Assistant Professor/Faculty Fellow
Mimi Niles's additional information
Mimi (Paulomi) Niles, PhD, MPH, CNM, is Assistant Professor/Faculty Fellow at NYU Rory Meyers College of Nursing. She is a theorist, educator, researcher and certified nurse-midwife. Her work explores the potential of integrated models of midwifery care in creating health equity in historically disenfranchised communities. She is trained in utilizing critical feminist theory, as theorized by Black and brown feminist scholars, and qualitative research methods as a means to implement policy and programming rooted in intersectionality and anti-racist frameworks. As a researcher, she hopes to generate midwifery knowledge as a tool to build equity and liberation for marginalized and minoritized people and grow the profession of midwifery in the US.
For the last decade, Prof. Niles has been a practicing midwife, serving childbearing women and families, within the largest public health network in the nation. In her current role, she provides full scope midwifery care in a collaborative practice setting in Brooklyn, where midwives attend 90% of all births while demonstrating stellar maternity care outcomes. She has also served as clinical faculty at Meyers College of Nursing – teaching in the graduate midwifery program and the undergraduate nursing program.
Prof. Niles is an active member of the midwifery community both locally, nationally and globally. Currently, she is the only appointed midwife to sit on the New York City Maternal Mortality and Morbidity Review Committee. She has received various awards including the Johnson & Johnson Minority Faculty Award and the Jonas Nurse Leaders Scholar Award. Dr. Niles now serves on the Board of Directors of the National Association of Certified Professional Midwives (NACPM) and the New York Birth Center Association (NYBCA). She earned her Ph.D in Nursing and her M.P.H in Global Health Leadership and holds a BA in Comparative Literature and English Education, She received postdoctoral training under the mentorship of Dr. Saraswathi Vedam, at the Birth Place Lab at the University of British Columbia – Vancouver, a leader in community based participatory collaborative research on respectful maternity care. She grew up in Queens, NY – the proud daughter of immigrants, has lovely two children, and honors her mother’s legacy as a nurse-midwife in India.
PhD - NYUMSN - Frontier Nursing UniversityMPH - NYUBSN - NYUBA - NYU
MidwiferyHealth Services ResearchWomen's health
Faculty Honors AwardsNYU University-wide Dissertation Award – Allied Health & Social Services (2020)Global Research Institute Fellowship – NYU – Paris, FR. (2019)Minority Faculty Nurse Scholar Award, Johnson & Johnson/American Academy of Nursing (2019)Presidential Community Service Award, NYU (2019)Ellen D. Baer Doctoral Nursing Scholarship, NYU (2019)Pauline Greenidge Doctoral Nursing Scholarship, New York University (2019)Conference Award, NYU Student Senators Council (2018)Carrington-Hsia-Nieves Doctoral Scholarship for Midwives of Color, American College of Nurse-Midwives (2018)Minority Faculty Nurse Scholar Award, Johnson & Johnson/American Academy of Nursing (2018)Nurse Leader-Scholar Awardee, Jonas Center (2018)NYC Midwives Community Research Grant Award (2018)Herman Biggs Health Policy Fellow, The Josiah Macy Jr. Foundation (2018)Nurse Leader-Scholar Awardee, Jonas Center (2017)Women’s Leadership Initiative – Selected Participant, NYU (2017)Herman Biggs Health Policy Fellow, The Josiah Macy Jr. Foundation (2017)Conference Award, NYU Student Senators Council (2017)Minority Faculty Nurse Scholar Award, Johnson & Johnson/American Academy of Nursing (2017)Conference Award, NYU Student Senators Council (2016)Minority Faculty Nurse Scholar Award, Johnson & Johnson/American Academy of Nursing (2016)Nurse Leader-Scholar Awardee, Jonas Center (2016)NYC Midwives Research Grant Award (2014)Assistantship Awardee, Evidence-Based Birth Research (2014)Arronson Foundation Scholarship, FNU (2009)International Midwifery Scholarship, FNU (2008)
I felt so much conflict instead of joy: an analysis of open-ended comments from people in British Columbia who declined care recommendations during pregnancy and childbirthAbstractAbstractBackground: No Canadian studies to date have examined the experiences of people who decline aspects of care during pregnancy and birth. The current analysis bridges this gap by describing comments from 1123 people in British Columbia (BC) who declined a test or procedure that their care provider recommended. Methods: In the Changing Childbirth in BC study, childbearing people designed a mixed-methods study, including a cross-sectional survey on experiences of provider-patient interactions over the course of maternity care. We conducted a descriptive quantitative content analysis of 1540 open ended comments about declining care recommendations. Results: More than half of all study participants (n = 2100) declined care at some point during pregnancy, birth, or the postpartum period (53.5%), making this a common phenomenon. Participants most commonly declined genetic or gestational diabetes testing, ultrasounds, induction of labour, pharmaceutical pain management during labour, and eye prophylaxis for the newborn. Some people reported that care providers accepted or supported their decision, and others described pressure and coercion from providers. These negative interactions resulted in childbearing people feeling invisible, disempowered and in some cases traumatized. Loss of trust in healthcare providers were also described by childbearing people whose preferences were not respected whereas those who felt informed about their options and supported to make decisions about their care reported positive birth experiences. Conclusions: Declining care is common during pregnancy and birth and care provider reactions and behaviours greatly influence how childbearing people experience these events. Our findings confirm that clinicians need further training in person-centred decision-making, including respectful communication even when choices fall outside of standard care.
