Birthing Justice

(soft tense music) - Yeah, something's happening, but I don't know what's happening.

And I just said, you know, I'm thinking I just want this to be over with.

Just do what you have to do so I can just be with Sloane.

And then I heard her say, "Book an OR and call for blood."

I held Matt's hand and I squeezed his hand and I said, "I don't wanna die."

And I don't know if I said it quietly, I don't know if I was screaming.

And I just held his hand so tight and I was holding Sloane and I said, "Please don't let me die."

- Like I'm just laying there and it's almost like I'm watching a movie happen.

Like you hear these stories about Black women.

And this beautiful Black sister came in there.

She says, "Sis, what's going on?

What's happening?"

I said, "I think I'm dying.

My head is about to explode.

And I think my pressure just shot up."

She puts the blood pressure cuff on.

I felt lightheaded.

The room was spinning.

And in that moment I really thought that I was going to die.

- I didn't wanna be in a situation where I had to mitigate some sort of racist or prejudice experience.

I didn't wanna be in a situation where I would have to come in defense mode.

I wanted to go into birth with peace.

(heartbeat pounding) (tense music) - The biggest misconception is, is there's something that we are doing.

There's something inherently wrong with our body, our makeup, our genes.

There's something that we're eating, there's some ways that we are behaving that somehow these bad habits have put us in a situation for poor maternal health outcomes.

And there's nothing that we are doing that is so different than anyone else in this country.

- The perfect storm is Black women who are dying during pregnancy because of underdiagnosed conditions.

Black women who are dying during childbirth because they are ignored when their concerns are heard.

Black women dying in the postpartum period because they do not have ready access to physicians.

When they experience postpartum complications.

- [Instructor] The baby actually moves with you.

They're moving in there with you, okay?

- It's not something that we're doing that's any different from anyone else.

So I really prefer to just say, hey, call it what it is.

It's racism.

Racism is killing us.

Right, your heart can't take it, so we literally die from broken hearts.

- [Instructor] They're just doing like a rotation and they're just like trying to find a lock and key, trying to get out of this way, like, you know.

- White people say that all the time, that they don't see race.

I've never ever heard a person of color say that in all the years that I've been alive.

And so it's obvious.

It's something that is 100% weighing on the minds of the families and the community that I serve.

And so not acknowledging it is, it does harm because it's almost like gaslighting an issue that is not okay.

- Unfortunately there was a state senator in a southern state who said, you know, maternal mortality isn't so bad if we don't count Black women.

- Louisiana, about a third of our population is African American.

African Americans have a higher incidence of maternal mortality, so if you correct our population for race, we're not as much of an outlier as it would otherwise appear.

- If that was not an illustration of implicit bias, I don't know, whatever could be.

- The idea that there is a single metric that you can use to determine the health of a society, which is the infant mortality rate.

And we have long had a significant disparity in this country for Black babies dying.

We've had that happen in my family, my extended family.

And it was something that as a nursing student, I was really compelled to work on.

- And she had called the doctor about her headache and about the swelling and the doctor told her that it would go down in a couple of days.

- Wow.

- Yeah.

- And I told her, I said, "No, you're not waiting a couple of days."

- Yeah.

- You know, you're gonna go to the emergency room today.

(soft tense music) - There is something deeply wrong when in 2022, we can't keep our moms alive.

Deeply.

And this is not a unique phenomenon.

I wanna be very clear about this.

It's not a unique phenomenon for Black birthing people, but our rates are the worst.

- When you went to the emergency room, did they do a urinalysis at all?

- So she did.

I left it, but I don't think they even tested it.

- [Doctor] Okay.

- There's two things at play there.

It's not only the racism that exists in a clinical setting between provider and patient, but there's the accumulated biological effects of the lived experience of racism.

- [Nurse] You're wearing like an undershirt just so the Velcro doesn't like- - I have a 29 year old daughter.

Many of her friends are afraid to become pregnant.

So I just wanna be clear, we can make people afraid.

- [Doctor] Have a seat.

I wanna take a look at you and your incision.

- There are Black women who are normal weight, who have college education and who have same wealth as white women are still more likely to die within a year of childbirth than their white counterparts.

So we cannot buy or educate our way out.

We can't exercise our way out.

The data shows that even when we do all of those things, we're still more likely to die.

(soft tense music) (people chattering) (announcer shouting indistinctly) - Sports has really just given me a life that I never could have imagined.

(crowd cheering) (announcer shouting indistinctly) I think it really taught me how to overcome a lot of adversity.

You know, you're always dealing with some type of hiccup or something and you have to overcome it and I think it prepared me, in a sense, for motherhood.

It's prepared me to be a fighter.

My husband was so excited.

We had wanted to be parents, you know?

I've always wanted to be a mom.

Professionally, it was difficult because in my sport there had just been a culture of silence regarding pregnancy and starting families and a lot of women had not been supported through starting a family.

And so I had always felt like I had to do everything first before I could even think of starting a family, and I hated that I felt that way.

And so it became true for me as well, you know?

I had a really difficult time at the time I was with Nike and letting them know that I was pregnant and seeing if they would support me through that.

And so I was asking that they not reduce my pay in the months following childbirth so that I would have time to regain top form.

And they said that they were willing to give me time, but basically they were not ready to set that precedent for all female athletes.

And that became an issue that I was not okay with.

I ended up parting ways because of that.

(soft tense music) I had a really great pregnancy.

I felt good.

I was exercising, I was running, I was in the pool.

I felt really strong.

And at 32 weeks I was going to the doctor for just a regular, routine appointment, and at that point found out that I was spilling protein and I was immediately sent over for further monitoring to the hospital.

And once I got there, things were kind of spiraling down.

I was diagnosed with a severe case of preeclampsia.

And it just became really scary because that was not in my plan at all.

They made the decision to have an emergency C-section delivery for my daughter, and it was scary.

I was terrified but really grateful that we were able to come out on the other side of that.

It wasn't what I had planned or expected at all or imagined, but at that moment, you know, the most important thing was seeing my daughter fight and seeing her regain her health.

We made it and that's something that, unfortunately, a lot of women, you know, don't experience.

- And this is not our burden to carry.

This is a society that has allowed this to happen.

We have allowed our moms to die for generations and what we are doing now is we're saying that's unacceptable and we will not allow that to continue.

(soft tense music) (soft tense music continues) - [Ebony] Have you ever seen somebody have a vaginal birth?

- [Father] Mm-mm.

- No?

I would encourage you to YouTube it, Instagram- - Yeah, I've seen that.

- Oh, okay, okay.

- Not in real life.

- Oh, not in real life?

Okay.

Just 'cause I was telling her, like, just to be prepared on what she's gonna look like when she's in labor and like she might throw up, there might be a little bit of poop, she'll be moving, she may not make great eye contact.

Like all of those things are normal and I don't want you to be stressed out.

