Education Sessions: Monday, May 23
ES 200 Addressing Health Disparities and Increasing Resiliency: Mindfulness Meditation for Women and Families in Low Income, Inner City, and Rural Populations
Midwives practice in diverse settings and encounter first hand the effects of economic, racial, social, ethnic, and geographic disparities. Bringing mindfulness skills to our clients can promote a change in their relationship to stress and habitual patterns of reactivity; bring greater resiliency; and create space for learning new ways of being. This educational session will provide an overview and results from implementing Mindfulness-Based Childbirth and Parenting (MBCP) in a low income, inner city setting and in a mixed income rural setting, including populations with limited educational, financial, and social resources. A brief mindful practice for the health and wellbeing of the midwife will be included in the presentation.
ES 201 Midwifery Work Force Data: A Tool for Legislative Change
Legislation regarding midwifery practice is often created in the absence of evidence based workforce data. By evaluating the midwifery workforce through information gathered during the licensure or approval practice, midwives can generate practice information that can drive improvement in practice laws. In North Carolina, analysis was performed of licensure data for both midwives and physicians in order to evaluate women’s access and distance to obstetrical care. This research helped to form a foundation for midwifery legislation for a change to collaboration from physician supervision to move forward in the legislative process.
ES 202 Native American Midwifery: Our Past, Present, and Future
This session will present an overview of the history of midwifery in Native American communities. We will discuss the unique challenges and health disparities Native American women face accessing culturally-safe care on and off the reservation. This will be offered in a storytelling fashion weaving traditional and cultural perspectives on Native American women’s health, as well as ancestral wisdom. An overview of the history of birth within Native American communities as well as current birth practices among Native American women will be discussed. Lastly, we will describe the current work of The Changing Woman Initiative in developing a culturally-centered reproductive wellness and birth center and how it will renew indigenous birth knowledge and healing through holistic approaches and community empowerment.
ES 203 ICM Format
Substance Abuse Disorders in Pregnant and Parenting Women: A Multidimensional Approach and Community Support for a Major Public Health Problem
Substance abuse in reproductive-aged women is increasingly prevalent in all populations. Midwives provide comprehensive and collaborative perinatal care for this vulnerable population. This program will evaluate the background of substance abuse, including prescribed and illegally obtained substances, define the scope of substance abuse in women of reproductive age, examine maternal, fetal, and infant risks, and discuss evidence-based treatment strategies that include multidisciplinary involvement. Discussion will include evaluation of neonatal abstinence syndrome, fetal alcohol syndrome, and immediate and long-term follow up of mother and neonate. Recommendations for universal drug screening and consideration of and the ethical rights of the mother and fetus will be addressed. In conclusion, the presentation will review options for treatment including federal legislation to increase the availability of chemical dependency programs.
Substance Abuse Screening and Brief Interventions: An Introduction to Interprofessional Screening, Brief Intervention and Referral to Treatment (SBIRT) in Women’s Health and Prenatal Care
Interprofessional training is essential to increase awareness of different roles and skills among health care providers, build trust and respect among colleagues, and facilitate future collaborative practices that will address effective health promotion of woman-centered care in the United States. An interprofessional approach to screening, brief intervention, and referral to treatment (SBIRT) that includes nursing, social work, and psychology can be very successful in identifying, educating, and referring women with high-risk substance abuse behavior in primary care as well as prenatal care. Midwives and other health care providers must be aware of their attitudes and knowledge surrounding alcohol and substance use and abuse, be able to identify the barriers to SBIRT, and develop enhanced skills with brief intervention techniques in order to improve this area of health promotion and primary, secondary prevention.
ES 204 The Art and Science of Peer Review for Refereed Journals
Peer review is an essential part of the process of ensuring the quality of articles published in refereed journals. Peer review is also an important contribution to the profession and a way to learn how to write manuscripts for publication. This presentation presents an overview of the peer review and editorial processes with an emphasis on becoming a reviewer and components of good reviews. Topics addressed include the purpose and effectiveness of peer review; tips for writing constructive reviews; and ethical guidelines for peer reviewers. Presenters are the editors of the Journal of Midwifery & Women’s Health.
ES 205 One Step Forward, Two Steps Back: How to Diagnose GDM When the Rules Keep Changing!
What’s the best way to diagnose GDM—the one-step/2-hour GTT method endorsed by the ADA? or the traditional two-step/1-hour-then-3-hour GTT method endorsed by ACOG? One approach will diagnose more women than the other—but does that mean that the one-step method over-diagnoses or that the 2-step method under-diagnoses? What is the research that supports each method? How can midwives accurately diagnose GDM without over-pathologizing normal pregnancies? This presentation will review key research, discuss the rationale behind each screening strategy, review strategies to avoid missing GDM, and discuss which interventions bring the greatest benefit to women with GDM.
