Education Sessions: Tuesday, May 24
ES 300 Evaluation and Management of First Trimester Bleeding
1:00-2:00pm • Ballroom A, West Building, Upper Level
This session will focus on the workup and treatment of first trimester bleeding. Accurate diagnoses using physical exam findings, lab tests, and ultrasound will be reviewed. Management options for missed abortions will be discussed including the use of misoprostol.
ES 301 Comprehensive Unintended Pregnancy Counseling: Navigating a Patient-Centered Approach
This education session will explore the often challenging landscape of comprehensive counseling when the patient has an unintended pregnancy, with the goal of balancing a patient-centered approach with the wide range of clinician values and biases. As midwives, we engage in shared decision-making on a daily basis with our patients, at times in situations that place patient preferences in tension with the clinician’s personal values. In this session, we will consider strategies for conducting pregnancy decision counseling that promotes patient autonomy while reducing midwife burn-out. Current evidence and best practices around comprehensive options counseling will be reviewed alongside interactive opportunities to practice these strategies with clinical case studies. Participants will leave with an understanding of what counseling practices lead to truly informed choice. They will also be given the tools necessary to provide excellent, nonjudgmental care to all pregnant people.
ES 302 Put On Your P COAT and Style a Smile: What Oral Health Information Midwives Must Know for Primary Care
Recent evidence demonstrates that oral health has an impact on overall health and well-being. This oral health presentation, developed for students and midwives, builds knowledge and skills and provides clinical practice guidelines to integrate oral health prevention, risk assessment, and management in a primary care midwifery practice. The presentation focuses on the importance of oral health for pregnant women and their infants utilizing evidence-based practice guidelines for prevention and treatment of common presenting oral conditions. In addition, we will introduce the PCOAT (Primary care Oral Assessment Tool) that may be adopted for use in primary care.
ES 303 A Midwifery Value Proposition: Economic Data as an Advocacy Tool
ES 304 Viral Hepatitis in Women and Pregnancy
Approximately 2.7 million people in the United States currently live with chronic hepatitis C virus (HCV) infection, and many are unaware that they have the disease. Community health centers (CHCs) serve as the primary care safety net for more than 22 million patients who are at risk for health inequities and represent an important frontline resource for early screening and treatment for HCV infection. Engagement of individuals infected with hepatitis C virus (HCV) with care pathways remains a major barrier to realizing the benefits of new and more effective antiviral therapies. Despite the clinical success in the real-world of all oral hepatitis C virus (HCV) therapy with response rates approaching that seen in the clinical trials, access has been limited by many payers with discussion of prioritization of treatment based upon AASLD guidelines. Treatment for hepatitis C virus (HCV) can lead to sustained virological response (SVR) in over 90% of people. Subsequent recurrence of HCV, either from late relapse or reinfection, reverses the beneficial effects of SVR.
ES 417 Can We Put an End to Chronic Hepatitis B? The Role of Perinatal Transmission
As many as 25,000 newborns each year are at risk for perinatal infection with hepatitis B in the United States alone. Transmission can be effectively eradicated if public education, screening, and vaccine programs are eliminated, infected mothers are treated, and exposed newborns are given immunoglobulin therapy before vaccination. ACNM is committed to health promotion activities that decrease risks of mother to child transmission of hepatitis B. These include screening, increasing women’s knowledge of their hepatitis status, and increasing access to immunization. When pregnant women are diagnosed with acute or chronic hepatitis B, infectious disease and maternal-fetal medicine consults can contribute to a healthy outcome. This presentation discusses the evidence for screening, vaccination, and treatment and barriers to implementation.
ES 305 ACNM Data Collection Tools: How to Document Your Value!
