Session Descriptions

Friday, October 16 - Conference Day One

8:30am - 10:00am - Plenary: Perspectives on Risk: MANA DOR's 2015 Research - Missy Cheyney, PhD, CPM, LDM

Each regulated state in the US sets its own Scope of Practice for homebirth midwives, and there is little consistency across states. Some allow only head down, singleton, term births in women with no previous cesarean, whereas others allow breech and twins.

Breakout Sessions Group A (11:00am -12:30pm)

1. Bipolar Illness and Postpartum Psychosis - Tara Tully, CPM, LCSW

While providers and the general public are becoming more aware of mental health factors as being an important part of maternity care and maternal and infant outcomes, postpartum mood disorders are a complex and little understood issue. Many providers are aware of postpartum depression and anxiety, but little is discussed about postpartum bipolar disorder. Women with an existing bipolar illness are at an increased risk of developing pospartum psychosis, committing suicide, or infanticide then women with depression or anxiety disorders. Women with a previous history of depression are also at greater risk for converting to a bipolar disorder during the postpartum period. We will discuss different categories of bipolar illness, mania and hypomania and the increase risk to mothers in the first few weeks postpartum. Also will be discussed the risks of developing psychosis,increased suicide risks, and risks of committing infanticide. We will discuss screening tools and actions steps that a midwife should take when a mother is not stable and may need higher levels of intervention then can be provided in an outpatient setting. Additionally, will be discussed the impact of forced hospitalization and how to address trauma and repair the interruption of the maternal infant bond when forced hospitalization or separation occurs. Additionally there will be handouts and resources given out for information on medication risks, benefits, and impact on pregnancy and breastfeeding outcomes in mothers with a bipolar illness who are maintaining mood stabilization with pscyho-pharmaceutical treatments.

2. Medicinal Plants of the Southwest Bioregion - Mary Lou Singleton, LM, FNP

The desert and mountain ecosystems of the American Southwest provide an abundance of healing plants for those who live here. Come learn about native and "invasive" species that offer medicinal qualities useful to midwives and the families we serve. This session will focus on the ecological connections between plants and their own communities, why plants make medicinal compounds that are also helpful to our own species, and the importance of sustainable, ecologically conscious herbalism.

3. Homebirth Cesarean Helping Homebirth Clients and Midwives Prepare, Cope, and Heal from Cesarean Births - Courtney Key Jarecki, Author

The following questions will be answered: 

  • Why do women who transport from home/birth center to the hospital for a cesarean often experience trauma, shame, depression, and anxiety following this birth outcome?
  • How are these women different from other women who have difficult homebirths, vaginal births in the hospital, or even planned cesareans?
  • How does the fight-or-flight and freeze stress response play into a traumatic birth?
  • How can midwives, doulas, and childbirth professionals prenatally prepare all clients for the possibility of cesarean?
  • How can midwives help facilitate transports and planned cesareans in a way that minimizes trauma and increases the mother's satisfaction with her birth?
  • What are the unique psychological, emotional, and physical needs of a postpartum homebirth cesarean client?
  • How can birth professionals confidently screen for perinatal mood and anxiety disorders and postpartum PTSD?
  • How can the midwife foster honest communication and encourage clients to offer feedback, both in the immediate postpartum time and long-term?
  • What are the long-term effects for these women on bonding, intimate relationships, future childbearing, and self-perception?
  • How can midwives shift to a more inclusive view of "successful" birth? 

These topics will be presented in multi-media format, including photographs and PowerPoint presentation which includes excerpts of interviews with homebirth cesarean clients, partners, midwives (CPMs, CNMs and NDs), doulas, childbirth educators, mental health professionals, and obstetricians. The presentation will include time for open discussion.

4. From Midwife to Midwifery Preceptor - Easy Teaching Techniques that Work for Midwives - Jennifer West, LM, CPM,CST, CH,TBMP,IPE; Anna D. Khamsamran

An introductory course in the methods of instruction for midwifery training. Most midwives are very skilled in their profession, but receive almost no instruction in how to be a preceptor. As at least some portion of all midwifery training still takes place in an apprenticeship setting, it is important for midwives to have instructional skills to be able to confidently pass on the art of midwifery to the next generation. This course talks about what is necessary for learning to take place and breaks midwifery training into the areas of academic/didactic, skills, and clinical instruction, and gives the most important instructional tools for each type of training. The midwife who takes this course will come away with an understanding of what a course syllabus is, and how to use it, have tools and methods for instruction in a variety of situations to start using immediately, and confidence in her or his instructional ability. 

