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Public media are made possible by PNC and the United Black Fund of Greater Cleveland, Inc.. Good afternoon and welcome to the City Club of Cleveland, where we're devoted to creating conversations of consequence that help democracy thrive.

It's Wednesday, December 11th.

And I'm Marlene Harris-Taylor, director of Engage Journalism at Ideastream Public Media.

And I'm your moderator for today's conversation.

According to the Ohio Department of Health, the infant mortality rate not only serves as a key indicator of maternal and infant health, but it's also an important measure of the health status of the whole community.

This year, at the Cleveland International Film Festival, a documentary film called American Delivery showcased nurses heroic efforts to support mothers and babies across the globe.

The film certainly hit home both literally and figuratively, as it featured Cleveland mothers and won the coveted Audience Choice Award.

We're going to see a few clips from the film during today's forum.

Now, in Cleveland, the infant mortality rate is one of the worst in the nation, and that's not a surprise to anybody in this audience.

And according to the Cuyahoga County Board of Health, black babies in the county are almost three times more likely to die before their first birthday than white babies.

And while there have been some improvements, the rates remain persistently high to support women and babies.

We must go beyond health care delivery.

Public private coalitions like first year Cleveland are rising to the challenge.

Building a community movement that identifies causes and develops sustainable, system driven solutions.

So what can we learn from the maternal and Infant Vitality movement?

And how can we ensure all mothers and babies are guaranteed healthy beginnings?

Joining me on stage to discuss this are Carolyn Jones, the director and executive producer of the documentary.

I was just referencing American Delivery.

And Angela Newman-White, executive director of First Year Cleveland.

If you have any questions for our guests, you can text 23305415794.

As City Club staff will try to work into your work, your question and to the Q&A portion of the program.

Now, before we begin, I'd like to set the stage for today's conversation and share the film trailer of American Delivery with all of you.

It might look like the moon, but it's something even more way out.

It's a picture of a human fetus inside its mother's womb.

In the 1950s, we shifted to thinking that anything medical was the preferred approach.

When I was a nurse in labor and delivery working nightshift, I bought into all of it.

Maternal mortality is dropping dramatically around the globe.

I cannot, man.

Nonetheless, the one exception, the United States, where the rate is actually rising.

The U.S. is the most dangerous place in the world to give birth.

I know about misdiagnosis.

I'm a two time survivor of preeclampsia.

For black women, it's become a literal life or death situation.

I never wanted to have that type of sense, this kind of lack of fear from the statistics are unacceptable in a nation is technologically advanced as the United States.

It goes back to listening to women.

Nurse midwives are specialist in low risk.

Technology is very important.

Hospitals are very, very important.

But I think there's a place for people who really need them.

People with complications of pregnancies.

But that's not the majority of pregnant women.

Quite often, women care for so many people in our lives.

We don't do a good job of caring for each other and caring for ourselves.

One thing that for more women was what motivated me to become a nurse midwife.

This can't just be about.

This is about life.

I survived something tragic, I believe to tell a story about it and to make a difference.

There's so many wonderful things about having the power to choose how you give birth.

I want women to have all the options.

I was made for this.

It's called labor for a reason for you to work it out.

They make it look so much easier on TV, right?

Yeah.

Just having a baby is.

Carolyn, congratulations on winning that coveted Audience Choice award at the Cleveland Film Festival.

Well, thank you.

You have a very lively audience here, and it was wonderful to win that award.

It truly was.

It was a good shot in the arm for that film.

So let's talk about the film.

Where did the idea for the film come about and how did you find backers and who was going to be on your team?

Well, there's a lot of questions there, Marlene, but thank you for asking.

So I've been looking at issues in the country through the lens of nurses for about 15 years.

The reason why I've done that and I've looked at everything from the opioid crisis to gun violence to returning war veterans to our prison systems, lack of insurance, all kinds of issues that affect all of us going on.

The wings of a nurse as a filmmaker has been so rewarding because it's a way to get in really deep, really fast and find out how all these things affect the human body.

And you go in without prejudice.

You go in with an idea of caring for everyone equally.

And so I'm able to address these issues without politics and without judgment.

So it's been a really wonderful way to look at the issues.

I also feel as though nurses play a unique role in our communities and we are underappreciated and underrepresented.

And so part of my kind of mission as it's become over the last 15 years is to raise the volume on the voices of nurses, because I think they're in this unique position to see us holistically and not kind of get into the weeds.

That's wonderful.

I love that.

I know.

I love it, too.

And and the nurse who inspired this whole film is right here from Cleveland, Joyce Fitzpatrick, who is the director of the Marion Case.

Shaughnessy Nurse Leadership Academy at Case Western.

And she is a woman who has just touched more lives than you can even begin to imagine all around the world, and made a huge difference in maternal mortality as well.

So she inspired the film.

The news inspired the film.

I look at the headlines everywhere, and I was not only struck by our maternal mortality crisis in the country, but how black women were suffering so much more than white women and and Native American women as well.

It's just been a really extraordinary education.

And as I went out into the world and discovered that people don't realize what's really going on, I wanted to raise some awareness so that that's basically the origin of the story.

