Sessions by Track | ACNM 66th Annual Meeting & Exhibition

Sessions by Track

The 2021 Annual Meeting session types include Podium Presentations, Panel Presentations, Round Table Sessions, ACNM Division of Research (DOR) Research Forums, Global Health Forums, & Symposium, and General & Research Posters.

Sessions are sorted below by track (Academic Education, Clinical, Global Midwifery, Leadership, Midwifery Matters – Business, Midwifery Matters – Public Perception, or Racism and Health Disparities). Presenter names, session types, and CE amounts are listed under each title.

95+ CEs and 3.25 RxCEs Offered!

VIEW SESSIONS SORTED BY TYPE HERE

Session recordings and posters will be available throughout the 2021 Annual Meeting and for 30 days after in the virtual meeting platform. Sessions are subject to change.

Academic Education
Clinical
Global Midwifery
Leadership
Midwifery Matters – Business
Midwifery Matters – Public Perception
Racism and Health Disparities

Academic Education

Addressing Maternal Mortality through Online, Interprofessional Simulations in Midwifery Education
Podium Presentation Academic Education 1 CE

In light of the current pandemic and social distance practices, cutting-edge strategies that aim to improve curriculum in a distance learning format are needed more than ever before in midwifery education. This session will discuss a project that aimed to create and continuously implement an online, interprofessional (IPE) learning experience for nurse-midwifery (NM) and nurse anesthesia (NA) students to support critical advanced practice skills in the remote learning environment. The online, simulated IPE provides students with the opportunity to participate in an experiential learning environment with peers, educators, and practitioners that is non-threatening and without risks to actual patients, while preparing them to be work-ready for collaborative practice in their clinician careers.

Applying a Structural Competency Framework in Clinical Education
Deena Mallareddy
Round Table Academic Education .5 CE

Inequities in health care are in part driven by bias and discrimination in the health care setting by upstream and downstream factors. In order for health care systems to provide equitable care, clinicians must be trained to take stock, take care, and take action in settings outside of health care. This round table explores the role of a structural competency framework as a way to promote health equity by training clinicians on the structural factors that produce health disparities.

Creating and Sustaining Midwifery Data Collection for Quality Improvement and Research
Joanne Bailey, Cathy Emeis, Elise Erickson, Ellen Tilden
Podium Presentation Academic Education 1 CE

As midwifery grows in the US, there is increasing demand for quality improvement and clinical science relevant to midwifery patient populations. Additionally, as more educational programs transition to DNP level degree termination, there is growing need for midwifery data to support student DNP work. These factors can lead to increased interest in launching nurse-midwifery data collection. The purpose of this presentation is to review the development and evolution of two interrelated nurse-midwifery data collection systems and existing data repositories. We will highlight lessons learned relevant to initiating and sustaining midwifery data collection and inter-university collaboration with each step of the research process. We will share pragmatic suggestions and a ‘roadmap’ for midwives considering creating or expanding data collection systems. Finally, we will highlight benefits of midwifery data collection, repository, and collaboration to support student DNP training, quality improvement, research, and health policy.

Development of an Intraprofessional Scholarship Workgroup: Systematic Process for Creating and Disseminating Midwifery and Nursing Knowledge
Rebecca Fay, Charlotte Swint, Eileen Thrower
Podium Presentation Academic Education 1 CE

It is essential for educators to contribute to the body of knowledge about best practices in midwifery and nursing. Collaboration is an effective approach to increasing scholarship and dissemination of midwifery and nursing knowledge and research. Lack of time, workload issues, fear and anxiety of failing, and lack of research skills have been reported as barriers to nurses’ scholarship. This session will describe a 10-step process used by an intraprofessional group of advanced-practice nurse educators to participate in collaborative scholarship including the creation of a manuscript. The 10-step process provides a roadmap for novice scholars wishing to disseminate best midwifery practices.

Dismantling Discussion Boards in Online Education: Building a Better Way for Engagement and Learning
Cara Busenhart
Round Table Academic Education .5 CE

Discussion boards are a staple teaching strategy in online education. This session will provide an example of how one experienced midwifery educator has used a lay press publication for a virtual book club discussion board in her graduate course on reproductive endocrinology. The discussion board uses traditional book club prompts to build engagement, increase course satisfaction, and provide connections for deeper learning with difficult concepts in course content. Examples of success with this teaching strategy, application tips for applying this in your course, examples of prompts and student writing using the book club discussion board, and excerpts from student evaluations will be shared. Finally, participants in this session will be able to develop ideas for applying this pedagogy to their own teaching-learning practice.

Disruptive Innovation: Integrating Virtual Clinical Simulations in Graduate Midwifery Education
Noelle Jacobsen, Jan Weingrad Smith
Podium Presentation – Academic Education – 1 CE

Clinical midwifery education has changed over time. In response to increased numbers of programs and students, preceptor and site availability are increasingly limited. This reality became critical in March 2020 when, in response to the COVID-19 pandemic, hundreds of University-partnered hospitals, clinics, and freestanding birth centers across the country suspended midwifery clinical student participation in patient care. Faculty and students were left without a way to continue students’ application of theoretical knowledge into clinical practice. To augment the traditional clinical educational options for students, faculty at Frontier Nursing University (FNU) expanded the existing use of simulations in the virtual environment from the didactic curriculum to the clinical curriculum. This presentation will discuss the expansion of this innovative strategy based on internal university surveys of student needs while incorporating ACNM’s Core Competencies. The discussion will include the development, implementation, and evaluation of the final four simulation topics.

Diversity Statements & the Learning Context
Victoria Baker, Linda McDaniel
Podium Presentation – Academic Education – 1 CE

Diversity statements litter the academic landscape. Does anyone even notice them? Research says students do notice diversity statements and that they can affect test scores, varying by race, gender, and statement content. Theory says that the statements in the syllabus can help “establish an environment that support diversity”, or not. Our university committee on diversity and the curriculum deployed a diversity statement in each course to increase student comfort in course discussions, garner comments on the quality of course materials, and increase use of our multicultural center. The statement was positively received by the large majority of those who responded to the survey. A small response rate limits the usefulness of these results. The statement is being deployed across all courses and programs at the university.

Doctoral Degrees for Midwives: The Need and Value Selecting the Degree That is Right for You
Barbara Hackley, Heather Findletar Hines, Karen Jefferson, Diana Jolles, Lisa Summers
Panel Presentation – Academic Education – 1 CE

The purpose of this podium panel is to expose ACNM membership to the value of the doctoral degree for midwives. The speakers review pertinent industry demand demonstrating the need to increase the number of doctorally prepared midwives. After exploring various doctoral degree options, participants will be able to align their career goals as clinicians, educators and researchers to the appropriate curriculum. Panelists will review the variations in curriculum, scope and the purpose of each degree. The panel will explore the professional and personal value of advanced degrees by sharing research and inspiring stories.

An Examination of Certified Nurse-Midwives’ Attitudes and Beliefs Surrounding Breastsleeping: Implications for Advanced Nursing Practice and Education
Jessica Bishop-Royse, Linda Graf, Lucy Mueller Wiesemann, Shannon Simonovich
Research Poster Academic Education
Health History Skills Development for Interprofessional Learners in Transgender and Non-Binary Populations
Melissa Avery, Jennifer Demma, Samantha Hoffman, Joseph Miller, Maria Ruud, Anne Woll
Podium Presentation – Academic Education – 1 CE

Transgender and non-binary individuals have been identified as vulnerable and underserved with known health disparities and barriers to accessing care. Health care provider knowledge is an identified barrier to quality care for individuals in these populations. Providers may include physicians, nurse practitioners and midwives. Ideally, providers acquire knowledge related to providing quality care to transgender and gender diverse individuals during their formal education programs. Interprofessional education is believed to support team based care and improved communication in the health care setting, thus improving patient care. In 2012, ACNM stated that midwifery scope of practice includes gender affirming care. The revised 2019 Core Competencies for Basic Midwifery Practice includes promoting “person-centered care for all … inclusive of diverse backgrounds…” and describes midwives “providing primary care of the individuals they serve”. To complement didactic program content, we developed a new simulation experience. Our project goal was to build a partnership between members of transgender and gender diverse populations and University faculty and staff to develop and evaluate a sexual and reproductive focused health history simulation learning activity for midwifery and women’s health nurse practitioner students, and obstetrics-gynecology residents. This session will discuss the project findings and future plans.

Hear Our Voices! Previous BIPOC Students Speak Out On How A New Professional Organization Mentoring Program (POMP) Provided Professional Growth
Leticia Fernandez, Onidis Lopez, Maria Valentin-Welch, Essence Williams
Podium Presentation – Academic Education – 1 CE

Mentoring is a powerful tool and we have the power! Mentoring leads to the production of more Black, Indigenous, and People of Color (BIPOC) midwives, clinicians, and nurses. These BIPOC providers are necessary to help combat our nation’s health disparity issues. Mentoring also helps us address our BIPOC faculty shortage. Therefore, this presentation will introduce the Professional Organization Mentoring Program (POMP) created by Dr. Valentin-Welch while working at Frontier Nursing University (FNU) as a strategy to support and retain BIPOC and all other marginalized students. POMP is a program where student cohorts attend four professional organizations, including ACNM, for an intense onsite professional organization mentoring experience. The program goal is for all students to learn the importance of becoming professionally involved and to coach students through professional activities such as submission of abstracts, podiums, and poster presentations. POMP’s tools, resources, strategies, and outcomes will be discussed. Finally, a live BIPOC midwifery panel who were previous POMP students/mentees will share their testimonies and how the POMP program assisted in their professional growth.

Impact & Effectiveness of “Fertility Awareness Based Methods (FABMs) for Women’s & Family Planning” Online Elective
Duane Marguerite, Eileen Sirois
Podium Presentation – Academic Education – 1 CE

Many health care professionals, including midwives, lack in depth knowledge about the Fertility Awareness Based Methods (FABMs). Therefore many women, especially women of color, are not offered these options. Georgetown University School of Medicine now offers a two week online elective, “FABMs for Women’s Health and Family Planning”. This elective is an effective way to teach students and health care professionals about FABMs, so that they may offer this holistic approach to women not only for family planning, but for complete evaluation of many gynecologic problems.

Improving the Quality of Midwifery Education Using a Social Justice Lens
Kristin Effland, Eva Fried, Judy Lazarus, Felina Ortiz, Karline Wilson-Mitchell
Panel Presentation Academic Education 1 CE

North America is in the midst of a maternal mortality and morbidity crisis. Increasing racial concordance between midwives and the families served by midwifery care can be part of the solution. In addition, students who are Black, Indigenous, or other people of color (BIPOC) are suffering from aggressions and inequities during midwifery education programs. The association between the elimination of health inequities and a racially, ethnically and culturally representative workforce has been well established in the literature, and social determinants of health cannot be addressed without a diverse workforce of both educators and clinicians. This session will discuss a project conducted to advance health equity for childbearing families by increasing the capacity of midwifery educators and subsequently educating a more diverse midwifery workforce. We envision learning environments for midwives that center equity and social justice, that prepare practitioners to provide culturally safe care, and that support the midwifery career development of persons from underrepresented and marginalized communities. Specifically, this project has two primary objectives: 1) to create a set of racial equity, diversity, and inclusivity (EDI) competencies for midwifery educators; and 2) to design an antiracist EDI skills development roadmap that will support educators in achieving the EDI-specific competencies. It will present the initial findings and deliverables from a February 2021 summit of midwifery education stakeholders that will aim to produce a set of anti-racist EDI competencies for midwifery educators alongside an accompanying skills development roadmap that will guide educators in achieving the specified competencies.

Incorporation of Midwives as Faculty in Community-Based Medical Resident Education
Aimee Feste, Dolly Pressley Byrd
General Poster Academic Education
Influencing Collaborative Maternity Care through Obstetric Hospitalist Education
Liane MacPherson
Research Poster Academic Education
Interprofessional Education with Midwifery Students and Obstetrics and Gynecology Residents: What Difference Does It Make?
Tia Andrighetti, Melissa Avery, Kim Dau, Sukey Krause, Michelle Mathiason
Panel Presentation – Academic Education – 1 CE

Interprofessional education (IPE) is recommended for all health professions learners in order to learn “about, from, and with each other” and to ultimately provide high quality team-based care. Research supports that IPE improves learners’ attitudes about other health professionals and that they increase their knowledge and skills in collaboration. Additional research is needed to demonstrate differences in care outcomes. Little is known specifically about midwifery students and obstetrics and gynecology residents working together during their education programs. The purpose of a funded national project between ACNM and the American College of Obstetricians and Gynecologists carried out between 2017 and 2020 included the development and implementation of learning modules and other learning activities for midwifery students and obstetrics and gynecology residents. Specific interpretation and sharing of successes and lessons learned will be summarized by each demonstration site team. These materials have been made available for other education programs to use, modify and enhance. Recommendations for evaluation of future programs will be provided. Future work should be aimed at ongoing evaluation of changes in women’s health and perinatal care provided by midwives and obstetrics and gynecology physicians who have learned together during their education programs.

The Language of Interprofessional Communication: Student Nurse-Midwife Reflections During Graduate Clinical Education: A Qualitative Study
Audrey Perry
General Poster Academic Education
Maintaining Clinical Continuity Through Virtual Simulation During The COVID-19 Pandemic
Christa Palancia Esposito, Kelly Sullivan
General Poster Academic Education
Nurse-Midwifery Objective Structured Clinical Examination (OSCE) Adapted for Use in an On-line Platform: A Simulation Design Project
Deborah Duran-Snell
Panel Presentation – Academic Education – 1 CE

As a result of COVID-19, nurse-midwifery education made immediate changes to teaching/learning platforms and altered planned assessment strategies to on-line formats. Demonstration of clinical competency is necessary in nurse-midwifery education and can be defined as the capability to perform acceptably those duties that underpin effective performance in professional practice. The objective structured clinical examination (OSCE) was developed for clinical evaluation of medical students more than 40 years ago and holds promise for use in nurse-midwifery clinical evaluation. Recognizing that no single assessment strategy can provide all the information required to assess something as complex as clinical performance and competency, the OSCE when viewed alongside other forms of assessment offers a valuable strategy for enhancing the assessment of nurse-midwifery learner clinical competence and confidence.

COVID-19 disrupted nurse-midwifery education and requires necessary changes by educators. Social distancing precludes learners from gathering and learning in face-to-face teaching environments including simulation and OSCEs. Educators are challenged to create experiences for learners that allow for clinical assessment while ensuring learner and faculty safety. This simulation design project presentation will define the process and frame a reference for OSCEs with the aim to describe and evaluate a modified OSCE currently being used at a northwest public university for second year graduate nurse-midwifery students from face-to-face to an online delivery.

