>> From WXXI News.

This is connections.

I'm Racquel Steven filling in for Evan Dawson.

Today we're addressing a nationwide health crisis, one that is hitting black women in our community, especially hard.

What is supposed to be one of the most joyous moments in a woman's life can sometimes turn into a life threatening emergency?

The term maternal morbidity refers to health problems or complications that occur during or after pregnancy and childbirth, and can range from manageable conditions to severe long term damage or even death.

For black women, the risk are especially high.

According to Common Ground Health.

The rate of severe maternal morbidity, morbidity among black non-Latino mothers in Monroe County is 151 per every 10,000 deliveries.

That's up more than 50% in the last ten years, and higher than the country's overall trend.

But these are not just numbers and statistics.

They represent real women, real families, and real disparities in our health care system.

Since 2019, maternal and child health has been a top priority in Monroe County's Community Health Improvement Plan.

Local leaders have been meeting regularly to understand the drivers of this crisis and to create change.

This hour, we're joined by two of those leaders in studio with me is Tracy Weber, the director of the University Midwifery Group at the University of Rochester Medical Center.

And on the phone, we have Dr.

Eva Pressman, the chair of obstetrics and gynecology at Urmc.

We'll talk about why maternal health outcomes are worsening for black women, how local providers and institutions are responding, and what it will take to save lives.

Thank you, ladies, for joining us for this important discussion.

>> Thank you for having us.

>> And of course, we welcome our listeners to join in on the conversation.

You can call us at 1844295 talk or at ( 585)263-9994 or email us at Connections at wxxi.org.

Or you can comment right in our YouTube channel.

Now I want to start with you, Tracy.

It's a very sensitive topic.

you are a midwife who works directly with patients.

When did you first hear some of these statistics?

And what does that what did it mean to you to hear it?

>> I first heard about it when I was working as a certified nurse midwife in New York City, because in New York City, those statistics go up exponentially.

just working in both city and private hospitals.

I came to experience some of the maternal health inequities that we see throughout the state.

And it was really difficult for me to witness because in New York City the health care providers reflect that I worked with reflected the community that we worked with.

But the statistics still look the same.

So why is that happening?

>> Yeah.

And here in Monroe County, do you did you see a significant difference when you came here?

>> about the same.

However, I will say in general, here in Monroe County and it may be true for the rest of the state that I'm seeing a lot more illnesses overall in pregnancy.

especially just my personal opinion since the pandemic, I'm seeing more mental health concerns preeclampsia, which is a hypertensive disorder of pregnancy and gestational diabetes.

>> Yeah.

And we want to talk to Eva about about what we're seeing.

The data tells us that severe complications are rising, especially among black women.

Yes.

Eva, what kinds of complications are we talking about?

What do you see most in your practice?

>> So Tracy touched on most of them already.

blood pressure issues are very high on the list.

gestational diabetes or preexisting diabetes is much more common in patients of childbearing age.

and mental health disorders, including substance use disorders, do contribute to the loss of life in and around pregnancy.

>> Yeah.

And and Monroe County in particular is we're hearing is worse than the the rest of the country or the rest of the state.

Why do you think that is?

Why locally?

Why are we why are we so much worse?

>> So that's a very challenging question and very disheartening because we've really been working on it for years, trying to improve access to care for patients early in pregnancy, during pregnancy and in the postpartum period.

We've recently expanded the availability of doulas in our community, which allow for one on one patient education and support, which I think really will help eventually.

But it's a process that has taken a long time to develop, and it will take longer than we want to solve.

>> And with Tracy, what what what do you think is happening here in Monroe County?

>> Well, I will say one disclaimer is that where I work, we're a regional perinatal center.

So I think that skews the statistics a little bit because we take sicker patients from all over.

You know, this particular region however it's just historical.

I'm not going to sit here and pretend like, you know, I don't see little microaggressions or, you know, unintentional harm and that type of thing.

I mean, that that happens.

But the health care system as it is within and without maternal health is built upon frameworks that does not support black people.

And we also have to look beyond the walls of the health care institutions and look at it from a position of a reproductive justice framework, which has four main pillars.

