(bright music) - Hello, welcome to "Forum 360".

I'm your host Leia' Love where we have a global outlook from a local view.

Today we are going to be talking about infant mortality rates, the causes, and how you can become your own advocate during your birthing process.

We have the beautiful, gorgeous Dr. Cheryl Johnson with us today of Summa Healthcare System.

So thank you for joining us today.

- Of course.

- So tell us a little bit of your background because she is going to be our expert today talking about infant mortality rates.

- Okay.

Well, background, I'm from northeast Ohio so I'm from Cleveland.

I went to an all girls school in Shaker called Laurel where in sixth grade I realized I wanted to be a physician.

So that's where that was birthed.

After Laurel, I went to Hampton University so that's a HBCU nestled in Hampton, Virginia.

From there I went to the Ohio State for medical school and I pursued a residency in obstetrics and gynecology where I did my residency at Akron City Hospital.

And after graduating, I stayed on in Akron.

So I always had intentions of coming back home to Cleveland to practice.

But in doing my residency in Akron, I realized that there weren't any OBGYN female providers that look like me servicing the women that look like us.

So I decided to stay there and that's where I've been.

- Awesome.

Well thank you for joining us today.

- Thank you for having me.

- So I'm gonna read a statistic.

According to the latest available data, Ohio's infant mortality rate is higher than the national average.

The national average infant mortality rate in the United States is around 5.7 deaths per 1000 live births as of 2019.

In comparison, Ohio's infant mortality rate was approximately 7.2 deaths per 1000 live births as of 2019.

So can you tell us an overview of what is all encompassing of infant mortality and what does that really mean when we hear that term?

- Sure.

So when we hear the term infant mortality, what that means is that a mother delivered a baby and that baby took its first breath.

And so it's measured by whether or not that baby expired before their first birthday.

So it's not stillborns or anything like that.

So it's a mom delivered a live infant, and then that child did not make it to its first birthday.

And so that's measured in 1000 live births and so that's how we get those rates.

- Okay.

What are some of the leading causes of infant mortality and what factors contribute to these causes?

- So I would say a leading cause of infant mortality would be preterm birth.

So a mom delivering before 37 weeks.

And so that's gonna have implications 'cause a lot of times maybe lungs aren't as well developed, their low birth weight or things of that nature.

There's also many other medical factors of the moms that can put you at increased rate for infant mortality and so that could be hypertensive disorders in pregnancy, diabetes in pregnancy, different heart diseases that a mom might have.

And so all of those things can contribute.

Other factors that play into infant mortality are safe sleep related practices.

So a lot of times babies expire before their first birthday just 'cause they weren't in a safe sleeping environment.

- Okay.

Now do socioeconomic status, does that impact the rates and can there be anything done that helps to address those disparities?

- So that's a myth that socioeconomic status could be protective of moms.

So most of my work is around infant mortality in the Black population.

So if I was pregnant and delivered, my rate of infant mortality would be higher than someone who was white and 18 years old of age.

- [Leia'] And why is that?

- So we believe that the infant mortality rate and this disparity that is between Black and white patients is due to systemic racism and the weathering that we endure as being Black in America.

- [Leia'] So what do you mean when you say the weathering that we endure?

- So when I say weathering, I mean all of the microaggressions, all of the things that show up for us from the time we wake up, leave the house, if the news is on and we heard that there was another Black male gunned down or there was police brutality, all of those things take a toll on us.

So I have a son, so when I hear those things, cortisol's released and so how does that impact my body systemically?

Does that increase my blood pressure?

And just imagine if I was carrying a child, how does that impact a child?

How does that constant release of cortisol day in and day out impact us?

And so other things that I would define as weathering or as if you're talking to a colleague and they say something that's triggering, "you people" or whatever have you.

So all of those things have a visceral reaction in our body and I don't think that we always necessarily understand that that impacts the child that we're growing.

- So what can be done to help during pregnancy that a mom can do to help with that?

- So I would say things that are protective for mom is making sure that you're taking care of yourself.

So self-care, loving on yourself, having loving thoughts as you try to nurture yourself and the one that you're growing.

Also having a good support system around you.

And I'm sure we'll talk a little bit more about support system, but yeah, family, friends that support us.

So a lot of times in my work with Black mothers and as being Black, when you announce that you're pregnant, it's not always celebrated in our community.