Precepting in a Virtual World
Kathleen Elizabeth Danhausen, Johanna Krygsman, Laura VonHandorf
Panel Presentation – Academic Education – 1 CE

The COVID-19 pandemic has resulted in a significant shift from in-person to telehealth midwifery service provision, and has greatly disrupted midwifery education as the clinical experiences and sites available to students have decreased. Telehealth has offered midwifery clientele a convenient and safe option for care and teleprecepting has enabled midwifery students to continue their education, thus decreasing potential workforce gaps and ensuring that students attain valuable telehealth skills. This session will bring preceptor, student, and client perspectives to a discussion of best practices, common pitfalls, and lessons learned in pandemic precepting.

Prospective Perinatal Research in the Time of COVID-19
Rachel Blankstein Breman, Nicole Carlson, Elise Erickson, Katherine Kissler, Julia Philippi, Denise Smith, Ellen Tilden
DOR Symposium – Academic Education – 1 CE

This research symposium will address prospective enrollment of individuals in perinatal research and quality improvement during the COVID-19 pandemic. Panelists will discuss resources for researchers and students for revising study approach, managing recruitment and revising protocols to be Covid compliant within their institutions. Equity in research practices and adaptations to protect participants and research staff will be emphasized. Panelists will include researchers from across the US in different institutions who have developed strategies to keep their work moving through resilience and adaptations during COVID-19 pandemic.

State of Education: The Use of Simulation Modalities Across the Midwifery Curriculum in US Based Midwifery Programs
Kelly McBroom
Round Table Academic Education – .5 CE

Simulation is a research-based approach commonly used in both prelicensure and graduate level medical professional education. It is especially suited to practicing for high acuity, low incidence obstetric events such as hemorrhage and shoulder dystocia, and can be used to teach affective skills and interprofessional teamwork. This session presents the results of survey of DOME examining the use of simulation throughout the curriculum in US based midwifery education programs, and proposes a model to integrate simulation throughout the curriculum.

Test-Taking Strategies for Students, Graduates, and Midwifery Educators
Cara Busenhart, Melissa Stec
Podium Presentation – Academic Education – 1 CE

Taking exams in midwifery school and for certification can be overwhelming and produce significant anxiety. In this session, two experienced midwifery educators and leading exam prep facilitators will help you with test-taking strategies focused on the exam experience, decreasing test anxiety, and how to approach multiple-choice questions (particularly when it feels like there is more than one correct answer). This session will help students, graduates, and educators think about their own test-taking successes, as well as facilitate the adoption of new, innovative ideas for future testing. Opportunity for group discussion and sharing of strategies among participants will be offered.

Tips and Strategies for Success for New and Experienced Preceptors
Judy Lazarus, Erin Morelli, Amy Nacht
Round Table Academic Education .5 CE

Whether you have wanted to precept and never done it, have a year or two under your belt or have been precepting for a long time, our sessions will offer you practical, helpful and innovative strategies and approaches to precepting. Join us for focused, hands on sessions on precepting where we will add tools to your toolbox and problem solve and discuss together! You are important to the future of nurse-midwifery and ACNM!

Using Educational Resources Wisely During a Pandemic: Simulated Telehealth Visits to Develop Clinical Decision Making Skills in Midwifery Students
Erin McMahon
Podium Presentation – Academic Education – 1 CE

Learn how to apply the INACSL Standards of Best Practice to use simulation to solve educational dilemmas. This session demonstrates how simulated telehealth visits were used during a global pandemic to continue effective learning for midwifery students. Students were able to develop skills: history taking, clinical decision making, and documentation.

Virtual Delivery: Practicing Birth Skills and Building Community in a Distance-Learning Format
Eva Fried, Eileen Thrower
Podium Presentation Academic Education 1 CE

The Coronavirus pandemic created an urgent need to transition in-person training of clinical midwifery skills to a virtual experience. Educators at two nurse-midwifery education programs transitioned in-person skills training to an online format. Three components of the in-person training were identified as critical for the virtual setting: 1) hand skills practice, 2) modeling clinical reasoning, and 3) socialization among students and faculty. The project’s short-term goal was to meet the learning needs of currently enrolled students unable to travel to campus during the pandemic. The project’s long-term goal was to strengthen the virtual delivery of clinical midwifery skills as most nurse-midwives in the U.S. are trained in a distance learning format. The purpose of this presentation is to demonstrate the effectiveness of a virtual approach to teaching clinical midwifery skills and creating a supportive social community. The findings from this initiative apply to teaching and learning post-pandemic as they inform the types of activities that can be accomplished in a distance format and better scaffold the hands-on skills that can be delivered once in-person learning resumes safely.

Clinical

ACNM Professional Liability Section Annual Presentation: Midwifing the Midwife: Preventing Second Victim Trauma in Malpractice and Disciplinary Actions
Michelle Collins, Erin Farah, Katie Page, Michelle Palmer
Panel Presentation Clinical 1 CE

Approximately 32.5% of midwives will be involved in a malpractice action at some point in their career. Being involved in a situation with an untoward outcome is admittedly unavoidable for the midwife who clinically practices for any length of time. When such incidents occur, everyone involved experiences the trauma – the individual who is harmed, the family members, and the practitioner(s) involved. Numerous surveys have documented that a significant portion of health care practitioners who were involved in events with an untoward outcome experienced psychological and professional sequelae after the incident. The “second victim” phenomenon was coined in recognition of the anguish and isolation that the practitioner experiences after untoward events.
After being involved in such events, practitioners may or may not have professionals in their own work organization, or professional circles, with whom they can be reassured that debriefing will not result in a conversation that is discoverable by attorneys representing patients and/or their representatives. The practitioner may experience mistrust by their practice partners, administration, and the nurses with whom they work. They may feel the physical effects of post- traumatic stress disorder simply walking back onto the unit in which the incident occurred to include sleep disruption, headache, vertigo, even muscle paralysis. They may feel self-doubt and lack of trust in their own skills and instincts. They are at greater risk for burnout, compassion fatigue, and reduced job satisfaction. Ironically, the second victim is then at greater risk of committing further errors while they are not physically or emotionally at the top of their game. If a second victim’s needs are not attended to, not only are subsequent patients who receive care from them at risk, but the providers themselves are at great risk.
In this session, the ACNM Professional Liability Section intends to present (in panel discussion format) the experience of a midwife who has lived through the experience of a malpractice action; the advice of a midwife who works as a patient safety and risk management officer; and the recommendations of a malpractice attorney who specializes in the defense of midwives and OB/GYN physicians. Capitalizing on the expertise of these individuals, the audience will leave with strategies to mitigate the trauma associated with being named in a malpractice or disciplinary action.

An Asthma Primer for Midwives
Julie Daniels, Dawn Lovelace
Podium Presentation – Clinical – 1 CE, .25 RxCE

Asthma is a common but potentially life threatening health condition that affects women more often than men. There are significant disparities in diagnosis, treatment, and outcomes based on race, income, and access to care. In addition, there is an association of worsening asthma outcomes with chronic and toxic environmental stress. Women can present to midwifery care with poorly recognized and/or controlled asthma, or with exacerbations of previously controlled asthma. However, midwives frequently feel underprepared to recognize and manage this condition.
Asthma management and treatment is multifactorial, based on avoidance of exposure to triggers and medication management. Significant confusion exists between European and US medication recommendations, further complicating management. This session will provide an overview of management of mild to moderate asthma, including medication management, client teaching, and consultation/referral indicators.

Babies, Breasts, and Bones: An International, Qualitative Survey of Individuals with Pregnancy & Lactation Associated Osteoporosis
Susanrachel Condon, Madeline Veitch
Research Poster Clinical
Benefits and Harms of VBAC Calculators: Midwives’ Perceptions
Kirby Adlam, Kathyrn Erbe, Kylea Liese, Barbara McFarlin, Patrick Thornton
General Poster Clinical
Body Temperature Before Birth
Elise Erickson, Kierstyn Tuel
Research Poster Clinical
Brief Behavioral Therapy for Insomnia
Jennifer Hensley
Podium Presentation Clinical 1 CE, .25 RxCE

Insomnia is the leading sleep disorder in developed countries. Inadequate sleep has adverse consequences in the physical, psychological, and relational realms. Lack of sleep can precipitate or worsen a mood disorder. For chronic insomnia, the proven treatment is cognitive behavioral therapy (CBTi). CBTi requires multiple sessions with extended visits with a paucity of qualified providers. An alternative to CBTi is brief behavioral therapy for insomnia (BBTi). BBTi can be learned by all professionals and woven into short clinic visits such as annual or problem GYN and return OB visits. BBTi is a useful tool that every midwife should have in her back pocket. Come and learn!

Cardiovascular Disease in Reproductive Age: The Role and Responsibility of the Midwife
Nora Drummond
Podium Presentation Clinical 1 CE

Cardiovascular disease is the number one cause of both maternal and overall mortality in American women. Despite this, many midwives are unable to detect cardiovascular disease in the peripartum period and are uncomfortable discussing future cardiovascular risk with their patients. The purpose of this talk is to give midwives actionable tools to recognize cardiovascular disease in pregnant and postpartum patients, and to confidently counsel women on cardiovascular disease prevention strategies. At the end of this talk, participants will understand the important role they play, specifically in the role of midwife, in preventing cardiovascular morbidity and mortality in their patients.

Changes in Home Birth During COVID-19
Willa Campbell, Michelle Palmer
Podium Presentation Clinical 1 CE

Midwives caring for pregnant people and their families recognize stress and anxiety caused by the COVID-19 pandemic and the impact it has on individual decision-making regarding place of birth. This becomes more complicated by risk of exposure to COVID-19 in each setting and policies some settings instituted regarding number of support persons allowed, separation of infant, breastfeeding, and visitation. The pandemic has exaggerated existing unacceptable health inequities caused by structural racism in clinical practice and healthcare systems. Committing to the work of dismantling structural racism and advocating that people should have full agency over their healthcare decisions is essential. In the Position Statement on Planned Home Birth (2015), the American College of Nurse-Midwives (ACNM) affirms that planned home birth should be accessible to healthy people who desire to give birth at home.
In this session midwives will review best practice for ensuring parents and families are supported and their feelings validated, facilitating processes for shared responsibility and informed decision-making regarding place of birth, and delivering evidenced-based, respectful, person-centered care.

Changes to Planned Birth Location due to COVID-19
Jessica Ellis
Research Poster Clinical
Characterizing Uterine Activity During Augmented Labor in Obese Women
Katherine Kissler
Research Poster Clinical
Circumnavigation: Examining Routine Infant Male Circumcision (Documentary)
Emily Fitzgerald, Emily Rumsey
Podium Presentation Clinical 1 CE

Circumcision is a controversial issue in the U.S., fueled by cultural traditions and emotional debate. For many parents, circumcision seems like the “norm” and they make the decision to circumcise their sons without a thorough consideration of the choice. For parents seeking more information, existing media about this topic is often so polarized that they can find plenty of opinions, but have trouble finding helpful evidence-based tools. Clinicians were at a loss for resources to share with their clients.

Two nurse-midwives and media producers set out to change that. So they made a documentary with parents and clinicians in mind. Blending accurate health information, historical and clinical expertise, personal experiences, statistics, and bioethics, this documentary questions routine male circumcision and promotes an informed decision. The approach is gentle and respectful.

Drug Screening Practices & Policies of L&D Units in the Southeastern US: Considerations & Implications
Dolly Pressley Byrd
Research Poster Clinical
The Effect of Tailored Pre-Surgery Breastfeeding Education for Women Scheduled for Cesarean Birth on Their Success with Breastfeeding Initiation and Continuation
Jill Demirci, Evgenia Komar, Geraldine Maurer, Nancy Niemczyk
General Poster Clincal
The Effects of Oral Contraceptive Pills on Sexual Pain and Dysfunction
Kathy Herron
Podium Presentation – Clinical – 1 CE, .25 RxCE

Oral contraceptive pills are an excellent choice for some women and have many health benefits. In some cases, however, OCP use can lead to sexual dysfunction and pain. This session will discuss the physiologic basis for this, including which pills are more likely to cause an issue and which women are more likely to be affected. Midwives will learn to identify and treat these women. Physical examination, laboratory tests, medications, and complementary therapies will be discussed.

Evaluating mHealth Apps for Education and Clinical Practice: Translating the MARS Tool
Melissa Stec
Podium Presentation – Clinical – 1 CE

Although there are more than 160,000 mHealth apps in the major app store repositories, very few are evidence-based or have been evaluated for outcomes. mHealth, or the use of mobile devices and applications (apps), is rapidly expanding in many areas of society. The purpose of mHealth apps is to improve health outcomes, decrease health care costs, and improve client satisfaction. Given the constant influx of new apps into the into the major app repositories, clinicians need to be able to ensure the quality of information and interaction that occurs within the mobile health (mHealth) marketplace. Apps that are highly rated in stores may or may not contain current evidence-based information and recommendations. The Mobile Application Rating Scale (MARS) is a valid and reliable instrument developed to measure the quality of mobile healthcare apps. This tool requires training and knowledge of mHealth technologies and is very useful for comparing numerous apps systematically. A simplified version of the MARS tool was developed to be used without extensive training; the uMARS tool is valid and reliable and may be easier for the practicing clinician or consumer to use. This session will review the MARS instrument, the implementation of the simpler version, uMARS, and presents opportunities to explore it’s use in practice.

Evidence-Based Care of Opioid Use Disorders in Obstetric Triage
Jamie Swietlikowski
Podium Presentation – Clinical – 1 CE, .5 RxCE

Overdose, specifically opioid overdose is the leading cause of maternal mortality in many states across America. The majority of the maternal overdose deaths are seen in the postpartum period. Untreated opioid use disorders also increase risk of neonatal morbidity and mortality including but not limited to preterm birth, low birth weight, and fetal demise. However, pregnant women who receive evidence-based treatment for opioid use disorders have been shown to have decrease risk of overdose death in postpartum period and improved outcomes for their neonates. The primary entrance to the healthcare system for pregnant women with opioid use disorders is through the emergency department or obstetric triage not outpatient prenatal care. The obstetric triage visit may be the only opportunity to engage women with opioid use disorders into treatment. Evidence shows that offering initiation of opioid use disorder treatment during triage visits versus symptomatic treatment of withdrawal in combination with referral to community medication-assisted treatment (MAT) program may improve MAT initiation rates. This presentation aims to review current evidence on safety and efficacy of opioid use disorder treatment in obstetric triage setting. This presentation also aims to improve midwives confidence to diagnose and treat opioid withdrawal and opioid use disorder in the triage setting by providing an update on evidence-based recommendations for the clinical management of opioid withdrawal, initiation of medication-assisted treatment, and discharge planning. Participants will also leave the presentation with clinical pearls, quick diagnosis references, treatment algorithms, and EMR standardization tools to support the efficient incorporation of the above recommendations into midwives’ robust busy practice.

