Certified Nurse-midwives Research Articles

Family physicians provide maternity care in and around the maternity care shortage areas, particularly rural.

This study examined demographic, practice, and area-level characteristics associated with family physicians' (FP) provision of maternity care. Using the American Board of Family Medicine Certification examination application survey data, we investigated the relationship between FPs' maternity care service provision and (1) demographic (gender, years in practice, race/ethnicity), (2) practice characteristics (size, ownership, rurality), and (3) county-level factors (percentage of reproductive-age women, the number of obstetrician-gynecologists (OBGYNs) and certified nurse midwives (CNMs) per 100,000 reproductive-age women). We performed summary statistics and multivariate logistic regression analyses. Of the 59,903 FPs in the sample, 7.5% provided maternity care. FPs practicing in rural were 2.5 times more likely to provide maternity care than those practicing in urban areas. FPs in academic (odds ratio [OR] 4.6, 95% confidence interval [CI] 4.1-5.1) and safety-net settings (OR 1.9, 1.7-2.1) had greater odds of providing maternity care. FPs in the bottom quintile with no or fewer OBGYNs and CNMs had a higher likelihood of maternity care provision (OR 2.1, 1.8-2.3) than those in the top quintile, with more OBGYNs and CNMs. FPs in high-needs areas, such as rural and safety net settings, and areas with fewer CNMs or OBGYNs are more likely to provide maternity care, demonstrating the importance of FPs in meeting the needs of women with limited maternity care access. Our study findings highlight the importance of considering the contributions of FPs to maternity care as the organizations prioritize resource allocation to areas of highest need.

Voices From the Field: Amplifying Clinicians' Perspectives for Black Maternal Equity [ID 2683631

INTRODUCTION: Nationally, Black birthing individuals face a disproportionate burden of maternal mortality and severe maternal morbidity. Although there is growing research interest in tackling these inequities, a significant gap exists in incorporating the insights and perspectives of interprofessional front-line clinicians. This study sought to learn the experiences and viewpoints of physicians, certified nurse-midwives (CNMs), and registered nurses (RNs) to identify strategies for addressing maternal care inequities. METHODS: In collaboration with our community advisory board, we constructed semistructured questions to conduct interviews and focus groups with obstetrical clinicians. Transcripts were coded using NVIVO, utilizing inductive and deductive approaches, and content and narrative analysis to identify themes. Participant consent and IRB exemption status were obtained. RESULTS: We interviewed 20 clinicians: 6 ob-gyn physician interviews, 3 CNMs, and 14 RNs across two focus groups between January and July 2023. Key themes emerged regarding systemic challenges and opportunities. Identified challenges include 1) clinician bias and poor communication, 2) unequal care, 3) patient mistrust, and 4) lack of administrative data. Opportunities for future directions include 1) implementation of clinician training and simulation with an equity lens, 2) standardization of maternal care with safety bundles, 3) incorporation of group prenatal care and expansion of postpartum wraparound services, and 4) disaggregation of clinical operations data by race. CONCLUSION: This study identifies key challenges and opportunities to address the Black maternal health crisis. Our findings inform priorities to guide ACOG's collective action and commitment to eliminating racial inequities that lead to disparate health outcomes.

ACNM's Commentary on the Midwifery Workforce in the US.

The American College of Nurse-Midwives (ACNM) represents certified nurse-midwives (CNMs) and certified midwives (CMs) who are graduate-prepared advanced practice providers. They attend educational programs accredited by the American Commission for Midwifery Education (ACME) and are certified by the American Midwifery Certification Board (AMCB). Their scope of practice as defined by ACNM includes primary care, reproductive services beginning with menarche through menopause, gender-affirming services, contraception, abortion, prenatal, birth, postpartum, and care of the newborn. CNMs/CMs attend 10.9% of US births, but other high-income countries have the reverse proportion of midwives to obstetricians. The CNM/CM workforce is growing, but retirements and attrition slow the growth. Research demonstrates good outcomes from care provided by midwives, and ACNM's primary goal is to expand the midwifery workforce and increase consumer access to midwifery care to mitigate the persistent rise in maternal mortality and morbidity. Barriers to workforce expansion include restricted practice at the state level, inability to expand the number of seats in education programs due to lack of clinical preceptors, and a lack of diversity in the workforce. Strategies to address these barriers may allow the workforce to grow, increasing access to high-quality, equitable sexual and reproductive care for people in the United States.

