Equity, Race and Access to Midwifery Webinar Series

Barbara Blot with baby cropThis series will address the root causes of inequities in maternal and child health outcomes and examine the challenges of building a more representative midwifery workforce. Important research on the experiences of black midwives and students will be presented to inform our thinking about education and practice opportunities. National experts in public health and health policy, as well as midwives already making a difference in their own communities, will be featured. Action steps for the midwifery profession and for individual midwives on the ground will be explored as we more fully commit to increasing access to midwifery care for all childbearing people and increasing access for all aspiring midwives to the CPM profession.

Participation in the webinar series, as well as access to recordings, is free. CEUs, when available, are $15 per webinar.

Addressing Birth Disparities with Midwifery Care

1.5 MEAC CEUs applied for

Thursday, December 13, 2018, 2-3:30 pm, ET

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Please join NACPM and our presenters, Jill Alliman, DNP, CNM, Program Director of the American Association of Birth Centers (AABC) Strong Start project, and Saraswathi Vedam, Lead Investigator of the Birth Place Lab at University of British Columbia, to hear about exciting new research that demonstrates the critical role midwifery care plays in eliminating racial inequities and disparities in birth care and outcomes.

Part One: Birth Centers provide a Strong Start for Mothers and Babies!

Co-Presented by NACPM and AABC

A new report released by CMS/CMMI states that “Women who received prenatal care in Strong Start Birth Centers had better birth outcomes and lower costs relative to similar Medicaid beneficiaries not enrolled in Strong Start.” Strong Start for Mothers and Newborns Initiative was designed by the Center for Medicare and Medicaid Innovation (CMMI) to determine whether enhanced prenatal care could reduce preterm birth and other poor outcomes. Birth center care was one model studied.

Jill Alliman, DNP, CNM, will present and discuss the outcomes of the birth center group, including birth outcome data for women who received birth center prenatal care. Findings of the national evaluation led by Urban Institute with a risk-matched group of Medicaid recipients in usual care will be summarized. The birth center group showed lower preterm birth, low birth weight, and cesarean birth with disparity reduction for all measures compared to the matched group with similar risk profiles.

The AABC Strong Start evaluation is one of the most important studies of midwifery-led birth center care in recent years. The implications for policy change to increase access to birth center care are tremendous. Come learn about this important study and how to disseminate these findings.

Jill Alliman cropJill Alliman, DNP, CNM has worked for 32 years as a midwife and advocate to improve access to maternity care for women and families. A birth center midwife in rural Appalachian Tennessee for 26 years, Jill Alliman learned that access to quality maternity care improves maternal-infant health disparities. As Past President of AABC and Chair of Government Affairs Committee, Jill lobbied to pass the Birth Center Medicaid Bill in 2010 so Medicaid beneficiaries could have access to birth center care. From 2013-2017, she was the Project Director of AABC Strong Start, a grant program measuring the impact of midwifery birth centers on preterm birth rates and other outcomes for Medicaid beneficiaries, collecting data in 45 birth centers with funding from the Center for Medicare and Medicaid Innovation. Data from the 8806 participants in this project show that enhanced prenatal care provided by midwives in birth centers dramatically improves outcomes and reduces maternal and infant health disparities. Jill has been on the faculty at Frontier Nursing University since 2013, where she teaches Master’s and Doctoral APRN and midwifery students about policy issues and collaboration skills impacting their future practice. Jill’s life work has been supporting women and families through pregnancy and childbirth, which has expanded into advocacy, policy, and research to increase access to community birth for people insured by Medicaid.

Part Two: How Do Communities of Color Describe Quality and Safety in Birth Care?

In the United States, differences in adverse perinatal outcomes between White women and women of colors are well-documented, and persist even when controlling for socio-economic status and access to quality prenatal care.  Some policy makers and public health experts attribute these disparities to concomitant disparities in wages, housing, and safe environments.  However, researchers have proposed that institutional racism and poor access to community-based, culturally congruent models of care contribute to adverse outcomes.  Accordingly, new global standards (WHO) highlight the critical impact of patient-provider communication, emotional support, and respectful care on quality and safety for mothers and newborns.  Three different Lancet series (on midwifery, maternal health, and effective use of cesarean), and the AIM Mapping study  suggest that scaling up midwifery is the answer.

