June is month of celebrations for me personally and for PQI. I have so much to be grateful for and so much to celebrate. Here are four things I want to highlight this month:

First – June is the Institute for Perinatal Quality Improvement’s 10^th birthday!! We have accomplished a lot and there is even more we plan to accomplish. A few highlights are the creation of the SPEAK Up Program, the launch of the Intermittent Auscultation Simulation-Based education, the Birth Equity Modules Course, and the expansion of quality improvement capacity throughout perinatal health professionals throughout the United States. Thousands of perinatal health professionals have enhanced their expertise and improved their practice because of our free webinars, free resources, coaching and consultation services, and live in-person and virtual educational programs, and online modules.

Second – on June 8^th I am being given the Association for Women’s Health, Obstetric and Neonatal Nurses’ (AWHONN) Lifetime Achievement Award. This award is particularly meaningful to me because AWHONN has been my professional organization for decades. I also had the privilege of being a vice president of AWHONN from 2010-2016. In this role I spearheaded landmark initiatives including the implementation of the first staffing guidelines, the Postpartum Hemorrhage Project, POST-BIRTH Warning Signs, the Maternal Triage Index, and the Don’t Rush Me…Go the Full 40 campaign. These efforts reshaped standards of care, informed national campaigns, and elevated nursing’s voice in patient safety.

Third – Renee Byfield and I had our paper: Advancing Birth Equity Through Quality Improvement Education: The SPEAK UP Champion Course published in Health Equity. This paper highlights how the SPEAK UP Champion implicit and explicit bias course improved awareness, attitudes, knowledge, and behaviors about how to mitigate perinatal racial and ethnic disparities. Read it here. 

Fourth – I was able to share my son David K. Jones’ book Ripples of Hope in the Mississippi Delta: Charting the Health Equity Policy Agenda with students, public health leaders, and local elected officials. This included two in-person events hosted by the North Shore NAACP. I’m proud to announce the distribution of about 80 books to local town and public health leaders who work in Northern MA. This is in addition to distributing his book in February 2025 to every MS state legislator. I also used David’s book as a supplement to the Population Health course I taught at Curry College School of Nursing. It is a great gift to have so many people consider David’s ideas and discuss them with me and see how his ideas resonate with so many people. I also got to personally congratulate two students who were given the David K. Jones scholarship award sponsored by Boston University. Natalie Bower, a writer volunteering for the North Shore NAACP, wrote up a short life sketch about me and my son David. Here is a link to her write-up.

I hope to see many of you in Florida and online. Stay tuned because we are going to be announcing different ways to say thank you during 2026 to everyone who has supported us these past 10 years! 

All the best,

Debra

Do you know the differences among Research, Evidence-Based Practice, and Quality Improvement?

In 2015, I was hired to expand the rigor of the University of Maryland School of Nursing's Doctor of Nursing Practice Projects. While I started meeting with faculty to explore how I could best support their efforts, I found I needed a quick way to talk about the relationships among evidence-based practice, research, and quality improvement.

I created Bingham’s Evidence-Based Practice Quality Improvement Flow Chart to facilitate my discussions with faculty and students. The flowchart went through multiple iterations based on these conversations and also based on the feedback from students who have completed PQI’s Quality Improvement Essentials course.

This past fall I accepted the position as an Associate Professor for Curry College. At Curry, I am teaching master’s level students how to develop, implement, and evaluate QI projects. I have once again pulled out this flow chart that helps me explain to them the relationships and differences in methods and tools for each of these components and how they all inter-relate and support each other.

Since Spring is a time of rebirth and renewal it seemed like a great time of year to highlight and share this flow chart with all of you. 

On 9/11/01, 24 years ago, I was working as the Director of Maternal Child Health Nursing for two different New York City hospitals. That morning, me and several other nursing leaders from multiple hospitals in New York City were meeting together in a room that was located a few blocks from the World Trade Center.

At about 8:46 am our pagers started going off letting us know that a plane had flown into the World Trade Center. Without saying very much to each other, we all quickly and efficiently gathered our belongings and urgently left so we could get to our respective hospitals as soon as possible to help operationalize emergency plans and support our teams.

Later that day, after working frantically for hours to get ready for a lot of casualties the stark reality hit me and others. Most of the people working in the towers either walked away or died.

I will never forget the awful smell of smoke that hung in the air for months after the attack and collapse of the two towers.

I will never forget the armed police officers all around the hospital where I worked.

I will never forget the stunned looks on everyone’s faces as we carried on – because, as you all know – people were still in labor, and babies were being born. Indeed, the birth of these innocent little babies brought me hope for a better future.

I will never forget all of the home-made flyers that included photos of smiling missing people whose loved ones had posted at the bus stops I passed on my way to and from work.

I will never forget the lines of people who came to volunteer so that they could be of service to others and to give blood. Those lines of volunteers wrapped around the two hospitals for blocks.

I will never forget how kind everyone I interacted with was to each other in the face of so much pain.

What happened on 9/11 taught me that hate kills and love, kindness, and compassion generates goodness, joy, and beauty in the world.

Four years ago, on 9/11/21, my beloved son David K. Jones, who was raised in NYC, died due to disinvestment in public infrastructure. He fell to his death when he accessed a rusted staircase near a major transit area in Boston. For over a year these stairs had been known to be a hazard, yet the staircase was only properly secured a few hours after he died and was removed a week later. My son’s death is a very personal and painful reminder to me that complacency, especially the complacency of people in important positions, can harm or even kill people.

David’s death is one of numerous preventable deaths that happen every day in the United States. Data show us that people of color suffer a disproportionate number of deaths and injuries compared to White people.

On 9/11/25, as a way to honor the life of David and take a moment to reflect and remember how important it is to live life to the fullest while spreading love and care throughout the world, PQI hosted a FREE Innovation Webinar titled Race, Racism, and Perinatal Health Inequities. Our guest speaker was Veronica Barcelona, PhD, MSN, RN, PHNA-BC, FAAN. She outlined the connection she has found between using stigmatizing language in the medical record and perinatal health outcomes.

As with others, I am motivated to do more than I have done and I am doing when I read in the article recently published by Chen et al. “During 2018 to 2022, 2,679 pregnancy-related deaths could have been prevented if the national rate was reduced to the lowest state rate.” The authors go on to state that “there was a nearly 5-fold difference in pregnancy-related mortality rates by racial and ethnic groups.”

Infant deaths in the United States remain higher than other high resourced countries and Native Hawaiian or other Pacific Islander, American Indian and Alaska Native, and Black non-Hispanic populations have 2 to 3x higher number of infant deaths. In August, the Mississippi Department of Health declared a public health emergency on infant mortality because the infant mortality rate increased to 9.7 deaths per 1,000 live births, “which is the highest in more than a decade”. The report goes on to state that Black infant deaths (15.2) are about 3x higher than White infant deaths. Infant deaths have increased through and more than 2x higher in the United States. In addition, Black women’s pregnancy-related death ratios are more than 3x higher than for White women.

We need to not let these deaths go unnoticed. I know that these data can be overwhelming. I know that it is easy to get distracted and to get overwhelmed by data that shows that things are getting worse, not better, and that there is so much more we need to do. Then I am reminded that out of small things proceeds that which is great, that each of us can send out our own ripples of hope and together these ripples will make a huge difference.

One place to start is to spend one hour learning more about stigmatizing language and how to remove this dangerous language from our reports to each other, our case reviews, our huddles, our debriefs, our medical records, our daily interactions. Even better, organize a journal club and show the webinar to others and spend some time discussing next steps for your organization. As we say in the SPEAK UP Champion Course and online SPEAK UP Modules – Conversation is where change begins and we all have the power to change the conversation.