So I'm so glad that you were able to connect with the folks here in Cleveland, because this is an issue that we have been paying a lot of attention to as a community.

But I'm not sure.

Angela.

Are we moving the needle?

What's the state of where we are on maternal mortality and the numbers in Cleveland?

Well, unfortunately, you know, for those of you that were able to tune in from the press conference yesterday that was hosted by the county executives office, we are trending in the wrong direction.

In 2022, we had an unfortunate number of 91 families that lost a child.

But in 2023, it shot up to 112.

Our infant mortality rate increased last year to 8.82, and it's also, you know, the racial disparity is still three times that compared to black to white families.

And so, you know, despite all of the phenomena of work that we're doing on the ground, because we are doing the work from our direct service organizations to the number of amazing black led work, I think that, you know, we just need to place more emphasis on our larger systems issues and the inequities that exist.

How are we best supporting women not only during the pregnancy journey, but way before she gets pregnant?

Absolutely.

And there is a connection between maternal mortality and the infant mortality rates as there.

Absolutely.

I mean, you know, when you think about the role of health care.

Right.

Health care, I don't believe is the solution, but it is a part of the solution.

And so when we think about the experiences of black women through the life course, black families in general, you know, the exposure to racism, discrimination and the limitations that are placed on families that are outside of our control is the problem.

And so when you present in a health care setting and you come with all the lived experience and yet are still treated unfairly and differently from your white counterpart, you know, unfortunately, the outcomes are inevitable.

And so, you know, first year, Cleveland's perspective, it's important that we continue to hold people accountable, hold the systems accountable to doing the right thing, not only within the health care setting, but I'm thinking, you know, in the private sector, business sector, all of the above.

And, you know, we often try to use language to bring about change.

And we were talking about how we're trying to think about not this as maternal mortality, a maternal vitality.

That's the new phrase.

Yeah, absolutely.

So way back when, when I was a part of the one community movement and zip code four four went to eight as the resident led initiative around, you know, asking people what they need and doing it.

And when we came into the community and start talking about infant mortality and folks said, why do you keep telling me about all of this devastation and death, I live here.

All right.

What am I going to do about it?

And so it's like it's an eye opener to stop talking about, you know, everything from a negative perspective and look at it from an assets lens.

And so how do we have lived vitality, celebrate black joy, all of the wonderful things that are happening and do more of that as opposed to focusing primarily on death.

And I think if we shift the narrative and do more of what's working, we'll make some headway.

So, Caroline, in the film, you talk about the importance of that nurse patient relationship, and we're going to show a clip from the film.

And if you could like tee it up for us what we're about to see.

Sure.

Well, the nurse patient relationship is really it's such a strong connection when someone's having a baby.

You know, we need to listen to women.

And if there's one thing that everybody said to me as I met women across the country, it was that they didn't feel listened to.

They didn't feel heard, but they spend more time with nurses than anyone else.

So this is a great place for us to sort of open a door in the film to speak to what Angie just said just for a moment.

You know, this idea of presenting information in a really negative way or in a very positive way.

We live in these silos.

We hear a lot of negative information all day long.

As a filmmaker, if I'm trying to change people's mind and introduce them to an idea, I can't start from a place of negativity.

I have to somehow find a way in to present the information so people can accept it and also be a little bit entertained.

And that's what the clip you're about ready to see is we haven't changed much since 1950, and I needed to save that someway, somehow in this film.

So I tried to do it with a little bit of humor, but also to kind of wake us up to what the thinking really is.

So let's take this let's roll it over a few days or a few weeks after your baby is born.

You may feel depressed or perhaps you feel that you can't cope with all your new duties, but you're not doing enough for your baby or look, your husband doesn't show enough interest.

Don't worry about these blues.

Get out to a beauty parlor.

And those days, postpartum depression was still called the baby Blues.

You had it for a couple of days and then you were done.

We now understand that more than half of maternal deaths happened in the postpartum period.

But after a woman gives birth, she goes home and everybody forgets about her.

At a time when she needs attention and care.

I wish we could create a system that's not a medical system.

It's a care system.

We wouldn't just save lives because we would be recognizing physical symptoms and giving women medicine.

We would be saving lives because we would be giving them help and nurturing and so powerful.

Well, the powerful and it's always so entertaining to see those old clips just go out and get your hair done on your hair.

And that will take care of the baby blues, right?

What were they thinking?

To say that.

But I'm so glad we were able to share this because it led me into one of the things I loved filming in Cleveland, which was the Nurse Family Partnership program.

What an extraordinary program this is.

And, you know, having those touch points with a new mom from the very beginning that she finds out that she's pregnant until that child is two years old.

It's a brilliant program that I would love to see expanded.

It's one of the places where I really feel like the needle's moving in the right direction.

And it was just it was a beautiful thing to witness here.

I'm so grateful to have it in the film.

So wonderful to hear that the needle is moving in the right direction in some areas.

Right.

But after you spent some time in this space and did the film, what were your big takeaways around this issue?

You know, I'm always looking for solutions, so I'm trying to find solutions or something that we can do to make things better.

