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To Live and Thrive

David Kovaluk

We wanted to know how environmental issues affect babies and birthing people during childbirth, one of the most delicate life processes. In the U.S., Black babies are two times more likely to die before their first birthday than white babies, and Black women are three times more likely to die from pregnancy-related complications then white women. So in this episode, we hear from a documentary filmmaker about humanizing Black birthing people, a neonatal hospitalist about the effects the environment has on newborns and mothers and an executive director of an Equal Access Midwifery Clinic about supporting people of color through the birthing process.

To Live and Thrive Transcript

Seg 1

[soft, pensive piano and strings music]

Lauren: Hey y’all its Lauren

We wanted to know how environmental issues affect babies and birthing people specifically during childbirth, one of the most delicate life processes.

Because in the U.S., Black babies are two times more likely to die before their first birthday than white babies and Black women are three times more likely to die from pregnancy-related complications than white women..

Brittany Ferrell, a Black mother, organizer and Nursing Science PhD student saw these disparities first hand when she worked with Black patients as a high-risk labor and delivery nurse…

Brittany: The way that I saw them treated by some of my coworkers, my fellow nursing colleagues, it was something that made me really upset as a person, as a Black person and as a Black practitioner. But it also made me think about how, you know, because of the medical racism that Black pregnant people experience when they are in the institutions, because of the systemic racism and then leading to the health disparities, the maternal health disparities, the infant health disparities that you see coming out of our community, it is because our experiences in these institutions.... we're not seen as full people.

Lauren: Brittany points out that maternal health disparities continue to lead to tragic outcomes for Black families.

She reminded us about the stories of Sha-Asia Washington and Amber Issac, two Black women from New York who lost their lives during childbirth after medical professionals failed to take their concerns seriously.

Brittany: It’s after they've already died and then a loved one is talking about how amazing they were, how much they cared about people, how much they wanted this baby in this pregnancy. And we rarely ever get to give people their flowers while they're still here. We rarely ever get to recognize a person's dignity and their humanness, while they're here. And so I wanted to use just my access as a clinician, my expertise as someone who has worked in this field for several years, and my relationships as an organizer. And, you know, to create something that could explore the intimacy of Black pregnant people's lives that people don't see.

Lauren: And she says oftentimes Black women are blamed for their own demise.

Brittany: We don't get to see that in addition to the obesity or the poor diet, this person might live in a food apartheid where the nearest grocery store is miles and miles away, and they don't have access to transportation to get there, you know? We don't get to see the fact that someone's state Medicaid has been revoked because they didn't provide a particular document. And so they go two months without seeing a prenatal doctor. These are things that people don't get to see that I have seen. So I wanted to really shine a light on these structural inequities and the systemic racism that disrupts Black people's ability to have a healthy and safe pregnancy, to guarantee outcomes for a healthy, healthy and safe delivery and a baby.

Lauren: That’s why she’s producing You Lucky You Got A Mama, a photographic memoir and documentary project that aims to humanize Black birthing people.

The title of the project came from a chance conversation with her friend and colleague Damon Davis, co-director and producer of Whose Streets, a documentary about the Ferguson uprising.

Brittany: We were talking on my couch and I was explaining like this idea that I had to tell these stories because I'm so sick of these false narratives and people blaming Black people for dying.

Like, I'm just frustrated and I'm explaining it. And he was like, I didn't even know this was a thing. And he is like sharing, you know, as he was listening he was like he's just like, you lucky you got a mama. And I was like, OK, that's it. And he's like, yeah that's it. So I was like OK, because mama, you know, I've always called my mom my mama. I've never said mom, I've never said mother, it's always been mama. It feels so culturally appropriate.

You know, my daughter calls me mama and I just, you know, it’s just relevant to our culture. It feels warm, it feels familiar, you know, it feels like Black love.

Lauren: But she says the title is subject to change because she wants to make sure she honors all pregnant people.

Brittany: The reason you hear me say like pregnant people, pregnant persons a lot, because You Lucky You Got a Mama, one of the goals of them is to really expand and broaden the way that we see pregnancy, who's capable of getting pregnant, who can give birth. You know, I think the medical system in general is very binary in terms of gender. Only recently have people begun to ask patients, if they ask patients, what their pronouns are and really honoring people's gender identity. But for the most part, we have a lot of work to do in medicine and nursing in terms of understanding how to respect people's gender. And so, I could not do this project as a queer black woman myself. I could not do this project without honoring the fact that cisgender women are not the only people who get pregnant, right?

