 And we're good to go. And Cindy, take it away. You can do all the introductions. All right. Thank you, Lorraine. Happy International Day of the Midwife, 2016. And welcome to the Georgetown Student Cafe. My name is Cindy Harling, and I'm a midwife and faculty at Georgetown University's online nurse midwifery and women's health nurse practitioner education programs. Joining me later will be Jennifer Jagger, also a midwife and faculty at Georgetown University, and the current chair of the American College of Nurse Midwives Political Action Committee. We are so delighted to be broadcasting out to midwives and midwifery students around the globe. 18 midwifery students, in their final terms, are here on campus to share their experiences learning advocacy skills on Capitol Hill in Washington, DC. It was a happy occurrence when we realized that our students on campus time and their visits to federal legislators fell on the International Day of the Midwife. We used the materials prepared by the organizers of this day in our messages to our politicians and their staff. Before we get started, I would like to acknowledge a number of people who brought this event to fruition. The entire midwifery faculty of Georgetown University has been supportive of these visits on Capitol Hill and the Student FAA. This is a slide of some, but not all, of our esteemed faculty. The staff and volunteers of the American College of Nurse Midwives have helped with the scheduling of the visits and preparing our students to discuss currently supported federal legislation of interest to midwives here in America. And the organizers of this event are to be commended for their hard work, in particular, Seal Jevitt of Yale's Midwifery Education Program, and Lorraine Mockford, our tech support for this session from Nova Scotia. They both have been very helpful, and we thank you. Whether you are a fan of the fictional television shows Scandal or House of Cards, or if you've been following the circus show that is the American presidential election process, we know that politics and policy are important to the health of women and their families. Midwives can make a difference in the health policy arena for midwifery and women's health by advocating for legislation that promotes social justice and the common good. Political participation is addressed, but not a focus in basic midwifery education as students and faculty are prioritizing the acquisition and application of the foundational midwifery knowledge and skills to become safe beginning midwives. However, once new graduates step out into practice, they begin to realize the importance of legislation and regulation on the ability to practice to the full extent of their training and expertise. This importance is usually experienced as legislative barriers to practice. New midwives need to have beginning skills and political advocacy in addition to beginning skills in midwifery care in order to make significant positive change. Georgetown University, with its geographic location in Washington, DC, and its history of proactive engagement in federal relations in the United States, is ideally situated to provide powerful experiential learning for their midwifery students. Today, our students scheduled visits with their United States senators and representatives on Capitol Hill. As Congress is in recess this week, we met mainly with legislative aides and interns involved in healthcare. We anticipated that students would learn about the latest legislative initiatives of interest to midwifery and women's health at the national level, gain experience in communicating the value of midwifery and its contributions to women's health, to legislators and other stakeholders, and appreciate the influence of law and policy on midwifery practice and healthcare system. We hope going forward that these students who have had such powerful learning experiences in political advocacy will be more likely to engage in the health policy arena. I'm now going to turn the microphone over to the various students who will share their experiences and answer any questions that you have. Thank you. Hello, my name is Nicole Mortensen. And I'm Breanne Hudson. We are from Stafford and Phoenix, Arizona. The Grand Canyon and Suara Cactus are in Arizona and we are located in the Southwestern United States. There are 190 midwives that are licensed in Arizona currently. Midwives attend nearly 6% of all vaginal births in the state. This is better than many other states, but we have a long way to go to ensure the ideal of a midwife for every woman. Arizona is considered an independent practice state, meaning we do not have to have supervision by a physician. Today we visited Republican Senator Jeff Flake's office and met with a representative for Republican Senator John McCain. And I met with Senator or the senior legislative assistant for Republican Congressman Paul Gosar. And during the meetings today, I learned how enthusiastic these representative assistants are and how much midwifery really makes an impact across the world. We heard personal stories about how midwifery had involved people in their family and their friends. And it's great that we were able to talk to them one-on-one and really impact their thoughts about midwifery in the United States. And I met with the chief of staff for Democratic Congresswoman Ann Kirkpatrick, who is pregnant and due to give birth in June, and Shera Burke will be attended by some local Washington DC midwives. And both the chief of staff and Ann are both their friends of midwives. They understand the importance of midwives. Where I live in Arizona is very rural. We're a two-hour car drive from any sort of metropolitan area, as is most of the area that Congresswoman Ann Kirkpatrick is over. And so they understand the importance of getting midwives out to the people where they're at. And we talked about some legislation that can support that. So happy International Day of the Midwife. Goodbye, thank you. Hi, my