- [Father] I'm not gonna be stressed out.

- [Ebony] You're not?

You do give me a vibe that you're real chill.

- Try to be.

- Okay, I'm with it.

I'm with it.

(patient laughs) My whole approach, especially working with, like, new moms is really shaped off of my own experiences.

I came from a background that was under-resourced, I'll put it like that, and we had to engage in healthcare systems through the ER.

And I remember the providers that treated us like crap and they knew that we were, you know, on government assistance.

And then I remember providers that treated us well and it was a goal of mine whenever I became a healthcare provider that I always wanted to treat people well.

There you go.

That's perfect.

Nice, strong heart rate.

By the time I got into midwifery school, it was such a buildup to finally, like, be in this place.

I just remember being, like, so excited.

And of course my preceptor, who's like been to tons of births who just was kind of like, come on girl.

We have this brand new student and like shoved me in the room.

I just remember how magical it was.

I still remember her name.

We had this beautiful hands and knees birth and I just remember looking, like, thank you for letting me catch your baby.

And, like, being like, "Excuse me."

And then walking out the room and, like, sobbing.

It was so tremendous.

I just couldn't believe like I was finally here after like doing so much to finally get there.

(baby crying) My squishy newborns, I love newborn exams.

Who doesn't like a squishy newborn?

Let's see, what gifts do you have in here for us?

I still get excited.

I still get, like very, very happy.

I love catching siblings.

You know, I've worked with families that I've caught, you know, four of their children.

From what I can feel, the back is over here and the head is right there.

You wanna try to feel it?

- Yeah.

- But I also still have like that same joy with getting to teach somebody about their body, working with somebody to, you know, have a baby.

I still run into people who say, "Oh you're a midwife so that means you're a doula, right?"

And I'm like, "Nope, very different."

And the way I like to explain it is that like a doula, her focus is for the support and comfort for this mother.

- [Doula] So I'm gonna lift you up, okay?

- [Patient] Okay.

- [Doula] All right.

- [Patient] Yeah that feels a lot... - [Doula] It feels great?

And then you can, like, shake a little bit.

- Okay.

- Like this.

- I'm the clinical person.

I'm making sure clinically that the the birthing person is okay and the baby's okay.

What was her birth weight?

- Seven pounds.

- Seven pounds?

- Yeah.

- And she's today seven pounds, 12 ounces?

You are doing fantastic.

But also a lot of like encouragement, empowerment.

That's good milk, huh?

She's like, "I want some more."

Because I think that's also kind of missing from a lot of care.

(soft music) I commonly will talk about this with my staff to take away that it's not about you, it's about the families that we're trying to take care of.

And life.

Life is hard.

We're gonna see late prenatal patients and we're gonna see late babies.

I don't care if she's 15 minutes late, four hours late, we're gonna see them.

I was like, "Guys, you gotta trust me.

This is really important."

What I found is some people would come into the office and be like, "I'm so glad you saw me.

I had no idea that this morning was gonna start like this, but thank you for seeing me."

- It's definitely a more personal experience when you have midwives and doulas from just a basic doctor appointment.

Sometimes I can feel like you're talking to a stranger about your problems.

- [Zoe] A lot of people say, "I'm gonna fall asleep Zoe."

I'm like, "Don't do that."

- Right.

- With my doula Zoe, she'll educate me on my birth and she'll still be there for me after the baby's born, which is great.

- [Zoe] And you can do it the other way, too.

So like you can lean into somebody like this.

- This is like a grandma hug.

- It is, right?

- [Destany] Yeah.

- [Zoe] Yeah, so that's another great position too.

- Okay.

- All right?

- I got interested in working with birthing people, pregnant people, just stemming from my own experience.

I was a teen mom in the 90s and back then, there were not a lot of services.

I had my baby, he was a healthy baby boy.

But I had a lot of experiences in the healthcare system that were honestly traumatizing where I felt that I didn't have a voice, I didn't have agency, that people made decisions for me that didn't include me.

What's most frustrating are sometimes barriers that are outside of our control to do anything about.

We have a lot of patients who are trying to remain stably housed in Washington, D.C. and that's really tough with the changing of the neighborhoods around us and the rapid gentrification that we're seeing in the city.

As someone who is from Washington, D.C., several generations in my family are from D.C., it's really hard to see people not able to stay within our community because they're being priced out.

- Racism is about power and, like, we are trying to break down those power dynamics.

I think what you see is free Black folk.

They feel comfortable being who they are and expressing who they are.

And yes, you don't find that a lot of different places.

I know I can't go into a lot of spaces and feel safe and feel, you know, able to be free.

(soft tense music) (cars whooshing) (soft tense music continues) - All right, so let's go see Ms. Williams.

One of you ladies are gonna assist me with Ms. Williams?

Okay.

When we look at where we are in 2022 in this century... (knocking on door) Hey darlin'.

There are women who could very well leave our state and deliver in a third world country and be safer than they are here in some of our counties in Georgia.

Greater than 70 of our counties do not have ready access to obstetrical care.

Okay.

Hey sugar.

I'm gonna let you have a seat on the bed and I'm gonna take him from you.

- Okay.

- All right.

How you feelin'?

Did you get the- - So much better.

- So much better?

So you got the new blood pressure medicine and you stopped the other one?

- Yes.

- Okay, very good.

Come on, come on, come on.

- I have a total of three now.

My oldest is about to be nine.

I have a three year old and then the newborn.

(chuckles) - So you feeling okay about the hysterectomy?

- Yes.

- Yes.

Okay.

- I knew it was necessary.

- [Donna] Was your husband nervous?

- [Tiffany] He was.

- [Donna] But I have to say both of you were so calm.

- Right?

My first two I was able to deliver vaginally, no problem, no surprises.

All the way up until my water broke, everything was fine.

And then when they checked me right at 10 centimeters, we found out that he was, his feet was down instead of his head, so then it was panic mode.

You're gonna have to have an emergency C-section.

- Oh, you're healing beautifully.

It looks real good.

Doesn't even look like I was there.

- Right.

- I'ma thank your surgeon.

I gave you that Beyonce closure.

All right, so, and have you, are you having any bleeding?

- [Tiffany] No.

- [Donna] Okay.

- That was scary for me 'cause I have never had any type of major surgery, but Dr. Pickett, she was just completely awesome.

She calmed my nerves 'cause immediately I broke out in tears when I found out I had to have surgery.

She prayed over me, which put me at ease.

- Faith is huge in my practice.

When you walk into the room, there's so much that we don't know will happen within moments.

I truly just ask God for guidance so that everything that I do is for the safety of this mother and this baby.

- I honestly feel like if it wasn't for Dr. Pickett, I may not have been here to take my child out the hospital.

- [Donna] All right, and then... All right darlin'.

How you feelin'?

- I feel tired.

- Tired?

All right.

- I'm tired.

- [Donna] You're taking your iron?

