Black Midwives: A Labor of Love and Change

Black Midwives: A Labor of Love and Change

A midwife–especially a Black midwife–can tilt the balance between life and death for African American infants and their mothers. Regardless of income and education level, childbirth for Black women is more dangerous than it is for White women. Even Serena Williams had a dangerous close call during her pregnancy, after doctors failed to heed her request for a CT scan and blood thinner medicine. Despite her history of blot clots, it was posited that “Williams’ pain medication must be making her confused.”

The Centers for Disease Control reports that African American mothers die at three to four times the rate of White women, and the mortality rate of Black infants is higher than that of any other ethnic group in the US. Why? As AmericanProgress.org states in a 2019 policy blueprint, “Racism is part and parcel of being black in the United States, and it compromises the health of African American women and their infants… Put simply, structural racism compromises health.” According to Dr David Williams, a pioneer in measuring the effects of racism on health, “We now know that discrimination is linked to higher blood pressure, to high levels of inflammation, to low infant birth weight…”

Enter the Midwife

One action that promises to change these dire statistics is expansion of the midwifery movement, especially within the African American community. Angela Doyinsola Aina, interim director of the Black Mamas Matter Alliance (BMMA) recently told an American Public Health Association (APHA) conference, “We have to go beyond just talking about giving people, especially low-income people, access to care…. We also need to ask whether that care is high quality and culturally relevant.”

Where do Black midwives come into the picture? ProPublica notes in a report on how increasing the role of midwifery in the US could reduce maternal complications and mother/infant mortality rates, “Many… [US] states characterized by poor health outcomes and hostility to midwives also have large black populations, raising the possibility that greater use of midwives could reduce racial disparities in maternity care.” And Lamaze.org suggests, “When Black families are cared for by Black health professionals, like midwives, they are better heard, seen, respected, understood, and get their needs met, which relates directly to health outcomes.”

One of the women at the forefront of the Black Midwives movement is Jennie Joseph, founder of the Birth Place in Winter Garden, FL. Joseph’s work as a provider of perinatal services to underserved and uninsured women of color has already brought about positive change in the CDC numbers. Trained in the UK, where half of all babies are delivered by midwives, Jennie Joseph arrived in the US to find that in the most affluent country in the world, owing to concerted opposition from doctors and hospitals, midwives attend only 10% of all births. She also found that the US has a much higher incidence of maternal and infant mortality rates—particularly among minorities and the disenfranchised—than in countries such as Canada, Sweden, and the UK, where midwives attend the majority of births.

Joseph’s “open access” clinic at the Birth Place provides pre-natal and post-partum care for women regardless of their ability to pay and focuses on minority and underserved women in the area. As Miriam Zoila Perez marveled in the New York Times, the Birth Place manages to beat the dire maternity figures for women of color: “When you look into her statistics, you find something quite rare: Almost all of her patients give birth to healthy, full-term babies… maybe not surprising until you learn that the majority of them are low-income African-Americans, Haitians and Latinas….”

Expanding the Midwives’ Movement

Another pioneering Black midwife is Shafia Monroe, who has long been one of the major forces behind the Black midwives’ movement. Founder of the International Center for Traditional Childbearing (which was re-formed in 2018 as the National Association to Advance Black Birth) and winner of a Lifetime Achievement Award from the Human Rights in Childbirth Foundation, Monroe started working with mothers and infants as a nurse’s aide in the postpartum ward at Boston City Hospital at the age of 17. It was in 1991, when she encountered difficulties in finding a midwife of color for her own pregnancy, that Monroe founded her influential International Center for Traditional Childbearing. Under the auspices of the ICTC, she became a pioneering figure in the cause of Black midwifery. Monroe has worked tirelessly to reduce mortalities linked to pregnancy and to increase the number of Black midwives and doulas. To women who are interested in becoming midwives, Moore urges, “Join an organization! There’s MANA (Midwives Alliance of North America), ICTC, ACNM (American College of Nurse Midwives); there’s so many organizations. Look into organizations that are familiar with black reproductive issues, and our history.”

As the co-director of Black Mamas Matter Alliance (BMMA), Elizabeth Dawes Gay, says, “If even one more person just says they want to take up the cause, they want to become a doula, they want to become a midwife, they want to start an organization—to me that’s a success.”

AAMN Announces 2019 Best Schools for Men in Nursing Awards

AAMN Announces 2019 Best Schools for Men in Nursing Awards

Duke, Rutgers, University of Alabama-Birmingham, and nine other colleges and universities have been recognized as the “2019 Best Schools for Men in Nursing” by the American Association for Men in Nursing (AAMN).