And this is such a complicated issue, and it's easy to get bogged down by how hard it is to solve.

And I think part is partly one of the reasons why I like to share the stage with Angie is because I think she's coming from the top down, like looking at the systems and really how we can make big change.

And I also feel like we need to do some work from the bottom up.

We need to raise awareness.

Women need to know what they can ask for.

And as I was working on the film, I just found that there was so much misinformation out there.

People are getting so much information from TikTok and not from really places that are, you know, it's dependable.

Everybody's not listening to ideas or who they should be.

They should be.

But it's a big world out there.

And there's a lot of Tik Tok going on.

Not that that's always a bad thing, but but I do see that there's misinformation.

You know, I would talk to people about midwifery and they'd say, oh, does anybody really do that?

Is that like when you give birth in the woods?

I mean, you know, this is America.

This and this is the level of understanding sometimes of what some of the things that we're talking about.

A lot of this audience understands what we're talking about, but a lot of the rest of the country doesn't.

Mm hmm.

Angela, this is a big issue.

And it's hard to course correct?

Right.

Hard to move the big ship.

And you mentioned earlier that more work needs to be done with the systems.

And you mean the hospital system in Cleveland?

Cleveland Clinic, University Hospital, MetroHealth.

So what's the work that needs to be done there?

Well, I mean, we want to acknowledge the work that is being currently being done.

You know, I'm so excited that MetroHealth is offering nurse friendly partnership and going to be expanding their eligibility to serve women that have more than one child and, you know, past 28 weeks.

And so there's an opportunity to have a nurse visit you throughout your pregnancy.

I would like to think that we need to also pursue different ways to fund nurse family partnership.

You know, right now, I know they're heavily dependent on grant dollars and philanthropy, but are there opportunities to pursue Medicaid reimbursement for these are clinical providers visiting folks in the home.

And so thinking about sustainability and expansion within all health care systems, you know, that's an opportunity.

Why is that not the present case?

You know, honestly, I think it's because it's taking care of women.

Like we don't do a good job of taking care of women and prioritizing pregnancy.

We can tie that to the lack of paid leave, the access to child care.

There's a whole list of, you know, opportunities to support women and families that I think that we're behind the eight ball.

But the you know, I want to mention, too, that, you know, midwifery is expanding and all of the health care systems.

And we also have a local village of healing.

I see David Lankford in the audience where, you know, this is a black lead for black women.

And we have, you know, nurse midwives being offered in that space, too.

So regardless of where you're going, we now are having more access to midwives.

There's team birth.

This was recently launched at the Cleveland Clinic and approaching you age, and that's a patient centered model.

And so there are you know, there's traction being being met, I think.

But we also have to think about how are we funding health care?

You know, how are we compensating nurses?

How are we compensating OB-GYNs?

You know, what's what is the give and take when it comes to maternity deserts?

You know, why don't we have more labor and delivery hospitals?

It shouldn't be an issue for families to have to travel to to deliver their babies that have to travel too far to where they could have avoided, you know, a complication with the missed time because many of the hospital systems are no longer have baby delivery units, right?

Yes.

And and that's basically a money issue, right?

Yes.

Those those operations don't make money for the hospitals, right?

Correct.

So they have basically made made the access less.

Instead of going the other way.

So we've talked about the great things.

But other than expanding Medicaid for for workers in this space, is there anything else that we could be thinking about changing locally?

So we recently first year Cleveland hosted that.

We host community partner gatherings and our last meeting focused on health care.

And we invited our sister project from Cradle Cincinnati to present their mama certified model.

And this is there's an opportunity here for data transparency and accountability, asking health systems to actually publicly report out their outcomes, their C-section rates, their preterm birth rates, you know, by provider, by location.

And so that will provide the patient the opportunity to choose like what could be the safest place for me to deliver my baby.

And we would hope that for the, you know, we're not trying to shames particular systems, but to encourage folks to raise the bar, to try to find identify ways and effective strategies, to hold the physicians accountable, to hold their front desk staff accountable, to make sure that we are assessing what the true needs are in the community.

And we are responding to that.

So, Carolyn, on the when we look outside of Cleveland on the national level, do we see pockets of places where there's some pilots going on that are exciting or some some national trends that maybe haven't made it to Cleveland yet?

Well, I wish I could say yes to that.

But I think that some of the things that you're doing here are really extraordinary.

It's a problem all over the country.

You're talking about access, right?

We went to parts of Mississippi where people have to drive for hours to give birth and that they're sometimes giving birth by the side of the road because they can't make it there in time.

There are parts of the country that, you know, are dealing with so many issues that we're all looking at it.

It's it's complicated.

I think that the one thing that I've seen that works more than anything is a community approach and opportunity to have these touchpoints with with the patients that are more frequent, more often listening, hearing the women.

You know, that's that's where I saw change.

And you know, in other countries, midwifery is perfectly normal for women who have uncomplicated births.

And so if we could introduce that and get more comfortable with that, we did see.

Well, I'll tell you one place where we did see something I was really interested in witnessing, which was that University of Kentucky Hospital where we the midwives, were able to be with the moms on on the labor and delivery floor.

