Sessions

The Annual Meeting offers a variety of session types, including Education Sessions, Panel Discussions, Round Table Sessions, Fast Track Sessions, DOR Global Health Research Forums, and Symposium Sessions. Each session qualifies attendees for 1 CEU credit. Session recordings will be available on-demand beginning at 8:00 AM ET on each date listed below, then throughout the rest of the meeting and for 30 days after.

Sessions are sorted below by type, then listed alphabetically. Session tracks are listed under each title (Clinical, Education, Global Midwifery, Leadership, Midwifery Matters – Business, Midwifery Matters – Public Perception, or Racism and Health Disparities)

The ACNM Virtual Meeting Offers the CEUs You Need!
*Please Note: All sessions are subject to change.

Saturday, May 30, 2020
Birth in Eight Cultures
Melissa Cheyney, Robbie Davis-Floyd
Education Session – Education – 1 CEU

This presentation, based on Birth in Eight Cultures, edited by Robbie Davis-Floyd and Melissa Cheyney (2019), takes a comparative cross-cultural approach to birth in the US, the Netherlands, Japan, Brazil, Greece, New Zealand, Mexico and Tanzania. It describes how the core values of each culture are reflected in their birthways, an important part of the process of turning young women into mothers. Each chapter in the book this presentation describes is based on intensive and lengthy ethnographic fieldwork conducted by the chapter authors on the maternity care systems of their respective countries. This presentation clearly shows that obstetric systems in most countries are not founded on science but on cultural belief and tradition, yet evidence-based systems such as those of the Netherlands, Japan, and New Zealand are possible to achieve and can offer valuable lessons to midwives in the US regarding how to transform maternity care in this country. It concludes with a global overview of key issues in childbirth, midwifery, obstetrics, and maternity care.

Brief Behavioral Therapy for Insomnia: All Midwives Can Help Women Sleep and Improve Mood
Jennifer Hensley
Education Session – Clinical – 1 CEU – 0.25 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!

Building Professional Resilience Plans: A Primer for Midwifery Students and Their Faculty
Erin Wright
Education Session – Education – 0.1 CEU

Work-related tension and stress have been shown in multiple studies to alter the trajectory of midwifery careers. Students face a unique set of challenges as they try to successfully navigate the rigors of midwifery training and subsequently as new graduate midwives. This session is designed to enlighten midwifery students, their faculty, and new graduate midwives about the benefits of building a resilience plan to help lay the foundation for a robust and life long career. By exploring sample plans and available evidence based modalities for the reduction of student and professional stress, students and their educators may experiment with building resilience plans which are tailored to their specific needs. Multiple studies have shown the positive impacts of midwifery care on their clients. By providing future midwives with tools for career longevity we have the opportunity to improve outcomes for birthing parents and their infants.

Buprenorphine for Opioid Use Disorder: Understanding the Pharmacology
Angela Mitchell
Education Session – Clinical – 1 CEU – 1 RxCe

Buprenorphine has been noted to be an effective treatment in caring for those with opioid use disorder (OUD). In 2018, the Support for Communities and Patient Act further expanded the OUD treatment workforce to include certified nurse-midwives (CNMs). CNMs are now able to apply for the SAMSHA DATA 2000 waiver, which would allow them to prescribe buprenorphine. Buprenorphine has multiple pharmacological benefits such as suppressing opioid withdrawal symptoms, blocking effects of illicit opioid use, reducing cravings, reducing or stopping illicit use of opioids, and facilitating patient engagement in recovery activities. It has been shown to significantly reduce the illicit opioid use, maintain patients in treatment, and reduce HIV risk behaviors. This is a great opportunity for CNMs to meet the unmet needs of so many of their patients.

Caring for the Female Veteran
Robin Neumeier
Education Session – Clinical – 1.0 CEU

Female veterans are the fastest-growing population of veterans today. Learn about the unique challenges female veterans face as they transition from military to civilian workforce. Additionally, learn how midwives can provide holistic, compassionate and gender-specific care to women warriors.

Correlates of Reproductive Coercion among College Women in Abusive Relationships
Karen Trister Grace
DOR Research Symposium – Research

This session will discuss the results of a study conducted to examine correlates of reproductive coercion (RC) among a sample of college women in abusive relationships. RC describes coercive and controlling behaviors that interfere with a woman’s autonomous reproductive health decision-making. College age (18-24 years) women are known to experience the highest prevalence of intimate partner violence and sexual violence and reproductive coercion may be an important facet of such violence exposure, with significant impact on reproductive health and well-being. RC may be an indicator that a young woman is experiencing more severe violence and is at risk for severe sequelae such as Traumatic Brain Injury. RC remained a significant predictor of depression after adjusting for severity of IPV, which indicates that RC is independently associated with depression. This finding has important implications for midwives working with college-aged women, regarding the need for depression screening and referral to mental health services concurrent with providing services related to IPV and RC. A larger proportion of women who experienced RC sought help from a healthcare provider for contraception, which indicates an important opportunity for midwives to intervene when women are experiencing RC.