One is about body autonomy, the other one is a woman's right to decide to have a baby, a woman's right to decide not to have a baby, and then a family's ability to raise a baby within, you know, safe and sustainable neighborhoods.

So, you know, it is a multifactorial, multilayered kind of a stinky onion that we have to peel the layers away from and get to the to the source, the source in some, in one word, is just racism, right?

Because as we look back at black maternal deaths throughout the country, the women who have been you know, discussed publicly have been women who have the means, you know, we talk about Kara Johnson and there's an act named after her.

however, Cara Johnson was an accomplished person, and she had access to health care, but yet she had a C-section was her complaints were ignored.

And by the time they brought her to the operating room, most of her blood was in her belly, and she coded and died.

And, you know, hemorrhage is another thing that we really see a lot that we try to, to, to prevent.

But it's really systemic racism.

And people love to point at, oh, they don't they're not going to their prenatal care.

You know, it's because they're poor.

It's because they don't know anything.

But that's not the case.

>> And Eva is it is it as simple as not as simple, but is it just one word?

Racism.

>> Well, I think racism is at the heart of it.

It is what has allowed the system to develop in a way that puts certain patients at a disadvantage.

And no matter what, you know, we try to do around the system that exists, we can't get rid of that disadvantage if we use the same system.

>> Because for so this is both.

Pregnancy is supposed to be a joyous time, right.

For for anyone.

but black women, there's a fear there, right?

When we're going in to give birth now there's a fear that are we going to make it out?

And I say we because I'm a black woman.

what are you hearing from your patients?

Is there is there a fear towards the health care system currently?

I know we have a historic distrust, but is there still fear right now?

>> Yeah, especially if you're entering a health care system with people that don't look like you.

that can be a little fearful.

for some women so they enter the health care systems you know, they become impatient.

They're afraid.

and then they're seen as angry, and then it just kind of snowballs from there.

So then, you know, you're going home into a community where you don't feel safe raising your baby.

And and also when you're interacting with the health care system, if there are any, any social needs that, that you address, you're treated like a criminal.

So like you may not be able to say, hey, like, you know, I'm really struggling because I have housing insecurity or I have food insecurity because then that might set off the alarms and now it becomes an issue where you have to be policed through, you know, child protective services or something like that.

So, it's just very stressful because even in the best conditions and the best, you know, medical conditions, socially black women are just really stressed out.

>> Yeah.

And, Eva, do you see a significant difference in attitude when it comes to your your black birthing people?

>> often, yes.

You know, it's not universal, but I think there is fear.

And fear makes people not only release hormones that affect their pregnancy, but also it makes them react to situations differently and be perceived differently.

And so, as Tracy said, it can escalate because what's a normal fear reaction gets taken out of context and gets used against patients in certain circumstances.

>> So how do issues like provider bias and rotating clinicians and lack of health literacy plans like birthing plans?

How does how does this play a role in in the outcomes that we're seeing?

>> When I was a new nurse, we we I worked in an environment where if somebody walked in with a birthing plan, we were like, oh, they're going to have a C-section.

And perspectives have changed because as a practicing midwife, I really work with people on their birthing plans and their birthing preferences, but it's a matter of just earning the trust of the patient no matter what color you are, right?

because if they don't trust you, it doesn't matter what's in that birthing plan.

You know, if they don't feel like it's going to be honored, right.

but just making sure that the patients that I see, no matter what color they are, but especially patients of color, understand that, you know, even though I'm, you know, trained as a, as a midwife, right.

So I have this, you know, extra medical training even when things fall off, the birth plan that they can trust that I have their best interest at heart.

>> And Dr.

Eva, I'll say, doctor Eva.

establishing that trust with your patient from the beginning, right.

How important is that?

>> So it's critical.

I mean, trust is really the foundation of any patient provider relationship.

It's probably the foundation of any relationship in general, but it really amounts to listening and truly hearing what your patients are saying.

And we have created a medical system where there's often more of a rush to medical appointments than is conducive to to good listening.

And so that needs to be addressed.

You need the time to know your patient as a person and be able to hear the fears between the words, right.