However, research on how communities of color experience maternity care in North America is scarce. In the Giving Voice to Mothers-US   study, community members worked with clinicians, NGO leaders, and researchers to design a study on quality of maternity care as experienced by pregnant persons of color (African American, Native American, and Latina), and those who planned to give birth in homes and birth centers.  Together they developed and administered a national survey to explore novel topics including: women’s experiences of agency in decision-making, non-consented care, access to supportive services, access to options for care, and systemic respect or discrimination over the course of care.

In this webinar, Professor Vedam will explore what clients say about why place of birth and type of provider matter, and what midwives can do to upscale access to high quality maternity care for all communities.

Saraswathi VedamSaraswathi Vedam, RM, FACNM, MSN, Sci D(hc), is Lead Investigator of the Birth Place Lab at University of British Columbia. Over 35 years, she has been a midwife, educator, and researcher.  Her scholarly work includes provincial, community-based participatory studies, Changing Childbirth in BC and the Giving Voice to Mothers Studies, exploring experiences of maternity care across diverse communities in North America.  These projects led to the development of 3 new person-centered quality measures. She also led a multidisciplinary team for the Access and Integration Maternity care Mapping (AIMM) Study linking integration of midwives to improved maternal-newborn outcomes in the US. Currently she is PI of a 5-year CIHR funded national study of respectful maternity care across Canada. Professor Vedam has been active in setting international policy on place of birth and interprofessional collaboration, providing expert consultations to ministries and Health Boards in 10 countries. She convened 3 national Home Birth

Battling Over Birth: Research Justice as Framework for Transforming Maternal Health Care

1.5 MEAC CEUs Applied for

Wednesday, April 11, 2018

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There is a crisis in black women’s maternal health care. African American women in California are 3 to 4 times as likely as white women to die of childbirth related causes, our infants are twice as likely not to survive their first year. “Birthing while black” is a site of struggle, which for too many leads to disabling, trauma or even death. Using a research justice approach, Chinyere Oparah and members of the Oakland-based collective Black Women Birthing Justice spent five years documenting black women’s experiences of childbirth, with a focus on prenatal care, relationships with medical professionals, birth locations, labor and delivery, and the first six weeks. The result was Battling Over Birth, a human rights report that has been described by DONA International as “an accurate and chilling snapshot of the state of birthing as a Black person.”

In this webinar, Oparah explains the research justice framework and explores how it can be used to advance birth justice; she also shares findings and recommendations from the report and discusses how midwives can get involved in the movement to #liberateblackbirth.

Chinyere Oparah

Dr. Julia Chinyere Oparah PhD is an activist scholar, social justice educator and experienced community organizer, who is dedicated to producing groundbreaking critical scholarship in the service of progressive social movements. Dr.  Oparah is an African diaspora specialist, whose interests span a number of different social concerns, including activism by women of color, violence against women, women and the prison-industrial complex, restorative justice, queer and transgender liberation, race and adoption, research justice and birth activism. Dr. Oparah is professor and department chair of Ethnic Studies at Mills College as well as Provost and Dean of the  faculty. In addition to her graduate degrees in Sociology and Ethnic Studies, Oparah trained in community  development. Prior to entering academia, she coordinated a black women’s center in the UK, and was executive director of a national development agency for non-profits serving communities of color.

Dr. Oparah is author of Other Kinds of Dreams: Black Women’s Organizations and the Politics of Organization, the only comprehensive history of the black women’s movement on Britain. She is editor of Global Lockdown: Race, Gender and the Prison-Industrial Complex, a seminal work that mapped the connections between globalization, gender and mass incarceration. She is also co-editor of 3 books: Activist Scholarship: Antiracism, Feminism and Social Change, Color of Violence: the Incite! Anthology and Outsiders Within: Writing on Transracial Adoption. Oparah has Nigerian (Igbo) and British origins, and immigrated to the US in 1995. She lives in East Oakland with her partner and daughter.

Linda Jones

Linda Jones, Doula and Black Women Birthing Justice Collective Member, will be presenting alont with Dr. Oparah.  She is a mother of two who lives in Oakland, CA. She founded and owned Waddle and Swaddle Baby Boutique and Resource Center in Berkeley, CA and has been a part of the natural birth advocacy community in the Bay Area for over two decades. She belongs to Sistahs of the Good Birth, a group of Black Doulas who work with low income mothers. She was one of the founders of a volunteer Doula group that provided services for low income, uninsured and teen moms that birthed at Alta Bates Hospital in Berkeley.