And part of doing this work on this project is knowing that not everybody is going to identify as a mama. You know, some people might not identify, might not even, you know, that's not a term that even crossed their mind when they think about themselves as being a parent. And that's something that I'm constantly talking to with my team throughout the creative process.

Because, you know, a lot of times and in the industry, like film and other artistic projects, you start with one title, you end with another, you know. And so I am definitely always in conversation about that because we are telling the stories of Black trans people and Black non binary or gender nonconforming people as well. When we are exploring these experiences, we do know that while Black trans people and Black gender nonconforming and nonbinary people are Black and giving birth, they might be subjected to the same disparity that Black cisgender women are experiencing just due to the simple fact that they are Black And. We do not explore how their gender identity also impacts those outcomes as well.

Lauren: She hopes that by sharing these stories, people will be inspired to learn and take action to dismantle systemic and structural racism.

Brittany: I want other folks to be able to see the connection between the systemic racism that they might benefit from and how it impacts the lives of people that they either are caring for or if they are a clinician or that they call themselves to be in relationship with right? I want there to be a critical, there needs to be like this-- we need to be very critical of the systems that are in place that say that they’re helping our communities, you know?

Very true story: a part of You Lucky You Got a Mama, when I mentioned earlier, someone's Medicaid getting cut off because they didn't turn in a document? That is the story of one of the women that I'm following. She didn't see her doctor for two months and she was seven months pregnant at the time. [pensive music comes back in] And so these structures and systems that call themselves protecting us. Yet you are OK with someone not receiving care for two months and knowing the cards stacked against them, right? And so I want to raise this critical awareness of how systems have been designed supposedly for us and to take care of us, they're not working because if they were working, we wouldn't have to talk about environmental racism in the way that we talk about it today.

[music fades out]

Lauren: In addition to Damon Davis, Brittany has been able to work with other documentary producers like Sabaah Folayan and Philadelphia’s Shannon Sun-Higginson.

Brittany: I learned that there is a place for artistry and creativity and, you know, of course, social justice and raising issues of equity and narrative is really important in policy. I have learned that trust is one of the most important things that must be maintained, restored and upheld when you're in relationship with community.

I have also learned that it is such an honor to be able to work with and be trusted with Black people's bodies, their stories. You know, things that have often been exploited and taken advantage of and and working in collaboration with other creators. And we are a really great, dynamic team who are invested into this work and really care about these stories. And I've learned that this creative process is really special. You know, working with people who care about the same things that you care about, and for the same reasons makes all the difference in the quality of how you work together and the quality of the work itself.

Lauren: The creative process can be long and challenging, so we asked Brittany what she hopes audiences take away from the project when it's released.

Brittany: I also wanted to lift up just the sheer resilience and the joy that despite all the odds that are against our community, despite the facts of, you know, birth outcomes for Black people and Black women, we still manage to thrive. You know, we still manage to make the best of what we've got.

And I think restoring dignity, you know, this perceived dignity that people have of Black people through storytelling is something that I think You Lucky You Got a Mama offers to our community. And I want people to see it as an intellectual piece of art to be explored. But I also want them to see it as a film, the documentary part as a film that was created from lived experiences and from heart. And I want Black people to feel seen. I want Black people to feel seen in all of our experiences.

Lauren: And her hope for better days motivates her to continue the work and encourage others to do the same.

[pensive piano music and strings]

Brittany: And I think right now, thankfully, we're hearing a lot more about reproductive justice because Black people in leadership is on the rise in this country. Black women in leadership is on the rise in this country. And I think fortunately for us and our community, people who believe that the single-sided story is no longer working for us.

And I think that. As long as we continue to take this multi-faceted approach, seeing how safe and quality housing means that a parent can raise their children in a safe home, you know, with heat and with food and with running, clean running water, that is a matter of reproductive justice. If we do our work through a lens of reproductive justice, everybody, I think, you know, once we win, everybody will have the things that they need.

Lauren: Brittany is using her artistry and voice to uplift the stories of Black pregnant people and educating people on the importance of humanity.

