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Breastfeeding: Answers to Frequently Asked Questions

Breastfeeding: Answers to Frequently Asked Questions

August is National Breastfeeding Month, and Daily Nurse sat down with Dr. Susan Crowe, an obstetrician/gynecologist and clinical professor of Obstetrics & Gynecology – Maternal Fetal Medicine at Stanford Medicine Children’s Health to answer some of the frequently asked questions about supporting moms on their breastfeeding journey.

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Dr. Susan Crowe is an obstetrician/gynecologist and clinical professor of Obstetrics & Gynecology – Maternal Fetal Medicine at Stanford Medicine Children’s Health

How can nurses make breastfeeding/chestfeeding a safer practice?

Nurses are critically important to the safety of the delivery process and postpartum care. They play a pivotal role in assisting with skin-to-skin contact during a cesarean section delivery when the mother is unable to care for her baby. They can also help with skin-to-skin during hospital recovery. In addition, the World Health Organization recommends initiation of lactation one hour after giving birth. Nurses help facilitate this process to ensure it goes smoothly for the mother and child. Nurses can closely monitor vitals and help the newborn breastfeed for the first time, giving families the best start to life during critical hours post-birth.

How do weight loss drugs impact pregnant women and their babies?

Although dietary supplements can help support good health, they may also cause side effects and health problems, which is why the U.S. Food and Drug Administration recommends talking to your healthcare provider about what kind of prenatal vitamins and other supplements you should take.

Depending if the pregnant person needs to be on a weight gain program during pregnancy, it is usually okay for mothers to lose about 1-2 pounds per week postpartum. It’s important to note that this will happen naturally during the weeks after delivery. Even though lactation requires two-to-three times the caloric needs of a pregnancy, many women will find themselves hungry during lactation. If they choose to undergo medical treatment, it is always encouraged to follow the instructions and guidance from their healthcare provider. They can determine what is appropriate based on individual medical history and health condition.

Regarding weight loss drugs like Ozempic or Wegovy, there have not been enough research studies to determine their effectiveness or safety during lactation. As healthcare providers, we think about medication that would have to be absorbed by the newborn to have an impact.

What are the benefits of breastfeeding/ vs. formula feeding? 

There are numerous benefits of breastfeeding/chestfeeding for both the infant or toddler and the mother. Babies often see decreased ear infections, lower respiratory infections, and even reduced hospitalization rates. Throughout the years, healthcare providers have seen positive correlations between nutrients in breast milk and a child’s brain development.

There are also health benefits to the lactating individual. For example, for patients with diabetes, I educate them about the limited opportunity that lactation offers as a “vaccine of sorts” against diabetes. It can lower the risk of diabetes when lactation continues to six months and even further reduces the lifetime risk when lactation is extended beyond a year. Lactation also brings about a long-term metabolic effect. Research shows a correlation between lactation and a decrease in breast and ovarian cancers – and the longer the lactation period, the greater the associated benefits. Emerging evidence also shows the potential cardiovascular benefits of lactating.

What diseases can spread through breast milk?

Some infants have rare metabolic diseases, meaning they cannot metabolize human milk (i.e., galactosemia). In these cases, newborns and infants require a special formula. Concerning these diseases, it’s important to screen every newborn for galactosemia (galactose in the blood) and other inherited metabolic diseases, which are, fortunately, very rare.

Pending a conversation with your health care provider, it is generally encouraged for people with infections such as hepatitis B and C to continue breastfeeding. There are excellent vaccines for these diseases, and we do not see an increase in hepatitis C for lactating infants compared with infants that do not lactate. Fortunately, we do not see these as widely transmitted through human milk. However, there are several diseases where recommendations may differ by country or region, and this is an evolving conversation as it relates to people living with HIV who have undetectable viral loads.

Do you have any advice for lactation consultants or clinicians?

My advice to advanced practice providers, nurse practitioners, and midwives is that we continue to talk about lactation. We must discuss it before pregnancy, during pregnancy, during a breast exam, and more. We must look to see if there are particular challenges someone might encounter, and we should prepare to address those challenges accordingly. Those conversations should address why we recommend breastfeeding, including many of the health benefits already discussed. Most importantly, we can use those discussions to reassure mothers and give them the confidence that they can successfully take on the breastfeeding journey. When I ask people if they plan to breastfeed, the most common answer I get is, “I’ll try.” There remains an underlying lack of confidence in the body’s ability to make enough milk, so anything we can do to educate, encourage and support the lactation journey goes a long way.

