May 8, 202218 min read

CNMA Newsletter: May 2022

HAPPY MOTHER'S DAY!

Message from the President

Hello California,

May has gotten off to a rocky start with the leaked draft Supreme Court opinion in the Dobbs v. Jackson Women’s Health Organization (read more below about what YOU can do!). We as midwives are reminded of the fragile state of reproductive healthcare rights and access, and the urgency which surrounds the work we do.

Meanwhile, May 5th was the International Day of the Midwife! I know I’m not alone when I say the call to do this work feels both energizing and daunting. We are called simultaneously to advocate and to care, to stand up for what we believe in while standing beside those we serve. And it feels like there’s never enough of us to go around. Wouldn’t it be nice if we could simply clone ourselves?

Well, if we can’t clone ourselves, the next best thing is bringing in more folks to share the work. We need more midwives! Our Workforce Development and Educational Support Committee is hard at work creating real strategies to train and sustain more midwives in our state. But to make that work, we need YOU to precept! You can read more below about what our students need in order to share in this work. In the meantime, I hope you’ll consider opening up your practice to student midwives. We were all new once, and none of us would be where we are today if someone hadn’t taken the time to help us get to where we wanted to be.

As always, I’m available by email at parisbury@gmail.com and by text at (805) 415-2553.

In the spirit of service,

Paris Maloof-Bury, CNM, IBCLC

President, California Nurse-Midwives Association

California Health Policy

Future of Abortion: Call to Action!

Our hearts are heavy as we read the leaked draft Supreme Court opinion in the Dobbs v. Jackson Women’s Health Organization suggesting that the court is set to enable states to ban abortion outright. We know that this document is not the final word, but it does appear to confirm our worst fears.

As midwives, with people throughout the course of their reproductive lives, we intimately understand the importance of ensuring safe, legal access to abortion care, and we are committed to protecting this fundamental right. We know that if Roe is overturned, the impact will be felt the hardest by low-income people and BIPOC folks. We also know that CNMA and California midwives will be on the front lines providing care to the increasing number of people who would find their nearest abortion provider in California. The projected increase will be from 46,000 to 1.4 million people!

CNMA is a proud member of the California Future of Abortion Council (FAB Council). We are actively supporting a package of 13 bills and related budget requests to protect and expand access to abortion care for all Californians and for anyone who is forced to travel to our state for the services they need. This package also includes efforts towards workforce development to ensure more CNMs are able to practice and provide needed abortion care in our state. Nationally we have taken a support position on the Women’s Health Protection Act and have encouraged ACNM to do the same.

Last night, Governor Newsom and legislative leaders in both houses committed to a state constitutional amendment to further protect the right to abortion in this state. The fact that both Senator Atkins and Speaker Rendon agree clears the way for the legislation to likely pass in time for the June 30th deadline to qualify for the November statewide ballot. CNMA will be on the lookout for a bill to be introduced in the next few days.

We encourage you to take the time you need to rest, grieve and to process your feelings of anger. When you are ready here are some things you may want to consider doing:

Advocacy things you can do

Join the call for Congress to pass the Women’s Health Protection Act to codify the right to abortion into federal law.
Support ACCESS, the Californa abortion fund.

Clinical things you can do:

Register for the abortion training workshop at the ACNM annual conference in Chicago. It is a full day (8hrs) and 7.5 CEs. It is only offered in-person and will be Saturday, 5/21.
Consider becoming a medication abortion provider or training to offer manual vacuum aspiration abortion in your clinical setting.

Resources to share for people in communities at risk of losing access to abortion:

M+A Hotline: a confidential, private and secure phone and text hotline for people in need of support for self-managed miscarriage or abortion.
If you have questions about self-managed abortion and the law, @ifwhenhow can help. The Repro Legal Helpline is a free, confidential source for legal advice and information on self-managed abortion. Visit ReproLegalHelpline.org or call 844-868-2812.
INeedanA.com Find a clinic - to find vetted, up to date, and personalized info on how to get an abortion ; no search or user data saved.