How do we measure the effect of midwifery on women and newborns in our collaborative practices? This presentation will provide guidance on implementation of 3 new web-based data collection tools developed for ACNM members. Research has demonstrated that midwifery care is associated with fewer interventions, higher patient satisfaction, and increased cost-effectiveness. At the same time, health care reform is causing a shift to performance-based payment systems with increasing requirements for quality, performance, and cost-effectiveness reporting by providers to maximize reimbursement. Participants will learn to develop quality improvement and research questions and how to answer them using the ACNM Data Center, the new ACNM Benchmarking Platform, and “Having a Baby: Every Mother has a Story,” our patient experience database. In this workshop, we will provide an overview of relevant concepts, teach participants how to formulate QI and clinical questions, and then create the metrics that will assist them to answer those questions. There will be a hands-on session using 2 of the new data collections tools and a live demonstration of the patient experience database will conclude the session. Each registrant will be required to bring a laptop and jump drive to the session. Other information about pre-workshop preparation will be emailed to all registrants.
ES 306 Brains on Drugs: Women, Substance Use, and an Innovative Midwifery/Mental Health Partnership
This Extended Session is for midwives interested in improving their skills in caring for pregnant and parenting women with substance use disorders. After providing an overview of addiction, the presenters will engage the audience in acquiring skills for providing direct midwifery care to this population. The presenters will also share their experience working together as a midwifery/mental health team to improve individual competencies of care providers and to reform perinatal systems of care.
ES 307 Pelvic Floor Control: Experiences with Urinary Incontinence During Pregnancy and Postpartum Periods
Up to 67% of women experience urinary incontinence during pregnancy with around 38% still experiencing problems post-birth. Risk factors for urinary incontinence include a variety of circumstances that occur before and during pregnancy and in the intrapartum periods. The purpose of this study was to discover women’s perceptions surrounding urinary incontinence and determine if there are any patterns to previously identified risk factors among pregnant and birthing women. Specific symptoms were evaluated at the repeated measure data points of immediate post-birth and 3 and 6 months post birth. Understanding women’s perceptions of experiencing urinary incontinence surrounding pregnancy and birth will help practitioners be able to approach treatment options from a patient’s perspective of impact on quality of life.
ES 308 Beyond the Google Glass: Innovative Approaches to Teaching Intrapartum Skills
New technologies can enhance midwifery education by allowing students more opportunity to view and practice skills. Wearable technology, such as Google Glass, has the potential to allow students to see through their professor’s eye and visualize proper technique for a variety of skills. In addition, they allow students to submit videos to faculty for assessment. However, new technologies often have pitfalls. We will discuss new technologies for skills teaching and assessment, including Google Glass, and low-cost models for teaching rupture of membranes and fetal station assessment that can be created with simple supplies.
ES 309 The Second Victim: Supporting Providers in the Midst of an Adverse Event
Adverse events occur every day in the medical field especially in obstetrics. These events are devastating to the patient and their family but what about the provider? Too often the provider is left with feelings of guilt and blame. How do we build a culture of safety for the patients and providers?
ES 416 Update on Federal Policy Pertinent to Midwifery
This session will cover recent events in federal legislation and regulation that are pertinent to midwifery. Topics could include ACNM’s advocacy efforts around legislation to identify maternal care shortage areas, reimbursement for CNMs who supervise interns/residents/SNMs, and recognition of CPMs and CMs under the Medicare and Medicaid programs. Any events around provider network adequacy requirements applied to insurance offered through the exchanges would also be discussed. Additionally, if there are other pieces of legislation or regulation that have recently been finalized that have a significant impact on midwives, they will be touched on during the presentation.
ES 310 An Evidence-based Approach To Prevent Cesarean Birth: Old and New Tools for Intrapartum Care
Management of the fetus in a persistent occiput posterior position can be challenging for even the most seasoned midwives. This EXTENDED Session goes beyond midwifery basics to provide an advanced skill set for use in clinical practice. It will provide an evidence-based approach to utilize knowledge and clinical skills for preventing cesarean birth in your practice and enhance communication skills. Discussion, interactive case studies, and hands-on practice with models will prepare you to integrate these skills into your clinical practice.
ES 311 Table Talk Discussions
Compassion in Maternal Health: The Missing Link in the Discourse on Quality and Satisfaction
Sunshine Vitamin in Pregnancy: What Does the Evidence Tell Us?