But she’s also passionate about supporting the people working hard to provide better care and opportunities for Black babies and birthing people to thrive.

So in this episode, we hear from a neonatal hospitalist about the effects the environment has on newborns and mothers and an executive director of an Equal Access Midwifery Clinic about supporting people of color through the birthing process.

From St. Louis Public Radio and PRX, this is We Live Here.

[music fades out]

Seg 2

[pensive piano music and strings]

Lauren: The You Lucky You Got A Mama documentary is putting faces and names to the racial disparities we see in infant and maternal care.

But we wanted to know how St. Louis compares to the rest of Missouri and the country, and what can be done to alleviate environmental challenges birthing people face.

That’s why we are introducing you to Dr. Jesse Davis, a neonatal hospitalist in St. Louis Children’s Hospital Neonatal Intensive Care Unit.

He’s also a clinical instructor at Washington University’s School of Medicine, whose research focuses on how policies can help prevent infant mortality.

Dr. Davis: I'm really inspired to do this work because, you know, these babies, this is their first go at it. This is their fresh start. But a lot of them don't really have a fresh start for a number of reasons, right? From things that happened prenatally, things that that environment in which the mom lives, things that are happening to mom, family situations, birth defects that they had no control over. I'm very, very motivated to, to just come to their aid and just try to get them off to the right start.

Lauren: Infant mortality is a direct result of those challenges, and according to the Missouri Department of Health and Social Services in the City of St. Louis, Black babies are three times more likely to die before their first birthday than white babies.

Dr. Davis: The CDC list of top five causes of infant mortality and in 2018, those causes are listed as birth defects, preterm birth and low birth weight, maternal pregnancy complications, sudden infant death syndrome or SIDS, as well as injuries like suffocation or, you know, non-accidental trauma or those kinds of things. My particular interests are specifically geared towards preterm birth and low birth weight, as well as maternal pregnancy complications.

Lauren: And Jesse says, even though infant mortality rates have gone down over the last two decades in the U.S., the disparities between Black and white babies have continued to persist and we see the same pattern in maternal mortality rates as well.

For instance, between 2010 and 2018, Black women in St. Louis had nearly twice the rate of pregnancy-related deaths compared to white women.

Dr. Davis: They rank maternal mortality deaths per 100,000. And so, that's 20, around 27 compared to around 49, you know, per 100,000. That’s in St. Louis. The mortality is them dying, but the morbidity is actually the quality of life, you know, and the different ailments that they're going to have to deal with and the chronic conditions that they have. I think there's a direct correlation to how we treat those mothers and how those mothers are dying and the rates at which they're dying and the inequitable nature in which they're dying.

Lauren: These disparities hit home for Jesse this past year….when his wife who is also a physician gave birth in May.

Dr. Davis: You know, it's a baby in a pandemic. So that came with all of its own issues. But we had real concerns. We had real concerns reading the statistics about how these deliveries go, how, you know, the labor process goes, how, you know, these women are dying. You know, I had real concerns about my wife and my child, [chuckle] you know? And so, you know, I think there's a lot of work to be done and there's a lot of data out there about the problem. There's a lot of statistics about the problem. This is a well-stated, well-researched problem. And, you know, but it's very difficult to. To really find the solution.

Lauren: But Jesse says there are a lot of women who don’t have the same resources and opportunities for quality care like his family does.

That’s because health care access often comes down to access to health insurance.

Medicaid is an important source of healthcare coverage for millions of people including people who are low-income or pregnant.

It provides coverage for pregnant people through 60 days postpartum, but in states that have not expanded Medicaid under the Affordable Care Act, many women are left without a pathway to coverage and become uninsured just two months after giving birth.

Dr. Davis: My involvement is in the NICU with the babies, right? But as a neonatal hospitalist , I actually see the moms that are there, right? Because they are with us for an extended period of time. But what happens is that you have a failure to follow up for mom, you know? Either because they're really concerned about their infant at the time or they're having multiple issues within the social determinants of health. We're talking about economics. We're talking about like, you know, I have three or four other kids at home that I'm having issues trying to feed. I have to get back to work. I can't go to my postpartum appointment, you know, my Medicaid is going to be dropped.