Sometimes they either don't know how to express the fears or are afraid to express the fears, and you need to spend enough time with patients to really understand what their life is like, what this pregnancy means to them, what it means to their families, and how to help them get through the pregnancy in the safest possible way.

>> Correct.

And sometimes that means, you know, because we only have 15 minute appointments for prenatal visit.

But if I suspect that somebody is struggling, their next appointment might be with me in a week instead of four, or I might say, you have some time.

I have another patient.

I'm going to go see her.

I want you to sit for a minute.

I'm going to come back and see you while they ruin my next patient.

You know, like just trying to figure out how I can best serve that patient in that moment because they're so vulnerable.

But you touched on something else.

in terms of colleagues and unintentional harm and biases, and we just have to call them out.

>> Yeah.

>> There's no other explanation or no other solution.

So, you know, if you see somebody say something or doing something, and I'm not saying that people come to work, you know, physicians, midwives, nurses come to work every day and say, I'm going to be a racist.

You know, that's not that's not what's happening.

But, you know, we all have biases.

And sometimes unintentionally, your impact and your intent are completely different.

So whenever those things aren't congruent, if I witness it, I will say something without putting them on the defensive.

Of course.

Right.

>> So holding our our our colleagues accountable.

Sure.

>> And just holding space for the mistake.

Yes.

Without, you know, wanting them to, you know, sit in their car and cry like, I don't want that.

But just having those open conversations about, hey, I heard you say this, but this is how I think it landed for the patient.

This is how it landed for me.

And I want to talk to you about it.

>> So.

So what?

Dr.

Eva, what originally drew you to obstetrics and gynecology?

And and now witnessing all these healthcare disparities, like, how are you feeling about this, this health care field?

Now?

>> So I am a high risk OB/GYN by training.

I do high risk pregnancy almost exclusively.

So I was drawn to the field because of the potential complications, but not to allow them to cause harm, but hopefully to prevent harm from occurring in situations that are starting from a challenging place.

So.

So I appreciate all of the different ways that pregnancy can go wrong.

And that's true in patients who start out completely healthy in a pregnancy.

But it's particularly true in patients who are starting with underlying medical conditions like hypertension or diabetes.

And so some of the the disparities that we see are because patients black and brown patients might start a pregnancy with a higher risk for hypertension and diabetes because of the stress of racism.

The food food deserts in in which they might live, the the the higher rates of certain diseases in certain populations.

And so my goal in starting this career was to make things better.

And it is very disheartening to see that now, I've been doing this for several decades, and many things have actually gotten worse rather than gotten better.

And they've gotten worse for both blacks and whites, but not in a proportional way sometimes.

>> And how is OB/GYN practices?

How are they helping address these gaps in care?

Are the current strategies working.?

>> So, you know, one of the things that Tracy and I have been involved in is a very community wide effort to address these issues, not directly from the medical perspective, but really from the community perspective.

So we've partnered with community organizations like Common Ground Health and Health Connect One and Healthy Baby Network, who have good, solid, trusting relationships with members of the community and as well as the Rochester Regional Health System, Anthony Jordan Health System, and the University of Rochester Health System to try and look at this from a broader perspective.

We've been trying from the pure perspective for many years, and we're better at some things, but we're not better overall.

And I think the reason is because we haven't had that strong community input to really look at things from the patient's perspective as to what goes well and what doesn't go well, and how to make things better.

So, you know, we've we've we've partnered with doulas.

There's a doula presence in our community.

And that's a really nice way to get at the voice of the patient in a trusted way.

>> So so Tracy, we want to talk about the maternal and Child Health Advisory Group.

Right?

I think that's what doctor E was referring to.

can you can you take me inside a meeting with with this group?

And what are the conversations like?

>> the conversations are trust building conversations.

So they're not always about what it is that we need to do in the community to try and fix it.

Like that is a broader conversation, and it's going to take a lot more meetings.

And, and that type of thing.

But just trying to figure out what our goals are as a group and ways that we can reduce the silo work that has been going on because we all have the same goal, but we're all doing a multitude of different things, so how can we come together and join forces and expertise to push the needle forward in the right direction?

So right now we meet.

There's laughter, there's serious conversations, there's food.

