Call the Midwives: Yale Nursing Clinicians Practice, Teach, and Advocate

October 4, 2021

Yale School of Nursing (YSN) is full of clinicians who love pregnancy and babies. Studying them, researching them, and teaching the next generation of midwives all about them. Pregnant members of the community walking the halls have been known to sharpen a keen sense of any midwives in the building “just in case!” 

Midwifery Week runs October 3-9 and offers an opportunity to explore the clinical practice, teaching, policy work, and research of these faculty who have dedicated their careers to providing the highest quality care to childbearing individuals and the best outcomes for their children.

Alternative Models of Maternity Care

“Many midwives are drawn to the excitement around pregnancy and birth and have a passion for changing the way health care is provided,” said Associate Professor of Nursing Dr. Gina Novick ’83 MSN, ’09 PhD, CNM, FACNM. “Group prenatal care is a person-centered approach that empowers patients and gives them the opportunity to become agents in their own care.”

A longstanding member of the YSN faculty, Novick pursues a range of research and policy interests that focus on understanding and implementing alternatives to conventional models of maternity care, such as group prenatal care. In this model, groups of 8-12 patients with similar due dates and their significant others come together to receive prenatal care in a group setting. 

When they arrive, patients take their own weight and blood pressure and then a prenatal abdominal exam is conducted by a prenatal care provider (such as a midwife) off to the side. After patients are examined there is facilitated group discussion for 60-90 minutes. Topics range from common pregnancy discomforts, nutrition, and baby care to preparation for childbirth and pain relief in labor. An important part of the experience for patients is the connection participants develop with others in the room.

Novick said research indicates that this evidence-based model reduces preterm birth, reduces racial and ethnic health disparities, and improves psychological and social outcomes. And it gets great reviews from patients and providers. Before COVID-19 hit Connecticut, Novick had been working on reintroducing the model to Yale New Haven Health with her colleagues and is hopeful she can continue that work when the pandemic recedes.

Childbearing Individuals and COVID-19

Women’s Health Nurse Practitioner Specialty Director Dr. Tamika Julien, DNP, CNM, WHNP-BC, CLC has nearly a decade of clinical experience as a women’s health nurse practitioner in a federally qualified community health center (FQHC) and has worked extensively with adolescents. As a certified lactation counselor, her doctoral research focused on improving exclusive breastfeeding rates in the immediate postpartum period. 

Dr. Julien arrived at YSN in January 2020, just before COVID-19 closed the majority of the school for the rest of the year. She is working towards continuing her research to promote and increase exclusive breastfeeding. Dr. Julien is currently partnering with Dr. Joan Combellick ’91 MSN, PhD, MPH, CNM, FACNM to research how COVID-19 impacted childbearing individuals who gave birth during the pandemic. 

As Dr. Julien told Yale Nursing Matters magazine, “We saw how the pandemic underscored the importance of the midwifery model of care. Childbearing individuals wanted to be heard, have their needs valued, and appreciated shared decision making. We had childbearing individuals who changed their birth plans in the middle of their pregnancy to seek midwifery care with interest in a home birth or birth center because of COVID-19 concerns.”

Simultaneous Teaching & Learning

Erin Morelli ’02 MSN, CNM, CLC, FACNM, is the Director of the Midwifery Faculty Practice, a collaborative full-scope practice at Yale-New Haven Hospital, Cornell Scott Hill Health Center, and Yale Medicine. Morelli is currently pursuing her PhD and her research interests include midwifery pedagogy, role transition, collaborative practice in obstetrics, and use of early labor tools such as walking paths to delay admission in early labor. She also is a certified lactation counselor and is passionate about supporting lactation.

In addition to clinical practice, Morelli also teaches every semester and introduced a new assignment and activity on health disparities for GEPN students in the spring with Dr. Sascha James-Conterelli, DNP, CNM, LM, FACNM and Wendy Mackey ’93 MSN, APRN-BC, MSN, CORLN. At the end of the fall semester, her first-year midwifery students will test their skills in an OB Escape Room exercise.  

Morelli is the chair of the YSN Academic Success Team (AST) that works with students who are experiencing life/health events that are impacting their learning. She also co-chairs the American College of Nurse-Midwives Student and New Midwives Committee.  Earlier this year, she was honored with the Nightingale Award for Excellence in Nursing.