Weight Bias Among Certified Nurse-Midwives and Certified Midwives: Findings From a National Sample.

Weight bias toward individuals with higher body weights permeates health care settings in the United States and has been associated with poor weight-related communication and quality of care as well as adverse health outcomes. However, there has been limited quantitative investigation into weight bias among perinatal care providers. Certified nurse-midwives (CNMs)/certified midwives (CMs) attend approximately 11% of all births in the United States. The aims of this study were to measure the direction and extent of weight bias among CNMs/CMs and compare their levels of weight bias to the US public and other health professionals. Through direct postcard distribution, social media accounts, professional networks, and email listservs, American Midwifery Certification Board (AMCB)-certified midwives were solicited to complete an online survey of their implicit weight bias using the Implicit Association Test and their explicit weight bias using the Antifat Attitudes Questionnaire, Fat Phobia Scale, and Preference for Thin People measure. A total of 2257 midwives participated in the survey, yielding a completion rate of 17.7%. Participants were mostly White and female, with a median age of 46 years and 11 years since AMCB certification. More than 70% of midwives have some level of implicit weight bias, although to a lesser extent compared with previously published findings among the US public (P <.01) and other health professionals (P <.01). In a subsample comparison of female midwives to female physicians, implicit weight bias levels were similar (P >.05). Midwives also express explicit weight bias, but at lower levels than the US public and other health professionals (P <.05). This study provides the first quantitative research documenting weight bias among a national US sample of perinatal care providers. Findings can inform educational efforts to mitigate weight bias in the perinatal care setting and decrease harm.

Giving Birth With a Midwife in Attendance: Associations of Race and Insurance Status With Continuity of Midwifery Care in Philadelphia.

From 2013 to 2019, Black women comprised 73% of pregnancy-related deaths in Philadelphia. There is currently a dearth of research on the continuity of midwifery care from initiation of prenatal care through birth in relation to characteristics such as race/ethnicity and income. The aim of this study was to investigate whether race/ethnicity and insurance status were associated with the likelihood of a pregnant person who begins prenatal care with a midwife to remain in midwifery care for birth attendance. This was a retrospective cohort study of a diverse population of pregnant patients who gave birth in a large tertiary care hospital and had their first prenatal visit with a certified nurse-midwife (CNM) between June 2, 2009, and June 30, 2020 (n = 5121). We used multivariable, log-binomial regression models to calculate risk ratios of transferring to physician care (vs remaining within CNM care), adjusted for age, race/ethnicity, prepregnancy body mass index, insurance type, and comorbidities. After adjusting for pregnancy-related risk factors, non-Hispanic Black patients (adjusted relative risk [aRR], 1.14; 95% CI, 1.04-1.24) and publicly insured patients (aRR, 1.11; 95% CI, 1.01-1.22) were at higher risk of being transferred to physician care compared with non-Hispanic White and privately insured patients. Secondary analysis revealed that non-Hispanic Black patients had higher risk of transferring and having an operative birth (aRR, 1.35; 95% CI, 1.18-1.55), whereas publicly insured patients were at higher risk of being transferred for reasons other than operative births (aRR, 1.35; 95% CI, 1.18-1.54). These findings indicate that Black and publicly insured patients were more likely than White and privately insured patients to transfer to physician care even after adjustment for comorbid conditions. Thus, further research is needed to identify the factors that contribute to racial and economic disparity in continuity of midwifery care.

Provider attitudes and current practice regarding the prescription of opioid-containing pain medication for vaginal delivery.

