Day 2 :
Keynote Forum
Renée Mirkes
The Center for NaProEthics- The Pope Paul VI Institute, USA
Keynote: Nurse-Midwifery & NaProTECHNOLOGY: Healthcare women really need
Biography:
Sister Renée Mirkes, OSF, PhD is a member of the Franciscan Sisters of Christian Charity, Manitowoc, WI. She serves as director of the Center for NaProEthics [the ethics division of the Pope Paul VI Institute, Omaha, NE] and was editor of its ethics publication, The NaProEthics Forum, from 1996 to 2002. Together with an undergraduate degree in music education and an undergraduate and master degree in vocal performance from Wisconsin Conservatory and University of Michigan School of Music, Sister Renee has a graduate degree in theology from the University of St. Thomas, Houston, TX and a doctorate degree in theological ethics from Marquette University, Milwaukee, WI (1995). In her current position, she deals with procreative and birth ethics through consultations, publications, and public speaking. To these commitments Sr. Renée brings experience in clinical ethics as well as broad experience in bioethics as a research fellow from 1987-1990 with the National Catholic Bioethics Center (formerly the Pope John Center: Houston, TX). She was appointed to the Nebraska Bioethics Advisory Commission by University of Nebraska President L. Dennis Smith in 2000. She is a founding member and serves on the board of Nebraska Coalition for Ethical Research. Sister Renee is currently serving on the national Rights of Conscience (ROC) Working Committee and its subcommittee on state ROC legislation. She has also been appointed chair of the Legislative Committee of the American Academy of FertilityCare Professionals and spearheads its website focus on protecting healthcare rights of conscience in reproductive medicine. Sister Renee serves on the board of directors for the Twin Cities FertilityCare Center. Recently, the Center for NaProEthics has been approved as a host organization for the Blackstone Legal Fellowship Program and Sister Renee as on-site director of the Phase II practicum. Sister Renee has published articles in The Journal of Philosophy and Medicine; Ethics & Medics; New Blackfriars; The Thomist; Linacre Quarterly; The American Catholic Philosophical Quarterly; Catholic Answer; Our Sunday Visitor; The NaProEthics Forum; National Catholic Bioethics Center Quarterly; Ethics and Medicine, and The Catholic Response.
Abstract:
Na Pro TECHNOLOGY is a dynamic, universal women’s health science developed by Dr. Thomas W. Hilgers and his colleagues at the Pope Paul VI Institute, Omaha, NE. Evolving over four decades of clinical research, Natural Procreative Technology (NPT or NaPro for short) utilizes a standardized and prospective system of monitoring a woman’s menstrual and ovulatory cycles whose biofeedback is critical in helping women understand their gyn-ecology and fertility. One abiding hallmark distinguishes NPT’s 40-year history: A woman’s healthcare goals—the regulation of fertility and the identification and treatment of reproductive abnormalities—are realized in cooperation with her natural reproductive system. Here I bring the defining concepts and clinical practices of NaProTECHNOLOGY (NPT) into dialogue with those of nurse-midwifery (NMY). Speaking for the former, NPT, will be a representative group of female patients who will recount their experiences in taped sound bites taken from their personal testimonies included in the book, Women Healed. Speaking for the latter, NMY, is a member of the American College of Nurse Midwives (ACNM) recounting her experience of the philosophy-of-care principles as enunciated by the College. In Part One, the representative nurse midwife articulates her lived experience of ACNM’s philosophy-of-care principles:
(1) Women’s healthcare is both preservation of wellness and prevention of illness that includes screening (e.g., annual gynecological exams); fertility education/family planning; minimization of risks during labor and delivery, and optimization of natural benefits in every phase of childbearing (pre-, peri-, and post-birth).
(2) Women’s healthcare is a holistic concept that views birthing as a normal physiological process that encompasses a woman’s bio-psycho-social wellbeing.
(3) Women’s healthcare must be comprehensively studied so that (a) basic diseases can be analyzed within the larger picture of women-specific responses; (b) the menstrual and ovulatory cycle can be seen as a natural bodily phenomenon that affects and is affected by a woman’s total health, and (c) the natural process of childbirth is respected by optimizing chances for a normal vaginal birth while minimizing technological and invasive interventions.
