 Okay, now I will introduce today's presenter and please welcome Suzanne Wertman and her presentation will be midwifery advocacy leading beyond the bedside. Suzanne Wertman is a consultant in the state government affairs for the American College of Nurse Midwives, ACNM. She has over 20 years experience providing midwifery care to people of all ages and backgrounds in public, private and non-profit settings. She has served as a joint facility at East Carolina University and University of North Carolina at Wilmington. Suzanne has been active in ACNM state affiliate leadership throughout her career. She was named the legislative political nurse of 2014 by the North Carolina Nurses Association and she's completed fellowship at American Nurses Association and Duke University in advocacy and leadership. Suzanne has organized college peer educators in sexual health, educated parents about HIV and AIDS, founded a hospital-based volunteer doula program and facilitated her trauma-informed discussions about racism and anti-racism in Wilmington, North Carolina. She lives there with her two loves, a teenage son and a very old dog. Okay, thank you. Welcome again, Suzanne and over to you. There you go. Thank you so much, Ely. It's so nice to be here. Thank you to the BIDM folks for allowing me to talk with you guys today. I'm so happy to be here and seeing so many friends. Hi, everybody. It's so great to see old friends and hopefully by the end of this, those of you I don't know will be new friends because that's why I'm here. I'm here to have fun and make friends. So I, some of you already heard some of this talk. I talk to students and other midwives about how important it is for us to advocate for the people we serve and ourselves beyond the bedside. So let's first take a look at the word advocacy. I've been doing this for so long since I became a midwife and even before that as a college student and as just a general person in the public. This is something that I love deeply. But it was interesting to look back at the word itself and think about what is it that advocacy really is? Just taking the word and I didn't know that it came from the Latin, advocare to summon or call to one's aid. And I thought, well, that's called the midwife, right? I mean, who else should be advocating? You know, and you hear sometimes too the, you know, that there's like, oh, well, we're going to midwife this into existence. And so I think that we are naturally advocates in what we do at the bedside and what we could do or what some of us are doing beyond the bedside. So public support of a cause or proposal, we're all familiar with that. That definition, the act or process of advocating, right, for someone or something, arguing for supporting a cause or policy, and supporting or promoting the interest of a group. So, you know, we do that both for our communities and for ourselves. I think sometimes where it becomes difficult for some of us is to think about advocating for ourselves since we're very, very good at advocating for others. Sometimes we forget, you know, that oxygen mask for ourselves, right? For those of you who have flown, you know, you put the oxygen on yourself first and then you help the people around you. So, you know, a lot of times this is portrayed as a hierarchy and I'm a feminist from way back and I like to think about things in circles rather than, rather than hierarchies. So I feel like we're surrounding the people that we're taking care of and we're taking care of those folks in the clinic hospital birth center. So sometimes you're just taking care of that one person and advocating person to person, right? But then you go to the next level and you become involved in, you know, committees in your health system or your hospital, leading the birth center, taking on projects for quality improvement or, you know, leadership projects of other types of change. And then we think about, and I think this is a hard leap, but it's a leap that I want, all of us, I want to challenge everybody to go to the next level. Outside of your circle of comfort, I want you to think about ways that you can go take your advocacy to the next level. So that might be at your city or town level in your community. How do you show up for the people in your community? How do you show up for your community? Are you on any task forces? Are you sitting on any boards? Are you involved in your, in the school for your children? Are you involved in your church? How do you bring midwifery to the greater community? And then, you know, in your province or state, how are you showing up? How is midwifery represented? Raising the visibility of midwifery at each one of these levels is critical and we all have a part. And I want people to think outside of the box of, well, I don't do politics or I don't do public speaking or I don't do, I can't write a letter or I don't have time to get involved in a big campaign. I want you to think about even just what are the things that you can do. And I've got my, some of you may be able to see my necklace today. I've got my vote necklace on to remind everybody what, what we can do at a basic level. Another basic level is, and I'm going to get to this in a few slides, is just being a member of your professional organization. This raises the visibility of midwifery in your country. And then of course, globally, and I don't need to lecture to any of the folks who are attending this virtual international day of the midwife celebration because you're already here participating in doing that. So what can advocacy do? And the definition of advocacy for me is, is thinking about policies and laws that impact midwifery regulations that that can be, you know, once a law is passed, how does that law get carried out or policies within an institution? Or an insurance, an insurer, an insurer's policies that affect midwifery? How does your country create policies? How do your networks, your health networks create policies affecting midwifery? And, and advocacy is using our outside