Co-Sleeping Confusion: Are Families Best Served by Current Practice?
Michelle Collins
Education Session – Clinical – 1 CEU

In the recent past, there has been an intentional movement on the part of some maternal-child health stakeholders, to aggressively “warn” parents as to the “dangers” of co-sleeping. Despite sound evidence to prove the benefits of, and lack of harm, when practiced in the absence of all known hazards especially by breastfeeding mothers, and with likely over 2 million USA mothers at least intermittently bedsharing with their infants, the US government NICHD has launched a nationwide educational campaigns to inform the public as to the inherent “danger” of co-sleeping. This session will discuss the current climate of support (and lack thereof) for co-sleeping (in various forms) between infants and their parents. The biologic imperatives that underlie the practice and which support the co-sleeping relationship will be presented, as well as diverse lines evidence that justifies and legitimizes co-sleeping. Finally, directives on how to best counsel clients amidst a sea of conflicting information on the topic will be presented.

Disparities in Access to Reproductive Health Care: A Presentation by the ACNM Ethics Committee
Kimberly Allard, Ira Kantrowitz-Gordon
Panel Discussion – Racism and Health Disparities – 1 CEU

Disparities in access to reproductive health care in the United States exist along multiple dimensions, including race, citizenship, gender diversity, geographic location, and disability. The scope of access disparities ranges across the continuum of care offered by midwives, including infertility treatment, perinatal care, and family planning. Differences in access to health care and services may be an important mechanism for disparities in health outcomes. This presentation will provide an overview of the scope of the problem and the clinical and ethical challenges of combatting systems that directly and indirectly restrict access to care. An ethical and social justice lens will be used to analyze the health care access disparities across racial, ethnic, and cultural differences. A panel discussion of representative clinical cases will present diverse perspectives to guide ethical strategies to increase health care access at the individual and population level.

Duration of the Latent Phase of Labor: Characterization and Outcomes Associated with Longer Latent Phase Among Low-Risk Women in Spontaneous Labor
Mia Ahlberg, Nicole Carlson, Aaron Caughey, Mekhala Dissanayake, Julia Phillips, Jonathan Snowden, Ellen Tilden
DOR Research Forum I – Research

This session will discuss the results of a study conducted to characterize entire latent phase duration and evaluate the association between latent phase duration at five points of distribution (mean, median, 80th, 90th, and 95th percentiles) and perinatal processes/outcomes. Little is known about the full duration of the latent phase of labor or if duration of the latent phase predicts labor processes or outcomes. The study found that the duration of the latent phase of labor was longer than described in previous U.S. studies. Longer latent labor duration may signal longer total labor processes, increasing dystocia, interventions to manage dystocia, and epidural use. Women’s hospital admission during the latent phase may be a result of longer latent labor duration rather than a true causal risk factor for intervention use. Longer latent labor in multiparous women may signal underlying complications that lead to NICU admission.

Exploring Experiences of Structural Racism and Its Influence on Maternal and Child Health
Kamila A. Alexander, Kelly Bower Joffe, Keyona Hough, Kelley Robinson, Amber Summers, Brielle Weber
DOR Research Forum I – Research

This session will discuss the results of a study conducted to explore the ways in which structural racism influences the health of pregnant and postpartum people and their infants in Baltimore, Maryland. Systematic racism and discrimination has been proposed as a significant risk factor that contributes to health disparities in maternal and child health outcomes for African American families. There is evidence to suggest that racism is associated with poor birth outcomes and limited evidence to suggest a link between racism and maternal health outcomes. However, most studies examine the role of interpersonal racism, whereas fewer explore the role of systemic racism, and few have examined the mechanisms by which systemic racism impacts health from the perspective of those affected. Preliminary results have identified a variety of systems that play a role in the health of pregnant and postpartum people and infants including: medical, justice, government, neighborhood environment, schools, and commercial/retail. For most systems, racism acts by way of the quality and availability of goods and services; bias, stereotyping, and racial profiling; and power imbalance. For example, participants commonly reported experiencing disrespectful medical care and described the ways in which it impacts their health. Other specific examples will be provided.

Group Counseling for Shared Decision Making (GCSDM) about Birth after Cesarean for Haitian Speaking Women: A Mixed Methods Study
Somphit Chinkam, Allison Shorten, Courtney Steer-Massaro
DOR Research Forum I – Research

This session will discuss the results of a study conducted to develop culturally appropriate group counseling sessions about the mode of birth after cesarean for Haitian Creole-speaking women. Haitian women in Massachusetts have high rates of cesarean and low rates of vaginal birth after cesarean (VBAC), despite evidence suggesting many are eligible for labor after cesarean (LAC). Limited English and Haitian Creole reading comprehension coupled with cultural norms, including limiting questions of providers, challenges the traditional approach of written educational material and clinic prenatal visits. The study found that the Group Counseling and Shared Decision Making (GCSDM) session was acceptable to Haitian Creole-speaking women and was feasible to implement in practice. Evaluation of ongoing program effectiveness is planned for continuous quality improvement. The GCSDM session could be adapted to improve shared decision making discussions for other non-English speaking women.

Hypoxic Ischemic Encephalopathy: An Unexpected Event
Maribel Morgan
Education Session – Clinical – 1 CEU

Hypoxic ischemic encephalopathy is a common cause of neonatal morbidity and mortality. This session will discuss the epidemiology, risk factors, presentation and available management strategies for this disease. Since it is typically an unexpected tragic event, the session will also discuss how to discuss findings with involved families in a sensitive and comprehensive manner.

