♪ ♪ >> Renee: WELCOME TO MATERNAL HEALTH, A KET FORUM.

I'M RENEE SHAW.

THANK YOU FOR JOINING US.

IN 1925, MARY BRECKENRIDGE LAUNCHED THE FRONTIER SERVICE, A PIONEERING VENTURE WHICH TRAINED AND SENT NURSE MIDWIVES ON HORSE BACK ACROSS THE MOUNTAINS OF EASTERN KENTUCKY TO PROVIDE CARE FOR PREGNANT WOMEN AND THEIR FAMILIES.

THIS STORY IS THE SUBJECT OF A RECENTLY RELEASED KET DOCUMENTARY ANGELS ON HORSE BACK, MIDWIVES IN THE MOUNTAINS, WHICH IS NOW AVAILABLE ON OUR WEBSITE AT ket.org.

WE CERTAINLY HOPE YOU'LL WATCH.

TODAY, WE ARE GOING TO EXAMINE THE STATE OF MA TERM MATERNAL HEALTH AND CHILD BIRTH OPTIONS IN KENTUCKY NEARLY 100 YEARS AFTER MARY BRECKENRIDGE BEGAN HER VISIONARY PROJECT.

JOIN JOINING US IN OUR LEXINGTON STUDIO IS MARY CATHERINE DeLODDER, SUSAN STONE, PRESIDENT OF THE FRONTIER NURSING UNIVERSITY, AND Dr. COY FLOWERS, AN OB/GYN WITH U.K. HEALTH CARE OF WOMEN'S HEALTH IN GEORGETOWN AND WE HAVE PRERECORDED INTERVIEWS WITH OTHER GUESTS WE'LL SHARE THROUGHOUT THE PROGRAM.

BEFORE WE BEGIN OUR CONVERSATION, WE WANT TO SHOW A CLIP FROM THE DOCUMENTARY WHICH PROVIDES US WITH A BRIEF OVERVIEW OF THE FRONTIER NURSING SERVICE AND ITS CONTRIBUTION TO THE FIELD.

>> IN 1925, NURSE MIDWIVES FROM ACROSS THE GLOBE BEGAN TRAVELING TO LESLIE COUNTY, KENTUCKY, TO DEMONSTRATE THE POSSIBILITIES OF RURAL HEALTHCARE IN AMERICA.

LED BY MARY BRECKENRIDGE, THESE SPIRITED WOMEN DELIVERED UNPRECEDENTED CARE TO THE FAMILIES LIVING IN REMOTE REGIONS OF APPALACHIA.

THEIR EFFORTS REDUCED THE MATERNAL AND INFANT MORTALITY RATES TO BE AMONG THE LOWEST IN THE NATION, AND IMPROVED THE OVERALL WELFARE OF THESE MOUNTAIN COMMUNITIES FOR GENERATIONS TO COME.

>> Renee: SO, WE WANT TO START BY PUTTING A SPOTLIGHT ON THE PROFESSION OF MIDWIFERY, EXACTLY WHAT IT IS.

SUSAN STONE, TELL US.

EXPLAIN TO US WHAT IS A MIDWIFE?

>> OKAY, A MIDWIFE IS SOMEONE WHO IS EDUCATED TO CARE FOR WOMEN AND SO ACTUALLY THE TITLE MIDWIFE MEANS WITH WOMEN.

AND CERTAIN TYPES OF MIDWIFES, BOTH CERTIFIED NURSE MIDWIVES AND CERTIFIED MIDWIVES CARE FOR WOMEN THROUGHOUT THEIR LIFESPAN.

SO PRIMARILY FROM THE TIME THAT THEY START TO THINK ABOUT BIRTH CONTROL AND THAT KIND OF THING, THROUGH MENOPAUSE AND OF COURSE THERE IS A FOCUS ON MATERNITY CARE DURING THAT TIME.

>> Renee: YOU JUST MENTIONED TWO TYPES.

AND YOU SAID IT PRETTY FAST.

I'M GOING TO HAVE YOU SAY IT AGAIN.

THERE ARE TWO TYPES, RIGHT?

>> I'M SORRY.

THERE ARE ACTUALLY THREE.

THERE ARE CERTIFIED NURSE MIDWIVES WHO ARE NURSES WITH A MASTERS DEGREE IN MIDWIFERY, SOMETIMES A DOCTORAL DEGREE.

AND THEN THERE ARE ALSO MIDWIVES WHO HAVE THAT SAME EDUCATION.

THERE ARE FIVE PROGRAMS IN THE COUNTRY NOW WHERE IF YOU ARE EDUCATED MAYBE AS A PHYSICIAN'S ASSISTANT, YOU CAN GO ON AND BECOME A MIDWIFE.

SO IT'S THE SAME TYPE OF EDUCATION AS A NURSE MIDWIFE.

AND THEN THERE ARE CERTIFIED PROFESSIONAL MIDWIVES THAT ARE EDUCATED PRIMARILY FOR MATERNITY CARE.

THEY DON'T HAVE THE FULL SCOPE OF GYNECOLOGY CARE AND THAT KIND OF THING.

AND THEY FOCUS ON MATERNITY CARE AND PRIMARILY WORK IN THE HOME.

THEY PRIMARILY DO HOME BIRTH AND SOME BIRTH CENTER BIRTHS.

>> Renee: SO TELL US ABOUT HOW THE U.S.

STACKS UP IN THE USE OF MIDWIFERY COMPARED TO OTHER COUNTRIES.

>> WELL, AS YOU KNOW, OUR MATERNITY CARE OUTCOMES ARE NOT AS GOOD AS ANY OTHER INDUSTRIALIZED COUNTRY AND WHEN YOU LOOK AT THE NUMBER OF OBSTETRICIANS LOCATED IN THOSE COUNTRIES COMPARED TO OURS, IT'S NOT THAT DIFFERENT.

WE HAVE ALMOST THE SAME NUMBER OF OBSTETRICIANS BUT MIDWIVES, THEY HAVE TREMENDOUSLY MORE MIDWIVES.

SO, FOR EXAMPLE, THE UNITED STATES, IT'S I THINK FOUR PER IS IT FOUR PER 1,000 BIRTHS AND THEN IN ENGLAND, FOR EXAMPLE, IT'S 46 PER 1,000 BIRTHS.

AND THAT, YOU CAN SEE, NETHERLANDS IT'S 78.

SO WE HAVE OBSTETRICIANS AND THEN WE DON'T HAVE THE MIDWIVES SO OVERALL WE ARE LACKING MATERNITY CARE ALL TOGETHER.

AND I THINK THAT RESULTS IN THE OUTCOMES THAT WE ARE SEEING.

$AND WE'LL TALK MORE ABOUT THOSE OUTCOMES AS WE GO THROUGHOUT THE PROGRAM.

MARY CATHERINE, TELL US ABOUT YOUR EXPERIENCE WITH MIDWIVES AND YOU HAVE BECOME SO PASSIONATE ABOUT THIS ISSUE?

>> SURE.

BEFORE MY FIRST CHILD WAS BORN A LITTLE OVER 10 YEARS AGO, I LEARNED ABOUT THE MIDWIFERY MODEL OF CARE AND DECIDED THAT WAS SOMETHING THAT APPEALED TO ME.

WHEN I WAS PREGNANT WITH MY FIRST CHILD, I SAW A CERTIFIED NURSE MIDWIFE IN THE HOSPITAL SETTING AND THEN I LEARNED ABOUT HOME BIRTH.

I WANTED TO PURSUE THAT AND EXPLORE IT AND I FOUND OUT IT WAS REALLY CHALLENGING IN KENTUCKY AT THAT TIME TO FIND A PROVIDER TO ATTEND A HOME BIRTH.

IT WASN'T JUST SOMETHING YOU COULD GO ON THE INTERNET AND LOOK UP LIKE YOU COULD AN OB/GYN.

I THOUGHT IT WAS CRAZY THAT HAD YOU TO WORK SO HARD TO FIND A PROVIDER.

I ENDED UP FINDING A CERTIFIED PROFESSIONAL MIDWIFE WHO SERVED MY AREA AND WORKED WITH HER WITH ALL MY CHILDREN.

I HAVE FOUR CHILDREN AND THREE OF THE FOUR WERE BORN AT HOME.

SO AFTER THAT EXPERIENCE, I GOT INVOLVED WITH WHAT IS NOW THE KENTUCKY BIRTH COALITION AND WANTED TO MAKE IT EASIER FOR OTHER FAMILIES WHO WERE SEEKING THAT KIND OF CARE TO FIND A QUALIFIED PROVIDER.

AND SO KENTUCKY BIRTH COALITION WAS THE RECENT IN A LONG LINE OF ORGANIZATIONS OVER SEVERAL DECADES THAT HAVE WORKED TO INCREASE ACCESS TO THAT KIND OF MIDWIFERY CARE AND IN 2018 WE GOT A LAW PASSED TO CERTIFY PROFESSIONAL MIDWIVES IN KENTUCKY MAKING IT EASIER FOR FAMILIES TO FIND WHEN THEY'RE SEEKING THAT CARE.

>> Renee: I WAS GOING TO ASK YOU ABOUT THAT LEGISLATION.

THIS APLIES TO CERTIFIED PROFESSIONAL MIDWIVES ONLY, CORRECT?

>> CORRECT.

THE TYPE OF MIDWIVES THAT ARE EDUCATED, FOR EXAMPLE, AT FRONTIER, THE NURSE MIDWIVES HAVE BEEN LICENSED AS ADVANCED PRACTICE NURSES AND ALWAYS HAVE BEEN BUT MOST OF THEM IN KENTUCKY PRACTICE IN THE LP SETTING.

THERE ARE ABOUT SEVEN CURTLY WHO ATTEND HOME BIRDSES.

THEY CAN DO THAT IF THEY CHOOSE TO BUT THERE ARE A THE LOVE OF REASONS WHY THEY MIGHT CHOOSE TO WORK IN A HOSPITAL VERSUS HOME BIRTH.

A LOT OF THE HOME BIRTHS ARE LEFT TO OTHER MIDWIVES IN KENTUCKY.

SO THOSE TYPES OF MIDWIFES HAVEN'T BEEN CREDENTIALED IN THE UNITED STATES.

YOU HAD TO GET A PERMIT FROM THE STATE IN THE 50s AND 60s.

IN THE 70s THEY STOPPED ISSUING PERMITS EXCEPT TO THE NURSE MIDWIVES SO THE OTHER TYPES OF MIDWIVES WERE LEFT WITH NO LEGAL OPTIONS TO PRACTICE AND PUSHED THEM UNDERGROUND.