name is Kate Washburn. I'm from Fairfield, Ohio, the heart of it all in the Midwestern part of the United States. Ohio has produced more U.S. presidents than any other state, but unfortunately it doesn't look like we'll be producing one this year. There are 359 midwives licensed to practice in Ohio, and midwives do about 6.8% of the birth. I visited Congressman Mike Turner, Senator Shera Brown, and Senator Rob Courtman's offices. It was really empowering to go out and educate as to what midwives are. Two of the aides had no idea. One said, like, I think I have a partner who's a midwife, but I don't really know what she does. So it was great to educate and ask for support. I felt like the reaction was positive. The aides were engaged, they were supportive, and overall it was a fun, rewarding, and educational experience. So I see myself continuing to stay active in the promotion of midwifery and legislation to allow midwives to practice the full extent of our education and training. Happy International Day of the Midwife. Hello, my name is Heidi Crookshank, and I am pursuing my midwifery education in Seattle, Washington in the Pacific Northwest of the United States. The population of Seattle is 662,400, and the Seattle Public Library items in circulation are 11,744,874. And if that number doesn't knock your socks off, compare it with New York City, population 8.5 million, circulating materials, 6.6 million. So a very educated, curious place to live, and going right along with that, when I spoke with aides and advisors to Senator Murray, Senator Murray, I can't well, and Representative Jim McDermott today, all three of them knew what midwives were, what they could do, and nodded knowingly when I still reiterated what we could do, and had very nice talks with all three office representatives. I thoroughly enjoyed today. I had the special privilege of going to meet with those offices accompanied by Jesse Bushman, who was in a previous slide, and Patrick Cooney, and I really appreciate this opportunity. Thank you very much Georgetown faculty and happy International Day of the Midwife. Hello, my name is Lisa Johnson. I'm from Howell, New Jersey, and in New Jersey we have 299 midwives that was in 2015, and certified nurse midwives have attended 7,437 births in 2013, which is 7.25% of all births, and vaginal births were attended by midwives at 11.69%. Today we met with Senator Bob Menendez of the Republican Party and Senator Corey Booker of the Democratic Party. We met with their staffers, and we had some mixed reviews, mixed experiences with them, mixed levels of education regarding midwives, and mixed reception of midwives, and we really learned the importance of advocacy for women's healthcare legislation, and we are the voice of the women, and it is important for us to spread the education about who we are as midwives, and what we do, and we, going forward, definitely are looking forward to getting more involved in the legislative process, and really moving forward with improving healthcare for women and improving outcomes with legislation in the future. And my name is Lori Knoth. I went along with Lisa, who you just heard speaking to talk to the senators and a congressman of the state of New Jersey, where I also live. I was in Hoboken, New Jersey, which is outside of the New York City metro area. So it's a really interesting patient population with really individual needs, considering the region and the diversity and just women's healthcare needs in general being for women. Like Lisa said, we had a really interesting day on the Hill, but I think the most important thing to think about when you're advocating for women's health or for midwifery is that the most important thing is just to show up. So just to be there, just to show yourself, just to be visible, no matter what country you're in or no matter what city you live in, what kind of town you live in, or the types of limitations or challenges that you face as a midwife, just showing up, but letting people know about that is important. And most importantly, and what we found today was that people didn't really care how much you know until they know how much you care. So if you go in there with something that you're passionate about, whether it's a bill that's being passed in legislature that could really pave the way for other midwives, or if it's some kind of social constraint that you have in the community that you're in that would possibly interfere with the delivery of healthcare to women or your own provider care, I think that it's important to know what those things are and just to identify the problems that you have and to go out in front of somebody and that can make a change, whether it's a congressperson or a senator or some kind of a community leader and just get it out there because that's where change begins. And so if there's enough people like there is on a day like today for the international day of the midwife, many voices speak together and they're all speaking for the women that do not have voices. And that is what midwifery is all about. So even if you're not experienced in politics, if you don't know how a bill is passed, it doesn't matter if you love midwifery and if you think that women deserve that, then there's something that you can do and it's just a matter of showing up. So happy international day of the midwife from us here at Georgetown and get out there and make a change. You're already doing it with every one of your patients. So keep it up. Hi, my name is Stacy Sheeran and I am also representative of the student body at Georgetown North-Smidwives. And I come from the state of Virginia where we have currently as of 2015, 263 certified nurse midwives. Within that we have 736 of those, 7376 of those attended births by certified nurse midwives. The percentage of all births attended by sort of by nurse midwives in the state of Virginia is 7.22% and the percentage of all vaginal births attended by certified nurse midwives is 10.65%. So