CNMA participated in the Future of Abortion Council last fall. The FAB Council produced a report with various recommendations for legislators in order to expand and ensure access to abortion in California even if Roe is overturned in June.

AB 2529

CNMA'S bill, AB 2529 (Davis/Calderon) has been referred to the Appropriations Committee. Keep watch on our advocacy page for how you can support and be involved! This bill would allow midwifery education programs to apply for funding under the Song Brown Act, something our physician, PA, NP, and RN counterparts have long been able to do.

National Health Policy

Support the Midwives Political Action Campaign

The Midwives PAC is ACNM's Political Action Committee and the fundraising arm of ACNM's national advocacy efforts. We are gearing up for our biggest event of the year, the PAC Rally, and are still gathering items for our auction! The PAC Rally is our biggest fundraiser of the year. In the past, we have auctioned off everything from crocheted baby Yoda dolls to a week in San Diego! If you have something you would like to donate to the rally, please click here to fill out an in-kind donation form providing us with more information! You can also reach out to me at ecmharper@gmail.com or 847-636-6140 with questions. ACNM members can support the PAC by purchasing tickets to the PAC Rally, which will take place at ACNM's Annual Meeting in Chicago, IL, both virtually and in-person at 4:30 CST on 5/24. You can also sponsor a student ticket! We are so excited to be together again in person for the Annual Meeting 2022 and look forward to seeing you soon!

Spring Off-the Hill Advocacy

Join us throughout the Spring season! Due to the pandemic, our Members of Congress and their staff have become more accessible through virtual meetings. Engagement with legislators now is crucial to educate about midwifery and to establish us as expert resources to the office on midwifery and more broadly healthcare. Learn more!

Midwives for MOMS

The cost of a midwifery education is a barrier to many aspiring and prospective midwives. Investment in federal grant funding designated solely for accredited midwifery education programs is integral to making midwifery education a viable option for many communities. ACNM encourages members to continue engaging their federal policymakers about existing congressional legislative efforts (e.g., passage of the Midwives for Maximizing Optimal Maternity Services Act, H.R. 3352/S. 1697) to increase the number the number of racially and ethnically diverse midwives, thereby diversifying the maternity care workforce with individuals who represent the lived and cultural experiences of the patients they serve. Access ACNM’s online toolkit and help spread the word on social media!

BABIES Act

Co-sponsors are urgently needed to move this important legislation forward. Click here to look up your Representatives and Senators and use AABC's scripts to contact them via phone or email. In particular, we are asking you to make calls to the offices and speak with the healthcare legislative aide to request that the Representative (or Senator) become a co-sponsor of the BABIES Act. After you share your reason for calling, you may need to leave a message, so be sure to leave your name and phone number so they can return your call. The BABIES Act (H.R.3337/S.1716) seeks to promote the accessible and affordable use of freestanding birth centers by Medicaid beneficiaries. It would build off the Strong Start initiative by creating a demonstration payment program under Medicaid and providing guidance to develop a prospective payment system to reimburse birth centers for prenatal care, perinatal care, and postpartum mother and infant care.

Midwifery Workforce Development and Educational Support

California’s Preceptor Crisis

The pandemic has been hard on all of us, but especially for California-based midwifery students. California nurse-midwives precept student midwives from California-based programs (UC San Francisco and Cal State Fullerton), as well as distance learning programs ( Frontier Nursing University, Georgetown University, and Shenandoah).

According to a recent survey sent to students and program directors in California by Devon Herbst (Chair of the Midwifery Workforce Development and Education Committee), more than 50% of the students in California are in distance learning programs and more than 90% of the midwifery students in the state are having difficulty finding preceptors to complete their programs.

Because more than 90% of student midwives can’t find preceptors, midwifery students are migrating to other states for academic completion. This migration creates a huge obstacle for keeping graduating midwives in California. We need more midwives, not fewer. It is time for CNMs and CNM practices across California to engage in conversations about strategies to precept student midwives within their organizations. The more preceptors we have available, the more we can diversify and encourage the growth of the midwifery profession in California.