Join us so you can see how easy, effective, fun and almost automatic teaching future midwives can be.

5. Beyond White Bellies: Reflecting Families of Color in Birth Imagery - Carrie Murphy; Esperanza Dodge 

This session will present an analysis of the imagery of pregnancy and birth as seen in pregnancy manuals (books, pamphlets, etc) as well as birthing websites, both mainstream and those geared towards unmedicated birth. Participants will be able to identify why and how the majority depiction of white women is dangerous and problematic for pregnant people both emotionally and mentally, and come away with a greater awareness of systemic racial and socioeconomic inequities in maternity care today.

6. What a Little Data Can Do:How Midwives in Washington Are Using Data to Drive Change - Audrey Levine, LM, CPM; Bruce Ackerman, Data Collection Director for the MANA DOR; Valerie Sasson, LM, CPM; Emily Stephens, BA.

An exciting collaboration, years in the making, has borne fruit this year! The care given by members of Midwives Association of Washington State (MAWS) is now fully represented alongside hospital's outcomes in the state's public reports showing the outcomes of all birth care providers, through the Obstetric Clinical Outcomes Assessment Program (OB COAP). MAWS raised over $25,000 to make this possible and builds on years of successful alliance-building, including four years planning with the MANA DOR. We will describe this strategic work, and some of the benefits such as greater transparency for consumers and deepening collaboration with the WA Medicaid office (following the 2007 DOH Cost-Benefit Study).

1:30 - 2:30pm - Plenary: Umbilical Cord Stories - Navajo Perspective - Ursula Knoki-Wilson, CNM, MSN,MPH 

An exploration of Navajo cultural views and meanings of the umbilical cord, the importance of keeping the sacred in Navajo birth practices and the human experience of umbilical cord stories and connection to other cultures.

Breakout Sessions Group B (4:30pm - 6:00pm)

1. Human Placentophagy: Modern Values, Primal Needs - Sarah Hunter, CPM, CH, CQIA

The practice has seen many transformations from its first written appearance in the 16th century to the 2013 UNLV study, and women's reasons for consuming their placentas are as varied as the numerous processing methods. In this presentation I will situate the contemporary practice of placentophagy within its roots in the wisdom of Traditional Chinese Medicine and draw the line through to the modern raw food movement. Along the way I will address crucial questions such as: When is placentophagy inappropriate for your client? What are the risks involved? Are there known side-effects? Are there established benefits? By surveying a variety of practices and their associated scientific and philosophical bases I aim to demystify placentophagy for my fellow birth workers.

2. Pelvic Organ Prolapse and Urinary Incontinence: What Every Midwife Needs to Know - Christine Ann Kent, RN, BSN

From modern hospitals in New York City to substandard outreach clinics in rural Nepal, women are being treated with radical pelvic surgery for the common conditions of pelvic organ prolapse and urinary incontinence. These operations are based on an archaic and inaccurate model of female anatomy, setting women up for additional and often far more severe symptoms. 

The female pelvic organ support system develops over childhood as we move and breathe under the forces of gravity. This system moves intraabdominal pressure through the abdomen and pelvis in a very specific way. When the body is properly aligned, the pelvic organs are pinned into position directly behind the lower abdominal wall, instead of being forced backward toward the pelvic outlet. 

OBGYN cites childbirth as the primary cause of prolapse and incontinence in all ages. Yet, 12 years of observation of the 10,000 members on the Whole Woman forums has illustrated that these conditions do not immediately follow vaginal delivery. Rather, symptoms arise in the early weeks postpartum as mothers spend time reclining with their newborns. Older women develop prolapse and incontinence for similar reasons of poor alignment and misdirected intraabdominal pressure. Once women understand their true anatomy, efforts to re-establish natural dynamics through posture and exercise result in stabilizing and reversing their symptoms. 

Hysterectomy has been the standard of treatment of these conditions for over a century, permanently disabling the pelvic organ support system. Women worldwide must be taught how to prevent and reverse pelvic organ prolapse and urinary incontinence.