And you know, you know, we sip things and just trying to understand that we are all in the same boat, rowing in the same direction and then defining what that looks like for our community.

But at the same time, including community in as well, because oftentimes we say we're going to go in and do X, Y, and Z, you know, for the community.

But that's not what the community asked for, you know?

So just trying to figure out what direction we need to go in next and building upon that, that framework.

>> And I'm sure it's not all peaches and cream.

Right?

I know there's some.

Is there some conflicting viewpoints?

And do we see or not?

Is everyone on the same page?

>> I think everybody has been on the same page.

From what I can understand.

I've had great conversations with people at the table.

I try not to sit at the same place every time.

I since forming the group, I asked that we bring in doulas at the table.

There's mental health professionals at the table.

I also ask that the Rochester Black Nurses Association have representation at the table.

So just, you know, bringing in the right people at the table to define or help define how we need to be more presenting to the community as a unified group to earn the trust of the community.

We need to 100% disclose to the community what we're seeing and then be receptive of the feedback that we also get from the community and build with the community.

From there.

>> And there's a lot of talk of including the community have to how are we doing that?

How are we including the community, and what are we hearing from?

>> so.

>> The community.

>> As a health care provider, I've basically heard that because I'm not in the the realm of working in the community in terms of being in a nonprofit in that world.

However as a healthcare provider, I've walked into rooms with patients and they just kind of look at me like I fell out of the sky because there's not enough people in midwifery in Rochester who look like me.

Yeah.

So as a, as a black midwife, I understand that the patients are asking for a better or a bigger presence of black midwives.

where I work.

>> And Dr.

Eva, what are you hearing from the community?

in regards to finding resolution.

>> So I think this is the hardest part is how do you reach sort of all aspects of the community in such an endeavor?

You know, we hear from a few vocal people who have either had a good or bad experience, and they want to share that, but we really want our our input to come from different places.

And so by working with many different community organizations, we're hopeful that we can really get that broad voice.

And so that we address all of the concerns and not just the ones that are most loudly stated.

>> So.

So what are some of the biggest challenges that you're you're finding?

Are you there's no challenges at all.

What are some of the biggest challenges you're finding as far as establishing a common ground?

>> other than diversity?

Like social determinants.

So it's really easy for me to tell a patient who is at risk of developing gestational diabetes because she had it in the past about, you know, diet and exercise.

If she lives in a food desert and doesn't have a safe neighborhood to walk in.

So just being aware of that and trying to figure out ways for patients to be able to address their health care and be safe at the same time.

So, you know that's that's one of them just being aware of what the social determinants are for the community that I'm serving and figuring out how to link that particular person.

And I shouldn't say, you know, woman, mother, that birthing individual to to resources that they need without judgment.

and without criminalizing them for being lacking, for being in a, in a, in a deficit.

>> One word comes to mind for me is accountability.

Yeah, right.

Accountability on the patient's part and accountability on the provider's part.

Yeah.

Right.

How does what does that look like for for the different worlds.

Eva.

Dr.. Eva.

>> Yeah, I think so much of it has to do from starting from a place of understanding.

both the, the patient's understanding, the things that can go wrong in pregnancy, not in a we want to scare you way, but in a these are the things we're looking for.

If you get a headache, you should think of this.

If you, you know are bleeding too much after you go home, after having a baby, you should think of this.

So some of it is increasing the the knowledge base so that the things that might be leading to harm are caught sooner and that education is done in a meeting.

People where they are kind of way, rather than assuming they know everything and therefore telling them nothing or treating them like children when they're clearly adults.

And so it's a it's a matter of developing that, that understanding and that common language that people are comfortable with.

And of course, that is what where the trust comes in.

Without the trust, you can't really get there.

>> Correct.

Like when I see patients in the office, I let them lead the visit.

So I don't go into the appointment and say, you're 18 weeks today.

we're going to do blah, blah, blah, blah, blah.

And thank you and have a nice day.

The question that I ask most commonly is, what do you want to talk about today?

And it catches them off guard a lot.

Yes.

You know, so it's like this is your point.

This isn't my appointment.

This is your pregnancy experience.

This is your appointment.

So I need you to guide this visit.

