The Atlanta Birth Center is chock full of #MidwivesMakingStrides by providing safe, out of hospital birth options. Why? “Because birth matters!”
Emory University faculty #MidwivesMakingStrides by leading in midwifery scholarship, research, teaching and clinical excellence!
L to R: Kate Woeber, Alexis Dunn, Desiree Clement
About the Emory University Nurse-Midwifery MSN Program (http://www.nursing.emory.edu/admission-and-aid/msn-programs/nurse-midwifery.html):
“Emory has been a leader in educating Nurse-Midwives for over 35 years. The focus of our program, born in 1977, is to prepare the next generation of nurse-midwives capable of leading positive change and providing the primary care needs of essentially healthy women across their lifespan, along with the care of normal newborns. Our faculty bring their diverse national and international leadership, research, and clinical experience into the classroom to advance the future of midwifery care and education.”
“We prepare students to become leaders who exemplify excellence in the care of women and families. We value holistic, family-centered care that honors the normalcy of women’s life cycle events, treating all with respect and dignity. Emory nurse-midwifery graduates are well-poised to develop and deliver evidence-based care in partnership with women, and in collaboration with an interdisciplinary team. Emory nurse-midwives strive to transform health care to improve the well-being of women and their families in local and global communities.”
Emory faculty attending the NIH/National Institute of Nursing Research in Washington, DC.
L to R: Alexis Dunn, Carrie Henry, Sara Edwards, Abby Mutic
“SUPPORTING WOMEN BECAUSE WOMEN ARE THE FOUNDATION OF HEALTHY, STRONG FAMILIES”
Check out how these midwives are making strides for women at Decatur Midwifery (http://www.decaturmidwifery.com/)!
Happy National Midwifery Week!!
Georgia Midwives are busy every day caring for Georgia’s women and families. Check out how the Kaiser Permanente CNM’s are Making Strides for Women below (https://healthy.kaiserpermanente.org/georgia)!
KAISER PERMANENTE CERTIFIED NURSE MIDWIVES
Lynette Allen-Pye, CNM; KP – Cascade Medical Center
“I’m making strides for all women by providing quality care for and to women across the life spectrum. I am supporting and assisting expectant mothers in the process of having healthy pregnancies, healthy babies and healthy outcomes and experiences.”
Staci J Cody, CNM; KP – Cumberland Medical Center
“I am making strides for women daily by listening to them and their unique stories as they pertain to them and their individual families. I deliver individualized care that is culturally competent and respectful and enables them to determine what is best for their health and make informed decisions about their healthcare.”
“I support women by meeting them where they and discussing how to get them to their best place. This includes taking into account their life’s experiences, family and religious beliefs, expectations, etc.”
Yolanda Gaines – Crawford, CNM; KP – Glen Lake Medical Center
“I’m making strides for women by providing exceptionally, culturally competent care.”
“I support women by listening and valuing their experiences and meeting them where they are to get them to the healthiest they can be.”
Catherine Salazar, CNM; KP – Crescent Centre Medical Center
“I’m making strides for all women by trying to listen to their individual, unique stories. Empowering them to make health care choices that are in line with who they are and where they come from, whether it is related to birth or with their GYN health care.”
“I support women because I believe in all women getting the best comprehensive care they deserve through their life span.”
Kelly McKune, CNM; KP – Alpharetta Medical Center
Sherennah Herring, CNM; KP – Panola Medical Center
Maureen Garcia, CNM; KP – Town Park Medical Center
Michelle Berkowitz, CNM; KP – Crescent Centre Medical Center
“I just don’t want to die.”
“I’ve heard about women dying in childbirth, is that going to happen to me today?”
“What are you going to do to make sure I won’t die after my baby is born?”
Familiar with comments like these? These and similar statements seem to have increased especially after the recent NPR story of the neonatal nurse who died from a serious (and treatable) complication during her labor and delivery. If you missed the article, you can read it here:
http://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger. There are many reasons that contribute to the rising US maternal mortality rate in a time when most developed nations are curbing and decreasing their mortality rates. Adding up the complexity of the health care system with poorer overall population health, potential lack of standard facility protocols, staff training, emergency drill practice, provider skill and experience and it’s no wonder that American women are having worse outcomes.
