- My name is Hermene Hartman, and I want to welcome you to N'Digo Studio.

Today we're going to have a conversation with something that's kind of swept under the rug, yet it is a pressing issue.

We wanna talk about black maternal health disparities.

Did you know that in this country, black mothers are three to four times more likely to die, that is to die from pregnancy related complications, at childbirth compared to their white counterparts.

Did you also know that in the United States, industrialized nation with a rising mortality rate?

That means lives, dreams and futures are lost.

And today we want to talk about this.

We want to talk about it with women who are doulas, midwives and doctors, because every baby should be born healthy and every woman should have a healthy baby.

This is an interesting and necessary conversation.

The conversations drop Drop The Kowledge.

That's For Real... Funding for this program was provided by Illinois Student Assistance Commission The Chicago Community Trust.

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Chicago.

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And Governors State University.

So today we're talking to Toni Taylor, who is a co-founder of Chicago Birth Works.

It is an organization for doulas.

We're also talking to Tennis Allen, who is also a doula, and studying to be a midwife.

So, ladies, first of all, you got to tell me what a dollar is and what a midwife is.

What what's the difference between the two?

So a doula is someone who teaches you how to advocate for yourself in labor.

Abdullah also is the one who's helping you through labor with, like, pain relieving techniques.

And then the midwife is the one who is doing all the medical things.

So giving you the prenatal care, and delivering the actual baby and giving you care and postpartum, like that's what your midwife is doing.

.

- Okay, now how did you ladies become interested in this process, the doula process?

How'd you become interested?

How did you found your organization of Chicago Birth Works?

- Our organization was started between me, and my daughter, when she had her second baby.

And we wanted to duplicate the support that I gave to her, and the safety that she felt and manifest that for other moms.

And this is having babies at home.

Having babies at home or in the hospital.

And so you can have the doula process in the hospital, Right.

So why would I want to do live rather than a doctor?

So the Dula is not medical.

The doula does not provide you with any medical, they don't perform any medical procedures, any medical, anything.

They will help you understand medical procedures.

They will help you understand medical norms, and different things like that, and just how to move through the medical process.

But doulas are not medical staff.

We're more so like birth assistants.

So doulas are the assistant to the midwives, or family assistants.

Okay, so you're coaching it, Really coaching.

So now with the midwife, can I have a midwife in the hospital, or is a midwife off of hospital, at home?

- So you can have a midwife in a hospital, which would be considered a certified nurse midwife.

But you can also have midwives that are at home, which are certified professional midwives.

The difference between the two is really the schooling.

So a certified professional midwife would be in school for probably about three years.

Whether a certified nurse midwife is in school for about six years because you have to do nursing school, then you go to midwifery school, then you have your clinicals and then you can become a midwife.

Do I need insurance to have to have a doula?

To have a doula?

So ensure I mean, doulas were initially out of pocket, but they just passed a law and they're being.

Provided, as we talk about this, we find a disparity with black women as compared to white women.

Talk about those disparities.

- So you have like racial bias you have- In the hospital.

yes.

Yeah.

Yeah, so you have racial bias, you have staffing that just aren't really informed about the nuances of caring for black women.

There was a video that was circulating saying that doctors, they were trained, and they were under the belief that black women have a higher tolerance for pain.

- I've read that.

- And, you know, so if this person is caring for me, and I'm telling you that I'm in pain, you are not receiving this the way that it needs to be received, and you're not providing me with care sensitive enough to actually help me relieve what's going on.

- So it's likely that the woman is not being listened to not being heard?

- In a lot of ways.

Is sometimes the maybe the medication is not being administered properly.

I'm not going to say that it's the medication.

I'm not going to say it's one thing or the other.

I think it's a series of a lot of things that just happened over the time where you become pregnant through delivery.

That's including the prenatal care.

yes.

So what should a woman do?

What's the best advice?

You should seek medical attention.

