Mimi Niles

Faculty

Mimi Niles headshot

Mimi Niles

CNM MPH PhD

Assistant Professor

1 212 998 5312

Mimi (Paulomi) Niles, PhD, MPH, CNM, is Assistant Professor 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 critical feminist and anti-oppression 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.

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. She continues to provide clinical care as a full-scope midwife working in a collaborative midwife-physician practice setting, within the largest municipal hospital system in the nation, NYC Health + Hospitals. 

Prof. Niles is an active member of the midwifery community locally, nationally, and globally. She was recently appointed to serve as a member of the Americas Regional Committee of the International Confederation of Midwives (ICM) as a research expert.  Locally, she serves on the New York City Maternal Mortality and Morbidity Review Committee and is an active member of the Brooklyn Borough President Maternal Health Taskforce Midwifery Committee.  She has received various awards including the Johnson & Johnson Minority Faculty Award and the Jonas Nurse Leaders Scholar Award. Niles was the first certified nurse-midwife to sit on the Board of Directors of the National Association of Certified Professional Midwives (NACPM). She earned her PhD in Nursing Theory, 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 was a Provost postdoctoral fellow at NYU under the mentorship of Dr. Audrey Lyndon - a nationally recognized qualitative researcher and leader on quality and safety in maternity care. She grew up as a first-generation immigrant in Queens, NY, is mothers to two young adults, and honors her mother’s legacy as a nurse-midwife in India.
 

PhD, NYU Meyers College of Nursing
MSN, Frontier Nursing University
MPH, NYU Global Institute of Public Health
BSN, NYU Steinhardt School of Education
BA, NYU College of Arts & Science

Birth Equity and Reproductive Freedom
Feminist Theory and Praxis
Health Services Research
Midwifery
Public and Global Health
Qualitative Research

NYU University-wide Dissertation Award – Allied Health & Social Services (2020)
Ellen D. Baer Doctoral Nursing Scholarship, NYU (2019)
Pauline Greenidge Doctoral Nursing Scholarship, New York University (2019)
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)
Herman Biggs Health Policy Fellow, The Josiah Macy Jr. Foundation (2018)
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)
Conference Award, NYU Student Senators Council (2017)
Minority Faculty Nurse Scholar Award, Johnson & Johnson/American Academy of Nursing (2017)
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)
Nurse Leader-Scholar Awardee, Jonas Center (2016)
Conference Award, NYU Student Senators Council (2016)
Minority Faculty Nurse Scholar Award, Johnson & Johnson/American Academy of Nursing (2016)
Assistantship Awardee, Evidence-Based Birth Research (2014)
NYC Midwives Research Grant Award (2014)
Arronson Foundation Scholarship, FNU (2009)
International Midwifery Scholarship, FNU (2008)

Perinatal Mood and Anxiety Disorder and Reproductive Justice: Examining Unmet Needs for Mental Health and Social Services in a National Cohort

Taiwo, T. K., Goode, K., Niles, P. M., Stoll, K., Malhotra, N., & Vedam, S. (2024). Health Equity, 8(1), 76-86. 10.1089/heq.2022.0207
Abstract
Abstract
Introduction: Perinatal Mood and Anxiety Disorders (PMADs) are the most common complications during the perinatal period. There is limited understanding of the gaps between need and provision of comprehensive health services for childbearing people, especially among racialized populations. Methods: The Giving Voice to Mothers Study (GVtM; n = 2700), led by a multistakeholder, Steering Council, captured experiences of engaging with perinatal services across the United States, including access, respectful care, and health systems’ responsiveness. A patient-designed survey included variables to assess relationships between race, care provider type (midwife or doctor), and needs for psychosocial health services. We calculated summary statistics and tested for significant differences across racialized groups, subsequently reporting odds ratios (ORs) for each group. Results: Among all respondents, 11% (n = 274) reported unmet needs for social and mental health services. Indigenous women were three times as likely to have unmet needs for treatment for depression (OR [95% confidence interval, CI]: 3.1 [1.5–6.5]) or mental health counseling (OR [95% CI]: 2.8 [1.5–5.4]), followed by Black women (OR [95% CI]: 1.8 [1.2–2.8] and 2.4 [1.7–3.4]). Odds of postpartum screening for PMAD were significantly lower for Latina women (OR [95% CI] = 0.6 [0.4–0.8]). Those with midwife providers were significantly more likely to report screening for anxiety or depression (OR [95% CI] = 1.81 [1.45–2.23]) than those with physician providers. Discussion: We found significant unmet need for mental health screening and treatment in the United States. Our results confirm racial disparities in referrals to social services and highlight differences across provider types. We discuss barriers to the integration of assessments and interventions for PMAD into routine perinatal services. Implications: We propose incentivizing reimbursement schema for screening and treatment programs; for community-based organizations that provide mental health and social services; and for culture-centered midwife-led perinatal and birth centers. Addressing these gaps is essential to reproductive justice.