voice. So giving, giving us and the people that we serve a voice for, for the needs of the people in our communities. So why be an advocate? This one you might have to put, put all the way to full screen. But this doc, this, hey, what am I trying to say? It's, it's a diagram. That's what it is. This is from the ICM and I'll put the link in the, in the chat, the ICM advocacy toolkit. And it basically shows what our essential competencies are, how we move midwifery through the world. And gender equality is there and enabling environment. We've got leadership, association, regulation, education, and midwife led continuity of care in the, in the model of how midwifery is practiced, research and evidence. These things, as you can see, are puzzle pieces that all fit together. And I love the circle. The circle is there. It's all connected. And why do we need it? Because the world needs us. And no one's coming to save us. We got to do it ourselves. And we've got the power to do that. So in the United States, and it's with a heavy heart this week that I talk about our advocacy efforts because we're facing restriction of abortion. We're in a critical, critical place right now. Those of you are from the US and or who are following the news in the US, our Supreme Court is thinking about overturning the decision to ensure abortion access in our country. And in our organization, the American College of Nurse-Midwives, we are looking at how to address maternal health in a midwifery way. And that means in a holistic way that looks at many different aspects of factors that affect maternal health. We've been very successful in having states pick up Medicaid coverage, expanding coverage for folks who are covered by Medicaid, which is our public health insurance, to 12 months postpartum. Some of you in in socialized medicine countries may gasp at this, but this is big news for America. We have a maternal mortality review committee in each state now. And we are making sure that there are midwives at that table, reviewing those cases, making policy recommendations, looking at equitable standardized data collection methods, expanding access to perinatal mental health care is so critical, expanding access to midwives. As you know, we are only attending about 10% of the births in the United States. And we are working every day to mainstream midwifery in the US and help us to have outcomes that that rival our friends in other industrialized nations. Access to birth centers, this comes with funding for birth centers. And expanding access to midwives is not only just with licensure but also with educational funding. Developing a racially and ethnically diverse midwifery workforce, our workforce in the United States has been primarily white. We are mindfully taking steps to make sure that we are more reflective of the people that we serve, that we have a workforce that looks like the people we serve. And of course, ensuring respectful care, equitable care, making sure that the care is of the highest quality and that it's safe. These are priorities for us at the policy level. So I mentioned a little bit about this before, joining your professional association. Think of this like a video game. You want to get in at the base level, this is your first start, joining the professional association. That's, you know, there's power in numbers, there's power in organization. Joining committees and boards, you know, that might be in your professional association, it might be in your community, it might be at your health system level, it may be at the international or national level. Get, we need midwives at every table where decisions are being made. My favorite quote, and I'd like to expand on it from Shirley Chisholm, the first woman to run for president of the United States. If they don't give you a seat at the table, bring a folding chair. And some of us even say they don't give you a seat at the table, make a new table. And from one of my other favorite change makers is make the table long. If the table doesn't fit everybody, make it longer. That's from Jose Andres. Getting support from the community. Once people know, and you all know this as midwives, once people know about midwifery, they want to tell their friends. So give them the tools. Give your patience in the communities the tools to support you. Don't be modest. This is the place where modesty is not part of the program. Making sure that we're in the spotlight, and that midwifery is highlighted is one of the most powerful things we can do to move midwifery forward. Collaboration, that includes collaboration with our colleagues, our physician colleagues, our nursing colleagues, our patients, healthcare administrators, legislators, other stakeholders, consumer groups. The more we move together, the stronger we are. Staying focused. There are so many distractions. There are so many little things that people will pick out and try to distract us. And we need to stay focused on why we're here in keeping the people that we serve in the center is key to that focus. Uniting. That's easy to say, hard to do. But we need to speak with one voice, be strategic. We may disagree, but on the outside, when we're using our outside voice, we're speaking with one voice. It's the way that we gain power. Being strategic and being bold, and I'm going to say more about that in just a minute. As I was going through the advocacy kit and preparing for this talk, I came across this wise woman, Lenny Camuendo, who some of you may know from the White Ribbon Alliance in Malawi. I love her advice. Be bold and speak without fear. And I'm going to read her words. In my experience, the greatest barrier is ourselves. That's hard to hear, right? We do not speak with one voice. We lack the boldness required to be advocates for ourselves. And perhaps we also lack knowledge of advocacy. We must start with the desire and interest to make things change and make a difference. We can't give our power away. We may not have much, but the power that we do have, we need to