DIFFERENT GROUPS OF FAMILIES HAVE BEEN WORKING SINCE THE 70s UNTIL 2019 TO CHANGE THAT.

>> Renee: IT'S SOMETHING THAT IT TOOK THAT LONG.

Dr. COY FLOWERS, THANK YOU FOR BEING HERE WITH US.

>> THANK YOU.

>> Renee: TAX CUTS ABOUT THE RELATIONSHIP BETWEEN OB/GYN AND HOW IT HAS EVOLVED?

>> I'M RECENTLY NEW TO KENTUCKY THE LAST TWO YEARS AND THE LAST FOUR OR FIVE YEARS IN KENTUCKY THERE HAS BEEN A REVOLUTION IN THE RELATIONSHIP WEN OBGYN AND MIDWIVES BECAUSE AS MANY OF US KNOW, 50% OF THE COUNTIES IN KENTUCKY DON'T HAVE AN OBJECTS OBSTETRICAL PROVIDER OR A PLACE FOR PATIENTS TO DELIVER.

IT HAS BECOME ALL HANDS ON DECK PHILOSOPHY IF YOU WILL THAT WILL ARE NOT ENOUGH OB/GNYs TO GO AROUND.

WE NEED COLLEAGUES, MIDWIVES PARTICULARLY IN ORDER TO PROVIDE THE CARE TO PATIENTS THAT WE NEED TO AND IT'SY SECTION FOR US TO WORK TOGETHER IN A COLLABORATIVE WAY IN ORDER FOR TO US PROVIDE THE BEST CARE POSSIBLE.

>> Renee: HOW DOES IT ENHANCE WHAT YOU DO?

>> I WORK IN A SMALL PRACTICE IN GEORGETOWN, KENTUCKY.

THERE ARE TWO OB/GYNs AND ONE MIDWIFE.

WE COMMUNICATE EVERY SINGLE DAY WITH EACH OTHER AND RELY ON EACH OTHER NUMBER ONE FOR SLEEP-- IF I DIDN'T HAVE A NURSE MIDWIFE, I WOULDN'T BE ABLE TO TAKE MY PAGER OFF ON CERTAIN DAYS.

AND SO IT'S ESSENTIAL FOR US TO BE ABLE TO CARE FOR PATIENTS.

I HAVE A LOT OF RESPONSIBILITIES AS AN OB/GYN OUTSIDE OF THE NORMAL BIRTH PLAN, BIRTH CARE PROCESS BUT MY MIDWIFE LOVES THAT ASPECT OF IT.

LOVES TO SIT DOWN AND TALK TO PATIENTS ABOUT EVERY ASPECT OF THEIR OBJECT AT THE TIME CAL CARE AND THAT'S SOMETHING THAT TAKES THE BURDEN OFF OF ME SO IS ON OTHER THINGS.

BLADDER SLINGS AND HYSTERECTOMIES.

KNOWING OUR STRENGTHS AND WEAKNESSES IS THE BEST WAY TO TAKE CARE OF PATIENTS IN KENTUCKY.

>> Renee: HOPEFULLY LEADS TO BETTER OUTCOMES FOR MOMS AND BABIES.

>> I THINK YOU ARE GOING HEAR TONIGHT AND ALREADY HAVE THAT THE DATA PROVES THAT.

THAT WORKING AS A TEAM IN ALL THE DIFFERENT ASPECTS GIVES BETTER CARE TO PATIENTS IN THE LONG RUN.

>> Renee: WE ARE GOING TO TALK MORE ABOUT THAT AS YOU SAID IN A LITTLE BIT.

WE WANT TO GO TO ANOTHER CLIP FROM ANGELS ON HORSE BACK WHERE WE LEARN MORE ABOUT THE HISTORY AND EVOLUTION OF CHILD BIRTH PRACTICES IN THE STATE AND NATION.

>> IN 1900, 50% OF WOMEN GAVE BIRTH AT HOME WITH A MIDWIFE.

BY 1930, ONLY 15% OF WOMEN ARE ATTENDED BY A MIDWIFE.

IN EARLY 20th CENTURY, THERE IS A BACKLASH AGAINST MIDWIVES, PAINTING THEM AS A THREAT TO SOCIETY AND THAT IF YOU HAVE THE MEANS, YOU NEED TO HAVE A TRAINED PHYSICIAN.

YOU NEED TO HAVE THE BEST OF THE BEST THERE READY TO HANDLE ANY SITUATION THAT ARISES AND A MIDWIFE ISN'T PREPARED TO DO THAT.

MIDWIVES HAVE BEEN DELIVERING BABIES FOR UNHUNDREDS OF YEARS.

>> SO THIS IS A POINT SUSAN STONE, I WANT YOU TO PICK UP ON.

VIEWED AS A THREAT, RIGHT SO LET'S TALK ABOUT THE SHIFT AS A NATURAL PART OF LIFE AS A CONDITION THAT REQUIRED SOME MEDICAL INTERVENTION TALK TO US ABOUT THAT.

>> THERE WERE SO MANY FACTORS THAT WENT INTO IT BUT WE HAD A LOT OF IMMIGRANT MIDWIVES WHO CAME TO THIS COUNTRY WITH THEIR FAMILIES AND WITH THEIR COMMUNITIES THAT PROVIDED EXCELLENT CARE TO WOMEN AND POSSIBLY WE COULD HAVE HAD COLLABORATIVE CARE AT THAT TIME WE MIGHT HAVE BEEN IN A MUCH BETTER PLACE BUT THERE WAS A MOVEMENT BY MIZ I GOESES AND ORGANIZED MEDICINE AND BY THE GOVERNMENT TO MORE PROFESSIONALIZE MATERNITY CARE.

THERE WAS ONE FACTOR FOR WOMEN WAS THEY WANTED PAIN RELIEF SO THEY STARTED TO HAVE PAIN RELIEF OPTIONS FOR WOMEN, WHICH WERE NOT ALL THAT GREAT BECAUSE THEY MIGHT BE ETHER OR BEING PUT TO SLEEP FOR YOUR BABY AND SO AND SO IT BECAME A MOVEMENT MOSTLY BY THE MEDICAL PROFESSION TO GET RID OF MIDWIVES AND TO BRING BIRDS INTO THE HOSPITAL.

THERE WERE A LOT OF COMPLICATIONS THAT WENT ALONG WITH THAT.

A LOT OF INFECTIONS BEFORE THEY REALIZED ABOUT INFECTION CONTROL, ABOUT BRINGING PEOPLE TOGETHER AND HOW THAT CAN, AS WE'VE SEEN WITH COVID, CAN CAUSE DIFFERENT INFECTIONS IN DIFFERENT THINGS BUT IT WAS VERY DRAMATIC, AS YOU QUOTED THE FIGURES, VERY DRAMATIC CHANGE TO MAKE SURE THE MIDWIVES COULD NOT PRACTICE.

NOW IN SOME STATES LIKE WAY DOWN IN MISSISSIPPI.

R, IT WENT ON FOR A LONG LONGER BECAUSE NOBODY WANTED TO GO DO THOSE BIRTHS, RIGHT?

BUT IN THE URBAN AREAS, IT BECAME A VERY MEDICALIZED PROCEDURE WHICH IT IS NOT A MEDICALIZED-- IT'S A NORMAL PART OF OUR LIVES AND THOUGH IT CAN GO VERY WRONG, IT CAN GO VERY RIGHT A LOT OF TIMES BY LEAVING IT ALONE AND JUST WATCHING TO MAKE SURE NOTHING BAD HAPPENS.

>> Renee: THE WISDOM WAS IF YOU WERE IN A CLINICAL HOSPITAL SETTING YOU WOULD BE BETTER OFF THAN IF YOU WERE AT HOME AND THAT'S JUST NOT TRUE.

>> I DON'T KNOW IF IT'S OBVIOUS OR NOT, BUT WHEN YOU PUT A WOMAN IN A HOSPITAL, IF THERE ARE NOT ENOUGH PEOPLE TO TAKE CARE OF HER, IF YOU ARE HOME WITH A MIDWIFE ONE ON ONE OR IN A HOSPITAL WITH A MIDWIFE ONE ON ONE, THEN, YOU KNOW, SOMEBODY IS WATCHING WHAT IS GOING ON WITH YOU.

IF YOU PUT A MOTHER, NINE MOTHERS IN A HOSPITAL WITH ONE NURSE TO CALL ONE DOCTOR, THINGS CAN GO WRONG.

DATA SHOWS US DRAMATICALLY HOW BIRTHS MOVED INTO THE HOSPITAL.

>> Renee: WE LEFT IT THERE BEFORE YOU SAW THE CLIP HAS YOUR PROFESSION HAS EMBRACED MIDWIFERY NOT AS A THREAT BUT A COLLABORATIVE TEAM, HOW IT LEADS TO BETTER OUTCOMES FOR MOM AND BABY AND IS NOT A THREAT TO THE PROFESSION.

>> I WOULD AGREE.

AND OVERTHE LAST 20, 30, 40S YEARS HAVE CHANGED DRAMATICALLY.

I WAS A FORCEPS BABY, MY MOTHER WAS GIVEN A TWILIGHT SLEEP AND PULLED OUT WITH FORCEPS.

I HAD A BRUISE ON MY FACE.

WE DON'T DO THAT ANYMORE.

20 YEARS AGO WHEN I FIRST STARTED THIS PROFESSION, I THINK PATIENTS WOULD BRING BIRTH PLANS INTO MY OFFICE AND THERE WERE A LOT OF THINGS THAT WE DIDN'T DO ROUTINELY.

THINGS HAVE CHANGED OVER TIME.

MOM WANTS TO BREAST FEED IMMEDIATELY, DAD WANTS TO CUT THE CORD.

DOESN'T WANT AN APPEASOTOMY.

THERE ARE SO MANY THINGS WE DID ROUTINELY THAT WE DON'T TWO ANYMORE.

WE ARE INCORPORATING A LOT OF THOSE THINGS OF ASPECTS OF CARE FOR WOMEN TO CHOOSE.

GLND AWHAT ARE THE COMMON CHOICES WOMEN ARE MAKING.

>> THE ONES I JUST MENTIONED.

THE PHILOSOPHY OF IF THINGS ARE GOING WELL, LET IT BE.

LET IT HAPPEN NATURALLY.

>> Renee: WHO DO YOU BALANCE MITIGATING THE RISK OF ENHANCING THE BIRTH EXPERIENCE AND LETTING NATURE TAKE ITS PLACE?