Spreading Ripples of Hope,

Debra

p.s. The Boston University School of Public community is reading David’s book Ripples of Hope in the Mississippi Delta: Charting the Health Equity Agenda and hosting a free zoom webinar on September 30, 2025. Feel free to join us!

Happy July!  Happy Summer!

The highlight of our summer has been being in person at the release of our daughter Tiffany’s debut album. It was a fantastic event with over a hundred people there rocking out to the music and celebrating this major accomplishment. Her band is called The Midnight Papers – a two-piece garage rock/protopunk band. Tiffany plays guitar and is the lead singer and Tim is on the drums and adds to the vocals. They describe their sound as, “a fuzzed out, distorted guitar tone layered over powerful drums”. Tiffany wrote many of the songs on the debut album. Some of the songs are very provocative and discuss heavy topics – like misogyny, heartbreak, and violence against women – other songs are more playful. Watching her put herself out there in this very personal way thrills and inspires me. I also enjoy adding her music and their powerful beat and catchy lyrics and music to my summer days and my workout playlist. You can find her music on all streaming devices. You can get a feel for her band by watching the music video for their song Quelque Chose (about women artists being seen simply as muses).

I also had the privilege of observing a Step Up Together Drill in the role as a quality improvement consultant for Primary Maternity Care (the owner and creator of these drills). The drill the hospital and homebirth midwives chose to run that I observed was about transferring a woman who gave birth at home and had a retained placenta. You can learn more about this exciting inter-disciplinary effort and access the drill kits at Primary Maternity Care’s website. The drills are designed to help practice how to transfer a pregnant (antepartum/intrapartum) or postpartum person and/or their newborn from a community birth setting to a hospital. The drills are to help improve communications, skills, efficiency, and collaboration. This is a great drill package for also strengthening collaboration among Emergency Medical Services, the Emergency Department, and the perinatal hospital-based teams. I can attest to the fact that the drills are engaging and very informative. Teams that have participated in the drills have also had the benefit of taking PQI’s state-of-the-art Intermittent Auscultation Simulation-Based online, on demand education.

I must admit that most of my summer is being spent in my garden, reading books (I just started The Hunger Games books series at the insistence of one of my grandchildren), being at the pool, binge watching a few streaming series like Outrageous, hanging out with family and friends, and last – but certainly not least - contemplating how I can best respond to so many changes in health policy and politics that are deeply concerning to me and also have a direct effect on PQI. As a public health expert I am appalled by decisions that I know are causing and will cause pain and suffering to so many people. This time in our country’s history feels surreal and hard to wrap my head around.

Hopefully you, like me, are making time for self-care and making some fun memories this summer.

Hoping you catch some sunshine when you can,

Debra

Happy June: a month when we happily celebrate the start of summer, Pride, and fathers. I want to take a moment to celebrate my son who was a beloved father and husband.

As many of you know, my son, David Kline Jones, PhD died of a tragic, preventable accident on September 11, 2021. He was a professor of public health policy at Boston University and was deeply committed to improving health for everyone. In honor of his life and his recently published book we created an introductory film titled: Create Ripples of Hope. This 15 minute film highlights my journey as David’s mother and one of the co-editors who finished his book, David, and four of the 14 individuals, organizations, and structures he identified to be “Ripples of Hope” in the Mississippi Delta.

After meeting these courageous leaders myself and seeing their work firsthand, I feel compelled to support and expand their work by bringing their stories to a wider audience. That is why I started a Go Fund Me campaign to support the creation of a full-length documentary film.

This full-length documentary will explore five topics that affect health, each corresponding to a chapter in David’s book: food, neighborhoods, jobs, education, and healthcare. The documentary film will show how these five social conditions affect real people and highlight groups and individuals working to eliminate health inequities. The film will also illustrate how structural constraints can impact health outcomes, sometimes causing preventable harm or even loss of life, as seen in David’s own story. Our goal is to inspire viewers to create their own ripples of hope in their communities.

We plan to begin filming in 2027, using 2025 and 2026 to secure funding. Individual donations will help demonstrate public interest to larger funding organizations. The finished documentary will be shared at film festivals, community events, and through educational channels. I am collaborating with Carolyn Jones, Lisa Frank, and Robert Gourley, experienced documentary filmmakers, to ensure the film reaches a broad audience. As a nurse educator and founder of the Institute for Perinatal Quality Improvement, I will also promote the film among health professionals and through social media, encouraging private screenings and community engagement. Your support will help bring these vital stories to light and drive meaningful change.

Go to: https://www.gofundme.com/f/davids-legacy-creating-ripples-of-hope to watch the introductory film we just released and consider donating toward this project.

Every donation is important – no matter how much you give. We want to demonstrate support for the project from as many people as possible. Support for this type of project is particularly important now that many public health policies are under attack.

For example, please follow AWHONN's lead and contact your U.S. Senators so that they will know that you oppose the Medicaid cuts in the "Big Beautiful Bill" passed by the US House of Representatives. Cuts to Medicaid are included in this bill and these cuts would have a negative impact on maternity care for all pregnant women. As perinatal health professionals know - maternity care units already struggle financially and reducing income would make our work harder, lead to closures, and more staffing cuts. Medicaid also helps support people with high risk pregnancy and supports efforts to reduce preterm birth rates. We can't afford to stop funding these programs.   

I also hope to inspire everyone to stay informed and create your own ripples of hope in our individual communities.

Thank you for considering supporting this effort.

With courage and hope,

Debra

Watch the introductory video here

Happy May. I am excited because the film American Delivery – that was directed by Carolyn Jones and produced by Lisa Frank – is available to view for free now on PBS.org! Don’t wait to watch it, because I am unsure of how long it will be available to view for free.

I am so honored to be in this film that shines a light on the maternal health crisis. The film also shows how necessary nurses and midwives are to improving perinatal health outcomes in the United States. Nurses are shown throughout the film supporting people before, during, and after childbirth. The release of the film on PBS is great timing because April is cesarean birth awareness month and May is when we celebrate both nurses and mothers.

You can also go to AmericanDelivery.film to see the film’s trailer, learn more about the film, and to request the ability to host a film event. Consider showing the film as part of one of your upcoming state or national conferences.

The overuse of interventions causes preventable harm. The film help shows how important it is that we expand the availability of physiologic birth options in the United States.

I also recommend you read Kathleen Rice Simpson, PhD’s recently published commentary about the 2016 to 2024 induction of labor and cesarean birth for low-risk nulliparous women (NTSV) trends in the United States. These data and other data show that we overuse medical interventions.

As I say in the film – I want birthing people to have all of the options available to them. However, performing major surgery on people who do not need major surgery just doesn’t make sense. I also try to explain in the film how the use of interventions at the start of labor leads to a cascade of events that too often leads to a surgical birth that could have been prevented.

We should do all we can to prevent unnecessary surgical births, starting with freedom of movement in labor!

When I say I want birthing people to have all of the options, examples of what I am referring to having routinely available and offered are:

• freedom of movement, e.g., the freedom to walk around as much as they want which means intermittent auscultation (IA) is the default way fetal surveillance is performed;
• emotional support, labor lounges in the hospitals where people in early labor can hang out and get some support, but not be put in a bed tethered to a continuous electronic fetal monitor;
• physical support, e.g., hydrotherapy, birthing balls, rocking chairs, ropes hanging from the ceilings for women to hold onto while they squat, and other non-pharmacologic support options; and
• the ability to give birth in any position they want rather than be forced to give birth laying flat on their backs

Nurses have the power to make these things routinely available.

Nurses are key to eliminating the harm caused by overuse of medical interventions. I call on all nurses to lean into their power and their skills as together we work to save lives. I call on all of our non-nursing colleagues to work with the nurses who are spearheading these evidence-based initiatives.