Gender, Sexuality, and Inclusion of All Families in Midwifery Practice

1.5 MEAC CEs (0.15 CEUs) Available

 November 22, 2017

In this introductory level workshop, Jaqxun Darlin, CPM, LDM and Jamarah Amani, LM, explored how providing client-centered care for lesbian, bisexual, transgender, and other queer spectrum clients improves and enhances the care we can provide for all families seeking midwifery care. LGBTQIA individuals face many obstacles to healthcare access including a lack of knowledgeable care providers, other people’s lack of awareness of identity issues, and outright prejudice and discrimination. This leads to underutilization of healthcare and contributes to health disparities and poor outcomes, especially by individuals with intersecting marginalized identities.

As midwives and birth workers, we are in a unique position to offer culturally sensitive care to this client population, while making simple changes that benefit all families we care for, regardless of identity. Information presented in this workshop is practical and evidence based, with resources and tools that will help you up your individualized care game!

Jaqxun Darlin newsletter photoJaqxun Darlin, CPM, LDM is a midwife and educator in Portland, Oregon, at Every Body Midwifery & Health and midwife at the Canyon Medical Center, and is the Director of Professional Development for the Midwives Alliance of North America. Jaqxun has over 15 years of experience providing direct health care to queer and transgender people and educational resources to health care providers and community members.

Jamarah for website

Jamarah Amani, LM  believes in the power of birth and that every baby has a human right to be breastfed/chestfed. Her mission is to do her part to build a movement for Birth Justice locally, nationally and globally. A community organizer from the age of sixteen, Jamarah has worked with several organizations across the United States and in Africa on various public health issues, including HIV prevention, infant mortality risk reduction, access to emergency contraception and access to midwifery care. She is director of Southern Birth Justice Network, a 501(c)3 non-profit organization working to end shackling of incarcerated women who labor and birth in chains.

Further resources on this topic:

Birth For Every Body:  Includes links to resources to learn more about gender and birth for patients and providers, including some trainings available for CEUs.

Fenway Institute and the National LGBT Health Education Center: Webinars, learning models and reading on LGBTQ health for providers

UCSF Center for Excellence in Transgender Health: Up-to-date protocols for primary care recommendations and current research

Southern Birth Justice Network: Jamarah Amani’s organization for birth justice through which you can contact her.

To contact Jaqxun Darlin, please email her at everybodymidwifery@gmail.com 

 

Steps For CPM’s To Be Part Of The Solution To Inequities In Maternity Care
April 20, 2017
1.0 MEAC CEs (0.15 CEUs) Available

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Jennie-Headshot website

This webinar helps CPMs understand the ways to negotiate and navigate the often complicated systems that provide perinatal health care for women and babies who are at particular risk for poor outcomes.Topics covered include each level of the perinatal hierarchy; from the grass roots right through to the specialist regional perinatology teams, as well as methods of access and approaches to increase linkages.

Jennie Joseph, a British-trained midwife and women’s health advocate, moved to the United States in 1989 and began a journey which has culminated in the formation of an innovative maternal child healthcare system, The JJWay®.

She is the Executive Director of her own non-profit corporation Commonsense Childbirth Inc. which operates two health centers in Orlando, Florida. Due to the poor birth outcomes experienced by low income and uninsured women she has established outreach clinics for women who are at risk of not receiving prenatal or gynecological care. Her ‘Easy Access’ Prenatal Care Clinics offer quality maternity healthcare for all, regardless of their choice of delivery site or ability to pay and have successfully reduced perinatal disparities. Jennie’s school, Commonsense Childbirth School of Midwifery, trains and certifies midwives, doulas and perinatal paraprofessionals emphasizing culturally competent and community focused care.View Jennie Joseph’s presentation slides here

Diversity Matters; What Are Our Challenges?
March 30, 2017
1.5 MEAC CEs (0.15 CEUs) Available

 

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As we think about the changing demographics of our country, the critical difference that midwives of color make in improving health, and the future of midwifery, we must ask serious questions about how we can expand and diversify the profession. Policymakers and other health professionals are asking similar questions. This webinar explores the evidence supporting the imperative of diversity in the health professions and examines more closely the experiences of student midwives and midwives of color entering the CPM profession.

Keisha Goode, PhD

Keisha Goode, PhD discusses her research entitled Birthing, Blackness, and the Body: Black Midwives and Experiential Continuities of Institutional Racism.