- I am.

- Okay.

- I take two a day though.

- Okay, okay.

That's why I want you to take two a day.

- [Kiana] Uh huh.

- All right, so let's go ahead and see how much sugar is weighin' today.

- [Kiana] Look at him.

- [Donna] You can?

- [Kiana] I can feel.

- [Donna] You can see him.

He has his hand right up there.

- He's so active.

- He is.

But that's good for you.

That's how we know that he's doing okay.

- [Kiana] Okay.

- I am still dismayed at how easily I am dismissed and women who look like me are dismissed.

That we can bring a certain level of gravitas to a situation, of knowledge to a situation and how easily we are minimized.

Trust me to know what I'm doing, you know?

Trust me to take the culmination of all these years of education and experience to know that I am truly making the best decision in the moment.

It bothers me that sometimes I have to explain why I'm advocating for my patient.

I had a patient I could clearly see was abrupting, which is the placenta pulling away from the uterine lining before the time of delivery.

I had to convince the anesthesiologist why we needed to do her C-section emergently as opposed to urgently, which was scheduled.

And even as he walked past me in the room and went to the nurse and asked, "Now why are we doing this emergently now?"

I had to go to the fetal tracing, point to the pattern and say this is an abruption pattern.

And it frustrated me that after 21 years of practice that I still have to justify advocating for my patients.

- During my first pregnancy, I had to end up going to the emergency room for bleeding.

And the doctor there told me, "Well, you can just stop coming because there's nothing wrong."

He was like, "It's very common for a woman to bleed up until they're six months pregnant."

And I told him, I just looked at him, I said, "I didn't know that."

I didn't think that was true.

But okay.

Fast forward a couple of weeks later, I was 10 weeks pregnant and I was at home having a miscarriage.

And I'm scared and traumatized to go back because he said it's okay.

And I, you know, lost my first baby listening to this doctor who completely ignored me.

(baby sneezes) Bless you.

It really did matter to me that she was African American, especially because in my history, in general, with other doctors, I felt like Black doctors actually would listen to us.

- I'm a firm believer in what we put into the universe is what we receive.

And so what I want to put into the universe is I genuinely care about you the same way I would want someone to care for my own daughter.

Okay.

- You know, she was the first set of hands that ever touched you.

- First set of hands to ever touch you.

Yes I was.

- She's my doctor mommy and these are her doctor grandbabies.

That's just how compassionate and sweet she is when it comes to her patients.

- I'm ready for you.

Yes, I do.

- See?

- I have found that having my own practice was something that I wanted to do because I wanted to have my own personal touch and provide for patients what I felt that they were missing.

She needs to get in quickly 'cause she has high risk pregnancies.

Every year, there are probably 20, 25 deliveries that I'm not reimbursed for.

And if you do the math, that's tens of thousands of dollars every year.

Look at that.

Look at those lips.

A lot of patients, they're concerned because they hear that I'm not planning to deliver anymore.

I've been doing about 25 to 30 deliveries a month solo.

The reality is I still can't take care of everyone.

- Okay.

- Okay?

All right, and don't forget your delivery socks.

- Okay.

- Okay?

All right, sweetie.

- Thank you.

- [Donna] And we're gonna see you in three weeks, okay?

- All right.

- All right, darlin'.

This is why it's gonna be hard for me to stop, because I'm gonna say, "Well I'm gonna still deliver them."

I'll still deliver her.

I've delivered all her babies.

I'm not, nobody else is getting their hands on that baby.

- I decided when I was seven years old that I was going to become a physician.

I watched my great-grandfather suffering from what I still don't know, in terms of his health condition, and I only understood it to mean that we didn't have access to a doctor.

We were waiting a long time for him to be able to see one and I promised my papa I was gonna become a doctor.

And when I became pregnant, it was a miracle for me because I had struggled with infertility for over a year.

I had suffered a miscarriage and it took a while to recover.

We kept trying and trying to the point where I got resentful because I felt like I had done all the right things and made all the right choices in the right order.

First, getting my career and then getting married.

And I remember clearly fussing at one of my patients.

The mom was pregnant with her seventh, I was seeing maybe her fifth or sixth child, and she yelled at the child and it made me mad because here I am struggling, as are many Black women in becoming pregnant and you're yelling at your kid?

And I screamed at her.

I was like, "How dare you?

How dare you not appreciate the blessing?"

And I caught myself.

Ran to my office, I prayed, asked God for forgiveness and then I went back in that room and asked that mother for forgiveness 'cause her journey was none of my business and my struggles had nothing to do with her.

And so that day I gave it up.

I said, you know, Lord, if it'd be your will, I'll get pregnant.

If it's not, I will be an exceptional aunt and a remarkable pediatrician.

And then in January of 2012, I thought I might have been pregnant.

I was so tickled, but I was so scared all at the same time because having had a background in public health, particularly in maternal and child health, being a Black woman, I knew what my odds would be in terms of low birth weight, premature delivery.

Like I knew the statistics like the back of my hand.

I committed to being my best self.

And it was hard to be my full self because I was nauseous all the time.

I literally felt like an incubator carrying my baby to full term.

For a lot of Black women, when you make it through the first trimester, everyone is like, "Ah, I can sigh a sigh of relief because I made it."

But for Black women, it's second trimester, sigh of relief.

Third trimester, sigh of relief because I know what the stats are.

And so I was so grateful, so happy on October 11th to make it to the hospital.

Delivered my daughter.

I finally allowed myself to be happy because I could feel her, I could see her, I could smell her and it was such a relief.

October 13th, I'd had some challenges again with my husband at the time.

We're now divorced.

We were so disconnected.

I didn't really know how to navigate through and so every little thing seemed to be a big deal.

I had to figure out the whole process and I didn't feel comfortable enough sharing with anybody what I was feeling because I felt like I should be better at it, I should do it better.

You're a pediatrician, you have a master's in public health.

And even with my OB, like she, I love her to pieces, but she never asked.

She never asked how I was doing emotionally, how I was navigating through pregnancy.

I remember being in the bathroom and I'm bleeding heavily.

I felt lightheaded.

The room was spinning.

And in that moment I really thought that I was going to die because all I could think is, "I made it this far.

I can't die now."

Like how cruel would God be to take me away, and I just got her?

And so they started a blood pressure drip, Nifedipine.

I'll never forget.

Like I'm just laying there and it's almost like watching a movie happen.

Like you hear these stories about Black women either dying or coming close to death.

When Dr. Chaniece Wallace, a physician training to become a pediatrician, had a similar story but a completely different outcome.

She had pregnancy induced high blood pressure and she died.

And it took me back to that place.

And my heart was so heavy because I'm like, I'm tired of Black women dying simply because they want to become parents because they're committed in the same way every other woman who decides to become a parent.

I don't know if she had Black healthcare providers.

I know I did.