In celebration of nurses,

Debra

Debra at the NYC premiere of American Delivery. Photo by Keith MacDonald.

February has been a month of extremes.

First, I feel compelled to share about the chilling effect Executive Order 14151 – that labels Diversity, Equity, and Inclusion (DEI) Programs as wasteful and abolished federal funding for all of these programs – is having on PQI’s efforts to save the lives of mothers and newborns in the United States.

Let this sink in…conversations between me and my colleagues about disparities, inequities, and being inclusive are being censored by the federal government due to fear of losing funding or because funding is being pulled. This is the opposite of free speech. This is the opposite of the promise of “liberty and justice for all” that we make to each other in the pledge of allegiance. This is un-American.

I am open to having a debate and discussion on how much we should spend on DEI education. But, to have an Executive Order in place that prohibits federal funding of all DEI education is contrary to who we are as Americans.

Two weeks ago I met with leaders working to save the lives of mothers and infants who were interested in having PQI teach a SPEAK UP Champion course in their state. They had someone on the call from the Health Resources and Services Administration (HRSA) who had to spend their time (talk about wasteful) determining whether this education would be able to be offered using federal funds. The person from HRSA asked me if I had updated the education since the executive order came out. I responded by saying, “No, I haven’t changed the course based on the executive order.” I went on to explain that I did not and cannot change the education because in this course:

• we discuss physiologic facts, e.g., there are no Black genes or White genes – we are all human beings;
• the course is based on research and we cannot alter the words of the researchers or the findings of their research;
• the words we use in the course have clear definitions;
• and our approach of supporting the learners to create their own data-guided quality improvement action plans allows them to decide what is a priority for their own communities and organizations.

I also explained that our multi-year evaluation shows the course to be highly satisfying to the learners and to be effective for helping save lives. The person working for HRSA looked uncomfortable and apologetic as she told us that based on what I said, that my course – that is helping save the lives of infants and mothers – could not be funded by the federal government because of the Executive Order. I and the state leaders attending the Zoom meeting got tears in our eyes. My gut tensed up. I felt sick to my stomach. I felt deeply shocked and sad. I looked these individuals in their eyes and I said, “Can I be real? I never thought that a representative from the United States government would tell me that I could not talk about facts, research, and data. I never thought I would be censored for speaking the truth.”

I have also had leaders working at universities tell me that funding for grants that are benefiting communities have been cut and that they have felt pressure to not talk about anything related to DEI due to fear of retribution and getting deeper funding cuts. Researchers have told me that they have been given guidance on how to write grants that do not include trigger words like diversity and equity. Hospital leaders have told me that although they remain committed to equity, they have to carefully consider their initiatives.

This is shocking to me. We have always been the land of the free; the country that has embraced people from all over the world. A country that encourages people to learn by funding research and supporting open dialogue. If we walk away from our core beliefs of free speech and liberty and justice for all we are walking away from the principles that make the United States great, and we as a country are turning our backs on the core messages of Christ and other spiritual and moral leaders.

DEI education makes us stronger as a nation. Diverse groups are stronger groups because they bring together people from diverse experiences and perspectives. Equity simply means treating other fairly and being treated fairly. Who doesn’t want to be treated fairly and who shouldn’t be treated fairly? Inclusiveness is ensuring that everyone’s needs matter. I believe that Americans care about each other and want and strive to live in kind and caring community with each other and want to end the preventable deaths of their neighbors.

The following sobering quote from Steven Levitsky - a professor of government at Harvard and the co-author of the 2018 book “How Democracies Die” - was published on March 9^th in the New York Times: “When you see important societal actors – be it university presidents, media outlets, C.E.O.s, mayors, governors [and I will add religious leaders] – changing their behavior in order to avoid the wrath of the government, that’s a sign that we’ve crossed the line into some form of authoritarianism.” Yes – this is what I have witnessed happening around me and describes the experiences I am having. But, oh my goodness, this is horrible. I never thought I would live to see my government cross this line.  

Because of the silence and complicity of some of the powerful, it is particularly important that each one of us SPEAK UP and not stand by silently when we know that an executive order or other actions will have a negative impact on all of us, on all of our families, on all of our communities, and on our country. Having leaders agreeing with and supporting actions that negate the needs of all members of their constituents, congregations, and communities is contrary to what I believe most American's feel is our social contract and our moral and spiritual obligations to each other. It is also important that we SPEAK UP when we see people use the executive order as an excuse for cutting non-federally funded DEI programs and positions.

As a person of faith, at this moment I am reminded of what Christ taught: “Do unto others what you would like them to do to you” (Mathew 7:12).

I am also reminded of the guidance of the Buddhist teacher Thich Nhat Hanh whose teachings are focused on ending all human suffering. He wrote: “Your mind is like a garden. Your thoughts are the seeds. You can grow flowers, or you can grow weeds.” And Mahatma Gandhi who said, “You must be the change you wish to see in the world.”

I am also reminded of the truth of what John F. Kennedy said – “A rising tide lifts all boats”. Working to make the world better for the marginalized and those with the greatest needs helps make the world better for everyone.

Standing up for each other matters. Addressing the needs of everyone in our communities makes us stronger not weaker! I stand for liberty and justice for all! I hope that all of you stand with me as we remind each other that conversation is where change begins and we all have the power to change the conversation.

Which brings me to an exciting announcement: Check out the new website – HealthEquityPolicy.com. This website was launched to outline key components of my son David K. Joneses’ book Ripples of Hope in the Mississippi Delta: Charting the Health Equity Policy Agenda. I am particularly excited to share with you the new graphic we developed that shows the difference between Equality, Equity, and Justice. Check it out and let me know what you think. Let me know if you want to host an in-person or virtual book launch event.

I also want to share, and I would be remiss if I did not mention, that I had a fabulous trip to the Mississippi Delta in February. On this trip, with the help and support of L. Nicole Stringfellow of FABRIC, Inc. and others, we gave a copy of David’s book to every state legislator in Mississippi, addressed the Mississippi Black Legislative Caucus, and had book release events in Charleston, Cleveland, and Clarksdale, Mississippi. I was able to spend time with people and leaders of organizations who were identified by David to be “Ripples of Hope in the Mississippi Delta.” Their courage and work, against what are often significant barriers, to support members of their communities is awe inspiring. I will talk more about this trip in a future message. But suffice it to say – David would have been so proud! I felt his spirit of love and joy with me throughout the trip.

I will end this message recognizing that many of you are “Ripples of Hope” in your own communities and in the world. I know that there is much good in the world and your efforts inspire me and give me strength. For example, we had 626 people from 41 different states join our February 28 Day Anti-Racism Challenge. Some of these individuals also took it upon themselves to spread the messages of the challenge throughout their organizations.  In February we also welcomed 55 new SPEAK UP Champions from Nebraska for a total of 1,828 SPEAK UP Champions and in 2025 we know more people are going to join. Which reminds me of what the anthropologist Margaret Mead said: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”

With deep concern, and also deep hope that all of us will come together with love and kindness for each other,

Debra

I am deeply concerned about the divisive discourse and the aggressive actions being taken that are having – and will continue to have – a negative impact on the health of all people who live in the United States and throughout the world. But I am particularly concerned about the health of our most vulnerable populations and people of color who are being attacked. All of us are connected; what impacts you has an impact on me.

Because of my concerns I am more committed than ever to continue to work to:

Eliminate preventable perinatal deaths and injuries and end perinatal racial and ethnic disparities because each death and injury that could have been prevented that we don’t prevent is a tragedy for ourselves and for each other. We all lose.