And I can't spend this money on my health because of my pre-existing whatever condition. I can't afford my medications. I can't, and that is a problem because, you know, there is a statistic out there that, you know, the pregnancy-associated deaths, you know, are five times higher in women on Medicaid than they are for those and for those with private insurance.

Lauren: Jesse adds that supporting pregnant people also requires supporting them outside of the healthcare system.

That means helping pregnant people pay for transportation and food.

Dr. Davis: The second most common cause for infant mortality is low birth weight. You know, so these babies who, you know, mom is just just not able to maintain her health through nutrition and not able to get enough calories, not even get enough food. It's a huge issue.

And like I would say that we have to do we have to take a holistic approach, you know, to taking care of these moms, you know, through exercise, through nutrition, like those kind of resources need to be available to them. I don't think that we are doing a great job holistically taking care of all of our communities when it comes to our moms health, you know, the burden very frequently falls 100 percent on mom. I don't think that that is good when we were talking about certain moms or certain socioeconomic backgrounds, right? If it's 100 percent on me and I can barely, you know, survive, you know, as it is, then how am I supposed to bring this kid into the world in a healthy way?

Lauren: But food access isn’t the only challenge, housing conditions can affect the overall health of birthing people and babies as well.

Dr. Davis: The tenant or the residents themselves are doing the best that they can. I think that the standard should be placed on landlords, on those who are profiting on the rent or the collection of Section eight housing and, you know, those who are profiting off on these housing projects and everything that are able to make money, get government subsidies and tax write-offs without maintaining a certain standard.

And then as soon as the standard is upkept, then the property value goes up and then those people who live there are now kicked out of their homes. Gentrification is a big issue, you know, as we should be able to live and have housing that is affordable and meets the standard that should be set for the safety of the children that live there, as well as the mom or the family.

Lauren: According to Dr. Nhial Tutlam, Chronic Disease Epidemiologist for St. Louis County Department of Public Health, based on current projections St. Louis County won’t eliminate the racial gap in infant survival until 2085.

But Jesse says 2085 is waiting too long and we need to think about short term goals now.

Dr. Davis: I think that maternal care and maternal health should be something that is covered just like you have kids who are covered to a certain extent. You know, we're talking about policy changes. I think that's a policy that can be addressed. Is it fair to say that we only cover moms, pregnant moms through a certain period on Medicaid? Should we extend our postpartum coverage of moms? Should we increase the benefits and resources for moms of certain ages if they're going to be pregnant, if they're going to have kids? Those are things that should be addressed. The environmental conditions like you talked about, child care is a huge issue, care for their other children is way too expensive and they're wholly dependent on schools.

Something that is short-term, that can be done is expanding coverage to include doula care. Everybody can't afford the fancy OB office, you know? Everybody can’t afford the private OB office. So you have to go where you can go. And these community hospitals are doing a great job. They're overwhelmed sometimes. By the time that they get to them, you know, it's too late sometimes. And so initiating care early through doula care is a way to really reach the community in the community. But Doulas are not even reimbursed for their care, just like physicians are or like nurse practitioners are. They're not reimbursed for the great job that they do to care for these moms leading up to pregnancy.

Lauren: And some solutions might take longer to implement.

Dr. Davis: I think there's room for us to collectively approach infant mortality as a whole, you know, to come together and say these are the top five causes, this is infant mortality. Let's approach infant mortality, and let's not just approach infant mortality as a rate. Let's approach infant mortality with the proper racial equity lens right with the proper socioeconomic lens. The social determinants of health matter. And I think that trying to close the racial gap, we have to really go to the root causes of it. And we tried to talk about how it is on labor and delivery, how it is to the trust issues between the complex, complex trust issues between the patient and the health institutions. We try to talk all about all these different factors that are real, but we are not approaching the social determinants of health. Right? We're not approaching the holistic care of the moms.

Lauren: Providing affordable doula care and applying a racial equity lens to the infant and maternal mortality crisis will take time, so we asked Jesse what’s at stake if we don’t try to meet these goals.

[pensive piano and strings music]

Dr. Davis: There's actually a lot at stake. The infant mortality rates have gone down, but the disparities have continued to be high. And so if we're seeing that our focus is on infant mortality and our infant mortality rates are actually coming down, but our disparities are high, that just tells me that we are not looking at this with an equitable lens. That it means that we are approaching the whole and we are not approaching this from an aspect of who's most at need. You know, if we continue to go this way, there will be a complete lack of trust. And you know, we're going to continue to have these big disparities and eventually, I think our overall numbers will start to rise again, just by the way that we're going.

