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Entries in nurses (4)

Wednesday
Nov272013

Notes From the Salon: Midwifery Paths and Practices

By Becky Michelson, BADP volunteer

On October 23rd, the living room of Langton Labs overflowed with people eager to learn more about midwifery paths, lifestyles, and perspectives. To understand the distinctions, nurse-midwifery student Holly Carpenter moderated a conversation with Kim Dau, a certified nurse-midwife (CNM) and Maria Iorillo, a certified professional midwife (CPM). Kim is the Assistant Director of the nurse-midwifery education program at the University of California, San Francisco (UCSF) while Maria has attended over 1100 births, primarily in homes.

Some general points of departure between CNMs and CPMs are their education, places of practice, and privileges. CNMs are initially trained as nurses, may practice in hospitals and clinics, and can provide first trimester non-surgical abortions in some states (and recently in California, thanks to the passing of AB154). CPMs can choose from a combination of midwifery certificate programs and apprenticeships and practice in homes and birth centers. There are many nuances regarding the legality of both roles on a state basis. Many research studies cite the benefits of having a midwife as your primary health provider, such as lower rates of preterm births and interventions.1 The American College of Nurse-Midwives has more information on essential facts about midwives.

The Salon Series was intended to shed light on the different ways of practicing midwifery and their respective certifications, work dynamics, and parameters. Instead of having this instructional focus, the gathering felt more like a community bonding through story sharing. Despite their differing paths, both midwives shared stories that reaffirmed their life’s purpose of being in service at births where they felt in awe of the immense courage and vulnerability displayed by mothers.

Kim’s path began working in a laboratory after finishing her undergraduate studies in Biology. She missed connecting with people in her work and her desire to pursue midwifery was sparked from reading Immaculate Deception by Suzanne Arms and Spiritual Midwifery by Ina May Gaskin. She embarked on a journey west to gain experience by working at birth centers in Oregon, New Mexico, and Texas. After attending the UCSF nurse-midwifery program she worked in North Carolina at Duke University for several years, before returning to San Francisco in clinical capacities at both Kaiser Permanente and San Francisco General Hospital. In the past few years, she has maintained a clinical role at SFGH while fulfilling her dream of working in CNM education as the Asst. Director fo the nurse midwifery program at the University of California, San Francisco. Meanwhile, Maria Iorillo attended midwifery school at age 23 and received her licensure in New Mexico. When she moved to California, midwifery was illegal. She has maintained attending 4-8 births a month and has been practicing her incredible craft for over 28 years.

Upon painting a picture of their paths, the conversation shifted toward what midwifery is about and the elements of inspiration. Maria explained that to her, midwifery is about creating a safe space for women who are being vulnerable and courageous enough to seek their own authentic power. Women often seek her care with a deep belief that they are capable of birthing, and she facilitates their connection with that inner power. Maria told two stories about unexpected c-sections and home deliveries where despite the unexpected changing circumstances of the women’s intended births, they emerged supported and empowered. Kim also shared poignant birth stories that included a family confronting melanoma and a laboring woman who was recently grieving her partner. Kim stayed present in these intense experiences, holding space for the brave families. She also spoke of how offering support during trying situations has led to her own potent self-growth.

The Salon Series also included a handout called, “A Baker’s Dozen Ways for Doctors and Midwives to Preserve Simple Birth.” Kim and Maria’s stories included elements of the handout’s holistic advice that supports birth as not just a clinical but also a social process. A few of these recommendations include:

  • Ask permission to touch the laboring person in your own language

  • Dissolve fear by providing options

  • Keep the baby and mother together

Both midwives also highly recommended Witches, Midwives, and Nurses: A History of Women Healers by Barbara Ehrenreich.

In thinking of a vision for cultural change, both midwives promote women being treated with respect, kindness and as if they are smart enough, which they are, to make their own decisions without the manipulation of hospital staff. Beyond the birthing process itself, Kim is excited that more midwives are sitting at tables they previously have not before, meaning that the midwifery perspective is being taken into account more frequently on issues such as neonatal and infant care on state and management levels. Midwives are still a minority health care provider, but at least in the Bay Area, interest and support for them is rapidly growing.

After an evening of stories filled with with births, unexpected events, midwifery muses, and raw inspiration, Holly exclaimed that the UCSF midwifery program should be expecting many more applicants this year. With the full house of doulas, advocates, allies, and aspiring midwives bubbling with questions, anecdotes, and curiosity- she must be right. Thank you Holly, midwives, Salon Series team, and engaged audience!