Improving Care for Women with Urinary Incontinence
Bailee Burningham, Samantha Lawson
Education Session – Education – 1 CEU

A significant evidence-practice gap exists in the diagnosis and management of urinary incontinence (UI). There are many effective treatment options and there are several practice guidelines from professional organizations outlining the management of UI; however, providers do not screen for or treat this condition and many women live with the burden of UI unnecessarily. This session will describe the barriers, facilitators and strategies for implementation, as well as the role of the midwife, to improve care for women with urinary incontinence.

Let’s Talk About Post-Menopausal Sex
MaryJane Lewitt
Education Session – Clinical – 1 CEU – 0.25 RxCe

As women mature, many factors influence their ability to form caring, intimate relationships with others. We know these relationships influence all aspects of women’s lives. Menopause creates physiologic and psychologic changes that directly impact a woman’s sexual relationships in the second half of their lives. This presentation will review these changes and provide concrete examples of how we can work with women to address their sexual concerns as they enter and navigate menopause. With the average US life expectancy now almost 80 years, women will live over 1/3rd of their lives with the physiological and psychological changes associated with menopause. Sexuality in older people is often overlooked by current health care providers, yet it is critical to an individual’s overall health. The presenter will discuss these physical and psychological changes and offer solutions that you can bring to your care of women in this part of their life.

Making More Midwives: Midwifery Education in an Academic Medical Center
Susan DeJoy, Susan Krause
Education Session – Education – 0.5 CEU

The present education of new CNMs/CMs is not robust enough to meet the growing demand, with a stagnant number of CNM/CM education programs. There is an existing but underutilized model for CNM/CM education: programs based in academic medical centers. Numerous academic medical centers with robust midwifery practices exist and midwives are involved in the education of residents and medical students throughout the nation. It is possible to develop midwifery education programs within such academic medical centers. Using Baystate Midwifery Education Program as a model, this presentation will explain how a clinical service can expand to include a midwifery education program, adding CNM/CM positions while improving job satisfaction and CNM/CM retention. Opportunities for interprofessional education will be discussed. Discussion will also include the possibility that this program design may provide the opportunity to increase the diversity of the midwifery workforce.

SPONSORED BY MARCH OF DIMES:
Maternal Mortality in the U.S. – What is Being Done to Decrease the Problem
Katrina Nardini
Education Session – Racism and Health Disparities – 1 CEU

The goal of this session is for participants to understand 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 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 solutions to decreasing maternal mortality and improving health inequities.

SPONSORED BY UBERLUBE:
Maximizing Midwifery!
Ginger Breedlove, Wendy Gordon, Karen Jefferson, Elle Schnetzler
Education Session – Midwifery Matters – Public Perception – 1 CEU

This session will bring together thought leaders from all nationally certified midwives for a panel discussion regarding the barriers that we face as a profession in meeting the reproductive healthcare needs of the US. We will discuss various perspectives on the barriers that exist to scaling up and integrating midwifery in the US and what changes are needed in order to establish midwifery care in all settings as the new norm. After you view the session, let us know how you are moving our profession forward by Maximizing Midwifery by using this hashtag #maximizingmidwifery.

Millennial Women are Having Postpartum Sex Before They are Ready. What is the Midwifery Response?
Diana Spalding
DOR Research Symposium – Research

This session will discuss the results of a study conducted to examine the sexual practices of millennial women (defined as women born between 1981 and 1996) following birth to better understand where support is needed during this vulnerable time. Additional qualitative research is needed regarding why a significant portion of women are having postpartum sex before they feel ready. Regarding implications for practice, there are both individual clinical and societal investigations and improvements needed. Midwives are in an excellent position to work with women to understand the potential physical and emotional consequences of reengaging in sexual activity before they feel ready. And, as advocates for women, midwives can be instrumental in influencing cultural shifts that are more supportive of all aspects of the postpartum experience.

The New ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors: Understanding and Using the New App
Sally Hersh, Jeanne Murphy
Education Session – Clinical – 1.0 CEU

Cervical cancer prevention strategies in the United States are complicated and, at times, controversial. HPV vaccination will eventually prevent most cervical precancer and cancer. However, cervical cancer screening will remain important as efforts to increase vaccination rates in the U.S. continue. This session will review the new ASCCP Risk-Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. ACNM, along with other women’s health organizations and advocacy groups, has participated in development of the consensus guidelines. Controversies around setting of risk benchmarks and other challenges will be reviewed. Explanation and a walk-through of the new app will be provided.

Probiotic Interventions to Prevent Antenatal Group B Streptococcus Colonization: A Systematic Review and Meta-Analysis
Lisa Hanson
Education Session – Clinical – 1 CEU – 1 RxCE

This systematic review will provide midwives with the available evidence concerning the efficacy of antenatal probiotics to reduce GBS colonization. Implications for practice and future research will be discussed. The scientific evidence concerning probiotic interventions to reduce antepartum GBS colonization will be systematically reviewed and meta-analyzed. Probiotic species, strains, dosage, route and intervention onset and duration shown effective against GBS in available clinical trials will be presented.