Student Perspectives on the Preceptor Crisis

Frontier Nursing University student Merilee Vance shares her story:

“When I started my clinical search I was fairly new to the state, therefore I wasn’t working and didn’t know any CNMs or RNs. I reached out to our clinical advisor at Frontier and she gave me a list of former clinical sites in California. I started searching in a short radius from my location and realized I was more in trouble than I had originally thought. I only heard back from a handful of sites, all of which were full or no longer taking students. Several places told me they couldn’t believe that we weren’t automatically placed by our school because the other two schools in the state have secured the majority of clinical sites. After about a year of no success, I ended up deciding to split up my last two classes to have more time to find a site. Unfortunately, this delayed my graduation by a term. My Regional Clinical Faculty advisor through Frontier lived in Phoenix and told me I would likely find a site there because there are no midwifery schools in Phoenix. The second site I called was able to take me as a student and I started just a couple of months later! During my clinical site search in California, I was hoping to find a website where current, available CNMs were listed or some sort of assistance that would have made me feel less alone in my search. I placed a bio on the California ACNM site but didn’t hear from anyone. Not knowing anyone in the area was a barrier but having all of the sites taken “locked-up” by the in-state schools was my biggest obstacle. I can only look to pay it forward when I’m able to precept. I want to help students find placement in any way I can.”

Despite the work that in-state schools do to help place their students in clinical sites, their students also face challenges to secure preceptor placement. Summer Felcyn-Ghenco from Cal State Fullerton shares:

“I am a senior Women’s Health Nurse Practitioner student. My experience with the shortage of preceptors has been profound and has negatively affected my academic experience. I was able to find a clinical site that requires me to drive 3 hours and am only scheduled a few times a month. The preceptor shortage has left me with feelings of academic abandonment and doubt regarding my future in this field. If my clinical placement circumstances don’t improve quickly, I won't be able to graduate on time. I have struggled with fears about how this shortage will impact not only my future job opportunities but also my practical abilities. We absolutely must do better!” Although Summer is a WHNP student her experience is a reflection of the difficulties faced by many student midwives.

Another respondent to the survey shared:

“Midwifery care has its roots in empowering communities. It’s hard to believe that we as a profession of midwives would make it so challenging for students to get clinical placement. If we want midwifery to grow, we need to provide the care but also support the student learning process. We need to help the next generation of midwives learn and grow so our profession can benefit as a whole.”

We can and must do better for students and this may mean taking on the leadership at our institutions. Our institutions need us and we must embrace our power and advocate so we can support student midwives in their education!!

The Research

According to a 2021 survey completed by the American Midwifery Certification Board (AMCB), there are 1204 CNMs in the state of California, more than any other state in the US! According to Midwifery program leads, CSUF accepts 12 Midwifery students a year and UCSF accepts 12-16 students per year. CSUF and UCSF turn away dozens of students each year because of the shortage of clinical sites. Frontier currently has 52 students based in California and at least half of them cannot find preceptors.

Why are students having such a difficult time?

It's important to recognize the Covid pandemic, staffing shortages, burnout, as well as the work it requires to precept a new midwife. Most preceptors are not financially compensated for their work. Additionally, many CNMs are required to train OB residents and medical students, which fosters collaborative care teams, but negatively impacts student midwives in their search for clinical placements.

According to the recent Midwifery Workforce Development and Education Committee survey, the biggest barriers that students are facing in finding preceptors include:

Lack of response to emails inquiring whether a person or site are taking students
Practices not accepting students, taking too few students, or only taking students from certain schools
COVID-19 pandemic training restrictions established at the start of the pandemic limit hosting trainees despite school vaccine requirements for students
Lack of accountability amongst schools identifying students placement, especially since this is a requirement by the Accreditation Commission for Midwifery Education (ACME)

Many students share that they are being turned away from sites because some practices will only take students from certain schools. However, both CSUF and UCSF midwifery program directors shared that their schools do not have exclusive contracts with clinical sites for their students.