>> THAT'S A GOOD QUESTION.

IN THE BIRTHING PROCESS, IF YOU LET IT HAPPEN NATURALLY, RISK MINIMIZE ITSELF OVER TIME.

AND I THINK TOO MUCH INTERVENTION, WHICH WE HAVE SEEN IN THE PAST, HAS CAUSED MORE PROBLEMS THAN IT WAS DESIGNED TO PRECLUDE.

>> Renee: SO FOR HIGHER RISK PREGNANCIES, IS THERE MORE OF A CONCERN THERE OR DIFFERENT APPROACH AND METHOD?

>> ABSOLUTELY.

THERE ARE CERTAIN PERCENTAGE OF PATIENTS WHICH NEED TO HAVE A HIGHER LEVEL OF CARE AND WE ALL RECOGNIZE THAT.

AND THAT'S WHY I THINK IT'S SUPER IMPORTANT FOR TO US HAVE THE COMMUNICATION OF ALL LEVELS OF CARE; NOT THAT ONE IS HIGHER THAN THE OTHER.

IT'S JUST A DIFFERENT TYPE OF ASPECT OF WHAT THE PARTICULAR PROVIDER CAN PROVIDE.

AND SO THERE DEFINITELY IS-- THERE ARE PATIENTS THAT NEED TO BE SEEN AT A TERTIARY CENTER OR AQUATIC CENTER.

C-SECTION RATES, FOR EXAMPLE, THE INTRODUCTION OF C-SECTION HAS BEEN PROVEN IN STUDY AFTER STUDY, IN ORDER, HAS BEEN ABLE TO SHOW TO HELP LIVES AND SAVE LIVES AND BABIES BUT OUR C-SECTION RATE HAS GOTTEN WAY TOO HIGH OVER TIME.

>> Renee: WE KNOW STUDIES HAVE SHOWN THAT USING MIDWIVES OVER OBSTETRICIANS HAS LOWERED BY 30% SEA CESAREANS AND LOW RISK MULTI-PATIENTS.

I'M NOT SURE WHAT THOSE MEAN.

>> MULTIPARITY IS SOMEBODY WHO HAS HAD A BABY BEFORE.

>> Renee: LET ME GO TO YOU, MARY CATHERINE DeLODDER YOU SAID THREE OF FOUR FOUR CHILDREN WERE HOME BIRTHED.

TELL US ABOUT THE HOME BIRTH MOVEMENT AND WHERE YOU SEE IT GOING AND HOW IT'S BEEN ABLE TO SUSTAIN AND GROW PERHAPS IN POPULARITY.

>> SURE.

WELL HOPE BIRTH ISN'T FOR EVERYBODY.

MAYBE IT'S BECAUSE THEY DON'T WANT TO CHOOSE IT FOR THEMSELVES.

MAYBE SOMEONE WANTS THE PAIN MEDICATION OFFERED IN THE HOSPITAL OR MAYBE THEY'RE NOT MEDICALLY A GOOD CANDIDATE.

THAT'S IMPORTANT TO UNDERSTAND.

PEOPLE ARE OFTEN LOOKING FOR SOMETHING DIFFERENT THAN WHAT IS OFFERED IN THE HOSPITAL AND THEY ARE AWARE THAT SOMETIMES INTERVENTIONS, WHICH CAN BE LIFE SAVING BUT SOMETIMES THEY ARE USED UNNECESSARILY AS Dr.

FLOWERS REFERENCED IN THE HOSPITAL, SO FAMILIES AND MOTHERS WANT TO AVOID THAT SO THEY CHOOSE HOME BIRTH FOR THOSE REASONS AND PEOPLE CHOOSE HOME BIRTH FOR A MYRIAD OF REASONS.

IT IS CERTAINLY NOT AS POPULAR AS IT WAS ONCE MANY YEARS AGO BUT MORE POPULAR THAN A COUPLE DECADES AGO.

WE THINK IF SOMEONE WANTS TO CHOOSE THE OPTION, WE WANT THEM TO HAVE THE BEST CARE POSSIBLE IN THE SETTING.

>> Renee: FOR SOME PEOPLE WHO ARE WORRIED IT MAY BE TOO DAWNING RUSS, MAY NOT BE FOR THEM OR THEY'RE CONCERNED ABOUT RISKS THAT MAY OR MAY NOT BE PRESENT, WHAT DO YOU DO TO CONSOLE THEM?

>> LIKE WE SEE IN SOME OTHER COUNTRIES THAT UTILIZE MIDWIFERY A LOT IS INTEGRATING MIDWIFERY INTO THE GREATER MATERNITY CARE SYSTEM IS WHAT MAKES IT SAFER.

KENTUCKY HAS COME A LONG WAY IN DOING THAT, ESPECIALLY AS I MENTIONED IN 2019, LICENSING THE CERTIFIED PROFESSIONAL MIDWIVES, THAT BROUGHT THEM OUT OF BEING AN UNDERGROUND PROFESSION, GIVES THEM ACCESS TO THINGS THAT ARE VERY IMPORTANT TO HELP MAKE THE PROCESS SAFE SUCH AS SPECIFIC MEDICATIONS THAT MIGHT BE NEEDED, FOR EXAMPLE, TO TREAT A POST-PARTUM HEMORRHAGE, TO BE ABLE TO ACCESS LAB TESTS THEIR PATIENTS WILL NEED AND GIVES THEM GREATER ABILITY TO INTERFACE WITH OTHER PROVIDERS SUCH AS OBSTETRICIANS AND HOSPITALS SO THAT THEY CAN HAVE THAT PROFESSIONAL RELATIONSHIP AND BE ABLE TO MOVE THEIR PATIENTS TO A HIGHER LEVEL OF CARE IF NEEDED.

SO IT'S ALSO IMPORTANT TO REMEMBER WHAT I MENTIONED THAT HOME BIRTH MEDICALLY MAY NOT BE FOR EVERYONE.

THE FIRST TIME SOMEONE MEETS WITH A MIDWIFE, THE FIRST THING THEY'RE GOING TO DO IS TALK ABOUT IF THEY'RE CHOOSING A HOME BIRDS THAT IS, ARE THEY A GOOD CANDIDATE FOR HOME BIRTD OR DO THEY HAVE A SPECIFIC CONDITION, PERHAPS THEY HAVE INSULIN DEPENDENT DIABETES OR DEVELOPED PRE-ECLAMPSIA.

YOU MAY START OFF YOUR PREGNANCY LOW RISK BUT MAY BECOME HIGH RISK SO THE MIDWIFE IS GOING TO KEEP TRACK OF THAT AND MAKE SURE IT IS SAFE TO BE AT HOME AND IF NOT, THEY'RE THERE TO WATCH AND TO MAKE SURE YOU ARE IN THE SAFEST PLACE THAT YOU NEED TO BE.

>> Renee: QUICKLY, YOU ARE ALSO WORKING ON LEGISLATION ABOUT HOME BIRTHS.

CAN YOU TELL US ABOUT WHAT THAT IS AND IF THAT COME UP IN THE 2022 SESSION?

>> WELL, CURRENTLY WE ARE WORKING ON LEGISLATION FOR A DIFFERENT TYPE OF OUT OF HOSPITAL BIRTH WHICH WOULD BE FREE STANDING BIRTH CENTERS.

WE COULD HAVE BIRTH CENTERS CURRENT WILL I IN KENTUCKY BUT WE HAVE SOMETHING CALLED THE CERTIFICATE OF NEED FOR HEALTH FACILITIES THAT THEY HAVE TO APPLY FOR THROUGH THE GOVERNMENT AND GET APPROVED FOR.

SO IF YOU WANTED TO OPEN A HOSPITAL, FOR EXAMPLE, THAT'S A PROCESS WOULD YOU GO THROUGH.

BUT SMALLER FACILITIES LIKE A FREE STANDING BIRTH CENTER A PLACE WOULD YOU GO JUST TO HAVE A BABY, NOT ALL THE THINGS THE HOSPITAL HAS AND IT WOULD BE A PLACE WHERE YOU WOULDN'T UTILIZE PAIN MEDICATION.

SOMEWHERE TO GO TO HAVE A NATURAL BIRTH SO TO SPEAK.

SO GETTING RID OF THE BARRIER OF HAVING TO APPLY FOR THE CERTIFICATE OF NEED WOULD MAKE IT MUCH EASIER FOR THOSE TO OPEN IN KENTUCKY.

SO LEGISLATION WE HAVE BEEN WORKING ON FOR THE PAST FEW YEARS WOULD BE TOY LIMB THAT IT THAT BARRIER TO MAKE IT EASIER FOR FOLKS TO OPEN A FREE STANDING BIRTH CENTER?

KENTUCKY BECAUSE WE CURRENTLY HAVE NONE OF THOSE IN OUR STATE.

>> Renee: I SAID HOME BIRTH BUT I SHOULD HAVE SAID BIRTH CENTER.

PARDON THE SLIP OF THE TONGUE.

NOW WE WANT TO INTRODUCE YOU TO ANOTHER CONCEPT AND MODERN BIRTH CONCEPT WHICH IS ACTUALLY A VERY OLD CONCEPT.

I HAD THE OPPORTUNITY TO SPEAK WITH RENEE BASHHAM OF HOPE'S EMBRACE.

>> RENEE, IT IS A PLEASURE TO HAVE YOU WITH US.

>> THANKS FOR HAVING ME.

>> TALK TO US ABOUT WHAT A DOULA IS.

CAN YOU DEFINE THAT AND MAYBE IT'S ORIGINS?

>> DOULA COMES FROM THE GREEK WORK THAT MEANS WOMAN WHO SERVES.

IT'S ALWAYS BEEN KIND OF THIS ROLE THAT WOMEN WOULD COME ALONGSIDE OTHER WOMEN AND HELP THEM THROUGHOUT THEIR PREGNANCY, LABOR AND BIRTH AND EVEN THE POST-PARTUM PERIOD AND IT WASN'T UNTIL PROBABLY THE 60s THAT THE TERM KIND OF GOT LIKE COINED IN THE UNITED STATES AS A COMPANION WHO WOULD COME ALONGSIDE YOU AND FULL IF ILL THAT ROLE.

>> Renee: IT SEEMS LIKE IT HAS BECOME MORE POPULAR IN THE LAST 10, 15, 20 YEARS.

IS THAT TRUE, DO YOU THINK?