“We don’t really address the trauma”: Patients’ Perspectives on Postpartum Care Needs after Severe Maternal Morbidities

Niles, P. M., Nack, A., Eniola, F., Searing, H., & Morton, C. (2024). Maternal and Child Health Journal, 28(8), 1432-1441. 10.1007/s10995-024-03927-1
Abstract
Abstract
Objectives: This qualitative study explored experiences of 15 women in New York City who suffered physical, emotional, and socioeconomic consequences of severe maternal morbidity (SMM). This study aimed to increase our understanding of additional burdens these mothers faced during the postpartum period. Methods: Qualitative analysis of in-depth interviews (n = 15) with women who had given birth in NYC hospitals and experienced SMM. We focused on how experiences of SMM impacted postpartum recoveries. Grounded theory methodology informed analysis of participants’ one-on-one interviews. To understand the comprehensive experience of postpartum recovery after SMM, we drew on theories about social stigma, reproductive equity, and quality of care to shape constant-comparative analysis and data interpretation. Findings: Three themes were generated from data analysis: ‘Caring for my body’ defined by challenges during physical recuperation, ‘caring for my emotions’ which highlighted navigation of mental health recovery, and ‘caring for others’ defined by care work of infants and other children. Most participants identified as Black, Latinx and/or people of color, and reported the immense impacts of SMM across aspects of their lives while receiving limited access to resources and insufficient support from family and/or healthcare providers in addressing postpartum challenges. Conclusions for Practice: Findings confirm the importance of developing a comprehensive trauma-informed approaches to postpartum care as a means of addressing SMM consequences.

Between “a lot of room for it” and “it doesn't exist”—Advancing and limiting factors of autonomy in birth as perceived by perinatal care practitioners: An interview study in Switzerland

Rost, M., Stuerner, Z., Niles, P., & Arnold, L. (2023). Birth, 50(4), 1068-1080. 10.1111/birt.12757
Abstract
Abstract
Background: Numerous studies show that negative birth experiences are often related to birthing people's loss of autonomy. We argue that a fetal-focused decision-making framework and a maternal–fetal conflict lens are often applied, creating a false dichotomy between autonomy and fetal beneficence. Given the high prevalence of autonomy-depriving decision-making, it is important to understand how autonomy can be enhanced. Methods: We interviewed 15 Swiss perinatal care practitioners (eight midwives, five physicians, and two doulas) and employed reflexive thematic analysis. We offer a reflection on underlying assumptions and researcher positionality. Results: We generated two descriptive themes: advancing and limiting factors of autonomy. Numerous subthemes, grouped at the levels of companion, birthing person, practitioners, birthing person–practitioner relationship, and structural determinants are also defined. The most salient advancing factors were practitioners' approaches to decision-making, antenatal contacts, and structural determinants. The most salient limiting factors were various barriers within birthing people (e.g., expertise, decisional capacity, and awareness of own rights), practitioners' attitudes and behavior, and structural determinants. Discussion: The actualization of autonomy is multifactorially determined and must be understood against the background of power structures both underlying and inherent to decision-making in birth. Practitioners attributed a significant proportion of limited autonomy to birthing people themselves. This reinforces a “mother-blame” narrative that absolves obstetrics of primary responsibility. Practitioners' recognition of their contributions to upholding limits on autonomy should be leveraged to implement training towards rights-based practice standards. Most importantly, autonomy can only fully materialize if the underlying sociocultural, political, and medical contexts undergo a fundamental change.