3. AME Presents: Forgotten Midwives:A Better Look at the History of Midwifery - Neve Gerke,LM, CPM, MSM; Eve German, LM, CPM, MSM

Most history written about United States midwifery focuses only on the political side of midwifery's demise and the medicalization of birth, making no acknowledgement or analysis of ways the issues of race, class, and privilege contributed to midwifery's mid-century disappearance from the U.S. healthcare system. Our research utilizes the specific lens of Native American, African American, and Japanese American midwives in Washington State to show through their stories and history how the loss of midwifery was not only the result of a choice to uphold the rising medical field and extinguish traditional healthcare systems, but was also the result of social and racial discrimination. We draw direct parallels to the effects of both medicalization and racism on midwifery nationally then and now, but more importantly to how these same events are directly connected to today's devastating health disparities. We feel strongly that this in-depth study of midwifery history brings clarity and insight into the events that created these disparities in the first place, and therefore instructs us as a profession in how we might work to resolve health inequities today. Identifying specific ways that racism shaped the midwifery of the past—and our current system—is deeply relevant to today's activism, bringing important clarity to the complex problems our profession faces today, empowering us to gain vital insight as midwives and leaders in our efforts to help midwifery fully thrive in our current healthcare system, and to overcome barriers to both midwifery education and midwifery care.

4. Toronto Birth Centre: An Indigenous and Midwife-Led Space - Cheryllee Bourgeois

The Toronto Birth Centre is a striking example of grass-roots visioning and a coming together of different communities to create a powerful Indigenous and Midwife-Led space for birth. Opened in January 2014, the TBC is an Independent Health Facility located downtown in a large Canadian city, funded by the provincial government but governed by midwives and the Indigenous community using an Indigenous framework. This presentation will explore the journey from community action to operationalization of this unique facility and explore the importance of Indigenous Governance of a facility open to every women in the care of midwives in Toronto, regardless of their racial or ethnic background. Finally, participants will be taken on a virtual tour of the finished space to experience the many layers of meaning that reflect both Indigenous values and midwifery ways of working.

5. Outcomes for Planned Home VBACs from the MANA Stats 2.0 Cohort: Implications for Practice and Shared Decision-Making - Kim J. Cox, PhD, CNM

This session will focus on the findings of a recent retrospective analysis of outcomes of planned home VBACs that utilized the MANA Stats 2.0 cohort, years 2004-2009. The research was recently published in Birth: Issues in Perinatal Care and was co-authored with Marit L. Bobvjerg, PhD; Melissa Cheyney, CPM, LDM, PhD; Lawrence M. Leeman, MD, MPH. Data from a subset of 1052 women with a prior cesarean who planned a TOLAC at home were analyzed using descriptive statistics, chi-square analysis, and exploratory subgroup analysis as appropriate. Maternal and neonatal outcomes, transfer characteristics, and midwife practice patterns from this subset were compared to a subsample of 12,092 multiparous women without a prior cesarean from the original cohort. VBAC success was high overall (87%), and even higher in women with a previous vaginal birth (90%) or a previous VBAC (96%). The intrapartum transfer rate was higher for the prior cesarean group (18% vs. 6.6%, p = < 0.001) than for the comparison group, and failure to progress was the most common indication for transfer. Women with a prior cesarean had higher proportions of blood loss and maternal postpartum infections, and their infants had higher rates of NICU admissions and hospitalization in the first week of life than the comparison group. There were 4 uterine ruptures and 5 neonatal deaths (4.73/1000). Women planning a home VBAC should be informed of the increased neonatal risk. There is potential to decrease morbidity and mortality in this group, however, by adopting a more stringent client selection criteria and adhering to a standard of care that includes prenatal ultrasound, frequent fetal monitoring, and a low threshold for intrapartum transfer. Implications for practice will be discussed.

6. Darling, We are Growing older: Silver Threads Among the Gold - Karen Ehrlich, CPM, LM

Having been a part of the renaissance of midwifery in the 1970s (we were all so young!), retirement was never part of our conversations. As we grow older, there are riches of age and experience that make us incredibly valuable. But midwifery is challenging on so many levels! There are pitfalls ahead as our abilities, focus, energy, and flexibility shift. Let's talk together about how we decide when we need to step down from the labors that we love so deeply. What are the signposts that give us messages that we don't necessarily want to hear? How many of us are still doing births because we have no other way of making a living, but don't have financial retirement planning to support us? Do we approach an elder midwife who doesn't want to acknowledge that she is no longer working at the top of her game and give her the benefit of our loving perspectives on her situation – and if so how exactly do we go about creating such an intervention? And how do we continue to be midwives if we are no longer midwifing?

6:15 - 7:15pm - Plenary: AME presents: Direct Assessment and What it Means to the CPM Credential- Justine Clegg, MS, LM, CPM, LMHC; Sandra Butoni Stewart, MEAC Executive Director; Ida Darragh, LM, CPM, NARM Chairperson; Mary Lawlor, CPM, NHCM, LM, MA.