with that, our state does need more representation of certified nurse midwives and I am glad to say that I will be one of those to help add to the number in that state. Today I was able to speak with two representatives. So Mark Warner was not available if I spoke with Charlie Arnawitt and then, and he's part of the Senate and then our representative for my district, Randy Forbes was not available so I spoke with Chris Manable. I also had the privilege of speaking with them last year with the ACNM conference when we did lobbying. So it was quite impressive that they did remember seeing me last year and remember some of the points that I mentioned prior. And so when I asked them again, if they remember where the midwife was, it was nice to hear that they still remembered. But it was also important to note that they did kind of forget that we are studied under master's degree prepared and there are some differences that they didn't quite understand and that was nice to be able to educate them on that. They also didn't understand the shortage and they didn't understand what great benefit a midwife is in practice to women, children and their families. So as we know when we care for the women we care for the entire family. So it was important to make sure that they understood that. In addition to we were also able to bring into light the bills that we currently have and play in both the Senate and the House. So they were very impressed to hear that and see what ways they can help to make things better for everyone. My name is Elizabeth Lannick. I'm a student nurse midwife at Georgetown University and I actually live right here in Washington DC. Washington DC is a great place to be a midwife and incredibly independent and supportive practice environment in DC. We do have representation from delegate Eleanor Hans-Morton. Unfortunately she does not have a vote. So I chose to join Stacey to talk about Virginia and what was really wonderful about visiting people and talking about Virginia is the staff members that we were meeting there they represent Virginia but they all live in Washington DC. So when I was able to tell them that midwives practice right here in Washington DC there are 33 certified midwives in DC and 10.7% of births in DC are attended by CNN. It really kind of drove the point home that the hospitals that are right there in their neighborhoods have practice in CNN and their family, their friends, their neighbors are having births attended by certified nurse in the Y. So I really want to talk to them about that and also just to learn more about the future of Virginia. Hi, this is Katie. I am also in DC but decided to join along with Stacey in the Virginia meetings. Just to echo what they said already I was really impressed with how much more interest they seem to have this year from the meeting that Stacey had last year. Stacey said in one of her meetings last year she was in a hallway for five minutes this year we got to sit in the representative's office and spent over 20 minutes and he was engaging us in a lot of questions, clarifications and just where the future of midwifery is. I think there's a lot of focus on this now as people are really looking to birth choice. So I'm happy to be a part of this community and happy to be here celebrating International Day of the Midwife. Hello, my name is Ashley Honesby-Clark and I'm from Sulphur, Louisiana, home of Mardi Gras and currently in my state there are 52 licensed midwives to practice and as of 2013 there were 2.62% of midwives that attended all births and 4.27 that attended vaginal births. I visited with David Vitter's healthcare advisor, Taylor and also with Bill Caspi's advisor, Genevieve and what I found was they were very receptive to the information that we were there to present. I went into this very naive and not knowing very much about the legislative process and I still do not know very much at all about the legislative process. But what I do know is that our presence here on the Hill today was important, it was necessary and whatever, even if my senators do not come on board with the bills, I planted a seed. So that next go round, when the next cohort comes that seed can blossom a little more and a little more and a little more until it's time for them to finally jump on board. And I'm excited about that. I'm excited to go back home to Louisiana which is not a midwifery friendly state. Take what I've learned here, apply it to my state and hopefully Louisiana can start to have better outcomes and we can take care of women with all of these healthcare disparities that come from a very poor area. So I'm very, very, very excited to take what we've done here on the Hill back home and happy international day of the midwife from us over here on the Hill with Georgetown University. Hello, this is Morgan. And this is Marion. And we are talking to you in D.C. but we are from Illinois. I am from Chicago, Illinois. And I'm from Belleville, Illinois which is right across the state line from Missouri. We have 444 midwives in the state of Illinois. We do 8.9% of a birth in the state and we have two birth centers, one in Chicago and then one out in the rural area. And this has taken about 10 years to get a birth center up and running. So it's been brought to you by some wonderful midwives locally in Chicago and they did an incredible job getting that up and running. Today we visited Senator Durbin and spoke to his legislative aide and it was such an encouraging meeting. She reinforced and reaffirmed Senator Durbin's interest in women's health and the midwifery. And he even told us about other bills that he's supporting to increase funding to midwives and title eight. And was very interested in the bill that we talked about today. So that was very exciting to hear that he referred with the work that we are doing. Absolutely. Unfortunately, we didn't get to meet with anybody else on our list from our state who represents the voters in our state but we were able to