I think that if more of us had providers who looked like us, where we don't have to advocate as strongly, as clearly we do, to be taken seriously.

There are times where our outcomes would be significantly different.

(soft music) - The Flexner Report was part of a larger movement to reform medical education.

In the early 1900s, the way medical education was structured, it would be really unrecognizable to a lot of us now.

You didn't have to go to college beforehand.

Almost anybody could go to medical school.

You didn't have to study biology and chemistry before going.

Most medical schools were proprietary.

Some were linked to universities, but not most, and they mainly consisted of lectures and apprenticeships.

And America was really seen as backward.

So there was a movement afoot in the early 1900s to really catch America up with the European model, and the Flexner Report was part of that movement.

It had the backing of the Rockefeller and Carnegie Foundations, which led state medical licensing boards to make mandatory a lot of the recommendations that were there.

On the surface, it does sound lovely.

As it stands out of the roughly 170 medical schools that existed at the time, 56% of them didn't make it on the other side of the Flexner Report.

They were rated either poor or fair and did not receive A ratings, and that really shifted public funding and support of those institutions in ways that meant that they weren't gonna be able to survive.

They weren't going to be able to meet the licensing requirements of state medical boards and thus would be unaccredited.

And if they were unaccredited and their graduates could not be licensed, it was the death nail for them.

This was particularly salient for Black medical schools.

In 1900, there were 10 Black medical schools that existed in the US, and this was part of sort of the larger boom in Black institutions that happened in the Reconstruction Era.

And the Flexner Report was particularly harsh on them and only recommended, out of all of them that existed, that Howard and Meharry remain open, as both of them were affiliated with universities.

The Carnegie, the Rockefellers and the the robber baron classes of that day realized that they had a problem.

1900 American lifespan was average of 49 years.

They realized they were losing money on the poor health of Americans and they really wanted to restructure healthcare in America, not only to improve the health of Americans, that they live longer and work longer, but also that they get larger production output in their factories.

They also had a third motive, which was to make sure that the unfolding of American medicine really followed in the same direction as industry.

That healthcare would be provided as a commodity and not provided as public service.

This became part of American capitalism.

That was extremely important to them.

- The Flexner Report was really one of those codifying the survival of the fittest.

They decided who was fit, which schools are good, which ones are bad.

Created all these standards, these standards for prenatal care, these standards for medical education.

But if you think about the standards, there were still based upon patriarchy, white supremacy, eugenics.

- Eugenics is one of the uglier parts of the history of medicine that a lot of people like to sweep under the rug.

Eugenics is based on the belief that our social characteristics, things like our intelligence, things like the type of employment we will have, are all based on our internal sort of genetic predispositions.

Under the guise of eugenics, which was really a way to biologize previous notions of racial difference and racial inferiority, Black medical schools, just like the Black people who were attending them, were really seen as inferior and not intellectually up to the task of being doctors.

It influenced the particularly harsh criticisms that Flexner levied against Black medical schools and the inherent belief that Black people were more suited toward sanitary type work.

At the time, hygiene was the buzzword in the burgeoning public health movement in America.

And it was to say that Black folks should be focusing on things like the delivery of clean water, the delivery of sanitation services, of antiseptic services in healthcare settings, and not be responsible for being the main ones in charge of patient care.

What the Flexner Report helped do was shift philanthropic funding toward white institutions and shift philanthropic funding away from Black institutions.

What those 10 Black medical schools needed that existed in 1900, but that did not exist years after the Flexner Report, they needed state funding, and that's the larger injustice.

(soft tense music) - I've worked in two large healthcare systems and it became pretty clear that despite resources or lack thereof, the care that I wanted to deliver, that I would expect for my own family, wasn't possible.

And the reason for why it couldn't be done was money.

Though there are lots of people that understand medicine, certainly in a hospital system, and there are a lot of people that understand finances, there are very few people that understand both.

(soft piano music) - Equity is a word, I think that particularly right now after the pandemic, where we're clear that COVID-19, you know, was not an equal opportunity offender.

It took advantage of bodies and people and communities that were already suffering.

I have the responsibility as an elected policy maker to invest in a disproportionate way into communities that had a disproportionate experience as a result of this public health and economic pandemic.

And sometimes people hear that as if you're gonna give more to a group, that means less for me.

And those are difficult public policy conversations to have.

And then sometimes we fall back on not having them and then we just divide equally.

And it's that attitude that has promoted far too many communities that I live in and grew up in and now represent of not really getting, in all honesty, their fair share given the fact that we are starting yards behind others.

(people chattering) - Write a new one.

- Postpartum, Michelle speaking.

- A good DFW, by Leopold's ultrasound, and then making sure it's perfect.

- I'm glad you brought your computer.

I didn't bring mine, so.

Thank you all for coming.

We have actually been working on a special project with CMQCC.

We are developing a toolkit to improve the healthcare disparities among African-American women.

Our percentage of African-American women was higher than any of the other three hospitals.

I think around 30% of our patient population, it comprised of African American women and our outcomes are better.

And so that's why they wanted us to be a part of it.

We treat everybody the same.

I didn't understand what was wrong with that, treating everybody the same.

If everyone doesn't start at the same starting point and you treat everyone the same, then you're gonna miss the mark on certain populations.

And so there's definitely an opportunity to look at providing equity in healthcare versus equality.

How do we provide care for a patient that's appropriate for that patient and then for a different patient, how do we provide care that's appropriate for that patient and for a different patient?

- The challenges that we are addressing in South LA and at our hospital are lack of resources in the community, lack of healthcare resources.

So women come into our small community hospital through our emergency department and frequently they have not had prenatal care, which means that it's a higher risk pregnancy and we have to adapt to addressing the needs of a higher risk pregnancy.

One of the things that actually gets me angry is knowing that in our community there aren't enough doctors to take care of the people who live there, that women go without prenatal care because there aren't obstetricians to care for them.

That really makes me angry.

The women who live in this community deserve to have appropriate, comprehensive reproductive healthcare and they don't have access to it because there aren't enough doctors here because the payment system is structured in a way that leaves this community without it.

(railroad track bell ringing) In California, the Medicaid program is called Medi-Cal, and the community that we serve in South Los Angeles is a community of concentrated poverty, mostly Black and brown people, and the community is mostly dependent on Medicaid insurance for health coverage.

The challenge is that the Medicaid program is under-resourced for healthcare.

It pays providers a fraction of what Medicare and commercial private insurance pay, so there aren't the resources in the community to address access to healthcare.

For an average emergency department visit, you might bill $2,000 to commercial insurance, $650 to Medicare and $150 to Medicaid, and you can see that difference in resources that are available to providers.

(soft tense music) - Let's listen to this baby.

What do you think, dad?

Are you excited?

A little anxious?

(chuckles) We ready for the baby to be here?

- So women's health during pregnancy is related to their health before and in between pregnancies.