And so just from the start, we're not always in a loving environment or in a loving or accepting mindset and I think that impacts the pregnancy and the course that it'll have.

- Interesting to know.

Are there any regions that are highly or higher affected?

Is that any type of... - In regards to infant mortality?

- Mm-hmm.

- Yes.

So I do most of my work in Akron.

So there are high risk zip codes where our infant mortality rate is higher.

And I've been working with a PhD candidate who has interesting research coming out in regards to if you look at the redlining map, does the infant mortality rate follow that?

So that's to come.

We'll see.

We'll see what her research shows but I hypothesize that it does.

So yes, there's absolutely high risk zip codes.

And so that's where we started our work in dealing with the Black infant mortality rate.

But because we recognize that it crosses all socioeconomic status, then we open it up to all moms.

- So you just told me that there was one myth.

What are some of the other myths surrounding infant mortality rates?

- So the biggest myth that's my pet peeve is that sometimes in medicine we put the issue back on the patient.

So we'll say that the infant mortality rate is what it is in the Black community because they don't show up to their visits or they're using the ER for healthcare instead of coming to preventative visits and things of that nature instead of us as providers taking ownership for the fact that Black mothers might seek care late or terminate care early 'cause they don't like the way we make them feel when they interface with us or they didn't like how they were treated at check in or that the nurse made assumptions when they were rooming them or they didn't feel heard or seen from their provider.

So I think that we're at a pivotal point in the healthcare system where we as providers can take ownership for the numbers and the disparities that we see instead of putting it back on the population.

- Were there any other myths that you have?

- Let me think.

- That's okay.

We can come back to that one.

- Okay.

- So what role does access to quality healthcare play in reducing infant mortality rates and what is considered quality healthcare?

- So I would say quality healthcare, I'm not gonna give you like the textbook definition.

So my definition of quality healthcare is that a mom feels like she's seen, she feels like she's heard and that she's comfortable with her provider and that there's a shared decision making that's going on so that you're leaving your office visit feeling educated and feeling empowered on being able to execute exactly what will lead to the outcome that you're looking for.

So I think it needs to be a conversation where both parties hear each other and then they come up with something that's tailored specific for that patient to get the outcome that we want.

So that's what that looks like to me.

- Are there any questions that they should make sure they should be asking to help build that relationship?

- Oh yeah, for sure.

So questions, well, I think it depends on the type of patient, but yeah, absolutely.

And I definitely encourage patients to ask questions of their providers.

I definitely encourage patients to write down those questions before they come.

So research has shown that providers are pretty good about cutting patients off seven seconds into their explaining why they came to this visit.

And so I think it's definitely good to have a support system and also to have written down what it is that you hope to accomplish so that you can say, "I'm concerned that my child's not meeting their three month milestones because I don't see X, Y, and Z."

Or "my blood pressure's gone up and I'm having headaches, so what do we do now?"

So I would actually be very specific about what is concerning you 'cause a lot of times in working with moms, they know when something's off or their support system knows and so I think that if we tap into that and hear that, we can start to build some trust within our community.

- Okay.

And if you are just joining us, we have Dr. Cheryl Johnson of Summa Health System and we are talking about infant mortality rates, causes, and how to be your own advocate.

Okay, so are there any specific interventions or programs that have been proven to help with infant mortality rates?

- So I'd say one program that's in place that helps with the infant mortality rate is centering.

So the Centering Healthcare Institute developed centering a long time ago and it wasn't necessarily for Black mothers, it was created by a white midwife.

But what it is, is it's group prenatal care.

So you get moms together in groups of maybe eight to 12 and they'll have their prenatal visit and then they have about an hour and a half of education on certain topics.

So those topics could be breastfeeding, it can be newborn care.

There's a plethora of topics that we cover in our centering.

But what we've found is that it decreases the preterm labor, it decreases the preterm birth rate, it increased the breastfeeding rate and all of those things so yes, I think that moms that participate in centering pregnancy, also there's a centering parenting that sees their children till they turn the age of one.

I think that those things are very protective and decreasing the infant mortality rate.

- Awesome.

Sometimes before, during, or after labor, things may not be going as planned and patients know that something's wrong, but they're just not necessarily getting the care that they want.

What are some of the ways that they can advocate for themselves in those instances?