It’s going to be very important for us to really address it, because it's a public health matter. It’s a huge, huge, huge public health matter, something that's very important and needs to be addressed before it's too late. 2085 is too late. That is a couple of generations that we will lose, you know, and I think it's more urgent than that.

Lauren: And Jesse is leading in his own way by being a part of the STL 360 Doulas project which will train 360 doulas to be available for those in need of culturally congruent care.

Dr. Davis: Doulas have a history of just being excellent caregivers and representatives for those in the community. It's a great, great start to trying to decrease those stressors for moms trying to improve their environment, trying to improve their health conscious decisions, as well as their relationships with health providers. And I think it is going to be very important for us to pay attention to, you know, moving forward to limit our disparities.

Lauren: With all of the work Jesse is doing in his community we asked him what type of environment is he hoping to create for the next generation?

Dr. Davis: I’d like to create an environment for moms that is the kind of environment I would want my wife, my mom, my daughters to be able to live in, to be able to thrive and to be able to grow in. I mean, for everyone, right? Not just for a particular people, not just for people who can afford it, not just for people of a certain economic background.

But I think that, the pulse of our socioeconomic status as a nation relies on our health, our GDP, our infant mortality rates. Maternal health is definitely directly related to infant mortality and infant health. We need to really make it a priority. And an environment should be an environment in which a mom can step into this environment, have good nutrition, no matter where they are, no matter what their status is, have access to resources, the same resources that should be available to anyone who is being cared for by any OB. To be able to make good decisions, as far as like, well-informed decisions. They shouldn't be making the decision without being informed. And so, me informing one person is not the same as me informing another person. You understand what I'm saying?

For me to actually reach them, talk to them, have the discussion about their health. For the information to not just be there on a pamphlet, but for us to actually engage the community and actually partner with the different organizations that surround them to make an effort to increase their overall help, their foundation of health, build that up so that when they do become pregnant, they're able to have a healthier pregnancy. You know, I think that we forget about mom, you know, moms until they're pregnant. And then we kind of say, let's put them on Medicaid, let's try to get them plugged in somewhere. But we don't address the problems that they are having before then, and so that's a huge issue as well. If we as a community care for these moms, the way that we think about our mom, our wives, our daughters, our sisters, and then I think that, you know, it'd be a lot different.

Lauren: The disparities we see in infant and maternal mortality rates show why it's important to have advocacy groups and resources for birthing people of color.

And the emergence of doulas and midwives of color is creating a healthier path forward for the next generation of babies and mothers.

So up next, we hear from a doula and midwife providing affordable care to birthing people in the St. Louis region and using her platform to dismantle barriers to maternal care.

Seg 3

Lauren: The data around infant mortality and maternal mortality reveal the need for more supportive care and the emergence of doulas and midwives of color is helping to fill in that gap.

That’s why we spoke to Brittany “Tru” Kellman, executive director of Jamaa Birth Village, a nonprofit maternal health organization located in Ferguson, Missouri.

And she says her personal challenges with maternal care are why she is so passionate about providing equal access midwifery to her community.

Brittany: Real lived experiences as a black woman, I was a teen mom, so I was pregnant at 13, had my first son at 14, but my prenatal experience was very isolating, you know short of non-informational visits where things were kind of being done to me and my body. And I didn't even know why or what it all meant. I was induced without a valid medical indication that would indicate an induction and by them inducing me without my body or my baby authentically being ready to come. It tail spinned me and my baby into almost losing our lives. I was on oxygen my baby's heart tones were dropping and it was like really a crash moment. So it was a traumatic first birthing experience that led to a C-section and a very rough patch of postpartum depression.

My second birth experience, I was hoping to be better and different by finding a different provider, but I was labeled high risk because of my prior C-section almost five years prior, and I was not given a chance. And again, the same behavior continued. And after that C-section, I went through a life changing, debilitating postpartum depression that landed me in a very dark place and being alone. And it ended up sparking my light to heal the trauma that I had experienced and to also see that I was not the only black woman who was experiencing these negative pregnancy and birth outcomes with their providers who often did not look like them. So that's where my passion came from, healing through that postpartum depression, wanting to learn more and then wanting to do something about it.