1. http://www.huffingtonpost.com/2013/08/20/midwifery-benefits_n_3787058.html 

Monday
Nov112013

Blog Series: Notes from a Full Spectrum Nurse-Midwifery Student

by Holly Carpenter, RN, UCSF School of Nursing-CNM/WHNP Candidate 2014

 

Part I: Finding Full Spectrum Nurse-Midwifery

 

Part II: What are we being taught? What do we "want" to learn?


In the previous post in this series, I introduced the big picture of nursing education in sexual and reproductive health care. This section discusses the extent of training that currently exists within nursing education programs in U.S., including a student-led elective that was piloted at UCSF this past year.

Both APC and pre-licensure nursing students still face a fairly bleak picture in terms of standard SRH training and education. In a preliminary review of existing curriculum and educational programs, the results demonstrate a significant need for further study and development of curriculum. Most importantly, we have zero baseline data regarding the content in RN (or “pre-licensure”) programs in terms of sexual and reproductive health. Without this information, we can only operate on assumptions to make the case for improvement or plans for curricular change.

The sole national survey of APC programs (conducted in 2001 and not updated since) demonstrated that only 53% of schools in the U.S. offer didactic instruction in medication or aspiration abortion, and a mere 21% offer clinical training in these procedures (Foster et al. 2006). This is all despite the fact that “professional associations and accreditation bodies have repeatedly identified the need to include reproductive health in the standard curricula” including The American Association of Colleges of Nursing (AACN), the National Organization of Nurse Practitioner Faculties (NONPF), the AAPA, and the American College of Nurse Midwives (ACNM), all of whom have “...developed guidelines that recognize the need for their graduates to possess competence in providing care related to sexual and reproductive health” (Taylor et al., 2009). Even at UCSF, with the passage of AB154 a firm reality, CNMs only receive two hours of comprehensive options counseling training, and two didactic hours of instruction on medication and aspiration abortion*. Contraception is a very basic, pharmacology-focused online course.

In conversations with other nursing and medical students at UCSF, I have found a shared sentiment of disappointment in this educational gap. Nursing students at all levels are eager for more training and education in sexual and reproductive health - specifically focused on abortion. To meet these demands, a first year medical student and I designed a noontime interprofessional elective entitled “Family Planning and Reproductive Choice”, to which we invited guest speakers who covered options counseling, adoption, values clarification, clinical and public health aspects of abortion, and IUD insertion, among other SRH-related topics. As UCSF students, we were incredibly lucky to have access to the top SRH/abortion researchers and providers in the world, which made the task of selecting speakers very enjoyable. Dr. Tracy Weitz gave an electrifying introductory session on the state of abortion in the U.S., and Dr. Eleanor Drey followed with a comprehensive overview of clinical abortion provision. Residents and Family Planning Fellows taught our IUD and MVA papaya workshop, and Exhale (After Abortion Talkline) hosted a personal experience panel.

Student reception was overwhelmingly positive, and we had packed classrooms throughout the quarter. After presenting on this experience at the National Abortion Federation conference in 2013 and meeting with nursing students from around the country at the conference, it was clear to me that nursing students’ desire to be taught SRH curriculum is a national phenomenon. Anecdotally, their reasons included a desire to achieve competency in patient care provision, desire to increase abortion access in underserved and underinsured populations, and competitiveness in the job market, among others. In collaboration with an incredible, interdisciplinary group of nursing educators and innovators, I’m currently in the process of creating and disseminated the elective as a nationally applicable curriculum. We are planning to implement the first pilots at Oregon Health and Sciences University, Yale University, the University of New Mexico, and the University of Pennsylvania, among others. The elective materials and curricular resources will be added to the Nursing Students for Choice website as well. Through the efforts of dedicated grassroots nursing student activists at these campuses, we hope to demonstrate to faculty and administrators that we strongly believe this content needs to be included in our standard curriculum, not just to satisfy our own interests, but to prepare us to be competitive entrants to the nursing workforce, provide access to high quality sexual and reproductive health care to our patients, and normalize abortion care within the full spectrum of nursing scope of practice.

The final post in this series will review resources and opportunities that exist to build and improve SRH curriculum in U.S. nursing programs at both the pre-licensure and advanced practice levels.

