Identifying Drivers and Barriers to Precepting Midwifery Students: "A Little Part of Me Lives on in Each Student Midwife".

INTRODUCTION: Increased access to midwifery care is one strategy that could improve perinatal health outcomes and help address the maternal health crisis in the United States. A modifiable barrier to increasing the workforce is greater access to midwifery preceptors for clinical training. The objective of this research is to use the socioecological framework to identify midwives' perceptions of the barriers and facilitators to precepting students in clinical areas. METHODS: Midwives attending a preceptor education and training workshop series responded to 3 different questions at the end of each session: (1) What makes precepting midwifery students challenging? (2) What makes precepting midwifery students possible? and (3) What makes precepting midwifery students worthwhile? Responses were coded to align with the socioecological framework, which distinguishes individual, interpersonal, community, institutional, and policy-level influences. RESULTS: Midwives' responses were spread across the levels of the socioecological model except for policy. Participants identified institutional influences such as support as factors that made precepting feasible, both individual and interpersonal factors such as time constraints as areas that presented challenges to precepting, and community factors, like the joy of sharing midwifery, contributing to what made precepting worthwhile. DISCUSSION: Multiple levels of influence were identified in the preceptor process. Participants were internally motivated to precept while also articulating that to make precepting possible, there is a need for support from both colleagues and the greater systems within which they worked. Further studies are needed to investigate an ecosystem that facilitates an effective and sustainable model for midwifery precepting. Additionally, there is a need for efforts to engage and educate midwives in clinical practice about government advocacy that could actualize policy initiatives to support clinical midwifery education.

"You and Me Do It for the Love of Teaching": Exploring the Expansion of Clinical Training Opportunities for Midwives.

PURPOSE: To better understand the barriers and facilitators to precepting midwifery students from across the healthcare ecosystem in New Jersey. BACKGROUND: Growing the midwifery workforce is a crucial step to alleviating disparately poor perinatal health outcomes and expanding access to care. Difficulty recruiting and retaining preceptors has been identified as a barrier to graduating more midwives. METHODS: In-depth qualitative interviews were conducted with 19 individuals involved in different stages of the clinical training process: midwives, physicians, and administrators. Transcripts were coded using the tenets of qualitative description and thematic analysis. Analysis was guided by the Promoting Action on Research Implementation in Health Services framework. RESULTS: The following themes were identified and organized within the domains identified by our conceptual framework. Evidence: (mis)understanding the benefits of midwifery care and impacts on patient care. Context: the time and energy it takes to precept and practice considerations. Facilitations: developing the next generation of healthcare providers and the quiet and ever-present role of money in healthcare. CONCLUSIONS: Findings from this study support the importance of approaching midwifery precepting as a multifaceted endeavor, one that necessitates the full support of individuals within many different roles in an organization. IMPLICATIONS FOR PRACTICE AND RESEARCH: Getting buy-in from various levels of the healthcare ecosystem requires a flexible approach but must include a targeted effort toward showing the value of midwifery care in terms of patient outcomes, satisfaction, and cost.

Educating Housekeeping Staff to Encourage a Culture Supportive of Breastfeeding.

Latina women breastfeed at high rates immediately postpartum but also frequently introduce formula. Formula negatively affects breastfeeding, and maternal and child health. The Baby Friendly Hospital Initiative (BFHI) has been shown to improve breastfeeding outcomes. A BFHI-designated hospital must facilitate lactation education for clinical and non-clinical personnel. Housekeepers, often the sole hospital employees sharing the linguistic and cultural heritage of Latina patients, have frequent patient interactions. This pilot project at a community hospital in New Jersey investigated Spanish-speaking housekeeping staff's attitudes and knowledge regarding breastfeeding before and after implementing a lactation education program. After the training the housekeeping staff overall had more positive attitudes toward breastfeeding. This may, in the short-term, contribute to a hospital culture more supportive of breastfeeding.