Why is keeping mothers breastfeeding so important?

I see it from my vantage point and the countless conversations I’ve had with expecting and new mothers that people want to breastfeed. We continue to see high initiation rates. Breastfeeding is a healthy way for pregnancy to transition to the postpartum phase. People are choosing to lactate. The entire healthcare community must ensure that we provide the societal and medical structure to support individuals in this choice.

How can nurses best support moms on their breastfeeding journey?

Nurses help patients postpartum for a much shorter time than they did in the past. Now, nurses are only with individuals 24-48 hours after birth, slightly longer after a cesarean or a delivery with complications. During this time, nurses must take the opportunity to instill confidence and educate mothers on the basics of lactation (and dispel any myths or misconceptions, which is a large part of the task at hand). For example, people come in thinking lactation only happens every three hours. That’s not true. It can be much more frequent. During these times, nurses can help with initial latches when the baby is learning to feed, help families notice the signs their infant is hungry, and show how important frequent lactation is to milk supply.

Additionally, nurses can teach patients about normal lactation volumes and what determines adequate feeding. Initially, normal feeding volumes might be close to a teaspoon, shocking many people. So, setting these expectations is vital.

Anything else to add?

I encourage everyone involved in birthing and postpartum to remember that each individual’s pregnancy journey is unique. Getting “back to normal” after giving birth looks different for everyone, and that doesn’t mean striving for unrealistic weight loss goals one might see on social media, for example. And I am grateful for all the work nurses do to bring attention to lactation and the positive health benefits it can provide both the parent and child.

Midwives Provide Better Birth Experiences Marked by Respect, Autonomy

Midwives Provide Better Birth Experiences Marked by Respect, Autonomy

According to a new study , people giving birth report more positive experiences when cared for by midwives in both hospitals and community settings than physicians. Additionally, those receiving midwifery care at home or birth centers reported better experiences than those in hospital settings.

Physicians attend the majority of U.S. births (88%), while midwives attend 12% of births. Most births occur in the hospital, with less than 2% occurring in community settings, including homes and freestanding birth centers. Midwives attend most community births.

Measures of quality around maternity care often focus on clinical markers such as complications or rates of C-sections, leaving the lived experience of childbearing people unmeasured and neglected.

“In contrast to the standard obstetrical model, midwifery care is rooted in a philosophy that honors pregnancy and birth as a physiological, social and cultural process, not solely a clinical event,” write the authors, including lead author Mimi Niles, PhD, MPH, CNM, assistant professor at NYU Rory Meyers College of Nursing. “The care relationship between the client and the midwife serves as the primary vehicle through which values such as autonomy, respect, and informed decision-making are operationalized to preserve an overall satisfying experience of childbearing.”

To better understand people’s experiences during childbirth, the researchers examined 1,771 responses to the national Giving Voice to Mothers survey assessing four domains of the childbirth experience: communication and decision-making autonomy, respect, mistreatment, and time spent during visits. The researchers then analyzed differences between provider type and birth settings, breaking responses down into those cared for by a midwife at a community birth, a midwife at a hospital birth, and a physician at a hospital birth.

Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy and were five times more likely to report that their providers showed them high levels of respect. They also reported lower odds of mistreatment.

The researchers also found significant differences across birth settings: patients cared for by midwives at home or birth centers had significantly better experiences than those in the hospital settings across all four measures—autonomy, respect, mistreatment, and time spent. For instance, people cared for by midwives in the community were 14 times more likely to report having enough time in prenatal visits than those cared for by physicians, while people receiving midwifery care in hospital settings were nearly twice as likely to report having enough time during prenatal visits. Their findings generate more evidence that while the midwifery care model offers enhanced experiences of care, access to midwifery across all settings is needed to improve health outcomes for birthing people.

“Our findings add to evidence showing the model itself seems to be strongly influenced by the setting in which care is given—with community settings (home and freestanding birth centers) offering greater likelihood of support and the hospital settings being limited by the constraints of a medical approach to care which deprioritizes experiential outcomes,” Niles and her co-authors write.