An Exploratory Prospective Study of Water Birth at UUMC
Jessica Ellis, Gwen Latendresse
Research Poster Clinical
Fatphobia in Healthcare: Weighing the Science and Best Practice
Heather Bradford, Katie DePalma, Kaity Mole, Signey Olson
Panel Presentation – Clinical – 1 CE

Implicit and explicit weight bias and a weight-loss centric approach to care are pervasive among clinicians. These attitudes and beliefs are associated with adverse physiological and psychological health outcomes. Further harm can also occur with chronic dieting and weight cycling. This presentation will provide an overview about fatphobia, weight bias, weight stigma internalization, and their effects on health, and review current evidence that promotes weight positivity and the principles of a “Health at Every Size” approach. Health-enhancing strategies and practical tips will be identified that are weight inclusive and promote healthy lifestyle habits. Through personal reflection, clinicians can better understand the harms of a weight-loss centric approach. Through an understanding of the current weight science, clinicians can begin to incorporate more respectful client-centered language and weight inclusivity practices into their care using the “Health at Every Size” approach.

Feasibility of a Volunteer Doula Program in a Metropolitan Hospital
Cara Busenhart, Ruth Steward
Research Poster Clinical
Genital and Oral Herpes Update
Terri Warren
Podium Presentation Clinical 1 CE
Helping People Conceive: Fertility Counseling & Evaluation, An Important Component of Reproductive Primary Care
Elizabeth Smith
Podium Presentation – Clinical – 1 CE

Multiple studies show that patients of all types posses minimal awareness regarding natural fertility rates, age-effects on reproduction, and fertility risk factors. Frequently, people overestimate the chances of spontaneous conception and the effectiveness of assisted reproductive technologies. At the same time, other studies demonstrate the failure of providers to address issues of fertility in routine health encounters, and when addressed, studies find their advice to be outdated, non-specific, and untimely. People of color and LGBTQIA clients experience greater inequity and inaccuracy in their family expansion efforts. In this presentation, we will discuss fertility counseling and evaluation from a reproductive justice framework and why it should be a component of routine, midwifery-led, health promotion. We will review the basic anatomy and physiology of conception, discuss the influence of racism and gender bias on fertility. We will explore the four pillars of a thorough, evidenced-based fertility evaluation, discuss lifestyle factors that influence conception, dispel myths regarding getting pregnant, and review evidence-based behaviors that improve fertility. Finally, we will present evidence-based guidelines for incorporating intrauterine inseminations into midwifery practice.

Implementation of Effective Care with a Body Mass Index Specific Mediated Toolkit at a Military Treatment Facility
Komkwuan Paruchabutr
General Poster Clinical
Implementation of the Hormone Health Network’s Menopause Map™ Toolkit to Improve Patient-Centeredness of Menopause Care
Lynn Anderson
Research Poster Clinical
Implementing a Standard Practice to Circumvent Perinatal Morbidity – A Postpartum Depression Screening Process Prior to Inpatient Discharge at an Academic Health Care Institution
Carrie Kilma
General Poster Clinical
Implementing Universal Intimate Partner Violence Screening Utilizing a Patient-Centered, Shared Decision-Making Approach
Bobbi Bennett-Wolcott
Research Poster Clinical
Improving Access to Evidence-Based Lifestyle Interventions for English & Spanish Speaking People with Gestational Diabetes Mellitus in an Interprofessional Women’s Healthcare Clinic: A QI Project
Cathy Emeis, Jennifer Ham, Sally Hersh
General Poster Clinical
Increasing Use of Intermittent Auscultation of the Fetal Heart Among Low-Risk Laboring Patients: A Quality Improvement Project
Cathy Emeis, Sally Hersh, Caroline Miller, Julia Vance
General Poster Clinical
Influences of Maternal Obesity on Induction of Labor Requiring Cervical Ripening
Jessica Ellis
Research Poster Clinical
Interpreting Cervical Cancer Screenings Guidelines and Management Strategies
Lacey Cross, Mary Lauren Pfieffer
General Poster Clinical
Interprofessional Simulation Training to Improve Out-of-Hospital Birth Transfers
Jami Baayd, Susanna Cohen
Research Poster Clinical
Intrapartum care during COVID-19 from the patient perspective
Erik Barr, Rachel Blankstein Breman, Danielle Bradley, Adriane Burgess, Carrie Neerland
Research Poster Clinical
The In Vitro Fertilization (IVF) Experience of Survivors of Sexual Abuse: A Narrative Analysis
Jenna LoGiudice
Research Poster Clinical
Iron Deficiency Anemia in Pregnancy: Treatment and Monitoring with IV Iron
Jessica Ellis, Christina Elmore
Podium Presentation – Clinical – 1 CE, .25 RxCE

Iron deficiency anemia (IDA) during pregnancy has been associated with maternal, fetal, and newborn complications. There are conflicting recommendations from major organizations such as the American College of Obstetricians and Gynecologists (ACOG), the Center for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the Society for Maternal Fetal Medicine (SMFM) on best practices for treatment and continued monitoring of IDA in pregnancy. Recent studies highlight the potential for IV iron to expedite treatment and improve maternal, fetal and neonatal outcomes. We have worked closely with Maternal Fetal Medicine Physicians at the University of Utah to develop a clinical practice guideline for screening, treatment and continued monitoring in the context of iron deficiency with or without anemia. This presentation will highlight key clinical considerations as well as review select cases to emphasize how guidelines might aide clinical practice.

Labor Induction vs. Expectant Management: Birth Outcomes in a Midwifery Model of Care
Joanne Bailey, Nicole Carlson, Elise Erickson, Ellen Tilden
Research Poster Clinical
Lessons Learned from the COVID-19 Stress Test on Perinatal Care
Molly Altman, Meghan Eagen-Torkko, Ira Kantrowitz-Gordon
Podium Presentation – Clinical – 1 CE

The COVID-19 pandemic has forced health care systems to rapidly adapt policies and procedures in order to protect patients and staff from exposure. These changes have had varying effects on how midwives and nurses are able to provide care and how patients experience that care, both positive and negative. For example, visitor policies restricting support people during the hospital stay both increases need for nurses and midwives to be at the bedside in a supportive role (thus increasing potential exposure) and has been shown to negatively affect patient experiences, often disparately for families of color. Other changes such as increased telehealth visits and reduction in overall prenatal, postpartum, and pediatric visits have decreased patients’ sense of connection and relationship with providers. While these changes have been made in part to protect patients and staff from exposure, they have had the effect of reducing overall trust in the system, leading patients to transfer to community-based birth settings or to miss care appointments. In this presentation, we will share evidence from interviews with patients and nurses and facilitate discussion on how midwives can use this information to promote changes within their own health care systems.

Limitations on Birth Support People During the COVID-19 Pandemic: A Presentation by the ACNM Ethics Committee
Meghan Eagen-Torkko, Ira Kantrowitz-Gordon, Michael McCann
Panel Presentation – Clinical – 1 CE

Hospitals restricted the presence of support people during perinatal care to prevent the transmission of COVID-19. Such policies can have a disproportionate impact on people of color because they face a heavy burden of disrespectful care, racism, and reduced social support and have increased vulnerability to COVID-19 through employment in service industries and increased prevalence of chronic health conditions. The unequal power dynamics between prenatal care providers and patients of color can influence how information is shared and diminish patient autonomy. People of color, therefore, have a greater need for advocacy in the labor room to overcome the power differentials between midwives and patients. An ethical and social justice lens will be used to analyze the challenges to providing safe, respectful, and culturally appropriate perinatal care during a global pandemic. A panel discussion of representative clinical cases will present diverse perspectives to guide ethical strategies to develop and implement policy.

Maneuvering Through the Challenges of Shoulder Dystocia
Frances Sahrphillips, Cheri Van Hoover
Podium Presentation – Clinical – 1 CE

Shoulder dystocia is an unpredictable obstetrical emergency with potentially devastating consequences. In this presentation, the etiology, pathophysiology, and evidence-based management of shoulder dystocia are reviewed. Institutional readiness, potential legal implications, and adverse psychological consequences of shoulder dystocia are discussed.

Midwifery versus Obstetric Models: A Comparison of Primary Birth Outcomes
Christine Cannon
Research Poster Clinical
Midwives’ Perceptions of Risk and Preparedness During the COVID-19 Pandemic
Beth McManis
Research Poster Clinical
A Mixed Methods Study of Posttraumatic Growth in Military Nurses Who Served in Iraq and Afghanistan
Mary Ellen Doherty, Elizabeth Scannell-Desch
Podium Presentation Clinical 1 CE

This session discusses a study on posttraumatic growth in U.S. military nurses who served in the Iraq and Afghanistan wars. The study provided initial evidence that some nurses who served in these wars experienced posttraumatic growth. While healthcare providers need to be educated about their vulnerability when exposed to trauma, they also need to be aware of potential growth when caring for casualties. Nurses preparing to serve in war, as well as those returning, need to pay attention to their physical, psychological, emotional, and spiritual health. Following return from deployment, the military services need to take deliberate and careful measures to ensure that no returning personnel ‘fall through the cracks’ in getting the help they need.

Multimodal Pain Management Interventions to Decrease Opioid Use After Cesarean Section Delivery
Jennifer Rockhold
General Poster Clinical
Music as a Modality during Antepartum and Postpartum – The Evidence
Katie Moriarty
General Poster Clinical
Navigating Medical Complexity in Community Births: Lessons from the MANA Statistics Project
Merit Bovjberg, Melissa Cheyney, Elise Erickson
Becky Gams, Ann Forster Page, Samantha Manning
Podium Presentation – Clinical – 1 CE

More families are choosing community birth in the United States due to real and perceived risks of hospital-based care, concerns about COVID-19, and mistreatment during birth. Globally, there is consensus that community birth can be safe for low-risk women. However, specifically constitutes a “low-risk” pregnancy or how best to support pregnancies with specific risk factors when they occur outside the hospital is less well-defined. In this session we highlight three papers that contribute to these discussions using MANA stats data from planned, midwife-led community births in the US. Together these studies help to nuance conversations around shared decision making, risk perception and birth setting selection. Collectively findings also suggest strategies for mitigating risk associated with specific factors and provide insights regarding risks conferred by birth setting versus risks inherent to conditions.

A Needs Assessment for a Peripartum Mood and Anxiety Disorder Support Group
Cara Busenhart, Emily Martinez
Research Poster Clinical
Open-Label Quasi-Experimental and Feasibility Study of Florjajen Digestion Probiotics to Reduce GBS Colonization in Pregnant Women by the Time of Birth
Katrina Nardini
Research Poster Clinical
Outpatient Cervical Ripening: Implementation of Outpatient Cervical Ripening Using the Foley Balloon
Becky Gams, Ann Forster Page, Samantha Manning
Podium Presentation – Clinical – 1 CE

Outpatient cervical ripening for women with low-risk pregnancies has the potential to decrease length of stay, decrease cost of care and increase patient and provider/nurse satisfaction in relation to inductions of labor needing cervical ripening. 20% of all women in the U.S. undergo an induction of labor during their pregnancies, and of those 20%, up to half will need some form of cervical ripening. The purpose of this quality improvement project was to establish and implement an evidenced-based guideline and procedure for outpatient cervical ripening. Implementation of outpatient cervical ripening using the Foley Balloon has been implemented in a large healthcare system including one academic hospital, and 8 community/regional hospitals within the system. The implementation utilized a collaborative interprofessional team of key stakeholders including midwives, physicians, advance practice nurse leaders, registered nurses and nurse managers. With an urgency to respond to COVID-19 and a desire to reduce hospitalization time for patients, the team reviewed current evidenced-based practices to update an unused guideline, electronic medical record order-sets and education materials for providers, nurses and patients. Data collection has begun and is ongoing. To date, two PDSA cycles for improvement have been implemented. Metrics will include 6-9 months of outcomes encompassing length of stay, cost of care, and evaluation of provider, nurse and patient satisfaction. After this presentation, attendees could consider aspects of the outpatient cervical ripening policy development, implementation process and sustainment into their own workplace with collaboration with other providers, nurses, leadership and patients.

Parturition: What We Think We Know (And Don’t Know!) About the Physiology of Childbirth
Nicole Carlson, Elise Erickson
Podium Presentation – Clinical – 1 CE, .25 RxCE

Despite decades of research, scientists and care providers still do not really know why labor starts and why the birth process can be so variable between people. This talk will orient the attendee to the new (and old) thinking around the physiologic mechanisms of parturition including traditional pathways of steroid hormone function, cortisol, the fetal influence on birth timing as well as newer ideas like sterile inflammation, gestational tissue senescence and the autonomic nervous system. In addition, the presenters will highlight important new findings around nutrition/metabolic influences on labor, genetic differences between individuals and how body type could affect pharmacologic stimulation of labor. Gaps in collective knowledge will be covered, including processes that are still considered hypothetical (i.e. Ferguson reflex). This talk will provide key take-away lessons for clinical practice to support physiologic labor as well as manage labor induction to achieve optimal outcomes.

Grounded in these evidence based principles, the PATH framework, a series of open-ended questions appropriate for any client population, is designed to shift how we approach reproductive health questions and counseling. The efficient PATH framework ensures all clients, regardless of any provider biases or assumptions, sex assigned at birth, sexual orientation, age, parity, race or ethnicity are directly asked about their reproductive goals or intentions. Using PATH supports our moving away from an inherently biased, crisis mode demanding we take responsibility for resolving all unintended pregnancies, to an approach that helps us move toward reproductive justice for all by giving clients the space to express their autonomous reproductive goals and preferences.

This session presents the PATH framework which begins with the questions: Do you think you might like to have (more) children at some point?; and when appropriate: When do you think that might be? and How important is it to you to prevent pregnancy (until then?). The questions are designed to facilitate active listening on the part of the provider with scaffolding from client centered counseling skills and evidenced based patient education techniques. Participants are invited to examine personal biases, practice the PATH questions, and develop effective counseling skills and efficient tools aligned with a client-centered, shared-decision making approach.