drop off some information on material and we do hope that it will take the time to read and one of the senators is also our main sponsor of our access to maternity care bills. So hopefully we'll be able to follow up with him and continue to stay involved to make sure that Illinois moms get the best available care from us. So happy International Day of the Midwife. For me too, happy International Day of the Midwife. Okay. Hi, I am Melissa Wilmars. I'm a student nurse midwife at Georgetown University. I am from San Diego, California. Fun fact about my district is that we have ridiculous delicious Mexican foods literally on every single corner as a wonderful place to eat. And in my district, there are approximately 43, there are about 1,028 midwives in the state of California and about 43,000 births that are attended by midwives. The total number of births attended by midwives are just under 9% at 8.72. And I was able to have the honor to visit with my congress, excuse me, my senator, Diane Feinstein. I met with her medical fellow, Dr. Tyler Lorrig. And it was a really wonderful meeting. He had lots of questions about midwives. He didn't even, he honestly didn't even know anything about them. He was very, very interested to learn all about what we do and all the information that we could pass along to Senator Feinstein. So it was a really encouraging meeting. I also had the opportunity to meet with the staffer of congress person, actually my representative, Devin Munoz. I met with his assistant, her name is Ruth Hasdavak. She was super awesome. She had a lot of questions as well and she was very interested in passing along the information to Mr. Munoz about midwives in California. And it was really awesome to speak with her most specifically because she is from, literally from right down the road from my hometown. And so she knows and understands that we have a lot, a lack of midwives in my area. So it was really awesome to talk to her. And I was really nervous starting out lobbying but it actually turned out to be really, really fun. And I really hope I have an opportunity to do it again. And yeah, so I hope you guys have a great day and have the International Day of the Midwives. My name is Amanda Willey and this is Casio Deore, right? We are both from Maryland. And an interesting fact about our state is the state court is gel stuck. So there are 290 midwives licensed to practice in our state and midwives do 15% of all the vaginal births in the state. They have performed almost 7,000 births actually in the year 2013, our most recent data is from that year. Today, myself, Amanda and Tally and Allie who will speak next visited representatives Van Hollen and Harris and Senators McCalkey and McCartan. I was really impressed with how today went and how the staff members were to meeting with us. We had one staff member whose wife is due on Monday and was telling us how a face to her his wife is. So we were able to sort of speak on a midwife level and that was very encouraging especially because the senator has been resistant to midwife support of girls in the past. So to have a staff member whose wife was going to be delivered by a midwife was very encouraging and he's going to definitely speak to the senator on our behalf. So and one of the other senators that we met with was really able to relate to the lack of access of care especially with primary and maternity care providers that we are with the bill that we're talking about. His county has no hospitals and no maternity providers or OBs or midwives. So he was really interested to hear about he was really interested to hear about some of the bills that we were discussing and excited for more information. So it really was a great, a great learning experience. Hi, I'm Tally. I was also with Katya and Amanda and me. I had a great experience in representatives of the Young Holland office. We spoke with a young woman who was a staffer. I know Clint East probably and she knew nothing about midwifery so it was really cool to educate her on that and she was just so interested. We actually spent a long time chatting with her about what midwives do and then at the end of the meeting she said, I just can't wait to have a midwife. So it was a pretty cool experience and we got to talk about those bills with her and she was very excited to chat with the representative about that. So it was a pretty cool experience. Yep, and I'm Allie and I'll just kind of read on everything that everyone said already but it was just an amazing experience to share what we've been learning about this entire program and share our excitement and it was really awesome to see how excited the people that we spoke with responded to us and not many only knew about midwives and now they all seem to be much more educated and much more excited to share what we told them today and hopefully this makes a big impact on what they relay to the congressmen and the representatives that they work for. I think that's all I have. Thank you and happy International Day of the Middle. Hi, my name is Jennifer Jacker and I am faculty at Georgetown University. I wanted to thank all of the students for both their full engagement and enthusiasm in today's most amazing opportunity. The students, some of them were nervous, all of them were excited and all of them just represented the profession of midwifery both here in the United States and around the world very well. So a huge virtual applause please for the students and they're just absolutely awesome participation. Happy International Day of the midwife to everyone who is listening, tuning in. I want to also echo the sincere thanks expressed by Dr. Farley to the virtual day of the midwife organizers as well as the Georgetown University and faculty and staff who were instrumental in putting this effort together. To the American College of Nurse Midwives Volunteers as well as staff for coordinating this effort and participation in the day of and again for just these awesome