The epidemic of opioid misuse and abuse is rampant in the United States. A large percentage of patients who go on to misuse or abuse opioids were initially legally prescribed an opioid medication by their physician. One of the most common reasons patients of reproductive age seek medical care is for pregnancy and delivery. These patients are frequently prescribed opioids. Greater than one in 10 Medicaid-enrolled women fill an opioid prescription after vaginal delivery. To assess the opioid prescribing patterns of obstetric providers following vaginal deliveries. Obstetric physicians and certified nurse midwives (CNMs) from different practice backgrounds were administered a questionnaire regarding opioid prescribing practices for patients who undergo vaginal delivery. Providers were contacted via email and completed survey via REDCap. Ninety-nine providers completed the survey between October 2018 and January 2019. Eight percent of all providers reported prescribing opioids at discharge after vaginal deliveries. There was a statistically significant difference in the proportion of physicians who provided opioid prescriptions at discharge compared to CNMs (16.7 percent vs 1.8 percent, respectively, p < .05). Common reasons for prescribing opioids at discharge included post-partum tubal ligation (56.4 percent), third- and fourth-degree lacerations (59.6 and 73.4 percent, respectively), and operative deliveries (26.6 percent). Physicians were significantly more likely to prescribe an opioid after a second-degree laceration than CNMs (19.1 percent vs 5.3 percent, p < 0.05). Practice patterns for opioid prescription vary by provider type as well as by delivery characteristics. Further study is necessary to delineate the optimal care while minimizing unnecessary opioid prescriptions.

(118) Pilot Survey Study Evaluating Sexual Healthcare Delivery and Provider Habits for Pregnant Patients

Abstract Introduction Female sexual dysfunction affects many women throughout their lives and is associated with medical, psychological, and quality-of-life issues. Studies show an increased prevalence of sexual dysfunction in pregnancy, particularly in the third trimester. However, limited empirical data on sexual dysfunction in American pregnant women exist, and there is a lack of recommendations for intrapartum sexual healthcare screening. It is difficult to find concise screening resources to aid in detection and management. Studies have found that healthcare providers may not inquire about a patient’s difficulty due to known barriers, including a lack of knowledge and training. Objective This pilot survey study aims to assess current provider patterns and modalities surrounding screening patients for sexual dysfunction in pregnancy through a direct questionnaire. Methods This pilot study is an IRB-approved, observational cross-sectional survey conducted via REDCAP. The anonymous questionnaire contains approximately 20 items, including questions regarding provider demographics and screening practices. We identified perinatal care providers, including Physicians, Advanced Practice Nurses (APNs), and Certified Nurse Midwives (CNMs), through Doximity. The data is largely quantitative and includes some qualitative responses to open-ended questions that are not powered. Descriptive summary statistics are reported overall and stratified by provider background. Results 25 perinatal care providers completed the survey; 15 (60%) physicians and 10 (40%) APNs and CNMs. Male providers represented 8% (n=2) of responses. 16 (64%) providers reported that they regularly screen for sexual dysfunction in pregnant patients. Of those 16 providers, the age range most represented was the 41-50 age range (n=7, 43.75%), and they consisted of 10 (62.5%) physicians and 6 (37.5%) APNs or CNMs. Of the providers who regularly screen, 7 (43.75%) selected that the most important time to screen was in the postpartum period and 4 (25%) selected the initial obstetric visit. Physicians reported asking both patients and their partners about sexual dysfunction in pregnancy “almost always” (n=1, 6.25%), “sometimes” (n=4, 25%), “almost never” (n=6, 37.5%), or “never” (n=4, 25%). APNs and CNMs reported asking both partners about sexual dysfunction in pregnancy “sometimes” (n=3, 33.3%), “almost never” (n=3, 33.3%), or “never” (n=4, 44%). Qualitative data revealed these barriers to regularly screening for sexual dysfunction in pregnancy: a lack of time, other screening prioritizations, lack of training, and lack of knowledge surrounding screening in partners. Conclusions Approximately two-thirds (64%) of providers support screening for sexual dysfunction in pregnancy. A similar proportion of physicians (66%) and APNs/CNMs (60%) reported that they regularly screen for sexual dysfunction in pregnancy. Of the providers who regularly screen, providers selected that the most important time to screen is postpartum (43.75%) followed by the initial obstetric visit (25%). In general, providers report screening via open-ended questions or questionnaires. Some providers who support, but do not regularly screen detailed these specific barriers to screening: lack of time, other screening prioritizations, lack of training, and lack of knowledge surrounding screening in partners. Disclosure No

Maternity care clinician inclusion in Medicaid Accountable Care Organizations.