This session will report on the work of the US MERA Direct Assessment Task Force to develop a competency-based educational model for individuals who want to become midwives to validate their academic knowledge and skills learned in non-traditional methods. 

There is a very serious shortage in the maternity care workforce projected by 2025 and training more midwives is one part of the solution. In order to advance the US MERA goals to promote innovation, flexibility and accessibility in midwifery education through multiple education pathways and to create a larger, more robust, diverse, high-quality maternity care workforce, the US MERA Direct Assessment Task Force was formed at the April 2014 meeting. This Task Force is comprised of CNMs and CPMs and others who are experts in US midwifery and midwifery education, and is charged with overseeing the work required to meet the following goal identified in April 2014 by US MERA: to support development and implementation of direct assessment midwifery education programs accredited by MEAC and/or ACME by 2020 to radically increase our ability to educate more midwives to meet increasing consumer demand. 

This session will explain the direct assessment educational model and how it will work to enable those who have learned midwifery through apprenticeship, self-study and other non-traditional education methods to validate through a user-friendly, affordable process, what they have learned, in order to graduate from an accredited midwifery program and become nationally certified to practice midwifery in the US. The implications for the CPM credential will be discussed by a member of the NARM Board of Directors.

Saturday, October 17 - Conference Day Two

8:15 - 8:45am - Know Your Rights- Indra Lucero - Director of the Birth Bar Association

This short presentation will provide midwives with a general overview of their legal rights and responsibilities. Midwives will also get handy tips on what to do in case of an investigation, inquiry, or other legal action. 

Breakout Sessions Group C (9:00am - 10:30am)

1. Thriving With Homeopathy During Pregnancy,Birth and Postpartum - Angelika Maria Koch, D.N.M. LCH H.N.H.Ir.

Thriving With Homeopathy for Pregnancy, Birth & Postpartum Period is an opportunity for  midwives, students and practitioners of integrated medicine to explore the principles and concepts of homeopathy and the application of useful homeopathic remedies for pregnancy, birth, and postpartum periods. This lecture includes assessment of the individual signature of each case, which constitutes the expecting mother and baby’s personality, as well as an introduction to the main homeopathic remedies indicated for pregnancy, birth & postpartum period. 

2. Now that Marijuana is Legal: Creating an Evidenced Based Conversation About Cannabis Use During the Perinatal Period - Heather Thompson, PhD

Cannabis is now legal for medicinal use in 20 states and recreational use in four states, so perinatal health care providers must learn to craft a conversation with their pregnant and breastfeeding clients about marijuana use. Unfortunately, this is not a simple scientific question; rather it requires a multifaceted examination of the perinatal environment to create an evaluation of risk. This session will provide tools to help midwives create an evidence-based conversation about perinatal cannabis use with their clients. 

This workshop will explore the pharmacokinetics of THC in humans and review the scientific literature on cannabis during the perinatal period. In addition, participants will examine some of the limitations to current and future research on marijuana in the U.S, including the role that race and poverty may play in the interpretation of available data. A cross-cultural comparison of perinatal cannabis use will allow for perspective on our own cultural biases, a concept that will be continued with a discussion on the current implementation of these regulations in Colorado (a state with both medicinal and recreational cannabis). 

The aim of this workshop is to help midwives create an environment of honest disclosure about cannabis use that will foster improved individual and realistic conversations about marijuana with their clients. The combination of scientific evidence, cross-cultural perspective and real social implications is designed to provide midwives and other perinatal providers tools to provide evidence-based care for those using cannabis while pregnant or breastfeeding.

3. Traditional Medicine: Curanderismo and Childbirth - Eliseo Torres, Rita Navarrete Perez, Tonita Gonzales

The University of New Mexico has seen a resurgence of Curanderismo and Traditional medicine. New Mexico is on the forefront in bridging a cultural understanding on healing and the blending of different modalities of healing including allopathic medicine. In addition, learning the rich history of New Mexico parteras, and the evolution of midwifery in New Mexico. In this class you will see demonstrations of traditional practices that are currently used in our communities today. Participants will learn the benefits, and positive healing outcomes in the blending of traditional medicine.

4. Birth Story Medicine - How to Excavate and Heal a Birth Story - Pam England, MA, CNM

Every human is a story-teller and a story-listener. Every midwife is a birth story listener, and she teaches through story, too. Everything is recorded and explained through story; humans are compelled to explain what happened, and why, through story. (Evidence based-research is a story, too.) And yet, no birth story is set in stone. Over time it undergoes an organic and somewhat predictable evolution (The Nine Stories will be outlined in this talk). . . and so does the meaning the story holds. 

