Early Childhood Leadership: A Photovoice Exploration

The first five years of a child’s life represent critical windows in physiological, social-emotional, and cognitive development. Administrators of early childhood (EC) programs play a pivotal role in determining the quality of experiences that unfold for young children in center-based care. Using photovoice, semi-structured administrator interviews, and participant-observation, we aimed to identify the factors contributing to one center’s atypically excellent outcomes with diverse children and families. Our textual and photographic analyses revealed three findings. First, administrators saw themselves as embedded within a larger system of barriers characterized by low positionality within an educational caste system that is marked by pervasive resource scarcity. Second, with external supports marginal at best, they leveraged multiple internal supports and resources, including agency, interdependence, and advocacy. Third, administrators operationalized literacy leadership by building and sustaining a climate of professional support for teachers within a “25 Books a Day” guiding philosophy

The Duration of Spontaneous Active and Pushing Phases of Labour among 75,243 US women when intervention is minimal: A prospective, observational cohort study

Background Friedman\u27s curve, despite acknowledged limitations, has greatly influenced labour management. Interventions to hasten birth are now ubiquitous, challenging the contemporary study of normal labour. Our primary purpose was to characterise normal active labour and pushing durations in a large, contemporary sample experiencing minimal intervention, stratified by parity, age, and body mass index (BMI). Methods This is a secondary analysis of the national, validated Midwives Alliance of North America 4·0 (MANA Stats) data registry (n = 75,243), prospectively collected between Jan 1, 2012 and Dec 31, 2018 to describe labour and birth in home and birth center settings where common obstetric interventions [i.e., oxytocin, planned cesarean] are not available. The MANA Stats cohort includes pregnant people who intended birth in these settings and prospectively collects labour and birth processes and outcomes regardless of where birth or postpartum care ultimately occurs. Survival curves were calculated to estimate labour duration percentiles (e.g. 10th, 50th, 90th, and others of interest), by parity and sub-stratified by age and BMI. Findings Compared to multiparous women (n = 32,882), nulliparous women (n = 15,331) had significantly longer active labour [e.g., median 7.5 vs. 3.3 h; 95th percentile 34.8 vs. 12.0 h] and significantly longer pushing phase [e.g., median 1.1 vs. 0.2 h; 95th percentile 5.5 vs. 1.1 h]. Among nulliparous women, maternal age \u3e35 was associated with longer active first stage of labour and longer pushing phase, and BMI \u3e30 kg/m² was associated with a longer active first stage of labour but a shorter pushing phase. Patterns among multiparous women were different, with those \u3e35 years of age experiencing a slightly more rapid active labour and no difference in pushing duration, and those with BMI \u3e30 kg/m² experiencing a slightly longer active labour but, similarly, no difference in pushing duration. Interpretation Nulliparous women had significantly longer active first stage and pushing phase durations than multiparous women, with further variation noted by age and by BMI. Contemporary US women with low-risk pregnancies who intended birth in settings absent common obstetric interventions and in spontaneous labour with a live, vertex, term, singleton, non-anomalous fetus experienced labour durations that were often longer than prior characterizations, particularly among nulliparous women. Results overcome prior and current sampling limitations to refine understanding of normal labour durations and time thresholds signaling ‘labour dystocia’

Community Versus Out-of-Hospital Birth: What's in a Name?

The term out‐of‐hospital has long been used as a kind of shorthand to refer collectively to births that occur in birth centers or at home. However, this term has also been a persistent cause of concern among health care providers who attend births in these settings, and researchers and midwives are increasingly adopting the term community birth instead to refer to planned home and birth center births. Some who resist the term out‐of‐hospital have argued that it reifies hospital birth as normative and community birth as other, marginal, or alternative. Here we propose community birth as a preferable term because it labels the practice for what it is—instead of for what it is not. This argument is similar to those made by communities of color who have critiqued the use of nonwhite as a demographic category that elevates Euro‐Americans as the default race. Medical anthropologists have also compared the use of the term out‐of‐hospital to the tendency to call nonallopathic forms of healing complementary or alternative. Yet, many so‐called complementary and alternative medicine practitioners prefer to identify their forms of healing as holistic, integrative, or functional to indicate that modalities such as acupuncture, Ayurveda, chiropractic, and so on are autonomous approaches that may exist outside of, but are not subservient to or less than, allopathic and biomedical modalities. These health care providers, too, commonly choose to refer to their practice with terms that convey what it is, rather than what it is not, just as persons of color choose to be identified for who they are, not for who they are not