Reproductive Coercion Among Latina Women and Strategies for Minimizing Harm
Karen Trister Grace
DOR Research Symposium – Research

This session will discuss the results of a study conducted to explore risk factors for reproductive coercion (RC), association with pregnancy intention and intimate partner violence (IPV), and the use of RC safety strategies among Latina women attending an urban clinic. The study articulates the risk of RC in abusive relationships for Latina women. Results are contextualized with qualitative interview data from Latina women who have experienced RC. Midwives working with racially and ethnically diverse women have an important role in screening and support for safety/harm reduction strategies that include informing women about less detectable methods of contraception.

Transgender Persons Contemplating Gestation: Midwifery Considerations for Care
Tanya Vaughn-Deneen
Education Session – Racism and Health Disparities – 1 CEU

Research is lacking for reproductive care of transgender individuals considering gestation. It is important for midwives to have a general understanding of the reproductive options and necessary counseling of preconception care for the transgender community. Transgender individuals may desire to have children while undergoing gender affirming hormonal or surgical therapy that can complicate fertility. Assisted reproductive technologies can offer options for this population, however, it is imperative to discuss issues that can arise associated with hormonal or surgical gender affirming interventions. Midwives should be able to understand and navigate the barriers and disparities of care that transgender people may endure. Information offered at this presentation will help the midwife provide culturally competent, sensitive reproductive healthcare for the transgender individual considering gestation.

Sunday, May 31, 2020
“Arrival” of a Big Problem: Interpreting the Evidence on 39 Week Elective Inductions
Rebecca Dekker
Education Session – Clinical – 1 CEU

New findings from the highly publicized ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management) have led to an upsurge in elective induction across the U.S. In some practices, providers are informing all of their clients that they must be electively induced at 39 weeks! Many midwives are finding themselves caught between collaborating physician desires, hospital administration pressures, client preferences, and ACNM guidelines. This session will provide clarity on the ARRIVE trial and help you develop an action plan for facing clinical challenges related to 39-week inductions in your community. It will examine the methods of the ARRIVE study, as well as its outcomes, strengths, and limitations, and discuss the evidence from other randomized trials on this topic. Following this examination of the evidence, attendees will discuss whether or not these research findings can be generalized to clients in their communities. Midwives will leave this session with confidence in their ability to face the clinical challenges created by the publication of this influential study.

Assessing the Consistency of Carrier Screening Guidelines Across Seven Populations and 408,000 Individuals
Summer Pierson
Education Session – Clinical – 1 CEU

Current guidelines recommend carrier screening for several genetic conditions only in certain ethnicities. A recent study analyzed carrier rates of 176 serious conditions to determine whether current guidelines support consistent care across all ethnicities. Many conditions have population-specific incidence comparable to CF in the Southeast Asian population—the rarest population-condition pair currently recommended for carrier screening by both ACMG and ACOG. Expanding guidelines to include additional conditions with comparable or higher incidence in select populations would improve equitability of medical care across populations. Simultaneously, however, it would further complicate ethnicity-specific testing by inflating the panel of conditions—in excess of four-fold—for each ethnicity. This added complexity could be mitigated by adopting pan-ethnic expanded carrier screening as the recommended approach to carrier screening.

Breast Cancer Survivor Care for Midwives and Advance Practice Nurses
Dwynn Golden, Dawn Lovelace, Linda McDaniel
Education Session – Clinical – 1 CEU

Women are increasingly surviving breast cancer but the majority (up to 90%) experience unexpected long-term sequelae as a result of treatment. Symptoms can include physical, functional, emotional and psychosocial changes that can dramatically alter the quality of life for breast cancer survivors. Midwives and nurse practitioners are likely to care for these women, and should be familiar with common symptoms, treatment and best practices to avoid permanent dysfunction. A holistic approach to assessment and treatment as needed is an effective strategy and falls within the philosophy and the scope of practice of midwives and nurse practitioners.

Evidence on term breech since the 2000 Term Breech Trial
Rixa Freeze
Education Session – Education – 1 CEU

This presentation explores emerging evidence on term breech birth. It first shows how the 2000 Term Breech Trial (TBT) cemented a policy of universal cesarean for breech around the world. However, the TBT has since been criticized for flaws in recruitment, inclusion criteria, and protocol implementation. The findings from a PubMed search of “breech” and “pelvic presentation” in title & abstract from Jan 2000-Jan 2018 are presented, andall studies of term breech outcomes are examined, including single-center, multi-center, national registry/birth certificate studies, systematic reviews, and meta-analyses. Analysis includes short- and long-term outcomes for both mother and baby. Studies since 2000 do not support the findings of the TBT. Some large, high-quality studies have found no difference in perinatal/neonatal mortality between planned CS (pCS) and planned vaginal breech birth (pVBB). Other studies have found some advantage to pCS, but the advantage is significantly less pronounced than in the Term Breech Trial. Long-term neonatal outcomes and short- and long-term maternal outcomes tend to support the option of pVBB. Because of the long-term benefits of vaginal birth to both mother and baby, the session argues that providers and clinics should prioritize vaginal breech training, implement policies to support breech providers, and offer access to vaginal breech birth or referrals to breech specialty centers. This proposed approach also supports maternal autonomy and protects health providers from violating women’s legal and ethical rights to informed consent and refusal.

