Q&A with Lori Trego, Distinguished Nurse Scholar in Residence at the National Academy of Medicine

Lori Trego, PhD, CNM, FAAN, a nationally recognized researcher, talks about her role at the National Academy, why midwives are the perfect providers for military women, and much more.*

Q. Tell us about the Distinguished Nurse Scholar in Residence program at the National Academy of Medicine.

A. I am here for one year, September 1, 2018 to August 31, 2019, and I am sponsored in this position by the American Academy of Nursing, the American Nurses Association, and the American Nurses Foundation. My job at the National Academy of Medicine (NAM), as is everyone’s job here, is to provide scientific evidence and evaluation of health issues while remaining totally unbiased and impartial to any type of political influence, and as the Distinguished Nurse Scholar in Residence, impart my knowledge to whomever needs it at NAM.

I’m beginning my residence with this year’s cohort of the Robert Wood Johnson Foundation Health Policy Fellows. So, I am getting the whole overview of what’s going on in health policy in DC at this moment, which has been truly an eye-opening experience. It is like getting one year’s worth of health policy graduate level education crammed into 12 weeks. We meet with people from think tanks in DC from all the way on the left to all the way on the right. We also meet with the agencies and the legislative branch, so we’ve been meeting with the Health Resources and Services Administration and the Congressional Research Service, as well as with other people who help shape health policy.

So, I’ve come here to understand how the health policy world works and how we make an impact and change the culture around veteran women’s health care and the availability of health care services for military women and veterans.

Q. What do you hope to achieve by the end of your residency?

A. One of the ways I’d like to walk out of this year is by asking how do we start tying everything I’m learning together. It’s about taking the whole picture of veteran women’s health, for example, and gathering all the information and attacking the problem from many different perspectives, including the perspectives of hard science, the social determinants of health, and legislation. As I form my next study, for example, I’m going to craft it through the lens of how we can use this study to drive legislation to change the law for this population. So, let me create just the right kind of study with the right kind of variables. I think this will be invaluable to my program of research.

Q: What about on a professional level?

A. I’m a fellow at the American Academy of Nursing, and I’m also on their expert panels for women’s health and for military and veteran’s health. My experience here will be invaluable to the academy on these expert panels in terms of the knowledge and connections I am making. It will help us get to the right information and data, talk to the right people, and write just the right consensus paper, academic paper, or brief.

Plus, for ACNM, every time I say in these meeting that I’m a nurse-midwife, eyes light up, and I think this is very good PR for midwives and good PR for ACNM. It is important to let advanced practice nurses know that they are well thought of here at NAM. I can certainly bring to ACNM the exact same knowledge I’m bringing to the AAN in terms of health policy formation. I know there are people at ACNM and AAN who have much more knowledge than I have in this area, but now I’m another one of them, and I’m more than willing to share my knowledge.

Q. Tell us about the work you’re doing at the Academy.

A. The consensus report is probably the most well-known product of the Academy. The National Academy of Science was given a charge in the Constitution, signed by Lincoln, to provide a scientific opinion on things that the government was thinking about doing. Today, they still have that charge. The National Academy of Medicine pulls together a committee in the consensus process that represents the multiple views of a particular problem. This committee doesn’t just look at the data; they have to agree on a bottom line, and this gets peer reviewed. The critical thing is that they produce a nonpartisan, unbiased list of recommendations for a problem related to health.

I will be working with the program director who has shepherded many veterans’ consensus reports. We have to figure out what would be the most salient proposal for veteran women’s health, and throughout the year, I’ll be helping to craft a proposal for a project on a problem that we see that we need to have a consensus statement on. I’m excited about that process and will be working closely with the VA researchers and the Health Resources and Services Administration.

Q. You’ve mentioned that you’re convinced midwives are the perfect providers for military women and veterans. Why?

A. First, I think every woman should have a midwife; it is just my philosophy. In the military health care system as a practicing midwife, I loved to see active duty women in my clinic. We certainly saw everybody. My background is labor and delivery and intrapartum care, but I was also the chief of a well woman clinic. So, I gravitated in my practice toward active duty women for their well women needs, their contraceptive needs, and things like that.

Who can better see the holistic perspective of a military woman than a midwife? Military women bring with them into those well-woman appointments so many different things that we need to be cognizant of. We need to be cognizant of their position in the military, how their supervisors and peers view them and their health care, and what their reproductive life planning needs are. Military women have different needs than civilian women, period.

And I think that midwives can fully address them [because] we understand family stresses and we understand the challenge that gyn issues bring to your life, and for military women, those stressors are compounded.

Your whole career takes place in a masculine society. You have to balance your career needs with your desires to take care of your body, and many things play into this. For example, if you’re in a field environment, there is no bathroom, and there is no running water. You’re out there for two weeks without a shower. This is just part of the job. Military women have to think about if they have a child, will it keep them from getting that next duty position or impact their unit’s work. Is their spouse or partner deploying? Spacing or planning pregnancies is very important to military women. They are there to really figure it out. That’s why I think we’re the best providers. We can see the woman as a whole during these encounters, rather than just another prescription refill.

Q. What is your advice for beginning researchers?

 A. First, you have to research something you are passionate about. Without the passion, you hit so many barriers and bumps along the way that it may be easy to not proceed. [Second], consider your interprofessional colleagues. Just as our approach to women and women’s health is holistic, we need to approach any investigation with that holistic perspective. Why not reach out to that colleague who is an expert in preventive medicine? Know the areas you don’t know and reach out for collaboration in those areas. [Third,] always check the pulse of your population and confirm that you are really working for them. You are not doing [the work] for your own research portfolio, so check back and make sure that it is a salient study.

Q. What would you say to a student who is interested in pursuing midwifery through the Armed Services?

 A. I would tell any nurse and any nurse-midwife to join the military, if you are interested in the population and if you want to grow as a professional. The military has a collaborative practice model that has been working for many years (bit.ly/2DCO9nQ). Midwives work with the physicians in a hierarchy dictated by rank not profession. We work in an environment in which nursing is a respected profession, and we work as colleagues with our physicians. So, if someone is going to come to me and say, “I’m thinking about joining the Army as a midwife, I’m going to say, ‘Oh yes. I wholeheartedly support that.’”

*Disclaimer: The views expressed in this interview of those of Dr. Trego alone and are not intended to communicate the official views of the National Academies of Sciences, Engineering, and Medicine.