You should have a medical person that you're monitoring your pregnancy with a doctor, a doctor or CPM.

So I'm also a student midwife, so I believe in out of hospital birthing.

Okay, So tell me, why would I have a baby out of the hospital as opposed to in the home?

Because having a baby is not a medical thing.

It is.

It's normal.

And then you had the baby at the hospital.

You made the baby at home.

And you can very well have the baby at home.

There are some indicating things that, you know, might suggest that you need to be in a hospital multiples or if you have some sort of identified determinant, you know, that says I need medical attention, diabetes, different other things that you would present due out the pregnancy that would suggest this person needs to be seen by a doctor.

Right.

But if you are healthy and everything is all charting well, you can deliver at home fine and not have to go to the hospital after you after.

Is there a psychological comfort you think having a baby at home was supposed to go?

I believe it is because you're in your space and we're talking about post-COVID.

All of the germs are in your house are yours.

So when COVID came, did your business increase women having babies more at home than in the home?

So there was a.

Hospital had COVID people in it.

Well, COVID did a lot of things.

I don't think people slow down and having children, I think we had a lot of people having babies.

But I mean, but but I'm talking about in the birthing process.

So in the birthing process, it changed a lot of like what was available in the hospital.

They pushed a lot of doulas out.

And I've seen moms deliver with a mask on.

They were testing moms before they delivered and testing the baby and testing for COVID.

Homebirth went up 22% during COVID, and it hasn't decreased yet, though.

So I would say that it's on the rise - More people are choosing to give birth at home, because they're realizing that birth is not anything that's a medical emergency.

- Okay, so what if you are having a baby, and there are complications?

Are you prepared to handle those complications?

Yes.

A breach birth breech basket.

they can be delivered at home, but it's not recommended.

What can you tell me about the breach?

Birth is going to be a breach for you.

Can you.

Can you can.

You can tell through palpating the actual uterus.

You can tell what position the baby is in.

And that's what midwives I talk to do.

Doctors are really not taught to do that.

They're taught to read the machines, read the monitors, don't actually talk to this person that's in front of you, you know.

Same thing with nurses.

Like they're not coming in the room and checking on you as much as they should.

They're looking at you on the monitor to see what's going on.

So from a distance.

Yes, they're not they've.

Medicalized birth and they've they've they've monetized it.

So you're pregnant now?

I can charge you some money to get the baby out, but nobody charge you to put the baby in there.

Okay.

You all are educating me.

I don't have any children.

And after I saw and started reading, I figured out why, other than the obvious.

Right.

But that's a great work that you're doing.

What do they do?

How do they contact you?

You reach out to us through our website or you can visit us at our studio in Hyde Park.

- Off camera, we were talking about what happens to a woman's brain in the process of birthing.

Talk about that for me.

So in the process of birthing a woman's brain, waves change.

So when she gets to like that transition phase, then her brain waves are more so in like the delta brain waves.

And she is no longer in this world with us per consciousness.

So she's in a whole nother herself.

Nope.

She's in a whole nother plane of existence.

You have to go and retrieve your baby and bring them back.

So in order for birth to even happen as we to, for a mother to be birth, you know, we're missing that because in hospitals we're taking that away.

We're getting epidural and taking ourselves out of that entire process.

And I think that that the way that children are birthed and into this world changes the way that they will be forever in.

You see what's going on, especially in Chicago.

You know, I think.

So.

What would you elaborate on that?

The way that we bring our children into this world shapes their entire existence.

And when you don't allow yourself to go through the birth process because it's painful or you just don't want to feel.

It or forced, you have a doctor for.

Patients.

You don't want to feel.

That you want to take yourself apart from being a part of that experience in a hole, then you're not able to be birthed as a mother.

- It interrupts the connection between the mother, and the the baby in terms of the delivery.

So you interrupt those receptors, for the mom actually being in labor, and going through the actual phases of labor, and the connection that she has with the baby.