Perception of the Newborn and Why It Matters to Midwifery
Michelle Palmer
General Poster Clinical
Perinatal Disaster Evacuation Triage Tool: Preparing for the Future
Cathy Emeis, Karen Hays, Patricia Reddy
Panel Presentation – Clinical – 1 CE

Disaster preparedness involves the anticipation of an event and the integration of appropriate protocols that will mitigate the impact of a disaster. An evacuation triage tool for perinatal inpatients has been designed and integrated into an urban multi-hospital teaching consortium, but has yet to be evaluated for validity and reliability outside of that context. Childbearing women represent a distinct vulnerable population that is not always recognized for its unique needs. Birth is a dynamic process. Typically, the time of onset of labor is unknown and once labor begins, it cannot be stopped. Unlike admissions in other specialty areas of a hospital, most labor admissions are not scheduled. Labor is an unpredictable process & unique in that there are two patients requiring evaluation & monitoring. In addition, specific resources are required to maintain safety throughout the process. This quality improvement project evaluated the implementation of an evacuation triage instrument, the OB-TRAIN (Obstetric Triage by Resource Allocation for Inpatients), to address the lack of a perinatal-specific, internal disaster-preparedness policy at a rural hospital. Gender-based inequities are noted in allocation of supplies and resources in preparation and recovery phases of a disaster. Women are not recognized as a priority for aid and services. If services are available, that which is provided is often less robust than for the general adult population. Rapid and reliable assessment and projection of transport resource needs is critical to ensure safe passage of the vulnerable mother-baby dyad during a disaster. Adequate allocation of limited or scarce resources can be facilitated by implementation of OB-TRAIN in the perinatal unit while providing objective and standardized assessments to enforce structural equity of care. The small size of our population and staff lends to a recommendation of further study. The OB-TRAIN as implemented is a static tool with future recommendation to embed in the electronic health record allowing for linking of acuity to progression of changing stages of labor.

Placental Pathology Report Utilization by Providers and Influences on Maternal and Neonatal Care
Jane-Frances Aruma, Kelly Gallagher, Alison Gernand, Jeffery Goldstein, Christiana Oji-Mmuo, Jaimey Pauli
Research Poster Clinical
Polycystic Ovary Syndrome (PCOS) 101 for Midwives
Rebecca Fay
Podium Presentation Clinical 1 CE

Polycystic Ovary Syndrome (PCOS) is a common disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. Because PCOS carries an increased risk of metabolic sequelae that includes an increased risk of diabetes and cardiovascular disease, it is important midwives recognize the clinical manifestation. The purpose of this presentation is to inform midwives about this common disorder, including diagnosis criteria, medical management of symptoms, non-medical interventions, and lifestyle changes. Midwives providing care in primary care, adolescent, and women’s health settings are the ideal providers to identify and educate women about this disorder. Early diagnosis and initiation of treatment may reduce long-term sequelae.

A Postpartum Depression Screening Practice Change to Improve Pediatric Provider Knowledge and Identification of Postpartum Depression
Krysta Ramirez Henry
General Poster Clinical
Prenatal Opportunities to Improve Postpartum Contraception Decision Making
Arianna Blaine, Danielle Bradley, Adam Wolfberg
Research Poster Clinical
The Project Nurture Model: Integrating Obstetric and Addiction Services for Pregnant People with Substance Use Disorders (SUD)
Julie Bennette, Autumn Davidson, Diana Louise Smith
Podium Presentation – Clinical – 1 CE, .25 RxCE

Substance use disorders (SUD) in pregnancy has escalated in dramatically over the last decade, paralleling the epidemic observed in the general population. Pregnant people with SUD are less likely to engage with a health team due to fear of stigma and child welfare involvement. As a result, this population is at higher risk of complications for themselves, for their infants at birth, and for ongoing adverse social effects later in life. Recommendations for screening for SUD in pregnancy is evolving with most recent data supporting self-administered questionnaires asking about substance use over routine urine drug screening Substance use disorders do not arise in a vacuum. Instead, they are highly correlated to adverse childhood experiences, and frequently result in cycles of intergenerational substance misuse.

Traditional models of care for pregnant people with SUD separate obstetric care from addiction care, resulting in poor communication among treatment teams and isolation among patients. Project Nurture is a Center of Excellence model that integrates addiction treatment with obstetric care for pregnant people with SUD. Originally created in 2014 with funding from Health Share of Oregon, Project Nurture was piloted at three sites, each a partnership between a health system and a treatment system (Legacy/LifeWorks Northwest, OHSU/CODA, and Providence) and outcomes were evaluated by the Center of Outcomes Research. This interdisciplinary model has now been implemented at additional sites, including Kaiser Permanente NW and is widely considered to be the standard of care for treatment of pregnant people with SUD. The development process, model of care, outcomes, challenges, and lessons learned to date will be presented.

“The quicker they could be done with me, the better”: Women’s perspectives on time, equity, and quality perinatal healthcare
Abby Duerst, Lisa Graves, Catherine Kothari, Mounika Pogula, Joi Presberry, James Southard, Pamela Wadsworth
Research Poster Clinical
Rethinking Substance Use Screening: The Acceptability of Screening and Willingness to Disclose Substance Use in Prenatal Care
Nancy Berglas, Ana Delgado, Monica McLemore, Sarah Roberts, Signy Toquinto
Research Poster Clinical
The Role of a Federally Qualified Health Center during a Pandemic: Supporting Medically and Socially Vulnerable Patients
Barbara Hackley, Leah Hargarten, Scott Ikeda, David Herszenson, Fadhylla Saballos, Ariel Sarmiento, Mia Stange
Research Poster Clinical
The Role of the Nurse-Midwife in Promoting Enhanced Recovery After Cesarean Section (ERAC)
Julia Dickinson
Research Poster Clinical
Safely Reducing Cesarean Sections Utilizing the PROVIDE Toolbox in a Faith-Based Hospital
Diana Jolles, Minyon Outlaw
Podium Presentation – Clinical – 1 CE

Unnecessary cesarean sections can harm low risk women by increasing their risk for severe morbidity and mortality. This hospital’s cesarean section rate was 29.1% which demonstrated a need for improvement when compared to the Healthy People 2020 goal of 23.9%. The purpose of this presentation is to demonstrate the impact of unnecessary cesarean sections that have been on the rise among American women by presenting a project that safely reduced the NTSV cesarean rate from 29.1% to 20.2% by the end of a 90-day period.

Sexual Health in All the Right Places: Improving Effective Extragenital STI Testing
Daniel Stec
Podium Presentation – Clinical – 1 CE, .25 RxCE

Gonorrhea and chlamydia continue to be a public health concern, with most infections found via urogenital testing. There is a large reservoir of extragenital (oral or anal) infections missed in all populations with only urogenital testing. New guidelines exist to direct proper treatment. The project aim was to increase effective care by screening, testing, and managing those at risk for extragenital gonorrheal and chlamydial infections to 60% in 8 weeks. This project enhanced the organization’s sexual healthcare and created a more robust environment of communication and awareness of needs. The tools could be spread to other departments and in other settings with similar gaps. This presentation will include an interactive sexual health activity, a review of the new (2020) CDC STI Treatment Guidelines, and a demonstration of pharyngeal and anorectal swab collection with interactive hands-on opportunity.

Six is the New Four – But Does It Matter?
Nancy Niemczyk
Podium Presentation – Clinical – 1 CE

More than 30% of childbearing women in the United States continue to give birth by cesarean. In 2014, the American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) issued a Consensus Statement on Safe Prevention of Primary Cesarean Delivery, which redefined first stage arrest of dilatation from 2 hours with no progress in active labor to 4 hours with no progress with adequate contractions. Based on this recommendation, some hospitals, birth centers, and practitioners changed their clinical practice. Yet, the effect of implementing the Consensus guidelines on birth outcomes has had only limited evaluation, and results are conflicting. Overall, there has not been a national decrease in cesareans as had been hoped. While affecting all women, minority women in the United States bear a disproportionate burden of cesarean births with higher rates of cesarean overall for black (OR 1.12) and Hispanic women (OR 1.23) compared to white women, even after adjustment for socioeconomic confounders. Among low risk women in New York, black women had 3 per 100 more cesareans than white women, a difference which increased between 2008 and 2014. These differences are accompanied by higher maternal mortality and morbidity. This presentation aims to provide the attendee with a clear understanding of the rationale for the development of the Consensus guidelines and an up-to-date understanding of the research about the results of Consensus Guideline implementation in both hospital and birth center settings, and to help attendees understand racial disparities in cesarean for labor dystocia and the implication of updated guidelines for improving these disparities.

Spontaneous Vaginal Birth Varies Significantly Across U.S. Hospitals
Rebecca Clark
General Poster Clinical
Standardization of Postpartum Clinical Guidelines Using the Omaha System
Karen Monsen, Melissa Saftner, Codruta Vizoli-Hoover
General Poster Clinical
Stemming the Tide of Rising Congenital Syphilis in the United States: An Update and Review of the Provider Role
Aliza Machefsky
Podium Presentation Clinical 1 CE

Syphilis rates are increasing among pregnant people and their babies throughout the United States. More than 50% of pregnancies with untreated syphilis result in severe medical issues, including stillbirth, early infant death, prematurity, bone abnormalities, blindness, and deafness. Importantly, these are preventable with timely diagnosis and treatment during pregnancy. Efforts are needed to increase testing, educate patients, and improve systematic approaches to care in order to improve patient outcomes. The purpose of this presentation is to review increasing congenital syphilis rates in the United States, diagnosing and treating syphilis in pregnancy, current guidelines for congenital syphilis prevention, and challenges in preventing congenital syphilis.

Synthetic Oxytocin and Exclusive Breastfeeding in a Baby Friendly Hospital
Katie Kivlighan
Research Poster Clinical
Toward Improving Midwifery Care: Encoding Clinical Guidelines Using the Omaha System
Renee Kinstler, Karen Monsen, Melissa Saftner
General Poster Clinical
Treatment Options for Menopause Symptoms: An Evidence-Based Approach to Care
Amanda Clark, Kimberly Vesco
Podium Presentation – Clinical – 2 CEs, 1 RxCE
Understanding the Health and Social Needs of Families Living in Homeless Shelters
Barbara Hackley, Leah Hargarten, Arielle Hoffman, Scott Ikeda, Monica Kavanaugh, Justin Kopa, Alan Shapiro
Research Poster Clinical
Variation in Provider Practice and Physician Cesarean Birth Rates of Nulliparous, Term Women in the United States
Bingham Debra, Stacey Iobst
Research Poster Clinical
Women’s Experiences and Satisfaction with Giving Birth in US Hospital During the Early Phase of the COVID-19 Pandemic
Elizabeth Mollard
Research Poster Clinical

Global Midwifery

2021 Global Health Hot Topics for Midwives
Robyn Churchill
Podium Presentation Global Midwifery 1 CE

In their initial education, CNMs/CMs learn about providing culturally appropriate care for the U.S. population, an ACME core competency. In the global setting, midwives provide clinical care within a variety of cultural contexts, educate a variety of professionals, and participate in healthcare systems change. However, up to date information about groups outside the U.S. or recently resettled to the U.S. is often not easily available. As CNMs/CMs increasingly engage in global work, including care of refugee women, they need to learn the most recent information about immediate issues of the global arena. Additionally, the impact of Covid-19 on women’s reproductive health services is growing daily, and our understanding of it changes. This session will provide CNMs/CMs interested in global health with the latest information in these areas: providing culturally appropriate care to groups most affected by global crises, supporting and strengthening essential reproductive health services during the COVID-19 pandemic, up-to-date information about prevalent infectious diseases, including COVID-19, challenges and solutions to global maternal health workforce issues, and the role of midwives and impact on global health care systems.

Blood: The Forgotten Essential Commodity for PPH in Low- and Middle-Income Countries
Deborah Armbruster, Emma Clark, Mary Ellen Stanton
Round Table Global Midwifery .5 CE

While blood transfusion has long been used as an essential part of the package of interventions to manage severe postpartum hemorrhage in high-income countries, it has not been a focus of attention and support by the global maternal health community and remains out of reach for most people in lower- and middle-income countries.
In the last several years, this has begun to change. In November 2019, a meeting was held in Senegal on the topic of PPH and focused on listening to the voices of the South, blood emerged as life-saving product that countries from Uganda to India identified as one of their top two priorities needed to address PPH, despite the fact that few donors currently supported it. All participants were interested in Rwandan colleagues stories of using drones to get blood to where needed quickly. Given this perspective, there is increased attention and urgency to address the many challenges to improving access to blood products. We encourage attendees to discuss global reproductive health issues that they view as under-recognized or misaligned, and ideas for how we can highlight need, coordinate activities, and channel expertise to understand and address these issues to improve how responsive the global health community is to reproductive health needs and concerns around the world.

COVID-19 and Facility Birth: Impact and Implications
Robyn Churchill, Emma Clark, Lisa Noguchi, Theresa Shaver, Mary Ellen Stanton
Panel Presentation – Global Midwifery – 1 CE

While the direct risks to mothers and newborns from COVID are gradually being understood, the indirect risks posed by COVID are also becoming clear. COVID has highlighted existing gaps in access to and quality of services for pregnant women and newborns, exacerbating existing inequalities and threatening to reverse progress made in recent years. Early modeling using the Lives Saved Tool (LiST) showed 8.3-38.5% increase in maternal deaths per month across the 118 low- and middle-income (LMIC) countries included in their analysis, depending on the severity and duration of the pandemic. Early on-the-ground informal and anecdotal evidence suggested reduced use and quality of services. Now, more formal data and studies are emerging from Kenya, Nepal, Zimbabwe and Uganda confirming early reports and showing increased stillbirth rates and neonatal mortality. While biological processes from COVID infection may be at play, there is mounting evidence that much of this increase is due to reductions in such factors as fewer antenatal care visits, lower rates of institutional childbirth, interrupted supply chains for essential maternal health commodities, and reduced quality of care due to lockdowns, fear of exposure at health facilities, and health worker absenteeism and/or workload.

USAID and its partners have been leaders in synthesizing data and previous lessons learned and best practices, and promoting continuity of core maternal and newborn health interventions. While COVID presents challenges unknown to Ebola and vice versus, the recent Ebola outbreaks in West Africa provide some relevant learning. Similar reductions in health care utilization were observed, resulting in increased deaths from non-Ebola causes. Reproductive, maternal, and child health services were significantly affected, with notable decreases in facility deliveries, cesarean sections, and the volume of ANC and PNC visits. While utilization of services has improved post-outbreak, it has not done so to pre-Ebola levels, suggesting the need for targeted interventions to increase use post-pandemic in conjunction with efforts to reduce losses during the pandemic. We discuss risks and benefits of innovative, localized interventions, such as targeted communication campaigns, re-imagining the role of traditional birth attendants, moving skilled birth attendants out of facilities into communities, and enhancing access to emergency care outside the facility (e.g., through expanded community distribution of misoprostal). We also discuss early learning from this pandemic, such as the value of gathering and sharing initial experiential knowledge to shape early responses and prevent further deterioration.

This session contributes to the Understanding Global Health Global Competency by providing context on the current global burden of disease and morbidity for women and newborns and emerging evidence-based efforts to reduce disparities and the burden of illness in post-conflict and fragile states. It also contributes to the Health Equity and Justice Competency through its discussion of health systems and health workforce issues that affect population health and identifying strategies to reduce these disparities.

