The Black Mother’s Breastfeeding Association provides an local resource for families in the Detroit, MI area, and a great model for meeting the needs of a community of mothers. Check out this great advocacy video they placed on YouTube: Knocking Down Barriers: Reclaiming a Breastfeeding Tradition.
For readers interested in the changing US Healthcare Financing and its effects on pregnant women: two resources for you this week.
First, the MACPAC (Federal group that reviews the state Medicaid and CHIP access) put out a report to congress in March. You can view the report here: Report to the Congress on Medicaid and CHIP. The third chapter is about pregnancy coverage, and that starts on page 41 of the document.
Why do I think this is interesting? Because the report highlights some of the challenges midwives have working with the Medicaid program – a program that pays for nearly half the births in the US (Here’s an article about it). What are these challenges? The program receives federal and state funding, and states do have to meet minimum requirements. But this leaves a system where women in different states received different types of coverage, and have different eligibility criteria. This is why you may find the women in your state have such a different experience than the women another midwife works with in a different state.
Second, the National Association of Certified Professional Midwives (NACPM) is hosting a webinar this week all about the changes we can expect in women’s health due to the Affordable Care Act (ACA). This is just one of a series of webinars about the ACA, so take a look at the offerings and sign up to get answers to common questions. You can access the webinar series here: NACPM Resources
To prepare for our summer of statistics, I’ve put together a short survey for you – the readers. It is a simple survey asking a few questions about your beliefs about childbirth and your birth work. We will use the results to talk about research statistics so we can become better readers of research.
So here is the link you need: Birth Worker Survey
Feel free to share this link with your birth worker colleagues — more completed surveys mean more data to play with.
1. Is this anonymous? I can’t tell who you are when you fill it out, but I think Google can and probably keeps track of it. So it is anonymous to me, but not to the entire world.
2. Can I fill out the survey if I plan to become a birth worker? Yes, you can.
3. Can I fill out the survey if I don’t work anymore? Yes, you can.
4. What if I don’t like the questions, or the answers? You don’t have to answer any question that makes you uncomfortable. But it is a survey, and that means lines have to be drawn about what can be asked, how it can be asked, and how responses can be coded. Don’t worry too much about getting the “right” answer, this is just for fun and is in no way a “valid” survey. We’ll talk about what that means in June.
I look forward to completing this project with you. Enjoy!
I gave a talk last month about obesity and pregnancy. I had an inkling it wouldn’t be a well accepted topic. I have this image in my head that very few people are as interested in obesity as I am; and that probably for the most part American’s are sick of hearing that they should maintain a healthy weight.
I didn’t get booed off the podium. I actually had a few women ask questions when I was done, and a few who felt inspired that they really needed to take their own health more seriously.
I had three main points:
1. If at least 1 in 5 women will enter pregnancy obese, it is not an issue midwives can ignore.
2. We think about obesity as just having extra weight? As if the problem is that there is the extra stuff hanging on your body that slows you down because you have to go through the day essentially wearing a full backpack. And if you could just drop that backpack your life would go back to “normal.” The problem with this type of thinking is that it ignores the fact that adipose tissue is active tissue with a metabolic function – and that function is not to just store and release extra fat based on how many slices of pie I ate this week.
3. When I read popular literature about obesity and pregnancy, I read about a very limited set of problems. These problems begin with the labeling of obesity as a risk category for pregnancy, which allows the mother fewer options and results in unnecessarily high cesarean rate for obese women. My concern with this line of reasoning is not that it is necessarily wrong, but that it is dreadfully incomplete and gives the false impression that obesity adds no REAL risks to the health of mother or baby.
I have to rush off this morning – Statistics exam tomorrow and I’m having a dreadful time trying to stay focused and review. Over the next couple weeks I’ll fill you in on the details of the main points, and we can explore some ways to help women achieve their optimum health.
I have less than a week remaining in my first year as a doctoral student. That means this is a busier than normal week, but a wonderful break is ahead. It occurred to me this morning how helpful the semester system is, so I wanted to share a few thoughts with those of you whose learning doesn’t follow this structure.