(4) Women’s healthcare must be properly researched in evidence-based studies that address the female body and female health needs throughout the continuum of a woman’s life: preconception care, prenatal care, labor and delivery support, newborn care, family planning education, and menopausal management.
(5) Women’s healthcare must be pursued with sensitivity to women’s values and their experience in wellness and illness.
(6) Maternity care is optimally facilitated when women are informed participants in their own care and when they are encouraged to involve designated family members in their labor and birth experience.
(7) Maternity care is best supported with a multidisciplinary team approach (e.g., by a midwife-led continuity of care model for low-risk pregnancies).
In Part Two, a representative group of patients articulate how their lived experience of the care principles behind NaProTECHNOLOGY (NPT) seamlessly incorporates and complements those of nurse-midwifery (NMY):
(1) NPT embraces an essential priority of NMY by being, in the first place, holistic and woman-friendly.
(2) NPT achieves another positive goal of NMY by being person-centered.
(3) NPT attains the same worthy objective of NMY in being patient-specific and freedom-enhancing.
(4) NPT achieves a focal principle of NMY in promoting stewardship-focused empowerment.
(5) NPT attains an important tenet of NMY by being prevention-oriented.
(6) NPT honors yet another standard of NMY in being multi-disciplinary and research based.
(7) NPT realizes a significant goal of NMY in being family-friendly.
(8) Finally, NPT advances an important priority of NMY in being culture-friendly.
NMY and NPT are what women should really want from healthcare because they provide what women really need:
The opportunity to pursue the basic goods of health, family, and procreation encompassing physical, spiritual and social wellbeing. In sum, then, nurse-midwifery and NaProTECHNOLOGY offer women what they really need and, therefore, deserve: healthcare that is woman-, family-, and culture-friendly
- Midwifery Nursing Practice | Midwives in Maternal Care | Midwifery Pediatrics | Midwifery skills
Location: Atlanta ,Georgia,USA
Chair
Renee Mirkes
The Center for NaProEthics- The Pope Paul VI institute, USA
Co-Chair
Susan L Glodstein
Stony Brook University, School of Nursing, USA
Session Introduction
Vanessa Ackland-Tilbrook
Women’s & Children’s Health Network, Australia
Title: Opening the mind of midwives to multi-dimensional learning: Midwives experiences using open the VALTâ„¢ (Visually Authentic Learning Tools)
Biography:
Vanessa Ackland-Tilbrook is a Higher degree by Research Candidate in Health Science (Master’s) at Central Queensalnd University. She has 29 years of experience as a Registered Nurse, Midwife, Paediatric Nurse, Paediatric Critical Care Nurse and Academic. She has taught at University in Paediatric, Neonatal and Midwifery Programs, and developed curriculum for both the undergraduate nursing and midwifery programs and a post graduate complex midwifery program. Currently, she is working as the level 3 Midwifery Education Facilitator in Adelaide, South Australia. She is also the Creator of Open the VALT™ and has published on her concept
Abstract:
Visually Authentic Learning Tools (VALT™) are an authentic, three dimensional visual representation of a written scenario. They were conceptualised post evaluation of the undergraduate student’s experience using written scenario activities and learning preference survey outcomes. Student feedback indicated scenario based activities did not necessarily meet their learning styles. Learning preferences indicated a high visual learning result. Literature on learning style preferences from a variety of databases supported healthcare professionals to be visual or multimodal learners. Normal physiology links positive engagement to memory formation. Visually Authentic Learning Tools (VALT™) were created to teach complications of pregnancy and applied to scenario based learning at an undergraduate, transition to practice and post-graduate levels. Learners were given visually authentic learning tools (VALT™) representing real life clinical presentations of a variety of complications for women in pregnancy. Post evaluation audits using a paper based survey which was a mixture of open ended questions and Likert scale responses were given to all groups. Participation in the audit was voluntary. Response rates ranged from 48–90%. Audit results indicated recognition of visual authenticity, application of multiple learning styles and positive learner engagement in the activity across all experience levels of practitioners. Results of the audit indicated that the VALTs construction provided the scenarios an added dimension, making them accessible to visual and tactical senses, whilst promoting collaboration and decision making processes in regards to the clinical management of the simulated scenario
Safina Shakeel Ali
The Aga Khan Hospital for Women, Pakistan
Title: Leading change and promoting safe and high quality care by enhancing midwives’ knowledge, ability & competency about “Care for women in labor & newborn.â€
Biography:
Abstract:
Objectives: To assess and improve the knowledge, ability and competency in “Care for women in labor & new born” among two groups of Midwives from four secondary hospitals of Karachi and Hyderabad.