That's why "excavating a birth story" to find scattered and shattered pieces, buried shards, of the story, leads to surprising and meaningful self-discovery that is an integral part of holistic childbirth preparation and the postpartum recovery. With a midwife's guidance, this process allows parents to follow their intuition to find where something important for them lies fallow. During this talk, midwives will learn key questions and a "map" that helps parents get to the heart and healing of a birth story—even in the course a midwife visit. 

This same process and "map" is useful to the midwife, too, as she listens deeply to her own stories, and the stories of other midwives.

5. US MERA: Update - Colleen Donovan-Batson, MS, CNM

Exploration of the history leading to the development of US MERA and discussion of the consensus documents agreed upon in previous proceedings including the latest 2015 agreements

6. Risk Management for Adverse Outcomes in the Home Birth Setting - David Pulley

Have a thorough discussion of all aspects of liability as it relates to midwives and their home birth practices. Background of liability, including the differences between criminal and civil liability will be discussed, as well as the basic legal theories of negligence. 

Best practices to minimize liability will also be touched upon, including care for the patient, support for the family, and communication about unanticipated adverse outcomes. Other topics examined will be documentation of the medical record, responsibilities as a business owner including additional liability exposures as a business owner, reviewing processes and action plans, and reporting of adverse events to appropriate parties. e-Discovery requirements will also be considered in detail to better understand the complexities of lawsuits. Finally, a discussion of transfer issues and collaboration with physicians will be topics to talk about.

11:30am - 12:30pm - KEYNOTE: "Shining a Light on Midwives and Peri-conception Care: As Upstream as Health Gets" - Aviva Romm, MD

1:30 - 2:30pm - Plenary: New Mexico Birth Justice Coalition: Improving Access to Home and Birth Center Options in NM - Esperanza Dodge, Tannia Esparza, Nandi Andrea M. Hill, Jessica Frechette-Gutfreund

The New Mexico Birth Justice Coalition will highlight examples of our work dedicated to creating & improving access to home & birth center options, addressing inequalities while aiming to improve maternal & infant/child health outcomes for low-income women/families & women/families of color in New Mexico. 

We will discuss NMBJC legislative and administrative policy strategies including insurance exchange reimbursement and birth center licensure while sharing strategies for successful policy change. We will speak on the importance of having affordable and accessible models of education for upcoming midwives, including keeping the apprenticeship pathway alive as an option for accreditation. We'll discuss how this model has a positive impact in communities of color accessing the licensed midwifery model of care as well as increasing the number of midwives of color. 

Increasing the number of women and people of color birth workers and licensed midwives plays a major role in ensuring communities of color have greater access to birth options. 

We will highlight midwifery practices that support working class communities and people of color. We will share findings from our qualitative and quantitative research centering the access working-class and families of color have to licensed midwifery models of care in New Mexico.

Breakout Sessions Group D (4:30pm - 6:00pm)

1. Bringing Cultural Diversity to Midwifery - Tamara Joy Littles, RN, BSN, SNM; Nandi Andrea M. Hill LM, CPM; Felina Ortiz, CNM, DNP; Michelle Pino, CNM, MSN; Nichele R. Salazar, CNM, MSN; Brittany K. Simplicio, CNM, MSN; Hien Tran, SNM, RN

We will examine health disparities and the growing field of epigenetics, or how racism affects the health of women and their children. The discussion will include the importance of increasing the number of midwives of color, in order to address these issues. The rich history of midwifery, including the Partera and Curandera in New Mexico will be examined as well as an overview of the pathways and challenges for culturally diverse students of midwifery. We will also identify the strengths and assets women of color bring to midwifery.

2. When You Gotta Go: Hospital Transfers: What's Best Practice and What's the Next Best Thing  - Audrey Levine,LM, CPM;Jill Breen,CPM; Diane Holzer;PA-C, LM Lawrence Leeman, MD

In a plenary session at MANA 2014, representatives from the Home Birth Summit Collaboration Workgroup presented the recently released document, Best Practice Guideline: Transfer from Planned Home Birth to Hospital, to the midwifery community. In this workshop, we will review the guideline, which includes model practices for midwives as well as hospital personnel. Then we'll offer some case presentations and engage workshop participants in a discussion about the practical application of the guideline, including how to handle challenging situations such as clients refusing to transport, conflicts with EMS personnel, and the transfer difficulties that arise for midwives practicing in states without licensure. 