Kairos care in a Chronos world: Midwifery care as model of resistance and accountability in public health settingsAbstractAbstractBackground: In the Unites States (US), pregnancy-related mortality is 2–4 times higher for black and indigenous women irrespective of income and education. The integration of midwifery as a fundamental component of standard maternity services has been shown to improve health outcomes and service user satisfaction, including among underserved and minoritized groups. Nonetheless, there remains limited uptake of this model in the United States. In this study, we examine a series of interdependent factors that shape how midwifery care operates in historically disenfranchised communities within the Unites States. Methods: Using data collected from in-depth, semi-structured interviews, the purpose of this study was to examine the ways midwives recount, describe, and understand the relationships that drive their work in a publicly funded urban health care setting serving minoritized communities. Using a qualitative exploratory research design, guided by critical feminist theory, twenty full-scope midwives working in a large public health care network participated. Data were thematically analyzed using Braun & Clarke's inductive thematic analysis to interpret data and inductively identify patterns in participants’ experiences. Findings: The overarching theme “Kairos care in a Chronos World” captures the process of providing health-promoting, individualized care in a system that centers measurement, efficiency, and pathology. Five subthemes support the central theme: (1) the politics of progress, (2) normalizing pathologies, (3) cherished connections, (4) protecting the experience, and (5) caring for the social body. Midwives used relationships to sustain their unique care model, despite the conflicting demands of dominant (and dominating) medical models. Conclusion: This study offers important insight into how midwives use a Kairos approach to maternity care to enhance quality and safety. In order to realize equitable access to optimal outcomes, health systems seeking to provide robust services to historically disenfranchised communities should consider integration of relationship-based strategies, including midwifery care.
Barriers to Cervical Cancer Screening and Treatment in the Dominican Republic: Perspectives of Focus Group Participants in the Santo Domingo AreaAbstractAbstractIntroduction: Cervical cancer is the second leading cause of cancer death among women in the Dominican Republic, and high rates persist despite existing Pap smear screening programs. The purpose of this study was to explore Dominican women’s knowledge and attitudes regarding human papillomavirus (HPV) and cervical cancer, cervical cancer screening practices, and perceived barriers and facilitators to early detection of cervical cancer. Method: Six focus groups (N = 64) were conducted in Spanish in urban, suburban, and rural locations, in private and public school settings, community and workplace settings, in or near Santo Domingo, as part of a larger study on barriers and facilitators to HPV vaccine implementation. Audio recordings were transcribed verbatim and translated from Spanish to English. Qualitative data analysis used inductive and deductive approaches. Results: Knowledge regarding HPV and cervical cancer varied across groups, but all agreed there was significant stigma and fear regarding HPV. Most women reported having Pap screening at least yearly. Follow-up of abnormal Pap testing was less consistent, with cost and uncertainty about provider recommendations identified as barriers. Discussion: Broader examination of provider-level and health system barriers and facilitators to cervical cancer prevention in the Dominican Republic is essential, in order to inform interventions to improve the effectiveness of cervical cancer screening and treatment programs and reduce preventable deaths.
How Practice Facilitation Strategies Differ by Practice ContextAbstractNguyen, A. M., Cuthel, A., Padgett, D. K., Niles, P., Rogers, E., Pham-Singer, H., Ferran, D., Kaplan, S. A., Berry, C., & Shelley, D. (2020). Journal of General Internal Medicine, 35(3), 824-831. 10.1007/s11606-019-05350-7AbstractBackground: Practice facilitation is an implementation strategy used to build practice capacity and support practice changes to improve health care outcomes. Yet, few studies have investigated how practice facilitation strategies are tailored to different primary care contexts. Objective: To identify contextual factors that drive facilitators’ strategies to meet practice improvement goals, and how these strategies are tailored to practice context. Design: Semi-structured, qualitative interviews analyzed using inductive (open coding) and deductive (thematic) approaches. This study was conducted as part of a larger study, HealthyHearts New York City, which evaluated the impact of practice facilitation on adoption of cardiovascular disease prevention and treatment guidelines. Participants: 15 facilitators working in two practice contexts: small independent practices (SIPs) and Federally Qualified Health Centers (FQHCs). Main Measures: Strategies facilitators use to support and promote practice changes and contextual factors that impact this approach. Key Results: Contextual factors were described similarly across settings and included the policy environment, patient needs, site characteristics, leadership engagement, and competing priorities. We identified four facilitation strategies used to tailor to contextual factors and support practice change: (a) remain flexible to align with practice and organizational priorities; (b) build relationships; (c) provide value through information technology expertise; and (d) build capacity and create efficiencies. Facilitators in SIPs and FQHCs described using the same strategies, often in combination, but tailored to their specific contexts. Conclusions: Despite significant infrastructure and resource differences between SIPs and FQHCs, the contextual factors that influenced the facilitator’s change process and the strategies used to address those factors were remarkably similar. The findings emphasize that facilitators require multidisciplinary skills to support sustainable practice improvement in the context of varying complex health care delivery settings.