Lived Experience of Lay Midwives’ Struggle with Obstetrical Emergencies in Urban Guatemala
Kimberly Garcia
DOR Global Health Forum – Research

This session will discuss the results of an observational study conducted to evaluate methods for teaching Guatemalan Lay Midwives (LMs) about obstetrical emergencies. The study had two objectives. First was to examine the effect of a culturally sensitive training on LMs’ knowledge of obstetrical emergencies. The second was to evaluate LMs’ interpretation of drawings of obstetrical emergencies used in the training. The hypotheses were: the training would change LMs’ knowledge of obstetrical emergencies, and LMs would interpret simple color drawings more accurately than complex, black and white drawings. The background is government programs have not changed LM knowledge about obstetrical emergencies, primary because the programs are in Spanish with written material even though most LMs are illiterate and speak Mayan dialects. Recent studies revealed oral training in the primary language of LMs changed knowledge about obstetrical emergencies, and LMs understand simple color drawings better than complex, black and white drawings about obstetrical emergencies. Two methods were used in this study. One was a pretest-posttest design to examine LMs’ knowledge of obstetrical emergencies before and after the training. The second was evaluation of LMs’ understanding of drawings by assigning each drawing a percentage score based on the number of LMs who identified the intended meaning of the drawing. Seventeen LMs who work near a Refuge International Health Clinic in San Raymundo participated. Limitations were motivated LMs who lived near the clinic likely attended the training. Findings were LMs understood simple color drawings better than complex, black and white drawings and the training changed LM knowledge about obstetrical emergencies. The mean pretest score was 3.176 compared to the mean posttest score of 5.176. Change is knowledge was a P value of 0.000. Conclusions are future culturally sensitive trainings should be oral in the native language of TBAs and use simple color drawings to reinforce the training.

Management of Menopause Symptomatology
Desiree Clement
Education Session – Clinical – 1 CEU

Midwives may devote only a small percentage of their clinical practice to the management of menopausal symptoms and complaints. This may lead to discomfort in the care management for menopausal women with further potential to necessitate a referral instead to another provider. Although the research shows evidence that midwives remain knowledgeable and updated in traditional areas of women’s health including the management of menopausal complaints and health screenings for women transitioning from childbearing into menopause can be complex (i.e. non-hormonal or hormonal management for menopause symptoms). This all affords an opportunity for potential practice improvement within midwifery, along with the ability to increase one’s comfort level with managing menopause which remains a necessary part of being a full-scope midwife. The purpose of this educational session is to assist with increasing the midwifery comfort level with when caring for menopausal women supported by the research. The methods planned are evaluating and applying clinical knowledge gained through evidence-based lecture and integrative discussion. The clinical implications are the hopeful stated increase in midwifery comfort level and plan for the utilization of various safe options for managing menopausal symptoms. The ability for evaluation derives from the perceived intent to change practice and active participation within this educational session.

Metabolic Predictors of High- vs. Low-Oxytocin Requirements During Labor Induction
Nicole Carlson
DOR Research Forum II – Research

This session will discuss the results of a study conducted to identify metabolic profiles activated in serum collected during late pregnancy from African-American women who experienced difficult labor induction (e.g. high dose of synthetic oxytocin infusion following cervical ripening). During the past few decades, the use of labor induction has increased substantially. However, wide variations in labor induction success by hospital and maternal factors have been demonstrated. Little is known regarding the mechanism by which maternal variations cause labor inductions to require higher doses of synthetic oxytocin. The findings suggest that a prolonged, high-oxytocin induction phenotype may be predicted in part by a pro-inflammatory state characterized by low levels of circulating omega-3 fatty acids during pregnancy. Moreover, high levels of omega-6 fatty acids may have caused the cases in this study to be less likely to respond to cervical ripening medications, thereby leading to synthetic oxytocin infusions being initiated before effective cervical ripening was complete.

Midwifery Legislation In Action
Zoe Gutterman, Emily Hart, Amy Kohl
Education Session – Midwifery Matters – Public Perception – 1 CEU

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 2019 ACNM Annual Meeting, and will look at upcoming legislation of importance to ACNM members. Additionally it will offer practical advice will be included on how midwives can influence health policy.

Midwives Leading Quality Improvement Teams to Improve Quality and Outcomes for First Time Births
Cathy Emeis, Susan DeJoy, Lisa Kane Low, Katie Page
Panel Discussion – Leadership – 2 CEUs

Midwives are increasingly called upon to lead and participate in interdisciplinary quality improvement teams. These may be part of institutional initiatives, regional collaboratives, or statewide improvement initiatives, such as AIM. In this panel discussion, midwife leaders will share their leadership techniques used to engage interdisciplinary teams. These skills will be helpful for midwives participating in any quality improvement or change initiative. Presenters for this session are RPC coaches and nurse midwives who led improvement teams in their hospitals as part of ACNM’s Reducing Primary Cesareans (RPC) national quality improvement collaborative and their state’s AIM initiatives.