And the mom could go in and have her baby and never see a doctor if it wasn't necessary.

But if something did go wrong, the doctor was right there and it was a wonderfully integrated place that kind of got beyond the sometimes tension that you find between OB doctors and midwife, and that that is something very real that I think that needs to be addressed.

And if we can transcend it and when we do transcend it, the outcomes are better.

I have heard about that tension, particularly with like doula programs, and we have made some great strides and do the programs in the Cleveland area.

But I have heard that sometimes the doulas, depending on the house go on, depend on the staff may not be welcome for the birth.

Yeah, I think you know, with birthing beautiful communities on our days it's in the room they've done a phenomenal job of, you know, normalizing the presence of doulas in the health care system.

But that's not always consistent in every setting.

And I think we do need to continue to work on that.

You know, recently the state did approve some legislation that would provide reimbursement for do list, which I think would provide more of the acceptance, I guess, on the health care level, because when you see somebody that may not be a hospital staff trying to participate in the labor delivery process, I think that there could be some reluctance from providers because they are there to advocate.

Right.

Tools are there to let the folks know like this is not right, you need to do this and you need to do that.

And so I'm hopeful that, you know, as they continue to grow and evolve, that it will be just a standard of care coupling that even with our community health workers, we do a great job here with wrapping ourselves around our families.

But I think all of our challenges are they all have to go home.

And once they get home and they have to go to work or they have to do other things, that's where we're lacking as a system to make sure that they have all the necessary supports to, you know, implement all of the behaviors that we recommend in the different referrals we provide.

Like how do you actually get to that point?

So how did you find the Cleveland women that you featured?

Oh, my gosh.

Well, we loved filming here.

First of all, we filmed at Metro Health and we filmed a number, a number of births.

And I was struck by, even though there's a certain speed that all things need to kind of move along and keep things rolling forward.

They were very focused on skin to skin right after the baby was born.

So that was really wonderful to see.

And it was a real it felt like a real community approach.

There.

So basically, the women in Cleveland have been amazing to work with.

We have a couple of people from Nurse Family Partnership here today, Kim GREENE, just it's such an extraordinary program.

And I was struck by how deep within the community and how intimate it really is.

Deonna is also in our audience.

She was the she was the nurse family partnership for a young woman who was dealing with anxiety and depression, which is another whole big topic about mental health and pregnancy.

And and they're able to like, get over the the threshold of the home and get in there and really help.

So we were very moved by the women of Cleveland, which is why you take up more than half the film.

That's wonderful.

Well, you know, one of the things that that I've learned over the years, and particularly when we were creating the podcast Living for we if you guys haven't had a chance to check it out, please do.

Where we talk about black women in Cleveland and many of the struggles and in the health care system, And one of the big things we learned through that podcast is that advocacy is so important when women are in doctor's offices, health to all of us, not just women, really.

Advocacy is so important if you don't feel like you can advocate for yourself.

It's so important to bring somebody else right?

Absolutely.

I mean, I think that's why we do have a lot of the supportive organizations in place to to help to advocate for the individual on an individual level.

But then it's also important that organizations like First Year Cleveland are able to advocate on a city and a state level and potentially a federal level, because the goal here is to solve the root cause, not to provide, you know, to always have to provide treatment for an unjust society.

And so, you know, I think that any opportunity that we can shift the power to the patient or to the family to not only be an advocate for themselves, but actively participate in other advocacy opportunities, because as we use our voice as a collective, I think that's when, you know, change happens.

So with the current political climate, do we think there will be moves towards making Medicare, I'm sorry, not Medicare, but Medicaid more available to help with doulas, with the with freestanding agencies, with Medicare reimbursement and so forth?

I'm fearful.

I mean, I'll just be candid, since this is the stage to move forward.

I'm fearful, you know, with the proposed changes to Medicare and Medicaid, you know, everything remains to be seen.

So we're going to see what happens.

But I'm concerned about the economic stability of communities.

And honestly, the focus on equity, diversity and inclusion cannot go away.

We cannot you know, I think we've made a lot of progress as a nation, especially in Cuyahoga County, around really recognizing how important equity is and all of the things that we do.

And if we scale it back, I'm I'm concerned.

And so but I think here locally, there's so many great people doing the work.

So we're going to keep going and we're going to keep chugging along.

So rather than expanding these programs, you think it's probably going to go the other way.

It's going to be scaled back.

It could be.

But again, with remains, we have to wait till, you know, next year.

But I'm confident that with the commitment and passion of the folks here in this community, that we're not going to give up.

I think that the challenges will just be different and it's just going to take longer to to reach that North star that we're trying to reach.

Mm.

What do you think about that, Carol?

Oh, I mean, it feels a little dark, to tell you the truth, but.

But I think I'm really focused on what matters to me, I think, is that we remind people what we're fighting for, whether that's black moms or white moms.

But the children of the future of this country.

You know, we show five births in this film.

And I was struck by those births and I've given birth, But you don't see your own birth kind of so anyway, you felt when you film a birth, it's a whole different experience.