Georgia has been ranked for years at the bottom of maternal and fetal health outcomes- cesarean section rates, preterm delivery, low birth weight infants, maternal chronic disease and maternal mortality. So what exactly is going on in our state?
HOW DATA IS COLLECTED AND REPORTED:
Maternal Mortality Rate or Ratio (MMR) is defined as the number of maternal deaths per 100,000 live births from any cause related to or aggravated by pregnancy and/or management of pregnancy- this generally excludes accidental death causes.
– Pregnancy- related deaths occur by conditions related directly to pregnancy or management of pregnancy (i.e. hemorrhage, hypertensive disorders or complications).
– Pregnancy- associated deaths occur by any other method (i.e. accidents, suicide, heart disease)
When the maternal death occurs and whether it is included in the MMR is dependent on the organization reporting:
- The World Health Organization (WHO) defines pregnancy-related deaths as maternal deaths that occur during pregnancy or within the first 42 days after pregnancy is over.
- The Centers for Disease Control (CDC) with the American College of Obstetricians and Gynecologists (ACOG) developed a system in 1986 that is still used in CDC reports of MMR: pregnancy-related deaths occur during pregnancy or within 1 year after pregnancy is over.
HOW DEATH IS REPORTED IN THE US
In general, maternal death data is collected from ICD codes recorded on death certificates. In 1979 with the implementation of ICD-9, US maternal death rates increased by ~ 10% due to improved ICD coding definitions. There was another general increase in maternal deaths in the early 2000s due to more detailed questions regarding pregnancy on death certificates. However not all states used the same death certificates so this increase in maternal death rates was observed in states using updated death certificate documentation (Hoyart, 2007). Comparing maternal death rates between states becomes complicated when recorded data is often incomplete (despite improvements in ICD coding) or individual states are not asking the same questions on death certificates regarding maternal death in relation to pregnancy.
WHAT GEORGIA REPORTS
Georgia implemented the updated death certificate in 2008- which includes questions regarding pregnancy within 1 year of death (HMHBC, 2016). However the Georgia reporting system – the Online Analytical Statistical Information System (OASIS) only includes deaths occurring during pregnancy or less than 42 days of death- presumably because most pregnancy-related deaths occur during this time period. The OASIS system excludes any maternal deaths caused by external causes such as homicide or injury.
MOST RECENT GEORGIA DATA:
According to the OASIS reporting system, Georgia MMR for previous years is as follows:
2015 – 59.4 deaths/100,000 live births
2014 – 68.8 deaths/100,000 live births
2013 – 43.6 deaths/100,000 live births (national MMR as reported from the CDC was 17.4 in 2013)
2012 – 17.7 deaths/100,000 live births
The Georgia Maternal Mortality Review Committee (MMRC) is a collaboration between the Georgia Department of Public Health, CDC and the Georgia OBGYN Society consisting of ~ 45 members. It was established in order to review maternal deaths in Georgia and identify areas for improvement and intervention. In 2015, the MMRC published its first report with a review of all maternal deaths occurring in 2012. Below are the major findings of their review:
Total deaths in 2012: 123
26- pregnancy-related deaths (Of note, OASIS report generates 23 deaths)
60- pregnancy-associated deaths
37 – not actual cases – the death certificates were marked that pregnancy had occurred within 1 year of death but no actual evidence of pregnancy was available- this may be caused by data entry error, documentation of spontaneous or therapeutic abortions
Major causes of pregnancy-related death in Georgia include:
1- Hemorrhage – related to abruption, ectopic
2- Hypertension – delay in medication, lack of early response teams
3- Cardiac causes– women unaware of risks, providers failing to screen, educate or refer
4- Embolism – obesity and lack of prophylaxis
5- Suicide – one death related to pregnancy, the patient stopped her medication.