In addition, we'll present examples of how the transfer guideline is being integrated into policy work in several different states.

3. Introduction to Well Woman Care - Hilary Schlinger, CNM, MS

 This session will include:

  • Pap smear interpretation and action, review of decision tree with abnormal pap results and discussion of revised pap guidelines. 
  • Preparation of a wet prep, interpretation of slide/differential diagnosis of vaginal infections (BV, yeast and trich). CDC recommended treatment vs. alternative treatment for these. 
  • Performing a gynecological exam, including review of speculum and bimanual exam, review of cervical finding on speculum examination review of the purpose of the exam (assessment of uterine placement, size, shape and mobility; assessment of ovarian size and shape), discussion of interpreting findings and review of procedure for performing exam. 
  • Contraceptive overview including hormonal options in birth control and non-hormonal options: efficacy, candidates for use, contraindications to use, risks vs. benefits. Use of birth control for non-contraceptive gynecological purposes and the selection of hormonal options will be discussed. 

4. Gestational Diabetes Screening: Missing the Point? - Sora Colvin, CPM

Michel Odent called gestational diabetes "a diagnosis in search of a disease." Testing and treatment were introduced without evidence of benefit, and there is still no worldwide standard for screening nor consensus about appropriate and effective treatment. As a result, some home birth midwives have not taken gestational diabetes seriously. However, blood sugar regulation issues are becoming endemic in the "obesogenic environment" of modern western countries and the risks of uncontrolled hyperglycemia to both mothers and babies are very real. This session will cover the etiology of gestational diabetes, the current state of the evidence, and current standards of care in different countries worldwide. The speaker will propose a system for diagnosing and managing blood sugar issues that is deeply grounded in the midwives model of care and which has been proven effective over years of clinical practice.

5. Circumcision Myths and Facts: What Every Midwife Needs to Know to Keep Baby Boys Healthy and Whole - Adrienne Carmack, MD

Urologist Adrienne Carmack shares her perspective on the appropriate use of medical technology for disorders of the foreskin, one based on actual health needs and not cultural norms or myths. She believes in the responsible use of modern medicine, with the principle of first, do no harm always remembered.

6. Outcomes among Higher-Risk Women Receiving Care from Home and Birth Center Midwives: Evidence from MANA Stats and AABC’s Perinatal Data Registry - Marit Bovbjerg, PhD, MS and Melissa Cheyney, PhD, CPM, LDM

Women who begin pregnancy overweight or obese (“high BMI”) typically have poorer outcomes than women who begin pregnancy within normal weight ranges. The same is true for women who are over age 35 (advanced maternal age, “AMA”). We know from our previous work that:(i) home and birth center midwives universally have prenatal care visits that are at least 45 minutes long; and (ii) these midwives correspondingly spend more prenatal care time on healthy lifestyle-related topics.
The objective of this research is to determine whether the extra prenatal care time devoted to healthy lifestyle counseling translates into better outcomes for higher-risk women (either high BMI, AMA, or both) receiving care from out-of-hospital midwives.
We combined data from MANA Stats 2.0 and the AABC’s Perinatal Data Registry (PDR), and created a frequency-matched cohort of hospital births using vital statistics data. Outcomes include: gestational weight gain, labor duration, gestational age, cesarean, birthweight, NICU admission, 5-minute Apgar, and severe lacerations. All analyses will control for primiparity and whether or not the mother’s birth was paid for by Medicaid.
We will present results comparing three groups: planned home births, planned birth center births, and hospital births.  Our hypothesis is that high BMI and AMA women receiving midwifery care in the out-of-hospital setting will have better outcomes than their hospital-birthing counterparts.
This will be the first analysis comparing large samples from the three potential birth places in the US. Results will inform the national discussion on appropriate care for higher-risk women.

Sunday, October 18 - Conference Day Three

8:00 - 9:00am Birth Bar Breakfast Q&A - Midwifery in the Law: Understanding Your Rights Through Two Case Studies

Attendees in this presentation will delve into the cases of two fictional midwives, one who is facing a criminal trial, and the other who is facing an administrative action against their license. Through the stories of these cases attendees will learn more about the law and how it may impact them. There will be time for extensive Q&A.