End suffering for all people because I believe that deeply loving and caring for each other is possible and is how we end suffering. Hate and fear for others only perpetuates more hate and fear and leads to more suffering. Hate kills while love is generative. I believe that love and goodness and kindness are more powerful than hate.

Ensure health equity because I believe health equity is possible.

I believe, like my son David wrote in his book, that “we can become a country in which we cannot predict how likely someone is to be healthy based on their race, their ethnicity, where they live, or other demographic characteristics – a society in which everyone has equal opportunity to be healthy in the fullest sense of the word, not just the absence of disease but ‘a state of complete physical, emotional, and social well-being.’" [i]^, [ii]

During my doctoral studies I had an insight that has helped me speak my truth when the stakes are high. This insight is the following: “Conversation is where change begins, and we all have the power to change the conversation.”

One of the ways that we at PQI are working to change the conversation in our country is by offering everyone – for the fifth year in a row – a new version of the 28 Day Anti-Racism Challenge. Version three of the Challenge is designed to facilitate reflections, learning activities, and individual actions that we hope will help lead to positive change. The challenge is curated to bring about positive conversations, to help us all work toward the vision included in the pledge of allegiance that states we want “justice for all”.

I believe that everyone who cares about others can become an anti-racist. If they care enough they will take the time to do the heart work required and be willing to reflect – learn – and act as we challenge everyone who joins us to do every day for 28 days and hopefully beyond.

I hope you join our v3 28 Day Anti-Racism Challenge and encourage others to join too. You can join anytime during the month. You can participate for 1 day, 1 week, or all 28 days. If you missed a day or two you can go back and see what you missed. We try to make it as easy as possible for you to participate in whatever manner works for you.

Because – how do we know we need to change if we aren’t willing to reflect and learn?

How do we end suffering and ensure health equity if we refuse to see how we individually are causing suffering and are unwilling to change our behaviors?

I want to engage right now, more than ever, in activities that will help build people up, not tear people down because I believe that we all need more love in our lives, not more fear and hate. I believe, like the song “More The Same” by Leah Boyd and Heather Pierson says “we are more alike than we are different[iii]”.

We hope you join us!

Spreading the power of love,

Debra

[i] Jones, David K. (2024). Ripples of Hope in the Mississippi Delta: Charting the Health Equity Policy Agenda, Prologue, Pg. 1

[ii] “Constitution of the World Health Organization”, World Health Organization, accessed September 1, 2022, Https://apps.who.int/gb/bd/PDF/db47EN/constitution-en.pdf?ua=1, The constitution was adopted by the International Health Conference, New York, June 19-July 22, 1946. It was signed July 22, 1946, by the representatives of sixty-one states and entered into force on April 7, 1948. The definition has not been amended since 1948.

[iii] Boyd, L. and Pierson, H. (2024) More the Same, https://open.spotify.com/track/0MzDjfGtTDKHOkhD0p3Pdh

• Scott L. Greer, PhD, Professor Health Management and Policy, Professor, Global Public Health, Professor (by courtesy), Political Science, University of Michigan was David’s mentor for his PhD and moderated a panel that was held at the annual American Political Scientists Association (APSA) annual meeting. The panel presentations and Q&A session were recorded after the APSA meeting. 

• Jamila Michener, PhD in Political Science, Associate Professor of Government and Public Policy, Inaugural Director, Center for Racial Justice and Equitable Futures, Senior Associate Dean of Public Engagement, Brooks School of Public Policy, Cornell University first talked about David’s book as a gift. She highlights some key points about his book in a short video.

• Sarah Gollust, PhD, Associate Professor, Division of Health Policy and Management, University of Minnesota School of Public Health shared how David’s book is both a hopeful and practical guide for tackling structural barriers to health. Watch here.
  

• Boston University School of Public Health Dean Sandro Galea, MD, DrPH had an article about David and his book published by Health Affairs.

• Dean Galea also hosted a webinar where a panel of experts discussed the contributions of David’s book and a book launch reception. Check out the accompanying article about the webinar and the event.

I’m wishing you well this September. It’s officially fall, and while I embrace the change in seasons, September 11th has become an even more emotional time for me than it previously was. The date not only marks the attack on our country where so many people needlessly died, it, also is the anniversary of my son David’s death. I feel deep sorrow for his death and deep gratitude for his life as I reflect on the third anniversary of his death. Words do not adequately express how much I miss David.

One way we are keeping David's legacy alive is by getting his book that was under peer review at the time of his death published. I and two of his colleagues at Boston University have been working hard for the last few years to pick up the work he started on this book.

I am thrilled to announce that David's book is available for preorder wherever books are sold and that the publishing date is December 10th (just in time for the holidays). In addition, Boston University is hosting a book launch event on December 3rd. Stay tuned, because we are also planning other in person and virtual book launch events.

If you are interested in purchasing a copy, there is a 30% discount through the University of North Carolina Press bookstore (01UNCP30). Please note that David's family is honoring his desires by donating 100% of the proceeds from the sale of his book to local individuals and organizations working to improve health in the Mississippi Delta.

Below is a summary of David's book, titled: “Ripples of Hope in the Mississippi Delta, Charting the Health Equity Policy Agenda.”

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The Mississippi Delta consistently ranks as having some of the worst health outcomes in the United States. Even with this stark reality, researcher David K. Jones (1981–2021) found "ripples of hope." For four years, Jones turned to residents and local leaders to learn firsthand the intricate connections between race, place, and health in the region. Using an innovative mix of photovoice, policy, and social science research, Jones weaves their insights with data analysis to show how local, state, and national policies and structures, whether or not intentional, constrain or expand daily choices that affect health.

Blaming individuals for poor health choices isn't the remedy. Jones describes how a community-led, goal-oriented approach to creating health equity policies is needed and that everyone benefits when we ensure that all people can pursue a healthy, fulfilling life. In this compassionate and practical book, Jones provides a roadmap for anyone who would like to make a difference, wherever they live. Jones calls on his readers to act for change and provides examples from the Delta to show how. He reminds us that small steps—"ripples of hope"—can save lives and improve health.

Jones was killed in September 2021– at age 40 while his book was undergoing peer review. He died in a preventable accident that occurred due to lack of investment in public infrastructure. His death underscores the main point of his book: people suffer, even die, when society does not uphold its values to protect each other.

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I hope you’ll consider purchasing David's book for yourself or as a gift this holiday season. There are many ways that each one of us can expand health equity in our country.

Sincerely,

Debra

Happy May. We celebrate so many wonderful things in May… Women’s Health, Mental Health and Maternal Mental Health Awareness, Nurses Month and Nurses Week, and of course Mother’s Day, just to name a few.

I’m so proud to be a nurse, I love it. I’m honored to be among colleagues that care so much about our patients and provide high-quality, evidence-based care. Nursing is such a honorable and noble profession. I’m grateful to be a part of such an esteemed group. I hope my fellow nurses have enjoyed this month and have truly celebrated all the ways you make THE difference in your patients’ lives.

Here at PQI we’ve kept things moving. We have so many events coming up and I’d like to share a few of them with you!

It’s not too late to join tomorrow’s SPEAK UP Ambassador Course. Join SPEAK UP Program Director Renee Byfield and Connie Clauson as they facilitate this course, Friday, May 17.

I mentioned this course a few months ago and I’m so excited to share a preview during this webinar. Register to join me, Renee Byfield, Audra Meadows, and Anna Kheyfets on May 22, at 12:30p ET.

Lastly, If you still have colleagues or friends who haven’t become SPEAK UP Champions yet, now is their chance! Our next National SPEAK UP Champion conference is coming up in June. Early Bird savings have ended but you can still save with a Professional PQI Membership.