Methods: Two workshops were arranged for registered midwives who were working in labor room with greater than 1 year experience in 1st and 2nd qt of 2015. 1st workshop was arranged during Feb 10-11, 2015 in which 31 participants attended. The workshop content consist of normality of pregnancy, antenatal care, stages & care of labor, CTG interpretation, immediate new born care, assessment and neonatal resuscitation. The data were collected by taking pre and posttest in which multiple choice questions, True/False, match the column, interpret the CTG traces and short question answers were included. The pre and posttest were checked by using prepared keys. This workshop results were not up to the mark so, 2nd workshop was arranged with some major modification like: 3 days of workshop was conducted during April 28-30, 2015 in which 23 participants attended; Pre and posttest were modified and, more time was allocated for study time and the results were good this time.
Results: 1st group scored 6.45% in pre-test and 26% in post-test while 2nd group scored 47.8% in pre-test and 74% in post-test.
Conclusion: Therefore the mentioned results suggest that there is presence of areas of weakness in both the groups and the need of continuous enrichment of their education because they are the future health care providers who provide safe and high quality care to the patients.
Mary Steen
University of South Australia, Australia
Title: Perceptions and experiences of maternal birthing position and perineal trauma amongst mothers, midwives and obstetricians in the Niger Delta Region, Nigeria: A mixed method study
Biography:
Mary Steen is a Professor of Midwifery at the University of South Australia and Visiting Professor at the Universities of Port Harcourt, Nigeria, Sao Paulo, Brazil and Chester, UK. She is interested in a wide remit of midwifery and family health issues that has led her to undertake research studies in developed and developing countries. She has published her work widely and has written numerous articles, chapters and several books. Mary has received several awards for clinical innovation, original research and outstanding services to midwifery.
Abstract:
Cumulative evidence supports the use of upright positions during labour and childbirth, which has physical benefits for both mothers and babies. Despite strong evidence in support of upright birthing positions, semi-recumbent or lithotomy positions for birth continue to be practised in Nigeria. Furthermore, the use of episiotomy is commonly practised in some regions of Nigeria. Lack of evidence based guidelines and acknowledgement of the recommendation for restrictive use of episiotomy has contributed to the continuation of this surgical intervention being performed without justification. The challenges of implementing evidence-based maternity care are on-going. The complexity of closing the gap between best practice as determined by research evidence and clinical practice is well documented. This presentation will report the findings gathered from a mixed methods study that explored the views and experiences of mothers, midwives and obstetricians in Nigeria. At the outset of this study, midwives and doctors were all trapped in a vicious cycle of entrenched clinical practices. However, during the undertaking of this study, awareness and practices not based on evidence were reflected upon and challenged. A change process that involved critical thinking and some adaptation of practices occurred, such as enabling some women to adapt different positions during labour and birth and then had the effect of fewer episiotomies being performed. There was a clear willingness on the part of the midwives and doctors to change and adapt clinical practices that benefited women based on contemporary evidence. This shift resonates with an Appreciative Inquiry 4-D cycle of behavioural change. A transition from a vicious cycle of ‘practitioner’s centred’ led care to a virtuous cycle of ‘woman centred’ led care was evident.
Momoko Kusaka
The University of Tokyo, Japan
Title: Effects of yoga during pregnancy on birth among primiparous women: A randomized controlled trial in Tokyo, Japan
Biography:
Momoko Kusaka obtained her Master of Health Science degree from the University of Tokyo. Currently, she is a Doctoral student in the Division of Health Sciences, Graduate School of Medicine, at the University of Tokyo, Japan. She is registered as a Japan Society for the Promotion of Science Research Fellow (DC2). She is majoring in Midwifery and Women’s Health. Her research topic is exercise during pregnancy, especially stress reduction effects of yoga.
Abstract:
Aim: Yoga combines poses, breathing, and meditation, and can help women overcome labor challenges. The aim of this study was to clarify the effects of yoga during pregnancy on birth.