Medicaid Accountable Care Organizations (ACO) are increasingly common, but the network breadth for maternity care is not well described. The inclusion of maternity care clinicians in Medicaid ACOs has significant implications for access to care for pregnant people, who are disproportionately insured by Medicaid. To address this, we evaluate obstetrician-gynecologists (OB/GYN), maternal-fetal medicine specialists (MFM), certified nurse midwives (CNM), and acute care hospital inclusion in Massachusetts Medicaid ACOs. Using publicly available provider directories for Massachusetts Medicaid ACOs (n = 16) from December 2020 -January 2021, we quantify obstetrician-gynecologists, maternal-fetal medicine specialists, CNMs, and acute care hospital with obstetric department inclusion in each Medicaid ACO. We compare maternity care provider and acute care hospital inclusion across and within ACO type. For Accountable Care Partnership Plans, we compare maternity care clinician and acute care hospital inclusion to ACO enrollment. Primary Care ACO plans include 1185 OB/GYNs, 51 MFMs, and 100% of Massachusetts acute care hospitals, but CNMs were not easily identifiable in the directories. Across Accountable Care Partnership Plans, a mean of 305 OB/GYNs (median: 97; range: 15-812), 15 MFMs (Median: 8; range: 0-50), 85 CNMs (median: 29; range: 0-197), and half of Massachusetts acute care hospitals (median: 23.81%; range: 10%-100%) were included. Substantial differences exist in maternity care clinician inclusion across and within ACO types. Characterizing the quality of included maternity care clinicians and hospitals across ACOs is an important target of future research. Highlighting maternal healthcare as a key area of focus for Medicaid ACOs-including equitable access to high-quality obstetric providers-will be important to improving maternal health outcomes.

The State of Advanced Practice Registered Nursing in Alabama

Scope of practice for advanced practice registered nurses (APRNs) varies according to U.S. jurisdiction licensure requirements. Nineteen U.S. jurisdictions currently allow independent practice in all four APRN roles: certified nurse midwife (CNM), certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS). Twenty-six U.S. jurisdictions allow full practice authority for CNPs. APRNs practicing in the remaining U.S. jurisdictions have varying practice restrictions, which are dictated by their state licensure laws. Alabama's scope and standards of practice restrict all APRN roles. During the initial months of the COVID-19 pandemic, Alabama was one of many U.S. jurisdictions that implemented emergency waivers, thereby expanding the scope of APRN practice and granting increased autonomy to APRNs while caring for more complex patients. Once the pandemic threat lessened, many U.S. jurisdictions, including Alabama, returned to pre-pandemic restrictive scope of practice regulations. Through empirical evidence, we conducted a review of APRN practice before, during, and after the pandemic. The literature included anecdotal reports of safe delivery of healthcare provided by APRNs working under the emergency waivers. The literature revealed that APRNs are prepared to practice to the full extent of their scope of practice and provide high-quality healthcare services to improve access to care. Alabama and other U.S. jurisdictions where APRN practice is restricted should advocate for legislative changes supporting APRN full practice authority commensurate with their educational training and certification.