Decolonizing Global Midwifery in the Time of COVID-19: Midwives’ Experiences with Collaboration and Advocacy
Oveka Jana, Maria Openshaw
Podium Presentation Global Midwifery 1 CE

This education session will focus on the “Health Equity and Justice” and “Health System Strengthening” competencies from ACNM’s Global Health Competencies and Skills. The presenters are midwives from the U.S. and Malawi who have worked together since 2018 on a collaborative midwifery mentorship program pioneered by the University of California San Francisco Global Action in Nursing project (UCSF-GAIN), that works to promote global health equity by elevating midwifery leadership and quality of midwifery care in three countries in sub-Saharan Africa.

While the global Safe Motherhood movement has led to great improvements in global maternal and neonatal health outcomes over the past three decades, the flow of knowledge, funding, and scholarship largely follows colonial patterns from the Global North to the South, reinforcing global structural inequities. Midwives from high-income countries often pursue careers in global health seeking to reduce global health disparities and reduce suffering. However, they enter a global health landscape where funding and policy may be driven by international strategic interests ranging from global security, protection of investment, public health and advancing foreign policy. Because of this divergence between foreign interests and local needs, even with the best intentions, work that occurs within inequitable systems will sometimes result in unintended harm.

Recent calls in the global health community to “decolonize” global health and create a more equitable landscape have been amplified by the major disruptions in the global health ecosystem caused by the SARS-CoV-2 pandemic. At the same time, diversion of global resources to the pandemic have resulted in dangerous gaps in essential services such as maternal and neonatal care. There is a clear role for midwives in filling these gaps.

By grounding our conversation in a decolonizing perspective on global health, the presenters will discuss ways in which midwives’ work in global health can promote equitable power dynamics in global health collaborations. The presenters will share stories and examples from our experience in UCSF-GAIN to discuss common pitfalls in global health collaboration, and also to show how elevating midwifery through workforce development, leadership and advocacy and promoting health systems strengthening can result in decolonizing shifts in global health paradigms, leadership, and knowledge.

Determinants of Health, Stress, and Resilience in Nepalese Childbearing Women
Wasim Alsamah, Iftikhar Cheema, Nola Holness, Jawed Mallick, Abigail Paz, Praveen Sah
General Poster Global Midwifery
Respectful Maternity Care in the Time of COVID: A Global Perspective
Deborah Armbruster, Elena Ateva, Theresa Shaver, Suzanne Stalls
Panel Presentation – Global Midwifery – 1 CE

The respectful maternity care movement has gained momentum in recent years, with respectful care now widely understood as both a critical marker of quality of care and a basic human right. The COVID-19 pandemic has brought international attention to the prevalence of disrespectful care globally, including in the United States. Fear and the many unknowns of COVID have been used to justify a wide range of potentially harmful and disrespectful clinical and interpersonal policies, ostensibly to reduce COVID transmission. These policies often lack any evidence or credible explanation for reducing transmission or improving outcomes; in fact, many are in direct opposition to strongly evidence-based practices. In the context of COVID, disrespectful care has taken the format of forcing people to labor alone; forced cesarean sections for laboring people with COVID; separation of newborns from COVID positive mothers; forced or undignified isolation; and suspension or inaccessibility of essential services. These often exacerbate existing policies and practices that lead to disrespectful care.
Across the globe, it is the most marginalized women at risk for the poorest care, a fact COVID has only exaggerated. The individual and family repercussions of disrespectful care are devastating. However, it is also critical to understand that, particularly for vulnerable and marginalized populations for whom access to and engagement and comfort with health systems may already be tentative, a negative experience by an individual could have community repercussions lasting generations. This session will discuss the profound implications disrespectful care has for maternal and newborn health outcomes and why this demands a holistic global look in the context of COVID and beyond.

The Story of the Re-Birth of Midwifery in Afghanistan: The Razia Jan Institute
Sadaf Chaudhry, Razia Jan, Patti Quigley, Suzan Ulrich
Panel Presentation – Global Midwifery 1 CE

Midwifery in Afghanistan has emerged as the backbone of the health system following the collapse of the system under Taliban rule. The Ministry of Public Health partnered with the International Confederation of Midwives (ICM) to re-established midwifery in 2002 to address the highest maternal mortality rate in the world. A major component of the plan to restore midwifery was community education of midwives which was a difficult task because under Taliban rule girls did not attend school. Almost two decades later the Razia Jan Institute was established as a community vocational program for midwives by Razia Jan who first dreamed of building a school to educate girls in Afghanistan. Razia Jan will tell the story of her school and the international attention her work garnered including a 2012 CNN Top Ten Hero award. She will discuss the addition of the midwifery education to her school. Panelist will discuss the midwifery education program, the progress of midwifery in Afghanistan, and the future collaboration with ACNM. You will hear the voices of graduates from the Razia Jan Institute and learn how they are contributing to their communities.

Utilizing ACNM Global Midwifery Competencies to Practice Anti-Racism While Working in Global Midwifery
Barbara Floyd, Nola Holness
Panel Presentation – Global Midwifery – 1 CE

Volunteers with good intentions have a great responsibility to practice in a way that is anti-racist. This presentation shares the experiences of several CNMs who have worked or volunteered in Haiti, Honduras, Jamaica, the Dominican Republic, and India. Narrative, anecdotes and photos illustrate the need to promote anti-racism in global midwifery, thus promoting justice and equity. The purpose of the presentation is to encourage participation in global health activities in developing countries and to encourage practice of anti-racism through development of global midwifery competencies. Volunteer midwives with global midwifery competencies have opportunities to promote anti-racism, justice and equity, while building professional and personal relationships with colleagues in developing countries.

Leadership

Answering the Call: Lessons Learned Opening an Emergency Birth Center in a Pandemic
Jessica Henman, Amy Romano
Podium Presentation – Leadership – 1 CE

Where is the safest place to give birth? This question was just one of many brought to the forefront of American healthcare discussions in 2020. The COVID pandemic highlighted the need for community-based, rapidly-evolving healthcare solutions, and a birth center team in New York City answered the call. This discussion will address the need for a rapid-response birth center in Manhattan, how it was successfully opened in less than 2 months, and the lessons learned that can be carried through to other birth centers, midwifery practices and our nation’s healthcare system as a whole.

Fellows Talk: Beyond the Light of Day–Addressing Racism in ACNM Fellowship
Kim Dau, Alexis Dunn, Sascha James-Conterelli, Suzanne Wertman
Podium Presentation – Leadership – 1 CE

The ACNM Fellows Board of Governors have made a commitment to tell the truth about our history of racism in midwifery and the path to Fellowship, and move toward reconciliation with our actions. The presenters see the Fellows Talk as a vehicle to support the beginnings of the process of truth and reconciliation through presentation of factual history of racism in midwifery and ACNM, individual stories, and next steps to removing structural and systemic racist barriers to becoming a Fellow. This is an ongoing process, and and the presentation will include lessons learned and opportunities for change. The material presented in this session will have implications for every aspect of life as a midwife–but in particular leadership in the profession, in ACNM, and ACNM Fellowship.

Navigating Difficult Conversations Within a Midwifery Practice
Elizabeth Munoz
Round Table Leadership .5 CE

Failure to clearly communicate is one of the most common causes of medical error and professional “headaches”. Communication not only affects patient outcomes, it can also make or break a busy practice. Sensitive topics can be difficult to navigate and lead to tension when inadequately addressed. More discussions are needed for midwives and other birth workers and education on clear communication is important to the success of these interactions. The purpose of this presentation is to review methods and styles of communication that facilitate honesty and promote trust among birth providers.

Oral Histories: Empowerment Through Preserving Our Voices
Lucinda Canty, Winifred Connerton
Panel Presentation Leadership 2 CEs

Oral histories can be powerful meaning-driven and meaning-building acts of empowerment and defiance. Oral histories of midwives contribute to our collective understanding of the development of our profession, and of the ACNM itself. While oral histories are an established historical research methodology, they can be collected by peers; between students and experienced practitioners; family members; as well as by historians. The accessible nature of collecting and sharing oral histories explodes the boundaries of typical historical artifacts, and opens the door to a fuller, more meaningful history for everyone. Many groups within the college have embarked on oral history collection, these are their stories.

Taking the Lead: Scaling Up the Midwifery Workforce and Midwifery Education to Address Shortfalls of US Maternal Healthcare Delivery
Lastascia Coleman
Podium Presentation Leadership 1 CE

The United States is facing a multifactorial maternal health provider shortage. Multiple sources cite that midwifery is part of the solution. How do we actually build capacity for educating more midwives and filling the gaps of the workforce shortage? The objective of this presentation will be to give an overview of the current information regarding midwifery practice and education in the United States, discuss patient-related benefits of midwifery care and review innovative strategies to scale up our practice. Emphasis will be placed on racial disparities, racism and workforce development aimed at those interesting in becoming midwives who are currently underrepresented in the profession. Key findings from the state of Iowa will be discussed. Iowa is working towards building capacity for educating new midwives and addressing healthcare delivery and policy issues regarding midwifery practice. A feasibility study and needs assessment will be completed for a CNM education program with movement towards initiating a program that is affiliated with an academic medical center. Recommendations and lessons learned will be reviewed.

Midwifery Matters – Business

Data Collection and Reporting for Midwives: Making Your Numbers Work for You
Cathy Emeis, Karen Perdion
Podium Presentation Midwifery Matters – Business 1 CE

Collecting and reporting data is critical to promoting midwifery practice and improving outcomes. But where to start? This session will help you determine what information to collect, which tools are available, and how to create and effectively use reports to benefit your practice. We will also discuss using your data for quality improvement and Benchmarking Project participation, as well as leveraging it when working with administrators. Whether you are just getting started or are looking for new ideas, there will be something for you in this session.

Healing the Healer through Nature Therapy (Forest Bathing)
Katie Moriarty
General Poster Midwifery Matters – Business
Maternity Care Changes in Response to Pandemic
Jennifer Vanderlaan, Kathryn Woeber
Research Poster Midwifery Matters – Business
Understanding the ACNM Program Committee
Pamela Reis, Letitia Sullivan
Panel Presentation – Midwifery Matters – Business – 1 CE

The ACNM Program Committee is a vibrant and active committee within the College that is responsible for the educational content of the ACNM Annual Meetings as well as conducting the annual business meetings. We invite you to join two past Program Committee Chairs and the current Chair to learn about the history, restructuring, and current composition of the Program Committee, the structure of the Annual Meeting, and how abstracts are evaluated and selected for the Annual Meeting. We will also discuss the challenges and successes of conducting the first ACNM Virtual Annual Meeting in 2020.

Workforce and Practice Effects of State Midwifery Licensure and Regulation During the Pandemic
Mary Ellen Bouchard, Jessica Dunn, Maryann Long, Sally Steinbach, Jennifer Vanderlaan, Kathryn Woeber
Podium Presentation Midwifery Matters – Business 1 CE

The COVID-19 pandemic has presented the midwifery workforce with extreme challenges for maintaining access to high-quality care and safety for both clients and providers. Existing state-level APRN practice restrictions, as well as state government responses to pandemic workforce needs, may influence the ability of midwives to meet those challenges. The effects of state regulatory and licensure changes made during the pandemic on midwifery workforce and practice are unknown. This study examined changes in midwifery employment and practice in the United States in response to the COVID-19 pandemic, and related those changes to midwifery regulatory and licensing changes implemented during the pandemic. Women and infants have unique health and safety needs that must be addressed in emergency and pandemic planning and response. State governors’ executive orders during the COVID-19 pandemic frequently aimed to improve the interstate and intrastate flexibility of APRN and RN workforce distribution and/or to increase access to care through telemedicine, but unique strategies targeting maternal and infant health access are also needed. As midwives work to ensure access to high-quality, safe care, understanding midwifery workforce and practice changes made during the pandemic and relating those changes to regulatory and licensure changes will inform future professional advocacy efforts.

Midwifery Matters – Public Perception

Advocating for Midwifery: Addressing Systemic Racism Through Policy and Advocacy
Zoe Gutterman, Claire Harper, Amy Kohl
Podium Presentation – Midwifery Matters – Public Perception – 1 CE

This session will help give midwives up-to-date information and effective techniques to bring about policy change at local, state and federal levels. The presentation will review and discuss legislative successes and challenges since the 2020 ACNM Annual Meeting, and will look at upcoming legislation of importance to ACNM members. Additionally it will offer practical advice on how midwives can influence health policy.

Birth Plan Implementation and Subsequent Impact on Patient Satisfaction
Research Poster Midwifery Matters – Public Perception
Effects of Education on Public Perception and Knowledge of Midwives in Rural Kansas
Nora Elizalde
Research Poster Midwifery Matters – Public Perception
Evaluating Causes of Inaccuracy in Georgia Birth Certificate Data
Nicole Carlson, Rasheeta Chandler, Hannah Walters, Kaprice Welsh
Research Poster Midwifery Matters – Public Perception
Expanding Midwifery Through Interprofessional Education: Strategies for Every Midwife
Melissa Avery, Judy Lazarus, Amy Nact
Podium Presentation
Midwifery Matters – Public Perception – 1 CE

Interprofessional education (IPE) is defined as students from two or more professions learning “about, from and with each other”. Existing research suggests that learners develop an appreciation for working together and feel more comfortable collaborating when they experience IPE in their health professions academic and clinical education. Emerging research also suggests there may be improvements in care outcomes following IPE. A nationally funded project that was completed in 2020 investigated and documented the benefits of IPE when midwifery and OB/GYN residents learn together. Our goal in this presentation is to share current literature and midwives’ experiences with IPE as well as propose ideas for engaging midwifery clinicians and educators widely, both formally and informally, in interprofessional education. We will discuss equity in interprofessional education and how midwives can participate in being sure that all learners are welcomed into our practice and educational environments and explore how heath equity can be taught in interprofessional settings. By discussing and sharing ways to teach and practice interprofessionally, we may be able to increase the number of midwifery clinical sites available, enhance the education of midwifery students, and advance the midwifery profession by exposing multiple health professions learners to midwifery practice. Whether you are a clinical or academic educator, or a midwife in clinical practice, this session will inspire you to bring IPE into your professional role and provide you with some innovative ideas about how to do that! We encourage all midwives to bring their love for midwifery and be prepared to participate in a fun session sharing experiences and ideas for the future as we promote our profession and learning together.