Methods: We started a randomized controlled trial at universities and hospitals from November 2014. The yoga intervention group (YG) practiced yoga from 18-23 gestational weeks until childbirth. The control group (CG) received customary care alone. Participants who delivered vaginally completed a questionnaire including the Experience of Birth (EB) scale at three to five days postpartum. The EB scale contains four subscales: Done well myself; Satisfactory with both mother and child being well; Presence of reliable obstetric staff and Awareness as a mother. Higher EB scores suggest better birth experiences. Scores of the two groups were compared using Mann-Whitney U-test. This study was registered as a clinical trial and approved by the Ethics Committee of the University of Tokyo.
Results: We analyzed 84 women (YG; n=47, and CG; n=37). EB scores were not significantly different between YG and CG. Nine women in the YG did not practice yoga during the last month of pregnancy. Thus, on secondary analysis, we compared women who actually perform yoga program in this study group (APYG; n=38) and the other group (OG; n=46). The only “done well myself” scores for the APYG were significantly higher than for the OG (p=0.029).
Conclusion: Practicing yoga during pregnancy may improve the scores of “done well myself”, including controlling pain and feeling relaxed during labor
Susan L Glodstein
Stony Brook University, USA
Title: Advanced practice nurses mentor teen moms in a shelter setting: A unique experience to incorporate in nursing curriculum
Biography:
Susan Glodstein is a board certified Adult Psychiatric & Mental Health Nurse Practitioner, board certified Adult Psychiatric-Mental Health Clinical Nurse Specialist, and a Clinical Instructor in the Department of Graduate Studies, Stony Brook University- School of Nursing. She has been a Psychiatric Nurse for over 27 years with current practice in the community setting. She is engaged in Doctoral studies at Case Western Reserve University, Frances Payne Bolton School of Nursing with a research focus on suicide prevention and education in teens and young adults.
Abstract:
Two Advanced Practice Nurses (APNs) will share their unique experiences working with teen mothers and their children in a shelter setting. The APNs have backgrounds in academia, psychiatric-mental health nursing, community, and nursing education. The teen mothers seek stability for themselves and their children from unsafe, abusive and dangerous environments and are grateful for mentoring from APNs. However, the teen mothers gained friendship, support, and stability while living in this environment. Through modeling and direction from APNS the teen mothers have been able to be successful at parenting, attending school, and to secure employment. This environment is a wonderful educational experience for undergraduate and graduate nursing students specializing in mental health, community, pediatrics, midwifery and women’s health issues.
Florminda B Tejano
Philippine League of Government and Private Midwives, Inc, Philippines
Title: Traditional practices of pregnant indigenous people: Its effects to nutrition
Biography:
Florminda B Tejano is a licensed Midwife Practitioner in the Philippines. She finished her Doctor in Public Administration in 1999 at Cebu Normal College, Philippines and Doctor of Philosophy in Education in 2008 at Father Saturnino Urios University, Philippines. Currently, she is teaching graduate and post-graduate students and has helped in their unpublished thesis/dissertations research writings. She is also teaching in the school of midwifery. She has retired from the government service working with the Department of Health as Chief Administrative Officer. She is now the Hospital Administrator of Holy Child Colleges of Butuan Hospital.