Winning institutions are selected based on the significant efforts they have made to increase the number of male applicants, enrollees, admissions, and/or retentions in their programs, and have been shown to provide a supportive educational environment for male student nurses. All schools applying for the award are accredited by the National League of Nursing or the Commission on Collegiate Nursing Education and have had a minimum NCLEX pass rate of 80% over the past three years.

2019 Best Schools for Men in Nursing

In alphabetical order, the winners are:

  • Duke University School of Nursing
  • John Hopkins University School of Nursing
  • Lewis University College of Nursing and Health Sciences
  • Nebraska Methodist College of Nursing
  • Northern Illinois University School of Nursing
  • NYU Rory Meyers College of Nursing
  • Rutgers School of Nursing
  • University of Alabama-Birmingham School of Nursing
  • University of Cincinnati College of Nursing
  • University of Wisconsin-Oshkosh College of Nursing
    Vanderbilt University School of Nursing
  • West Coast University College of Nursing

2019 Best Workplaces for Men in Nursing:

  • New York Presbyterian Hospital
  • Vanderbilt University Medical Center

For a full list of 2019 AAMN awards, visit the AAMN awards page.

Improving Kids’ Hand Hygiene Skills: A Global Campaign

Improving Kids’ Hand Hygiene Skills: A Global Campaign

Healthcare providers all over the globe are fighting the good fight, working to inculcate healthy hand hygiene habits among youngsters.

In Ottawa, Canada, schoolchildren aged 6 through 9 are following the World Health Organization’s (WHO) six-step hand-washing routine while singing kid-approved lyrics to the tune of “Frere Jacques”:

“Scrub your palms, between the fingers

Wash the back (one hand), wash the back (other hand)

Twirl the tips (one hand) around (other hand)

Scrub them upside down

Thumb attack (one thumb)! Thumb attack (other thumb)!”

To test the effectiveness of the didactic sing-and-wash routine, researchers applied fluorescent marks to the kids’ hands prior to hand-washing and checked for the reduction of the markings afterwards.

In southern India, researchers from the University of Glasgow in Scotland and Amrita Vishwa Vidyapeetham University have been conducting their own experiments in improving kids’ hand hygiene. At a government primary school in Kerala, 45 Indian students ages 5-10 were trained in hand-washing skills while guided by an anthropomorphic hand-shaped attendant named Pepe.

Mounted on a wall beside the school’s hand-washing stations, Pepe consists of a basic robotic arm assembly with a plastic hand and a videotronic “mouth” through which he “speaks” to students as they wash. As kids clean their hands, Pepe refers them to an illustrated poster depicting an eight-step hygienic hand-washing routine, and “follows” their progress with his moveable eyes. Pepe has taught students to wash their hands before meals and after using the toilet, and overall has improved their hand-washing skills by 40%, according to the researchers.

In addition to the marked improvement in the children’s hand hygiene habits, Pepe was a hit. Over 90% of the students said they would like to see Pepe again after their summer holiday, and “over seven in 10 of them thought Pepe was alive, largely due to its ability to talk.”

Other projects focus on the spreading of germs to emphasize the importance of proper hand hygiene. During a height-of-flu season lesson at Angie Grant Elementary in Benton, Arkansas, a school nurse, Ronda Wagner, collaborated with second-grade school teacher Anna Lawrence to depict the ease with which germs can be transferred. They coated a soft football with a special powder, which students then tossed among themselves in the room. Afterwards, viewing themselves under ultraviolet light, the kids could see that the powder had spread—not only to their hands—but also to their faces and arms.

The Centers for Disease Control (CDC) presents compelling reasons to encourage training in hand hygiene at an early age. According to the CDC, hand-washing education can:

  • Reduce the number of people who get sick with diarrhea by 23-40%
  • Reduce diarrheal illness in people with weakened immune systems by 58%
  • Reduce respiratory illnesses, like colds, in the general population by 16-21%
  • Reduce absenteeism due to gastrointestinal illness in schoolchildren by 29-57%

And if plain statistics on hand hygiene are too dry for youngsters with dirty hands, you can always refer them to the revolting findings of the (figuratively) viral “Bread” science project of behavioral Specialist Jaralee Annice Metcalf in Idaho.

In the Midst of an OUD Crisis, Are Health Practitioners Biased Against Addicted Patients?

In the Midst of an OUD Crisis, Are Health Practitioners Biased Against Addicted Patients?

It is well-known that people with Substance Use Disorder (SUD) and Opioid Use Disorder (OUD) face a heavy stigma in society at large. For instance, in Victoria, BC, while exceptional caregivers such as Corey Ranger, the roving Narcan-toting nurse are saving addicts’ lives, hostile bystanders often offer disdainful suggestions such as “Oh, why bother? Just let them die!”