Let’s all be part of the solution

The California Nurse-Midwives Association (CNMA) and the California Nurse-Midwives Foundation (CNMF) are working synergistically to find solutions and help build our workforce.

CNMA has started the Midwifery Workforce Development and Education Support Committee to develop short and long term strategies and solutions and better understand why CNMs and sites are not taking midwifery students. We are dedicated to ensuring this is done equitably. Please consider joining this committee!

CNMF recognizes that precepting often comes at a cost, whether accepting students as an individual preceptor or advocating to allow for precepting at your institution. We partnered with Anthem and currently have $16,000.00 for a grant to support: a) precepting and b) mentoring. We are exploring the best strategy to encourage sites to open up now while we also look at long term strategies. A short term strategy may mean supporting individual CNMs (time for onboarding, orienting, decreased templates) or to support your ability to advocate for your institution to open up for student precepting. Please fill out the application and let us know what you need to become a preceptor in the short term, and share your ideas on how we can address this going forward.

Connect with us

If you or your organization are interested in precepting student midwives in the near future, let us help you! Midwifery programs can offer logistical assistance and ongoing support. We encourage you to reach out directly and NOT wait for a student to reach out to you! The programs will do their best to match students with preceptors. You may also reach out to Melanie Phipps or Paris Maloof-Bury to connect with the Midwifery Workforce Development and Education Committee for support.

Scholarships, Fellowships, and Grants

Request for Proposal:ACEs Aware State-Wide Learning Collaborative

The UCLA-UCSF ACEs Aware Family Resilience Network (UCAAN), in collaboration with the Office of the California Surgeon General (CA-OSG), Department of Health Care Services (DHCS), and Population Health Innovation Lab (PHIL), a program of Public Health Institute (PHI), are pleased to announce a third round of ACEs Aware grant funding called PRACTICE: Preventing and Responding to ACE-Associated Health Conditions and Toxic Stress in Clinics through Community Engagement. Applicants will be selected through a competitive process managed by the PHIL. Successful applicants will be awarded a subcontract. Non-binding Letters of Intent are due on May 13, 2022 at 5pm PDT; applications are due on June 13, 2022. An informational webinar will be held on May 11, 2022, from 12 p.m. to 1 p.m. PDT (register here).

Education, Trainings, and Webinars

CNMA Annual Meeting–Call for Presenters and Save the Date

Save the date! The CNMA Annual Meeting will take place on November 6 at the Madonna Inn in San Luis Obispo! If you are interested in presenting, please contact Jillian Cauley. More info will be coming soon!

Nurse Practitioner Awareness Training

Drug Enforcement Administration (DEA) will be hosting an one-day virtual training session entitled, DEA Diversion Nurse Practitioner Awareness Training. This educational activity is designed only for nurse practitioners who are certified to prescribe controlled substances. The virtual session will be held on May 10 from 10 AM to 2 PM PST. Register early, as the session will have a maximum capacity of 3,000 participants and will close once registration capacity is reached. Upon completion, participants will receive 3.7 CE credits and should be better able to understand the state of the Opioid Crisis today and identify current drug trends, learn where to locate DEA regulations and other resources, recognize drug diversion and learn about healthcare fraud schemes, and understand prescribing and applying DEA record keeping regulations.

Improving Community Birth Transfers in California

The Transform Maternity Care program at the Purchaser Business Group on Health (PBGH) engaged an expert panel of California physicians and midwives to develop resources and discuss strategies to increase hospital-birth center collaboration, and particularly to improve community birth transfers. Join us on May 18th at 11-12 PST, to learn how you can improve the transfer experience for your patients and your providers. We will discuss the benefits for patients, providers, and facilities of smooth transfer from community birth settings (home birth, birth centers) to hospitals; identify barriers to effective collaboration and smooth transfer; review approaches adopted in other states and regions to promote collaboration between community birth providers and hospitals; and share new tools to support standardized transfer processes and increase trust and respect in interdisciplinary care teams in California. Register here!