Abstract:
The study of Mamanwa women in this research was limited to 35 pregnant women aging 12-35 who are residents of three municipalities of Agusan del Norte namely: Santiago, Jabonga, and Kitcharao, Philippines, predominantly occupied by Mamanwa Tribe. Their culture and unique traditions, beliefs, and their ways of life have been transferred and practiced from generation to generation. By their culture, Mamanwa women during pregnancy would suppress their desire for food affecting the health and growth of their babies which naturally need nutritious food especially while inside the womb of their mothers. But on non-pregnancy period, they are basically dependent on root crops such as cassava which tastes like wood, “Onaw,” a flour derived from decoction of somewhat palm like tree, banana, camote or sweet potato, “abatud” or larvae of beetle. Fresh water fish from rivers and lakes are their regular viand. The manner of cooking is by sun drying, smoke or roasting. It is festive day if they catch wild pigs from the mountains which only non-pregnant women can share as primary and privileged sector being substitute to their deprivation during pregnancy on account of their elders prohibition to take nutritious food items which can increase weight of their unborn babies. This practice has endangered the development of the unborn babies because their health and growth are dependent on the food intake of their mother. The results of the survey and informal interviews from Mamanwa pregnant women revealed that their lack of awareness about nutritional food element has the trending effect of their indiscriminately taking high carbohydrate content diet but with insufficient protein. Pregnancy malnutrition of Indigenous People (IP) among Mamanwa Tribe is very high at (100%). Mamanwa pregnant women suffer this deficiency due to lack of education which by consequence prejudices the health of their babies in their womb
Fikirte Wubamlak Aynalem
Addis Ababa City Government Health Bureau, Ethiopia
Title: Magnitude and factors associated with episiotomy among mothers who delivered vaginally at Debre- Markos Referral Hospital, Ethiopia
Biography:
Fikirte Wubamlak Aynalem has completed her Bachelor of Science in Midwifery from Debre-Markos University. She has been working as a Supervisor for the data collectors in a WHO funded International non-Governmental Organization (NGO), Orthodox Christian Charity (IOCC) research team for the last two years. Now, she is a senior Midwifery professional under Addis Ababa City Government Health Bureau, Ethiopia
Abstract:
Episiotomy is the surgical enlargement of the vaginal orifice by an incision of the perineum during the second stage of labor or just before delivery of the baby. It was common to perform an episiotomy for almost all women having their first delivery, ostensibly for prevention of severe perineum tears in explosive period and easier subsequent repair. The aim of the study was to determine magnitude and the associated factors among mothers who were delivered vaginally in Debre-Markos Referral Hospital, Amhara, North West Ethiopia. A one year’s Institutional based retrospective cross-sectional study design, with systematic random sampling techniques on 331 sample size was carried out from a total of 2145 population who had vaginal delivery in Debre-Markos referral hospital. A chi square test and odd ratio were used to see the association and strength between dependent and independent variables. P-value <0.05 were considered through the analysis. Prevalence of performing episiotomy was 42% (132) after, bi-variate analysis through chi-square, it was found that a significant association of episiotomy with gravidity (
R= 3.69(95% CI(2.32,5.86))), parity (R= 3.85(95% CI(2.41,6.15))), mode of delivery (R= 4.66(95% CI(2.91,7.45))), birth weight (R= 0.04(95% CI(0.16,0.1))), duration of 2nd stage of labor >30 min considered as prolonged ((R= 0.22(95% CI(0.84,0.06))), fetal condition during delivery (R= 10.08(95% CI(2.00,51.9))), APGAR score at first and 5 min during delivery and age of parturient while, there was no significant relation with fetal presentation during labor. Prevalence of episiotomy in the institution was 42% and this was much higher than 10% which is recommended by WHO
Annu Kaushik
Maharishi Markandeshwar University,India
Title: Prevalence of needlestick injuries and its related factors among female nurses
Biography:
Annu Kaushik is a PhD Nursing Scholar at Maharishi Markandeshwar University, Mullana, Ambala, Haryana, India. A professional with 18 years of rich experience in Training, Education, Strategic Planning, Operations and Team Management, she has published more than 10 papers in reputed journals. She has been serving as an Editorial Board Member of repute and authored as well as edited nursing books
Abstract:
Needle Stick Injuries (NSI) is one of the common occupational hazards for nurses and can occur because of variety of causes. This study was aimed at finding out the prevalence of NSI and to explore the factors related to NSI incidences. This quantitative descriptive study was conducted among 150 nurses working two tertiary care hospitals in Haryana. Convenient sampling technique was used to select nurses for the study. A self-developed socio-demographic profile and a questionnaire to assess needle stick injuries and related factors was administered to each of the study participants. Majority (89.7) of nurses were females. 52% of nurses got needlestick injuries while they were pregnant. Overall, every third nurse (33.3%) had sustained needle stick injury at least once in the past. Only 19 (12.7%) nurses have received Hepatitis-B vaccination. Nearly two third of the participants (64.9%) did not think that it was important to have Hepatitis B vaccination. The most common cause of NSI as perceived by nurses was lack of proper equipment for disposal (50%) followed by increased workload (24%), carelessness (18%) and fatigue (8%). Majority (62%) of the NSI was sustained during night shift. Prevalence of NSI reported by the study is alarming and it needs attention to reduce the risk of occupational hazards. It is important to note that majotity of nurses were females and were in the child bearing age. Needlestick injuries causes substantial physical and mental trauma. Female nurses as the largest network of the health care enterprise need to be competent and up to date in their caring role to minimize sharp injuries at work and its sequelae.