Stand Up and Be Counted! Why Ensuring Birth Certificate Accuracy Should Be the Priority of Every Midwife
Erin Biscone, Kendra Faucett, Emily McGahey
Podium Presentation Midwifery Matters – Public Perception 1 CE

Accurate data on certified nurse-midwife/certified midwife (CM/CNM)-attended births may provide CNM/CMs with increased influence on maternal-child policy and legislation. Underrepresentation of CNMs/CMs in vital statistics has financial, political, and potentially ethical implications. Data from birth certificates is frequently used in research on perinatal outcomes. When CNMS/CM-attended births are underrepresented, we cannot fully demonstrate our wonderful outcomes, including the impact on health disparities due to racism, and other important benefits of the midwifery model of care. There are steps midwives can take to increase the accuracy of birth certificate data and ensure their births are recorded correctly. Using data collected from state health departments, midwives, and birth certificate clerks in three states, we will explore practical solutions for correcting processes that result in errors on birth certificates. By incorporating a few simple changes into practice, which they will learn in this session, midwives can make a difference to their profession and to women and birth people across the county, as we seek to make the midwifery model of care the standard of care.

State Practice Environment for Midwives in the United States: A DNP Health Policy Project
Marie Hastings-Tolsma, Erica Imaoka, Amy Kohl, Sharon Ryan, Suzanne Wertman
Research Poster Midwifery Matters – Public Perception

Racism and Health Disparities

Answering Better Questions: Collecting Variables and Conducting Analyses to Improve Health Equity
Nicole Carlson, Stephanie Devane-Johnson, Julia Philippi, Ellen Tilden, Jonathan Snowden
Podium Presentation Racism and Health Disparities 1 CE

Issues of health equity are at risk of biases in every step of scientific and quality improvement processes, from what is deemed worth measuring to how variables are defined, what questions are asked, and how analysis is conducted. These biases weaken the scientific and clinical knowledge needed to improve care among vulnerable individuals in marginalized communities. Midwifery leaders and scientists should be leading health equity quality improvement and research. Without excellent and proactive data collection strategies, factors that cause health inequities can be invisible. Identifying and addressing inequities in data collection and analysis is fundamental to generating science useful in improving health care. This presentation will:
1) Examine fundamental decisions about which demographic and health characteristic phenomenon have been deemed worthy of measurement;
2) Highlight how variable definitions can shape health equity research;
3) Discuss how decisions related to points one and two importantly impact many types of research and quality improvement- for example, prospective research often employs commonly used demographic and health characteristic variables to enable comparison of study findings with prior research and observational research must use demographic and health characteristic variables as they were defined when data was collected;
4) Consider the health equity impact of analytic choices –for example, problems inherent in using race or ethnicity as a covariate in multivariable regressions for pregnancy outcomes, which can make health disparities invisible;
5) Share a synthesis of top recommendations from anti-racist and health equity scientific leaders and propose how this knowledge might shape future data collection systems to improve maternal/child health equity science, quality improvement, and policy.

The Biology of Adversity and Perinatal Health: What Midwives Need to Know
Hector Olvera Alvarez, Elise Erickson
Podium Presentation – Racism and Health Disparities – 1 CE

People who experience adversity, discrimination and racism may experience higher rates of perinatal health problems; emerging research is beginning to link how social exposures influence a person’s physical health resulting in health disparities. The purpose of this presentation is to orient perinatal care providers to research that examines early life experiences in particular and lifelong health outcomes. Specifically, this talk will address how an adverse social environment can influence an individual’s biological/physiologic function as it relates to later pregnancy cardiovascular health, placental function, fetal growth/development, preterm birth or other perinatal morbidity. The lessons learned in this talk will help midwives think more broadly about their role in the context of the childbearing year and consider interventions to promote addressing social determinants of health or screening for adverse early life experiences.

Call to Action: Identifying and Addressing Unconscious Bias in the Midwifery Profession
Rita Ortiz
Research Poster Racism and Health Disparities
Centering BIPOC Conversations and Practices in Nursing and Midwifery Training Programs
Susan Dearden, Uma Dorn, Gwen Latendresse, Kritzia Merced, Paola Sepulveda
Round Table Racism and Health Disparities .5 CE

In the wake of George Floyd’s death and the affirmation of the Black Lives Matter movement, this roundtable seeks to center the conversation of anti-racism and pro BIPOC practices in our profession. Most of us are aware of the staggering inequities that persist in this country when it comes to maternity care. However, less is known about ways to dismantle the white-centric spaces and practices where these inequities arise and are sustained, starting as early as in our academic training, research labs, and practicing clinics. Taking on from the recent work published by Bala Chaudhary and Asmeret Asefaw Berhe, “Ten simple rules for building an anti-racist lab”, this roundtable will discuss the experience of our team in delving into anti-racist discussions, reflecting on our behaviors and project strategies, and we will describe actionable steps presented in the paper. In addition, we will open the discussion to attendees to share their experiences and provide alternative approaches and how these are aligned to the broader goal of ending racist-practices and promoting anti-racism in nursing and midwifery.

Compliance, Resistance, and Conspiracy: Lessons Learned from the Zika Epidemic with Application to the COVID Pandemic
Kelly McBroom
Podium Presentation – Racism and Health Disparities – 1 CE

In a time of emerging pandemics with reproductive implications, it is vital to understand the experience, psychological impact, risk perception, and protective behaviors elected by childbearing persons, and to develop midwifery specific interventions for encouraging informed choice. Reproductive coercion disproportionately impacts BIPOC and colonized peoples, and diseases with reproductive impacts must be viewed through a lens informed by Reproductive Justice.

Decolonizing Health: An Intersectional Approach to Addressing Health Needs of LGBTQ+ Communities
Michaela Rahimi, Roxanne Winston
General Poster Racism and Health Disparities
Depression as a Contradiction to the American Dream: Addressing Barriers
Susan Dearden, Uma Dorn, Gwen Latendresse, Kritzia Merced, Paola Sepulveda
Round Table Racism and Health Disparities .5 CE

According to SAMSHA, Latinx communities have less access to needed mental health treatment and have difficulty finding culturally responsive care. Prevalence rates for maternal depression in Latinas can be in the upwards of 59% and is compounded by the intersection of poverty and race/ethnicity. However, people of color are less likely to be screened for mental health conditions than the non-Latinx White population. Latina mothers are 3 times less likely to obtain services despite need, yet the majority of untreated women report positive attitudes about medication or counseling for treating depression. This is of concern because perinatal depression among Latina women is associated with poor outcomes, particularly mothers’ attachment to infants. This roundtable will discuss the focus group/interview data from a larger randomized clinical trial of telehealth group intervention to reduce perinatal depressive symptoms in diverse populations. Fourteen participants were included in the focus groups and individual interviews that were conducted in-person and via video-conference. Participants self-identified as Latina were pregnant or postpartum. The interviews were focused on questions related to enhancers and barriers to mental health treatment and use of technology and understanding of depression from a cultural framework. Data was analyzed using a grounded theory framework by a three-person coding team. Specific barriers that were found from the focus group/interview data included cultural layers of understanding and treating depression in the Latinx community, access to treatment and technology, stigma and awareness. Often providers are focused on addressing the access barriers, but fail to address the lack of culturally responsive strategies. Recommendations and strategies to address these barriers will be discussed.

Dismantling Transphobia: Gender Affirming Care in Obstetrics and Gynecology
Gene de Haan
Podium Presentation – Racism and Health Disparities – 1 CE

The evolution of gender affirming care has been rapid over the last decade but many of us have a lot to learn about to create an affirming clinical environment. During this session we will review basic terminology and how to use elicit and use pronouns correctly. We will also discuss how to contextualize trans/gender nonconforming patient experiences in light of racism, classism, homophobia, xenophobia, etc. We will review how to take our own inventory, dismantle our own allegiances to oppressive ideologies thereby working towards creating safer clinical spaces.

Disparities in Maternal Mortality in the U.S.
Diane Bohn, Jacqueline Campbell, Jennifer Heck, Emily Jones
Podium Presentation – Racism and Health Disparities – 1 CE

Rates of maternal mortality (MM) in the US are the highest amongst 49 developed nations. While global MM rates have dropped 38% in the last decade, the US continues to see increases in maternal deaths in and around the time of pregnancy. Women of color are more likely to experience MM, and the majority of pregnancy-related deaths are believed to be preventable. The purpose of this presentation is to explore disparities in MM in the US, reasons for these disparities, and solutions that could improve MM overall and among women of color in particular. Midwifery-led care, widespread adoption of evidence-based protocols to address pregnancy complications, and improved access to health care before and during pregnancy are among improvements in health care which hold potential to reduce MM in the US. Routinely addressing intimate partner violence in maternal health care is essential. Health care systems must address inherent racism and work toward provision of culturally-aware, patient-centered and trauma-informed care for pregnant women.

Educating Housekeeping Staff to Encourage a Culture Supportive of Breastfeeding
Julie Blumenfeld
Research Poster Racism and Health Disparities
Equitable Midwifery Care for Women of Color with Breast Cancer
Dwynn Golden, Dawn Lovelace, Linda McDaniel
Podium Presentation – Racism and Health Disparities – 1 CE

Breast cancer is more common in white women, but women of color are more likely to have earlier onset, more aggressive disease, more severe impact on quality of life and higher mortality rates. These disparities are multifactorial, including health inequities, genetics, access to care, and differences in treatment. The purpose of this project was to identify evidence-based practice changes for recognition and management of disparities in breast cancer diagnosis, treatment, and outcomes for women of color. Midwives, as advocates within the medical system, can assist their clients to navigate the complex and frightening process of dealing with breast cancer. Midwives can individualize screening, and recommend culturally appropriate interventions and lifestyle modifications to improve quality of life for cancer survivors. Midwives are well positioned to be involved with policy changes and advocacy for reduction of institutionalized racism in health care.

Everyone Deserves CHOICES: Using Midwives to Help Create a Full Spectrum Model of Care
Nikia Grayson, Kemetra King, Talita Oseguera, Brooke Prudhomme, Karen Scott
Podium Presentation Racism and Health Disparities 1 CE

CHOICES Memphis Center for Reproductive Health was established in 1974 by local women as an independent abortion clinic. In 2017, using the Reproductive Justice framework, CHOICES has refocused itself as a midwifery led, comprehensive reproductive health care center, providing birth & perinatal care, gynecological care, abortion, transgender care, fertility assistance, HIV prevention, sexual health care, and family planning; recognizing that abortion access and access to all birth options are social justice issues. The CHOICES model of high quality, non-judgmental, and patient-centered care understands poverty, gender, race, and sexual orientation as important structural/social determinants of health and actively addresses barriers to abortion care and the full range of birth options. In this presentation, we will discuss: (1) how CHOICES was born and has evolved to embrace our social justice mission; (2) The successes and challenges; and (3) Best practices to truly commit to reproductive justice.

Exploring Health Equity of Women Veterans through an Intersectional Lens
Lori Trego
Podium Presentation – Racism and Health Disparities – 1 CE

Veterans, who are at notable risk for physiological and mental health disorders, are emerging as a group that is experiencing health disparities in the U.S. In 2017, the National Academy of Sciences, Engineering & Medicine recommended that veterans be included in the national discourse of health disparity indicators and indices. The scientific literature is replete with evidence of variations in common conditions among women veterans when compared to non-veterans, including reproductive health, primary care, mental health, and chronic disease management. Health disparities, such as differences in the diagnoses and prevalence of mental illness, also exist between men and women veterans. Moreover, health disparities can stem from health inequities, which result from variance in access to opportunities for health that occur at the intersection of social identity and structural determinants of health. Approaching the health equity of women veterans through an intersectionality lens takes into account how systems of inequality in the U.S. overlap to create conditions for either health equity or health inequities. This session will explore the phenomena of health equity among women veterans. Examining women veterans’ health through this intersectionality health equity lens is an innovative approach. Given that 1) health is a result of multiple determinants, and 2) health inequities often result from poverty, racism, and discrimination, it is pertinent to further explore the social and structural determinants of health in these vulnerable populations of women veterans.

Fighting Racial Disparities in a Community Hospital System: A Collaborative, Committee Approach
Ellen Solis
General Poster Racism and Health Disparities
Flourishing Families Project: Socializing the Maternal Health and Educational Experience
Melissa Bowley, Elisabeth Howard
Podium Presentation – Racism and Health Disparities – 1 CE

Health education increases overall individual confidence, health agency and improves outcomes. Women who are pregnant rely heavily on information from their providers during their prenatal visits. Nationally, only 18% of women attend any childbirth classes, most of which are institutionally based. COVID-19 has highlighted the need to revamp how we educate and empower new and expecting families, especially families of color, to enhance their self-efficacy which will ultimately lead to improved health outcomes. Health education increases overall individual confidence, health agency and improves outcomes. The current model of education mainly focuses on child birth and the antenatal period. Current evidence reveals that the continuation of health education strategies after child birth contributed to improved maternal and child outcomes, especially in regards to breastfeeding. Hospital-based classes no longer fit community needs, are not well-utilized, and do not match the cultural or social diversity of our clients. Hospital-based education lacks a person-centric focus and women continue to face barriers to both prenatal care and education. Placing education within the community it serves and decentralizing authoritative knowledge to include doulas, birth workers, friends, families and providers builds capacity and strengthens individuals and communities. It provides opportunities for connection, mentorship and participatory action. We share a highly successful model for maternal health education that involves collaboration between community health workers, friends, families, and medical professionals that centers around the families’ needs. We share a collaborative strategy to access real-world, engaging, action-oriented maternal and parenting education that resulted in higher participation and engagement rates in our region. We believe this leads to higher self-efficacy within marginalized populations and ultimately result in better health outcomes such as initiation of breastfeeding, lower rate of pre-term birth, and lower C-section rate.

A Harm Reduction Approach to Substance Use and Pregnancy
Signy Toquinto
Podium Presentation – Racism and Health Disparities – 1 CE

Current clinical approach to substance use during pregnancy is often rooted in the belief that substance use as a moral, criminal, and legal issue for BIPOC communities. White pregnant people who use substances are often viewed as having a health issue or substance use disorder. In the United States, the legacy of racism has led to the disproportionate surveillance, criminalization, and punishment of individuals and communities of color who use substances. This injustice emerged from and is sustained by white supremacy. The purpose of this presentation is to provide participants with a foundation for understanding the legacy of criminalization of substance use during pregnancy and teaches a harm reduction approach to working with people who are using substances during pregnancy, birth, and postpartum.
Implications for practice: This presentation challenges current inequitable and harmful health care practices of screening, testing, and reporting substance use; and offers an alternative approach rooted in trauma informed care, harm reduction, reproductive justice and antiracism.