Improving Care and Access to Nurses (ICAN) Act: Legislators Want to Hear from Nurses 

Improving Care and Access to Nurses (ICAN) Act: Legislators Want to Hear from Nurses 

American Association of Nurse Practitioners (AANP ) and more than 235 organizations sent a letter to the leaders of the U.S. House of Representatives Committee on Ways and Means and the Committee on Energy and Commerce illustrating strong support for H.R. 2713, the Improving Care and Access to Nurses (ICAN) Act.

This bipartisan legislation, which was introduced in April in the House of Representatives, would authorize nurse practitioners (NPs) to order cardiac and pulmonary rehabilitation, certify when patients with diabetes need therapeutic shoes, ensure NPs’ patients are represented in the beneficiary attribution process for the Medicare Shared Savings Program, refer patients for medical nutrition therapy, certify and recertify a patient’s terminal illness for hospice eligibility, perform all mandatory examinations in skilled nursing facilities and more.

NPs provide high-quality healthcare to Medicare and Medicaid patients across all geographic areas and healthcare settings. Over 40% of Medicare beneficiaries receive care from NPs, the fastest-growing Medicare provider group. Yet, despite the high-quality healthcare NPs provide to Medicare and Medicaid beneficiaries, barriers still exist within the programs that prevent the effective and efficient delivery of care.

Daily Nurse spoke with former AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, and FAAN, about this critical legislation and how it will remove outdated barriers to practice that delay access to care for patients and move healthcare delivery forward for patients, providers, and our nation.

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Former AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, and FAAN

Talk about the Improving Care and Access to Nurses (ICAN) Act, how it strengthens patients’ access to care, and why it’s so important.

The ICAN Act is improving care and access to nursing. It’s focused on Medicare and Medicaid beneficiaries and removing barriers so that they can have timely needed care. And there are just a few things I can mention that are in the act. Nurse practitioners and advanced practice registered nurses providing access to APRN care can order and supervise cardiac and pulmonary rehab to certify when patients need therapeutic shoes and include their patients in the Medicare Shared Savings Program. There are no costs, no delays, and immediate things that can be put into place where Medicare and Medicaid beneficiaries can immediately have that much-needed care. So we’re very excited about reopening of the ICAN Act. We feel it will reduce barriers to care for Medicaid and Medicare beneficiaries, giving them full indirect access to NP care.

Please talk about APRNs, who they are, why they’re essential to nursing, and their role in healthcare.

APRNs are healthcare providers. Advanced practice nurses include nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives, and all play a pivotal role in the future of healthcare. They’ve been educated and clinically trained to care for patients in a particular field of practice. They can diagnose and treat and order and interpret tests. They’re great at coordinating care and educating. They provide a comprehensive but focused health promotion and chronic disease management approach. And you know, most of the people I’ve talked to either know an NP, or they see an NP and know precisely the type of high-quality care we provide.

APRNs are stepping up, and we’re meeting these huge needs that we see in healthcare today. According to the U.S. News and World Report, for the second year in a row are the number one job in healthcare. So people want to see nurse practitioners. There are over a billion visits to nurse practitioners every year 42% of Medicare Medicaid beneficiaries are seen by nurse practitioners. That’s why this piece of legislation is so important. It removes those outdated and unnecessary barriers to providing the care we’ve been providing so well.

Let’s talk about the history leading to the ICAN Act. In 2010, The Institute of Medicine (IOM) issued The Future of Nursing: Leading Change, Advancing Health and in 2021 The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.

The Future of Nursing Report in 2021 is the Future of Nursing 2020-2030. It focuses on health equity, understanding social determinants of health, and nine key recommendations. Recommendation four is to remove unnecessary barriers to practice that all nurses should be able to practice to the full extent of their education and training. And that is just absolutely to provide access to care for everyone everywhere. Over 100 million Americans lack access to primary care, and nurses are catalysts for this care. So the Future of Nursing Report is very important and comes on the heels of that foundation. We must allow nurse practitioners to practice to the full extent of what they’ve been educated and trained to do. And this will enable more and more Americans to have access to care.

Despite recognizing the importance of APRNs to our healthcare workforce, some federal statutes and regulations and state practice acts limit APRN practice. How is this thinking detrimental to patient care?