>> YES, WITHIN THE LAST COUPLE OF DECADES WE HAVE GOTTEN SOME RESEARCH OUT THAT SAYS THE PRESENCE OF A DOULA THAT CONSTANT COMPANION THROUGHOUT YOUR LABOR CAN REDUCE YOUR RISK OF INTERVENTIONS.

AND REDUCE YOUR RISK OF CESAREAN AND INCREASE YOUR SUCCESS RATE IN BREAST FEEDING.

>> Renee: WHY DID YOU WANT TO BECOME A DOULA?

>> I HAD A DIFFICULT BIRTH MY VERY FIRST ONE.

IT WAS LONG AND THERE WAS NOBODY THERE EXCEPT FOR MY HUSBAND AND HE GOT TIRED BECAUSE THEY DON'T HAVE THE SAME WHO ARE HONES-- HORMONES THROUGHOUT THE DELIVERING PROCESS.

I HAD POST-PARTUM DEPRESSION AND IT WOULD HAVE BEEN NICE TO HAVE SOMEONE THERE TO HELP FILL THAT ROLE.

>> Renee: AND THAT'S A VERY GOOD POINT ABOUT YOUR OWN EXPERIENCE KIND OF CHANNELING WHAT YOU DO.

AND SO WHAT IS IT THAT WOMEN GAIN FROM THAT, THAT THEY MAY THINK IT SOUNDS ONLY FOR A CERTAIN TYPE OF PERSON, BUT IT IS BECOMING MORE CONVENTIONAL.

WHAT IS IT THAT WOMEN GAIN FROM HAVING A DOULA BY THEIR SIDE?

>> YOU GAIN A LOT OF SUPPORT JUST HOWEVER THAT LOOKS, WHETHER IT BE INFORMATIONAL EMOTIONAL, PHYSICAL THERE IS SOMEBODY THERE THAT YOU CAN TALK TO THAT IS AFN IN BETWEEN FOR THE DOCTOR.

YOU DON'T ALWAYS GET TO CALL AND ASK ALL THE QUESTIONS THAT YOU HAVE.

SO A DOULA IS TRAINED TO KNOW THE WARNING SIGNS AND SHE CAN SAY, YOU KNOW, THIS IS EXPECTED.

THIS IS NORMAL.

OR YOU SHOULD PROBABLY CALL YOUR DOCTOR WITH THIS QUESTION.

>> Renee: SO IT'S NOT TO REPLACE A DOCTOR BUT TO BE ALONGSIDE AND A COMPANION TO FIZZ SIGNIFICANTSES.

>> YES.

>> Renee: DO PHYSICIANS LOOK AT DOULAS AS COMPANION?

>> IT IS DEPENDENT WHERE YOU ARE BUT IT IS STARTING TO GAIN TRACTION THAT WE ARE PART OF THE BIRTH TEAM AND THAT'S NICE HAVING PEOPLE UNDERSTAND OUR ROLE AND EVEN WELCOME US INTO THE SPACE.

>> Renee: HOW DOES ONE BECOME A DOULA?

>> THERE ARE TRAINING ORGANIZATIONS IT'S NOT LIKE A NATIONAL CERTIFICATION.

IT'S NOT ANYTHING THAT HAVE YOU TO DO BUT IT IS HELPFUL TO HAVE A LOT OF THAT BACKGROUND KNOWLEDGE.

>> Renee: BUT NO CERTIFICATION IS REQUIRED FOR THAT.

>> NOT REQUIRED.

NO.

>> Renee: BUT IT IS AVAILABLE.

>> YES.

>> Renee: ARE YOU CERTIFIED?

>> I AM.

I'M CERTIFIED AS A BIRTH AND POST-PARTUM DOULA.

>> Renee: TELL BUS HOPE'S EMBRACE.

>> HOPE'S EMBRACE WAS FOUNDED IN 2016 AND WE WERE FOUNDED TO CONNECT LOWER INCOME WOMEN TO THE MATERNITY SERVICES IN KENTUCKY.

SO WE HAVE PEOPLE ALL OVER THE STATE THAT WE CAN CONNECT TO WHETHER FOR LACTATION SUPPORT, BIRTH SUPPORT, POST-PARTUM AND WE WERE FOUNDED OUT OF A DESIRE TO HELP PEOPLE KNOW THE OPTIONS OUT THERE AND HELP THEM FIND WHERE THEY ARE IN THEIR AREA.

>> Renee: UP WITH OF THE PHRASES I UNDERSTAND THAT YOU ARE FOND OF SAYING AND THAT TRYING TO ERADICATE IS I WISH I HAD KNOWN.

WHAT IS IT MOST WOMEN DON'T KNOW WHEN IT COMES TO CHILD BIRTH.

>> THAT THEY HAVE CHOICES AND OPTIONS.

MOST PEOPLE DON'T KNOW THAT YOU HAVE THE RIGHT TO ACCEPT OR REFUSE ANYTHING THEY TELL YOU IN PREGNANCY AND BIRTH DURING POST-PARTUM.

THAT YOU CAN LEAVE YOUR CARE PROVIDER.

MY THIRD CHILD, I SWITCHED TWO DAYS BEFORE SHE WAS BORN.

SO YOU HAVE THAT OPTION AT ANY POINT TO SAY YES OR NO TO ANYTHING.

>> Renee: ARE YOU FINDING THAT MORE WOMEN ARE FINDING THEIR VOICE DURING THAT PROCESS?

>> YES.

A LOT MORE WOMEN UNDERSTAND THAT THEY HAVE A VOICE AND SO THAT'S BEEN REALLY HELPFUL TO WATCH THEM KIND OF ADVOCATE FOR THEMSELVES AND SAY NO, I DON'T REALLY THINK THAT WE SHOULD INDUCE JUST BECAUSE YOU ARE GOING TO VACATION.

OR THOSE COMMON REASONS THAT ARE NOT REALLY REASONS.

>> Renee: RIGHT.

WHAT DO WOMEN TELL YOU AFTER THEIR BIRTHING EXPERIENCE ABOUT HOW GLAD THEY WERE THAT YOU AND FOLKS LIKE YOU WERE THERE?

>> I GET A LOT OF GRATEFULNESS BECAUSE IN SOME INSTANCES WORKING WITH LOWER INCOME WOMEN, I HAVE BEEN THE ONLY PERSON IN THAT BIRTHING ROOM.

SO IT'S THE WOMAN GIVING BIRTH AND ME.

THERE IS A LOT OF GRATEFULNESS THAT I'M THERE TO REMEMBER THAT EXPERIENCE AND SHARE AND HELP THEM RELIVE THE CLOUDY MOMENTS.

>> Renee: THANK YOU RENEE BASHAM.

IT HAS BEEN A PLEASURE TO MEET YOU.

THANK YOU FOR YOUR GREAT WORK.

Dr.

FLOWERS, I WANT TO GET YOUR RESPONSE TO WHAT Dr. RENEE BASHAM JUST SHARED WITH US.

>> INCREDIBLE INTERVIEW.

I WANT TO GIVE A SHOUT OUT TO MY FAVORITE DOULA IN GEORGETOWN, KENTUCKY.

SHE HAS RETIRED AND HAS CREATED A DOULA SERVICE FOR OUR PATIENTS.

I WISH MORE AND MORE INDIVIDUALS FROM ALL WALKS OF LIFE WHO HAVE THAT INTEREST WOULD GET INVOLVED BECAUSE IT'S TRUE.

IT'S A HAND IN HAND SITUATION WHERE PATIENTS ALL THE TIME, IN MY EXAM ROOM, THEY SAY I HAVE THREE QUESTIONS I CAN ONLY REMEMBER ONE RIGHT NOW WHO IS GOING TO ANSWER THE OTHER TWO QUESTIONS LATER ON?

SO WORKING HAND IN HAND WITH A DOULA, NURSE MIDWIVES, OB/GYNS ARE OPTIMAL.

>> Renee: THANK YOU FOR SHARING THAT AND BACKING UP RENEE.

MATERNITY DESERTEDS.

LOOKING AT THE LANDSCAPE OF CHILD BIRTH OPTIONS.

WHERE ARE WE TODAY?

MANY PEOPLE MAY BE SURPRISED TO LEARN THAT APPROXIMATELY HALF OF KENTUCKY'S 120 COUNTIES AND I THINK YOU SAID THIS EARLIER Dr.

FLOWERS ARE, ARE CONSIDERED MATERNITY DESERTS MEANING THEY DO NOT HAVE A HOSPITAL OR BIRTHING CENTER OFFERING OBSTETRIC CARE.

THAT SOUNDS LIKE A WHOLE LOT IN THIS STATE, GEOGRAPHICALLY VAST AND HAS 4.3 MILLION PEOPLE.

>> MATERNITY DESERTS IS A NATIONAL CRISIS.

HAPPENING ALL OVER RURAL AMERICA, WHERE I CAME FROM IN WEST VIRGINIA, PEOPLE WERE HAVING TO DRIVE FURTHER AND FURTHER, SOMETIMES TWO AND A HALF TO THREE HOURS TO GET THEIR CARE.

AND THAT'S WHY A LOT OF THINGS LIKE INDUCTION HAPPEN BECAUSE YOU DON'T WANT SOMEONE TO DELIVER ON THE SIDE OF THE ROAD.

AND WE ARE LOOKING FOR SOLUTIONS AND ALTERNATIVES TO FIGURE OUT HOW TO GET PROVIDERS OUT INTO THOSE AREAS.

I DON'T THINK IT'S FEASIBLE FOR US TO EXPECT THAT 24/7 OBSTETRICAL CARE IN DELIVERY IS AVAILABLE IN EVERY COUNTY IN KENTUCKY BUT CAN WE GET CARE OUT THERE.

>> Renee: WHAT IS THE ANSWER?

>> ALL HANDS ON DECK LIKE I MENTIONED BEFORE.

IT IS GOING TO BE OB/GYNs MURS MIDWIVES AND FAMILY PRACTITIONERS.

NURSE MIDWIVES DID A HUGE NUMBER OF DELIVERIES BACK IN 1900 PLUS AND IT CAME-- IT FELL OFF PRECIPITOUSLY OVER TIME.

SAME THING WITH FAMILY PRACTITIONERS.

GENERAL PRACTITIONERS THEY CALLED THEM IN THE OLD DAYS USED TO DO A TON OF DELIVERIES.

THEY DON'T DO IT ANYMORE BECAUSE OF THE LIABILITY CRISIS.

