Mimi Niles

Faculty

Mimi Niles headshot

Mimi Niles

CNM MPH PhD

Assistant Professor

1 212 998 5312

433 FIRST AVENUE
NEW YORK, NY 10016
United States

Mimi Niles's additional information

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

Faculty Honors Awards

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)

Publications

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.

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 childbirth

Stoll, K., Wang, J. J., Niles, P., Wells, L., & Vedam, S. (2021). Reproductive Health, 18(1). 10.1186/s12978-021-01134-7
Abstract
Abstract
Background: 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.

"I fought my entire way": Experiences of declining maternity care services in British Columbia

Niles, P. M., Stoll, K., Wang, J. J., Black, S., & Vedam, S. (2021). PloS One, 16(6). 10.1371/journal.pone.0252645
Abstract
Abstract
Background The 2016 WHO Standards for improving quality of maternal and newborn care in health facilities established patient experience of care as a core indicator of quality. Global health experts have described loss of autonomy and disrespect as mistreatment. Risk of disrespect and abuse is higher when patient and care provider opinions differ, but little is known about service users experiences when declining aspects of their maternity care. Methods To address this gap, we present a qualitative content analysis of 1540 written accounts from 892 service users declining or refusing care options throughout childbearing with a large, geographically representative sample (2900) of childbearing women in British Columbia who participated in an online survey with open-ended questions eliciting care experiences. Findings Four themes are presented: 1) Contentious interactions: "I fought my entire way", describing interactions as fraught with tension and recounting stories of "fighting"for the right to refuse a procedure/intervention; 2) Knowledge as control or as power: "like I was a dim girl", both for providers as keepers of medical knowledge and for clients when they felt knowledgeable about procedures/interventions; 3) Morbid threats: "do you want your baby to die?", coercion or extreme pressure from providers when clients declined interventions; 4) Compliance as valued: "to be a 'good client'", recounting compliance or obedience to medical staff recommendations as valuable social capital but suppressing desire to ask questions or decline care. Conclusion We conclude that in situations where a pregnant person declines recommended treatment, or requests treatment that a care provider does not support, tension and strife may ensue. These situations deprioritize and decenter a woman's autonomy and preferences, leading care providers and the culture of care away from the principles of respect and person-centred care.