Persistent Occiput Posterior Position 20/20
Elizabeth Arnold-Leahy, Barbara Reale
Education Session – Clinical – 1 CEU

This session will discuss the results of a survey conducted to analyze occiput posterior position, the most common malposition in labor. While up to 90% of fetuses rotate to a more favorable position before birth, those fetuses remaining posterior result in an operative (vaginal or cesarean) birth rate of up to 73% and multiple sequalae for mothers and infants regardless of mode of birth. Persistent occiput posterior has been attributed to up to 12% of cesarean birth. The study found that No identifiable characteristic accurately predicts OP position at delivery before the onset labor or in early labor. Factors that appear to be associated with fetal position include nulliparity, short maternal stature, narrow supra pubic angle, posterior fetal spine position, anterior placental location, and increased epidural rates and oxytocin use in labor. Midwives can use these characteristics to increase awareness of posterior fetal in laboring women, allocate resources, and initiate corrective measures as needed. The fetal spine was identified as a better predictor of fetal position and outcome compared with the fetal occiput position. Additionally, the fetal spine may be more amenable to correction via position and manipulation. This may be a more beneficial area of research for pursuit.

Physiologic Latent Labor – What is Known, Unknown, and Mis-Known: A Critical Collaboration of Midwife Scientists
Nicole Carlson, Elise Erickson, Katherine Kissler, Julia Phillipi, Ellen Tilden
Education Session – Clinical – 1 CEU

Professional organizations recommend women in spontaneous labor complete latent phase at home based on evidence linking early hospital admission to increased intervention, including augmentation and cesarean birth. However, current guidelines do not discuss how to care for women who present to the hospital in latent labor. Five midwife-scientists from universities across the country will present a latest research on latent labor and labor onset from a physiologic and symptoms-based approach. We will critically analyze the physiologic and symptoms literature to describe what is known, not known, and misunderstood about latent labor and labor onset in women with healthy, term pregnancies. We will explore best evidence for caring for women in latent labor, strategies for future innovation, and recommendations for research.

Screening for Human Trafficking in the Health Care Setting
Pamela Glenn
Education Session – Clinical – 1 CEU

The health care team is a vital partner in addressing the human trafficking situation in the U.S. and around the world. This session takes on the extraordinarily hidden and complex challenge of screening for human trafficking in the health care system. One study notes that approximately 88% of sex trafficking victims had contact with a health care professional. Each of these contacts is an opportunity for identifying and assisting a victim. It is a goal of this talk to provide an increased awareness of the trafficking situation to all members of the health care team. Included in this presentation is the identification of the multiple trafficking types, behaviors and dynamics which play out in these situations, as well as “red flag” warning signs. Stereotypes surrounding this issue, barriers to screening, and the unique challenges faced when trying to identify trafficked victims are also discussed. Most importantly, techniques for effectively screening victims, as well as follow-up recommendations and resources, are provided. As a result, it is hoped that all members of the health care team are empowered to incorporate effective screening techniques into their everyday practice, along with strategies for identifying and assisting trafficking victims.

Second Victim: Impact of an Adverse Outcome
Linda McDaniel, Charlotte Morris
Education Session – Midwifery Matters – Public Perception – 1 CEU

Health care providers may experience multiple adverse events during their professional career. As a result of being directly or indirectly involved in the adverse event, health care providers are considered second victims. The second victim phenomenon leads to significant physical, psychological, and psychosocial sequelae that negatively impacts their personal and professional lives for either a short or long period of time. It is imperative for second victims to incorporate self-care behaviors and that health care organizations implement an efficacious support program to assist second victims during the recovery process. The literature shows midwives may be equally if not more affected by adverse events because of the intimate nature of their care. Since health care providers have a high probability to encounter adverse events they should be aware of this phenomenon, associated symptoms, appropriate treatment, and peer support options to avoid consequential negative outcomes.

Team-Based Learning Online: The New Frontier in Midwifery Education
Laura Kim Baraona
Education Session – Education – 1 CEU

Team-based learning (TBL) is an exciting, powerful form of small-group learning that actively engages students in critical thinking, supporting deeper long-term learning. While team-based learning has been successfully implemented in face-to-face national and international professional healthcare educational programs, its use in online programs is just beginning to emerge. This presentation will describe TBL’s essential elements, advantages and disadvantages, address barriers to integrating TBL to an online format, and describe a course design used for successfully adapting TBL to an online program with students from a variety of geographic locations.

Monday, June 1, 2020
Building Maternity Care Teams via Distance Online Simulation
Tia Andrighetti, Dominic Cammarano, Robin Grant, Audrey Perry
Education Session – Education – 1 CEU

The U.S. healthcare system often fails to meet the needs of women and their families. Providers are rushed and responsibilities are often fragmented. The projected deficit of maternity care providers, current poor maternal-child outcomes and uncoordinated care compounds the care crisis. Simulation is an effective teaching method to expose students to clinical situations prior to real-life encounters. Distance online interprofessional simulations may be an effective, cost-efficient and convenient intervention to bring student nurse-midwives and OB/GYN residents across the country together to lay a foundation for future collaborative practice. This session discusses the results of a project demonstrating how to accomplish interprofessional education when all students are not in the same physical location, and provides strategies to overcome challenges.