>> Renee: I WANT TO COME TO YOU, SUSAN STONE, FRONTIER NURSING SERVICES, THE FRONTIER NURSING UNIVERSITY, █WHICH, CONGRATULATIONS, NO LONGER PROVIDES SERVICE TO MOMS.

TELL US ABOUT THE TRANSITION AND WHY YOU MOVED OUT OF THE MOUNTAINS AND DISCONTINUED PROVIDING SERVICES.

>> SO THAT IS A VERY LONG STORY.

BUT THE HOSPITAL-- WE WERE A CRITICAL ACCESS HOSPITAL, 25-DEAD HOSPITAL AND WE HAD A MIDWIFERY SERVICE OVER THE 12 YEARS THAT I WORKED THERE, TRYING TO RECRUIT AN OBSTETRICIAN.

SO WHEN YOU TRY TO PAY A FULL TIME OBSTETRICIAN AND TWO TO THREE MIDWIVES AND THEN YOU HAVE 125 BIRTHS A YEAR, IS VERY DIFFICULT TO DO AND TO HAVE ANY CONSISTENCY IN CARE.

WE COULDN'T FIND FAMILY PRACTICE PHYSICIANS AND FINALLY, IT'S JUST VERY DIFFICULT TO RUN A HOSPITAL BY YOURSELF ANYMORE.

THEY NEED TO BE IN A SYSTEM.

WE ARE TALKING ABOUT ELECTRONIC MEDICAL RECORDS, YOU KNOW, ALL KINDS OF THINGS.

BUT I THINK EVEN IN THAT LITTLE HOSPITAL TODAY, A MODEL WHERE YOU HAD A FAMILY PRACTICE DOC AND A COUPLE OF MIDWIVES, AND THAT FAMILY PRACTICE DOC COULD BE DOING OTHER THINGS LIKE PRIMARY CARE AND LET THE MIDWIVES ATTEND THE NORMAL BIRTHS AND BACK HERE YOU HAVE A SCREEN THAT ATTACHES YOU TO YOUR OBSTETRICIAN OR FETAL PROVIDER AND GOOD TRANSPORT AND THAT KIND OF THING.

IT CAN BE DONE.

BUT WE DON'T HAVE ENOUGH MIDWIVES TO RECRUIT TO GO TO THOSE RURAL AREAS.

SO THAT IS ONE OF THE THINGS WE DO AT FRONTIER NURSING UNIVERSITY.

WE RECRUIT THOSE NURSES FROM THOSE AREAS, EDUCATE THEM IN THOSE AREAS AND THEY'RE MORE LIKELY TO STAY IN THOSE AREAS.

THAT'S ONE STRATEGY.

THERE ARE IDEAS OUT THERE BUT WE HAVE TO HAVE THE PEOPLE IN PLACE TO MAKE IT HAPPEN AND THAT'S GOING TO TAKE FUNDING, RECRUITMENT, YOU KNOW, TWO FAMILY PRACTICE TYPE THING.

FAMILY PRACTICE HAS JUST GOTTEN TOO COMPLICATED AND TOO RISKY.

>> Renee: YOU MENTIONED THE LITIGATION THERE.

>> WHAT YOU ARE SEEING, I WANT TO EMPHASIZE WHAT YOU JUST SAID, YOU ARE SEEING A REGIONALIZATION OF CARE TO BEST CARE FOR THE PATIENTS AND TELEHEALTH IS A BIG PROPONENT OF THAT, LOUISVILLE OF KENTUCKY AND UNIVERSITY OF LOUISVILLE GETTING OUT THERE IN A TELEHEALTH WAY AND HAVING MIDWIVES AND FAMILY PRACTITIONERS ON THE FRONT LINE.

>> Renee: HOW DOES THE KENTUCKY BIRTH COALITION THINK IT REQUEST HELP REDUCE THE LACK OF CENTERS, MATERNITY DESERTS IN THE STATE?

>> I THINK HAVING MORE OPTIONS AS Dr.

FLOWERS IS MENTIONING, ALL HANDS ON DECK.

THE MORE OPTIONS WE HAVE FOR BIRTSDS IN KENTUCKY IS BETTER EVERYONE IS.

NOW THAT WE HAVE OPTIONS FOR FAMILIES, THAT CAN HELP SOME OF THE FOLKS ARE ABLE TO GO AND SERVE IN AREAS WHERE THERE MAY NOT BE A HOSPITAL.

ALSO BY OPENING FREE STANDING BIRTH CENTERS, HOPEFULLY IN THE TUT, FAT WILL GIVE-- IN THE FUTURE, IT WILL GIVE PEOPLE MORE OPTIONS.

MORE OPTIONS IS BETTER.

>> Renee: LEGISLATION COULD HELP MOVE THAT ALONG, RIGHT?

>> CERTAINLY.

>> Renee: LET'S TURN TO TALK ABOUT A TOPIC THAT IS NOT PLEASANT.

MATERNAL MORTALITY.

ACCORDING TO CENTERS FOR DISEASE CONTROL, THE MATERNAL MORTALITY RATE IN OUR STATE IS MORE THAN DOUBLE THE NATIONAL AVERAGE AND CONTINUES TO TREND UP AND THE DEATH RATE FOR BLACK PREGNANT WOMEN IS THREE TO FOUR TIMES HIGHER THAN IT IS FOR THEIR WHITE COUNTERPARTS.

60% OF THOSE DEATHS ARE CONSIDERED PREVENTIBLE.

BEFORE I COME TO OUR PANEL TO DISCUSS THIS ISSUE, I WANT TO SHARE AN INTERVIEW I DID WITH de MARA JENKINS, DIRECTORY OF MIDWIFERY.

SHE SERVES ON THE STATE'S MATERNAL MORTALITY REVIEW COMMITTEE AND A MEMBER OF THE LOUISVILLE COALITION FOR BLACK MATERNAL HEALTH.

>> THANK YOU FOR BEING WITH US FOR A FEW MOMENTS.

WE APPRECIATE YOUR TIME.

>> THANKS FOR HAVING ME.

>> YOU SERVE ON THE STATE'S MATERNAL MORTALITY REVIEW COMMITTEE AND OUR MATERNAL MORTALITY RATES IN KENTUCKY ARE HIGHER THAN THE NATION, WHENS HIGHER THAN MOST DEVELOPING COUNTRIES, WHICH MAY BE SURPRISING FOR SOME TO HEAR.

HELP US UNDERSTAND WHY WE ARE RANKED AS LOW AS WE ARE RANKED AND WHAT THE COMMITTEE HAS FOUND SO FAR.

>> ONE OF THE BIGGEST PROBLEMS THAT WE FACE IN KENTUCKY WOULD BE SUBSTANCE ABUSE.

AND BECAUSE OF THE AGE OF CHILD BEARING WOMEN, AND HOW THAT, YOU KNOW, RUNS INTO SUBSTANCE ABUSE ISSUES THAT IS SHOWING US THAT 50% OF OUR ACCIDENTAL DEATHS RELATED TO PREGNANCY AROUND THE PREGNANCY PERIOD ARE DIRECTLY DUE TO OVERDOSE.

>> Renee: SO WHAT IS THE MATERNAL MORTALITY REVIEW COMMITTEE LOOKING TO DO TO UP END THAT TREND?

>> IF YOU LOOK AT THE REPORT THAT CAME OUT LAST YEAR, OUR JOB IN THE MATERNAL MORTALITY REVIEW COMMITTEE IS TO MAKE RECOMMENDATIONS TO THE STATE PUBLIC HEALTH DEPARTMENT FOR ACTIONS THAT CAN BE TAKEN TO TRY TO FIX THESE ISSUES.

THE OTHER THING THAT WE DETERMINED IS THAT THREE QUARTERS OF THE DEATHS ARE PREVENTIBLE AND ONE OF THE MAIN WAYS THAT WE CAN PREVENT THESE DEATHS IS THROUGH BETTER CARE FOR WOMEN SUFFERING FROM SUBSTANCE ABUSE DISORDERS.

WE NEED TO TREAT SUBSTANCE ABUSE DISORDERS AS A DISEASE INSTEAD OF AS AN ETHICAL AND MORAL ISSUE.

>> Renee: HOW LONG IN THE POST-PARTUM PERIOD IS A DEATH CONSIDERED A MATERNAL DEATH?

WE'VE HEARD ANYWHERE FROM SIX WEEKS TO A YEAR.

THERE IS A MORE CONCRETE TIME.

>> MATERNITY TECIAL DEATH IS 346 DAYS OR SIX WEEKS WHICH IS WHAT WE THINK OF AS THE POST-PARTUM PERIOD.

HOWEVER, IN ORDER TO CAPTURE THE FULL PICTURE, WE GO OUT TO 365 DAYS OR A YEAR FOLLOWING BIRTH OR THE DEATH IN PREGNANCY AND THAT IS CALLED MATERNAL MORTALITY F. WE JUST DID THE SIX WEEKS OR THE 42 DAYS, WE WOULD MISS A LOT OF THOSE OVERDOSES.

>> Renee: WE UNDERSTAND THAT BLACK WOMEN HAVE TWO TO THREE TIMES HIGHER RATES OF MATERNAL MORTALITY THAN NON-HISPANIC WHITE WOMEN.

WHAT DO WE KNOW ABOUT THOSE DISPARITIES?

>> THE THING THAT WE HAVE COME TO UNDERSTAND IS THAT IT'S NOT BEING BLACK THAT IS THE RISK FACTOR, BUT IT IS RACISM.

AND TO PUT IT BLUNTLY, THAT IS WHAT IS CAUSEDING HIGHER RATES OF DEATH AMONGST BLACK WOMEN.

THERE HAS BEEN OVER 30 YEARS OF RESEARCH PROVING THIS, BUT WE ARE JUST NOW STARTING TO ACCEPT IT AND FIGURE OUT WHAT TO DO ABOUT IT.

>> Renee: SO WHEN YOU SAY RACISM, IS IT ACCESS TO CARE?

IS IT TREATMENT BY PROVIDERS, THOSE THINGS COMBINED AND MORE?

WHAT ARE THE ACTUAL ACTS OF RACISM THAT ARE MANIFESTING IN THESE DISPARITIES?

>> IT'S ALL THOSE THINGS AND MORE.

SO RACISM IS SO PERVASIVE IN OUR CULTURE, THAT IT AFFECTS HOW WE EXAMINE FOLKS.

IT AFFECTS HOW WE ASSESS THEM.

IT AFFECTS THE TYPE OF PAIN MANAGEMENT THEY GET.

IT AFFECTS WHAT'S OFFERED TO THEM.