Creating an Alianza: Group Perinatal Education for Newly Immigrated Latinx Pregnant People.

Pregnant people who are recent immigrants often face barriers navigating the health care system and establishing a support network to sustain them through pregnancy and new parenthood. The Cultivando una Nueva Alianza (CUNA) program from the Children's Home Society of New Jersey was created to address these obstacles. For over 20 years, CUNA has collaborated with local midwives to develop a program for newly immigrated, Spanish-speaking Latinx pregnant people. The curriculum, facilitated by trained members of the community, provides education around pregnancy, birth, and early parenting and connects participants with prenatal care and community resources while cultivating a social support network. The program's success is seen in improved clinical outcomes, ongoing involvement by graduates, and strong continued support from community stakeholders. The CUNA program has been replicated in nearby communities and offers a blueprint for a low-tech intervention to improve the health and wellness of this population.

Navigating Uncertainty: A Case Study of Intrahepatic Cholestasis of Pregnancy.

Intrahepatic cholestasis of pregnancy (ICP), the most common liver disorder of pregnancy, is associated with complications for both a pregnant person and their fetus. The underlying cause is not well understood. The pruritus associated with ICP is uncomfortable for pregnant people; however, the primary concern is the fetal risk. Fetal risks include preterm labor and birth and intrauterine fetal demise. This is particularly significant for certain populations because of the disparities in incidence of ICP; in the United States, it disproportionately affects Latinx people, the largest and fastest-growing minority population. Diagnosis, monitoring, and treatment of ICP are vital to reduce discomfort from pruritis and avoid potential fetal demise. However, diagnosis and treatment are complicated by the lack of definitive diagnostic criteria, the frequent delay in laboratory analysis, and the cost of treatment. This case report aims to improve midwives' familiarity with ICP and discusses the epidemiology, risk factors, presentation, diagnostic criteria, and available management strategies for this disease as well as the importance of anticipatory guidance regarding increased lifetime risk of ICP in future pregnancies and hepatobiliary disease. Additionally, it discusses the challenges involved in diagnosis and access to treatment. Prompt diagnosis and initiation of treatment may reduce fetal morbidity and mortality.

Our Work Outside the Birthing Space: Advocating to Improve Outcomes.

In this column, the authors discuss the vital role birth workers can play in shaping policy that affect the birthing people and families they serve. The authors review recent policy changes that have tremendous potential to improve maternal child health outcomes. Additionally, they provide concrete suggestions regarding how birth workers can actively engage in government affairs at the local and state levels.

Antitumor effect and underlying mechanism of RGD-modified adenovirus mediated IL-24 expression on myeloid leukemia cells.

Interleukin-24 (IL-24), a member of the IL-10 cytokine gene family, causes growth suppression and apoptosis in various solid tumor cells. However, the effects of IL-24 on hematopoietic malignant cells have not been extensively explored. In this report, we constructed an RGD-engineered recombinant adenoviral vector, Ad.RGD-IL-24, and assessed its effects on human myeloid leukemia cells. Ad vector mediates gene transfer into leukemia cells with high efficiency. Ectopic over-expression of IL-24 has significant growth inhibition and differentiation inducement effects on these cells. Treatment with Ad.RGD-IL-24 could potentially induce leukemia cells' cell-cycle arrest. In addition, IL-24 expression could significantly induce apoptosis of the THP-1 cells. Ad.RGD-IL-24 had a potent effect on the up-regulation of the expression of GRP78/Bip, GADD34 and Bax, down-regulation of the expression of Bcl-2 and Mcl-1, and induced the activation of Caspase-3, which may be responsible for its apoptosis-inducing effect on THP-1 cells. Furthermore, IL-24 expression could retard transplanted leukemia cell tumor growth in vivo in athymic nude mice. These findings showed the marked antitumor activity of IL-24 and provided potential perspectives in designing therapeutic or vaccine strategies in immuno-gene therapy of myeloid leukemia.