Major causes of pregnancy-associated death in Georgia include:
1- Motor vehicle accidents
4- Heart disease
6- Drug toxicity
Number of deaths were significantly higher in African American, non-Hispanic women. Data was missing in almost 50% of cases regarding pre-pregnanacy BMI, initiation of prenatal care, adequacy of prenatal care so report findings have to be considered with some bit of caution. Concluding the report are suggestions offered by the committee to address the common causes of maternal death and it is expected that with review of additional years (currently undergoing) these data will become more specific.
Contributing to poorer outcomes in Georgia is the lack of providers in rural areas (only 80 of Georgia’s 159 counties have an OBGYN present, data on CNM/NP coverage in not currently available) as well as the closing down of labor and delivery units across the state. In the last 21 years, 31 L&D units have closed making it harder for women living in rural areas to receive timely obstetric care in emergent conditions.
WHAT YOU CAN DO
- Stay up to date on common pregnancy complications, risk factors, evaluations, treatments, pharmacology as well as patient education and warning signs to report.
- Review facility protocols for obstetric emergencies and if there aren’t any (or if they haven’t been updated recently) start working on them! The Council on Patient Safety in Women’s Healthcare has excellent resources available here:
- Encourage staff training and emergency drill practice.
- Use electronic records to your advantage- insert “dot phrases” or reminders in electronic notes to prompt referrals for patients with pre-existing diseases or morbid obesity.
- Get involved in your state ACNM Affiliate- connect with other midwives, participate in continuing education sessions, get involved in legislative efforts!
Healthy Mothers, Healthy Babies Coalition of Georgia. (2016, August 12). State of the state of maternal & infant health in Georgia; where we have been, where we are now, and what we can do. Retrieved from https://drive.google.com/file/d/0BxndQpkPFFfySm5aNmdkYXZYQm8/view.
Hoyert, D. (2007). Maternal mortality and related concepts. National Center for Health Statistics. Vital Health Stat 3(33).
Martin, N. (2017, May 12). Focus on infants during childbirth leaves U.S. moms in danger. National Public Radio. Retrieved from http://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger.
Maternal Mortality Case Review 2012. (2015, June). Department of Public Health. Retrieved from https://dph.georgia.gov/sites/dph.georgia.gov/files/MCH/MMR_2012_Case_Review_June2015_final.pdf
OASIS reporting system: https://oasis.state.ga.us/oasis/oasis/qryMCH.aspx
This year’s ACNM meeting and exhibition was one of the most well-attended conferences to date. The “Midwives: Reaching New Heights” meeting held in Chicago was jam-packed with educational sessions, premier speakers, networking events and fun which included the ACNM Foundation’s 50th Anniversary Celebration. But it wasn’t necessarily the events, sessions, or speakers that was so delightful. Being with over 2000 midwives in one location brought an energy and empowerment that can be difficult to evoke when walking the labor floors alone at 2am, waiting patiently on the next birth. Midwives bring a quality of being that is difficult to describe and is an honor to witness and share. Maybe it’s our passion and persistent drive to bring quality care to our patients and their families, our distinctive personalities, loud voices and humor, or something about the precious nature of birth that stays with us. The gathering of so many powerful and inspiring midwives was rejuvenating and energizing.
The Georgia Affiliate was well represented at the conference- both in members attending and in research talks and presentations. Dr Alexis Dunn spoke regarding her research in a round table discussion. Midwives (and soon to be PhD-prepared midwives!) Kate Woeber and Jessica Ellis participated in the poster sessions. The student midwives also represented Georgia well. The Marketplace table organized and hosted by the students was well-attended and sold over $1600 in Georgia goods for the Affiliate PAC fund.
The Affiliate Board members participated in planning meetings as we prepare to host midwives at the 2018 conference in Savannah. There is much to be done and what seems like a daunting task is being met with excitement and strong ideas by the Board. Be on the lookout for opportunities to serve and let your voice be heard – we will need support from our Affiliate to produce the best ACNM conference yet! Savannah better be ready because WE ARE BRINGING IT!
What were your thoughts about this year’s conference? What would you like to see more of at next year’s conference?
Join us for our quarterly ACNM Meeting!