Right.

And seeing these babies come into the world, I was so struck by the majesty of that of how what a miracle it is.

And why aren't we protecting that as a nation?

Why aren't we saying this is a a wonderful thing that we're able to do?

We need to focus on it and make it better for everybody.

And so the film, I hope, reminds us that, you know, seeing these five babies come into the world, I think brings you to a place that reminds you what matters.

And we need to fight for that, whether it's so many things that and she's been talking about and so many things that we witnessed in the film that can be better if we just cherish this incredible ability.

We have to bring children into the world.

What an awesome experience you had making this film.

So lucky.

I have the best job ever, but I'm thinking about what you said though, Angie.

Angela In terms of the diversity, equity and inclusion, for example, how would we know if we're making progress on the maternal mortality rates if we're not allowed to collect the data by race?

Exactly.

That must be a very tough question.

I mean, it is.

I mean, because that's what's important.

You know, when you're you have to break down the data.

Right.

We could say, you know, 8.8 is not an acceptable infant mortality rate, you know, but that's an overall.

Right.

But when you break it down by race, you know, there's a huge disparity.

And if you look at it by community, there's an even larger disparities, even based on where you live.

And so it's digging into the data that tells the real story and it identifies, you know, where you need to focus all interventions and investments in.

And so if we don't continue to do that, I think that, you know, the folks with privilege will continue to prevail.

And the folks without will, it will just be much more challenging.

Well, this has been a wonderful conversation, and I'd love to keep it going.

But we want to let these folks in the audience have a chance to get in on this.

We are about to begin the audience Q&A for our live stream audience.

And for those joining us, I'm Marlene Harris-Taylor, director of Engage Journalism at Ideastream Public Media and moderator.

For today's conversation, we're discussing the maternal and infant vitality movement and how we can ensure all mothers and babies are guaranteed healthy beginnings.

Joining me on stage is Carolyn Jones, the director and executive producer of American Delivery, the Audience Choice award winning documentary at the Cleveland International Film Festival, and Angela Neumann White, executive director of First Year Cleveland.

We welcome questions for air from everyone.

City club members, guests, as well as those joining us via our live stream at City Club, Dawg.

If you like to text a question for our speakers, please text to 23305415794.

That's 3305415794.

And the City Club staff will try to work it into the program.

So may we have the first question, please?

Yes.

We're actually going to start with one of the text questions we've already received in the film.

There were nurses in California who noticed women were dying in childbirth due to blood transfusions, not reaching them in time.

The hospital changed this.

Can you walk us through the steps they took to improve this situation?

Oh, so this.

This is actually a few years ago, a woman named Debra Bingham was behind starting this effort to try to understand why the numbers in California were so high for women dying during childbirth.

And what they discovered was that there wasn't a good record of how much blood was lost during the birth process.

And so she and a group of other people got together and figured out a way to measure blood loss so that when the doctor turned around and said, you know what's going on, the nurse didn't say, you know, the patient has lost a lot of blood.

She's lost exactly this much blood.

So measuring it made all the difference in the world.

And they were able to lower the the maternal mortality numbers in California within five years by an enormous amount.

But the rest of the country is now doing this.

And so this is this is pretty prevalent not only just in our country, but it's gone to other countries as well.

It's great.

Okay.

We're going to go to our next question.

Oh, good afternoon.

First, a shout out to our ideastream for the wonderful series, Call The Midwife.

I love it.

Oh, thank you.

Thank you.

I'll take all the credit.

But my question, one of the things that I've read and I've had confirmed by a number of doctors is the myth that black people do not experience pain the way white people do.

Doctors are actually being trained to believe that.

I read that.

They believe that black people have thicker skin, fewer Newton, fewer nerve endings.

And I've been told that contributes to the infant mortality rate.

So could you talk about that, that terrible myth?

And is has anything changed in the training that doctors are receiving?

Thanks for that question.

I heard about that, too.

I heard that that used to be a thing in medical school.

I don't know if that's still happening.

In medical school, the doctors are being taught that.

But Angela, can you address that?

Well, I'm not a physician, nor did I receive any medical training.

But I am aware.

So, you know, it's called eugenics, Right?

So they you know, during the times where folks were enslaved, I mean, there has been a lot of experimentation on enslaved folks, on slave people.

And all these determinations, these false myths around pain tolerance and things of that nature.

And it has been taught in a lot of the schools.

And when we even think about the other documentary that was done previously, and I'm drawing a blank, but talked about how, you know, there was a concerted effort even in this country, to close down a lot of the black medical schools where you would be actually taught the truth.

And so, you know, again, I can't confirm or deny if there's anybody here for medical school, they can they can make the comment.

But I see some hands out there.

Right.

Because when there was all of the legislation that passed around, even pulling back all the work that's being provided in, you know, how we administer our academic curriculums, like that's a fear of mine.

And so I'm hopeful that in the future, you know, we can at least retrain, but then also make sure that all of our future providers are taught the truth.

Right?

Right.

Well, you know, one interesting thing.

When I was a health reporter, I heard that there was one instance where this worked in favor of the black community.