IT AFFECTS, YOU KNOW, THEIR ACCESS TO CARE.

IT AFFECTS HOW COMFORTABLE THEY ARE PRESENTING FOR CARE, ASKING FOR HELP.

IT'S JUST IN EVERYTHING.

>> Renee: SO ACKNOWLEDGING THAT THERE IS A PROBLEM IS NOT A SOLUTION IN AND OF ITSELF.

WHAT WOULD YOU SAY THE SOLUTIONS ARE IN CREATING A PATH FORWARD TO BRIGHTER FUTURE IS FOR ALL WOMEN WHO ARE TO BE MOTHERS AND EXPERIENCE CHILD BIRTH?

>> IT'S A PROBLEM THAT PEOPLE WANT TO RUN AWAY FROM BECAUSE WE DON'T KNOW WHAT TO DO ABOUT IT.

BUT THE FIRST THING WE DO HAVE TO DO IS ACKNOWLEDGE IT.

AND FOR HEALTHCARE PROVIDERS, ANYONE THAT SERVICES BLACK FOLKS, WHAT THEY NEED TO DO IS LOOK AT THEMSELVES AND YOU CAN DO THIS BY LOOKING AT YOUR IMPLICIT BIAS, SO ASSESSING YOURSELF, ASSESSING YOUR BEHAVIORS AND SEEING IF EVEN THOUGH YOU THINK YOU ARE BEHAVING NOT IN RACIST PATTERNS BUT BY ASSESSING YOUR IMPLICIT BIAS, YOU CAN FIND THAT.

THAT'S ONE WAY TO START.

THE OTHER THING THAT WE NEED TO BE REALLY CAREFUL ABOUT COLLECTING DATA AND UNDERSTANDING WHERE WE ARE SEEING THE EFFECTS OF RACISM SO THAT WE CAN GET TO THE ROOT AND CHANGE THINGS.

>> Renee: SO YOU MENTIONED TO ME THAT YOU ARE ONE OF THREE BLACK MIDWIVES IN THIS STATE.

AND SOME MAY FIND THAT NUMBER SHOCKING.

OBVIOUSLY YOU ARE VERY PASSIONATE ABOUT THIS WORK BEYOND JUST CARING FOR YOUR OWN PATIENTS BUT TRANSFORMING HOW WE ALL VIEW MIDWIFERY AND ELEVATE THIS CRAFT, THIS PROFESSION.

WHAT IS IT THAT YOU WANT TO LEAVE OUR VIEWERS WITH ABOUT THE IMPORTANCE OF MIDWIFERY AND THE LASTING TAKE AWAY YOU WOULD LIKE TO SEND?

>> WE HAVE SO FEW MIDWIVES IN THIS STATE AND WE HAVE SO MANY FOLKS THAT WOULD LIKE TO PROVIDE MIDWIFERY CARE AND WE KNOW, FROM LOOKING AT OTHER COUNTRIES, WE KNOW FROM LOOKING AT OTHER STATES, THAT IF WE INCREASED MIDWIFERY CARE, ACCESS TO MIDWIFERY CARE IN OUR STATE, WE ARE GOING TO SEE IMPROVEMENTS.

>> Renee: MUCH APPRECIATED.

THANKS.

SUSAN STONE I WANT TO COME TO YOU AND ASK YOU WHERE de MARA LEFT OFF ABOUT RECRUITING MORE AFRICAN-AMERICAN MIDWIVES IN THIS STATE.

SHE IS ONE OF THREE.

SOUNDS WOEFULLY INADEQUATE.

>> RIGHT.

TO BE CLEAR, WHEN YOU LOOK AT THE DATA, KENTUCKY'S WHITE WOMEN 17.2 IS THE RATE, WHICH IS ABOUT NORMAL FOR THE COUNTRY.

BUT BLACK WOMEN OR WOMEN OF COLOR, 40%-- 40 PER 100,000 FOR THE MORTALITY RATE.

IT'S A HUGE DIFFERENCE SO IT IS A VERY BIG BARRIER.

ONE OF THE THINGS THAT HAS BEEN SHOWN TO BE VERY EFFECTIVE IS WHAT WE CALL RACE CONCORDANT CARE SO THE PERSON WHO IS TAKING CARE OF YOU LOOKS LIKE YOU, KNOWS YOUR CULTURE, KNOWS WHO YOU ARE AND YOU FEEL MORE COMFORTABLE, NO MATTER WHAT THE CULTURE IS.

WHETHER IT'S THE NATIVE AMERICAN OR-- BUT WE NEED TO INCREASE THE NUMBER OF MID WIFS OF COLOR.

WE ARE NOT JUST AT FRONTIER BUT THE NURSE OF MIDWIVES IS A BIG PUSH TO GET TO AT LEAST 35% STUDENTS OF COLOR.

ANOTHER FRON FRONTIER WE ARE AT 28% AND TRYING.

BUT IT IS, IN ORDER TO DO THAT, WE ARE GOING TO HAVE TO IDENTIFY OUR OWN BIASES IN ADMITTING STUDENTS TO SCHOOLS, IN EDUCATING THEM WHILE THEY'RE THERE AND TAKING CARE OF THEM AND MAKING SURE THEY FEEL INCLUSIVE.

IT'S AN INCLUSIVE ENVIRONMENT, SAFE AND SO THAT THEN THEY CAN GO OUT AND PROVIDE THAT CARE.

WE ARE GOING HAVE TO INVEST.

>> Renee: , YEAH, YEAH HERE, HERE.

Dr.

FLOWERS, I WANT TO ASK YOU.

IN ADDITION TO THE MATERNAL MORTALITY REVIEW COMMITTEE, THERE IS THE KENTUCKY PARA NATAL CAREER COLLABORATIVE.

TELL BUS THAT COLLABORATIVE.

WHAT IS IT ADDRESSING?

>> SO FOR SHORT IT'S CALLED THE KENTUCKY-- EVERY STATE IN THE COUNTRY NEEDS A COLLABORATIVE.

WE ARE MOVING IN THAT DIRECTION.

FEDERAL FUNDING HAS BEEN PROVIDED AS WELL ASTHMA TERM MORTALITY REVIEW COMMITTEES.

THOSE TWO WORK HAND IN HAND IN MOST STATES INTOrd TO ADDRESS THE ISSUES THAT FACE WOMEN BEFORE AND AFTER THEIR PREGNANCY AS WELL.

I WANT TO SAY SOMETHING ABOUT YOUR INTERVIEW.

SHE IS RIGHT.

THERE IS RACISM THAT'S PERVASIVE THROUGHOUT THE HEALTHCARE SYSTEM AND PROVIDERS DON'T KNOW WHAT THEY DON'T KNOW.

THERE IS A LOT OF BIASES THAT ARE INGRAINED IN US FROM BIRTH THAT WE DON'T KNOW.

THE MORE PROGRAMS YOU HAVE LIKE THIS, THE MORE PROGRAMMING WE CAN HAVE THROUGH CAN IT CUE AND OTHER ORGANIZATIONS TO BE ABLE TO HAVE A PROVIDER LIKE ME, A WHITE BOY FROM WEST VIRGINIA, WHEN I GO INTO A ROOM AND IT'S A MINORITY INDIVIDUAL, PARTICULAR WILL-- PARTICULARLY A BLACK WOMAN, I SAY NOT ON MY SHIFT.

IT DIDN'T HAPPEN OVER NIGHT.

WE NEED OTHER PROVIDERS TO GET TO STAT STAGE OF THE GAME.

>> Renee: GETTING BACK TO THE MATERNAL MORTALITY.

THAT'S NOT THE ONLY CONCERN MORTALITY.

OTHER COMPLICATIONS CAN COME INTO PLAY.

TALK ABOUT THAT.

>> MORE MID DIFFICULT.

PATIENTS WHO BLEED TOO MUCH AND HAVE TO HAVE TRANSFUSIONS.

PATIENTS WHO HAVE HYPERTENSIVE DISEASE AND END UP HAVING THINGS LIKE STROKE AND OTHER MORBIDITIES LIKE THAT.

DIABETES AND COMPLICATIONS.

THE IMPORTANT ASPECTS OF INITIATING THE KIT CUE, KENTUCKY IS AN AIM STATE.

AIM HAS SAFETY BUNDLES THAT ARE NATIONALLY RECOGNIZED.

AND KENTUCKY HAS CHOSEN TO BECOME ONE OF THOSE STATES AND IMPLEMENT THE OPIOID USE DISORDER MODEL WHICH, AS YOUR INTERVIEW RIGHTLY SAID, OVER 50% NOW OF THE DEATHS EVERY SINGLE YEAR ARE FROM WOMEN WHO HAVE HAD OVERDOSES.

MOST OF THOSE DON'T HAPPEN DURING PREGNANCY.

THEY HAPPEN AROUND THE THREE TO SIX MONTH POST-PARTUM PERIOD AND THERE ARE A LOT OF REASONS FOR THAT.

ONE IN PARTICULAR IS THAT WOMEN LOSE THEIR COVERAGE, THEIR INSURANCE COVERAGE AFTER ABOUT 60 DAYS SO THERE IS A BIG PUSH NOT ONLY IN KENTUCKY BUT AROUND THE COUNTRY IN ORDER TO HAVE WOMEN TO HAVE COVERAGE FOR A YEAR TO MAINTAIN THEIR SOBRIETY, MAINTAIN THAT CARE AND ACCESS TO CARE.

>> Renee: Dr. STONE, I WANT TO PICK UP ON THAT POINT.

51.6% OF ACCIDENT ACCIDENTAL DEATHS WERE DUE TO DRUG OVERDOSE IN 2018 LATEST DATA.

HOW DOES OPIOID AND SUBSTANCE ABUSE IMPACT MIDWIVES AND THE WORK THEY'RE TRYING TO DO.

>> MIDWIVES ARE FINDING THEMSELVES TREATING THESE PATIENTS AND SAMSA, THE FEDERAL ORGANIZATION PROVIDES TRAINING FOR MIDWIVES.

MIDWIVES HAVE BEEN INCLUDED IN MEDICAL MEDICAL ASSISTED TREATMENT SO THEY CAN PROVIDE THINGS LIKE BUPRENORPHINE AND THOSE SORTS OF THINGS AND HAVE YOU MIDWIVES DOING GROUP PRENATAL CARE FOR SUBSTANCE ADDICTED WOMEN, YOU KNOW, REALLY GETTING, WE HAVE TO ALL BE ON DECK.

WE HAVE TO ALL BE PART OF THIS.