Lauren: Tru read a book called Spiritual Midwifery by Ina May Gaskin and became inspired to become the person she needed during her first birthing experience.

Brittany: One woman who was in the book. Her name was Salamah Sandra Obdulio. She was a Black American midwife. And that made my light bulb go off, that I too could actually be a midwife. It was that revelation that led me into not just wanting to support people, but to also be a midwife what further concreted that was my third pregnancy. So I went through those two and then my third pregnancy. I'm just like, oh my gosh, I have all this knowledge and information now. There's no way I can go back to the hospital. So I set out to find a black midwife and a doula and it was the hardest thing ever. I found one black doula and zero black midwives in the St. Louis region. So even after knowing that that's what I was called to do, it further lit my flame that after I have my baby, I am definitely going to be the midwife that my community needs so that nobody has to go through wanting and needing and deserving something and not being able to get it.

Lauren: Jamaa Birth Village offers wraparound care because Tru believes that birthing people deserve to meet their needs without obstacles.

Brittany: When we talk about infant and maternal mortality, it's not just medical indications, such as you know a baby being born too small and losing its life or a mom hemorrhaging and losing her life, it can be socially being isolated and having providers who are not doing what they need to do for us. So, at Jamaa, we have wraparound care and that looks like having a midwife and a doula. But if you're high risk, we will connect you with the OB that we work with and you can still have a doula. But outside of that, you have a mental health care counselor that's on your team that you can meet with before you have a mental health care crisis. So you have a plan. We have a lactation specialist that's going to help first time breastfeeders or even subsequent breastfeeders to get through that. We have a chiropractor that works with our families who may have common complications, such as body pains or aches. We have an herbal apothecary with supplements and different herbal remedies that can help people naturally get through challenges.

Lauren: And she makes sure that Jamaa works on a sliding fee scale, provides scholarships, and offers as many pro bono services as possible to help birthing people afford quality care.

Brittany: We really want to show our families that if you're low income or you're unemployed, that does not mean that you have to get a secondary handout. That does not mean that you have to get the bottom of the barrel care just because you don't have what other people may have access to. And that's why we call it equal access midwifery. So when they come in and they get to see all of the beautiful herbs that typically upper upper middle class you know white women may be able to get the different types of supplements, and they feel that it's free or affordable. It just transforms them. So in the seasonal months, we also have an organic garden that feeds many of our families. We make sure we implement childbirth, education, as well as social support services, making sure that our families have diapers and wipes and utility and rental assistance if needed. So it's a very vibrant village where we do our best to not only make sure our families are thriving and well we want to make sure that what we're doing is sowing into our families and really helping them to weave together a very healthy and well life through all of the different services that we offer so that we're ending this cycle of generational poverty and health, poverty essentially for our families.

Lauren: Medical racism, health poverty and more impact stress but Tru explains that environmental issues can make stress even worse.

Brittany: So environmental stress is essentially going to create and have a substantial uptake and two hormones that are not needed or healthy in pregnancy, and that is cortisol and adrenaline. A lot of us know cortisol as that stress hormone that kind of kicks in when you are really in a stressful or intense situation. And actually we need that for when we are really in those situations. But a lot of us have chronic and toxic stress environments, which ultimately means our cortisol never shuts off or some of us may have a really intense event that happens in our life. A loved one dies, it maybe a separation or divorce in a household. We may lose someone or someone may lose a job. And essentially a lot of people don't have the tools to ground themselves and to know how to intentionally turn that cortisol off or say, I'm safe now, I'm OK now, so that their body isn't seeking more and more stress inducing environments. So it becomes a cycle.

And what that cortisol does is it actually acts as a wall and it makes it hard for the body to process nutrients, blood and oxygen to the fetus. What happens is that then the fetus feels very vulnerable and it also feels stressed out. And oftentimes babies will come sooner earthside because it doesn't feel like it's getting what it needs from the mom's body. So, again, at Jamaa, we are not just focusing on weight changes in the growth and development of the baby. Every visit we're asking about their emotional and mental wellness and we're cultivating individualized unique tools to handle it so that we're not focused on eating all this good food and exercising. But your stress levels are so high that your baby isn't even getting all the good stuff that you're doing.