*Due to the admirable efforts of several dedicated faculty, instruction in first trimester MUA is set to be implemented in 2014.

Please direct your feedback and comments to holly.carpenter@ucsf.edu.

References

Foster, A., Polis, C., Allee, M., Simmonds, K., Zurek, M., Brown, A. (2006). Abortion education in nurse practitioner, physician assistant and certified nurse–midwifery programs: a national survey. Contraception 73 (2006) 408–414.

Taylor, D., Safriet, B., Dempsey, G., Kruse, B., & Jackson, C. (2009) Providing Abortion Care: a professional toolkit for Nurse-Midwives, Nurse Practitioners, and Physicians Assistants. University of California, San Francisco. Accessible at: http://www.apctoolkit.org/index.html

Wednesday
Oct092013

Blog Series: Notes From a Full Spectrum Nurse-Midwifery Student

 

by Holly Carpenter, RN, UCSF School of Nursing-CNM/WHNP Candidate 2014 (originally posted on the Nursing Students for Choice Blog

Part I: Finding Full Spectrum Nurse-Midwifery

When I was choosing between various CNM (Certified Nurse Midwife) graduate programs in 2010, the faculty biographies at UCSF were the deciding factor. Every CNM on faculty was described as “Full Spectrum”, meaning they cared for patients through every reproductive health outcome, including abortion. My initial interpretation of this term was, “Wonderful! These midwives are providing abortions, and that means that I’ll be taught how to provide abortions.” As it turns out, while some UCSF CNM faculty provide medication abortions and place laminaria, CNMs in California do not typically perform first trimester “therapeutic abortions” or manual uterine aspiration procedures (MUAs).

This situation is not unique to California; CNMs and other advanced practice clinicians (APCs) are permitted to provide MUAs in only four states: Vermont, New Hampshire, Montana, and Oregon (Weitz et al., 2013). While the skills involved in first trimester MUAs are identical to those used in “miscarriage management” – a procedure that is legally within the APC scope of practice – many states have explicitly banned APCs from providing MUAs. Obviously, anti-choice politics play a major role in these bans, as evidenced by the recent rash of APCs-as-provider bans that have gone forward during the past two years of abortion limitation legislation. The impact of these bans is substantial, and connecting the dots is not difficult:

  • Under the Affordable Care Act, the proportion of the US population receiving primary care from APCs is expected to increase substantially (Taylor, et al., 2009).

  • NPs, CNMs, and PAs are …more likely than physicians to practice in medically underserved settings (Taylor, et al., 2009)

  • Abortion is one of the most commonly performed procedure for women (Boonstra, et al., 2006)

  • Limiting access to abortion is harmful to women (Foster, 2013)

  • The logical conclusion: banning the most accessible providers from performing a commonly demanded procedure is going to have a negative impact on medically underserved women.

However, progress is being made. In California, the Health Worker Pilot Program has been training APCs as first trimester MUA providers under a legal waiver from the CA State Legislature since 2005. The results of this project have been studied and published, and they offer proof that APCs are equal to MDs in safety, efficacy, and patient satisfaction (Weitz et al., 2013). The positive outcomes reported in this study have formed the basis for AB154, a CA bill which formally designates first trimester MUA procedures as within APC scope of practice. With the chances of passage of this bill looking promising, (it is currently on Governor Jerry Brown’s desk awaiting his signature), APCs in California are poised to address the important gap in abortion access that MD-only provider laws have created. There are millions of American women between the ages of 15-45, ⅓ of whom will seek an abortion at some point in their reproductive years (Weitz et al., 2013).

The first step in addressing this gap in access and care, however, starts with provider education at both the pre-licensure (RN) and APC levels. RNs play an important healthcare role by providing pregnancy options and contraceptive counseling in many clinical settings, and therefore need to meet competency standards in SRH care provision as well. In the next post in this blog series, the state of sexual and reproductive health in nursing education will be discussed, as well an innovative UCSF project: a student-led elective focused on abortion and family planning. Thanks for reading!

Please direct your feedback and comments to holly.carpenter@ucsf.edu.

References:

Foster, D., (2013). The Turnaway Study. ANSIRH. Accessible at: http://www.ansirh.org/research/turnaway.php.