So if you are living in a community that doesn't have good access to medical care and you're not able to see a doctor and have your high blood pressure treated, for example, or your high blood sugar or you're overweight, then you're going to go into pregnancy with poorer health and more health risks.

And those are conditions that don't always start during pregnancy.

So I was wondering, you guys had a particularly challenging experience last week with a pregnant woman who was psychotic and was in the emergency department for a week before she delivered.

- Initially they were looking for placement for her to deliver, or have a place to stay and deliver at another hospital because they assumed that she was high risk.

So I did let them know that having a mental health issue does not make her high risk and we were able to deliver the baby here.

- I love the way that you guys just stepped up and embraced her and said, you know, we can deliver her safely here.

- Yes.

They were able to find placement for her and the baby was eventually transferred out to foster care.

- [Elaine] That's great.

And where was, where did you discharge her?

- I was born and raised in Compton.

You know, when I say this community, my community, I have family members that come to this hospital, I have neighbors that come to this hospital.

I still live in the community.

So I wanna make sure that the patients in this community receive the same, if not better care, than the counterparts at other hospitals.

- We need midwives.

We need people who actually birth the world, who believe that the person who's in front of them is fully human and has the capacity to bring a spirit into the world that might change the world.

So I've had my colleagues who are OBGYN say, "You keep talking about midwives.

You're just a regular OBGYN, you're not even a high risk doctor.

You're gonna talk yourself out of a job."

This is not about my job.

The data shows that when you have Black midwives leading birth unit in a Black community, that you have better outcomes than when you send them to a high risk doctor.

Why wouldn't that be the story that we would tell?

- The benefit of having in hospital midwifery practice is that it's as natural and as normal as you can get, patient-centered, but then with the physician being on standby, we're ready to take over when things aren't so normal anymore.

- The nurses we work with understand the midwifery mode of practice and the physicians we work, we just work collaboratively together.

- What I loved was that the whole staff was just nice.

- [Midwife] Now she's got two bands on.

- My experience with my midwife was good because she was really friendly.

Anything I needed, if she was coming to check on me, and she's not my doctor, but I was really comfortable and actually I was more comfortable with her than with my regular doctor.

- When I first graduated midwifery school, I recorded a lot of the births that I did because it's just really fulfilling to know that, oh my gosh, I was part of this important milestone in a person's life.

So around 5,000 is when I stopped counting.

I know in the past, especially since I've been in the United States, we didn't let women get out of bed and move around and eat and drink and change positions and have a say in how their labor and delivery went.

Well, that's changed.

Women are more involved in their health, their bodies, how they deliver their babies, how many babies they have.

So that's, that's a really, really important aspect of women's health and child bearing.

So that's changed a lot and it continues to evolve.

and that makes me extremely happy.

- Okay, we're going home.

You know, the diversity of the staff is just beautiful.

And then you have the diversity of the patients.

And me being a nurse of color, if I walk into a room when the patient Black or brown, there's a sigh of relief.

It's like, (sighs) "I'm glad you're here to take care of me."

It's unfortunate, but it's also gratifying to know that I'm coming into someplace where I'm welcomed and then I'm letting them know I'm here to take care of you, and then we build on from that.

- My personal experiences as a Black woman definitely shape how I view healthcare and my aspirations for the healthcare that we deliver and my commitment to giving our patients the best possible healthcare.

- She is a normal, spontaneous vaginal delivery yesterday morning at 10:13.

- Everyone deserves to be treated with respect and compassion.

And that's why I went into medicine because I believe that and we need to stand up for ourselves and demand that.

- Breastfeeding only and doing well.

- Providing high quality healthcare to an underserved community absolutely can be replicated in other communities.

What it takes is will.

It's the will to do it.

The will to bring the resources needed, the will to bring the talent that's needed and the will to set high standards and hue to those high standards every day.

- I think COVID has pulled off the blinders for the entire world to acknowledge we have massive, massive inequities in our county, in our state, in our country, and we now have an opportunity and a responsibility to fix that.

(soft piano music) - Missouri's maternal health crisis is, well, a little bit worse than the rest of the country.

(soft tense music) We're struggling.

We're struggling, but I think everyone is at this point.

I think that the solutions should be thought about globally, you know?

We should think about, you know, how do we help Black moms, how do we help moms of color?

How do we help poor moms?

How do we help, you know, every situation?

We need to think about those things.

I came to find out that the top five causes of infant mortality are maternal complications, which is telling.

It's just saying that we need to take care of our moms in order to save our babies.

(soft piano music) - Come on daddy, come on down here and join us.

Come on, daddy.

This is for both of y'all.

So tell me, you know, a little bit about how you're feeling since we've had the baby?

- I'm feeling good mentally, physically.

Dad be pitchin' in- - Okay.

- 'Cause a girl be tired.

- That's right.

That's right, that's right.

I am a full spectrum doula.

One of the things that fuels my work is that there are so many inequalities right now in Black maternal health and infant health.

One of the things we wanted to talk about a little bit today is tummy time and how important tummy time is.

- Eventually a baby going to get bigger, they gonna wanna sleep a certain way, they gotta be able to not get caught on their blanket or put their head in the pillow or something and suffocate, so they need that neck strengthening, so tummy time is good for that.

- Tummy time is absolutely good for that.

The other thing that's really important about tummy time is that it strengthens their motor skills, right?

It also gets them stronger so that they can hit those milestones that we want 'em to hit.

- Definitely.

- I want to have that opportunity so that I can change birth outcomes.

There you go.

Look at baby girl.

- Zaya.

- [Robin] There you go.

Oh my goodness.

- Where you goin'?

You see, mama, over here.

Mommy's over here.

- Now this is exactly what we want her to be doin'.

- Hi.

- You see how she's lifting her head up?

And we wanna make sure that we provide our families with that basic, you know, education so that they can be their child's best and first teacher.

- Yes.

Orange.

- Wow.

- You like orange?

- And make sure that their child is thriving.

- This is the teddy bear.

Teddy bear.

Ah.

Teddy bear.

What you think?

You like it?

- Okay, hey everybody.

- Hello, hello.

- How's it goin'?

- All right.

- Good.

(doulas chattering) - Very good.

- Doing good.

- Wanted to have a quick meeting today to basically just talk about the births that we've had over the last month and the upcoming ones and challenges that we might have faced.

And you all know that I had a birth on the 9th of March.

Mom went home, I contacted her to just to check in.

And so mom said, "My feet and ankles are really swollen."

I immediately said, "Take your blood pressure."

She did, and her blood pressure was 159 over 102.

So I said, "You need to contact your doctor because I think that you might have postpartum preeclampsia."

The doctor told her that it would go down in a couple of days.

- Wow.

- Yeah.

- And I told her, I said, "No, you're not waiting a couple of days."

- [Doula] Yeah.

- She was really calm about it and I think that I was more, you know- - Scared for her?

- Scared for her.