When: Monday, May 8th at 6pm
Where: Nell Hodgson Woodruff School of Nursing- Room TBA (Free parking in Michael Street deck)
What: Education session, networking, & ACNM Meeting
Dinner & Wine will be provided!
As we come to the close of National Midwifery Week, we want to take a moment to thank all of you for your time, your caring, your hard work and your strength. Midwives across the state of Georgia provide an invaluable service to the women in our state and it is a huge privilege to be involved in this work with you.
National ACNM has just rolled out a Membership Contest through November 15. Members who recruit midwives to join ACNM will be entered into a drawing to win a FREE ATTENDEE REGISTRATION to the 62nd ACNM Annual Meeting in Chicago, IL in May 2017. Additionally, the Affiliate with the most new members also wins a prize to put forward to Affiliate actions in their state. Join us in collaboration, support, education, research and advocacy! Details can be found here: http://www.midwife.org/Membership-Contest
#MidwivesMakeADifference #NatMW16 #GeorgiaMidwives
GEORGIA MIDWIFE OF THE DAY
Name: Shana DeLoach
Years of Practice: 3
Practice name/location/website: Women’s Healthcare Associates, Athens, GA http://www.womenshealthcareassociates.com/
Population served: private pay population
Why Midwifery: Initially, I planned to practice primary care, but I became passionate about women’s health during graduate school – I love the relationships with women and seeing/being a part of the remarkable transition to motherhood. Also, I love the clinical skills we are able to practice and the high-intensity moments associated with practicing on labor & delivery.
ACNM member: Yes. I believe it’s important to stay connected through a professional organization – it’s been helpful during training, while seeking employment, and also, for continuing my education through CMEs and the journal.
Words of wisdom: As a recent student, it’s so important to take time to train the next generation of midwives – I’ve learned so much more from the women who have taken time to invest in me than I ever would have learned through reading and studying alone.
Words of wisdom to women: Birth is unpredictable and flexibility is key. Find a provider you can trust so that you are able to work together to make the best decisions for your birth experience. Teamwork is so vital and midwives want to be for you, not against you.
How I celebrate midwifery: I try to celebrate in the moment immediately after a baby is born – it’s such a special time – before the rest of the busy work has to resume, it’s a nice moment to take a deep breath and be thankful for each of these small moments.
Midwifery self-care… take time to celebrate you. In a world of working hard in caring for women, it’s time to take a breath and reset your energy. Revisit what motivates you to care for women, what keeps you going and how you came to be a midwife. #MidwivesMakeADifference; #NatMW16; #GeorgiaMidwives
GEORGIA MIDWIFE OF THE DAY
Name: Erin Graham
Years of Practice: 2.5 years
Practice name/location/website: Atlanta Birth Center (http://www.atlantabirthcenter.org)
Population served: We serve predominantly low-risk pregnant clients who desire to birth in a out-of-hospital birth center setting. The majority of our clients live within the metro Atlanta area, but some travel long-distances, even coming from neighboring states to be given the option to birth as they desire. When the need arises, we are able to proceed with labor and birth in a hospital setting for those clients with moderate risk-factors that may arise during pregnancy and/or labor.
Why midwifery: I became a midwife after having been a doula for several years in NYC, and my decision to do so was heavily influenced by my time serving families in that capacity. I chose midwifery because I felt at my core that women and their families deserve to be treated with the utmost kindness, respect and compassion during pregnancy, labor, birth and postpartum. As a doula, I witnessed both the best and the worst of what the current American model of obstetrics has to offer, and I felt compelled to do all that I could to provide the kind of care that encompasses not only the physical wellbeing of mother and baby, but their mental, emotional, and psychological wellbeing as well.
ACNM member? Why? Yes! Absolutely! I am a member of ACNM for so many reasons–for mentorship, camaraderie, and for ongoing learning opportunities. I am also a member of ACNM to stay engaged in the hard work being done at the legislative level to demand the respect, visibility and autonomy that nurse-midwives and other APRN’s deserve. There is power and solidarity that comes with engaging with and participating in the collective whole of those doing similar work to help propel the profession forward.