ES 206 Midwifery Clinical Simulation Skills Training: Best Practices and Pearls of Wisdom
Midwifery students must be taught and assessed for clinical skill competencies prior to entering live clinical encounters with women (American College of Nurse-Midwives, 2014). Most US distance-based midwifery education programs require that students attend onsite clinical skills training and evaluation. However, clinical skills training and evaluation are not standardized nor has information about best practices been formally shared within the midwifery community. Information about best practices, lessons learned, and pearls of wisdom about onsite clinical skills training from distance-based CNM/CM educational programs will be shared in this session. Collaboration and networking related to simulation are helpful, allowing those who are experienced in simulation to share their information with those less knowledgeable.
ES 207 Got Feedback? Real-Time Debriefing with Learners Using Critical Reflection with Good Judgment
Debriefing has been shown to be a key component of simulation-based learning. During post-simulation debriefings, learners have the opportunity to use critical reflection in a non-confrontational environment to consolidate their knowledge and skills and bridge performance gaps they may encounter in clinical practice. Keeping this in mind, these formalized debriefing techniques may assist clinical faculty in providing more meaningful real-time feedback to all levels of students. The nature of day-to-day clinical practice however, might not always lend itself to a safe environment and “in the heat of the moment,” students are simply told what they did wrong or what they need to improve on. This one-directional approach is often perceived as judgmental, and even when delivered gently, makes the assumption there is some type of failure on the part of the student. This not only creates barriers to learning, but can also contribute to the frustrations felt by faculty who may have good intentions for communicating non-judgmental feedback to students. This session will review the critical elements of reflective debriefing and the debriefing with good judgment model. Several case-study examples will be provided with strategies for giving students meaningful real-time feedback during their clinical experiences.
ES 208 Medication Management in Older Women
This session will review appropriate medication management in older women. In particular, principles of prescribing to avoid adverse drug effects and the effects of aging on pharmacokinetics and pharmacodynamics will be discussed. The 2015 Beers’ criteria for potentially inappropriate medications in older adults will also be described and applied in specific clinical case scenarios.
ES 209 The Next Big Thing: Immediate Postpartum IUD Insertion
This presentation will review the status of contraception and unintended pregnancy in the US and barriers to empowering women to access contraceptive methods. Additionally, it will discuss the opportunity for increasing access by initiation of methods in the immediate postpartum period. Actual techniques of insertion and clinical guidance on usage will be discussed.
ES 210 3rd Annual March of Dimes Symposium: The Role of the Midwife in Preventing Preterm Birth
Preterm birth remains the leading cause of neonatal mortality throughout the world. Early detection, prevention, and treatment have been one of modern obstetric’s biggest challenges. In May 2012, the Society for Maternal-Fetal Medicine released a clinical guideline discussing the use of vaginal progesterone for prevention of preterm birth in singleton gestations with no prior PTB and a short cervical length. Among women undergoing universal cervical length screening who were identified to have a short cervix, vaginal progesterone used daily demonstrated a 44% reduction in PTB in low risk women. A cost-benefit analysis in 2010 demonstrated a savings of $130 million dollars with the use of universal cervical length screening and vaginal progesterone for the prevention of PTB in low risk women with asymptomatic cervical shortening. Unfortunately, a significant amount of women decline this low intervention screening when it is offered to them. Many of these low-risk women are cared for by midwives across our nation. Midwives have an opportunity to impact a population that needs advocacy and education. We can save women, families, and their infants from the many hardships caused by an unexpected and potentially preventable preterm birth.
ES 211 Start the Conversation: How to Talk to Patients about Preventing Fetal Alcohol Spectrum Disorders (FASDs)
Although FASD is entirely preventable if women do not drink alcohol while pregnant, survey data shows that up to 25% of women continue to drink during pregnancy. Women often receive mixed messages about the effects drinking can have on their unborn child. That is why asking the right questions about drinking during pregnancy in a non-threatening, conversational way is vital. It can help prevent miscarriage, stillbirth, and a range of physical, behavioral, and intellectual disabilities for babies that can last for the rest of their lives. Midwives are already well-skilled at educating patients about health promotion and disease prevention, but it’s important to consider if the right questions about alcohol use are being asked in the right way. This session will help midwives feel more confident when starting a conversation about FASD prevention by learning how to use motivational interviewing techniques effectively. The use of evidence-based screening tools and intervention strategies has been shown to be effective with pregnant women, and yet are not widely used. In this session, participants will learn about educational tools available from ACNM and The Arc to help educate consumers and health care providers about FASD, and how they can prevent it.
ES 212 Labor Patterns and Birth Outcomes Following Spontaneous Labor Onset Based on ACOG/SMFM, Friedman, and NICE Active Labor Determination Strategies
Accurate diagnosis of active labor serves the 2-fold purpose of providing a basis for identifying slow labor progress that might require intervention while also protecting women in earlier labor from being managed as though active labor had begun. However, the active labor diagnostic criterion that is best suited for clinical use remains unclear. In this presentation, we describe labor patterns, labor interventions, and birth outcomes after retrospectively applying 3 diverse active labor determination criterion to populations of nulliparous and multiparous women admitted to a labor unit with spontaneous labor onset: (1) ≥ 6 cm dilatation, consistent with guidelines put forth jointly by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine; (2) cervical dilation rate ≥ 1.2 cm/hour for nulliparous women or ≥ 1.5 cm/hour for multiparous women, consistent with Friedman criteria; (3) ≥ 4 cm dilatation and progressive cervical dilation defined as ≥ 0.5 cm/hour, on average, over a 4 hour time period, consistent with guidelines put forth by the National Institute for Health and Clinical Excellence. Findings will be presented in context of a 3-point approach for diagnosing active labor onset and classifying labor dystocia-related labor aberrations into well-defined, mutually exclusive categories that can be used clinically and validated by researchers.