We have over 100 million Americans that lack access to care. We have 163 million Americans that lack access to mental health services. It is very much a need that we’re all focused on as nurse practitioners. We’ve evolved over the last six decades. We provide very high-quality, safe care. We’re educated and have nationally accredited education, training, and standards of care. And so we need all of our states to update their laws. We have a workforce today that includes nurse practitioners. We have healthcare changes to absolutely demand nurse practitioners to be out there providing care. And so we need our states to update their laws so that we have the licensure authority to practice to the full extent of our education and training. Twenty-seven states and D.C. are full practice authority states. In those states, we’ve seen an improved workforce, increased access to care, and more nurse practitioners working in historically underserved areas.

How can we reach those states that have yet to allow full practice authority? What can nursing do to get things in motion?

We must get in front of the lawmakers, educate them, and provide evidence of our patient care outcomes. We have decades of evidence out there that show that we provide high-quality, very safe care. We get that information in front of the lawmakers and give examples of what’s happened to other states that have moved to full practice authority. So I’ll give you an example. Arizona moved to full practice authority in 2001. Five years later, they saw their workforce doubled. And they saw a 70% increase in nurse practitioners working in historically underserved areas. We see this in every state that moves to full practice authority. No state has gone back. They’ve only gone forward. The states associated with the best healthcare outcomes are full practice authority states. Those states at the low end of the list are restricted with outdated laws. If they can update those laws, it would be a no cost. As I said earlier, there is no cost, no delay solution to increasing access to care for the people in their state.

How can nurses and others support this legislation and have their voices heard?

We need to speak up. We need to advocate. We need to speak with our legislators. We need to send letters and emails. We need to contact our lawmakers as constituents in their area. They need to hear from us as nurses. From a professional association standpoint, many nurses are part of a professional association. The American Association of Nurse Practitioners is the largest NP association representing all specialties of nurse practitioners. And we have an excellent state and federal advocacy team that keep all of our members updated on what’s happening. And they keep us updated on the bill number so that we can immediately advocate for the legislator that legislation and we can immediately connect with our lawmakers. I think what’s important is we need to make that reach out to our lawmakers. They want to hear from us. They want to hear from nurses. There are over 4 million nurses in the U.S. There are over 355,000 nurse practitioners in the U.S., and they want to hear from us.

Nursing Job Growth Projections for 2023 and Beyond

Nursing Job Growth Projections for 2023 and Beyond

It’s no secret that nursing is a popular and highly respected profession with excellent potential for job growth. The American Association of Colleges of Nursing (AACN) reported in April of 2022 that a “strong interest in nursing careers” was readily apparent based on increasing enrollment in entry-level programs. However, examining the job growth projections published by the Bureau of Labor Statistics (BLS) may lead us to wonder what the future may hold during the remainder of the decade.

Let’s Do the Numbers

The Bureau of Labor Statistics (BLS) tracks every occupation you might think of, from airline pilots and postal workers to nurses and psychologists. While any statistic should be taken with at least a grain of salt due to the potential for error, miscalculation, bias, and other factors, we can generally feel confident in what the BLS says.

For the BLS grouping of nurse practitioners, midwives, and nurse anesthetists, job growth between 2021 and 2031 is projected to be 40 percent, “much faster than average.” In addition, they report, “About 30,200 openings for nurse anesthetists, nurse midwives, and nurse practitioners are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.”

While we’re at it, let’s acknowledge the BLS median salary stats for this group of APRNs, which is $123,780 annually.

When it comes to the BLS statistics for registered nurses, it’s not quite the same, with job growth between 2021 and 2031 projected as six percent, which is deemed “as fast as average.” In terms of job numbers, the BLS reports, “About 203,200 openings for registered nurses are projected each year, on average, over the decade.” The median salary for RNs in 2021 was $77,600.

For comparison, let’s look at what the BLS says about physicians and surgeons, which is worse still. Projected job growth for this group during the same period is expected to be three percent, “slower than average.” On the other hand, physician assistants fair much better at 28 percent job growth and a median salary of $121,530, not far from NPs in terms of money, yet significantly behind for jobs.

According to a survey by Incredible Health, 34 percent of nurses were planning to leave their current role in 2022, and 32 percent were planning to leave the profession entirely or retire.

What Story Do the Numbers Tell?

The data mentioned above can be interpreted in various ways concerning registered nurses.