So when you when you intervene with that with, like, medications and different things like that be your choice or the doctor's choice, what have you, it affects your ability to breastfeed.

It affects the bond that you have with the baby, Babies that are born via c-section, they miss out on natural bacteria, that they're supposed to pick up from coming through the birth canal, and actually doing that rotation around, that's a necessary part of birth.

That's the defense system.

One of the things that was really interesting in covid, we saw a big rise in postpartum depression.

I feel like there was a really big spike in postpartum depression with women of color, because our partners were not allowed into doctor's visits.

Our partners were not.

There was like weird stuff going on in delivery places and- - So you're alone?

- Yeah, yeah.

And then you couldn't have people to the hospital to visit after the baby was born.

Then you were in fear, once you brought the baby home, nobody could still come and visit.

So now you have this new baby, you should be excited, And now you're even more sad.

So what's the mental consequence?

What's the social mental consequence of people.

Living in isolation, You know, feeling like there is nobody that is there for me?

There is no community connection.

Yes, that is a huge consequence.

And I think that's why a Chicago birth works.

We're really big on community.

We're really big on trying to bring moms together.

But not even just mothers, just.

Fathers, families.

What helped a lot of moms and then their postpartum blues was partners staying with them and not returning to work so quickly.

Thank you, ladies, for sharing.

Probably things that we don't discuss that we need to talk about at large, out loud.

The most powerful person in the world is a mother.

- Hmm.

- Now I know why.

Thank you so much for being with us.

We're talking to ladies, and we're talking about babies.

We're talking about healthy babies, and maternal healthcare.

continue our conversation on maternal health care.

We're joined by doctors.

We have two wonderful female doctors.

Dr. Kendra Outler is an anesthesiologist at John Stroger, Cook County Hospitals.

And Dr. Samena Rahman is a gynecologist, Northwestern Hospital.

Now ladies tell me, I'm getting ready to have a baby, to go to the hospital, or to have a baby at home?

- You know, when women are going into labor, and they're having children, it is very important for, you know, to get a full assessment of what's happening to them.

You know, from head to toe.

Your body changes from head to toe in pregnancy, things change for you.

Your cardiac condition changes, everything.

So it's really important to get into a hospital setting, In my opinion, obviously, because, you know, we have the urgent things that, you know, women still die from maternal related deaths.

And black women die more.

Three times as.

Much.

Why?

There's a number of reasons.

What's the reason?

reasons that we're finding is that you have hemorrhage, which we've actually been able to do to get better protocols in the operating room for, which would be my area.

Mental health actually is also a reason We have women who unfortunately may use substance abuse or may have suffered from depression both during pregnancy and after pregnancy.

And another reason that we have is heart changes.

There are physiological changes that happen during pregnancy.

So it makes it a very concerning medical condition that as women make their birth plans, that will determine if a homebirth versus a facility birth would be better.

You need to be healthier if you're going to have your baby at home versus the hospital.

Absolutely.

You should be considered low risk in your pregnancy to be able to have a baby at home, meaning, you know, you don't have any you're you're not over the age of 35.

You don't have any preexisting conditions or don't develop conditions during overweight.

yes.

Obesity, hypertension, diabetes.

And then women can develop gestational diabetes, gestational hypertension, pre-eclampsia, these conditions, there is no way that someone should try to have birth from home with these conditions because there are many complications that can occur as a result.

And, you know, this is how a lot of women die in pregnancy and pregnancy related deaths.

Well, I would I would add to that is, you know, when we did primary care before anesthesia and we had the birth plan, and so I want to put out there that women should consider their birth plan, Both when you're planning the pregnancy, prenatal care, then once you become pregnant with your obstetrician and see what support they would have if they have a home, if they decide to have a home birth.

So what's the discrepancy with black women versus white women and black women having more trauma, more deaths even than white women?

What's the cause for that?

What's the reason for that?

anti-Black racism, That's what most studies are, basically racism.