We hope to see some of you in June. Renee and I are heading to this year’s AWHONN Convention and we will be speaking on June 10. Be sure to join us as we discuss Safe Use of Intermittent Auscultation to Expand Freedom of Movement in Labor. We also plan to be in the Poster Room sharing SPEAK UP outcomes. At the end of June I am going to be attending and presenting at the Delta Consortium at Mississippi State University.

Registering for one of our free webinars, signing up to attend one of our conferences, becoming a paid member, following us on social media, seeing us speak at other conferences… these are all ways that you help support PQI and our mission, and I’m so grateful that you continue to do that.

Hoping to see many of you soon (in person or virtually)!

With gratitude,

Debra

Happy March and happy spring. I know I’m excited about the weather warming and seeing all the new colorful blooms. This month we are celebrating women with International Women’s Day and Women’s History Month.

In the spirit of celebrating and caring for women, PQI is excited to announce our NEW Birth Equity Modules Course. The course includes four 20-60 minute web-based modules designed to support the acquisition of specific skills and accomplish specific goals.

• Module 1: Creating an Anti-Racism Statement for Perinatal Facilities
• Module 2: Improving Data Collection and Data Review by Race and Ethnicity
• Module 3: Performing Team and Family Debriefs from a Racial Equity Lens
• Module 4: Ensuring Perinatal Care Standards Are Met for Birth Equity

We are first introducing these modules through a lottery. Lucky winners will receive FREE early access to the course before its national release on May 1, 2024.

Visit our website to learn more and enter the lottery for your chance to win. Winners will be notified via email and provided with instructions for how to access the course.

The Birth Equity Course was created because individuals who are taking our SPEAK UP Champion Implicit and Explicit Racial Bias course have informed us - via their pre-survey responses and also during the courses - that they and others at their facilities are struggling in these areas. We strive to support all perinatal health providers to be able to ensure high quality equitable perinatal healthcare as we work to eliminate racial and ethnic disparities.

We hope you check out this new resource and we look forward to reviewing the course feedback the learners provide us.

In solidarity,

Debra

Happy October. The fall season has finally settled in and I’m enjoying the falling temperatures and turning leaves.

If you are familiar with Lamaze international, the formation of the Lamaze Institute for Safe and Healthy Births, the Lamaze six healthy birth practices, the Journal of Perinatal Education, or the Official Lamaze Guide to Childbirth: Giving Birth with Confidence you are aware of part of the legacy and work of my friend and colleague Judith Lothian, PhD, RN, FAAN. This month I am honoring Judy’s work because I am very sad to say that she died last month on 9/11, just two years to the day after my son died.

Judy was a champion for physiologic birth. She was a tireless and devoted leader of Lamaze. I was one of many people she welcomed into her home in Brooklyn to mentor into becoming a childbirth educator. She served us tea in her china teacups and with her silver spoons while we had the privilege of discussing and having her share with us her awe of the power of the human body to create and give birth to other humans.

I had been a nurse who had cared for or oversaw the birth of thousands of women during labor and birth for over 20 years when I decided to become a Lamaze certified childbirth educator. I did not plan to leave my full-time job as a Director of Maternal Child Nursing for two hospitals in New York City when I took her course. I also thought I knew a lot about birth. What I realized was that I had very little knowledge of or experience with non-medicated physiologic birth. I had been, like most perinatal nurses and doctors in the U.S., schooled in the medical model. I sought out Judy and her co-teacher Alison Walsh because I realized that birth was more than a medical procedure. Yet my exposure to and expertise in physiologic humility was limited. Judy opened my eyes to new ideas and shifted my mental model using evidence-based information, videos, images, and great conversations.

I was so impressed by what Judy taught me that I hired her to teach a day-long course to all of the labor and delivery nursing staff who reported to me so that they would have more information on how to provide labor support. Interestingly, most of the nurses who worked in labor and delivery were like me, they had never been provided formal education on how to provide labor support or much experience with physiologic birth.

Judy’s insights and wisdom have guided my career choices and priorities since I met her. For example, I became an active leader of Lamaze for several years where I had the honor of having fun, learning from her, and working closely with her and other Lamaze leaders. We remained connected after I had to leave my leadership position at Lamaze when I became a Vice President for the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). I also recommend the book she wrote to pregnant people, in fact, I had recommended it to someone the day before she died.

I am trying to stay hopeful that Judy’s voice and wisdom will cut through all of the fear and mis-information that is being perpetuated while we continue to witness an increase in preventable perinatal morbidity that can be attributed to the overuse of medical interventions in the U.S. Overuse of inductions of labor and overuse of cesarean births are not the future that Judy was trying to bring about. She wanted all pregnant people to be able to give birth with the support they deserved and only with medically indicated interference.

In honor of Judy’s life let’s pause, reflect, and experience awe as we strive to spread information about the six evidence-based care practices that support safe and healthy births. These six care practices are:

• Healthy Birth Practice 1: Let labor begin on its own.
• Healthy Birth Practice 2: Walk, move around and change positions throughout labor.
• Healthy Birth Practice 3: Bring a loved one, friend or doula for continuous support.
• Healthy Birth Practice 4: Avoid interventions that are not medically necessary.
• Healthy Birth Practice 5: Avoid giving birth on your back and follow your body's urges to push.
• Healthy Birth Practice 6: Keep mother and baby together — it's best for mother, baby and breastfeeding.

I am so grateful for how Judy’s life touched my life. Let’s all join together to share joy, awe, and physiologic humility as we care for and support people and families before, during, and after birth. May Judy’s work and life live on through each of us.

Sincerely,

Debra

As you know, Labor Day occurs in September. Accordingly, this day inspires PQI to want to talk about labor and birth. I know from personal experience that giving birth is more than just a few hours in a person’s life. Bringing new life into the world is a transformative and spiritual experience. We, and everything in our world, are forever changed by this event.

This September marks the 2^nd year since my son, David K. Jones, died. I have been thinking about how giving birth to David has taught me how I can live life after his death.

I remember, for example, before David was born every part of my body wanted to tighten and stiffen out of fear of the intense and new sensations I was feeling in my body. But I was able to calm myself down. This helped to relax all of the muscles in and near my vagina so that I could push uninhibited and not be undermined by this consuming fear. In every possible way I needed to be open to the experience of giving birth.

Now as I face life after David’s death, I find myself in so much grief that I want to try to protect myself from more pain. I want to close myself off so that I won’t feel what I feel. But, then I remember David’s birth and remind myself of what I learned. If I put my energy into trying to stop the waves of grief or into trying to protect myself from the hurt that comes when we love others deeply, then I am only making the birth of this next phase of my life harder not easier.

While I reflect on the impact and lessons I learned while giving birth, I am thinking about how it applies to all of the perinatal health professionals who support intrapartum care. The support you provide matters a great deal. Birthing people will remember your actions for the rest of their lives. Yet, too often we as clinicians are also afraid or hesitant to try something new. Especially when it requires making some major shift in our clinical practice. Yet, these hesitations are causing people in labor to have less freedom of movement.

That is why we at PQI created the Intermittent Auscultation (IA) Simulation Based Education. We want to help support clinicians to practice performing IA in a safe setting so that they can expand the type of support they give to people during labor and birth.

As you can tell, I am passionate about IA, and the creation of this online education module is very personal.

So why should it be important to you? Well, evidence supports the use of IA instead of continuous electronic fetal monitoring in low-risk labor. IA supports freedom of movement during labor and may help reduce the risk of cesarean or operative vaginal birth. With these facts in mind, learning and practicing IA skills are necessary to ensure reliable, safe and consistent performance.

Who should use PQI’s Intermittent Auscultation Education? The education was developed for perinatal nurses, midwives, and physicians who provide intrapartum care, as well as students and clinical learners in these specialties.