Caring for the Obese Woman During Pregnancy
The ever present issue of obesity in United States today affects several avenues of health care, particularly obstetrics. Obesity in women of childbearing age is a growing concern among health professionals practicing obstetrics and midwifery. Copious volumes of research have shown the risks for mother and child when a pregnancy is complicated by obesity. This knowledge has worked to formulate consensus guidelines, both nationally and internationally, to promote the best possible outcomes for this dyad. In order to provide evidence-based care, it is imperative that midwives appreciate the significance of obesity in pregnancy and are informed of best care practices for this ever increasing population of pregnant women.
Supporting the Microbiome in Maternal and Neonatal Health
The function of the intestinal barrier and microbiome has profound effects on women's reproductive health. Common perinatal interventions such as antibiotic use and cesarean birth negatively impact the long-term health of the woman and her offspring. These effects include but are not limited to an increased risk of allergic and autoimmune disease, metabolic disease, obesity, mood disorders, and neurological function. Given the emerging understanding of the microbiome, how can midwives best inform patients on issues such as Group B Streptococcus management? How can we safely minimize antibiotic use, and what are reasonable strategies to protect and restore the maternal and neonatal microbiome?
What Work do Midwives Do in Low Resource Settings? Using a Data Collection Game to Describe Frequency, Importance, Where Learned, and Performance of Tasks
Task analysis is a descriptive methodology used to gather data on the importance of and frequency performed on a day to day basis by the health worker. In the United States, it is used by AMCB to validate content for the accreditation examination and to update the scope of midwifery practice. There is a critical lack of midwife workforce data in many low resource settings, hampering planning for education, regulation, and deployment. Countries lack current registries and there is not integration of curricula with expected work scope or regulation. A modified task analysis for health systems strengthening in low resource settings uses a game format to gather data in a group setting. Two additional variables, when/where learned and self-rated performance, arose from practical program needs for information about location of learning and self-assessment of capability. Each task has a range of options for selection: Frequency: daily, weekly, monthly, rarely, never Importance: high, moderate, low When/where learned: pre-service, in-service, on-the-job, never learned Performance: proficient, competent, unable to perform. The interactive card game, Taskmaster: Mining for Data© engages participants in rating tasks in a gaming format and bypasses a lengthy and more expensive survey process. Task analysis provides a valuable source of evidence that can be used to guide human resources for health systems strengthening. It has been well-received by governments, professional councils and funders and is relatively low-cost and easily adaptable to low resource settings. The Roundtable format will allow participants to play the Taskmaster game as they look at the work of midwives.
From Medically Centered to Family Centered: A Community Hospital’s Path to Improved Maternity Care
William Beaumont Hospital is a 1070 bed tertiary care community hospital, part of a larger health care system. In 2014, driven by directives from stakeholders, leadership opened the Karmanos Natural Family Birth Center. At the same time they evaluated the past model of care and looked to develop a new model of care with the goal of decreasing the primary cesarean section rate and improve overall maternity care. This is a synopsis of their work to date.
Midwives manage the obstetric care of women with hypertensive disease in many tertiary care centers. These diseases are increasing in frequency, compounding a woman’s risk for serious pregnancy complications, morbidity, and mortality. Guidelines from the American Heart Association conflict with the American Congress of Obstetricians and Gynecologists statements regarding the treatment of hypertension during pregnancy, resulting in uncertainty and confusion among midwifery providers. Aim: Educate midwives about the frequency of stroke in pregnant patients and the recent guidelines released by the AHA and ACOG in order to improve provider ability to recognize symptoms, screen for stroke, and identify the lifelong risk of heart disease associated with gestational hypertensive disease. Methods: Review of obstetric, primary care, and neurological literature and guidelines to ascertain frequency of occurrence, risk factors, symptoms, diagnosis, and nursing implications. Findings: Both Hypertensive disorders and the incidence of stroke in pregnancy and postpartum are increasing. Morbidity associated with stroke is significant and may involve permanent disability. In 2014 the AHA began including preeclampsia as a gender-specific risk factor for stroke later in life, while the 2013 ACOG guidelines address preeclampsia only as a risk associated with pregnancy. There are multiple differences in recommendations between the two professional organizations. Discussion: Current models of care regarding hypertensive disorders of pregnancy offer conflicting advice and recommendations for providers. While most obstetric providers adopted the 2013 ACOG guidelines, there continues to be a deficit in knowledge and variations in treatment. Midwives are going to increasingly be in contact with women at risk for stroke. Because of this, midwifery providers need to be able to rapidly recognize risk for stroke and transfer care of the acutely ill patient. Lastly, by addressing the knowledge gap among providers, women will receive better education regarding the risk factors associated with pregnancy related stroke.
