Mimi Niles

Faculty

Paulomi (Mimi) Niles

Mimi Niles

CNM MPH PhD

Assistant Professor

1 212 998 5312

433 FIRST AVENUE
NEW YORK, NY 10016
United States

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 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. 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 PhD 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 - NYU
MSN - Frontier Nursing University
MPH - NYU
BSN - NYU
BA - NYU

Midwifery
Health Services Research
Women's health

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)

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. 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.

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.

Kairos care in a Chronos world: Midwifery care as model of resistance and accountability in public health settings

Niles, P. M., Vedam, S., Witkoski Stimpfel, A., & Squires, A. (2021). Birth, 48(4), 480-492. 10.1111/birt.12565
Abstract
Abstract
Background: In the United 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.