Words of wisdom to midwives: Include yourself in the circle of compassion you draw around the clients, women and families you serve. Take time for self-care & for self-nurturing–however that may manifest for you–and resist the urge to prioritize every one else’s needs before your own.
Words of wisdom to women: Find your tribe. Find your village, and allow those who care for you to help you when you need it. Everything I know about strength, power, courage, vulnerability and beauty, I’ve learned from the clients I’ve been lucky enough to serve, but all too often, I see women who are depleted because they don’t know how to allow others to step in and help them. We are stronger together.
How you celebrate midwifery: Occasionally, in the middle of a particularly chaotic and overwhelming day, a still small voice inside reminds me of the absolute miracle of this work. To bear witness not only to the birth of the baby but to the transformation and birth of the parents is so incredibly humbling. Those quiet moments of gratitude and awe are my favorite kind of celebration.
**Come get outside and join Erin and the other midwives of the Atlanta Birth Center Saturday, October 8, as they celebrate National Midwifery Week! Join them at Noguchi Playscape in Piedmont Park from 2:00-4:00.
Details here: Celebrating National Midwifery Week is about celebrating the ancient practice and most importantly celebrating those we serve. This week is National Midwifery Week and Atlanta Birth Center would love to enjoy an afternoon at Piedmont Park with you! We will provide light refreshments and water, spend some time playing on the playground, and get moving with a nice walk around the park. Please bring your family and walking shoes to this family friendly event at Noguchi Playscape in Piedmont Park. Look for blue, green, and purple balloons to find us easily. This play area is most easily accessed through the 12th and Piedmont entrance to the park.
What is your midwife story? How did you come to practice midwifery care? Did you have midwifery care during a delivery? Share with us! #MidwivesMakeADifference; #NatMW16; #GeorgiaMidwives
GEORGIA MIDWIFE OF THE DAY
Name: Lindsey Kyte
Years of practice: 1 year
Practice name/location/website: The Woman’s Nest, Macon, GA (http://www.thewomansnest.com)
Population served: Middle Georgia area surrounding up to 2 hours away, both urban and rural areas served.
Why midwifery: Women should be with and supported by women during all stages of their female care. I fell in love with the midwifery model of care when I was in my maternal health nursing course and knew that one day I would fulfill my passion of becoming a midwife. Also, as midwives we are known to provide an abundant amount of support by way of education. I am a firm believer that our wellness and healing depends on how educated we are about the choices we make. Midwifery grants women with just that. Ultimately, I enjoy being a witness to a growing nest and nurturing women for the wellness of her family.
Are you an ACNM member? Yes. Why? I believe that being part of a community of professionals betters each of us and ultimately the profession and all those we serve. In the coming years I would like to get involved in more that ACNM offers. I also find great importance in staying up to date on research in the journal for providing the best care.
Words of wisdom to midwives: Embrace each moment, each family. Trust the process but stay keen to your intuition in all situations. Don’t forget the fourth trimester and preparing your mother’s for just that…motherhood. Help to create a sisterhood between the mothers you support. Connect with other midwives as two is always better than one and we can provide reassurance and comfort to one another during challenging times. Lastly, balance your time, nurture and honor yourself, and show compassionate love to your children and/or spouse in the way that you do for the families you assist.
Words of wisdom to women: Every women is important, worthy, honorable, beautiful, strong, and amazing. As women we are incredibly critical and judgmental of ourselves, ways, and choices. My wish for every women is to live free of this judgement and just BE YOU. Seek out supportive women and relationships that make you feel loved, appreciated, lifted, and worthy. You women are unique and are all fabulous and have a lot to share with the world and I want women to feel that and have a sisterhood that brings it out in them.
How you celebrate midwifery: Having only been a midwife for a short time I can say I celebrate midwifery through every single birth and every smile or “ah ha” moment I get from women when spending time to talk to them about how to care for their pregnant bodies and growing babies.Being a midwife creates a spirit within that allows us to celebrate the strength of a woman through all walks of life. I love that midwifery is a career that you can celebrate every day.