Keisha is on the Board of NACPM.  She is a Visiting Assistant Professor of Sociology at The State University of New York College. Her primary research area is Medical Sociology with specific attention to the medicalization of childbirth and the historical and contemporary complexities of black midwifery in the United States. She is completing a book proposal for the publication of her dissertation research. View Keisha Goode’s presentation slides here

 

Nancy Anderson, PhD, MPH

Nancy Anderson, MD, MPH, shares her research project/needs assessment sponsored by NACPM that aims to understand the barriers that women of color experience with respect to the midwifery profession, and to describe the optimal structure for a midwifery education scholarship program aimed at women of color.

Nancy is originally from New York City, and attended Barnard College and Columbia University College of Physicians and Surgeons.  She is a board certified pediatrician with an MPH in Maternal-Child Health from the University of Washington. Nancy spent five years working in Mozambique, and worked for the Department of Social and Health Services in Washington State for twelve years. She has taught public health in the division of Evening and Weekend Studies at The Evergreen State College and was adjunct faculty in the department of Midwifery at Bastyr University. Nancy is currently on the core faculty in a brand new program, a Master’s program in Maternal Child Health Systems in the Department of Midwifery. Her particular interests are health equity, global health issues, and the health of women and children, with a particular focus on the elimination of maternal infant health inequities in the US. View Nancy Anderson’s presentation slides here

 

Social and Physiologic Impact of Racism in Maternal-Child Health – Part 2 
January 26, 2017
1.5 MEAC CEs (0.15 CEUs) Available

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This webinar examines how racism has specific health consequences that cross socioeconomic and generational lines, describes important new research on the physiological effects of racism, summarizes key literature on race and maternity care, discusses the implications for midwives, and examines the role that federal programs can play to address and reduce disparities.

tanya-khemet-blue

Tanya Khemet Taiwo, LM, CPM, MPH, is a Graduate Student Researcher enrolled in a PhD program in Epidemiology at University of California – Davis.  She is conducting research on the role of prenatal maternal stress on infant neurodevelopment and immune system functions.  She also serves as Co-President of the Board of Directors of the National Association of Certified Professional Midwives. Tanya is an adjunct faculty member in the Department of Midwifery in both the Master of Science in Midwifery and the Master of Arts in Maternal-Child Health Systems programs. She also provides midwifery care on a part-time basis at CommuniCare Health Centers, a Federally Qualified Health Center with clinics in urban and rural communities around the Sacramento area.  Tanya will be introducing our speakers today.

 

michelecurtis-crop

Dr. Michèle Groark Curtis MD, MPH, MML, is an Obstetrician/Gynecologist and third year law student (JD and LLM, anticipated May 2017) with expertise in women’s health, health policy, bioethics, and medical law. Dr. Curtis serves as a voting member of the Medicaid and CHIP regional advisory committee (Region 6, Texas) in providing recommendations on the programs to the Health and Human Services Commission (HHSC), facilitates and responds to input from the public and various stakeholders, and forwards those comments to HHSC.  Dr. Curtis is recognized for her ability to explain complex medical issues to leaders of healthcare systems, clinicians, policy and business professionals, politicians, patients, patient families, and students. She has a history of designing and managing successful clinical trials and studies, persuading key funders to participate, and reviewing grants for National Institute of Health. Her experience includes working in clinical practice in academic medicine and U.S. Senate, and advising Centers for Disease Control and American College of Obstetricians and Gynecologists (ACOG).

Dr. Curtis speaks about the lingering effects of early environments on adult biology and health in humans, such as epigenetic changes, factors related to racial and economic inequality that are predictors for adverse birth outcomes, and the continuity of environments across generations. She addresses how  racial discrimination in particular confers an elevated risk for poor birth outcomes. View Michèle Curtis’ presentation slides here

Camille Sealy, MPH, joined the Health Resources and Services Administration in November 2015.  She serves as a Senior Advisor in the Office of Legislation where she provides strategic direction and leads national legislative efforts for the agency around various issues including health workforce, maternal and child health, and primary care. Prior to that she worked on Health Insurance Marketplace coverage issues as a Program Analyst with the Office of Personnel Management’s National Healthcare Operations.  She also previously served as a health Legislative Aide to congressional members in both chambers.  During her time on Capitol Hill, Camille co-drafted the Ryan White HIV/AIDS Treatment Extension Act of 2009 and also drafted provisions within the health reform law pertaining to maternal and child health, prevention and wellness and disparities.  Camille currently serves on the Board of Iris House, a New York City-based non-profit which provides comprehensive services and advocacy for women, families, and communities infected and affected by HIV/AIDS.  She is also a volunteer at the Smithsonian National Museum of African American History & Culture.  Ms. Sealy possesses a BS from Boston College, MEd from Saint Joseph’s University, and MPH from Emory University.

