANC were less likely to report postnatal visits for themselves and their babies within 2 days of delivery than women in I-ANC, and there was no difference between groups regarding postnatal visits at one week or 6 weeks after birth. CONCLUSION: This study illustrates that group ANC significantly improves knowledge of newborn danger signs and healthy newborn practices when compared to routine care, suggesting that the impact of G-ANC extends beyond impacts on maternal health. Further research elucidating care pathways for ill newborns and maternal behaviors around healthy newborn practices is warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04033003, Registered: July 25, 2019 Protocol Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508671/ .

  PublisherOA PDFDOI

• Fear of Childbirth Among Pregnant People Facing Anti-Fat Bias

  International Journal of Environmental Research and Public Health · 2024-12-11 · 1 citations

  articleOpen accessSenior author

  Explicit and implicit anti-fat biases are widespread among healthcare providers, leading to significant negative consequences for pregnant people, including poorer health outcomes. Fear of childbirth (FOC) can affect the length of labor, increase the risk of cesarean delivery, and negatively influence a new parent's perception of infant bonding. This study investigated the impact of perceived anti-fat bias on FOC among pregnant people. Data were gathered from 329 pregnant people recruited from three large academic prenatal centers in the United States and via social media. Participants completed a survey that included validated instruments measuring perceptions of anti-fat bias and FOC. Participants perceiving anti-fat bias reported higher FOC. Black participants perceiving anti-fat bias reported higher FOC. These findings suggest that perceived anti-fat bias from providers is associated with FOC for pregnant people, particularly those who identify as Black. Interventions to educate providers on these important concepts could help improve pregnant people's experience within the healthcare system.

  PublisherOA PDFDOI

• Knowledge, Acceptance, and Uptake of Family Planning: A Cluster Randomized Controlled Trial of Group Antenatal Care in Ghana

  International Journal of Environmental Research and Public Health · 2024-08-03 · 4 citations

  articleOpen access1st authorCorresponding

  The use of family planning (FP) methods significantly contributes to improved outcomes for mothers and their offspring. However, the use of FP remains low, particularly in low- and middle-income countries. A cluster randomized controlled clinical trial was implemented in Ghana, comparing group antenatal care (ANC) with routine care. The group ANC intervention included eight meetings where the seventh group meeting incorporated information and discussion regarding methods of FP. Data collection occurred at five time points: baseline (T0), 34 weeks' gestation (T1), 6-12 weeks post birth (T2), 5-8 months post birth, and 11-14 months post birth (T4). At T1, there was a significantly greater increase in the knowledge of FP methods as well as the intention to use FP after the birth among the intervention group. The uptake of FP was significantly higher in the intervention group for all post-birth timepoints except for T4 where the control group had significantly higher rates. The reasons for the diminishing effect are unclear. An increasing uptake of FP methods requires a multifaceted approach that includes increasing accessibility, knowledge, and acceptability as well as addressing societal and cultural norms.

  PublisherOA PDFDOI

• Effect of group antenatal care versus individualized antenatal care on birth preparedness and complication readiness: a cluster randomized controlled study among pregnant women in Eastern Region of Ghana

  BMC Pregnancy and Childbirth · 2024-08-16 · 6 citations

  articleOpen access

  BACKGROUND: As utilization of individual antenatal care (I-ANC) has increased throughout sub-Saharan Africa, questions have arisen about whether individual versus group-based care might yield better outcomes. We implemented a trial of group-based antenatal care (G-ANC) to determine its impact on birth preparedness and complication readiness (BPCR) among pregnant women in Ghana. METHODS: We conducted a cluster randomized controlled trial comparing G-ANC to routine antenatal care in 14 health facilities in the Eastern Region of Ghana. We recruited women in their first trimester to participate in eight two-hour interactive group sessions throughout their pregnancies. Meetings were facilitated by midwives trained in G-ANC methods, and clinical assessments were conducted in addition to group discussions and activities. Data were collected at five timepoints, and results are presented comparing baseline (T0) to 34 weeks' gestation to 3 weeks post-delivery (T1) for danger sign recognition, an 11-point additive scale of BPCR, as well as individual items comprising the scale. RESULTS: 1285 participants completed T0 and T1 assessments (N = 668 I-ANC, N = 617, G-ANC). At T1, G-ANC participants were able to identify significantly more pregnancy danger signs than I-ANC participants (mean increase from 1.8 to 3.4 in G-ANC vs. 1.7 to 2.2 in I-ANC, p < 0.0001). Overall BPCR scores were significantly greater in the G-ANC group than the I-ANC group. The elements of BPCR that showed the greatest increases included arranging for emergency transport (I-ANC increased from 1.5 to 11.5% vs. G-ANC increasing from 2 to 41% (p < 0.0001)) and saving money for transportation (19-32% in the I-ANC group vs. 19-73% in the G-ANC group (p < 0.0001)). Identifying someone to accompany the woman to the facility rose from 1 to 3% in the I-ANC group vs. 2-20% in the G-ANC group (p < 0.001). CONCLUSIONS: G-ANC significantly increased BPCR among women in rural Eastern Region of Ghana when compared to routine antenatal care. Given the success of this intervention, future efforts that prioritize the implementation of G-ANC are warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04033003 (25/07/2019). PROTOCOL AVAILABLE: Protocol Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508671/ .