Perinatal Mental Health: Culturally informed approaches to screening, assessment, and treatment.

These two 90-minute webinars, on May 18 and May 24 at 9 AM PST, hosted by Postpartum Support International and the American College of Obstetricians and Gynecologists (ACOG), will present an overview of perinatal mental health screening, assessment, treatment, and referral pathways through the lens of culturally-informed care and best practices in treatment of perinatal mood and anxiety disorders. Register and attend one or both FREE webinars.

Live Webinars: Overactive Bladder – Novel Therapeutics

Join ACNM on Wednesday, June 8, 2022 at 4 PM PST for a live webinar on Overactive Bladder, with Dr. Cheryl Iglesia and Alyssa Brown, FNP-C. The webinar will cover the impact of anticholinergic use on cognitive function, the role of newer beta 3 agonists, optimal management of bladder botox injections, and the newest neuromodulation technologies from MRI compatible sacral stimulators to implantable posterior tibial nerve devices. Register $14.99 (Students) | $24.99 (Members) | $29.99 (Student Non-Members) | $49.99 (Non-Members)

Live Webinars: Finding your Path in a Global Career

Join ACNM on Wednesday, June 22, 2022 at 4 PM PST for a live webinar on Finding your Path in a Global Career, with Sadaf Chaudhry, Jennifer Stevens, and Cris Alonso. Finding your path in a global career, will be your unique guide to your own “unique” path into one of the most rewarding careers in life. Curious about developing a career in Global Health? In this webinar you will hear from three leaders in Global Health who have impacted international, regional and national health. Emerging from three different career paths, academic training and types of jobs you will be inspired on beginning or expanding your path to improving the health of all worldwide. Register $14.99 (Students) | $24.99 (Members) | $29.99 (Student Non-Members) | $49.99 (Non-Members)

Live Webinars: Midwives and Liability: Experience, support, and risk reducing tools.

Join ACNM on Wednesday, June 29, 2022 at 4 PM PST for a live webinar on Midwives and Liability with Katie Page. Midwives are likely to experience adverse client outcomes that sometimes will result in disciplinary action against their license or litigation. Awareness and understanding about the incidence and outcomes of litigation involving midwives is limited. In 2018, the ACNM Professional Liability Committee conducted the third national survey on midwives and liability. This presentation presents the results of the survey, now published in JMWH, and includes discussion on support strategies for midwives who experience adverse events or disciplinary action, or who are involved in litigation, and secondary trauma which may follow. Register $14.99 (Students) | $24.99 (Members) | $29.99 (Student Non-Members) | $49.99 (Non-Members)

The Midwife as Surgical First Assistant

This workshop’s focus is on applying current evidence so midwives can participate and provide continuity of care for clients during a cesarean section. In this course, you will learn core knowledge and skills needed to perform as the surgical first assistant for cesarean, at a novice level. This course is designed specifically for midwives and addresses promotion of vaginal birth, shared decision-making and informed consent, and functioning as an active member of the peri-operative team. Following the workshop, each participant is responsible to set up mentored experience at their clinical setting to gain competency in the skills needed to function efficiently, effectively, and with greater confidence as a member of the peri-operative maternity care team. ACNM Members $699.00 | Non-Member $899.00 | Student $399.00 | Student Non-Member $599.00. Dates available June through December 2022. Learn more and register.

To view previously listed educational opportunities, please visit our website at https://www.cnma.org/courses.