Yes, semesters have their problems. They interfere with regularly scheduled life, I have to reorder things and I rarely feel as if I can relax or that I am “done.” When you live by semesters you are not finished until the semester is over.
But, think of these bonuses….
A semester forces me to make my learning a priority — something that doesn’t often happen when I don’t have the outside structure to motivate me.
A semester pushes me to expand further in a very short time, broadening my understanding of a subject and then letting me move on an apply that new understanding to the things I do.
Between semesters I get breaks, giving me a time to work hard and then a time to back off and let the new things I’ve learned change the way I think or act.
Semesters help me balance my life because the work gets done, and then I have a rest. I’m a rather organized and self-motivated person, but it still is not the same when I try to “just learn something” as I go along.
The deadlines of a semester require that I move ahead, even when I wade into uncomfortable territory.
What about you?
For me, the concept of a semester works great. I like it so much that I tend to plan other things in terms of a specific time period. For example every year I give myself that one year to learn a new cooking technique – and I’m not allowed to give it up in that year even if it is hard. When I have a “to do list” of the little things I want to do, but never seem to find time for, I can get them done by scheduling a few hours every week for a month or so. Even my exercise is partitioned into time categories – the next three months are all about being ready to run a 10K.
If you are learning midwifery through self-study without a semester structure, would creating a “semester” for yourself improve your learning?
I’m contemplating a new project for the summer. I want to help you, my audience, become better consumers of research. This isn’t a new idea, I have actually been thinking about it for over a year. But the reality of being in a PhD program by day and mom by night is not really a place to try new things.
But this summer seems like the perfect time. We could talk about a topic each week, and I can pull in examples from PubMed so you can learn to look deeper into an article.
If we do this, I want to have some fun and interesting examples. So I am putting together a little internet survey to give us data to use. Be on the lookout for a link to the survey in May, participate, and enjoy a summer of learning statistics.
Last week my class performed a mock review of our class projects. The class projects are sample grants we might submit to fund our research. The writing process is challenging, with only a few pages to make your case, proving the topic is important, the study you’ve designed will answer the question, and you are the researcher to do this study. This is just part of the research process, and is so difficult that in addition to having several “authors” for any grant, the faculty and staff do mock reviews before they are submitted to identify additional changes. Even then, a good “score” is still hard to get.
Reading a classmate’s grant application is difficult. We each have very different fields of nursing and are using different methods of research, which means when you review an application you are looking at something completely new-to-you and trying to decide what it means and if it will work. Did I tell you this was difficult? But it turns out this is also an exceptionally good way to learn how to read what your own grant really says. In fact, I had identified multiple ways to improve my grant just by reading my colleagues’ grants. But this is not the point of the story.
The point of the story occurs not while I am reviewing a classmate’s grant, but while a classmate is reviewing mine. I don’t consider myself a terrific writer, but I don’t think I’m terrible either. For the most part I have experience writing for readers who are not midwives and need a little help understanding terms. Still, my poor classmate was terribly lost in my grant – having to reread it several times to understand what was going on and still misunderstanding what I assumed were simple things. Yes, on some level the confusion is to be expected — remember we were reading grants way outside our areas of research and I had to go back and forth through the grant I was reviewing several times to understand what was happening too. My classmates confusion had been shared my some of my teachers earlier in the year. I’m sure this is true in most areas of nursing, but midwifery does not translate easily.
I learned some things by listening to her share her confusion. I want to share those things with you, because knowing these may help you communicate research findings or even basic pregnancy and birth information to others.
1. The difference between a midwife and an obstetrician is not clear. My classmate didn’t understand why I included midwives in a study about cesarean rates because midwives cannot perform cesareans. Even though I explained the metric, she couldn’t grasp the idea that a midwife could have a cesarean rate. When you share research about the differences between midwives and physicians, do people have a correct base of knowledge on which to understand the information?
2. The opposite of a VBAC isn’t obvious. My project was about understanding the cesarean rate, and one of the metrics was the number of VBACs. My classmate didn’t understand why I would count only VBACs and thought I should count all vaginal births. Never mind that the metric was spelled out, and it was written that I was comparing outcomes for women with a previous cesarean. The point is again that this information meant nothing to her and confused her. I might have thought she didn’t really read the paper except I have all her really helpful notes to prove that she did read it, and read it very thoughtfully. So the question is again, when you share research, do people have a correct base of knowledge on which to understand the information?