Lauren: And other hormones can produce the same outcomes.

Brittany: And I think a lot of Americans are hyped up on adrenaline and adrenaline also does the same thing. But in a little bit of a different way, it actually blocks the good hormones that we need to deliver our babies when it comes to time for childbirth. So it blocks oxytocin, which is the hormone needed to make the uterus contract for the baby to come. It also can block our melatonin, which is a hormone that's induced at nighttime, but it tends to boost oxytocin when melatonin can move very well. So a lot of people have trouble sleeping at night because their adrenaline is high. They may be looking at a bunch of stuff on IG and then they can't sleep. Because that melatonin isn't moving up, so again, it's blocking that really healthy hormone that's needed in the childbirth process. And then lastly, there's a hormone called endorphins, or there's this chemical in our body called endorphins. And essentially it's our body's own pain mechanism. And so when we think about natural birth, your body has its own natural pain mechanism to help you get through. And if your adrenaline is through the roof, it's going to block that. So, again, stress and environmental factors can land women in negative pregnancy and birth outcomes. And stress is definitely higher for black people in this nation because of racism.

Lauren: Racism and stress in the medical environment can negatively impact a birthing person.

That’s why Tru says Jamaa Birth Village fosters an environment that honors a person’s humanity above all.

Brittany: One of the key things is having the ability to see and experience things that celebrate you. So at Jamaa it's not just the clinic, it is a celebration of blackness. It's a celebration of cultural heritage. And so when they walk into our space, they're seeing positive images all over our clinic of women and families that look just like them. So immediately it begins to transform the negative thoughts or visions that we have in our mind from what society perpetuates. And they start to say, oh, I can do this or I am a good mom or, you know, it really starts there.

We have aromatherapy in our clinic that goes all throughout the day and even crystal therapies in our spaces. So that helps to work on an energetic and a cellular level to assist people in feeling more calm and comfortable. Some people have what we call white coat syndrome. So when you go to the doctor, you get nervous, your blood pressure shoots up because we're used to these really intimidating relationships. So having a natural essence is in our environment, helps people to automatically feel safe and comfortable. But then when your provider comes to see you and they look like you and they may talk like you and they may live in the same community as you, there's also a letting down of the shoulders and a feeling of I'm safe they feel me, they know where I'm coming from. But also this person is skilled and trained in what I need that's going to help me navigate that.

Lauren: Being a full-time care professional comes with many challenges so we asked Tru what she wishes people understood about maternal care.

Brittany: I really wish that people understood that pregnancy and maternal care is something that really has an opportunity to impact the rest of our lives. And so the delicate and sacred time that we have during that space is really important that we do invest in reshaping our lives so that we can create a healthy baby and we can care for ourselves or lead other people in collectively caring for us so that this once in a lifetime event where you're only having this baby one time so that it goes as good as it can go. So you know oftentimes women are forced into having to keep working like they're pregnant. They have to keep cooking and cleaning their house at home like they're not pregnant. They have to keep doing these things like other people who aren't carrying and growing a life. It's an investment. It takes time to find a good provider and it takes time to reshape and find different ways to eat what we need and want. So I would really say for people to invest a little bit into finding providers who fit with their needs. So joining community groups online or talking with your friends, but also finding different ways to cultivate some self care time and grounding time in between our busy lives so that they can have that positive experience.

Lauren: And Tru believes that there should be a complete deconstruction of the maternal health care system because it is the only way for it to be more racially equitable.

Brittany: We can't just change a few policies here and there and think that it's going to change. It also shouldn't just be on the backs of community members like me to right the wrongs of our biggest system. So what has to change is that leadership first needs to change. The maternal health care system ideally would need to be led by women, you know, but also the voices of the people in the community being served need to be at the top. So even if you have your director over health care services, there needs to be an advisory council at every major hospital or clinic that is profiting off of black bodies and trauma and stress. And there needs to be a community advisory committee where these people's voices are heard and not only heard, but action is taken upon it and that needs to influence their hiring policies. And so having a one hour module online about cultural sensitivity is not cutting it. There needs to be a comprehensive long term strategy to make sure that people coming on board are personally invested in racial equity and maternal health equity.