- Sure.

So I would say there's plenty of things that patients can do.

So if they feel so empowered, then they can speak up for themselves, they can talk to their nurse, they can talk to their provider, they can talk to a nursing supervisor in the moment.

However, in my experience, patients don't always feel empowered enough to do so which is where I've found that the doula patient relationship is very beneficial.

So a doula is a support person that's there for the patient before, during, and after labor.

And they're supportive in making sure that what it is that the patient wants that they're able to get those things.

If a patient doesn't have a doula, then having a support system there with you.

So whether that'd be father of the baby, mom, sister, friend, whatever have you, someone who knows you and knows your desires and can help support you when you're breathing through contractions and might be in pain and can't necessarily advocate for yourself in that moment.

- Okay.

And the doula, is this something that the hospital provides or do you have to find your own?

What's that process with the doula?

- So patients find the doulas on their own and then the doula meets them at the hospital or comes in with them.

So that's typically how that process works.

- And then I'm not sure, I guess in my mind I would think that doulas or midwives may have a background of being too clashy or whatever with healthcare professionals.

Is that just a myth or is that something that is highly welcomed in the medical community?

- Okay.

So I can only speak on, you know, I'm northeast Ohio born and grown.

So I would say that I was in a practice and there were eight midwives in our practice and those midwives come and deliver at Summa now and we have an excellent doctor-midwife working relationship.

- [Leia'] Is there a difference between midwife and doula?

Is it the same, just a different name?

- No, there's a difference.

So there's a different level of training and midwives can prescribe medication whereas the doulas do not.

They're more of a supportive and more of an advocate role.

- [Leia'] Okay.

- So I will say that our patients had the option of choosing do they want to be a midwife patient or did they want to be a physician patient?

Sometimes there's medical comorbidities and things of that nature that makes it in their best interest to be a physician patient.

But I said all that to say I think it's nice because they have the option.

A lot of times there's a lot of mistrust when it comes to physicians and there's a lot of mistrust when it comes to physicians in the Black community.

And so that's just because of history that's played out in this country and so I think that if we could take ownership of that, that we can start to build some trust.

- So what are some signs of postpartum and what is postpartum for those who do not know?

'Cause I know we hear that term but we don't necessarily know what it is.

And I know with the signs, not a lot of people really recognize what the signs are so can you tell us what that looks like?

- Sure, so when people say postpartum or they say postpartum blues or postpartum depression, pretty much there's a mood change that happens after delivery.

And that's for several reasons.

So women were made to birth babies, but right after the delivery, we deliver a placenta.

And so the placenta is extremely hormone rich.

So several times the amount of estrogen and progesterone than we usually see when we're non-pregnant.

And so once the placenta delivers, those hormones go with it.

And so it's like a rollercoaster effect.

And so a lot of women have different responses to the fact that those hormones are gone.

So over the course of those six weeks after delivery, we're trying to reach homeostasis and so there can be signs and symptoms that are concerning.

And so those things are if it seems like mom's not bonding with the baby or not attentive to the child's needs, then that's a concern.

If we're not eating, that's a concern.

We might not take pleasure in things that we used to take pleasure at or we might cry for no reason.

And so a lot of those things are normal, but then there's points where we get concerned and want to intervene.

And so points where we get concerned is if someone has thoughts of wanting to harm themselves or someone else, then we need to see them asap.

- I was just about to say what happens if left untreated?

- Oh, if left untreated depending on where it is 'cause I gave a whole spectrum of things that- - So let's say on the worst case scenario spectrum, what would that look like for somebody who doesn't realize it and doesn't seek help?

- It could look like they harm someone, it could look like they harm themselves, it could lead to psychosis where we're hearing or seeing things that aren't there.

So it's very important to touch base with their provider 'cause we have the means to get them the help that they need.

Most of the time it's self-limited.

So it's just crying spells- - You have to ride it out?

- Yeah, not wanting to be bothered with anyone, having feelings of being overwhelmed, feelings that you're isolated even though you have a lot of people around you to support you, you just feel alone.

And so a lot of that's self-limited and they'll notice that that passes after a few weeks.

- Okay.

What techniques or comfort measures do you use to help clients manage pain and navigate the birthing process?

- That's a good question.

So there's so many things that we use to help support moms in labor.