Motivational interviewing for maternal Immunizations: Intervention development

Background and ObjectiveVaccine uptake during pregnancy remains low. Our objectives were to describe 1) development and adaptation of a clinician communication training intervention for maternal immunizations and 2) obstetrics and gynecology (ob-gyn) clinician and staff perspectives on the intervention and fit for the prenatal care context. MethodsDesign of the Motivational Interviewing for Maternal Immunizations (MI4MI) intervention was based on similar communication training interventions for pediatric settings and included presumptive initiation of vaccine recommendations (“You’re due for two vaccines today”) combined with motivational interviewing (MI) for hesitant patients. Interviews and focus group discussions were conducted with ob-gyn clinicians and staff in five Colorado clinics including settings with obstetric physicians, certified nurse midwives (CNMs), and clinician-trainees. Participants were asked about adapting training to the ob-gyn setting and their implementation experiences. Feedback was incorporated through iterative changes to training components. ResultsInterview and focus group discussion results from participants before (n = 3), during (n = 11) and after (n = 25) implementation guided intervention development and adaptation. Three virtual, asynchronous training components were created: a video and two interactive modules. This virtual format was favored due to challenges attending group meetings; however, participants noted opportunities to practice skills through role-play were lacking. Training modules were adapted to include common challenging vaccine conversations and live-action videos. Participants liked interactive training components and use of adult learning strategies. Some participants initially resisted the presumptive approach but later found it useful after applying it in their practices. Overall, participants reported that MI4MI training fit well with the prenatal context and recommended more inclusion of non-clinician staff. ConclusionsMI4MI training was viewed as relevant and useful for ob-gyn clinicians and staff. Suggestions included making training more interactive, and including more complex scenarios and non-clinician staff.

Smooth Transitions: Enhancing Interprofessional Collaboration when Planned Community Births Transfer to Hospital Care.

In Washington state, planned community births are attended by direct entry licensed midwives (LMs) and certified nurse-midwives (CNMs). The most recently published vital statistics data from 2018 reported that 3.6% of the 84,648 births in Washington occurred at home or in freestanding birthing centers. Approximately 16.2% of planned home birth and birth center clients experience intrapartum or early postpartum transfer to the hospital, while 1.8% of their newborns do. The safety of and satisfaction with these types of referrals depends on multisystem processes performed by a variety of health care professionals. Smooth Transitions is a quality improvement (QI) initiative in Washington state that was developed to enhance interprofessional collaboration between community-based midwives, emergency medical services (EMS), and hospital personnel to improve the quality of hospital transfers from planned community settings. Key interventions to date have included (1) information sharing to dispel misconceptions and provide context regarding community births and midwives; (2) co-creation of transfer guidelines; (3) regularly held interprofessional meetings to review transfers and build relationships; and (4) ongoing review of qualitative feedback that captures the perspectives of all involved. Responses on questionnaires and audits indicate that Smooth Transitions has had a positive impact on provider, staff, and patient experiences with hospital transfers. Future endeavors will include strengthening quantitative data collection processes to measure safety indicators, expanding relationships with EMS, and building a case review process that is legally protected. By engaging representatives of all stakeholder groups and addressing community-to-hospital transfers as a multisystems issue, replication of the Smooth Transitions QI Program nationally could promote increased community midwifery integration by enhancing the referral experience for both patients and caregivers.

“Alexa, did the pandemic make you smarter?” A follow up content analysis of a virtual assistant’s responses to a prenatal query

ABSTRACT To compare responses to 40 common prenatal questions from Amazon’s virtual assistant, Alexa, one year apart during the COVID pandemic. Participants: Two researchers replicated a prenatal query using unique Alexa devices. A conceptual content analysis was conducted where the researchers independently queried Alexa the identical questions from their 2020 study during the same one-week timeframe, between May 20, 2021 and May 27, 2021. Alexa’s responses were compared to the 2020 study and the American College of Obstetricians and Gynecologists data and verified by one of the researchers, a Certified Nurse Midwife. Alexa provided accurate responses to 26 (65%) of the questions, an increase by 55 percentage points from 2020. Alexa was able to recite the symptoms of COVID-19 illness but was unable to provide a response to the two other COVID-specific questions. Compared to the 2020 query, Alexa provided more reputable sources for the responses including the CDC, WHO, NIH, and Mayo Clinic. Alexa’s ability to provide more accurate, evidence-based responses was remarkably improved in 2021. Mobile health tools, like Amazon Alexa, are highly utilized by the public, particularly with limited healthcare access during the COVID-19 pandemic. Technology-based platforms should provide credible, evidence-based content.

Diminishing returns: Beliefs and personal agency about racial disparities in endometrial cancer among front line women’s health care providers in the U.S. (592)

Diminishing returns: Beliefs and personal agency about racial disparities in endometrial cancer among front line women’s health care providers in the U.S. (592)

Prenatal Considerations and Outcomes for Girls Aged 14 and Under: Development of a Multidisciplinary Team in a Large Tertiary Care Facility.