‘Chimwemwe Mu’bereki’ (Joyful Motherhood): Closing the Gap in Unmet Need for Home Based Nurse Midwifery Care in High Risk Infants and Postpartum Women in Malawi
Joanne Chiwaula, Marcianna Nosek
DOR Global Health Forum – Research

This session will discuss a mixed methods descriptive study conducted to evaluate the home visit nurse midwife programs of Joyful Motherhood (JM), or Chimwemwe mu’bereki. JM is a Malawian nonprofit organization, founded by a US midwife in 2008, and provides care to high risk, critically ill postpartum women and infants in rural villages of Lilongwe, Malawi. JM employs three nurse-midwives who perform all community visits. Women served include, but are not limited to, those who experienced postpartum complications such as severe anemia, sepsis, eclampsia or ruptured uterus. Infant clients include premature, low birth weight, multiples, and orphans who lost their mother in childbirth. All are enrolled for up to two years. JM’s success for over 10 years demonstrates it is a viable model for unmet home care for high risk infants and postpartum women in Malawi. Financial challenges prevent scaling up of services and expansion of clientele. Efforts to improve data collection are ongoing.

Designing an Effective Anti-Racism Workshop for Midwives and Other Clinicians
Jatolloa Davis, Melicia Escobar, Mari-Carmen Farmer
Education Session – Racism and Health Disparities – 1 CEU

Are workshops and trainings that address implicit bias, racism, and health disparities an effective strategy for change? What ingredients are essential to make educational approaches to these topics relevant and effective? How can facilitators prepare for leading trainings and workshops focused on a topic fraught with challenging historical narratives and a wide spectrum of participant experience and belief? Are there skills that midwives have that lend themselves to designing and facilitating a workshop of this kind? Finally, and most importantly, are these trainings being implemented primarily to reduce harm, to prevent the loss of lives occurring as a result of racism, or are mixed motivations impairing outcomes? Participants will leave this session with a toolkit of strategies designed to help create an individual workshop or training to their own healthcare settings, and will be given the opportunity to ask questions and address scenarios that may have challenged participants when facilitating workshops in the past. The content that will be presented will be based in the evidence found in literature from various disciplines that has examined what is most effective in creating change, particularly among healthcare providers and in healthcare institutions.

The Effects of Oral Contraceptive Pills on Sexual Pain and Dysfunction
Kathy Herron
Education Session – Clinical – 1.0 CEU

Oral contraceptive pills (OCP) 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.

Evidence-Based Practice and Waterbirth: A Three-Pronged Approach
Elizabeth Nutter
Education Session – Clinical – 1 CEU

The goal of evidence-based practice is to improve patient outcomes, quality of care, and to provide standardization of treatment. This session will present a framework to help midwives articulate how waterbirth is an evidence-based practice through discussion of research findings, clinical expertise, and consideration of patient preferences and values.

Exercise in the Perinatal Period: Myths Explored and Debunked
Tanya Tringali
Education Session – Clinical – 1 CEU

Education and encouragement regarding exercise is a critical component of midwifery care, yet it is commonly overlooked or minimized by busy clinicians. Additionally, this subject is riddled with outdated information and myths, especially when applied to women in the perinatal period. Considering the positive perinatal outcomes associated with regular exercise including fewer newborn and maternal complications, improved birth outcomes, overall improved health throughout the lifespan and no association between complications such as miscarriage, preterm labor and stillbirth, it is important that midwives provide accurate, up to date and evidence-based care regarding exercise to their clients as a routine part of prenatal and postpartum care. An interdisciplinary approach to exercise in the perinatal period with a special emphasis on the postpartum period is warranted. Examples of individual exercise counseling and group exercise programs will be described.

Exogenous Oxytocin in Labor: Postpartum Hemorrhage and Third Stage Labor Duration Following Term Vaginal Birth
Elise Erickson
DOR Research Forum II – Research

This session will discuss the results of a study conducted to determine the level of risk for postpartum hemorrhage and prolonged third-stage labor associated with varying duration and peak dosage of oxytocin used during labor among women having a vaginal birth. Both oxytocin use during labor and postpartum hemorrhage are increasing in the United States. Oxytocin use may contribute to postpartum uterine atony as the oxytocin receptors available for postpartum uterine contraction have been down-regulated or desensitized during an oxytocin-stimulated labor. Oxytocin is also the first-line recommended uterotonic for postpartum hemorrhage prophylaxis and immediate treatment of postpartum blood loss after birth. The specific dose or duration of oxytocin that contributes to adverse postpartum outcomes is not known. The study found that both oxytocin duration and peak dose influenced the risk for postpartum hemorrhage. The definition of prolonged oxytocin use may need to be shortened to increase vigilance around postpartum hemorrhage prediction.