Moving Mountains for Maternal Health: Eliminating Barriers to Utilization of Midwives
While maternal and infant morbidity and mortality rates are decreasing globally, rates in the United States have hit epidemic proportions. The United States now ranks 46th among nations in maternal mortality with the rates doubling since 1990. The United States also has the highest first day infant death rate out of all industrialized countries. Under-utilization and lack of access to midwifery care contributes to poor maternal and infant outcomes. It is important to not only identify barriers that are in our community, state, and region but also to overcome these barriers. Midwives are extremely busy and may find it difficult to incorporate the resources that ACNM has created to help promote midwifery. Steps will be discussed to help identify barriers in your region. We will also identify tools created by ACNM to help eliminate the identified barriers and increase utilization and awareness of midwives.
Quality Agenda for Integration of Home Birth: Statewide System Change through Development of Professional Guidelines for Midwifery Practice in the Home Setting and Engagement of Obstetrical Partners in Adoption of Model Practices for Coordination of Transfers to Hospitals when Indicated
For women choosing childbirth at home, policy and research literature highlights the importance of integrated access to a maternity system that facilitates consultation and transfer to hospital care when necessary. In the United States, few models exist demonstrating system-wide collaboration between midwives serving at planned home births and hospital-based obstetricians. Integration of planned home birth into the maternity care system is promoted by three foundational steps: 1) Professional midwifery proficiency and accountability congruent with ICM standards for education and regulation. 2) Guidelines developed by the midwifery professional association outlining a community standard for quality maternal and newborn care including indications for collaborative care. 3) Joint midwifery and obstetric organizational support and outreach to midwives, obstetricians, and hospitals outlining steps for model practices during transfers of care, and recommending coordination at the local level. This presentation offers a theoretical review and practical steps learned from implementation of the New York Home Birth Integration Initiative. Come find out the rationale and process for developing trustworthy state midwifery association guidelines for planned home birth, while keeping the woman at the center of her care planning. Explore practical methods for engaging the state organization of obstetricians, as well as local hospital providers and staff, as partners in coordination of transfers of care from planned home births to higher level care when indicated.
I Have No Milk! Can You Help Me? Clinical Strategies for Helping Mothers with Low Milk Volume
Discuss issues that can affect milk supply and strategies to assess and evaluate treatment plans for assisting mothers in attaining their breastfeeding goals.
Beyond the Four Principles: Ethics Education in Midwifery
Medical ethics provides the framework to synthesize, analyze, and resolve the tensions that occur between principles or persons within a clinical encounter. An understanding of biomedical ethics concepts is a required ACNM Core Competency and a fundamental component of midwifery care. In addition, promotion of family-centered care and the advocacy of informed choice and shared decision-making are considered Hallmarks of Midwifery. In this session, current trends in clinical ethics education will be explored, including curricula content and educational formats. We will also discuss the results of a recent survey of midwifery education programs, which examined current curricula, formats, and timing of ethics education
Creating Narratives of Care: Direct Service and Full Spectrum Reproductive Health Care
In 2007, amid a burgeoning interest in “natural birth” in a wide cultural consciousness, The Doula Project in New York City became the first organization of its kind to normalize doula support throughout the spectrum of pregnancy, serving clients whether the outcome is birth, adoption, abortion, or stillbirth, miscarriage, or perinatal loss. To date, our 60-person volunteer base has collectively worked with over 25,000 clients. In this workshop, founding members Mary Mahoney and Lauren Mitchell will discuss how The Doula Project's unique model of care re-frames reproductive justice activism as a narrative practice that allows our clients' stories to guide our care, tailoring it to their individual needs. In this narrative-based care, we are working within a new activist framework that privileges an under-represented narrative of direct care alongside advocacy-based activism. We will discuss how addressing full spectrum doula work as a narrative practice has influenced our trainings in order to create context for new experiences and to increase awareness and empathy for activists, doulas, students, and medical providers alike.