The point is, what I assumed were simple concepts didn’t make sense to her because she didn’t have any kind of a framework on which to understand why it related to cesareans. Yes she is young and has not had children yet, but this describes most of the primipara population. It can be so easy to take for granted that everyone understands what you already know, but it simply isn’t true. I firmly believe in the power of asking first, “tell me what you know about midwives,” and starting the conversation from that point.
When I first started in birth work, I wondered why such obvious good questions were not researched. As I learned more I began to understand the problems of good research, and why certain types of studies would likely never be done (what woman wants to be randomized to epidural or not?) This week I am learning about another step researchers with questions must take — having a grant proposal reviewed.
The problem is, no matter how big a problem I think something is I still need to be able to convince a group of other scientists that my question is worth funding. This means I need to craft a compelling argument in just a few pages. I need to convince them the research is feasible, and that the answers will change practice and add to scientific knowledge.
And if that wasn’t enough pressure, I also need to convince them that my grant is more important than other grants they are reviewing because they cannot and will not fund them all.
What used to feel like conspiracy against natural birth now seems so obvious. While I am consider the utility of interventions that reduce the need for medication or shorten labor by half an hour invaluable, other grant readers are likely to consider them insignificant in the grand scheme of all the research that should be done — and then they would likely fund the research that has a bigger “impact.”
This is the side of research I had never really appreciated, but without it no work gets done. The next time I read a study about positioning in labor I will give due appreciation to the research team that took the time to craft a solid argument and convinced a funding committee that understanding comfort in labor was as important as understanding cancer.
Spring is conference season for me, and every year I have to make decisions about which conferences I will attend. How do I make those decisions? I rank them on their ability to meet my priorities.
When I first started working in the world of birth, conferences were about learning as much as possible. Attending them energized me (and every other newbie) and refreshed the excitement for working in the birth world. But that aspect of conferences quickly fades. I don’t learn very much at conferences anymore – I pretty much have the basics down, and speakers must turn in their outlines months in advance, which means I’ve usually already read any new research that is being talked about. This happens to everyone, and for many professionals it gives them a bad taste for conferences as a waste of time and money.
My priorities for conferences are a little different now. If I have an opportunity to present my research, that conference gets priority. If I have an opportunity to meet and talk with other researchers and leaders who could be part of a collaboration, that conference gets priority.
This year’s conference list begins with the International Confederation of Midwives — not only would I have to wait three years to attend again, but I have been accepted to present a poster. This makes this conference double priority because I can talk about my research as I network with leaders.
The second conference was a difficult decision, do I attend AWHONN (a group for MCH nurses) or Academy Health (a group for policy researchers)? I decided to go with AWHONN. The timing was a little better, and the connections I could make for research have a better chance of being focused on prevention effectiveness in reproductive health. Also, AWHONN has a mentored leadership position that I would love to participate in. My local meetings are always scheduled when I have class, so if I am going to get involved I have to step up at conference.
I am also attending a conference just for fun. Christian Midwives International is a group I’ve participated with for several years. Many of the members are friends, and I enjoy the opportunity to relax and catch up. It also gives me an opportunity to give back to the birth community. I don’t go to network and spread my research, instead I use the opportunity to help continue the education for midwives working ‘in the trenches.’
So, that is my spring conference schedule. Maybe I’ll see you at one.
Last week I challenged you to use spring break to plan out some educational opportunities for the upcoming year. If traditional courses don’t fit into your weekly schedule, you do have other options.
Check out edX, a totally free way to take classes for major universities. There are several classes wanna-be midwives could benefit from.
Food for Thought looks at the role of food in health.
Introduction to Global Health teaches you to identify and analyze variations between countries.
Health and Society looks at the social variables that affect health.
Behavioral Medicine teaches concepts to help clients make healthy changes.
Plus a whole section on statistics to help you become a better consumer of research.
Here’s to a very educational summer!