Weitz, T., Taylor, D., Desai, S., Upadhyay,  U., Waldman, J., Battistelli, M., & Drey, E. (2013). Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver. Accessible at: http://www.ansirh.org/_documents/library/weitz_AJPH2012.pdf

Boonstra, H., Benson Gold, R., Richards, C., & Finer, L. (2006). Abortion in Women’s Lives. Guttmacher Institute. Accessible at: http://www.guttmacher.org/pubs/2006/05/04/AiWL.pdf.

Taylor, D., Safriet, B., Dempsey, G., Kruse, B., & Jackson, C. (2009) Providing Abortion Care: a professional toolkit for Nurse-Midwives, Nurse Practitioners, and Physicians Assistants. University of California, San Francisco. Accessible at: http://www.apctoolkit.org/index.html.

- See more at: http://www.nursingstudentsforchoice.org/blog-series-notes-from-the-full-spectrum-nurse-midwifery-student/

Thursday
May092013

Full Spectrum Advocacy: A review of current bills in the California Legislature that effect your body & your community

There are some very exciting bills headed through the California legislature. These bills will have direct impact on reproductive health and justice in our communities! Come learn more about the following bills and what you can do to make sure they pass. Let's make California a full-spectrum state! 


AB 154 will reduce barriers to reproductive health care by allowing trained nurse practitioners, certified nurse midwives, and physician assistants to perform early aspiration abortions. 

AB1308 & SB 304 will clarify midwifery educational paths in California, make CNMs able to precept student midwives in the midwives/LM track, and allow midwives/LMs to order medications and devices they use within their scope of practice. 

AB271 will repeal the family cap law. The current law (hopefully to be repealed) states that if a parent is receiving money through CalWORKS and that parent has a child, the parent is not eligible for additional aid for that child, despite the growth of their family.

Come learn what you can do to get involved!

WhenTuesday May 28th 7-9pm
Where: 32 Langton St. SF, CA 94103 Just three blocks from Civic Center BART!
Cost: $5-$15 Suggested donation for BADP, no one will be turned away for lack of funds
Accessibility: The space is wheelchair accessible (but the restroom does not have grab bars). Babes in arms are welcome. Please email salon_fund [at] bayareadoulaproject [dot] org or send us a note on facebook if you have any questions about accessibility

Our Panel for the Night will Include:

Ashley Morris speaking on AB154: 
Ashley is the Senior Organizer at the ACLU of Northern California. Ashley’s policy and advocacy work is currently focused primarily on reproductive justice and increasing access to abortion care. While at the ACLU, Ashley served as the Northern California Regional Coordinator for the 2012 Yes on 34/SAFE California Campaign and the Northern California Regional Director for the 2008 Get Up/Vote Down 4&8 Campaign. She performs with Gamelan Sari Raras and previously served as board co-chair of Good Ol’ Girls, an organization that connects progressive women on the rise with social and professional opportunities.

Treesa McLean speaking on AB1308: 
Treesa Mclean is a midwife who has been serving Bay Area families in the reproductive health community for 30 years. She is currently active with California Families for Access to Midwives, working tirelessly to ensure that all Californians who want have access to midwifery care, and that those who give birth at home can have access to quality care. birthwithtreesa.com cafamiliesformidwives.org

Sierra Harris speaking on AB271: 
Sierra Harris is the Assistant Director of ACCESS Women's Health Justice. She is passionate about reproductive justice and eliminating systems of oppression that impacts people's reproductive and sexual health and decisions. In her spare time, Sierra enjoys cooking and hosting family dinners - a space she believes cultivates community outside the activism sphere and is central to revolution. accesswhj.org

Lupe Rodriguez will help us to understand the legislative process and how we can have an impact!
Guadalupe (Lupe) Rodríguez is Director of Public Affairs at Planned Parenthood Mar Monte, where she oversees government relations, communications and grassroots advocacy. Lupe is the board chair for ACCESS Women’s Health Justice, a statewide organization dedicated to making
health care more accessible for women. She also and sits on the board of California Latinas for Reproductive Justice, and serves as a commissioner on both the Human Rights Commission in the city of San José and the Santa Clara County Commission on the Status of Women. Lupe is an alumnus of the Women's Policy Institute (2007-2008), and of the Latino Leadership Alliance academy. Lupe is also an advisor on the Women’s Health Leadership Network, an advisory group for the Women's Health & Rights Program at the Center for American Progress.