>> Renee: SO NOW LET'S TALK ABOUT BLACK BIRTH JUSTICE WHICH IS A NEW NON-PROFIT IN LOUISVILLE THAT IS CREATING AN INTENTIONAL COMMUNITY TO SURROUND BROWN AND BLACK WOMEN WITH SUPPORTIVE CARE DURING THE POST-PARTUM PERIOD.

WE WENT TO THEIR HUB TO LEARN MORE.

>> HI KECIA, HOW ARE YOU?

>> I'M GOOD.

>> COME ON BACK.

>> AT BLACK BIRTH JUSTICE WE OFFER POST-PARTUM CARE.

AFTER YOU HAVE THE BABY, WE CAN COME TO YOUR HOME OR YOU CAN COME TO OUR HUB.

POST-PARTUM IS A VERY DIFFICULT TIME AND WHEN YOU DON'T HAVE A VILLAGE AROUND TO YOU GIVE YOU THE SUPPORT THAT YOU NEED AND THE RESOURCES, IT CAN LEAD TO THINGS LIKE THE MATERNAL MORTALITY RATE THAT WE ARE TRYING TO COMBLATT.

>> HOW IS THE BABY SLEEPING?

>> SLEEPING THROUGH THE NIGHT.

>> I FEEL LIKE MOST PEOPLE ARE AWARE OF POST-PARTUM DEPRESSION BUT MOST PEOPLE ARE NOT AWARE THAT POST-PARTUM DEPRESSION IS ALWAYS A BIG CHANGE IN YOUR MOOD.

IT COULD BE SMALL THINGS THAT YOU DON'T EVEN REALIZE THAT YOU ARE GOING THROUGH.

YOU YOU ARE NOT CONNECT THE WITH BABY THE WAY YOU SHOULD BE.

LOOK FOR PHYSICAL SIGNS OF SWELLING AND INFLAMMATION.

THINGS THAT, WHEN YOU ARE TAKING CARE OF A NEW BABY, YOU MIGHT NOT TAP INTO IT.

SO BEING ABLE TO PUT EYES ON OUR CLIENTS AND HAVING CONSTANT COMMUNICATION WITH THEM IS THEY CAN WE ARE ABLE TO PICK UP ON.

WE SUPPLY YOU WITH ESSENTIAL NEEDS THAT YOU MAY NEED AFTER HAVING A BABY, WE HAVE PAD, NURSING BRAS, NURSING SUPPLIES.

WE OFFER LACTATION SUPPORT.

IF YOU ARE BREAST FEEDING BABY, WE GO OVER DIET.

THINGS YOU SHOULD EAT AFTER HAVING A BABY TO PROMOTE HEALTHY HEALING AND HEALTHY BODIES AFTER GIVING BIRTH.

BLACK BIRTH JUSTICE, I LOVE IT.

IT'S A COMMUNITY, IT'S FOR THE COMMUNITY FOR BREG NABT MOMS.

MY FIRST PREGNANCY I HAD AN OB/GYN AND SECOND BIRTH I HAD A MIDWIFE.

THE DOULA BASICALLY COACHED ME ESPECIALLY WITHIN THIS PANDEMIC, IT WAS LIKE YOU COULD HAVE ONLY ONE PERSON IN THE ROOM.

SHE COACHED ME AND TAUGHT ME HOW TO BREATHE THROUGH PLY CONTRACTIONS.

ASKED ME HOW I WAS FEELING, ASKED ME IF I NEEDED A BREAK.

SHE WAS JUST LIKE A THERAPY PERSON THERE ON SITE DELIVERING THE BABY.

IT'S VERY IMPORTANT TO HAVE RESOURCES, ESPECIALLY IF YOU ARE DEPRESSED OR DOWN AND OUT, HAVING ANXIETY.

IT'S VERY, YOU KNOW, SPECIAL TO HAVE SOMEONE TO TALK TO, SOMEBODY IN YOUR CORNER.

A LOT OF TIMES BLACK WOMEN FEEL LIKE THEIR VOICES ARE NOT BEING HEARD: THEY HAVE ISSUES THAT THEY MAY NOT FEEL COMFORTABLE DISCUSSING WITH PEOPLE WHO DON'T LOOK LIKE THEM SO THEN IT'S NOT ADDRESSED AND IT'S NOT TAKEN CARE OF.

I THINK THAT THAT IS THE BIGGEST DISPARITY IS JUST NOT FEELING LIKE YOU ARE IN A SAFE SPACE TO COMMUNICATE YOUR NEEDS AND THINGS GOING ON WITH YOU AS FAR AS YOUR HEALTH WHILE YOU ARE PREGNANT.

IF WE CAN GET EVERYONE TO REALIZE THAT IT GOES BEYOND SIX WEEKS, I THINK THAT WE COULD DEFINITELY SAVE A LOT OF LIVES OF MOTHERS AND BABIES.

I LOVE MOMMIES AND BABIES AND THE OVERALL HEALTH AND KNOWING THAT I AM A PILLAR IN MY COMMUNITY AND MY PEOPLE CAN COME TO ME AND KNOW THAT I CAN HELP THEM.

I WON'T JUDGE THEM.

I WON'T MAKE THEM FEEL BAD FOR ANY SITUATION THAT THEY'RE IN.

I'M LITERALLY THERE TO HELP YOU AND UPLIFT YOU.

$MARY KATHRYN DeLODDER, AS A BIRTH ADVOCATE, SOMEONE WHO KNOWS THE IMPORTANCE OF THIS CARE DURING THE PROCESS AND AFTER BIRTH, HOW VALUABLE ARE PROGRAMS LIKE THIS ONE?

>> ANYONE WHO HAS HAD A CHILD KNOWS THAT IT'S NOT EASY, YOU GET THROUGH PREGNANCY, BIRTH AND THEN HAVE YOU THIS LITTLE PERSON TO TAKE CARE OF AND IT REALLY DOES TAKE A VILLAGE.

IT SEEMS CLICHE TO SAY BUT IT'S TRUE.

TO HAVE A SUPPORT SYSTEM BEYOND SIX WEEKS IS SO IMPORTANT FOR TAKING CARE OF BOTH BABIES AND NEW MOMS AND FAMILIES AS THEY ARE LEARNING HOW TO LIVE IN THE WORLD AND TO NAVIGATE THAT SO I THINK PROGRAMS LIKE THAT THAT REALLY TAKE CARE AND COWRNTD THOSE MOTHERS ARE SO IMPORTANT AND JUST LIKE WE TALKED ABOUT, MATERNAL MORTALITY, THE WAY WE CALCULATE THAT, THEY ARE LOOKING AT THAT THROUGH ONE YEAR.

THINGS CAN HAPPEN AT ANY POINT BEYOND JUST SIX WEEKS THAT YOU MIGHT BE SEEING YOUR CARE PROVIDER TO FOLLOW UP.

SO HAVING THAT KIND OF SUPPORT IS REALLY IMPORTANT.

>> Renee: EMOTIONAL AND MENTAL HEALTH CARE IS ALSO IMPORTANT POST-PARTUM OR DEALING WITH DEPRESSION AS WE HEARD IN THAT PIECE AND OTHER ISSUES.

THAT'S IMPORTANT TO ADDRESS AS WELL.

>> ABSOLUTELY.

I THINK PEOPLE HAVE BEGUN TO THINK THAT POST-PARTUM IS DEPRESSION.

IT'S NOT BUT IT CAN HAPPEN IN THE POST-PARTUM PERIOD.

EVERYONE HAS A POST-PARTUM PERIOD.

IT MEANS AFTER YOU HAVE YOUR BABY.

IT HAS BECOME A SYNONYM THAT HIGHLIGHTS HOW IMPORTANT MENTAL HEALTH IS ONCE YOU HAVE GIVEN BIRTH AND HAVING THAT SUPPORT SYSTEM REALLY HELPS NOT SUPPORT A MOM PHYSICALLY BUT MENTALLY AND EMOTIONALLY AS WELL $IT'S IMPORTANT TO REMEMBER THAT NEARLY MOTHER THAT DIES FROM CHILD BIRTH LEAVES BEHIND A CHILD WHO STARTS THEIR LIFE WITHOUT THE PERSON WHO BROUGHT THEM INTO THIS WORLD.

I SPOKE WITH MARY KAREN STUMBO WHO LOST HER MOTHER AT BIRTH 50 YEARS AGO ABOUT THIS LOSS.

MARY KAREN STUMBO, A PLEASURE TO HAVE YOU WITH US.

>> THANK YOU FOR INVITING ME.

>> Renee: I'M SORRY IT HAS TO BE ON SUCH A TOPIC SUCH AS THIS BUT I LEARNED YOU HAD LOST YOUR MOTHER SHORTLY AFTER SHE HAD GIVEN BIRTH TO YOU BY A POST YOU HAD SHARED ON SOCIAL MEDIA.

AND I DON'T THINK I EVER KNEW THAT ABOUT YOU.

>> IT'S NOT SOMETHING I SHARE VERY OFTEN.

PEOPLE WHO KNOW ME OBVIOUSLY KNOW THE HISTORY OF MY FAMILY AND EVERYTHING THAT MY BROTHERS AND I HAVE GONE THROUGH.

BUT, YES, IT'S A TOUGH TOPIC TO DISCUSS FOR SURE.

>> Renee: AND YOU ARE COMING UP ON A MILESTONE OF YOUR OWN AND NOW THAT MILESTONE BIRTHDAYS AFFECT US IN MANY WAYS WHEN WE THINK ABOUT WHERE WE COME FROM AND HOW WE GOT HERE.

AND HOW OFTEN DO YOU THINK ABOUT YOUR MOTHER AND WHAT YOU MISSED FROM MORE MOTHER.

>> PROBABLY EVERY DAY.

THERE ARE THINGS THAT, YOU KNOW, IF I'M UPSET, I WISH I HAD HER TO REACH OUT TO AND WHEN MY DAUGHTER IS ABOUT TO GRADUATE FROM COLLEGE IN DECEMBER, I THINK ABOUT THINGS THAT SHE MISSED AND THAT MY SIBLINGS AND I MISSED WITH HER.

>> Renee: TELL US ABOUT WHAT YOU KNEW ABOUT YOUR MOTHER AND THE CIRCUMSTANCES THAT LED TO HER DEATH.

>> SHE WAS 32 WHEN SHOE HAD ME.

I HAD THREE OLDER SIBLINGS, ALL BOYS SHE WAS VERY DESPERATELY WANTING A GIRL.