Volunteer Opportunities

Call for Public Member for the IBCLC Commission

As IBLCE announced in its 2021-2025 Strategic Plan, the governance structure of the organization is evolving to include an IBCLC Commission that will have autonomy over essential IBCLC certification activities. As IBLCE transitions, pursuant to best practices, the Commission will include a public member – someone who does not hold the credential but represents the interests of the public that is served by the IBCLC community. The Public Member cannot be a current or previous IBCLC but should represent the interests of the many stakeholders served by IBCLCs. The public or consumer member preferably should be a consumer or potential consumer of the certificants’ skills or services. If someone you know is interested in making a difference for the lactation consulting profession, please invite them to apply! Anyone interested in serving as a Public Member should send the completed Conflict of Interest Disclosure Form and current résumé/CV to VolunteerwithIBLCE@iblce.org with the subject line ‘IBCLC Public Member Application’ no later than May 20, 2022.

Job Opportunities

Midtown Nurse Midwives

Join our team at Midtown Nurse Midwives in Sacramento, CA. At our beautiful, accredited freestanding birth center, you will have the chance to provide full scope midwifery care while having a set schedule. This makes it easy to plan appointments, family events, or just have time to enjoy the beautiful country around Sacramento. We are 1.5 hours from either San Francisco or Tahoe, are surrounded by wine country, and are America's Farm to Fork capital. We attend 10-12 births per month and see 7-9 patients per day in the clinic. Our midwives screen clients for eligibility for birth center care; provide antepartum, intrapartum and postpartum care to childbearing clients; perform labor checks and triage; provide primary care to newborns up to 10 days of life; and provide family planning and Gyn care. Hours: 2 call shifts and 2 clinic shifts per week. For more information, please send your resume to bsasaki@midtownbirthcenter.com.

Kaiser Permanente Walnut Creek

Per diem CNM position at Walnut Creek Hospital. Independently manages the care of low-risk women during antepartum, intrapartum and postpartum periods. Co-manages higher risk patients when determined appropriate by CNM and MD. Provides standard maternity care and counseling to women, adhering to the standards of the American College of Nurse Midwives, procedures and instructions regulated by the State Nurse Practice Act and The Permanente Medical Group. Preference for 3 years experience as a CNM; current and valid California Nurse-Midwife furnishing certification (including any needed education in pharmacy); and didactic education and supervised clinical experience in third trimester limited obstetric ultrasound preferred OR to be obtained at midwife's expense within one year of hire. Learn more and apply here.

Best Start Birth Center

Best Start Birth Center is seeking a part time CNM–which will be a dream job for the right midwife! This is an excellent opportunity to learn and improve Natural Childbirth skills. Ideal candidates will have a desire to provide individualized and high-quality freestanding birth center care. Position entails OB/GYN clinic, being “on-call”, triaging patients, providing prenatal care, and delivering babies in a freestanding birth center. Must have current AMCB certification, California RN License, California CNM License, California Furnishing License, BLS and NRP Certification. Proficiency in Spanish is preferred but not required. Send CV to Karen Roslie.

Institute for Medicaid Innovation

The Institute for Medicaid Innovation is seeking qualified individuals who are passionate about salient issues in Medicaid to join our team in Washington, D.C. in the following positions: Design and Communications Assistant, Policy and Program Manager- Birth Equity, Health Policy and Research Assistant- Birth Equity, and Fellowships in Data Science.

Medi-Cal Rx

The Medi-Cal Rx Monthly Bulletin for May is available. The monthly bulletin consists of alerts and notices posted to the Bulletins & News page on the Medi-Cal Rx Web Portal. Sign up for the Medi-Cal Rx Subscription Service to be notified when new information is posted. Additional information is available below:

Midwife Crush Mondays!

Do you know an amazing Midwife who is doing revolutionary work? We want to feature them on our social media platforms!

CNMA is looking for submissions for our new social media series “Midwife Crush Monday” where we highlight the stories of trailblazing midwives across the industry who are making a difference in the midwifery profession. You can even submit yourself!

Here’s what we’re looking for:

Midwife’s name (include pronouns)
Affiliated organization(s)
Why you became a midwife (and anything awesome you’d like to brag about)
Headshot/Photo if available
Bonus: Please include social media handles for tagging!

Please send submissions to sm@cnma.org for consideration!