Yes.

Because what it turns out to be the Green Journal, which is the OBGYN Journal for obstetrician gynecologist, had an article that came out this month talking about how traditionally what we've been saying is that race is a risk factor for pregnancy and obstetric related complications.

Specifically, you know, a minority races, women of color, and non-Hispanic blacks, that kind of thing.

And they were saying that we should actually switch the narrative that anti-black racism is the risk factor.

And that means on the level of implicit bias, that healthcare clinicians, nurses, you know, support staff, all from ground zero up.

A lot of black women don't feel listened to.

And then, you know, along with that comes the idea of, you know, the allostatic load that black women carry.

So this is due to generational trauma, that changes the physiology on a cellular level.

So if you look at how, you know, why is it that, you know, black women are dying more, in maternal death or why black women might experience more complications in menopause?

All of these things are related to the our static load, which is really what they call, you know, traditionally was weathering.

But it's the the load of generational trauma on their system from a cellular level.

And it's really from chronic stress.

- Well, I wanna support you in the sense that we do think of almost, not just now, but over 20 years of research.

In 1997, we had a report in on cardiology by the Schuller report that said that black women Were the least likely group of women to be real, to be believed when they complained of chest pain.

Right.

This was a well-known study that was done at the AMA, where we dressed every woman, every person, the same white male, black male, white, female, black female.

They found that the black female was the least likely to be referred for higher level of care and the least likely to really be believed about her pain.

So go to the doctor.

Yes.

And I'm a black woman.

Yes.

And I'm least likely to be.

Hurt to be hurt.

By.

Your symptoms, about your symptoms.

And so we see this pain.

Pain is the one I got you when it comes to medicine.

Because if I say I have pain and you rate it as a two.

But I told you was a ten.

Did you believe me?

What part of the process and did you say that my pain really is not that bad?

We've been able to call out the medical community on one condition and that is pain.

And what's one unifying condition?

That women have pain in birth?

That's a symptom of labor.

And so we even see that being dismissed in the health health world.

And so when she when we mentioned as Dr. Beaumont about black women and and black anti-black racism, large birthing centers that see large volumes of black women still have higher numbers.

And we know that they are trained, they they have the volume, they have the clinical scenarios to say this is what we should be doing, but why isn't it happening?

What role does the do the does the midwife play?

Because they're talking about advocacy.

- Well the doula's role is advocacy.

The midwife, I've worked with midwifes even to this day, and the midwives and nurses, they have the one-on-one clinical training, and they can be in the birth room, okay?

And they can help with deliveries.

Midwives do an excellent job of delivering babies.

- Yeah.

- They are actually symbolized in the African American Museum of Culture in DC we have a tribute to the midwives.

The doulas in terms of their role, and being an advocate for the mom is always important.

And I want to put this in here, the studies have found that most women die within 72 hours if there's a complication after birth.

- 72 hours?

- 72 hours after birth.

So we're talking that most of the cases that were found in the review from the maternal mortality study found that women die after birth.

So we still need to care for moms.

That's why the Illinois Department of Public Health has now put women on Medicaid and assistance for a whole year, 365 days after giving birth.

That's how long you're covered so that you don't fall through the cracks, okay?

- Mmh.

- And you can't be seen.

This is actually where doulas can definitely be helpful.

'Cause it's not just during the birthing room, it's after the delivery, bleeding, - Within a year.

- have low pressure.

- Yeah.

even up to a year, 'cause that's when that mental, the rates of suicide, and issues around substance abuse, all that stuff is within the year postpartum.

- Yes.

- And mental health is now the leading cause of maternal death in America.

But that also includes a subset abuse, a postpartum depression.

-Yes That's why you see a lot of campaigns now helping us understand that after the delivery is a high risk time for the mom.

Even when she leaves, there needs to be connections with the medical community.

That's why we need coverage, you need support, and we also now have other modalities like texting the mom.

"How are you?'