  PublisherOA PDFDOI

• Effect of Group Antenatal Care on Breastfeeding Knowledge and Practices Among Pregnant Women in Ghana: Findings from a Cluster-Randomized Controlled Trial

  International Journal of Environmental Research and Public Health · 2024-11-28 · 7 citations

  articleOpen access

  The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months after birth to ensure child health and survival. Antenatal care provides an opportunity to educate pregnant women on optimal breastfeeding practices. A cluster-randomized control trial in Ghana examined the impact of group antenatal care on breastfeeding knowledge and practice. The study enrolled 1761 pregnant women from 14 health facilities in Ghana. The intervention group (n = 877) received eight group sessions, while the control group (n = 884) received individual, routine care. Data were collected at baseline and post intervention. Pearson’s chi-square test was performed to examine categorical data, while odds ratios were calculated using separate logistic regression models to examine differences between the intervention and control groups over time. Women enrolled in group antenatal care had higher odds of following WHO recommendations to exclusively breastfeed for the first six months (odds ratio [OR]: 3.6, 95% confidence interval [95% CI]: 2.1, 6.3) and waiting to introduce solid food until six months of age (OR: 3.1, 95% CI: 1.5, 6.9). Our results found that women who participated in group antenatal care were more likely to follow the recommendations for exclusive breastfeeding developed by the WHO.

  PublisherOA PDFDOI

• Impolite Birth: Theatre Voice Training and the Experience of Childbirth

  Routledge eBooks · 2024

  Senior authorCorresponding
  • Psychology
  • Geography
  • Biology

  Little data exists on vocalization during birth. What research does exist supports the notion that vocalizing can be a useful tool to birthing people. Similar to many childbirth courses, theatre-based voice training includes a strong focus on physical release and ease to function as a fruitful foundation for easy vocalization. Additionally, this type of training places specific focus on the use of sound and cultivates the ability to use the voice freely and without inhibition. This study hypothesized that using theatre-based voice techniques during childbirth would reduce the perception of pain during labor and improve women’s sense of autonomy during the experience. To explore this hypothesis, two groups of pregnant people were taught theatre-based voice exercises and researchers collected data on their experiences after their births. Broadly, this study suggests that theatre and voice-based experiences have the potential to improve women’s overall satisfaction with their birth experience and presents an important, cross-disciplinary application to voice work.

  PublisherDOI

Frequent coauthors

• Lisa Kane Low

  21 shared

• Megan Deibel

  20 shared

• Veronica Apetorgbor

  Dodowa Health Research Centre

  17 shared

• Kimberly Searing

  Committee on Publication Ethics

  17 shared

• Vida Kukula

  Dodowa Health Research Centre

  17 shared

• Elizabeth Awini

  Ghana Health Service

  16 shared

• John E. Williams

  Ghana Health Service

  16 shared

• Miller Jm

  Applied Technical Services (United States)

  14 shared

Education

• PhD/Certificate in Women's Studies, Nursing

  University of Michigan–Ann Arbor

  2009

• MS Parent Child Nursing/Midwifery, Nursing

  University of Michigan - Ann Arbor

  1995

• BSN, Nursing

  University of Michigan - Ann Arbor

  1992

Awards & honors

• Daisy Award, Nurses Advancing Health Equity - Daisy Foundati…
• Fellow in the American Academy of Nursing - 2019
• Fellow in the American College of Nurse Midwives - 2014
• Best Podium Presentation, Research forum – American College…
• Medical Activist Award – Women’s Health Foundation 2011