And that was during the beginning of the opioid crisis, because when people would go to the E.R.

and say, oh, I'm in pain, I need meds, the doctors wouldn't believe the black folks basically, and wouldn't give them opioids, but that kept them from getting hooked on opioids.

So I know things have changed in that space since then, but that was one unintended consequence of that kind of bias.

Okay.

We're going to go back to our questions.

Thank you.

This is a question for Dr. Newman White.

So the bad news is Ohio's recently reported most recent data as being the most deadly place for black mothers to deliver their baby.

We have the highest black infant mortality rate of all states in the country.

But in meeting with you, I was very moved.

I'd like you to say a word about the programs in the community that actually teach us these facts are movable.

Within one or two years, you can drop those numbers.

And I think I recall you mentioning the RSPT codes where infant mortality didn't just back and forth, how it didn't just match white infant mortality went to zero in these zip codes.

So within one or two years of intervention.

So I think if that's true, then this this catastrophe is really something that we can change.

If we had the will fairly rapidly.

So what you're speaking to is the one community effort.

So it's using the collective impact framework and basically doing place based work.

So, you know, we found early on that when we tried to implement county wide interventions, they weren't most effective for our black families.

So white families seem to have received the greatest benefit to these larger systems changes.

And so we kind of decided like, let's focus on communities that have the highest rates of infant deaths were why we convened folks and asked the community, What do you want?

What do you need?

What can we do more of as opposed to saying these are all the terrible things that are happening and, you know, I'm sorry.

And the community told us what they needed at that time.

That was when we discovered the labor and delivery in the southeast quadrant of the county whereby they were for emergency rooms and no labor and delivery at the time to labor and delivery hospitals on the east side and five on the west side.

50% of the births happened on the east side and 60% of the deaths.

And so, you know, we were excited that there is now a who's is delivering babies on the southeast quadrant.

But when we've talked about that with the community, they said they weren't even thinking about that.

Would they ask for was opportunities to meet their neighbors and build relationships.

And they talked about the importance of how do we support families with breastfeeding and can we do it like through the churches?

Because a resident said, I was told to go to the bathroom to want to breastfeed my baby, you know, And so we went to the pastor.

We asked, you know, why don't you allow people to breastfeed in the sanctuary?

And he said, well, there's no eating or drinking and surgery.

And I'm like, okay, well, let's find ways to.

But anyway, but it's like things like that where you don't think about, you know, building relationships with between residents, but asking people what's meaningful for them.

That created a groundswell of our folks saw immediate benefit of them using their voice.

And we think that led to a zero infant mortality rate in 44128.

We later worked with Mayor Blackwell and 44137.

And this is a similar interventions where the community there, though, just talked a lot about how do we make sure that first responders are more equipped to more equipped to responding to families who have children.

And so we provided trainings and also did a lot of out-of-school time activities for youth and that in that community, when we were active, zero babies died.

And so what that what the point is, is that when you ask people what they want and you do that, that's the evidence space behind the work.

I think we do a lot of evidence based interventions that works for a particular population in a particular community.

We don't take into account individual experiences and context.

And so if we do more of that, I feel like, well, we'll make more progress.

That's amazing.

So get it down to zero in those particular communities.

But there's some people who think, Oh, I'm sorry, do you have another question here?

I just have one quick follow up.

There's some people who think that if you just educate everybody, you know, educating everybody is the way out of this.

What do you think about that, Carolyn?

I think we can raise awareness.

We can teach people what they can have.

People don't know about doulas very often.

People don't know about midwifery.

They don't know what they can have.

They don't know what to ask for.

So it's not enough.

Just educating people simply isn't enough, but raising awareness and again, reminding us what matters.

That does go a long way.

And I think the two things together will bring us some success.

But I think we need to work this from both sides.

Mm hmm.

Well, thank you for your patience.

And we'll take your question.

Of course.

No problem.

Hi, my name is Faith Booth, and I'm a marketing consultant and the founder of Blue Magic.

I work with a couple of clients that are in the maternal infant mortality space.

Our healthy community has a platform so organizations can come together and talk about these issues.

And I also worked for the Centering Pregnancy Program through the university hospitals, and these are both great entities.

The thing that I'm struggling with is not just trying to reach youth, as in, you know, like children, but young adults.

So I heard what you said about Tick tock.

So people are out there using Instagram, Tik Tok, maybe not Facebook anymore, but to get their information about, you know, what's going on with them or what's going on with members in their family.

And I'm just wondering like, you know, it's still a struggle even when you give them these outlets, these mediums that are supposed to be connecting with them, they're still not connecting with it.

And it's more like that engagement pool.

It's like, you know, don't you want to know what's happening with your fellow person that's in the same situation as you?

So from your vision, because I love what everyone's set up, they're just what do you guys think that we can do to not just reach children?

Because I think, you know, there's a certain point when children get to middle school and high school, when they get to learn about these things a little bit more and they make their own decision on where they want to go forward.

But with young adults, you know, those ones where you said it yourselves, we're supposed to be getting to them before they're pregnant.

So how do you think that we can reach them more?

Is social media an outlet for that, or is it a copycat?