On the one hand, we can point to disappointing projected job growth for RNs in the coming decade despite the constant talk of an ongoing nursing shortage. On the other hand, one might also hypothesize that since many nurses are leaving their roles or retiring, those jobs that need to be filled may not be counted as “job growth” since those positions already exist.

Many nurses are seeking alternative career paths away from the traditional acute care bedside, perhaps to a large extent due to the rigors of the COVID-19 pandemic. As some seek ambulatory positions or entrepreneurship, their old jobs will be up for grabs.

Notwithstanding the numbers, demand for nurses should stay relatively consistent (six percent job growth is “as fast as average,” after all). We can also consider that changes in the economy or the healthcare industry may cause shifts in the nursing labor market of the coming decade. We may also encounter enacting legislative initiatives and other policies to counteract the nursing shortage, which could positively impact employment opportunities for nurses.

As for nurse practitioners, they are certainly in the ascendant and will likely stay there, especially as physicians abandon primary care and demand for NPs grows apace.

No Place for Fear

Nurses have always been, and always will be, in demand. As the very mitochondria of healthcare, the wheels of the system would grind to a halt in their absence.

For those who wish to remain in the profession in whatever capacity — be it acute care, research, case management, remote nursing, ambulatory care, or otherwise — there will assuredly be room at the inn for nurses seeking employment.

Creative approaches to one’s nursing career can yield interesting and unexpected opportunities (e.g., cruise nurse, a nurse script consultant for film and television). Still, those seeking something outside the box can find other unusual roles.

Nursing as a profession isn’t going anywhere, and nurses can rest assured that their skill, knowledge, expertise, and compassion will always have a place in a society that’s wholly dependent on them always being there whenever they’re needed.

Daily Nurse is thrilled to welcome Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column. 

Pandemic is Building Demand for Midwives

Pandemic is Building Demand for Midwives

Midwives as well as nurses are experiencing a momentous Year of the Nurse and Midwife. Back in April, the Pew Trusts noted , “Midwives across the country say they are stretched to accommodate additional deliveries because of the pandemic.” In May, a Cincinnati midwife remarked, “My inquiry rate for home birth has gone up 300% in the last month.” With COVID-19 cases on the rise in states such as Arizona, Texas, and Florida, the trend shows no sign of slowing down.

An understandable fear of the virus prompts many women to seek out midwives, according to Katie Bramhall, President of the Vermont Midwives Association. Bramhall told the Christian Science Monitor, “Pregnancy and birth and making a family is such a huge transformation for everybody involved; add the fear of a public pandemic, and that makes that transformation even more imperative in people’s hearts and minds. Fear on top of labor in a pregnancy can change an outcome, because fear will change any outcome in life if that’s the driving force.” The need for comfort and security is a decisive factor. Speaking to a local news station, Charlottesville, Virginia midwife Kelly Sicoli said a key consideration is “Just sort of the general level of anxiety and activity happening in the hospital setting right now… Wanting to stay at home and [be in] their own environment where they have more control and they’re healthy and there’s not anyone who’s sick.”

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As the pandemic drives expectant mothers to seek out midwifery services, support for birthing centers is on an upswing and issues such debate over regulations and insurance coverage have taken on a fresh urgency. A hopeful indicator of change appeared on June 16, when Governor Andrew Cuomo and the New York State COVID-19 Maternity Task Force directed the State Department of Health to allow midwife-led birthing centers in New York for the first time. In May, Health Affairs suggested that CNMs be reallocated from hospitals to birthing centers and recommended, “As states consider options for increasing staffing at birth centers, they should consider scope of practice, malpractice coverage, and Medicaid reimbursement policies that will facilitate that change.” States such as Nebraska and North Carolina have also relaxed practice regulations for Certified Nurse Midwives, and widespread media notice of the spike in demand is likely to make midwives more accessible in other parts of the country.

Midwives themselves have naturally had to adapt during the pandemic. They are making fewer pre-partum and postpartum visits in-person, and are instead conducting appointments via telehealth whenever possible. Ultimately, though, the experience has changed less than you might expect: Christine Yentes, a midwife in Bangor, Maine noted, “There is still normalcy within the unprecedented. The babies are still coming out, they’re still nursing, they’re still doing everything they’re supposed to do. That’s kind of reassuring. Here’s something that’s happening that’s still normal.”

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…”

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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.”

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