Health Providers’ Perception of Black Maternity Care in the US
Melva Craft-Blacksheare
Research Poster Racism and Health Disparities
Holding up the Mirror to Midwifery: Perinatal Outcomes by Race/Ethnicity Among Clients of Two Academic Midwifery Services
Joanne Bailey, Elise Erickson
Research Poster Racism and Health Disparities
Identifying and addressing racial bias in maternal health: Piloting a virtual training for midwives
Susanna Cohen, Jeelan Fall
Research Poster Racism and Health Disparities
“I’m not making up what’s going on with my body”: Women of Color’s Experiences with Healthcare Providers
Elissa Allen, Terra Bautista, Anmol Hans, Elishae Johnson, Catherine Kothari, Ainsley McWilliams, Joi Presberry
Research Poster Racism and Health Disparities
Implications of Race Among Pregnant People Experiencing Housing Instability
Ashley Gresh, Noelene Jeffers, Kelley Robinson, Phyllis Sharps
Podium Presentation Racism and Health Disparities 1 CE

Housing instability (HI) among pregnant people is a growing public health concern in the United States. Pregnancy-related morbidities are associated with adverse health outcomes among vulnerable populations. However, the nature of this association among people experiencing HI is poorly understood. Even less studied are racial health inequities within the context of HI during pregnancy. Guided by an adapted Socio-Ecological model, this research reduces the gap in knowledge to elucidate the intersection of housing instability, pregnancy, and maternal health. This study explores the relationship between pregnancy and housing instability, including the structural, interpersonal, and individual level barriers and facilitators to achieving safe, quality maternal health care during pregnancy within the context of race and housing instability. It is essential to actively listen to the stories of pregnant people experiencing housing instability. For African American people specifically, social determinants such as housing instability should be considered when evaluating maternal health disparities. Midwives can facilitate quality maternity care by ensuring housing questions are more deeply explored and that follow up support is in place for those who need it.

Implicit Bias Education: Addressing Racial Disparities in Maternal Healthcare
Amanda McPherson Shafton
Podium Presentation Racism and Health Disparities 1 CE

Maternal mortality disproportionately affects Black people. Implicit biases play in a role in how healthcare providers interact with and treat their Black patients. By increasing knowledge about implicit bias, healthcare providers can learn tools and strategies to decrease the effects of their implicit biases on clinical decision making. This has the potential to result in higher quality healthcare for patients who are at the greatest risk for poor outcomes. The purpose of this presentation is to increase healthcare provider knowledge regarding the effects of racial bias on maternal mortality. In addition, this presentation discusses the use of a novel evidence-based educational intervention used to address implicit bias and racism with Labor and Delivery Staff. This presentation outlines how to begin to speak about implicit bias and racism within the workplace and how we as a community can do better to care for Black families.

Improving Inequities in Prenatal Screening: Time to Modernize Guidelines
Aishwarya Arjunan, Susan Hancock, Katie Johansen Taber, Jamie Kostialik, Summer Pierson, Edith Smith, Raul Torres
Panel Presentation Racism and Health Disparities 1 CE

Professional guidelines can have a profound impact on reproductive health. In many cases, prenatal genetic screening is often only recommended for specific groups or those who have been historically recognized as high risk. Unfortunately, this approach results in missed opportunities to identify those who have equal or greater risk and results in a disparity in how prenatal genetic screening is conducted both preconceptionally and prenatally. This session will discuss the changes needed to promote equitable care.

Indigenous Birth: Colonization to Healing
Margaret David
Podium Presentation Racism and Health Disparities 1 CE

When assessing Indigenous reproductive health through our colonized medical systems disparities are often the focus, and racism is often further perpetuated. This discussion will look deeper into understanding what some of the structural factors are that influence Alaska Native/Native American perinatal health, both protective and damaging, from an Indigenous worldview. How can we then use this information to dismantle racism in our own midwifery practices to better serve Native birthing people? Examples of promising practices will be shared, and the newly formed National Indigenous Midwifery Alliance will be introduced.

Inequalities in Use and Donation of Donor Human Milk – Building a Model Response for Change
Kimberly Updegrove
Podium Presentation Racism and Health Disparities 1 CE

Racial and ethnic disparities in establishing and meeting breastfeeding goals, and ultimately, accessing human milk for human babies have significant implications for vulnerable infants and a community’s overall health. The US nonprofit milk bank industry was established to fill gaps in access to human milk, but statistics reveal that it has not accomplished this for families of color, most especially for black mothers and infants. The Mothers’ Milk Bank at Austin (MMBA) has begun a program to change this. Drawing on the success of similarly intended programs of care, MMBA is working to break down barriers to breastfeeding in the communities of color in Austin through development of relationships with community leaders, development of a scholarship program to train members of the community to be the breastfeeding resources within the community, and promotion of a unique model of breastfeeding education and support. Our intent is to develop a model that can be replicated in other cities

Launching Perinatal Health Equity: A Quality Improvement Project
Lauren Arrington
Podium Presentation – Racism and Health Disparities – 1 CE

Health care organizations have a responsibility to reduce racial and ethnic perinatal health disparities. In the US, Black women and childbearing people experience the worst perinatal outcomes with alarming disparities in morbidity and mortality. While there is tremendous momentum behind this issue, little is known about how to successfully address it in clinical practice. This session will discuss the launch of the Reduction of Peripartum Racial/Ethnic Disparities Bundle at a community hospital in Maryland. This is one component of a long-term process to address racial and ethnic disparities at the project site. The launch included a health equity party, implicit bias workshop, snack and learn sessions, online modules, two grand rounds, and the establishment of a health equity committee. Initial steps were taken to collect data to understand disparities in client experience and outcomes at the project site. Systems for identifying, reporting, and addressing inequities in care were strengthened.

Maternal Mortality Review in New Mexico: Process, Findings and Recommendations
Katrina Nardini
General Poster Racism and Health Disparities
Measuring Equity: How Do Hospitals and Health Systems Improve Outcomes?
Lastascia Coleman
Podium Presentation – Racism and Health Disparities – 1 CE

Many individuals struggle with how to transition from doing antiracism work on the individual level and moving to a system and structural level. This presentation will give an overview of the racist institutional and systemic structures and policies that have contributed to disparities in maternal health we see today. In order to understand how to move within these entities, a historical overview of the US healthcare system will be given as a foundation. Next we will discuss what factors contribute to health by reviewing structural and social determinants of health with the Socio-Ecologic Model as a framework. Several national organizations have recommendations addressing measures and tactics to eliminate inequities in health care systems; an overview of these recommendations will be discussed. Finally, participants will leave with actionable steps that can be taken in their own place of work and communities.

Melanated Group Midwifery Care (MGMC): Group Prenatal Model of Care Utilized by Black Midwives in Response to Healthcare Delivery Changes due to the COVID-19 Pandemic
Karie Stewart
Panel Presentation – Racism and Health Disparities – 1 CE

Prenatal care (PNC) is an ideal venue to initiate prevention of perinatal morbidity and mortality and to address the systemic healthcare needs of pregnant Black women. Pregnant women are highly motivated to improve health behaviors. However, structural racism and implicit bias overshadow healthcare interactions during pregnancy, contributing to worse pregnancy and neonatal outcomes. The COVID-19 pandemic, social distancing and reduced in-person prenatal visits increase Black women’s isolation and stress and may exacerbate perinatal risk factors. Already, Black and Latina women make up over 70% of women in Illinois who have had COVID-19 while pregnant. And yet, their access to health care is evaporating. With only two labor and delivery units remaining, the south side of Chicago has become a maternal health desert. This study seeks to improve patient-provider interactions, health communication, and perinatal health outcomes for Black women in Chicago by changing the current prenatal care paradigm to a community-based model of group prenatal care that can be delivered electronically. This study will test the feasibility and acceptability of Melanated Group Midwifery Care (MGMC). Racial concordance between the midwife and patients is supported by studies demonstrating Black women feel safe and more connected with providers of color and/or fearful of receiving judgement from white providers. Meeting with other Black pregnant women in a consistent group also provides social support and joint problem solving. The collaborative midwife-client relationship and continuity of care, including self-assessment (weight and blood pressure) plus individual physical assessment by the midwife, respects both practitioner expertise and client self-knowledge.

Midwifery Care Improves Birth Outcomes in the BIPOC Community
Kate Keller, Lonnie Morris
Podium Presentation – Racism and Health Disparities – 1 CE

Large gaps in birth outcomes exist between the BIPOC and white communities. This independent midwifery practice found minimal differences in birth outcomes between the two groups. Utilization of the midwifery model of care plus incorporating additional interventions and practicing proactively equalizes the outcomes across all racial groups.

Midwifery Community-Based Models of Care to Reduce Maternal Mortality: Breaking Barriers of Racial Injustice During Birthing Experiences in New York, USA
Jennifer Dohrn
Panel Presentation – Racism and Health Disparities – 1 CE

Maternal mortality remains an issue globally, and for women of color in the United States, it doubles that of white women. Midwifery-led models of care that include community women’s leadership and participation offer a way forward for safe motherhood. From 1988 -2012, thousands of pregnant women found a refuge at the Childbearing Center of Morris Heights (CBC), a midwifery-led maternity center in the Bronx, NY. In a community that was home to Black, African, and Latinx families who historically experienced high rates of maternal/infant mortality and morbidity, CBC became a thriving hub for women to learn and help direct their care. Their stories focused on their traditions, their perceptions of racial disparity within the US healthcare system, and how their experiences with midwives affected their families and lives.
This session will discuss how midwifery-led community birthing centers that engage women in leadership and policy as well as easy access to high quality care offer a sound public health model for maternal/infant well-being.

Midwives for Black Lives: Improving the Pathway to Midwifery Scholarship for Black Student Midwives
Letitia Salazar Monk
Podium Presentation – Racism and Health Disparities – 1 CE

Midwives for Black Lives (MBL) is a BIPOC operated campaign organized to support the improvement of Black maternal-fetal health outcomes through the diversification of the field of midwifery. Specifically, we seek to increase the enrollment and retention of black midwife students in midwifery educational programs as well as increase the number who successfully transition into practice by giving scholarships to Black Student Midwives and new graduates. In the very recent past, Black midwives were purposefully decommissioned and excluded from the professional field of midwifery and formalized midwifery education. Despite the significantly disparate poor health outcomes for black families, existing health care systems fail to treat the black patients as inherently valuable and lack the incentive to remediate their own contributions to these poor outcomes. Racism is causal in poor health outcomes and so racially concordant care must be prioritized among remediating efforts. However, the pathways to midwifery licensure are paved with unrecognized and unexamined assumptions of white privilege, resulting in a dearth of support for Black student midwives. Midwifery programs are graduating classes of white midwives primed to work with those who have access, while being out of reach for those most in need of lifesaving midwifery care. The lack of diversity is compounded by cultural and racial bias in the science, clinical skills, testing methods, and preceptor experience in midwifery education. MBL recognizes the fortitude and talent exhibited by black student midwives in accomplishing the prerequisites, curriculum demands, and challenges of a midwifery education despite these many systemically racist obstacles. In addition to offering financial support for Black student midwives, MBL is also working directly with our applicants and community to better understand the holistic needs of black student midwives beyond the financial. This presentation will include the history, structure, and fundraising dynamics of MBL as well as an analysis of the student needs assessment. We will also lead a solution-oriented discussion for increasing the accessibility of a successful midwifery education and practice initiation for Black identifying individuals.

The Origins of Elderly Primigravidas: Tracing Age as a Determinant for Maternal Obstetric Risk
Elise Erickson, Jessica Mezmar
Research Poster Racism and Health Disparities
Postpartum Post Traumatic Stress Disorder in Black Women with History of Trauma: Associations Between Perceptions of Respect, Racism, and Discrimination in Healthcare and Rates of Birth Trauma
Abby Britt, Rebecca Hinrichs, Andrea Joyner, Vasiliki Michopoulos, Abigail Powers, Meghna Ravi, Shimarith Wallace
Research Poster Racism and Health Disparities
Racial Disparities in Immunizations and the New Maternal Immunization HEDIS® Measure
Carol Hayes
Podium Presentation Racism and Health Disparities 1 CE

Many minorities and persons of color have lower immunization rates than whites. This presentation will discuss the racial, social, and economic impacts on immunization rates. Discussion will include the views of African American, Hispanics and Asians about immunizations, and how we can address their concerns about vaccines. Beginning in 2021, The Centers for Medicaid and Medicare Services, along with The National Committee for Quality Assurance (NCQA) and the National Quality Forum, will begin a new Healthcare Effectiveness Data and Information Set (HEDIS®) on maternal immunizations. Learn what that means!

Racial Disparities in Perinatal Outcomes Among Beneficiaries of the U.S. Military Healthcare System
Gwendolyn A. Foster, Stacey Iobst
Research Poster Racism and Health Disparities
The Role of the Maternal Brain-Gut-Microbiota Axis in Black Women with Obesity
Sara Edwards
General Poster Racism and Health Disparities
Strong Black Woman Imperative: A Promising Framework to Guide Care of Black Women After Perinatal Loss
Carrie Henry, Mi-Kyung Song
Podium Presentation Racism and Health Disparities 1 CE

Perinatal loss is devastating, and is more common for Black women than other races. Research has shown that Black women cope with perinatal loss differently than White women, yet conceptual frameworks to help guide midwifery care for Black women following perinatal loss are lacking. The Strong Black Woman (SBW) imperative, a conceptual framework designed to explain how Black women cope with life adversities and stress, may be a useful framework to guide care for Black women after perinatal loss. This session will summarize the current literature on the SBW imperative and propose ways to use the framework to guide the care of Black women following perinatal loss. SBW influences the way many Black women respond to difficulties and trials, likely including perinatal loss. Black women who endorse SBW may be less likely to seek mental healthcare for psychological distress related to perinatal loss; yet, they may call upon internal resources to meet the demands of grief and loss. The SBW imperative may discourage Black women from caring for their own needs during a time of grief and loss; yet, it may encourage them to consider the emotional needs of other family members who are also experiencing the loss. Familiarity with the SBW imperative may give clinicians insight into their Black patients’ mindset and motivations following perinatal loss, but avoiding stereotypes is important.

Structural Anti-Racism Strategy to Prevent Pregnancy Complications
Abby Britt, Victoria Gordon, Priscilla Hall, Amy Kayler, Kaprice Welsh, Kathryn Woeber
General Poster Racism and Health Disparities
Universal Alcohol Screening and Brief Intervention as Routine Clinical Practice: A Strategy for Reducing Alcohol Use During Pregnancy and Overcoming Barriers to Treatment
Alexandra Edwards, Marilyn Pierce-Bulger, Hannah Rebedulla, Sharon Ryan
Podium Presentation – Racism and Health Disparities – 1 CE

Alcohol use, including binge drinking is increasing among women of reproductive age in the U.S. Considering that there is a stable rate of unintended pregnancy and the fact that only 60% of all women in this age group use a form of contraception, the risk of an alcohol exposed pregnancy has increased nationally. Patient and provider perceptions of stigma, bias, racism, and cultural norming can create barriers to personalized health care and advice, especially when alcohol or other substance misuse is involved. This presentation will review the risk factors for alcohol use during pregnancy, describe and define fetal alcohol spectrum disorder, and present a practical strategy for addressing alcohol and substance misuse in this vulnerable population. Universal alcohol screening and brief intervention is an evidence-based practice that, when integrated into daily clinical practice can help normalize and de-stigmatize conversations about alcohol use and empower patients to reduce the risk for alcohol exposure during pregnancy.