What birth setting is the program designed for? This education is appropriate for all birth settings! It includes imagery of IA being used in hospital, birth center and home birth settings.

Are there any real-world examples of using IA to promote vaginal birth? As a matter of fact, we do have quotes and testimonials on our website, but I especially love the PQI Profile highlighting Beth Hennessey. In her profile she describes how her team at Sutter Davis expanded the use of intermittent auscultation as a key strategy to reduce primary cesareans and promote vaginal birth at their facility. She noted, “We realized that our staff did not have the competency or the tools that they needed to perform intermittent fetal monitoring or auscultation.” After the Sutter Davis staff received training, Beth confirmed, “They do nothing but intermittent monitoring unless they hear something abnormal.”

PQI is very proud of helping give birth to this new way of learning IA skills that I personally celebrate and recommend to all of you. Those of you working to become certified through NCC.org will be pleased to know that PQI’s IA education has been approved for four certification exams – an accomplishment that brings me great pride and joy. PQI is also pleased that this education is also available through the Association of Women’s Health Obstetric and Neonatal Nurses (www.AWHONN.org).

You can learn more about the IA module on the PQI website, which features an FAQ page with more information, questions and answers, quotes, and the ability to purchase the education. There have been over 2,300 individuals who have taken the IA course through the PQI learning management system.

It’s my hope that we all open ourselves to continue learning to embrace freedom of movement – in all of its forms.

With a desire to be more open,

Debra

I am wishing you all an amazing August. This month we recognize a very important observance: National Breastfeeding Month, with Week 1 being World Breastfeeding Week, Week 2 being Indigenous Milk Medicine Week, Week 3 being Asian American Native Hawaiian and Pacific Islander Breastfeeding Week, Week 4 being Black Breastfeeding Week, and Week 5 being Semana de La Lactancia Latina.

I have a confession to make. For many years I separated healthy mothers from their healthy babies soon after they had given birth. I continued to separate mothers and babies after I gave birth to my son, even though it was upsetting to have my son separated from me. I continued to do this harmful practice after I became aware of the research outlining how damaging it is to separate mothers and newborns and the benefits of having them skin-to-skin. The main reason I did not provide what I knew was the best, evidence-based care for newborns and their birthing parent was that I did not feel like I had the power to change the healthcare system I worked in. I also did not want to disrupt the status quo and make waves. I regret that I did not advocate for the families I cared for and did not do a better job ensuring they received evidence-based care.

In 2002 I began to make amends for all the years I was complicit. I led several efforts that I called – Keeping Moms and Babies Together. I have carried on these efforts in one way or another since then, including helping specify and  conducting feasibility testing on two skin-to-skin nursing care quality improvement metrics. I share this article almost every August with the hope that this work will motivate others to create better mechanisms to track skin-to-skin rates in the United States.

Studies show that the benefits of supporting bonding by providing skin-to-skin have lasting benefits for mothers and babies. Indeed, the benefits of skin-to-skin are more powerful and longer lasting than any of the postpartum medications that I am aware of. I believe that skin-to-skin for healthy moms and healthy newborns should ALWAYS be encouraged and supported, whether the person who gave birth plans to breastfeed or not.

In addition, keep in mind that historic trauma related to breastfeeding is real. Slavery existed in the U.S. for 246 years and after slavery there were Jim Crow Laws and Black Codes and other inequitable laws enacted that have sustained breastfeeding disparities. During slavery Black lactating women in the United States were often forced to be separated from their newborns and were often forced to breastfeed white babies at the expense of the needs of their own infants.  This traumatic historic past has implications for all of us today. In addition, breastfeeding other people’s children did not end with slavery. Given the centuries of abuse and mistreatment, Black women in particular need more support and encouragement related to breastfeeding because the disparities remain.  In 2019, initiation of breastfeeding rates for white infants was 85.5%, compared to 73.6% among Black non-Hispanic infants. I highly recommend that all skin-to-skin interventions be carefully documented and all quality improvement efforts track skin-to-skin and breastfeeding data by race and ethnicity.

Other reasons why breastfeeding rates among Black women are lower are inflexible work schedules, the need to return to work earlier than 12 weeks, and challenges in finding workplaces that support breastfeeding.

We all could do better no matter where we work. The below figure from the report based on the National Vital Statistics System  shows the largest disparity in breastfeeding initiation in 2019 among racial/ethnic groups, by percentage point difference.

If you are currently separating mom’s and babies – have the courage to change! Also take time to consider ways that you can better support people who have been historically and are currently marginalized. Examine your unconscious biases and consider changes that you need to make in your own practice. We can change the way this map currently looks! We can eliminate breastfeeding disparities through a trauma informed lens and a racial equity lens.

We hope you join us at PQI as we join the U.S. Breastfeeding Committee’s efforts to protect, promote, and support breastfeeding and human milk feeding for the 13^th annual National Breastfeeding Month. The 2023 theme is:  This is Our Why . This year’s National Breastfeeding Month  image lists reasons why babies and families need our support. 

I hope you take time to expand your efforts to promote and support breastfeeding and also take some time to enjoy the last few weeks of summer.

Sincerely,

Debra

Need more information? Refer to the following links:

• https://www.cdc.gov/mmwr/volumes/70/wr/mm7021a1.htm – Initiation rates; 2019
• https://www.cdc.gov/breastfeeding/data/facts.html  - rates; 2015 Racial Disparities in Breastfeeding Initiation and Duration Among U.S. Infants Born in 2015 | MMWR (cdc.gov)
  
• Racial disparities persist for breastfeeding moms. Here’s why. | PBS NewsHour
  
• BMBFA | Black Mothers' Breastfeeding Association (blackmothersbreastfeeding.org)
  
• Reimagining Racial Trauma as a Barrier to Breastfeeding Versus Childhood Trauma and Depression Among African American Mothers | Breastfeeding Medicine (liebertpub.com)
  
• A new look at the complicated history of Black women and breastfeeding | Novant Health | Healthy Headlines
  
• Black Mothers and Breastfeeding (healthline.com)

Happy July. At the height of summer we’re celebrating independence and hopefully you’ve had a chance to enjoy this inherently happy and sunny season with your families. Maybe you’ve already taken some form of summer vacation, or you have an upcoming vacation. Whatever the case, I hope you take some time to live in and enjoy the moment. I’ve personally just returned from two weeks in France with my family and can confirm it’s been great for my mental health and overall wellbeing.

Now that I’m back, my focus has returned to my work on PQI’s mission. In my passion for perinatal quality improvement, I was fortunate to be a co-author of a study that was just published in May in the Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN) titled: “Three Missed Critical Nursing Care Processes on Labor and Delivery Units During the COVID-19 Pandemic.” The authors of this article are Joyce K. Edmonds, Ph.D., M.P.H., RN, Stacey Iobst, Ph.D., RNC-OB, CNE, Erin George, MSN, CNM, and myself, Debra Bingham, DrPH, RN, FAAN.

The three critical nursing care activities that labor and delivery nurses perform that were the focus of our study were: 1) timely recognition of and response to indeterminant or abnormal fetal heart rate changes, 2) excessive uterine activity, and 3) new maternal complications. If any of these three critical nursing care activities are missed, there could be serious harm to the mother and fetus.

The following are quotes from the article that highlight some of our key findings:

“Less nursing time at the bedside was associated with greater odds of missing any of the critical aspects of care.”

“Among our respondents, 33% reported that they or their nursing colleagues missed (omitted in part or whole or delayed) at least one of three critical care processes in the last month” during the study period which was during the height of the pandemic.”