Childbearing at the margins: A systematic metasynthesis of sexual and gender diverse childbearing experiences

Soled, K. R. S., Niles, P. M., Mantell, E., Dansky, M., Bockting, W., & George, M. (2023). Birth, 50(1), 44-75. 10.1111/birt.12678
Abstract
Abstract
Background: The reproductive and perinatal health of sexual and gender-diverse (SGD) individuals is a research priority area for the National Institutes of Health. Over the past decade, this childbearing population has been the focus of several qualitative studies providing the opportunity to evaluate and synthesize the qualitative literature on SGD childbearing experiences in a metasynthesis. Methods: We conducted a literature search of four databases to identify original research published from January 2011 through June 2021. These results were augmented by forward and backward searching strategies. Two authors independently screened studies. All qualitative studies of the childbearing experience were eligible. Data were extracted and inductively coded using conventional content analysis, and studies underwent a quality appraisal by two authors. Results: From 2396 articles, 127 full-text articles were screened, and 25 were included in this synthesis. Three overarching themes were identified: (a) Systematic Invisibility; (b) Creating Personhood Through Parenthood; and (c) Resilient Narratives of Childbearing. Conclusions: Relative to heterosexual and cisgender parents, SGD childbearing parents experience unique structural and interpersonal challenges and employ critically important resilience strategies and coping techniques to manage an overwhelming heterocisnormative experience. These findings provide an important target for health care organizations and professionals to improve SGD perinatal health. In addition, this metasynthesis identified persistent gaps in our understanding of this marginalized childbearing population, which have important implications for reducing health disparities that SGD parents experience.

Examining respect, autonomy, and mistreatment in childbirth in the US: do provider type and place of birth matter?

Niles, P. M., Baumont, M., Malhotra, N., Stoll, K., Strauss, N., Lyndon, A., & Vedam, S. (2023). Reproductive Health, 20(1). 10.1186/s12978-023-01584-1
Abstract
Abstract
Background: Analyses of factors that determine quality of perinatal care consistently rely on clinical markers, while failing to assess experiential outcomes. Understanding how model of care and birth setting influence experiences of respect, autonomy, and decision making, is essential for comprehensive assessment of quality. Methods: We examined responses (n = 1771) to an online cross-sectional national survey capturing experiences of perinatal care in the United States. We used validated patient-oriented measures and scales to assess four domains of experience: (1) decision-making, (2) respect, (3) mistreatment, and (4) time spent during visits. We categorized the provider type and birth setting into three groups: midwife at community birth, midwife at hospital-birth, and physician at hospital-birth. For each group, we used multivariate logistic regression, adjusted for demographic and clinical characteristics, to estimate the odds of experiential outcomes in all the four domains. Results: Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy (aOR: 5.22, 95% CI: 3.65–7.45), higher respect (aOR: 5.39, 95% CI: 3.72–7.82) and lower odds of mistreatment (aOR: 0.16, 95% CI: 0.10–0.26). We found significant differences across birth settings: participants cared for by midwives in the community settings had significantly better experiential outcomes than those in the hospital settings: high- autonomy (aOR: 2.97, 95% CI: 2.66–4.27), respect (aOR: 4.15, 95% CI: 2.81–6.14), mistreatment (aOR: 0.20, 95% CI: 0.11–0.34), time spent (aOR: 8.06, 95% CI: 4.26–15.28). Conclusion: Participants reported better experiential outcomes when cared for by midwives than by physicians. And for those receiving midwifery care, the quality of experiential outcomes was significantly higher in community settings than in hospital settings. Care settings matter and structures of hospital-based care may impair implementation of the person-centered midwifery care model.

Measuring midwives' perceptions of their practice climate across racial-ethnic identities: An invariance analysis of the Midwifery Practice Climate Scale

Thumm, E. B., Giano, Z., Niles, P. M., Smith, D., & Howard, B. (2023). Research in Nursing and Health, 46(6), 627-634. 10.1002/nur.22349
Abstract
Abstract
Diversification of the midwifery workforce is key to addressing disparities in maternal health in the United States. Midwives who feel supported in their practice environments report less burnout and turnover; therefore, creating positive practice environments for midwives of color is an essential component of growing and retaining midwives of color in the workforce. The Midwifery Practice Climate Scale (MPCS) is a 10-item instrument developed through multiphase empirical analysis to measure midwives' practice environments, yet the MPCS had not been independently tested with midwives of color. We conducted invariance analyses to test whether latent means can be compared between midwives of color and non-Hispanic White samples. A step-up approach applied a series of increasingly stringent constraints to model estimations with multiple group confirmatory factor analyses with two pooled samples. A configural model was estimated as the basis of multiple group comparisons where all parameters were allowed to freely vary. Metric invariance was estimated by constraining item factor loadings to be equal. Scalar invariance was estimated by constraining intercepts of indicators to be equal. Each model was compared to the baseline model. The findings supported scalar invariance of MPCS across midwives of color and non-Hispanic White midwives, indicating that the MPCS is measuring the same intended construct across groups, and that differences in scores between these two groups reflect true group differences and are not related to measurement error. Additionally, in this sample, there was no statistically significant difference in perceptions of the practice environments across midwives of color and non-Hispanic White midwives (p > 0.05).