Great question.

Yeah.

Social media is does wonderful things at times.

But what's what is the way to reach that young adult population?

Meet them where they are, if you will.

I mean, we do find your social media is a pretty effective way to reach, obviously, 10 to 25 olds and it's building a network and forming groups and so folks can feel better connected.

I find that the place based work in your own community, it kind of works.

If you can have partnerships with the schools or college, local colleges, sororities, fraternities.

But I think word of mouth is the best way.

If we can kind of build the groundswell across the life spans and normalize conversations around overall health and well-being, not only would we hope that it would motivate different decisions around health behaviors, but also have folks thinking about the reality of access to actually implement these suggested health behaviors.

Because if folks don't know like this, you know, Maya Angelou said, you only know better.

You do better, Right?

If people don't realize how challenging something a goal is to achieve and what the actual path is, they're not going to step in to make it easier.

And so I think from whatever capacity that all of us come from, it's important that we help to navigate and come up with actionable steps and that just raising awareness or information.

But social media is a pretty effective tool.

Unfortunately, it can hurt and, you know, help us.

I'm working on it.

We're working on it.

The first year Cleveland got to get some some younger folks and let's see was a generation Z that we're into now.

Was it or is it Generation Alpha now?

So I can't keep up.

I'm sorry, but we need some people from those generations creating that content.

And I can also mention too, so we're excited.

Hopefully by January 1st or Cleveland will be launching a resource app.

It's called First year Connects like connects, but it's pretty cool.

But the first iteration is really to make sure that everybody is aware of all of the great services and programs and organizations in the community.

But the next iteration of that will then allow folks to connect with one another.

So to address social isolation.

So how can we you know, find ways to protect folks, you know, information, but allow them to connect based off of where they live?

And so be on the lookout for the NYC connects and that's across the lifespan.

All right.

All right.

Things are moving there.

Yes.

Next question.

Hello.

Today I am speaking as a Ward seven resident and I was very fortunate to have two legs of my children.

I have the bigs who were many moons ago and I have littles.

And when I was having my littles with all this new information that I have, it was very, very important for me to have autonomy in this choice of raising my family.

And so I thought vigorously to find a midwife in the community, to find my own way of of how I wanted to raise my family.

And so I was fortunate enough to have Dana as my midwife.

And I swear I wish there was a village of healing where I could have gave birth to my baby because that's where I would have done it.

One of the things that I realized as a advanced maternal age at 40 and 42, having my children is this fight with the sister.

I couldn't believe it, you guys.

I literally said, No, I am a knowledgeable person.

I can say and do and ask questions and navigate this.

I'm this is a happy time for my family.

But why am I in the fight with this system?

Why can't I make my own choice?

Why am I feeling this thing in this business or I don't know, is it racism?

But it is a thing.

I lived it and that's why I support with Dana and Jasmine are doing is important for families to have those choices.

So when you talk about the systems and the business of it all, do they care?

Do they know it?

I mean, like the numbers speak for themselves, but there are real people.

I am a real person.

I am home grown.

I went to Cleveland State.

You know, I work in nonprofit.

I served in government.

I was born at Boothe Memorial and my mom was a young mom, you know, So that's taking you all the way back.

But did you have that advocate with you?

I had a Dula I had a midwife both times.

It was covered.

So Dana didn't get to deliver my baby, but she was there with me every step of the way.

But you still had to fight the system, even with those supports with you, even still, even still the fight with the system.

And so because I had a healthy pregnancy, that's the only thing I feel like that made the difference.

But if there was any sight of anything wrong, then I would have been just swept up under the rug Of all the things that come along with having a tough pregnancy.

Yeah, but the the business, I guess my question is like, thanks, but thanks for sharing that.

Yeah, that's a hard question.

Do they care?

They do care.

That's hard.

So I know I can't speak for the entire system, Right.

But we have so many amazing providers that care and are doing the best that they can.

But systemically, I know that there's all these prescribed protocols on what you need and should do.

And I think with the introduction of the Village of Healing model with the teen birth model and even with nurse family partnership and midwifery at MetroHealth, there is an effort to move in centering the patient into actually doing what the patient needs and what the patient wants.

Now, is this going to be, you know, standard of care?

Hopefully, But I think we're building the momentum.

And so I understand because I had a similar problem when I delivered my son, nobody listened.

And I had to go through this process and it was like a business.

And so I think at a state level or a federal level, we really do need to think about how do we reimburse for non clinical interventions during the prenatal and childbirth experience, especially when it lends itself to a healthy birth outcome that saves us money in the long run.

You know, a lot of that was in the Affordable Care Act.

It didn't actually get implemented.

But, you know, there are opportunities.

It's just we got to get everybody board.

Yes.

Because we talked before about how many hospitals will push you towards C-section.

We talk about the business of health care.

C-sections are billable, right, at a higher rate.

Yes.

Yes.

Hi, I'm Dr. Amy Stephens.

I'm an obstetrician gynecologist with the Cleveland Clinic.

Hey, hey, hey, hey.

What's coming around?

That's great.

And for your first Cleveland surgery.