students for their energy and commitment to the profession both clinically and also professionally advocating for legislation and policy that can make our job easier and in turn make the care of women and babies improve outcomes and make our communities healthier. So it's comes full circle. In closing, I'd like to highlight a few things that the students remarked on. It is in addition to being faculty at Georgetown University, I'm also the chair of a committee with the American College of Nurse Midwives who focus on political activities and on advocacy and government affairs work. So I believe fully, it is so important that midwives engage and advocate for changes in health policy legislation and regulation in their hospitals, in their cities, in their counties, in their states. At the federal level, which is what we all did today and also around the world, many midwives engaged in global efforts and the challenges to provide high quality care to women and babies around the world is great. But we have to start here at home too because we could do a lot of things better. And we have the hands and the skills and the love and the dedication, but there are a lot of barriers to practice that we need to get fixes for. And if we aren't going to policy makers, if we aren't engaging in dialogue about how to make change and what change needs to happen, it just won't get easier to care for women and babies the way that they deserve to be cared for. The healthcare system here in the United States is not perfect and we can't make great big leaps in changes all at the same time, but we are trying to make incremental changes that will benefit the patients that we care for. Specifically, there were three pieces of legislation, three bills that we were discussing with federal legislators today. The students and faculty brought the Quality Care for Moms and Babies Act, which is a bill that would improve maternity care for women and families. It's Senate Bill 466 as well as a House Bill, Companion Bill 4695. And students were talking with their legislators today about quality measures and how if we pay for outcomes, good outcomes that midwives typically provide, we're really known for our high quality outcomes. Instead of for procedures that maybe don't have as high outcomes, then we, this is a way to improve maternity care. So really looking at what are quality measures, identifying areas, opportunities for improvement and seeing with changes in policy how that can improve. Also, another bill that we looked at was improving access to maternity care Act of 2015, which is a HRSA, the Health Resources Services Administration Bill that looks at designated areas around the country that don't have adequate maternity care providers. Right now HRSA looks at shortages in terms of primary care providers and this bill would help identify areas around the country where we need more maternity care providers and pay more attention to the sometimes rural, sometimes urban areas where midwives and OBs are needed in order to help the communities be healthy. There was also an education piece that we were talking with some senators and legislators, representatives and their staff about it's a piece that looks at how can we improve access for students to more preceptor sites and that's a reimbursement for teaching both midwives here in the United States that are teaching residents and medical students as well as midwifery students, how do we incentivize the growing of our young and helping to bring more midwives and other maternity care providers into the workforce. So all really important issues, specific federal legislation that can help with the maternity care problems that we have in the United States. There are issues at the state level and again at local levels and global levels but that was our focus for today. The students all have now the responsibility of following up with their state leaders, midwifery state leaders as well as leaders at the national level reporting to midwives in their state about the conversations that they've had with their representatives and also encouraging other students and other midwives to engage and to advocate for changes that will help us care for women and babies in a more efficient and more effective way. We can make a difference not just at the bedside but in terms of systems change and it takes days like this and everyone coming together and supporting each other to make that happen. So again just a tremendous applause pat on the back, job well done to the students and the faculty and thank you to the organizers of the International Day of the Midwifery and this opportunity for students to cafe about their experiences. Are there any questions from anyone in the audience? Feel free to type your questions in chat or to open your microphone and ask a question there but identify yourself if you do grab the mic. Well here's one and maybe I'll just throw it out to the entire room. If you had an opportunity to speak to your legislators what would you say to them about midwifery and midwifery? Hi Lorraine, this is Cindy. Hi Lorraine. Go right ahead. It looks like we don't have many questions so my message to the global viewing audience is to get involved in politics and policy whatever that looks like in your own country and to support midwifery do that in groups. I think it's much more helpful and user friendly to teach our students to value this activity is also important. And it looks like we're gonna end early so thank you so much Lorraine. You've been a great help and happy International Day of the Midwifery to everyone around the world. And happy International Day of the Midwifery to you as well. How wonderful to hear these wonderful students have been doing it. What a terrific opportunity for you. They're all excited too. All right, we're gonna sign off Lorraine. Thank you for your help. Okay, thank you very much. And if people wanna stay around and chat that'd be lovely but I am going to close the recording now.