Breakout Sessions Group E (9:00am - 10:30am)

1. Supporting Plus Size Birth - Jen McLellan, CBE

60% of women in their childbearing years are classified as overweight or obese. Currently obese women face a nearly 50% c-section rate and that statistic increases to over 80% for those who are morbidly obese. If we want to lower the national c-section rate, we need to learn how to best support women of size. This includes addressing the increased risks of being obese and pregnant, emotional obstacles, as well as size discrimination by care providers. There are also physical differences between supporting an average size woman and a plus size woman. Following this presentation attendees will be able to identity increased risks and how to help their clients reduce their risks. They will walk away with new skills for supporting obese women physically and emotionally.

2. Worried Waters: Learning about Legionaires - Colleen Donovan-Batson,CNM, MS

Current concerns regarding risk of Legionaire illness after water birth: incidence, pending policy recommendations, case studies 

Overview of legionella bacteria: cause/transmission, water risk factors, water distribution systems, identifying client understanding of water safety 

Prevention: Simple household water fixes and water birth pool tips 

Signs & symptoms of neonatal infection

3. Lyme Disease 101: What Every Midwife Should Know about Tick-Borne Infections - Hilary Schlinger, CNM, MS

Lyme disease is the most common tick-borne disease in the Northern Hemisphere. If untreated, it can cause multisystem disorders. The bacterium which causes Lyme disease, Borrelia burgdorferi, is a spirochete; like syphilis, it has also been demonstrated to cross the placenta and cause congenital transmission. One current research physician has cultured Borrelia from the breastmilk of untreated women. With Lyme disease presenting as one of the fastest growing epidemics in the US, midwives need to integrate information on the recognition and treatment of both the acute and chronic forms into their maternity and women's health care practices. 

4. So BABY, Am I Hearing You Right? The Art and Science of Fetal Auscultation: More than a Pulse Check - Wreatha Carner, DNP, MN, CNM

Fetal auscultation is a challenge to learn because we all hear what we hear and is that really what someone else hears at the same time? Learn to distinctly define fetal heart rate baseline, baseline changes, and come to understand the impact of different situations that occur in labor can have on baseline fetal heart rate. Learn what variability is and what it means as you master techniques to teach your ears to hear variability. Know how to use standardized terms to explain what the baby is telling for your clients and colleagues. Know for a fact when that baby is doing absolutely fine and how to completely document this fact in your records. Learn several actions you can take to ease the way for a baby that is sending you messages that are not reassuring. Know when you do or do not need to move to a different level of care. Work for safe mother and safe baby every birth. Persons attending this session should bring the sort of timing device they normally carry to a birth and may want to also bring a stopwatch or second timing device with which to experiment.

5. Fostering the Future of Latina Midwifery Care - Vanessa Caldari, Melissa Cheyney, PhD, CPM, LDM

International midwifery is in the early phases of acknowledging and attempting to rectify its underlying "white savior complex", where midwives have historically used international midwifery practices and schools to meet their clinical requirement for their education, while often simultaneously (and inadvertently) undercutting local and traditional midwifery practices. As a labor of love and with an emphasis on maternal, infant, and family well-being, midwifery has the potential to de-colonize practice through the engagement of community-led research, collaborative midwifery practice and service-learning. Community-led collaboration requires that the local community determine their own needs for research, resources, and support and that the researchers function within the parameters of these locally-identified needs, bolstering the support system and providing assistance and access to resources as requested by the community. The importance of community-led collaboration may be widely acknowledged, yet the pragmatics of decolonizing midwifery on the ground and in practice is still largely uncharted territory. On this panel, we talk about our experiences of wading through the "how to's" of a community-led collaboration between Puerto Rican parteras and activists, birth professionals and academics at Oregon State University (OSU), and the Midwives Alliance Division of Research. We share lessons learned in this evolving collaboration as we work to improve maternal and infant health within a middle-income, colonized nation. 

Within the Puerto Rican community-led collaboration that our panel will be sharing, there are three, key, community-led projects: 1). the MANA Stats Puerto Rico project, 2). the OSU community health field school for OSU students in San Juan, Puerto Rico, and 3). the development of the first Puerto Rican midwifery school and birthing center. In addition to these projects, there will also be a presentation addressing how this collaboration has been shaped by and is contributing to our understanding of how to engage ethical and equitable models of international midwifery collaboration in Latin America. The panel will begin with four brief presentations that describe the relevance of each of these projects and models as determined by the parteras and other community partners. Collectively, we believe that these projects have the potential to bolster the position of midwifery in Puerto Rico which is currently unregulated, and to provide sustainable solutions to the poor obstetric outcomes the island is currently experiencing which include high rates of preterm birth, low birth weight, and a 49% primary cesarean section rate. Questions and future directions will be discussed following the overviews provided by the panelists with a focus on: 1) benefits and challenges of working within a community-led research and service-learning framework; and 2) future directions for each of these projects as viewed through the lens of our commitment to de-colonize international midwifery as we collaborate to create sustainable, midwife-led solutions within the overburdened and underfunded health infrastructure of a current US commonwealth (read colony).

