Paulomi Bhatt

Faculty

Mimi Bhatt headshot

Paulomi Bhatt

PhD MPH CNM

Assistant Professor

1 212 998 5312

433 FIRST AVENUE
NEW YORK, NY 10010
United States

Mimi (Paulomi) Bhatt, 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. Bhatt 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. 

Bhatt 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. Bhatt 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 Prof. 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
MSN, Frontier Nursing University
MPH, NYU School of Global 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)
Presidential Community Service Award, NYU (2019)
Minority Faculty Nurse Scholar Award, Johnson & Johnson/American Academy of Nursing (2019)
Ellen D. Baer Doctoral Nursing Scholarship, NYU (2019)
Global Research Institute Fellowship – NYU – Paris, FR. (2019)
Pauline Greenidge Doctoral Nursing Scholarship, New York University (2019)
NYC Midwives Community Research Grant Award (2018)
Carrington-Hsia-Nieves Doctoral Scholarship for Midwives of Color, American College of Nurse-Midwives (2018)
Herman Biggs Health Policy Fellow, The Josiah Macy Jr. Foundation (2018)
Nurse Leader-Scholar Awardee, Jonas Center (2018)
Conference Award, NYU Student Senators Council (2018)
Minority Faculty Nurse Scholar Award, Johnson & Johnson/American Academy of Nursing (2018)
Minority Faculty Nurse Scholar Award, Johnson & Johnson/American Academy of Nursing (2017)
Conference Award, NYU Student Senators Council (2017)
Women’s Leadership Initiative – Selected Participant, NYU (2017)
Nurse Leader-Scholar Awardee, Jonas Center (2017)
Herman Biggs Health Policy Fellow, The Josiah Macy Jr. Foundation (2017)
Minority Faculty Nurse Scholar Award, Johnson & Johnson/American Academy of Nursing (2016)
Nurse Leader-Scholar Awardee, Jonas Center (2016)
Conference Award, NYU Student Senators Council (2016)
NYC Midwives Research Grant Award (2014)
Assistantship Awardee, Evidence-Based Birth Research (2014)
Arronson Foundation Scholarship, FNU (2009)
International Midwifery Scholarship, FNU (2008)

Transdisciplinary Imagination : Addressing Equity and Mistreatment in Perinatal Care

Niles, M., Vedam, S., Zephyrin, L., Hardtman, P., Lusero, I., Olson, R., Hassan, S. S., van den Broek, N., Stoll, K., Niles, P., Goode, K., Nunally, L., Kandal, R., & Bair, J. W. (2022). In Maternal and Child Health Journal (Vols. 26, Issues 4, pp. 674-681). 10.1007/s10995-022-03419-0
Abstract
Abstract
Inequities in birth outcomes are linked to experiential and environmental exposures. There have been expanding and intersecting wicked problems of inequity, racism, and quality gaps in childbearing care during the pandemic. We describe how an intentional transdisciplinary process led to development of a novel knowledge exchange vehicle that can improve health equity in perinatal services. We introduce the Quality Perinatal Services Hub, an open access digital platform to disseminate evidence based guidance, enhance health systems accountability, and provide a two-way flow of information between communities and health systems on rights-based perinatal services. The QPS-Hub responds to both community and decision-makers’ needs for information on respectful maternity care. The QPS-Hub is well poised to facilitate collaboration between policy makers, healthcare providers and patients, with particular focus on the needs of childbearing families in underserved and historically excluded communities.

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

Niles, M., Rost, M., Stuerner, Z., Niles, P., & Arnold, L. (2022). In SSM - Qualitative Research in Health (Vols. 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

Niles, M., Stoll, K., Wang, J. J., Niles, P., Wells, L., & Vedam, S. (2021). In Reproductive Health (Vols. 18, Issue 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, M., Niles, P. M., Stoll, K., Wang, J. J., Black, S., & Vedam, S. (2021). In PloS one (Vols. 16, Issues 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, M., Niles, P. M., Vedam, S., Witkoski Stimpfel, A., & Squires, A. P. (2021). In Birth (Vols. 48, Issues 4, pp. 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.

Reimagining Perinatal Mental Health : An Expansive Vision For Structural Change

Niles, M., Foster, V. A., Harrison, J. M., Williams, C. R., Asiodu, I. V., Ayala, S., Getrouw-Moore, J., Davis, N. K., Davis, W., Mahdi, I. K., Nedhari, A., Niles, P. M., Peprah, S., Perritt, J. B., McLemore, M. R., & Mask Jackson, F. (2021). In Health affairs (Project Hope) (Vols. 40, Issues 10, pp. 1592-1596). 10.1377/hlthaff.2021.00805
Abstract
Abstract
Diagnoses of depression, anxiety, or other mental illness capture just one aspect of the psychosocial elements of the perinatal period. Perinatal loss; trauma; unstable, unsafe, or inhumane work environments; structural racism and gendered oppression in health care and society; and the lack of a social safety net threaten the overall well-being of birthing people, their families, and communities. Developing relevant policies for perinatal mental health thus requires attending to the intersecting effects of racism, poverty, lack of child care, inadequate postpartum support, and other structural violence on health. To fully understand and address this issue, we use a human rights framework to articulate how and why policy makers must take progressive action toward this goal. This commentary, written by an interdisciplinary and intergenerational team, employs personal and professional expertise to disrupt underlying assumptions about psychosocial aspects of the perinatal experience and reimagines a new way forward to facilitate well-being in the perinatal period.

Barriers to Cervical Cancer Screening and Treatment in the Dominican Republic : Perspectives of Focus Group Participants in the Santo Domingo Area

Liebermann, E. J., VanDevanter, N., Shirazian, T., Frías Gúzman, N., Niles, M., Healton, C., & Ompad, D. C. (2020). In Journal of Transcultural Nursing (Vols. 31, Issues 2, pp. 121-127). 10.1177/1043659619846247
Abstract
Abstract
Introduction: 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 Context

Niles, M., Nguyen, A. M., Cuthel, A., Padgett, D. K., Niles, P., Rogers, E., Pham-Singer, H., Ferran, D., Kaplan, S. A., Berry, C., & Shelley, D. (2020). In Journal of general internal medicine (Vols. 35, Issues 3, pp. 824-831). 10.1007/s11606-019-05350-7
Abstract
Abstract
Background: 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

Niles, M., Claudio, E., Donahue, J., Niles, P. M., Pirsch, A., Ramos, P., Neely, I., Conceiçaõ, R., Thomas, M.-P., St Vil, T., & Kaplan, D. (2020). In Maternal and Child Health Journal (Vols. 24, Issues 9, pp. 1083-1088). 10.1007/s10995-020-02984-6 ; http://link.springer.com/10.1007/s10995-020-02984-6
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Reflecting on Equity in Perinatal Care during a Pandemic

Niles, M., Niles, P. M., Asiodu, I. V., Crear-Perry, J., Julian, Z., Lyndon, A., McLemore, M. R., Planey, A. M., Scott, K. A., & Vedam, S. (2020). In Health Equity (Vols. 4, Issue 1, pp. 330-333). 10.1089/heq.2020.0022
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Abstract
Growing 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.