use. Effective principles. This came from a wonderful advocacy video created by ICM for responding to the COVID-19 crisis, but the principles can be applied in any situation for any issue. Making sure that you have a clear message outlining the problem that we're facing, a proposed solution, a clear reason why it's important to solve the problem, visuals and graphics to make the case. And I would say even a compelling story. I think as midwives, we are really good storytellers and we need to expand on that. A plan outlining how and where the message will be shared. This is on the back end of things internally. And making sure that our message is shortened to the point. What we do is so complex, right? And in medicine, healthcare these days, it's just getting more and more complex every day. Levels of involvement of governments in healthcare. Funding the interworkings of interdisciplinary action. We can get bogged down in the details, but when we're speaking about midwifery, we need to be to the public. We need to be clear to the point when we're speaking with legislators, when we're speaking with the media. And that sometimes means leaving out details that we know are important. Again, from that fabulous toolkit, here are some types of communication and how they can be used, where you would use things. With governments and institutions and experts, this is where we can share policy studies, research papers, reports, journal articles. We can invite our legislators to conference presentations. We can go to conferences where they are and speak out. Lobbying, of course. Working groups or public hearings are a great place to speak out. And then making dedicated advocacy websites. Digital is where it is. We're all here today, gathered because of the advances in technology. So making good use of our digital resources is a powerful way to spread the word about midwifery. Informed non-experts. Not sure who those people are, but they might be, oh, I don't know. I do actually know who those people are. They might be anthropologists, or they might be the folks that work at consumer agency that works on health care issues. They might be someone in your public health department who doesn't have exposure to midwives. These presentations can be helpful to them, too. And then the general public. Are we writing articles in the newspaper? There was a campaign here in the U.S. when Call the Midwife is being aired. There's a group of midwives at the Detroit public television station who publish a blog and do some advertising in that way. So the public, you know, you're watching Call the Midwife and getting information about what does midwifery look like in America, too. Pitting ourselves out there. And I think there's some great examples of folks that are doing wonderful things out on social media. All you have to do is Google Midwife to see those folks on Instagram and Facebook and Twitter. It's fun. I think we get a lot bogged down. Maybe it's just in the United States that this is work. And while it is work and while it is, you know, marathon to run advocacy campaigns and change sometimes immovable legislatures and work against organized medicine, it can be tough, but it also can be fun and fulfilling. You know, schmoozing with legislators. I know even when I say that, I kind of cringe a little bit, but it's fun. They're people. Yes, yes, yes, there's problems, but it can be fun to be out there talking about midwifery and the camaraderie that I have experienced in my own networks. And I'm thinking like of the people that are here in this room today listening, you know, we we're fed by this work. We're fed by the advocacy work and knowing that our communities will be healthier is is fulfilling. So be the face of midwifery in your community, build relationships with policymakers, that nurse that writes all the policies on your on your unit, take her out for coffee, bring her a donut, go for a walk, make friends, make friends with your legislators. Don't bring them gifts. It's usually illegal, but you can, you know, meet them as a person, wear your midwife t shirts everywhere you go to the store. You know, when you see your patients out in public, make sure that everybody knows what you're doing and be be there as an expert. Even the novice midwife has so much information to share and be a resource for policymakers in their in their communities. And now I want to open it up for questions. We have about a half hour. Well, we have like 25 minutes, 20 minutes before you have to get to your next next place. But I'm so thankful that all of you are here. And I'm happy to answer some questions now. Awesome. Thank you. I have a question from Catherine. How do we counter negative media attention from a policy perspective, for example, bad home birds outcome? That's a tough one. I think it is difficult to be on the defensive. And I think, you know, helping people to understand and you don't want to go into like we even amongst ourselves will talk about it. Well, bad things happen in the hospital all the time. I think that we need to keep it positive and factual. And, you know, I don't know, Catherine, if it's like right away that you want to, yeah, the policy perspective, like there's two different levels to this question, I think. You know, I think working with professional organization experts in marketing and public relations and messaging, I would go there first, mostly because those folks have a national perspective and contacts in media. So addressing it at the media level, writing an op-ed, talking with the person that was reporting on that bad home birth outcome can be, you know, some of the ways of getting through that. You know, and from a policy perspective, I know that we here in the U.S. have had our state associations have used, I don't want to say used them, but have illustrated the need for regulatory reform through those hyped up stories, because I think they do get hyped up. And then everyone paints midwifery with a broad brush, right? I hope that answers some of your