Adolescent girls account for 11% of all births that occur globally every year. Among developing countries, the United States continues to have one of the highest adolescent birth rates, despite a decreasing trend between 1990 and 2010. Pregnant adolescents are a vulnerable population who are at increased risk for maternal morbidity and mortality. Additional risks are noted within the early adolescent population, usually defined as age 10 to 14. At Parkland hospital, a large tertiary care facility in Dallas, Texas, a multidisciplinary team was created in 2017 to care for this vulnerable population. The team consisted of a certified nurse-midwife (CNM), a Certified Child Life Specialist, a maternal fetal medicine physician, a social worker, and a Spanish interpreter, with additional services consulted as needed. Between 2017 and 2020, this team grew to include 8 CNMs and provided care to 76young adolescents ages 14 and younger. Of the young adolescents who attendedprenatalvisits with theAdolescent Prenatal Care Team at Parkland, 87%presented toParkland for birth.Eighteen percent had pregnancy-induced hypertension or eclampsia. Only7% of adolescents in the program gave birthprior to 37 weeks. Seventy-four percent had vaginal births. Sixty percentof the adolescents attendedknown postpartum visits. In contrast to most studies, this Adolescent Care Team did not find a high rate of premature birth in early adolescents. Further work by this team is needed to compare the data obtained during this period with data on similar adolescents who have given birth at Parkland in prior years. In addition, comparing outcomes of early adolescents with those aged 15 to 19, who were not included in the Adolescent Care Team, will help to understand the impact that such a team or similar intervention might have on this vulnerable population.

Midwives' Perspectives about Vitamin K Prophylaxis Against Vitamin K Deficiency Bleeding of the Newborn.

BackgroundThe American Academy of Pediatrics recommends one intramuscular (IM) vitamin K injection at birth to prevent Vitamin K Deficiency Bleeding of the Newborn (VKDB). Among factors associated with IM vitamin K refusal, investigators have reported an increased frequency of IM vitamin K refusal among parents who select midwife-assisted deliveries. Reasons behind this association are unclear.MethodsTo understand the perspectives of midwives on IM vitamin K prophylaxis and approach to counseling parents using qualitative methodology, we conducted in-depth semi-structured interviews of midwives associated with 3 tertiary academic medical centers and surrounding communities in Connecticut, Iowa and Michigan. We used the grounded theory approach and the constant comparative method until saturation was reached.ResultsWe interviewed 19 white female midwives from different training pathways. Participants who were Certified Nurse Midwives (CNMs) routinely recommended IM vitamin K prophylaxis and Certified Professional Midwives (CPMs) took a more neutral approach. The following 4 themes emerged: (1) Emphasis on an educational approach to counseling that supports parents’ decision-making authority; (2) Low-intervention philosophy in the midwifery model of care attracts certain parents; (3) Need for relationship building between midwives and pediatricians and (4) Opportunities for the future.ConclusionsMidwives in our study perceived that the midwifery model of care, the focus on physiologic birth and prioritizing parents’ decision-making autonomy appears to attract a sub-set of expectant parents with certain belief systems who question interventions such as IM vitamin K prophylaxis. There are opportunities for better collaboration between midwives and pediatricians.

Expanding Opioid Use Disorder Treatment in Priority Areas: The Role of Certified Nurse-Midwives.