The Fellows’ Panel: Midwives Mentoring Midwives
Heather Bradford, Ginger Breedlove, Heather Findletar Hines, Deborah Walker
Panel Discussion – Leadership – 1 CEU

Many challenges in midwifery advancement exist within the practice and professional environment, such as bullying in the workplace, barriers to autonomous practice, lack of diversity in leadership, and uncertainty as to how to attain leadership positions within ACNM. Although one to one mentoring in professional leadership development is different than mentoring midwives’ entrée into practice, principles that lead to successful mentoring are similar. The Fellows of ACNM recently initiated a formal mentorship program in conjunction with the Students and New Midwives Committee, offering a mentorship program between Fellows and midwifery students and new midwives. Panel members will discuss successful mentoring strategies that play an important role in meeting mentee goals, developing mentee leadership skills and encouraging aspiration to leadership roles in the professional organization. Mentors will receive guidance on establishing and maintaining a satisfying mentor-mentee relationship. The focus of this session will be on providing skills for a successful relationship for both the mentor and mentee and is designed for all conference attendees, not just those seeking a mentor.

The National Academy of Sciences, Engineering, and Medicine Consensus Study: Assessing Health Outcomes by Birth Settings
Jilli Alliman, Melissa Cheyney, Michelle Collins, Wendy Gordon, Debbie Jessup, Lori Trego
Panel Discussion – Racism and Health Disparities – 1 CEU

In 2019, the National Academies of Sciences, Engineering, and Medicine (NASEM) formed an ad hoc committee to examine and synthesize the available research on birth settings, focusing particularly on health outcomes experienced by sub-populations of women. This panel session will bring together representatives from the NASEM consensus study committee, staff, and sponsor for a discussion of the findings as presented in a forthcoming NASEM report, Assessing Health Outcomes by Birth Settings (anticipated for public release in January 2020).

Transform Nursing Students into Professional Allies, Clients, and Future Midwives
Barbara McAlister
Education Session – Midwifery Matters – Public Perception – 1 CEU

Although vast pregnancy and childbirth resources are available digitally, lack of understanding of the midwifery model of care persists. For midwives interested in enhancing the public’s perception of midwifery while potentially cultivating the future midwifery workforce, student nurses are a pragmatic choice for focusing efforts. The purpose of this presentation is to share approaches for midwives to educate student nurses about midwifery and normal birth. Maternity nursing faculty are sometimes hesitant to explore normal birth topics with students when medicalized birth experiences are exclusively witnessed in their clinical setting. Midwives can fill that crucial gap. Topics such as the midwifery model of care, physiologic vs. medicalized birth, research evidence for maternity care practices, and birth as a transformative process, can heighten nursing students’ awareness and ignite their curiosity.

Violence Update for Midwives: Emerging Topics and Promising Interventions
Karen Trister Grace
Education Session – Clinical – 1 CEU

Midwives frequently encounter patients who have experienced violence and coercion. Understanding the wide variety of forms of violence and coercion is critical to providing sound, compassionate care. Best practices for screening, documentation and management will be discussed. Recent phenomena such as “stealthing” will also be covered, as well as emerging technological interventions to aid survivors of violence. Attendees will develop an understanding of the barriers to disclosing violence, and what to do if violence is disclosed.

Monday, June 1, 2020: Round Table Sessions

Changes in Reimbursement and Why Every Midwife Should Be Excited
Iain Holmes
Round Table Session – Midwifery Matters – Business – 0.5 CEU

Bridging the Gap: Innovative Approaches to Increasing Access to Holistic Midwifery Care for Populations Vulnerable to Health Disparities in a Culturally Diverse Environment
Sunday Smith
Round Table Session – Midwifery Matters – Business – 0.5 CEU

Curandera-Parteras, Midwives, and Nurse-Midwives: A Legacy of Caring for Mind, Body, and Soul in Texas
Eileen Thrower
Round Table Session – Midwifery Matters – Public Perception – 0.5 CEU

Implementation of Preeclampsia Prevention Guidelines in a Birth Center Setting
Lana Giles
Round Table Session – Clinical – 0.5 CEU

Implementation of a Perinatal Telemedicine Program to Address Health Disparities in an Urban Federally Qualified Health Center
Catherine Daily
Round Table Session – Clinical – 0.5 CEU

Inclusion of Reproductive Justice in the Education and Health Care System
Lodz Joseph
Clinical – 0.5 CEU

The International Childbirth Initiative (ICI): 12 Steps to Safe and Respectful Mother-Baby-Family Maternity Care
Robbie Davis-Floyd
Round Table Session – Education – 0.5 CEU

Socioeconomic Disparities as Root Causes of Obesity and Midwifery Interventions to Support Those With Obesity
Cecilia Jevitt
Round Table Session – Racism and Health Disparities – 0.5 CEU

Stress, Acculturation, and Preterm Birth in Mexican-Origin Women
Robin Page
Round Table Session – Racism and Health Disparities – 0.5 CEU

Tips for Getting Published: Turning Your Presentation into a Publication
Patricia Murphy
Round Table Session – Education – 0.5 CEU

Triple Oppression: A Primer for Midwives. Understanding the Confounding Effects of Structural, Institutional and Interpersonal Racism, Classism, and Transphobic Attitudes Affecting the Health of Black Gender Nonconforming and Transgender Men
Theresa Coley-Kouadio, Michelle Drew
Round Table Session – Racism and Health Disparities – 0.5 CEU

Vaginal Birth After Two Cesarean Sections
Christina Shutters, Rebecca Winnike
Round Table Session – Clinical – 0.5 CEU