And I told her, I said, "I don't want you to be another statistic."

- Black women aren't being heard.

Flourish is an organization that we as parents, as teachers, we partner with.

They have been laser focused on Black maternal health and infant health in St. Louis area.

They partner with different people in the community so that they can try to achieve this goal.

(soft piano music) - I am the first Black certified professional midwife in the state of Missouri.

It's a big, big way to come from me walking the streets barefoot.

My oldest son, Kylen, who will be 21 in two weeks, sleeping on the side of a vacant building, holding him in my arms.

I literally came from nothing and I literally built an entire Black maternal health movement in this city.

(knocking on door)ú Jaszzmyn?

Hi.

I think I may have told you my name up front, but I'm Okunsola.

- Nice to meet you.

- Nice to meet you, too.

Is it okay if I take my mask off while I'm over here?

- Yes, yes.

- All right.

In our first initial visit, it really gives me an opportunity to learn more about you.

I want you to have an enjoyable, healthy pregnancy.

A lot of people just focus on a birth like, ooh, I want this and I want that and it's like, well, we gotta prep.

- Yes, absolutely.

ó_ And train your body.

- Yes.

- I'm glad we've continued to grow and we've continued to get support so that we can truly build policies and systems that respect doulas and don't start working them like workhorses because now people know that they're a part of the solution, but that also centers the voices and experiences of Black women.

(heartbeat pounding) - Oh.

- Hi, Nova.

(heartbeat pounding) We're standing outside of Jamaa Birth Village and we are in the heart of Ferguson.

And a lot of people don't know that Ferguson lives within the St. Louis metropolitan area.

Right across from us is the Ferguson Public Library, which is where we started gathering and meeting before we formally created Jamaa Birth Village as a non-for-profit organization.

And we can see Ferguson City Hall right up here.

It was on one night during the uprisings that we saw a Ferguson police car flipped over and then engulfed in flames because of the rage and the despair.

- [Protestor] How about I throw this shit back?

- We're tired of it.

You know, when that that report came out through the Justice Department, it was evident that we weren't just upset for no reason.

We truly have been being treated unfairly all of these years and we really needed a change.

- I think that we have some issues in our institutions of racism in our past that we have had issues working through.

While we work very hard for our patients, sometimes as doctors we have issues with trust.

- We have hospital systems that will approach us through white saviorism and they'll say, oh, what you're doing is great and we just wanna help, we just wanna support.

But how can you help us dismantle the same racism that's killing Black mothers and babies and you are approaching us with the same racist tactic?

We only have 15 Black-owned birth centers out of almost 400 in this entire country.

- There is an acknowledgement that needs to happen from our organizations that, you know, we have messed up in the past, this is something that is ingrained in our institutions and we need to acknowledge them, we need to work towards equity, we need to work towards community improvement.

We all have to work together and play our parts.

- [Patient] I'll do this one.

- [Okunsola] Do you have any primary concerns today?

Like any discomforts, any issues?

- [Jasa] I had went to the hospital, the emergency room on Tuesday.

- Okay.

- I had some bleeding.

- Okay, yes.

- They had did an ultrasound.

They said everything looked fine.

- Did they do a urinalysis at all?

- So she did.

I left it, but I don't think they even tested it.

- I know that was probably a scare, but it sounds like everything's okay.

Once you do go into the second trimester, the chances of a miscarriage greatly, greatly decreases.

- Okay.

- Okay?

So we just have like one more week to hang on, okay?

- Okay.

- But the signs to look out for is that consistent pain, cramping and fresh, bright red bleeding.

- [Jasa] Okay.

- I can help you up.

- Thank you.

- [Okunsola] You're more than welcome.

All right, and legs up here.

- Okay.

- There you go.

Get comfy.

I'm gonna wash my hands and you hang out wherever you want, okay?

- Given that all that I've researched and studied on poor maternal health outcomes for Black women, I just wanted to be as much of a support to her in this whole process as I possibly can be.

- [Okunsola] Okay.

So I'll start.

I'll have some light pressure.

Hopefully it's not too much.

(heartbeat pounding) (tense dramatic music) - You have so many indicators that are high risk.

You have unemployment, you have poverty, you have crime and we have to deal with those with very limited resources.

And many of our staff come from the communities that we serve.

I'm here to see how things are going.

That's some of the criteria that we have when we hire them.

The networking that we do on the ground and you all being a part of that makes such a big difference in our clients, and they trust you and understand, and the fact that you all are from the community makes a big difference is that they see you, they understand, they can relate to you, the trust is there and that when you work for them, they know the sincerity and the empathy is there when you talk to them and they feel it and they know it and they know that it's real.

That plays a big part in it.

(soft tense music) - [Carolyn] How you doing today Miss Tina?

- [Tina] Fine.

- [Carolyn] Mr. Daniel, how you doing?

- [Daniel] I'm doing lovely.

- [Carolyn] Okay, are y'all ready for y'all visit today?

- I'm ready.

- Yes.

- When I first came into the program as a volunteer, I had no idea what low birth rate meant, I had no idea what infant mortality meant, what maternal mortality meant.

I knew none of that.

I actually grew up in the Bootheel and I've never heard of any mother dying during birth or after birth or losing a baby.

So when I came back, even though I was, my root was here, it was a shock treatment.

On your risk factor, it does state that you kind of had a high score and because you do have high blood pressure and pregnant, it's kind of like in that not a safe zone for you right now.

So I have another program that... We don't have resources and there's not a hospital in 25 miles.

If you go in labor and you got high blood pressure and you got other chronic disease going on, it's a 50/50 chance.

- Before I had her, I went to like my apartment.

Everything was good that night.

I had to go to the emergency room because I was hurting real bad.

They took me upstairs and hooked me up to the machine.

Then the doctor came in, she said, "You got pre-eclampsia so we got to rush you to Cape."

So I called him, I said, "Oh, we gotta go to Cape."

The next morning, I was on so much drugs, I didn't know what happened.

- Yeah, it's- - Woke up, the baby was out.

- It was horrible.

It was disgusting 'cause I watched everything and I had to see everything and I had to cut.

And I said, "Nah, I don't wanna experience this no more."

- It was stressful 'cause all my organs and stuff was shutting down and then after I woke up, they told me that she had a hole in her heart.

They tried to keep me in Cape for a month, in there, but I told them I had two other kids so I just released myself.

- What really bothers me that the ladies don't get the proper care after they have the baby and they get very discouraged, so we really encourage them to just get in the ring, put your boxing glove on, go for the fight, 'cause if you don't start, you can't win.

- Birth class, I've been going back and forth, travel to learn different things, so how women go through so many problems, health problems and manage their blood pressure and sugar and all that.

I learned a lot and they teach you a lot, you know, how to raise the children better, to do better, you know.

Look at me.

I'm doing good.

- Fathers play such an important role to the mother and the child.