Yeah, yeah.

>> And, Dr.

Eva, what approach works for you?

>> So it's really can be very different for for different patients.

And I think that's, that's where the listening comes in.

Tracy's approach of letting the patient guide the conversation is a great way to start, because then you know what the patient's concerns are.

And you also know how they express those concerns so that you can match your answer to where they're starting from.

If you start, you know, in a place very different from where they're starting from, you might never get to a point of understanding.

But if you start from where they are, you get there much more quickly.

>> And this approach for for black and brown patients, right.

It's significant right to have them guide this conversation.

Is that something that you stress even more when you do have your black and brown patients.

>> Same across the board.

Okay.

Yeah.

And different people respond to it differently.

And that's okay.

But at least if they see me again during that pregnancy, they know that the floor is open for them to, you know, dictate what it is that they need and what it is.

They don't they don't need.

there have been times like I've had patients who only come see me even for Gyn.

And I saw a patient recently and I just kept looking at her and I was just like I said, talk to me.

You're off today.

And she completely opened up, but only because we had that rapport in the past.

I've only been here seven years.

So we've had that rapport in the past that I was able to pick up on what she was not putting down.

Yeah.

And then finally I handed it to her and she picked it up, and then she ran with it.

And we were able to really touch on what was what was really eating at her during that visit.

>> And Dr.

Eva for the maternal and Child Health.

>> This word is not coming out.

Adversary group.

Right.

What progress?

What does progress look like for this group?

Is it new protocols being formed, new programs.

>> So we're really still in a very exploratory phase of figuring out how to gain not only the trust of each other, but the trust of the community.

And so we've tried different approaches, different interactions with the community.

In fact, some of the group right now are on a road trip to Detroit to look at some of the ways that their looking at improving maternal morbidity and mortality.

So it it's very we're in the seeking mode, right.

Trying to gain the knowledge and the understanding to figure out the next steps forward.

In the past, I think many groups have been too action oriented too quickly, which didn't take into account what the community actually wants or needs.

>> Maternal and child health Advisory group.

I got the word I got it.

The advisory group.

We're going to take a quick break.

And Dr.

Eva Pressman, the chair of obstetrics and gynecology at Urmc, I want to thank you for for joining us with this conversation, we when we get back, we'll we'll speak more with Tracy Weber and answer questions.

We're gonna touch on doulas and all that great stuff right here on WXXI Connections.

>> I'm Evan Dawson Monday on the next connections, we're joined by one of the most prolific American writers, a journalist and an author, David Grann, who has written for The New Yorker.

A number of publications.

He wrote the book killers of the Flower Moon, which became the Scorsese film, and he is coming to Rochester.

We're talking to David Grann about his craft, about journalism and the state of journalism.

In 2025.

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>> And we're back with WXXI Connections.

We're talking about maternal morbidity in local efforts to make changes to improve women's health care, especially for black mothers.

We're joined in studio by Tracy Weber, the director of the University Midwifery Group at the University of Rochester Medical Center.

Now, Tracy, my colleague Evan Dawson spoke with some experts about doulas in health care.

can you speak to the role of doulas and midwives specifically in this context?

>> Yeah, they're they're really, really essential.

so doulas oftentimes connect the dots and that we sometimes miss because when a patient has hired and decided to work with a doula, they have a special relationship that I may not have with the patient.

There are patients.

So the way our group is, the midwifery group, we share patients.

So I might walk into a labor room with a patient that I've never met before.

Right.

But if she has a doula, that doula can help guide me into understanding exactly what it is that that patient wants and does not want for their delivery experience, right?

So they are the go between.

They are the advocates.

They are the the support person.

sometimes they have to advocate for what the patient wants, but at the same time, if things are starting to to kind of get a little risky or concerning, they can also guide the patient into not coercing them to make a decision, but saying, hey, this is what the midwife is saying, that they're concerned about, and let's talk about that.

And then ultimately the decision about where to go from there is up to the patient, right?

Because we believe in shared decision making.

I came from New York City in Brooklyn, and I worked at a hospital where doulas were completely forbidden, like they were not allowed to step foot into the hospital based on one experience that someone had with a with a doula who was overstepping a little bit.