Vanessa Ackland-Tilbrook
Women’s & Children’s Health Network, Australia
Title: Through the looking glass and into the rabbit hole: Representational reflective imagery as a tool for practice development
Biography:
Vanessa Ackland-Tilbrook is a Higher degree by Research Candidate in Health Science (Master’s) at Central Queensalnd University. She has 29 years of experience as a Registered Nurse, Midwife, Paediatric Nurse, Paediatric Critical Care Nurse and Academic. She has taught at University in Paediatric, Neonatal and Midwifery Programs, and developed curriculum for both the undergraduate nursing and midwifery programs and a post graduate complex midwifery program. Currently, she is working as the level 3 Midwifery Education Facilitator in Adelaide, South Australia. She is also the Creator of Open the VALT™ and has published on her concept
Abstract:
Reflective Imagery is a figurative, descriptive language that assists with the portrayal of an idea, actions or objects. It is a form of communication that transcends culture, age, cognition & language. Traditionally midwives use words to reflect on their continuous practice development. Yet the evidence suggests that many midwives struggle with reflection. Representational reflective imagery was implemented as an assessment activity post completion of a Global Women’s Health module. Attending Nurse/Midwives were asked to illustrate their context position. They were asked to consider their role, and how they view themselves as practitioners within the current context of Global Women’s Health issues. Calico squares were given to the group and they were asked to portray their attributes and personal thoughts or opinions using imagery. Imagery could be drawing, sewing or quilting. A written description of their image was also completed explaining the choice of image and its significance. Students found this activity to be challenging, thought provoking and rewarding as evidenced below;
‘An understanding of what the client has experienced and from where they have originated from can only lead to a more compassionate and meaningful interaction in our delivery of health care’
‘This was a very rewarding and important activity. The feelings of contentment as I completed the process of reflection through this craft piece, caught me by surprise.’
Representational reflective imagery proved a worthwhile tool to aid in the reflection of the personal attributes that help midwives be with and care for women and their families.
Poonam Sheoran
Maharishi Markendeshwar University, India
Title: Quench for motherhood and adoption: Dilemmas of infertility
Biography:
Poonam Sheoran is currently pursuing her PhD in Nursing and is working as an Associate Professor at Maharishi Markandeshwar University. She has published more than 25 papers in national and international journals and has been serving as a member of Research Committee at institutional level. She has completed her Post-graduate degrees in the field of Nursing, Sociology, Psychotherapy and Counseling. She has been awarded INSPIRE fellowship for Doctorate by Department of Science and Technology, Govt. of India and Presidents’ Gold Medal award for academic excellence during MSc Nursing program
Abstract:
Reproducing and upbringing of children has been a part of life since the beginning of mankind. Motivations for parenthood and perceived meaning of children vary among cultures. In developed countries the desire for parenthood is expressed as a wish for personal happiness and fulfillment where as in low income countries, reasons for the wish of child are different. A phenomenological study was conducted at an infertility clinic of Haryana, India with aim to explore experiences of childless women. Semi structured interview guide was used to collect data via face to face in depth interviews. Criterion sampling technique was adopted to select participants. All interviews were audiotaped using a digital recorder. Findings revealed five subthemes with two themes as factors affecting desire for child and adoption emerged under core theme of desire of motherhood. Childless women shared their wish and need to have child and outlook towards adoption as an option to counteract infertility. Factors affecting need to have child included fulfillment of personal desire to experience pregnancy and childbirth, continuation of family lineage, feeling of contentment and happiness, fulfilling social and religious obligation to procreate, preserving relations and reputation in society. Although desire to be mother was very strong among participants but adoption was not a preferable choice. Though motherhood has got tremendous value among Indian women, still to adopt a child is not a popular solution. Midwives working in public health need to understand reasons behind preferred choices among couples and can take initiative to provide an integrated, professionally facilitated group support to the couples suffering with infertility