ES 213 Integration of the Maternal Health Care System: Building Bridges for Transfer Among Home, Birth Centers, and Hospitals
The presentation will focus on practices that guide out of hospital (OOH) practitioners for better and safer transfers into hospital care. Women who choose OOH care are often frightened of hospitals and unnecessary and unwanted intervention. When OOH practitioners have welcoming hospital physician and midwife collaborators and consultants, women will often be transferred appropriately and with far better outcomes. Integration of the maternal health care system that includes a functional communication pathway between OOH and hospital providers will result in more trusting relationships among practitioners as well as with the women that we care for.
ES 214 Positive Outcomes of Collaborative Practice within the Indian Health Service
CNMs and physicians have been working together in a collaborative practice model within Indian Health Service for over 40 years. Despite working within a population with high risks of obesity, diabetes, hypertension, and multiple social stressors, we observe positive birth outcomes, including low cesarean section rates, high rates of successful VBAC, and high rates of successful inductions. This collaborative model has benefited Native American women by providing the midwifery philosophy within a medical model of care.
ES 215 Quality Improvement Panel: Midwifery-led Rapid Cycle Improvement
Midwives from 6 practices demonstrate completed quality improvement projects including implementation of intermittent auscultation, increasing 6 week post-partum attendance, adherence to PAP guidelines, use of partographs to decrease cesarean section, and implementation of nitrous oxide. In less than 10 minutes each, attendees appreciate the Plan, Do, Study, Act quality improvement cycle.
ES 216 Improving Competence in Sexual Health Care: Development, Implementation, and Evaluation of an Online Sexual Health Course
An innovative online sexual health course using multiple methodologies to improve midwifery and nurse practitioner competence in sexual health care. This session will discuss the development of a nonjudgmental course to promote student discussion of biases and cultural issues related to sexual health across the lifespan including LGBTQI health care. Strategies for student evaluation in this area will be discussed.
ES 217 Hypertensive Disorders in Pregnancy: What a Headache!
Hypertensive disorders of pregnancy continue to be a major cause of maternal morbidity and mortality. In this presentation, the incidence and definitions of hypertensive disorders in pregnancy will be reviewed. The pathophysiology of preeclampsia with be discussed as well as risk factors. Evaluation and treatment of hypertensive disorders will be reviewed. The obstetric emergency of acute hypertensive crisis will be discussed and treatment outlined. Finally, neurologic complications of acute onset severe hypertension will be discussed.
ES 218 Your Hospital Can Reduce Primary Cesareans Using the Healthy Birth Initiative! Lessons from Midwifery Leaders
The American College of Nurse-Midwives’ Healthy Birth Initiative: Reducing Primary Cesareans is changing the maternity care dialogue from one of crisis management of birth and risk factors, to one of a focus on healthy birth using physiological care practices. This year, ACNM has engaged with hospitals in the northeast corridor of the United States to reduce primary cesareans in low-risk women. We will discuss how to engage with your hospital in creating a successful change in unit culture that supports physiologic labor and birth, resulting in fewer cesareans. Preliminary progress from the first 6 months of the project will be presented.
ES 219 Mindfulness Training for Childbirth as Primary Prevention: Life Skills for Expectant Women, Families, and the Midwife
Multiple studies have shown that the practice of mindfulness meditation can reduce the effects of stress and improve physical and mental health and well-being. Stress can impact the health of a pregnant woman and her developing infant in multiple unwanted ways, such as low birth weight, preterm birth, increased use of medication during labor, and postpartum depression. In a win-win situation, mindfulness practice offers a way for midwives to reduce their own stress and offer life skills for her clients for working with the contractions of labor—and the contractions of life.
ES 220 Strategies for Successful Management of Diabetes
American Indian and Alaska Native women experience high rates of gestational and pre-gestational diabetes. Indian Health Service clinicians have developed practical, patient-centered, interdisciplinary strategies to diagnosis and manage diabetes in pregnancy. We will review current screening guidelines and the importance of a team approach to the successful management of pregnancies complicated by diabetes.
ES 221 How to Incorporate Newborn Care Into Your Clinical Practice—From Rewriting Hospital Privileges to Updating Clinical Skills
Though most hospital-based midwives don’t provide newborn care, it is a core competency of midwifery practice. Including newborn care in your inpatient practice increases continuity of care, facilitates improved breastfeeding support, and can provide increased revenue. This workshop will provide you with the tools you need to expand your scope of practice to include newborn care. Topics include:how to rewrite hospital privileges; review of key components of routine newborn care as well as common complications; how to develop a training/proctoring process; writing consultation guidelines; and the basics of billing.