Perinatal opioid use disorder (OUD) is associated with maternal and neonatal morbidity, and treatment has been definitively shown to improve outcomes for both. As of 2018, certified nurse-midwives (CNMs) can prescribe buprenorphine for the treatment of OUD by obtaining a Drug Addiction Treatment Act waiver. This research aims to identify the number of CNMs who are waivered to prescribe buprenorphine for the treatment of OUD and who practice in priority areas for treatment expansion. Through a descriptive study design, authors collected and analyzed publicly available data from August 2020 to January 2021. Using the software GeoDa, authors identified priority counties in the United States and the number of waivered and nonwaivered CNMs in these areas. Counties were designated as priority if they had drug-poisoning mortality rates in the top 20th percentile of all US counties and no health care providers waivered to treat OUD or had a waivered health care provider per population rate in the bottom 20thpercentile. Analysis identified 141 priority counties in 23 states concentrated in rural areas throughout the Appalachian region of the United States. Tennessee had the most priority counties of any state. As of 2020, only 26 CNMs in the United States were waivered to prescribe buprenorphine, none of whom practiced in priority counties. Of the CNMs practicing in priority counties and without waivers, 59% (39 of 66) practiced in states where CNMs have independent practice authority. CNMs are uniquely positioned to treat perinatal OUD given their scope of practice as primary and reproductive health care providers, especially in rural, underserved areas. To increase the number of midwives prescribing buprenorphine and expand treatment access, researchers, educators, practice leaders, and policy makers must address barriers to and experiences of treating OUD.

Use of the Reduction of Peripartum Racial/Ethnic Disparities Patient Safety Bundle to Influence Nurse-Midwives’ Knowledge, Attitudes, and Perceptions

There is no existing evidence regarding the use of the Alliance for Innovation on Maternal Health (AIM) patient safety bundle (PSB) Reduction of Peripartum Racial/Ethnic Disparities (RPRD). This study examines the knowledge, perceptions, and attitudes of certified nurse midwives (CNMs) practicing in the United States regarding the AIM PSB RPRD. A secondary objective was to identify barriers and facilitators to CNMs’ use of this AIM bundle.

Building APRN Gerontology Workforce Capacity Through New APRN Gerontological Specialist Certification

Building APRN Gerontology Workforce Capacity Through New APRN Gerontological Specialist Certification

Creativity, Resilience and Resistance: Black Birthworkers' Responses to the COVID-19 Pandemic.

This article documents the experiences of Black birthworkers supporting pregnant and birthing people and new mamas during the first six months of the COVID-19 pandemic. Building on the methodology and outcomes of Battling Over Birth–a Research Justice project by and for Black women about their experiences of pregnancy and childbirth–the authors utilized a “community-based sheltered-in-place research methodology” to collect the narratives of Black birthworkers, including doulas, certified nurse-midwives (CNMs), homebirth midwives, lactation consultants, community health workers and ob/gyns. The article examines the impact of restrictions put in place by hospitals and clinics, including inadequate or inconsistent care, mandatory testing, separation from newborns, and restrictions on attendance by birth support people, including doulas. Birthworkers shared the innovative approaches that they have devised to continue to offer care and the ways that they have expanded the care they offer to make sure the needs of Black birthing people and new parents are being met during this uncertain time. The article also explores the threats to health, safety, and financial security faced by Black birthworkers as a result of the pandemic, and the overt and subtle forms of racism they had to navigate. Finally, it documents the sources of strength that Black birthworkers have found to sustain them at the frontlines of a maternal health care system in crisis.

Certified Nurse-Midwives in Rural Kansas Hospitals: A Survey of Senior HospitalAdministrators.

Little is known about the nurse-midwifery workforce in rural Kansas hospitals, despite Kansas facing a shortage of primary care physicians providing maternity care rurally. This study investigated the current number of hospitals with certified nurse-midwives (CNMs) with privileges to attend births in Kansas hospitals located in frontier, rural, and densely settled rural counties and anticipated trends in the size of the CNM workforce at hospitals over the next 5 years. Electronic surveys were distributed to senior hospital administrators at 94 hospitals in rural Kansas from June to July 2019. The survey included both open and closed-ended questions related to scope of CNM privileges, collaborative agreements, and forecasted trends in the CNM workforce in rural Kansas. Fifty-six hospitals completed the survey. Only one hospital reported having CNM-attended births. Twenty-eight of 37 hospital administrators agreed CNMs should have collaborative agreements with physicians. Most respondents did not anticipate the number of CNMs with privileges to increase at their hospitals over the next 5 years. Future research should focus on understanding the factors limiting CNM expansion in rural Kansas, because CNMs represent an untapped, additional maternity care workforce for rural Kansas.