Cervical Ripening Balloon: Evidence for Safety in Vaginal Birth after Cesarean
Research Question: Does the evidence support the safety for the use of a cervical ripening balloon (CRB) in women who desire to undergo a trial of labor after a cesarean (TOLAC)? Significance: Women with prior cesarean delivery are not consistently offered a TOLAC. Although the benefits of vaginal birth after cesarean (VBAC) are well-documented, the numbers of women attempting a TOLAC have remained low particularly when induction of labor is indicated. For women desirous of TOLAC requiring induction of labor, the American College of Obstetricians and Gynecologists (ACOG) supports oxytocin use; does not recommend misoprostol; and is less clear whether prostaglandin E2 should be used. However, ACOG suggests that mechanical dilation methods such as CRB to be “possibly useful for TOLAC candidates with an unfavorable cervix.” Provider reluctance to use pharmacological methods combined with certain women’s desire for a more physiological approach support reviewing the evidence for a non-pharmacological method - CRB to initiate induction of labor in women with prior cesarean. Methods: A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses is being conducted to determine whether evidence supports the use of the CRB for women with prior cesarean. Findings: To date, three recent Level III studies and one Level V study have been identified. In the Level III studies, 20% of the women had cervical ripening with a CRB. Their risk of uterine rupture was not significant and VBAC success rates ranged from 51% and 71%. The Level IV study concluded that professional organizations support use of the CRB or have no opinion on its use. Implications for practice: The study results will guide clinicians on appropriate use of CRB in women with prior cesarean so that women preferring this non-pharmacological approach may be able to experience the physical and emotional benefits of a vaginal birth.
What Midwives Can Do To Prevent Alcohol-Exposed Pregnancies
With unintended pregnancy rates near 50% and American women drinking more in binge patterns, the risk for an alcohol-exposed pregnancy (AEP) is very real. However, most individuals who have a Fetal Alcohol Spectrum Disorder (FASD) have a lifelong 'hidden disability' as they do not meet criteria for full Fetal Alcohol Syndrome (FAS.) As a result of their disability, they may be having difficulty with increased health care needs across the lifespan and functional problems with mental health, substance abuse, academic and vocational achievement, legal involvement, independent living, and problems with parenting. This presentation will discuss the scope of FASDs in the United States, the teratogenic impact of alcohol on the fetus, and the recommended screening and brief intervention techniques used with reproductive age pregnant and non-pregnant women to prevent alcohol-exposed pregnancies.
Midwife-Physician Collaboration: State of the Science
Midwife-physician collaboration is the future of women's health care in the United States. As we work to increase the number of interprofessional collaborative practices, we also need to understand how successful collaborative practices are built and maintained. This session will review current research on midwife-physician collaboration, describe how this knowledge can inform practice, and discuss future research.
The New Integrated Team: CNMs, OBs, RNs, Doulas, Navigators, and Social Workers Within a Hospital-based Midwifery Service
Providence Oregon Women and Children’s Program developed and implemented a pregnancy care package that provides women with connected and coordinated care across the entire pregnancy continuum. The creation of this model of care was innovative, sparked by Providence Health Plan (PHP) asking its leaders to think of new ways to address and transform current clinical practices. PHP provided funds for innovative transformations, enabling Providence Oregon Women and Children’s Program to embark on designing and piloting a new integrated team-based model of care, anchored by certified nurse-midwives and utilizing other health care workers including RNs, doulas, patient navigators, consulting OBGYNs, and social workers.
Maternity Outcomes in Manitoba Women: A Comparison between Midwifery-led Care and Physician-led Care
The Society of Obstetricians & Gynaecologists of Canada delineated 7 priorities to address the maternity care challenges in Canada. One priority was the need for collection and analysis of comprehensive data on obstetricians, family practice physicians, and midwives related to outcomes for future health planning of maternity services. Secondly, the need for multidisciplinary maternal and newborn care models was identified. In Manitoba, to date, no large cohort studies exist that compare maternity outcomes between registered midwives, obstetricians/gynecologists, and family practice physicians. For global context, an overview of the maternity care system in Manitoba, Canada will be given related to utilization of midwifery services. Secondly, findings will be presented from a pilot study that compared maternal and neonatal outcomes of low-risk pregnant women whose birth was attended by 3 health provider groups: registered midwives, obstetricians/gynecologists, or family practice physicians in Manitoba from 2001/02 to 2012/13.