SHE FINALLY GOT ONE BUT UNFORTUNATELY SHE DIDN'T GET TO ENJOY LIFE WITH A LITTLE GIRL.

BUT SHE DEVELOPED A STAFF INFECTION AFTER SHE HAD ME AND DIED SIX DAYS LATER AND THIS WAS JUST 50 YEARS AGO, RIGHT?

THIS ISN'T 1800s.

WE THINK ABOUT SOMETHING AS SMALL OR TREATABLE AS A STAFF INFECTION.

>> ANTIBIOTICS.

>> COULD HAVE TAKEN CARE OF IT.

SHE WAS VERY COGNIZANT OF THE FACT THAT SOMETHING WAS WRONG.

SHE HAD THREE OTHER CHILDREN AND WAS VERY VOCAL WITH THE NURSE THAT SHE DIDN'T FEEL RIGHT, THAT SOMETHING WAS WRONG.

AND THEY DISMISSED HER CONCERNS REPEATEDLY AND I KNOW THAT WITH MY SIBLINGS THAT SHE WAS OUT OF BED THE SAME DAY SHAT SHE HAD THAT SHE HAD THEM AND WALKING AROUND WITH THEM BUT SHE NEVER GOT OUT OF BED AFTER SHE HAD PLEA.

SO SHE KNEW THAT SOMETHING WAS DIFFERENT.

HER CONCERNS WERE NOT PASSED UP THE CHAIN AND BY THE TIME THEY WERE, IT WAS TOO LATE.

THERE WAS NOTHING THAT THEY COULD DO TO SAVE HER.

>> Renee: DO YOU EVER THINK ABOUT THAT; THAT THIS IS A CASE IN POINT WHERE SOMETIMES WOMEN JUST AREN'T LISTENED TO, EVEN THOUGH THEY KNOW WHAT THEY KNOW.

>> Renee: ABSOLUTELY.

>> I THINK ABOUT HOW FRUSTRATED SHE HAD TO HAVE BEEN.

AND THE CHANGING OF THE HORMONES IN HER BODY JUST FROM GIVING BIRTH AND EVERYTHING SHE WAS GOING THROUGH BUT I MEAN SHE ABSOLUTELY KNEW, AND YOU KNOW, THAT'S A CASE WHERE HAVE YOU TO EXPLAIN TO WOMEN, YOU HAVE TO BE YOUR OWN BEST ADVOCATE.

WHEN YOU KNOW SOMETHING IS WRONG, YOU EXPRESS IT AND IF YOU ARE NOT TAKEN SERIOUSLY, YOU GET LOUDER BECAUSE THERE IS NOBODY THAT CAN TAKE CARE OF YOU BETTER THAN YOU CAN.

>> Renee: THANK YOU, MARY KAREN.

>> I APPRECIATE THE OPPORTUNITY TO BE HERE AND THE FACT THAT YOU GUYS ARE DISCUSSING THIS BECAUSE IT IS AN IMPORTANT TOPIC AND ALL THESE YEARS LATER, YOU STILL HEAR THE STORIES OF WOMEN WHO MAYBE AREN'T LISTENED TO WHEN THEY'RE TELLING YOU SOMETHING IS WRONG SO IT'S IMPORTANT AND I'M GLAD YOU ARE DOING IT.

THANK YOU.

>> Renee: Dr.

FLOWERS, I WANT TO COME TO YOU BECAUSE ONE OF THE BIG TAKEAWAYS FROM MARY KAREN STUMBO'S EXPERIENCE IS THAT WOMEN HAVE TO BE THE LOUDEST AND MOST VOCAL ADVOCATE, RIGHT?

THAT, YOU KNOW, IT SEEMED THAT MARY KAREN'S MOTHER WAS TRYING TO COMMUNICATE THAT SOMETHING WAS WRONG BUT WASN'T BEING HEARD.

>> I COULD GIVE A PEARL OF WISDOM TO ANY RESIDENT, INTERN OR MEDICAL STUDENT, IF YOU LISTEN CLOSE ENOUGH TO THE PATIENT, THEY'RE TELLING YOU EXACTLY WHAT IS WRONG WITH THEM AND WE JUST HAVE TO OPEN UP OUR EARS AND OUR MINDS AND FOLLOW THOSE CLUES THAT THE PATIENT IS GIVING US.

>> Renee: THEY DON'T KNOW THE SCIENTIFIC OR MEDICAL TERMS BUT THEY KNOW SOMETHING IS OFF WITH THEIR BODY BECAUSE THEY HAVE BEEN LIVING WITH IT.

>> THEY DON'T KNOW THE SPECIAL WORD THAT THE STUDENTS PAID A QUARTER OF A MILLION DOLLARS TO LEARN, BUT THEY'RE TELLING YOU IN THEIR WORDS EXACTLY WHAT IS WRONG WITH THEM.

I AGREE.

>> I WANT TO GO TO YOU SUSAN STONE WHEN YOU HEAR A STORY LIKE MARY KAREN STUMBO'S HOW DOES IT RESONATE WITH YOU?

>> WE HAVE PROBLEMS WITH WOMEN BEING HEARD IN MANY SITUATIONS, BUT I THINK ONE OF THE THINGS THAT ALSO GOES ON IS THE LACK OF MATERNITY CARE.

SO WHEN YOU HAVE AN OBSTETRICIAN WHO IS IN AND OUT BECAUSE THEY HAVE 100 THINGS ON THEIR PLATES AND YOU DON'T HAVE MIDWIVES AND NURSES MAY OR MAY NOT BE WELL TRAINED IN MATERNITY CARE, THOSE THINGS CAN LEAD TO THOSE TYPES OF ERRORS AND THE LACK OF LISTENING.

WE NEED BETTER CARE AND BETTER PROVIDERS.

>> Renee: AND THE OVERLAY OF COVID DURING ALL OF THIS, Dr.

FLOWERS IS A COMPLICATED ADDITIONAL AGGRAVATOR I WOULD THINK.

>> IT HAS BEEN AND WITH THE INCREASE OF COVID AMONGST PREGNANT PATIENTS, THERE HAS BEEN A DISCOMBOB LAYINGS OF THE HEALTHCARE SYSTEM FOR THE LAST TWO AND A HALF YEARS WITH COVID AND WE ARE TRYING TO GET BACK TO HANDS ON CARE GRR I WANT TO COME TO YOU FOR FINAL WORDS ON THE WORK YOU ARE DOING AND THE LEGISLATION YOU HOPE TO SOON HAVE PASSED.

>> PARTICULARLY FOR PHYSICIANS WHO MIGHT WATCH THIS OR HOSPITAL ADMINISTRATORS, I WOULD HOPE THEY WOULD EMIGRATES MIDWIFERY CARE BRINGING NURSE MIDWIVES INTO THEIR HOSPITALS AND PRACTICES ALONGSIDE THEM AND NOT BEING FEARFUL OF THAT BUT EMBRACING THE ALL HANDS ON DECK PHILOSOPHY WE TALKED ABOUT AND NOT BEING FOOERFUL OF WORKING WITH THE COMMUNITY MID WIFS OUT IN THE COMMUNITY TAKING CARE OF FOLKS WHO MAY OR MAY NOT AT SOME POINT NEED TO BRING PATIENTS TO THEM AND TRANSFER THEM AND MAKE THAT A TEAM AND FOR INDIVIDUALS AND FAMILIES WHO WANT TO ADVOCATE FOR ADDITIONAL MATERNITY CARE OPTIONS IN KENTUCKY.

KENTUCKY BIRTH COALITION RUNS WITH VOLUNTEER AND GRASSROOTS POWER SO WE WOULD LOVE TO HAVE ANYONE WHO CARES ABOUT THAT BE INVOLVED WITH WHAT WE ARE WORKING ON.

>> Renee: Dr.

FLOWERS, YOU GAVE SOME ADVICE TO MAYBE FUTURE OBSTETRICIANS AND OTHERS IN THE MEDICAL PROFESSION WHO ARE MIDWIVES.

WHAT ELSE WOULD YOU SAY IS A FINAL TAKEAWAY THAT YOU HOPE PEOPLE WILL TAKE HOLD ENOUGH.

>> A COUPLE OF THINGS.

ONE THAT OB/GYNs ARE ARE AT THE TABLE.

WE ARE LISTENING AND WANT PARTNERS.

WE NEED MORE PARTNERS TO BEST TAKE CARE OF WOMEN IN THE STATE OF KENTUCKY AND WE MENTION THEY'RE HAVING A BIG MEETING ON OCTOBER 20-31.

YOU CAN REGISTER.

IT IS GOING TO FOCUS SUBSTANCE ABUSE ISSUES IN PREGNANCY.

>> Renee: GOOD PLUG THERE AND DR. SUESS AN STONE, FINAL WORD.

>> THANK YOU.

MOST IMPORTANT THING IS THAT WE HAVE IS GOING TO TAKE A WHOLE TEAM OF DIFFERENT TYPES OF PROVIDERS AND WE HAVE TO OPEN OUR ARMS AND OUR DOORS TO THEM.

WE HAVE TO HAVE OBSTETRICIANS.

BUT OBSTETRICIANS AND MIDWIVES ARE NOT THE SAME.

AND SO IF YOU ONLY PROVIDE OBSTETRICAL CARE, YOU WON'T GET THE BEST CARE.

YOU NEED MIDWIFERY CARE, YOU NEED THE DOULAS, BLACK BIRTH JUSTICE, ALL OF THESE THINGS WORK TOGETHER TO GET THE BEST OUTCOMESES AND THAT IS MY TAKEAWAY.

WE NEED MORE PROVIDERS.

>> Renee: AS THEY SAY, TEAMWORK MAKES THE DREAM WORK, RIGHT?

>> EXACTLY.

>> Renee: THANK YOU ALL FOR BEING PART OF THIS TEAM THIS EVENING AND HELPING US DELIVER SOME GREAT INFORMATION.

THANK YOU AT HOME FOR JOINING US FOR THIS VERY IMPORTANT DISCUSSION.

WE HOPE YOU HAVE A BETTER APPRECIATION FOR THE IMPORTANT ROLE OF MIDWIFERY AND DOULAS AND MATERNITY CARE AND THE NEED TO PROVIDE SAFE SUPPORTIVE BIRTHING OPTION FOR ALL WOMEN, NO MATTER WHERE THEY LIVE.

PLEASE CHECK OUT ANGELS ON HORSE BACK ON OUR WEBSITE AT ket.org FROM ALL OF US AT KET, TAKE