Yeah, Yeah.

And, you know, our systems do care, and we have many representatives in this room, but it's hard to move the needle.

I'm.

I have a couple comments as we talk about changes in government and going forward, you know, philanthropy is going to be more and more important.

So we really have to tap into those resources and continue to educate those who will support these initiatives on the challenges, you know, of.

You know, black women giving birth is, you know, not unique, as we know.

You know, regardless of your education or your socioeconomic status.

But I think that implicit bias does have a great bearing on, you know, black women's experience.

And I will encourage everyone in this room, if they can support implicit bias training at any institution to support it.

We have efforts in my system to educate our providers and our residents and have them do implicit bias training.

But understand this starts when you make a phone call to make an appointment, right when you're at the front desk or even if you're late for an appointment.

Like if my patient gets there late, everyone's like, Oh, she's always I was like, I asked the patient, Well, why are you late?

You know, Did you have childcare issues?

Will bring your kid, You know, we delivered your child.

I'd love to see them.

Bring them.

You know, I rather you bring your child and not miss your appointment as opposed to just struggle.

So sometimes we just have to be a little bit more sensitive.

And there are really hard conversations.

People, you know, are often sensitive about these things.

So, you know, we have to be strategic in how we present this and also encourage others to hopefully support these efforts and fund these efforts.

May I ask you, Doctor, are you open and is the system where you work open to dualism, midwives being a part of the birth experience?

Yes, we are.

And I'm a former chair of the Department of Obstetrics and Gynecology at Fairview Hospital, which is a Cleveland Clinic hospital and the second busiest.

So the hospital in the state of Ohio, which we're very proud of.

But yes, we do have a relationship with birthing beautiful communities and we have a very robust midwifery program also headed by Sue Hudson.

We have about 40 midwives across the system.

So, you know, we are really embracing that.

And we also have centering in pregnancy and teen birth.

And I sound like a commercial and I'm so proud of where I work, but the work is hard.

We're not moving the needle as fast as we want, so we just have to continue to move ahead.

Thank you.

Thank you for being here.

I think we have time for one more question.

Yes, one more.

This is a text question.

How can we watch and or stream the American delivery film?

Great questions.

Well, thank you for that.

I'm so proud to say that starting on May 1st, American delivery will be available to stream to stream at pbs.org.

And so that we're very excited about it.

It's the our version of the film.

The longer version will be still available through my distribution company, Kino Lorber We're delighted to have them on board, but we are really excited about the PBS opportunities and we're hoping for stations to really embrace it.

During Nurse Appreciation Week, we're kind of aiming towards that.

It's March also happens to be Women's Health Awareness Month, I believe it is, and also Midwifery Day.

So all of those things are converging at once in in the month of March.

And so we're looking forward to that.

That's wonderful that I say March.

You said March.

Yeah, she did.

And I'm so happy that we're providing that opportunity for more people to see the film.

So, Carolyn, your final thoughts on this topic for today.

We've covered a lot, but is there anything that we haven't touched on?

Oh, I just want women to be noisy.

I want women to say what they feel and know their bodies and have advocate advocates for every step along the way and wherever we can, like add a touch point so that women can connect to people who are helping them along the way, whether it's from the minute they find out too, they're pregnant all the way through to their children or our two years old and beyond, I think that's what we need to do and communities need to come together.

And I think people do care.

I think people do care all across the board.

We just have to remind them what they need to care about.

Angela, your final thoughts on this discussion today.

You've shared a lot about what we're doing in Cleveland and is there anything that we haven't touched on?

I mean, we've covered most of it.

I just, you know, our ask or my ask is just really to make sure that we all get involved like you have to.

This is not something that we can turn a blind eye to.

And I feel like no matter who you are and what capacity you serve, you do have a space in this work because it's not just really about even pregnancy in particular.

It's about how do we take care of communities, how do we take care of families?

And so, you know, our work is just get involved, you know, contact us first or Cleveland dot org, but also partner with a number of the great organizations that what was that that was the first year Cleveland that or first year Cleveland dot org because we do want to build a really a shared ownership you know in this community with egos aside and make sure that we all just have a seat at the table so we're stronger together.

Absolutely.

And I want to thank all of you in this room, because I know so many of you are in this space.

You're in the trenches every day.

You're trying to make sure that women are delivering babies healthy and that the women themselves are staying healthy.

So I'd like you to give a round of applause for yourselves.

So thank you very much, Carolyn Jones and Angela Newman White for joining us at the City Club.

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Dawg.

The City Club would also like to welcome guests at the tables hosted by Capital Partners.

First year Cleveland, the MetroHealth System and Ohio Guides Dome.

Thank you all for being here.

This Friday, the City Club will close out 2024 with a conversation with Connie Hill Johnson and Kevin Johnson and celebrate the soul of entrepreneurship and community leadership.

You can learn more about this forum and others at City Club, Dawg.

And that brings us to the end of today's forum.

Thank you once again to Carolyn and Angela.

I'm Marlene Harris.

Taylor and this forum is now adjourned for information on upcoming speakers or for podcasts of the city, go to City Club.

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