Camille Sealy speaks about disparities in maternal health and birth outcomes as well as access to care, policy implications associated with these disparities and policy changes and legislation needed to improve maternal health and birth outcomes. View Camille Sealy’s presentation slides here

smolnarcrop

Shandanette Molnar, JD, is a graduate of the George Washington University School of Law and Milken Institute of Public Health, where she earned Juris Doctor and Master of Public Health (Maternal & Child Health) degrees. Currently, Shandanette works as a Staff Attorney in the Bronx, NY, where she aids and counsels tenants and families facing the threat of eviction and advocates for those seeking Social Security disability benefits.  Shandanette is also a full-spectrum doula, Certificated Lactation Educator & Counselor, and childbirth educator with more than 10 years experience working with families to advocate for their reproductive health needs. Looking forward, she hopes to blend her legal advocacy skills and public health scholarship with her commitment to bettering reproductive health policy and reducing race- and income-based disparities in healthcare access and outcomes. She is particularly interested in intersectional approaches to health policy, strategies to address social determinants of health and access, and maternal health advocacy.

indra-luseroIndra Lusero, Esq., is the President and founder of the Birth Rights Bar Association and the director of Elephant Circle, and works as an organizer, trainer, and lawyer practicing family formation and regulatory law. Indra went to law school after attending a MANA conference in 2005 where folks lamented not having a “hot shot team of lawyers” who could help defend midwives. Indra has endeavored to become just such a lawyer. Indra’s law review articles “Challenging Hospital VBAC Bans Through Tort Liability” and “Making the Midwife Impossible: How the Structure of Maternity Care Harms the Practice of Home Birth Midwifery” are published in the William and Mary Journal of Women and the Law and the Women’s Rights Law Reporter respectively. Indra is honored to have been named “All Around Reproductive Justice Champion” in 2013 by the Colorado Organization for Latina Opportunity and Reproductive Rights. Indra is a genderqueer Latin@ parent with a diverse family of people from all over the world.

Shandanette Molnar and Indra Lusero present recent research on racism and birth outcomes, including racial discrimination as an independent risk factor affecting pregnancy and birth outcomes, and maternal, infant and child health. They include a statistical overview of racial disparities in birth outcomes and talk about recommendations to dismantle racism, improve US birth outcomes and eliminate healthcare disparities. View Shandanette Molnar and Indra Lusero’s presentation slides here

 

Keynote Presentation on Equity, Race and Access to Midwifery:
Social and Physiologic Impact of Racism in Maternal-Child Health – Part 1

January 5, 2017
1.0 MEAC CEs (0.10 CEUs) Available

This webinar series shares new insights and identifies action steps we can take to impact health outcomes and increase diversity within the profession.

michael-lu

Dr. Michael Lu, MD, MS, MPH, became Associate Administrator of the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA) on November 3, 2011. Since joining HRSA, he has transformed key federal programs in maternal and child health, launched major initiatives to reduce maternal,
infant, and child mortality in the U.S., and has been awarded the Hubert H. Humphrey Award for Service to America (2013) and the HRSA Administrator’s Award for Equal Opportunity Achievement (2015). He has been voted one of the best doctors in America since 2005.

In response to decades of failed public health efforts to improve perinatal outcomes for women and infants of color, Dr. Lu developed a 12-point plan to reduce black-white disparities in birth outcomes using a comprehensive Life-Course approach that has become seminal in maternity care in the U.S. PDF of Dr. Lu’s webinar presentation slides

Keisha Goode, PhD

Dr. Keisha Goode, PhD, Public Member on NACPM’s Board of Directors, serves as Discussant, highlighting the significance of Dr. Lu’s work to midwifery, and specifically to the work of NACPM, followed by questions and discussion.

 

 

 

View Recording of Main Presentation Here

Please note that the sound quality of the video is compromised in the beginning. Any information missed was covered again during a later portion of the webinar.

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