Because we know young women is Gen Z, they rely on their phones.

So you're able to give them information through the phone, and stay in contact.

I think we have to have education in the community.

You have to have education in the community, that's why platforms like this is important.

We have to be able to talk about it in the community across different medium, okay?

- Awareness, consciousness.

- Yeah, the awareness.

But we also then we need to empower our community when they go into partner with health systems, partner with physicians, to have that important list.

It doesn't have to be anything fancy, but I always encourage patients, write it down if you can't remember.

- Yeah.

- Remember who was part of your care team.

Tell us who we need to speak to on your behalf.

Should you not be able to speak for yourself?

I mean, when moms are in pain, they don't have a lot of conversation.

So always have these people that you have to have that advocate.

I always even for breast cancer patients, please bring somebody else in that room.

Don't leave your your families alone.

You can have at least one person.

- Implicit bias training is really big, you know, in the medical community, they're doing it across the board.

You know, you have to listen to your patients.

You have to listen to your patients.

You have to listen to your patients.

That's a big thing.

Like, we don't listen.

We we look and we judge, you know, So that's huge.

In the medical community right now, we're starting to listen to our patients more and more.

That training is getting embedded in the training.

- Realization.

- And then the self-advocacy and education, I always tell my patients, 'cause like I said, I don't deliver babies anymore.

So if I have a black patient that is leaving my care to go and get seek care elsewhere, I'm like, if something doesn't feel right to you, you verbalize it.

If you're feeling pain, you verbal, and you wait until somebody listens to you.

You don't let go, this is your baby, this is your life.

And so you have to advocate for yourself.

And we have to take ownership of our own health, too.

And we have to understand, you know, what are the what are the things that we're going to experience in pregnancy.

So that's why educating yourself on all the complications.

The CDC has a big thing on, you know, just knowing the signs of to be to be worried about what are the signs I should worry about in pregnancy when something might go wrong?

What are the signs of hemorrhage potentially?

So all of this is around education, self advocacy and educating clinicians as.

Well to add an add in his whole race and medicine course.

But I also want them to understand it has to be culturally competent.

Right.

Okay.

Because sometimes it's, we did the course.

But is the course culturally competent, number one for the residents?

Because the largest pool of physicians that we're producing are whites, white females.

Then we have the second group is white males.

Black physicians are about 5%.

And we have the other, you know, category.

So we have to really understand that the messages that we send to our patients, the message that we send to our residents and medical students, has to be culturally competent.

And black people come in all socioeconomic levels.

They come in all backgrounds and all shades.

And so sometimes when they're doing this education, our medical schools are primarily white institutions.

They don't know how to bring it in without making stereotypes of us.

- Wow, thank you.

Thank you for an enlightening discussion.

But this is a discussion that needs to be really, really had - And continued- - to come to the forefront - Mmh.

because I mean, health is important.

- Yes.

- It's important.

- You gotta have good communication with your doctor.

- Yeah.

- Mmh.

- I don't know this personally.

I just don't, I don't, - Yeah.

I don't know it personally.

Thank God, I don't know personally.

- May I share that 1972, my aunt died in childbirth?

It was my grandmother's lifelong heartache.

It's something I didn't understand for many, many years, why I had a cousin with no mom.

Who did she belong to?

And we didn't discuss it.

And so what I will say is, at this time in life, to be able to have a conversation and bring up her name and bring up her presence, I think that has promoted some healing within the family and it actually helped her daughter feel more accepted because we can say her mother's name.

Whereas before it was just something so painful that we couldn't talk about it.

- There's so many hidden things like that amongst black, because was the time we couldn't go to the hospital.

We had to have a midwife.

Thank you very much for such enlightenment, Dr.

Outlaw and Dr. Rotten.

Thank you.

Thank you for being with us.

I hope you learn something and.

Advocate for yourself.

Yeah.

Because I will remain heartened.

Heartened with Indigo Studio.

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