So in our centering class we talk about what our expectations are in regards to how we wanna deliver, do we want medication, do we not want medication?

How we let our nurse know that and our provider know that so that we're not breathing through contractions and someone keeps offering you an intervention that you don't want.

So we also talk about things that you can do to support someone in labor.

So those things, walking is often very beneficial to mothers.

Sitting on a birthing ball really helps alleviate some pain.

Sitting on a birthing ball in the shower is helpful.

We have rooms with tubs at our hospital, so hydrotherapy is extremely beneficial to moms.

Aromatherapy.

So we have these conversations ahead of time so that when moms are packing their bags, they can be intentional about what it is that they're bringing to support themselves.

But yes, I think that it begins with before you go into labor, like what your expectations are, how you want things to go, and then who's there to make those things come to fruition.

Massage is another big one.

So partners massaging the lower back or wherever there's discomfort, all great options.

- Okay.

Now some people can get very YouTube crazy and looking up everything and get paranoid and scared.

Like me, I'm just terrified of the whole birthing process.

I don't think I would mind carrying the baby but I don't want an epidural, I don't want any of that.

What are some resources that are available for parents and caregivers to help educate themselves to be proactive to help with the rates?

- Yeah.

So I would say asking your provider whether or not there's a centering option is great because what I've found is, especially for Black mothers, if you can get us in community, somebody has a question that you might not have thought of or that you didn't feel empowered to ask.

And so learning and community is great.

And then there's always a seasoned mom there that can tell you, "oh, don't worry about that" or "worry about this."

So getting in community I think is important especially in this day and age where we tend to feel very isolated because we have YouTube and all of these things at a touch of a button.

So I would say getting in community is important.

I would say attending a birthing class, whether that's something that your doula told you about, your midwife, a lot of times they offer classes.

I would definitely recommend that.

- And then you mentioned a couple programs, but I wanted to go back.

The Safe Sleep program, what is that?

- Okay, so Safe Sleep goes over the ABCs of safe sleep.

So a baby should be alone in a crib on their back, C in a crib.

Then they've added onto that where there's D, don't smoke and things of that nature.

So that's one of our centering talks, around safe sleep and we even have a demonstration room where moms can point out what's safe and what's not safe and why so that others won't make some of the mistakes that others have made.

We talk about co-sleeping.

- Okay.

- And how to best support moms who are breastfeeding or making sure we put baby back down to sleep so that we don't have any accidents 'cause we've drifted off to sleep so that's what that looks like.

We partner with other hospitals in the area so we've partnered with Akron Children's and they bring safe sleep initiatives to our hospital.

They also provide free pack and plays for mothers.

Same thing, we have an initiative in regards to car seat safety and they'll provide car seats, car seats as well.

- Okay, perfect.

So there's a lot of different resources that are out there for the expecting mothers and I know we have spoke a little bit touching on the African-American community and that is just because they are three times more likely to have higher infant mortality rates.

So in our last minute, do you have anything that you would like to leave them with that's either an encouragement, just a brief little tidbit, anything that the expecting mothers can take with them on their journey?

- So just piggybacking on what you said in regards to the disparity between Black birthing moms and white birthing moms is since they've been measuring the infant mortality rate since 1935, there's always been this gap.

And even though it's been declining since 1935, there's still a gap between Black birthing moms and white birthing moms.

And so I think we touched on why that's the case, being our experience as being Black moms in this country.

And so I think that everyone can take away a notion in regards to how we show up in the world and how we support one another, Black, white, or whatever you are, so that we can all be healthy and birth healthy babies that make it one and beyond.

- Thank you all for joining us today.

You can help your neighbor have a better pregnancy, you can help yourself have a better pregnancy and you can be an advocate for yourself as we have learned today.

So I hope you all have taken a small nugget on our rates that we have in the country as well as in our state and how we can help our babies live longer to see past their one year birthday.

I'm your host Leia' Love and thank you for joining us for "Forum 360" where we have a global outlook from a local view.

Bye-bye.

- [Presenter] "Forum 360" is brought to you by: John S. and James L. Knight Foundation, the Akron Community Foundation, Hudson Community Television, the Rubber City Radio Group, Shaw Jewish Community Center of Akron, Blue Green, Electric Impulse Communications, and Forum 360 Supporters.