Indeed, it is not uncommon for the general public to regard SUD and OUD as examples of societal weakness and personal failure, rather than viewing the condition as a medical condition that is frequently combined with other chronic disorders. In many cases, those suffering from addiction are also subjected to negative attitudes from nurses, doctors, and other healthcare practitioners. As a nurse in one study says of SUD patients, “[they create] a cycle of problems,” where “the staff perceives them to be annoying or obnoxious…” Another nurse in the same study notes, “staff attitudes are obvious, you can’t really hide them that well.” It is acknowledged that “Stigmatizing attitudes among health professionals have been shown to be widespread, which has detrimental consequences for connecting persons with OUD to treatment.”

Nurses, Doctors and SUD; Nurses and Doctors with SUD

There is an irony when healthcare practitioners display this attitude toward patients with SUD and OUD. According to the American Journal of Psychiatry and the National Council of State Boards of Nursing [NCSBN] publication “Substance Use Disorder in Nursing,” the prevalence of substance use disorders among doctors and nurses is similar to that of the general population—and is higher than the general public in the case of prescription drugs.

However, doctors’ tendency to protect colleagues with SUD, and the policy of the NCSBN that promotes a nonjudgmental, stigma-free approach to treatment of nurses with SUD (approximately 70% of nurses who seek treatment successfully return to practice) coexists with strong evidence that a substantial number of doctors and nurses have a negative attitude toward addicted patients. The consequences are as grave as they are incongruous; as a study in Canadian Nurse.com remarked, “perceived discrimination on the part of health-care staff was a major barrier to [patients’] seeking medical help, both for their substance abuse and for treatment of general and chronic conditions.”

Doctors and OUD: A Static System

“Fresh out of medical school, you can prescribe for pain relief any of the opioid medications that can lead to addiction, but you have to get a special waiver to treat addiction, a disease process. That just doesn’t make sense…”

–Dr. Sandeep Kapoor, director of the Screening, Brief Intervention and Referral to Treatment (SBIRT) program at Northwell Health

The situation of doctors is particularly unfortunate with regard to patients with OUD. The reaction of one doctor, when asked about the sparse availability of buprenorphine treatment, was a flat comment that “Most doctors don’t want to treat OUD or SUD patients.” A Statnews editorial on this topic concludes that a pervasive problem is that a) many doctors do not see addiction “as a brain disorder requiring treatment, but as a personal failing,” and b) “some physicians believe that medication-assisted therapy is little more than switching one addiction for another.”+

Even among those doctors who are willing to treat OUD patients, the problem is compounded by the fact that even now—in the midst of an opiate crisis—treating addicted patients with medications such as buprenorphine is highly regulated, requiring strict state and federal registration. To be permitted to prescribe, regulations require that doctors take eight hours of training (for NPs and PAs the requirement is 24 hours of training), after which they are required to register for a DEA waiver.

A further deterrent to the propagation of buprenorphine treatment is the inspection of office records by DEA agents (see within link, “What to Expect When the DEA Comes to Your Office”). An independent-minded physician—who may already be unenthusiastic about treating “addicts”—is unlikely to readily tolerate this sort of heavy-handed government interference in his or her practice. As it is, at present, despite the generally acknowledged opiate crisis, fewer than 7% of US physicians currently have DEA waivers for the prescription of one of the safest and most effective methods of treatment for opiate addiction.

Ties that Bind

This means that while the opiate crisis is raging, the hands of the practitioners who ought to be on the front lines of the fight are bound—both self-bound and bound by regulations. Doctors Kevin Fiscella and Sarah Wakeman ask in another StatNews editorial, “Would deregulation work?” They go on to note that “after France instituted this approach in 1995, deaths from opioid overdoses dropped nearly 80 percent.” Until attitudes among caregivers become more advanced, and until a proper deregulation movement for the prescription of buprenorphine gains national attention, attempts to stem the crisis are little more than a grand display of running in place.

Three DailyNurse Readers Win Soothing Scents Giveway

Three DailyNurse Readers Win Soothing Scents Giveway

The nurse-founded company Soothing Scents had a free giveaway contest for DailyNurse readers earlier this month, and three lucky entrants won special kits containing a sampler of Soothing Scents products:

  • Lauren Hancock
  • Allison Harting
  • Lisa Hoffmann

Soothing Scents creates evidence-based, drug-free nursing interventions to manage patient nausea and anxiety. Delivered via on-the-go inhalers, Soothing Scents products such as QueaseEASE (which manages nausea experienced during and after surgery) are used in over 2,000 hospitals across the US.

For more details on Soothing Scents products, visit https://soothing-scents.com/.

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