Universal Healthcare – Justice, Antiracism, and Advocacy
Amy Alspaugh, Keely Robinson, Cheri Van Hoover
Podium Presentation – Racism and Health Disparities – 1 CE

COVID-19 has laid bare many of the inequities that have existed for so long in the US: an underfunded public health infrastructure, racial & ethnic health disparities in morbidity and mortality resulting from profound and unchecked systemic racism, and the economic vulnerability of both lower and middle-class families. At a time when access to quality, affordable health care has never been more essential, millions have lost their insurance because of a system built on employer-based insurance. Universal health care is a necessary and practical step that must be taken in the US to combat both moral injustice and uncontrolled economic spending. Using the Reproductive Justice framework, we explore the racist roots of employer-backed health insurance and the importance of re-envisioning health care as a human right, not a commodity for purchase. Next, this presentation will explore international universal health care options and lay out the moral and economic reasons why universal health care is essential to enhance the health of all Americans through increasing health equity, benefiting the economy, and enhancing the practice of midwifery. Lastly, we will present practical steps that all midwives can take to promote universal health care as a necessary right for the families we serve and society at large.

Update on Maternal Mortality
Katrina Nardini
Podium Presentation – Racism and Health Disparities – 1 CE

About 700 women die each year in the US. The ratio of pregnancy-related deaths in the US continues to increase and the disparities in deaths by race/ethnicity is widening. Black and American Indian/Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women. And as women age, this disparity in race/ethnicity increases even more. It is estimated that 3 out of 5 deaths can be prevented. Reducing disparities will require the participation of multiple systems to address the factors affecting these disparities. The goal of this session is for midwives/participants to better grasp the complexities surrounding the causes of maternal mortality and the current disparities that exist. Different models and frameworks that demonstrate pathways to racial/ethnic disparities will be discussed. The session will focus on health inequities, including a closer look at the role of racism and discrimination in our society as a contributor to maternal mortality and morbidity. The session will stress the importance of maternal mortality reviews as a means of identifying underlying causes of maternal death and examining disparities to inform prevention strategies. It is important for midwives to understand what is being done at a national level as well as on their own state level, including the coordinated efforts of the Centers for Disease Control (CDC) to bring together state entities to try to optimize solutions to this problem. Midwives/participants will leave the session with an understanding of the recommendations that have come out of state data sharing, in order to better understand the strategies and potential interventions to decreasing maternal mortality and improving health inequities.

Variation in Preterm Birth Among New York Prenatal Sites caring for Medicaid Recipients
Patricia McGaughey
Research Poster Racism and Health Disparities
VBAC Calculator Prediction by Race & Body Mass Index
Pamela Pearson, Patrick Thornton
General Poster Racism and Health Disparities
Wide Neighborhoods, Small Communities: An Analysis of Midwifery in the Southeastern United States in the Early 20th Century Through the Careers of Mary Breckinridge and Margaret Charles Smith
Letitia Salazar Monk
Podium Presentation – Racism and Health Disparities – 1 CE

This presentation compares and contrasts two midwives in the rural Southeast during the early to mid-20th century. Mary Breckinridge was a white woman of high-society whose life’s work was caring for women, children, and families in rural Kentucky. Margaret Charles Smith was an African American woman of very limited means whose mission was caring for her community in rural Alabama. These pioneering midwives came from very different backgrounds but both created enduring legacies in their communities. Their combined stories illustrate the effect of race, financial, and social status in the elimination of the centuries-old, marginalized midwifery profession and its replacement with nurse-midwifery, white-dominated and situated in the mainstream nursing profession.

Words Matter: Avoiding Bias in Health Care Communications and Scholarly Writing
Frances Likis, Kathryn Osborne
Podium Presentation – Racism and Health Disparities – 1 CE

The language used in health care communications and scholarly writing has the power to influence readers’ perception of the individuals and populations described therein. It is critical that health professionals avoid the use of biased language, which can be inaccurate, harmful, and disempower people. This session, led by editors of the Journal of Midwifery & Women’s Health, provides best practices for avoiding the use of biased language and is intended for health professionals and students with a wide range of writing interests and skills. From e-mail messages to clinical practice documents and course materials to published manuscripts, this session will provide content you can use to make a positive difference with your words.

DOR RESEARCH FORUM I

Barriers and Facilitators of Engaging Pregnant African American and Hispanic Women into Research
Sierra Shanahan, Jennifer Woo
Research Forum Presentation – Racism and Health Disparities

African American and Hispanic women are often underrepresented in medical research even though these populations are at higher risk for adverse pregnancy outcomes. These populations also show a higher risk of COVID-19 infection in preliminary COVID-19 research. These risk factors highlight the importance of including African American and Hispanic pregnant women into research and finding effective recruitment strategies during the COVID-19 pandemic. The purpose of this study was two-fold: 1) Evaluate the barriers and facilitators that pregnant African American and Hispanic women face, and 2) Assess the effectiveness of social media as a recruitment tool during the COVID-19 pandemic. In order to improve health disparities in pregnant African American and Hispanic women, they must be represented in research. Due to a history of racism and unethical conduct done in the name of research, there is a clear need for change. It is important that nurse researchers engage at-risk populations in research to make an impact on health disparities. The findings from this study will help to inform future researchers and medical professionals on ways to diversify their practices while also informing professionals on a few ways to proceed with recruitment and interactions during the COVID-19 pandemic.

“I just decided to put up with their behavior…I didn’t want to be labeled any more than I already was”: Dismantling Institutional Racism and Oppression in Healthcare Still Matters
Alexis Barr
Research Forum Presentation – Racism and Health Disparities

Institutional/systematic racism and oppression produces a system of barriers and policies that unfairly restricts access to goods, services and opportunities for African American (AA) communities. For AA women, racism further impacts their motherhood experiences by regularly subjecting them to motherhood messages, images, and stereotypes which influence their infant feeding (IF) practices. Very few studies focus on the intersectionality of AA’s race, gender, class, and culture, specifically addressing the factors that influence their IF behaviors. The intersectionality paradigm addresses the marginalized, oppressive, and intersecting social existence of AAs by examining identity, social class, and power. This study explored the collective lived experiences of multi-generational AA families and how intersectionality plays a role. An essential element of health disparities practice should integrate an intersectionality lens to dismantle systemic racism. Therefore, it is necessary for healthcare providers to understand the importance of intersectionality and its adverse effects, as contributors to health disparities in the AA community. Additionally, those who work with AA families should strive to be flexible, respectful, supportive, and actively learning about an individual’s beliefs and culture, creating space to reframe, without judgment or paternalism. Increased understanding of AAs interlocking social identities, and the structural factors underlying them, should lead to more nuanced, informed, and culturally appropriate breastfeeding support and promotion initiatives.

The Lived Experience of Severe Maternal Morbidity Among Black Women
Lucinda Canty
Research Forum Presentation – Racism and Health Disparities

Black women have a long history of poor maternal health outcomes. They are three to four times more likely to die from a pregnancy-related complication and twice as likely to experience severe maternal morbidity when compared to White women. A serious gap exists in our knowledge of health disparities in maternal health. There is also a gap in the literature on the experience of Black women during childbirth and among those who experienced severe maternal morbidity. The purpose of this study was to explore the experience of Black women who suffered a life-threatening complication during childbirth or postpartum. Knowledge about possible complications; the health care provider-patient relationship; race; and mental wellbeing in the aftermath play an essential role in the experience of severe maternal morbidity among Black women. Midwives should be aware, their interactions influence women’s mental wellbeing when they suffered a life-threatening complication and the need for culturally sensitive care. Further studies are needed to examine Black women’s experiences during childbirth and the relationship with health care providers. The voices of Black women can provide perspective into the unique challenges that Black women face during pregnancy, childbirth, and postpartum.

DOR RESEARCH FORUM II

Anxiety Symptoms and Severity Among Perinatal Women Screened for Depression with the Edinburgh Postnatal Depression Scale
Susan Dearden, Eli Iacob, Gwen Latendresse, ‪Ryoko Pentecost, Sara Simonsen
Research Forum – Clinical

Anxiety is a common feature of perinatal mood disorders, and often co-occurs with depression. Screening perinatal women for depression is increasingly common, while a concurrent focus on identifying anxiety is less common. The EPDS is a well-validated and widely-used screening tool for depression. Factor analysis of the EPDS suggested that the EPDS may have value as a multi-dimensional tool, with three items forming a subscale measure for symptoms of anxiety. Evidence-based approaches to treating women with anxiety and those with co-occurring depression/anxiety can differ from the approaches for addressing depression alone. Thus, a more precise understanding of women’s mental health issues will facilitate optimal care. The purpose of this study was to identify anxiety symptoms and severity among perinatal women screened for depression with the Edinburgh Postnatal Depression Scale (EPDS). A large proportion of women who screened positive on the EPDS tool also had a positive screen on the anxiety sub-scale. Among those with a positive anxiety screen, approximately 1 in 20 would have been missed based on their total EPDS score. Consideration of the total EPDS score as well as scores on the anxiety sub-scale is important in providing more comprehensive perinatal mental health screening and care with appropriate guidance and resources.

Innovative Approaches to Midwifery Education in the Time of COVID
Kelly McBroom
Research Forum – Academic Education

The COVID epidemic has challenged midwifery educators to rapidly develop innovative approaches to adapt midwifery education in a virtual format. These approaches hold great promise to provide additional avenues and flexibility to include more diverse students and increase the reach of educational opportunities for midwives.

Military Women’s Health Research Priorities: Combining Knowledge, Science, and Strategy
Lisa Braun, Dawnkimberly Hopkins, Molly Middleton, Leilani Siaki, Lori Trego, Candy Wilson
Research Forum – Leadership

As military women now serve in all combat specialties, the impact of environmental and occupational conditions on their health is critical. Military health care professionals, as well as leaders in the Department of Defense (DoD) and U.S. Government, need an evidence-based understanding of military women’s health issues in order to ensure their wellbeing. The purpose of this study was to determine priorities for military women’s health research. Specific aims were to generate a list of military women’s health research priorities that are validated through subject matter expert (SME) consensus and to produce a Military Women’s Health Research Agenda (MWHRA). Research on sexual assault, genitourinary health, and behavioral health should be prioritized to fill gaps in knowledge on military women’s health. The final MWHRA should direct future scientific efforts and funding of research towards studies that will lead to evidence-based care for military women.

DOR GLOBAL HEALTH FORUM

Midwife-Led HIV Services in East and Southern Africa
Sydney Spangler
DOR Global Health Forum – Global Midwifery

Almost 20 million people are currently living with HIV/AIDS in East and Southern Africa, about 40% of whom are not consistently getting antiretroviral therapy (ART). In response to this persistent problem, many countries are authorizing and training midwives and nurses to routinely provide first-line ART and other HIV services. However, much remains unknown about the extent to which this form of task sharing is being used, its effectiveness, and implementation issues it presents for health facilities. The purpose of this study was to identify perceived challenges and opportunities for midwife and nurse-initiated and managed antiretroviral therapy (NIMART) in high volume, high HIV-burden health facilities in 11 countries across sub-Saharan Africa. The findings revealed that deficiencies in health facility support structures are viewed as substantial challenges to effective provision of NIMART for both PMTCT and pediatric HIV services. Although the midwives and nurses had clear authority to provide NIMART services, they did not necessarily feel well-prepared and supported to do so. Despite structural challenges related to infrastructure, staffing, and pre-service education, health facilities have important opportunities to strengthen NIMART through standardized in-service trainings, formalized clinical mentorship programs, and specific protocols for supportive supervision.

Outcome Evaluation of the BLiSS Program on Afghan Maternal and Child Health
Diana Jolles, Minyon Outlaw
DOR Global Health Forum – Global Midwifery

Afghanistan’s perinatal mortality and morbidity rates are staggering due to lack of social infrastructure, untrained birth attendants, and women’s limited decision-making power. According to UNICEF, the maternal mortality rate in Afghanistan was considered “very high” at 500-999 maternal mortalities per 100,000 live births in 2017. Similar to the maternal mortality rate, the neonatal mortality rate is alarming; in 2017 it was considered “high” at 38.1 deaths per 1,000 live births. Birth Life Saving Skills (BLiSS) is a perinatal education program adapted from a curriculum developed by ACNM known as Home Based Life Saving Skills. BLiSS is a community-based program focused on educating families to recognize life-threatening signs and symptoms as well as prevention of perinatal complications. BLiSS training helps community members problem-solve regarding issues of access to perinatal care and recognition of complications as well as appropriate first steps to use during transport to emergency services. Both men and women are taught how to recognize perinatal emergencies (e.g. preeclampsia) and respond. In Afghanistan, men are essential to this process, providing permission, transportation, and logistics in seeking care. The BLiSS training has been shown to be effective in educating Afghans on perinatal wellbeing and emergencies through community-led facilitations, demonstrations, storytelling and simulation from 2006-2016. It is necessary to document a consistent negative trend in Afghanistan’s maternal and neonatal mortality as impacted by BLiSS participants’ knowledge retention from the 2015-2019 time period. This session will discuss a program evaluation documenting the effectiveness of BLiSS education on reducing maternal and neonatal mortality in Kabul, Afghanistan from 2015 to 2019.

Reducing Maternal and Neonatal Mortality in the Dominican Republic
Maria Diaz, Jasmin Garcia, Tanya Pablo Gonzalez, Gabriela Henriquez, Estefania Henriquez Luthje, Nola Holness, Miquel Mejia
DOR Global Health Forum – Global Midwifery

Globally, 295,000 mothers died in 2017 and 2,500,000 newborns died in 2018. The Dominican Republic occupied the 5th highest maternal death rate and the 2nd highest neonatal death rate in Latin America in 2019 (171 maternal deaths and 2240 neonatal deaths). The most preventable deaths were neonatal bacterial sepsis, neonatal respiratory distress, maternal hypertensive crises, and obstetric hemorrhages. The purpose of this project was to provide nurses in the Dominican Republic with the knowledge and skills to provide key components of care to mothers and newborns towards reducing maternal and neonatal mortality. The collaboration between nurses and the team has identified the need for professional training and follow-up to narrow the gap between the rural communities and effective, quality healthcare. Data gaps, especially information regarding GBS, confirm the need for more surveillance in the facilities. Providing nurses in the Dominican Republic with the aptitude to provide competent care to mothers and newborns could contribute to reduction in maternal and neonatal mortality.