And we've had many programs under our organization targeting fathers and the absenteeism of fatherhood plays such an integral part of that child's life and the mother's life.

- Yes.

- They made me actually a better person than when I am because I'm still married and my marriage is just getting stronger and stronger and I love it.

- I've seen men that have come into our program and literally be transformed.

A lot of dads want to be good dads, but they don't know how.

They need some time, that guidance or mentorship or role models from other men and many of our programs provide that.

People have to start looking at management and leadership as part of the system to change, because you have to have people that come in with fresh lenses and different ideas.

We really need to work together because we're all in it together, whether we want to be or not.

We are here together.

- It's kind of funny, it's like so cliche.

We met the first day of college.

Yeah, we dated for years.

He proposed and we got married two years later.

Waited a while 'cause that was one of the things my mom said was important.

One of her things was don't get married right away and then don't have children right after you get married.

You have to wait, so that's what we did.

I was 38 weeks pregnant.

We went for our routine checkup.

My doctor was asking just how was I doing, how was work going?

I said, "Oh, I'm, you know, I'm good.

I'm trying to hold it all together at 38 weeks."

And she said, "Well, what if I told you that today was the day that you're gonna have a birthday party?"

She just said, "Nope, we're not taking any chances.

Today's the day.

We're going."

We got to the hospital and I checked in, and I, you know, at that point, started to feel a little anxious just because, you know, it was real.

Dr. Kumetz, she would come check on me every now and then and say, "Okay, you're progressing, but it's just moving slow.

Everything's fine.

Baby's okay."

By Friday evening, she said, "I'm giving you four more hours, and you know, then I'm gonna have to call it.

If you don't do it in four hours, we're gonna do the C-section."

I didn't want a C-section, but I wanted her to be healthy and get here safe.

And I trusted that Dr. Kumetz would make that call and help me make that decision.

We got a new nurse on shift and the new nurse said, "Hey, I got this.

I can get her to drop down, don't worry."

She came in, she hung my legs off the bed, she put me in all these weird positions and within the next hour and a half there it was, Sloane had dropped.

When I heard her cry, it was like finally.

Words can't even describe that feeling of finally.

Just all of the doctor's appointments and the medication and the shots and the pills for IVF and miscarriage after miscarriage.

Just knowing that this was the angel that God wanted us to have and she was just our little blessing.

And I felt tugging from, you know, below, and I could feel Dr. Kumetz tugging and tugging and I knew that the placenta had to come out and I remembered that from Madison, so I kind of thought, "Oh, that's okay.

This is a normal thing."

But I felt like, why am I feeling the tugging?

Why do I feel it so much?

Maybe the epidural's wearing off.

I didn't know.

But I was still kind of in that moment of joy with Sloane.

I remember Matt being right next to me and being beside me and he, you know, said, "You did it."

You know, as moments passed and minutes went by and then I thought, okay, something's not okay.

And then I heard her say, "Book an OR and call for blood."

At that point, I just knew that this was it.

This was the stories that I've heard about that I didn't think were gonna happen to me.

But I held Matt's hand and I squeezed his hand and I said, "I don't wanna die."

And I don't know if I said it quietly, I don't know if I was screaming and I just held his hand so tight and I was holding Sloane and I said, "Please don't let me die."

And they took Sloane away and then I saw Matt look over and I could tell it wasn't good by his face.

- You wanna go to mommy?

Wanna go to mommy?

Yeah?

Okay.

I would say in a matter of seconds, the number of people in the room probably tripled.

People were moving much faster.

- Dr. Kumetz was down below when she said, "I'm gonna have to take your uterus."

And I said, "Okay, okay."

You know, 'cause I was in so much pain.

And then she came around me and she put her hand on my shoulder and she said, "Do you understand what I'm saying?"

And then that was the last thing that I remember.

- My whole life flashed before my eyes.

Am I gonna be a single dad?

Is my wife even coming back?

How am I gonna raise two little girls to be the woman that she would want them to be?

- I just remember waking up and I saw Matt and you know, I was trying to keep my eyes open and I was trying to just take all the strength that I could.

I later found out that my placenta was stuck to my uterus and doctor couldn't get it out, so I was hemorrhaging.

She said I lost three fourths of my blood and they had to give me multiple blood transfusions.

- After 48 to 72 hours, she was ready to go home.

And then that's when really the recovery period started to happen.

There's still residual pain and there's still the trauma of going through something like that, that you have to find solace in, okay, well we're happy with these two.

She's here, she's alive.

That's what matters.

- [Narrator] Thousands of studies have shown inequities in care between Black patients and their white counterparts.

- Training and awareness of implicit bias is a part of the culture that we're trying to cultivate in healthcare now, so I do think there's some value in that.

You know, I must say that the scientist in me is looking for the evidence that it actually works and changes outcomes for people.

I personally have come to believe that the answer to bias in healthcare is a diverse workforce and to have providers who look like the people that they're treating.

You know, that's my belief.

- [Narrator] In this training, you will be challenged to look beyond the surface of concepts and relationships and explore the workings of race and racism.

- Bias trainings are important, but they are as different as blades of grass and clouds in the sky.

It all depends on how they're presented, what type of support is given, financially and otherwise.

Whether there is just a box that we're checking.

I didn't learn medicine in an hour watching a video.

I'm certainly not gonna learn how to combat my implicit bias and institutional racism in an hour once a year.

- We found this study done by an East Coast Ivy League institution of medical students, and it was a, you know, simple questions about their attitudes about Black women.

And to read findings from medical professionals in training who felt that Black women had a higher threshold for pain, that our skin was more difficult to penetrate took my breath away and brought it all home.

People left to say, oh, Holly, you know, I am not racist.

But to own that we all have life experiences that influence our lens and to own that and to attempt to self-correct.

You know, that's the first step.

- If you can't trust your medical provider, if you've been harmed by an entire institution and you go in and see your doctor and the doctor says you have hypertension, you don't necessarily believe that, right?

Because how, if you put it in the frame of all the other things they've ever said about you, racism is making us not even be able to do things for our own selves because we don't know what to believe.

How do you hold on to a truth when a system that's supposed to, make you ensure that you're healthy, has been used to police and harm you?

I don't believe that just talking about people's perceptions and their feelings is gonna change anything, but having honest truths about how we got here is important for all of us.

- If you don't have that sort of, especially like the anti-racism as a lens to look at an experience, you might not, you know, that can be a really traumatizing thing for a patient.

(soft music) - So FASEB just like requested to put our paper on like the bulletin so that it was, like, one of the featured articles for the month.

'Cause I guess our initial goal was to try to make sure that like most MSTP programs or MD PhD programs could have something like this to make sure that there's, like, a community dedicated to learning about anti-racism and bias training.

But I think it's hard to start these programs off the ground so having a template through our paper is pretty useful.

- I can think of some situations where, you know, maybe I didn't say something that, or like, I said something that came across wrong or that came outta my mouth and feeling comfortable with saying, "I'm sorry I said that wrong."