questions. And I'd love to hear if anybody else, I know that there are some experts out there listening that are in this room. So yeah, go ahead, Jane. Well, thank you so much. And I know this will be maybe a little specific to us folks in the United States. But one of the concerns I have is how do we persuade maybe the up-and-coming stars of midwifery to join our professional organization? Because I've noted I'm a Floridian midwife that our rates of continued engagement within our professional bodies is very low. We maybe engage students and then we don't see the added value to pursuing membership of our professional organization. So any pointers that you can give to us to maybe persuade them is, as you say, it's fun and sexy to be on the stage. And how do we persuade maybe the newer folks so that we can actually retire soon? So that would be good. So I'd love to help with that. Yeah, I think meeting them where they are, so they're out on social media, on Instagram and Twitter. I think if there's a couple of different prongs, I know that what we're doing at the American College of Nurse Midwives is speaking to students. We've made a concerted effort and we're working with midwifery educators to incorporate robust public policy training and gets back to what Dr. Pizarro and Dr. Hartman were speaking about earlier today in leadership and building leadership skills. So empowering folks and helping people to understand, listen to me making them, brainwashing them into understanding that through the professional organization is how we build power. I think there are some social forces that work right now that tend to make us more individualistic. And that's a long conversation. But I think if we're working at several different levels, I think that helps. I think mentoring helps. And, Jane, I know you do a good job with that. I think making sure that people are mentored through leadership and through policymaking, I think that's where we can, we're always recruiting, you know. Good question. Thank you. And if anybody has anything that they'd like to add, please speak up and or put it in the chat. Because we have experts out there. I know I'll start calling on you if you don't speak up. Cindy Farley, what do you think? You want to talk about the Georgetown public policy work that you do? Because I think we've had some great leaders come out of that program that continue on and do advocacy work and stay with us. Also, I would love to hear from folks from outside the United States and hear what's been working in your countries. Oh, Eli does, does, is there a way to have Cindy be able to speak? I think you can change it by clicking on the microphone icon. Let me see if it gives you, sorry, the headset icon at the bottom of the page. Does it give you, yeah, should give you an option to add voice as well. And you have to allow the browser to use voice. You should get a pop up. I just made you a moderator. Cindy, do you see a mic now, a little blue mic down below Suzanne's last slide, or do you still just have your headset? Oh, something's changing. Her icon changed. There you go. Thanks, Cindy. Thanks, Catherine. Your words of wisdom. Oh, I don't know that they're words of wisdom. I think we're organized well at Georgetown and we're persistent. That would be one of the things that we try to do. But we were able to go to the hill this April, just about two weeks ago, in a post insurrection post COVID world, which was very interesting, because previously, we would make appointments with our students with their federal legislators, two senators, one congressperson, and we would visit if the offices weren't responsive, we could still get in the building and hand out materials and request spontaneous meeting. But this time, you have to go in and be met by a legislator and escorted to an office. So that was interesting. And we did get two live meetings, and then we scheduled two remote meetings. And so the students that didn't have live meetings still had an interaction with legislative aid. And I was thrilled to be back on the hill, have to say, very exciting. And we met with a young man. And of course, you have to think about COVID, they've been shut down for live meetings for a long time. And he was a fairly new legislative aid. And here comes four, I'll see three midwife faculty and four midwife students, including a British midwife. And his first live meeting with any constituents, and of course, we're flinging around words like vagina and cervix all over the place and just laughing, and just had a great time. So he'll remember us. Excellent. And being body positive, that's excellent. And I think that's where it becomes less daunting for students, the experiential piece of public policy exposure. We know anecdotally that it really does work to engage folks. And most people will say, wow, this was far easier and way more fun than I thought it would be. Exactly. That's what our students find. When they do three visits, as we used to do, the first one, they're universally nervous. And then they get through that and they understand that they're speaking what they know about midwifery to people less knowledgeable and promoting that. And it doesn't even have to get into the nitty gritty of all of the, like I said before, about all of the ins and outs of our practice. It can just be about telling the story of how you came to midwifery. That can be so compelling. I think so many folks, and I know this from my experience here in North Carolina, the most powerful story we can tell is of a person from a small rural area, a small rural community who's gone to East Carolina University for midwifery training to be able to go back and serve for community or his community. In the case of, you know, we've got a great midwife practice in Goldsboro that was started by a student who he was a nurse and a father of many and, you know, saw the need and figured it out. And, you know, those stories are so powerful. We don't have to go very deep for those. Yes. And I'll share another story, if