Development and Validation of a National Data Registry for Midwife-Led Births: The Midwives Alliance of North America Statistics Project 2.0 Dataset

INTRODUCTION: In 2004, the Midwives Alliance of North America's (MANA's) Division of Research developed a Web-based data collection system to gather information on the practices and outcomes associated with midwife-led births in the United States. This system, called the MANA Statistics Project (MANA Stats), grew out of a widely acknowledged need for more reliable data on outcomes by intended place of birth. This article describes the history and development of the MANA Stats birth registry and provides an analysis of the 2.0 dataset's content, strengths, and limitations. METHODS: Data collection and review procedures for the MANA Stats 2.0 dataset are described, along with methods for the assessment of data accuracy. We calculated descriptive statistics for client demographics and contributing midwife credentials, and assessed the quality of data by calculating point estimates, 95% confidence intervals, and kappa statistics for key outcomes on pre- and postreview samples of records. RESULTS: The MANA Stats 2.0 dataset (2004-2009) contains 24,848 courses of care, 20,893 of which are for women who planned a home or birth center birth at the onset of labor. The majority of these records were planned home births (81%). Births were attended primarily by certified professional midwives (73%), and clients were largely white (92%), married (87%), and college-educated (49%). Data quality analyses of 9932 records revealed no differences between pre- and postreviewed samples for 7 key benchmarking variables (kappa, 0.98-1.00). DISCUSSION: The MANA Stats 2.0 data were accurately entered by participants; any errors in this dataset are likely random and not systematic. The primary limitation of the 2.0 dataset is that the sample was captured through voluntary participation; thus, it may not accurately reflect population-based outcomes. The dataset's primary strength is that it will allow for the examination of research questions on normal physiologic birth and midwife-led birth outcomes by intended place of birth.This is the publisher’s final pdf. The article is copyrighted by the American College of Nurse-Midwives and published by John Wiley & Sons, Inc. It can be found at: http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291542-2011.Keywords: registry, data collection, research design, birth center, cohort study, home childbirth, parturition, midwifer

Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009

INTRODUCTION: Between 2004 and 2010, the number of home births in the United States rose by 41%, increasing the need for accurate assessment of the safety of planned home birth. This study examines outcomes of planned home births in the United States between 2004 and 2009. METHODS: We calculated descriptive statistics for maternal demographics, antenatal risk profiles, procedures, and outcomes of planned home births in the Midwives Alliance of North American Statistics Project (MANA Stats) 2.0 data registry. Data were analyzed according to intended and actual place of birth. RESULTS: Among 16,924 women who planned home births at the onset of labor, 89.1% gave birth at home. The majority of intrapartum transfers were for failure to progress, and only 4.5% of the total sample required oxytocin augmentation and/or epidural analgesia. The rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. Low Apgar scores (< 7) occurred in 1.5% of newborns. Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent. The majority (86%) of newborns were exclusively breastfeeding at 6 weeks of age. Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively. DISCUSSION: For this large cohort of women who planned midwife-led home births in the United States, outcomes are congruent with the best available data from population-based, observational studies that evaluated outcomes by intended place of birth and perinatal risk factors. Low-risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes.This is the publisher’s final pdf. The article is copyrighted by the American College of Nurse-Midwives and published by John Wiley & Sons, Inc. It can be found at: http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291542-2011.Keywords: pregnancy outcomes, home childbirth, midwifery, midwife, birth place, perinatal outcom

The Best of Me: Exploring Photovoice with Gilligan’s Listening Guide

This workshop will begin with an overview of our study of early childhood leadership in one high poverty community (Cheyney-Collante & Cheyney, 2018). We will set the stage for the context of the study: a day in the life of a child enrolled in a community childcare program situated in a high poverty neighborhood. Discussion will then include an explanation of our methods and an account of the photographic installation of results we co-created with participants, with an emphasis on how our findings disrupt narratives of early childhood in high poverty communities. Participants will then examine how we blended photovoice methods (Rose, 2007; Wang, 2006) with Gilligan et al.’s Listening Guide (Gilligan, Spencer, Weinberg, & Bertsch, 2003) by exploring examples of deidentified data. Finally, participants will experiment with their own brief, impromptu photovoice assignment and discuss opportunities for implementation of this and other democratizing forms of qualitative inquiry in their own contexts