And like, let me try again.

And actually trying again and saying it again in a way that was how I intended it to come across.

Feeling comfortable with that is a learned skill and practicing, practicing really being an anti-racist physician, like in the work that you do, in the way that you present yourself every day.

- There is definitely a hierarchy in the clinical setting.

I think that's not a secret to anybody.

So I think as a medical student, we're kind of on the bottom of that hierarchy, and I think a lot of the times it is hard to question more senior members of the team, like the resident physicians or the attending physician, because as a medical student, we spend so much more time with the patient than the rest of the team.

So a lot of the times in the team setting, I would bring it up as like, oh, here's this extra piece of information I found, acting in a more collaborative manner than calling somebody out.

But the hierarchy of the system does make it difficult, I will admit.

It really is like in the clinic, like in those interactions where we have the opportunity to, you know, actually learn from our patients.

Taking our experiences and sharing it with each other I think is the best way that us as individual physicians or physicians in training can do the work to improve our understanding without, like.

putting the burden on our patients.

- Yeah.

- Like I don't think it's their job to teach us, you know?

It's really like for us and for us to serve other patients better.

- I think it's important that we don't shy away from the real issues, that we educate on what can happen because I think that's so important.

But we also offer help, you know, that there are things that we can do to make the situation better.

- I'm honored that Vice President Kamala Harris and Joe Biden have centered this issue of awareness and action around maternal health, not only in policy in general, but really through executive action and through what I believe will be one of the greatest pieces of legislation in American history.

- [Speaker] Right now, policy makers have the opportunity to address the maternal health crisis head on, by passing the Momnibus.

- In the Senate, I introduced the Black Maternal Health Momnibus Act.

And I believe we must create a more community based approach to maternal healthcare.

I also believe that we must, collectively, all of us, speak and name out loud the issues that cause so many women to experience complications and in many cases to silently suffer.

- [Speaker] The Momnibus invests in and expands the maternal healthcare systems.

It also improves the social and economic conditions that impact pregnant and birthing people in their everyday lives.

And it addresses the unique needs of pregnant and postpartum people during the COVID-19 pandemic.

- Let's push the whole Momnibus Act through, on all 12 bills.

Let's get that rolling and see how we transform maternal health in this country.

- All of the bills are focused around trying to change outcomes, really, really exclusively focused on Black maternal health.

And they're so needed, right?

Because we commonly will hear, oh, it's three to four times more likely.

But really, in some areas, it can be eight times more likely.

In the certain areas of the Bronx, it's 14 times more likely.

So, like, it's so, so needed.

- What we have done is we have written a policy solution to end a disparity, to end our nation's maternal mortality crisis that improves the quality of care that everyone receives.

- I want to be very optimistic because I feel like this is our time.

This is the first time that you've seen so much attention around maternal health.

Now it finally has a seat at the table, and I feel like we're definitely gonna change the tide this time.

- [Courtney] You took a long time, little mama.

Yeah, what were you doing in there?

- We're not saying that somebody's more important or that this is one person's better than the other, anything like that.

That's not what this is.

But we're saying that as neighbors, as Americans, we can do this.

We can fix this and our moms are worth it.

- There is such a thing as Black joy.

To me it's about highlighting beautiful experiences, Black excellence, uplifting these stories and putting them on display.

- I do think we need to put more energy to talk about Black joy, 'cause it does exist.

There are beautiful births being had at home, in birth centers and hospitals by Black birthing individuals that are fabulous and joyful.

Let's shift the narrative.

Let's share great birth stories.

- August 15, 2020.

I was 40 weeks and four days pregnant.

At this point, I am over it.

I'm over being pregnant.

I woke up that morning, I see the sun shining through the window and I'm like, okay, this might be it.

I waited for a contraction to come.

So around 6:00 AM I get the first contraction.

Then I was like let me just see if another one comes so I know it's real.

Talk to my doula first.

She was like, "You think it's time?"

"Yep, she's on her way."

Talked to midwife number one, was like, "Okay, I'm on my way."

Midwife number two calls.

She's like, "Okay, I'm on my way, too."

Everyone gets there.

I'm just bouncing on my yoga ball, going through the motions of the contractions, breathing and everything.

It's going smooth at this point.

My husband's nervous energy is just doing something, stirring about.

The contractions intensified.

It went from mm, and just being able to rock through it, to a ooh!

And when that sound changes, when it goes to that deep, guttural sound, then you know like the body is clearly ready to push.

I drop down to my knees, kneeling on my couch.

I glance over to my right, there's my ancestral shelf, an altar that has my mom's ashes.

Everyone's around me, the contractions intensified.

I can feel my baby's body descending down further into the birth canal.

I'm feeling the weight of him and I'm thinking to myself, "This baby's a lot bigger than my other kids."

In my head, he's stuck.

And I say that.

I'm like, "He's stuck."

They're like, "He's not stuck.

Just push.

You're almost there."

And I'm like, "No, he's stuck.

Help me."

They keep reassuring me he's almost there.

The midwife said, "Well just reach your hand down.

His head is right there.

You could feel it."

And I'm like, "No, I don't want to."

But then I reached down anyway 'cause I kind of did want to.

He's there and I'm starting to feel his head crowning and oh my gosh, it was so intense.

But then this warmth just came over me.

Another push and his head was out and she's like, "Give me one more push."

And I'm feeling real weak, like I done gave it all I got got.

And she said, "Come on TaNefer, one more push.

Give me one big push."

And I just take a deep breath and I just ooh and just blow and I'm letting it all out and I'm sending that energy right down to my womb, through my baby, and his body came out.

And I'm still on hands and knees at this point and I can't see him yet.

He did need a little bit of help breathing, and my midwives gave him a little breath and I heard him cry.

And then I was able to turn over and they helped me turn over so that I could greet my baby.

He was absolutely perfect.

I felt so much love in that space right there on my living room floor.

And my youngest daughter, who was five years old at the time, she came with her blanket and sat down next to me and met her baby brother for the first time.

(soft piano music) - I would say to her, "Honey, be as big and as loud as you can be.

Be bold because you're deserved of justice and you're deserved of joy."

Righteous anger is important.

And also knowing that our goal, though, is joy.

Our goal is pleasure.

- [Zoe] Wow, so good.

- We're still keeping a fight.

We're still studying war.

I wanna study war no more, right?

I want us to just have peace.

- I don't know if you've ever witnessed a birth, but I remember the first delivery room I was ever in as a student nurse.

It was a joyful, exciting, incredible experience and that's something that should be available to every family, and you can have joy and justice together.

That is possible.

A lot of people hear justice, they hear accountability, they hear something hard and negative.

What we're saying is you can't be passive and get joy for everybody.

(Tiffany laughs) (Erin laughs) (soft upbeat music) Women In The Room Productions.