“Reducing missed nursing care is essential to provide high-quality care and avoid delays in the recognition of preventable morbidity and mortality. Our results suggest this can be enhanced through the provision of adequate staffing and increased nursing presence or time at the bedside.”

“Perinatal outcomes are dependent on the timely recognition of and response to abnormal maternal and fetal conditions during childbirth. In times of unexpected complexity in care and resource constraints, a focus on three critical aspects of perinatal nursing care is needed to maintain patient safety.”

Read our paper to get more information about the research methods used and findings. It isn’t your typical beach reading, but I highly suggest that you take a few minutes to identify ways that these findings can be helpful to your work.

Please note: the study participants were recruited by PQI. This means that Labor and Delivery RN's connected to PQI in one way or another made this study possible!

Thank you for your support,

Debra

Now that we’ve reached June I can officially say Happy Summer! June is always a fun time of year for us at PQI because it’s our birthday month. This year PQI is 7! Thank you for your continued support on our journey to expand the use of quality improvement strategies to eliminate preventable perinatal morbidity and mortality and ensure equity in perinatal outcomes.

I’d love to share some things we’re especially proud of accomplishing this year.

We continued to provide intermittent auscultation (IA) education through PQI’s IA Simulation-Based Education online module. In addition to partnering with multiple states and organizations to educate more learners on the safe use of IA, we also partnered with the Association of Women's Health, Obstetrics and Neonatal Nurses (AWHONN) to bring IA education to an even wider audience. As of May 2023, over 2,600 learners have accessed this IA module!

Our SPEAK UP Program continues to grow, and this past year has been no exception! This year’s 28 Day Anti-Racism Challenge (v2) had over 1,700 participants. In 2023 to date, we’ve hosted four SPEAK UP Champion Conferences, two SPEAK UP Ambassador Conferences, and are very excited to announce our first-ever SPEAK UP Faculty Course on August 22. Those considering becoming Faculty can read more here and submit an application before July 10. We hope this new Faculty class can help grow the 1,500 SPEAK UP Champions and Ambassadors that currently exist.

We are especially grateful to Healthcare Georgia Foundation for working with us to help provide anti-racism training to Georgians this year. We have also been able to compound our efforts across the nation by working with organizations like the Oklahoma Department of Health, the Massachusetts Department of Health and Perinatal-Neonatal Quality Improvement Network of Massachusetts (MA PNQIN), Atrium Health, the Pennsylvania Perinatal Quality Collaborative (PA PQC), and the Connecticut Hospital Association.Let us know if you want to expand your state- or hospital-based birth equity efforts by partnering with PQI.

I had the wonderful opportunity to represent PQI’s mission this year at the national level. On April 19 I was invited to participate as a speaker at the National Governors Association’s 2022-2023 Governor Murphy Chair’s Initiative and First Lady’s Murphy’s Policy Focus Roundtable that was held in Detroit. I focused on the worsening maternal and infant health crisis in the United States and the importance of eliminating overuse of inductions of labor and surgical births. As a country we need to protect and promote vaginal births.

We are also thrilled to once again be able offer quality improvement education. On June 6 we hosted the newly revised and updated Quality Improvement Essentials course. It was better than ever! Let us know if you want to host a QI conference for your organization, state, or region.

There’s so much more that PQI has been doing, and I encourage you to visit our 7^th Birthday Highlights page to read more about our efforts. In particular, check out the recorded library of PQI Innovation Webinars hosted this year as well as previous years.

We appreciate all of the support you have given us. We can accomplish much more together than we can alone. If you’re interested in practical ways to support our mission and help us grow, I invite you to become a Professional Member of PQI, visit our store, or attend any of our upcoming events.

Thank you for your support,

Debra

Happy May! This month marks one of our most familiar observances which is Mother’s Day. On Mother’s Day I am reminded of my own mother, M. Bernice Bingham, who I am happy to say is still alive and in good health compared to others her age.

My mother is a very joyful and giving person – someone who laughs a lot and who is fun to be around. My mother has helped support me my entire life. In fact, it is impossible to count all the many ways that her life has made my life better. My mother has also nurtured countless others over the years. One of the reasons I am working so hard to eliminate preventable maternal deaths and injuries and end perinatal racial disparities is because I know that no one can replace a mother; it is a huge disadvantage for someone to grow up without their mother or to have their mother seriously ill.

Perinatal health professionals work tirelessly to provide the best care they can. Unfortunately, sometimes we get stuck performing “strong but wrong” routines. For example, we have centuries of evidence to tell us that physiologic birth practices are key to having the best outcomes. Yet, too often we do not practice what I like to call physiologic humility. Humility that the physiology of a woman's body before, during, and after giving birth is complex and typically works well on its own. Thus, we should proceed with physiologic humility because there are so many limitations in our knowledge of the complex physiologic processes related to birth. For example, we do not even know why labor begins. Yet we sometimes proceed to give women medications that they do not need such as high alert medications like the exogenous hormone oxytocin.

I, for one, am very concerned by how commonplace inductions of labor have become. It seems like we should take this time to reflect on the classic categorization of quality improvement opportunities, which are: overuse, misuse, and underuse. In the case of inductions of labor without a medical indication, I propose we have a situation of overuse. Overuse is occurring when we give healthy patients a medication that they do not need.

As perinatal health professionals it is our responsibility to do everything possible to ensure that women in our care get to experience Mother’s Day. Especially this month, may we all continue to keep that in mind and as a top priority.

Happy Mother’s Day,

Debra

We are now in the season of Spring, and I am so glad that we have more sun in our lives and that the flowers and trees are starting to bloom.

April is National Minority Health Month. This observance is championed by the US Department of Health and Human Services Office of Minority Health with the goal of improving health and reducing health disparities of racial and ethnic minorities and American Indian/Alaska Native communities. During this month, we also observe Black Maternal Health Week every April 11-17, an annual event officially recognized by the White House since 2021. 

I love April as it continues to remind and reinforce PQI’s mission to expand the use of quality improvement and improvement science to eliminate preventable perinatal morbidity and mortality and end perinatal racial and ethnic disparities. Every decision we make is thoughtfully guided by PQI’s mission so that we can get closer to accomplishing this goal. One way we are working to meet our mission is by hosting our annual 28 Day Anti-Racism Challenge. This year we launched the second version of our popular Challenge, featuring 28 days of new, specially curated content and activities for participants to reflect, learn, and act. Although national participation in the 28 Day Anti-Racism Challenge is over, you can still challenge yourself and/or your team at any time by accessing the Challenge here.

Here are a few Challenge highlights we’re especially proud of:

• We had 1,700+ registrants
• People joined from 45 states and 4 countries
• PQI reached nearly 6,000 people via social media (this number does not include those who graciously shared our posts with their networks)
• 91 people signed the SPEAK UP Pledge since the Challenge began
• Of surveyed participants:
  • 98% felt the information improved their knowledge of racism
  • 96% agreed that the daily activities were useful in their clinical practice
  • 98% agreed that the activities were useful in their personal life

We will continue to host the 28 Day Anti-Racism Challenge annually as we continue working toward accomplishing our mission. We thank you for your enduring support.

With perseverance,

Debra Bingham

Happy February and Happy Black History Month. We are now 15 days into our 3^rd annual 28 Day Anti-Racism Challenge, and though we already have over 1,600 participants, we are excited that that number continues to grow every day. Anyone can join the Challenge at any time, so please do help us continue to share this work by promoting it to your friends, family, and colleagues.