The value of including reproductive justice into nursing curricula

Niles, P. M., Augé, L., & Gilles, S. A. (2023). Nurse Education Today, 123. 10.1016/j.nedt.2023.105742

Advancing quality and safety of perinatal services in India: opportunities for effective midwifery integration

Vedam, S., Titoria, R., Niles, P., Stoll, K., Kumar, V., Baswal, D., Mayra, K., Kaur, I., & Hardtman, P. (2022). Health Policy and Planning, 37(8), 1042-1063. 10.1093/heapol/czac032
Abstract
Abstract
India has made significant progress in improving maternal and child health. However, there are persistent disparities in maternal and child morbidity and mortality in many communities. Mistreatment of women in childbirth and gender-based violence are common and reduce women's sense of safety. Recently, the Government of India committed to establishing a specialized midwifery cadre: Nurse Practitioners in Midwifery (NPMs). Integration of NPMs into the current health system has the potential to increase respectful maternity care, reduce unnecessary interventions, and improve resource allocation, ultimately improving maternal-newborn outcomes. To synthesize the evidence on effective midwifery integration, we conducted a desk review of peer-reviewed articles, reports and regulatory documents describing models of practice, organization of health services and lessons learned from other countries. We also interviewed key informants in India who described the current state of the healthcare system, opportunities, and anticipated challenges to establishing a new cadre of midwives. Using an intersectional feminist theoretical framework, we triangulated the findings from the desk review with interview data to identify levers for change and recommendations. Findings from the desk review highlight that benefits of midwifery on outcomes and experience link to models of midwifery care, and limited scope of practice and prohibitive practice settings are threats to successful integration. Interviews with key informants affirm the importance of meeting global standards for practice, education, inter-professional collaboration and midwifery leadership. Key informants noted that the expansion of respectful maternity care and improved outcomes will depend on the scope and model of practice for the cadre. Domains needing attention include building professional identity; creating a robust, sustainable education system; addressing existing inter-professional issues and strengthening referral and quality monitoring systems. Public and professional education on midwifery roles and scope of practice, improved regulatory conditions and enabling practice environments will be key to successful integration of midwives in India.

Honoring Asian diversity by collecting Asian subpopulation data in health research

Niles, P. M., Jun, J., Lor, M., Ma, C., Sadarangani, T., Thompson, R., & Squires, A. (2022). Research in Nursing and Health, 45(3), 265-269. 10.1002/nur.22229

“Real decision-making is hard to find” - Swiss perinatal care providers’ perceptions of and attitudes towards decision-making in birth: A qualitative study

Rost, M., Stuerner, Z., Niles, P., & Arnold, L. (2022). SSM - Qualitative Research in Health, 2. 10.1016/j.ssmqr.2022.100077
Abstract
Abstract
Purpose: Ineffective communication and limited autonomy frequently lie at the core of negative birth experiences. Numerous studies indicate a need to improve decision-making with a deliberate shift towards person-centered care. Thus, it is imperative to study the determinants of autonomy-depriving decision-making and ineffective communication through both provider and birthing people perspectives. Our study explores providers’ perceptions of and attitudes towards decision-making in birth, particularly regarding person-centeredness, autonomy, informed consent, and decision-making capacity. We conducted a qualitative interview study and employed reflexive thematic analysis. In total, 15 Swiss providers from birth hospitals and birth centers participated. Results: Analysis resulted in the development of three themes and eight subthemes. First, the “otherness of birth” encompasses providers' perception of birth as a clinical situation that is fundamentally different from other clinical situations. Second, the otherness of birth goes along with an “ethical fading”, that is ethical dimensions – to some extent – fade into the background as they are obscured by various circumstances that are related to birth, birthing people, and providers. Third, the “physiology-pathology-dichotomy” describes the permeative power of this dichotomy with respect to providers’ decision-making approaches and their normative weighing of ethical principles. Conclusions: Decision-making in birth is a critical factor in the actualization of autonomy and characterized by bioethical complexity. Our study reveals important insights into how autonomy-depriving decision-making and ineffective communication unfolds in birth. Our findings provide a framework for future research and yield points of leverage for enhancing decision-making in birth.