6. Hands on Workshop: Managing Obstetrical Emergencies (PPH,shoulder dystocia and unexpected breech) - Laura Migliaccio,CNM, MSN; Ruth Kaufman,RN, CPM; Larry Leeman, MD; Rebecca Leeman, CNM

Advanced Life Support in Obstetrics (ALSO) is an evidence-based multidisciplinary training program that prepares maternity providers to better manage obstetric emergencies. ALSO courses have been offered in 62 countries and promote safety by teaching standardized approaches to emergency situation through for hands-on practice. The instructors for this course are experienced ALSO instructors. 

This workshop will use components of the ALSO program with a team-based approach, hands-on training, and mnemonics. Specifically we will review strategies to manage unexpected emergencies and then have smaller groups work with mannequins to practice identification, communication and response/maneuvers for managing shoulder dystocia, post-partum hemorrhage and unexpected breech. We will discuss communication in emergencies, information for families, and transition to the transportation or hospital team if required. Lastly we will review approaches to set-up emergency drills.

11:30am - 12:30pm - Plenary: A Bun in the Oven - Barbara Katz Rothman, PhD

This presentation will be an introduction to my new book with the working title A BUN IN THE OVEN (NYU Press, forthcoming.) Throughout the world, we are concerned about losing traditional midwifery and its skills. Midwifery is not valued as we would have it be. How does a country, a culture, come to value some of its traditions while discarding others? In the world of food there is an active and successful movement to increase respect for traditional or 'artisanal' workers. 

Both the midwifery movement and the food movement have a value system that disdains 'mass production' and 'industrial-style'. But both groups are concerned with being 'elitist,' available only to a few wealthy or very knowledgeable people. In both movements there are concerns about 'deskilling' and also about 'cooption,' as hospitals offer attractive 'home like' environments for select clients, and mass produced food packages itself as 'home made goodness.' Both groups sustain a vision of the 'natural,' while developing the extraordinary skills required to work with the natural. 

The food makers have been convincing to government, to media and to consumers, arguing that their work is a valued part of a nation's cultural heritage. In food, the value of the Japanese Shoku-nin, the Italian olive oil maker, the American baker, and other cultural food workers is increasingly being recognized. Midwives have skills of the hands, the kinds of craft skills that are increasingly being valued in our overly industrialized world. Artisanal workers are leading the food movement, from elite food down to school lunch programs, and, I suggest, offering a fine role model for midwives to follow.

1:45 - 2:45pm - Plenary: Medicaid Payment For Homebirth: A Closer Look at the New Mexico Birthing Options Program - Cassaundra Jah, LM, CPM, IBCLC

In 2009, the percentage of home births was three to five times higher for non-Hispanic white women than for any other racial or ethnic group, this growing gap in midwifery care could be shrunk if each state mandated payment of out-of-hospital births for Medicaid participates which are 58% non-white nationwide. 

This workshop will cover a brief history of the New Mexico Birthing Options Program; how out-of-hospital midwives (DEM/LM and CNM) get paid through Medicaid in New Mexico. The Birthing Options Program found its roots in the state's long tradition of homebirth, and came into existence with a little assistance from the Governor, a malpractice release, and a protected list of procedural codes. Medicaid payment for homebirth is a wonderful opportunity for the state, the midwife and her clients. 

A discussion about the realities of the program; money (state savings and midwifery billing), logistics, what works and what is challenging.

2:45 - 3:45pm - Plenary: Change Makers Unite: How to Build Lasting, Effective Partnerships Between Midwives and Consumers -Jeanette McCulloch, IBCLC & Nasima Pfaffl, MA

Most successful efforts to pass legislation or create change to increase access to midwifery has happened as the result of efforts by consumers and midwives. How do we maximize the efforts of both groups as we move midwifery forward and fend off attacks on practice? What helps make coalitions work? What makes partnerships between consumers and midwives fraught with problems? State midwifery and consumer groups were surveyed for feedback on models and examples of successful and problematic interactions. These responses captured both what made coalitions and efforts successful and what created conflict and ineffective change. Participants will leave this session with a roadmap of strategies to build effective coalitions between midwives and consumers and the roadblocks and barriers to be avoided.