Mobilizing a Public Health Response: Supporting the Perinatal Needs of New Yorkers During the COVID-19 Pandemic
Reflecting on Equity in Perinatal Care during a PandemicAbstractAbstractGrowing discourse around maternity care during the pandemic offers an opportunity to reflect on how this crisis has amplified inequities in health care. We argue that policies upholding the rights of birthing people, and policies decreasing the risk of COVID-19 transmission are not mutually exclusive. The explicit lack of standardization of evidence-based maternity care, whether expressed in clinical protocols or institutional policy, has disproportionately impacted marginalized communities. If these factors remain unexamined, then it would seem that equity is not the priority, but retaining power and control is. We advocate for a comprehensive understanding of how this pandemic has revealed our deepest failures.
A case study on building capacity to improve clinical mentoring and maternal child health in rural Tanzania: The path to implementationAbstractOjemeni, M. T., Niles, P., Mfaume, S., Kapologwe, N. A., Deng, L., Stafford, R., Voeten, M. J., Theonestina, K., Budin, W., Chhun, N., & Squires, A. (2017). BMC Nursing, 16(1). 10.1186/s12912-017-0252-0AbstractBackground: Tanzania is a low income, East African country with a severe shortage of human resources for health or health workers. This shortage threatens any gains the country is making in improving maternal health outcomes. This paper describes a partnership between Touch Foundation and NYU Rory Meyers College of Nursing - Global, aimed at improving clinical mentorship and capacity among nurses and midwives at two rural hospitals in the Tanzanian Lake Zone Region. Clinical mentoring capacity building and supportive supervision of staff has been shown to be a facilitator of retaining nurses and would be possible to acquire and implement quickly, even in a context of low resources and limited technology. Methods: A case study approach structures this program implementation analysis. The NYU Meyers team conducted a 6-day needs assessment at the two selected hospitals. A SWOT analysis was performed to identify needs and potential areas for improvement. After the assessment, a weeklong training, tailored to each hospitals' specific needs, was designed and facilitated by two NYU Meyers nursing and midwifery education specialists. The program was created to build on the clinical skills of expert nurse and midwife clinicians and suggested strategies for incorporating mentoring and preceptorship as a means to enhance clinical safety and promote professional communication, problem solving and crisis management. Results: Nineteen participants from both hospitals attended the training. Fourteen of 19 participants completed a post training, open ended questionnaire for a 74% response rate. Fifty-seven percent of participants were able to demonstrate and provide examples of the concepts of mentorship and supervision 4 and 11 months' post training. Participants indicated that while confidence in skills was not lacking, barriers to quality care lay mostly in understaffing. Implementation also offered multiple insights into contextual factors affecting sustainable program implementation. Conclusions: Three recommendations from this training include: 1) A pre-program assessment should be conducted to ascertain contextual relevance to curriculum development; 2) flexibility and creativity in teaching methods are essential to engage students; and 3) access to participants a priori to program implementation may facilitate a more tailored approach and lead to greater participant engagement.
Mentoring to build midwifery and nursing capacity in the Africa region: An integrative reviewNiles, P., Ojemeni, M. T., Kaplogwe, N. A., Voeten, S. M. J., Stafford, R., Kibwana, M., Deng, L., Theonestina, S., Budin, W., Chhun, N., & Squires, A. (2017). International Journal of Africa Nursing Sciences, 7, 89-95. 10.1016/j.ijans.2017.10.002
Mentoring to build nursing and midwifery capacity in Sub-Saharan Africa: An integrative reviewNiles, M., Ojemeni, M. T., Kibwana, M., Deng, L., Voten, M., Stafford, R., Theonestina, S., Budin, W., Chhun, N., & Squires, A. (2017). International Journal of Africa Nursing Sciences, 7, 89-95.
Notes from the Field: Residents’ Perceptions of Simulation-Based Skills Assessment in Obstetrics and GynecologyAbstractAbstractSimulation in obstetrics and gynecology (OBGYN) training captures a range of interpersonal, cognitive, and technical skills. However, trainee perspectives on simulation-based assessment remain unexplored. After an observed structured clinical examination (OSCE) simulation hybrid exam, two focus groups of residents were conducted. Analysis grounded in a thematic coding guided the qualitative research process. Responses suggest a valuation of cognitive and technical skills over interpersonal skills. Realism was seen as critical and residents perceived the assessment as more valuable for the educator than the learner. Feedback was highly valued. Resident perspectives on this exam give insight into their perceptions of simulation-based assessment as well as their conceptions of their own learning through simulations.