The Work of Midwives to Reducing Maternal Mortality in the United States: Past and Present
The focus of this presentation is to highlight the unsung work of midwives to reduce maternal mortality in the United States in the past as well as currently. It is important to highlight the work of these midwives who have taken a population based focus to improve outcomes for mothers. This work is crucial at this time because the United States is one of only 8 countries with a rising maternal mortality rate.
Evolution of Nursing: Men and Gender Issues in Nursing and Midwifery
An exploration of the role men play in nursing by examining the historical background of nursing. Men compose less than 10% of all nurses and less than 1% of midwives. They face unique challenges and barriers. Identification of these barriers and examination of the image of nursing will help to identify the issues many men face. Using the example of men in nursing, we will examine the importance of a diverse nursing profession to serve an increasingly diverse patient population.
Get Involved Nuts and Bolts of Midwifery Advocacy
This presentation will be an in-depth review and discussion of how midwives can influence health policy. Effective techniques to bring policy change at the state and federal levels will be reviewed. Legislative successes and shortcomings pertinent to women's health since the 2015 ACNM Annual Meeting will be briefly reviewed and discussed.
Growing the Midwifery Workforce: Academic Medical Center plus Midwifery Clinical Service could equal a Midwifery Education Program. Let Us Show You How We Did It
There is a projected shortfall of more than 20 thousand qualified maternity care providers by the year 2050. We need to double our capacity to educate midwives in order to grow the maternity workforce and make midwifery the standard of maternity care. There are many high volume midwifery practices in large medical centers whose volume could support a midwifery education program. Incorporation of teaching into clinical practice can enhance job satisfaction. Using the Baystate Midwifery Education Program as a model, we will demonstrate how a medical center can create an accreditation worthy, fiscally viable certificate midwifery education program. Content will include: creating a business plan, determining class size and faculty staffing needs, integrating teaching with existing clinical services, academic affiliation, and educational articulation to allow concurrent acquisition of a master's degree. We will also discuss areas of reasonable inter-professional education including overlap with OBGYN or family practice residencies and methods of including midwife students in clinical areas with other learners. Increasing the number of programs of this design may have the added benefit of improving access to midwifery education for students of color and first generation college students.
ES 312 Midwifery and Nursing: Can Nursing Organizations Help Us to Advance the Midwifery Agenda?
The profession of midwifery is linked to the profession of nursing in the United States in many ways, through legislation, regulation, and education, as well as clinical practice. The vast majority of CNMs practice in states in which they are licensed by boards of nursing, and CNMs are designated as one of 4 roles of advanced practice registered nurses (APRNs) in the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education. Organizationally, ACNM is working at both the federal and state level with nursing organizations and coalitions to advance full practice authority for CNMs/CMs. This presentation will provide an overview of key nursing organizations with whom ACNM collaborates, an update on the Consensus Model for APRN Regulation and what it means to practicing CNMs/CMs, examples of states in which ACNM has worked effectively with nursing/APRN organizations and of states in which these groups have not collaborated well together, and most importantly, will engender discussion about how we can most effectively use the power of 3.4 million nurses to help us move midwifery forward.
ES 313 DOR Forum I
Presented in this forum:
A Randomized Trial of HPV Self-Sampling as an Intervention to Promote Pap testing among Women with HIV
Implementation of the ASCCP Cervical Cancer Screening Guidelines
A National Study of the Third Stage of Labor and US Birth Attendant Practices
ES 314 OCPS and Sexual Dysfunction
Oral contraceptive pills are an excellent choice for some women and have many health benefits. In some cases, however, OCP use can lead to sexual dysfunction and pain. This session will discuss the physiologic basis for this including which pills are more likely to cause an issue and which women are more likely to be affected. Midwives will learn to identify and treat these women. Physical examination, laboratory tests, medications, and complementary therapies will be discussed.