With the Challenge we’ve been sharing daily ways to SPEAK UP and show RESPECT with prompts to reflect, learn and act. The first E in RESPECT stands for Equitable High Quality Care. I believe that perinatal health professionals want to provide high quality, equitable care to every patient they encounter. I also believe that most people do not wake up thinking – I want to do something today that is racist. I think we all go about our busy lives feeling like we have too much to do and that overall, we are good people, not a part of the problem. Too often we think we are not personally perpetuating perinatal disparities, or we don't know where to get started. Those are some of the reasons that maternal mortality disparities are one of the longest disparities in U.S. history. As pointed out by Ibram X. Kendi, we are all a part of the problem unless we are a part of the solution. Lack of action keeps the status quo in place. Thus, we all need to be active anti-racists. We need to work daily to dismantle racist structures and processes that unfairly advantage white people at the expense of Black people and other marginalized populations. 

The good news is that all of the racist structures and processes can be eliminated, which means that perinatal disparities can also be eliminated. For example, disparities from preventable childhood diseases were eliminated with the equitable distribution of vaccines. But these structures and processes weren't magically improved; it took effort. What we need are more QI leaders who do their work using a health equity lens. To help expand the number of leaders with QI + Equity expertise we are offering the Quality Improvement Essentials National Conference on June 6, 2023. This is also why our SPEAK UP Champions are provided support to create and implement individual QI action plans.

We also know that one of the first ways to lead change is to change the conversation. That is why we have created and launched the 28 Day Anti-Racism Challenge, v2. A fun addition this year is the use of badges, given to individuals for each week of the Challenge that they complete. To offer even more incentive, we’re also offering a 50% discount on the SPEAK UP CNE/CME modules once the challenge and post-event survey are completed. This discount is just another way to encourage our participants to stick with this important step in their anti-racism journey.

Ensuring equity is work we all need to do. Leading QI efforts utilizing a health equity lens is critical. Together we can make a huge impact!

With continued determination,

Debra Bingham

Happy New Year! I hope you all had a wonderful and fulfilling holiday season with your loved ones. We missed David more than ever. We did enjoy celebrating Christmas at home with family but brought in the new year in beautiful Puerto Rico. I came back feeling refreshed and ready to get to work. I feel like that’s always a sign of a good break – enthusiasm to return to work.

This year PQI has many exciting things on our docket, and I can’t wait to share them with you.

Version 2 of PQI’s 28 Day Anti-Racism Challenge is right around the corner, kicking off next week on February 1. We hope to make the Challenge even bigger than last year's 1,900 participants. We need your help to exceed last year’s effort. If you’ve ever completed the Challenge, we invite you to sign up again, as this version features 28 new Reflect, Learn & Act tools that we believe will help anyone on their journey to anti-racism. We even have weekly badges this year, to honor each week you’ve completed. Please do sign up and share with others. 

The PQI Innovation Webinar Series is back next month with a powerhouse panel to start the year. Please join us for our webinar titled: Missed Nursing Care on Labor & Delivery During the Pandemic. After research and surveying 836 L&D nurses, my colleagues and I have very interesting results and data to share. This free webinar is on February 7.

Thanks to the MA Department of Health, PNQIN and Healthcare Georgia Foundation, we are pleased to be able to offer TWO SPEAK UP Ambassador courses this spring. We’re excited to convert some of those 1,300+ SPEAK UP Champions into Ambassadors on April 13 or May 25, 2023. (Remember, to attend the Ambassador course you must have completed the 8-hour SPEAK UP Champion training.) These are the only Ambassador courses offered in 2023 and attendance at one of these courses is a required prerequisite to apply to become a member of the first SPEAK UP Faculty cohort. The first faculty course will be offered in September 2023. If you want to continue your training along the SPEAK UP Action Pathway, you must attend an Ambassador course. 

We continue to be grateful for your support as we grow and work to achieve our mission of using QI to eliminate preventable perinatal morbidity and mortality and ensure equitable outcomes.

Before I sign off I wanted to mention that, additionally, I’ll be focusing on some advocacy work in my spare time. Many of you know that my beloved son David died in a preventable accident. Last month I wrote a letter to the Editor of The Boston Globe calling for improvements at the Massachusetts Bay Transportation Authority because his death underscores the one of the main points of his soon-to-be-published book – all of us, especially those who are marginalized, suffer injuries and even death when the structures and institutions we interact with are unsafe. Equity must be the focus of all decisions for every person, every time. We have a lot of work to do to achieve this vision. But, your engagement with PQI brings me hope. I know that if we each do our part we can transform perinatal health care and the communities where we live and work.

With hope and determination,

Debra Bingham

Happy Holidays to you and your loved ones. It’s hard to believe we’re here again; time truly flies. I wish for you all the best holiday season yet. The world is constantly reminding us how quickly things change and how important it is to cherish every moment. I am trying to be present and soak up every good moment as it happens. Though we talked about being grateful last month, I’m still grateful for you and your support of PQI, and I can’t help but reflect on that as we close out the year.

This year PQI celebrated our 6^th birthday. We were able to enjoy some great wins this year, like the release of our new and improved Intermittent Auscultation (IA) Simulation-Based Education online module this spring. Through partnership with multiple states and organizations, we hope to continue to promote this important education to expand freedom of movement during labor for all eligible laboring people.

The SPEAK UP Implicit and Explicit Bias Training program continues to grow. While we ended last year with over 900 Champions, we celebrated crossing the 1,200 Champion mark this summer. We are working to continue growing the program in Georgia thanks to a grant from Healthcare Georgia Foundation. PQI is excited that we have funding to add 150 more individuals to the 140 SPEAK UP Champions already in the state of Georgia.

With anti-racism in mind, Monday we made the decision that we will no longer be posting to Twitter. PQI’s mission is to save lives and part of saving lives includes anti-racism and anti-hate speech. We know that conversation is where change begins and we do not want to utilize a platform that allows hate speech and perpetuates misinformation that hurts people. We do not want to be a part of an institution that thinks this type of discourse is ok. If you are a Twitter follower, please keep in touch through our other social media accounts (Facebook, Instagram, LinkedIn).

Lastly, I encourage you to sign up to join our third annual 28-Day Anti-Racism Challenge, beginning February 1, 2023 during Black History Month. Participation is FREE for individuals and organizations. The more participants the better!

Please help us spread the word about the Challenge:

• Share the below images with your network (email, social media)
• Like/comment/share Challenge posts that PQI shares on our social media
• Share a link to the Challenge landing page on your website

Let us know if you have other ideas or suggestions – we’re so excited to make this the biggest Challenge yet.

With warm holiday wishes,

Debra Bingham

Happy November. I hope you’ve all been able to enjoy Thanksgiving with your loved ones. Besides a cold running through my family, we enjoyed the holiday together here in MA. Thanksgiving is the unofficial kickoff to the holidays (though the retail industry and some of my neighbors would argue that we’re late)! Though a bit bittersweet, I’m still looking forward to this magical season.

PQI is already in the giving spirit and I’m excited to share what we’re up to:

Cyber Monday may be over but we’re keeping this sale going through Friday (12/2, 11:59 PM ET). Save 25% on SPEAK UP Modules with code CYBERMONDAY25%.

It’s almost time for our 28 Day Anti-Racism Challenge again. V2 of this challenge offers 28 brand new ways to Reflect, Learn and Act as you explore your anti-racism journey. Sign up now to join us; be sure to use the social image on your registration confirmation page to let others know what you’re doing so they can sign up too! This free challenge kicks off February 1, 2023.

There is a new FREE webinar in our PQI Innovations Series. Register now to join us February 7, 2023. Hear the results of our study of 836 L&D frontline nurses about missed care during the pandemic. You won’t want to miss this.

We are so grateful for your support.

Sincerely,

Debra Bingham

(From left to right) Sarah Gollust, PhD, Debra Bingham, DrPH, RN, FAAN and Jamila Michener, PhD