A Collaborative and Global Model

In addition to serving as the PI of the Birth During COVID Study, Interim Nurse-Midwifery Specialty Co-Director Dr. Combellick conducts ongoing research at the nearby West Haven VA Medical Center. Her work with veterans relates to severe maternal morbidity and mortality and the intersection of maternity care and mental health care services, especially in the area of chronic stress and trauma.  

Dr. Michelle Telfer, DNP, MPH, CNM, FACNM, also an Interim Nurse-Midwifery Specialty Co-Director, has created a thriving partnership with Makerere University in Kampala, Uganda and Mother Health International in Atiak, Uganda to allow midwives, residents, and midwifery students from Uganda, Rwanda, and YSN to experience the midwifery model of care and physiologic birth in the clinical setting. She has a strong focus in global public health and an ongoing program of research that relates to exercise and pregnancy.

In an example of the collaborative and global nature of midwifery, Dr. Combellick and Dr. Telfer joined forces to launch YSN’s first Coursera course in 2020, “Global Quality Maternal and Newborn Care.” More than 6,500 students have enrolled in the free online course designed for health administrators, policy makers, clinicians, and advocates.

One user described the class this way: “This was an incredibly insightful and well-taught course. I was so appreciative to break away from fully Western standards, to learn from educators all over the world. This was a person-centered, inclusive, and culturally sensitive course that was thoroughly enjoyable and useful.”

Internationally Recognized Research

The Coursera course is based on a landmark 2014 Lancet journal series on midwifery co-authored by Helen Varney Professor of Midwifery Dr. Holly Powell Kennedy, PhD, CNM, FACNM, FAAN, an internationally renowned researcher.

Dr. Kennedy is also deeply involved in the Quality Maternal & Newborn Care Research Alliance that brings international researchers together to collaborate on research priorities identified as a result of the Lancet series.  

Coming up next in this area is the international conference “Normal Labor & Birth: 20 Years of Evidence and Debate” on December 1 and 3. The summit is cohosted by Professor Kennedy and YSN and Professor Soo Downe at the University of Central Lancaster in the United Kingdom. 2021 marks two decades of researchers gathering to share and debate the evidence on supporting normal, physiologic labor. Registration is now open.

Better Health Policy Through Midwifery

A practicing midwife for nearly two decades, Dr. James-Conterelli, is the new Chair of the Graduate Entry Prespecialy in Nursing (GEPN) program. 

In addition to her clinical practice, Dr. James-Conterelli has also pursued policy and advocacy work. She served as a member of the COVID-19 Maternity Task Force for the state of New York and co-chaired a Maternal Mortality and Racial Disparities Task Force at the state level. Dr. James-Conterelli sat on New York State’s Maternal Mortality Steering Committee and the New York State Maternal Mortality Review Board. 

In a few weeks, Dr. James-Conterelli is being honored as the recipient of the 2021 Diane O. McGivern Legislative and Policy Award in recognition of her outstanding work in legislation and policy on behalf of professional nursing. Later this month, she will also celebrate induction as a Fellow in the American Academy of Nursing.

Interdisciplinary Social Justice

As a student at YSN, Ash Draper ’16 MSN, CNM, WHNP-BC enrolled in the US Health Justice pilot course designed for future nurses, doctors, and physician associates. Now a Lecturer in Nursing, Draper serves as a Faculty Advisor for the same class. 

The course aims to “teach health profession students about health inequities that manifest as a result of social marginalization and structural inequities,” as well as how to address those inequities as future providers. Objectives include gaining anti-oppressive, trauma-informed clinical skills, training provider activists and organizers, and advancing health justice in classrooms, clinical practices, and across the country.

In this model, the not-for-credit course is completely student-run by elected leaders who took the class the previous year, and Faculty Advisors provide assistance. Student leaders design the curriculum and facilitate the classes each week, often welcoming community leaders and activists. Enrollment is limited to about 30 students to allow for the intimacy of deep discussion.

“It is our job as healthcare providers to be knowledgeable not only in nursing and medicine, but the larger system in which we work and our patients live,” Draper said. “To effectively address patients’ healthcare needs we need to actively consider the roles of race, class, gender, and the environment.”