We also need to think about how we're investing in the literature and the education of the providers. Many times maternal health providers are able to go into poor communities to practice on their bodies. And so they have this image of us. Essentially there needs to be a rewriting of education. And also, the way that education is taught so that we are valued and respected at a very high level and we're not looked upon as or as a marginalized community where we kind of have the white saviorism and different things that come that are very harmful for us.

Lauren: Because if we don’t make an effort to change policies and create new strategies our society will be at a great disadvantage.

Brittany: Our nation is going to be greatly at stake. Women are the backbone of families. If racial equity is not something that we attain soon, very soon, then essentially our nation is going to crumble. And I feel like our families are really going to continue to suffer. I just keep hearing that this is not who America is and America is better than that. And we're the number one country in the world. But America is number one in the developed world for maternal mortality, you know, and so I really feel like America is going to fall as a whole if we do not turn this around.

And I feel like one of the best ways to get there, and I'm not saying that midwifery can solve all the issues, and I know Jamaa can't. But what I do know...what has worked in other countries is a risk appropriate care model. A little bit over 90 percent of all pregnancies are low risk and midwives only provide care for low risk women. But if you have a low risk woman receiving high risk care, she's more likely to have interventions that are unnecessary and she's more likely to have these complications. So if we move into a model that like Canada is using or the UK is using where we have enough midwives. So going back to that maternal health justice, have enough midwives of color essentially in these communities and those 9 out of 10 women who are low risk if they're able to start in that care, that where you have 30 minute and hour long visits and you're being empowered and inspired and you have hope, then women will begin to thrive, families will thrive, babies will make it past their first birthday. And then the one percent of women who are high risk and who definitely need to be in the hospital and who need an OB, they will get that lifesaving care through maternal health justice.

If we know that these providers are trained in anti-racism and anti bias and they are able to get what they need that can save their lives instead of women who are at high risk...being afraid to go to the hospital because of all of these things we have been talking about and then having more complications. So risk appropriate care. If America just stood up and said, you know what, we've been doing this backwards for a very long time and we've lost a lot of people. And the quickest way to do this is to invest in more low risk providers of color midwives, get them in the communities and then invest in our workforce that we already have into eliminating racism. And then we can really save ourselves. So right there and it's a trickle effect.

Lauren: And the one thing Tru hopes she can create for the next generation is a more personable and earth conscious environment.

Brittany: We want to eliminate as much as possible toxic things that are in our everyday lives. So at the village, when people come, they see that we're using natural products to clean our facility. They see that we're using unbleached and hand products and things from the earth. It’s just basic things like using bamboo or recycled toilet paper, you know, it’s basic needs….the pads that we share with our families for postpartum to help them in their healing. They're organic and natural. So it helps them to see that that's not a far range thing that only well to do people can afford to have. So really opening up the lens that even though unhealthy habits have been pushed on us through our commercialized industrial nation, we have the individual choice by seeing around us that this is possible to to make sure that we're using safer things for ourselves and our families based on our individual needs, but also personalized environmentalism, meaning that what do you need in your environment to bring joy every day? What do you need in your environment to feel safe? For me, it's my books. If my home has lots of books in it and I have lots of candles, I can come into my house and really feel safe and comfortable. But kind of thinking of how we can merge together these different earth responsible choices and finding things in our home to make us feel comfortable and safe. I believe that can really help to shift mental and emotional health for people and actual real physical health.


Lauren: This show is produced by me Lauren Brown

And Lead Producer Jia Lian Yang

For more information about the STL 360 Doulas Initiative visit Jamaabirthvillage.org

St. Louis Public Radio is a member-supported service of the University of Missouri-St. Louis.

From St. Louis Public Radio and PRX this is We Live Here

Lauren Brown holds a Bachelor of Journalism degree from the University of Missouri where she also studied Social Justice. Lauren joined St. Louis Public Radio in June 2019 as an associate producer for the We Live Here podcast. In March 2020 she became the co-host and producer for We Live Here.
Jia Lian Yang holds both a Master of Social Work from Washington University in St. Louis and a Master of Divinity from Eden Theological Seminary. She is the co-founder of the St. Louis-based Who Raised You? podcast, which explores culture and family with a focus on stories from people of color. The show won the Arts & Education Council of St. Louis’ 2018 stARTup competition. And this year, St. Louis Magazine’s editors named it the best local podcast.

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