I may, of a current faculty member at Georgetown had been a legislative aide. She was visited by a nurse anesthetist and so inspired by, you know, their passion for their craft and that she then was put on the path to become a nurse practitioner. And she ended up in Women's Health Nurse Practitioner and just finished a DNP with us. But we love her journey to us and all the skills that she brings with that. Very powerful. Yeah. I need her address. I'll send it to you. With her permission. You know, it is interesting too and I don't want to only focus on, you know, the legislative visits, but rather I think the challenge, like I said at the beginning, is to go to that next level. So if your next comfort level is serving on a committee in your hospital or clinic, do that. And then you build those skills, those communication skills, those leadership skills, and you build, you can build up to the legislative or you can stay being an advocate where you are. I think one of my greatest lessons in leading our state association was understanding that everyone has a part to play and everyone has a piece of it. So maybe not everybody comes to the lobby day. Maybe not everyone writes a letter. Maybe not everyone gets on TV and gets interviewed. Maybe not everyone has a social media presence. But everyone does have interaction with people. So use those interactions with people. Utilize your connections and be strategic about it. I think a lot of times too, our humility gets in the way of us promoting ourselves. And I think we need to be a little prouder and a little bolder about sharing what we do with the world. And sharing. And sharing. And sharing it again. And not getting tired of the repetitive nature of, oh gosh, these people still don't understand what's a midwife, especially in the US. The question we always get here is, oh, are you like a doula? Oh, I thought those were, or the other question is, I thought those went out with the horse and buggy. So making sure that you've got lots of patience and persistence is key. We have about six more minutes. I'll call on somebody else. And again, I'm going to reach out to folks from outside the United States to please share your experiences or share any questions that you might have. Oh, thank you, Ella. You're saving the day. Does anyone from the international public would like to share their experience? Ella Kane is writing in the chat right now. We could unmute you too, Ella, if you'd like. Oh yeah, you can use voice, Ella, if you want. Okay, she says, yeah, it's okay. Yes, we can hear you. I couldn't come off the chat. I was just saying, from a UK perspective, where government policy is very much in favour of midwifery, midwifery like care continuity, you know, it's in our national health service 10-year plan to have continuity of carer. So our advocacy is something a bit different. We're kind of faced with a lot of media attention towards midwives, claims of midwives pushing normality to a detrimental effect. So that's where our kind of, it's really more advocacy for ourselves as a profession, I think is a really important thing for us because ostensibly, we have support for us as a profession. I don't know if there's anyone else from the UK on here that would kind of agree with that, but we have a different focus that we need to pursue when it comes to our survival, I think. Yeah, I would agree with you because I see the headlines and I'm always stunned. There aren't any headlines about consultants damaging women or, you know, doing awful things. So I think, you know, it makes me think, too, that it's not just government, right, that we need to be advocating for as you've brilliantly illustrated. You know, it's the public perception and really fighting misogyny or overcoming misogyny, right? Because I think we are primarily, midwives are primarily women, that we need to combat that. And I think one of the things that's worked in the United States pretty effectively is coming at this from an intersectional approach and making sure that we're talking about autonomy. And not just our own professional autonomy, but the autonomy of the people that we're serving, right? Because I don't know, Ella, if, you know, the messages that you're giving in your advocacy would be focused about centering the people and not necessarily pushing an agenda of unmedicated birth. I think it's quite obfuscated in the UK, though, because of those very things like support, because we, within our framework of clinical governments, we very much have to have it in built, you know, interactions with women representatives of service users. That's very much, you know, every NHS trust maternity service will have a, what do we call it, maternity voices partnership where service representatives come regularly meet, express what they do want or don't want from maternity services. So I think there is something else going on there, and I wouldn't necessarily say it's misogyny. I think that that's part of parcel of it. I think that what's happening here is somehow an attempt to undermine the health service, the kind of, our socialized medicine, you know, because there is a creep of privatization of the NHS. And so, yeah, it happens that most of us are women and most consultants, well, I don't know about obstetricant, yeah, so I suppose medicine is very much more likely to be a male orientated, but part of it is undermining the system of midwives being at the forefront because there's this whole thing of slowly but surely capitalism having its way. You took the word right out of my mouth, capitalism, yes. Yeah, so say that again, capitalism, oh my goodness, it absolutely, absolutely. Oh, it was just getting good, okay. Yeah, I know right, sorry. I agree, thank you. Come see me at ICM in Bali. Thank you very much everyone, and thank you Suzanne for this presentation, because it's very important, I think, for the future of midwifery and other fields to push for advocacy and try to push the boundaries and comfort zones. So thank you everyone. Thank you.