So.

But that didn't mean that you banned doulas from your institution.

That meant that you came to the table and had a discussion about those boundaries.

Right?

But, you know, I have the benefit of working here at the University of Rochester Medical Center, where doulas are just welcomed into the room.

And when they are present in the room, their power is really palatable.

And I tend to back off because I do not want to interrupt the dynamic that they have with their patients.

So I am like, you need me.

Okay, bye.

And then also also sometimes, like, you know, I don't have one patient admitted at one time.

I've had four patients in labor at one time.

So, you know, I'm running from room to room, answering phone calls, going to triage.

I may be rounding.

We perform circumcisions like we do all the all the things.

Somebody might need a C-section.

I'm in the or, you know, helping with that.

Meanwhile, the doulas with the patient.

Right.

So they are a huge support not just for the patients, but they do love me too.

>> Wow.

So that relationship between midwife and doula, it's it's important.

Yeah.

So when you were in that that hospital where doulas were not that you roll your eyes.

Yeah.

When were banned.

Right.

Did you see you see a difference in patient care when it comes to.

>> Yes.

>> Birth and labor and delivery.

>> Yes and no.

because even here, not everybody has a dual.

And fortunately in the state of New York, doulas accept, you know, different insurances now and that type of thing.

So that makes doula accessibility improved.

in the past, that was definitely a disparity there because you can have a doula if you could pay for one, you know, and if you couldn't, then you know, oh, well but yeah, I mean, the family members too were important in New York City.

Like, they would kind of come in and, you know, support and do things sometimes they did not.

but yeah, I yeah, yeah.

>> So when, when a doula is not present.

Right.

Yeah.

Yeah.

As a, as a midwife, do you have to be that consoler and a clinician if.

>> That's what the patient asks for.

Like I was in a delivery once with this patient who did not want me to talk to her.

She didn't want me to look at her.

She didn't want me to touch her.

The lights were out.

She had headphones on the whole time.

She didn't look at me.

She didn't face me.

She was on her hands and knees.

She was rocking.

She had the most beautiful delivery.

And then after she was like, boop boop boop boop boop boop boop.

And I was like, oh, you do talk, you know?

But she was in her zone and I didn't dare interrupt her.

I just meet people where they're at in that moment.

I feel worse for people who are birthing by themselves.

Like, that's horrible.

So I try to be there as much as I possibly can.

The nurses at the U of R are great and very supportive as well.

so, you know, they're in an in and out of the rooms, but sometimes they have more than one patient.

Right?

So it's really difficult if I don't have one patient.

I remember having a patient that I stayed in the room with until she delivered.

I remember being a new midwife at a hospital, another hospital in Brooklyn, and I literally the patient was laying on her side, and she was determined to have a natural birth.

And she had such horrible back labor.

And I turned her on her side, and I was almost like leaning in, laying next to her in the bed, giving her a counterpressure.

And she had the most beautiful delivery, like we were just like working in that, in that bed.

And, and her family just kind of stood off and watched.

So I intervened.

She was my only patient, so I was able to give her more 1 to 1 care.

But sometimes that is a challenge if you're, you know, having a really busy shift.

>> Yeah.

And for, for black and brown patients.

Right.

Having a doula, would you recommend recommend this.

>> Sure.

I recommend it for everybody.

I wish I had one.

my daughter's dad was amazing though in labor.

Like he was really great.

But you know, not all partners are can do that, right?

Like, it takes a special type of you've got to have some grit to, you know, give some labor support.

And I really commend doulas for that because they do like, you know, they're making sure that you're hydrated and you have your snacks and you're in the water and you're out of the water.

And they're advocating and they're watching over you every step of the way.

Not all family members can do that.

Like I've had dads gagging and deliveries.

We've had dads pass out.

And mother, you know, my grandmother was there when my aunt had her baby and she said, I will never, ever do that to myself again.

Like she was traumatized by it.

So not everybody, you know, not every family member can do that.

And that's okay.

That's okay.

I always ask too.

I've had dads who are just like, absolutely not.

Like, I can't even look.

I'll just stare at the head of the bed.

I can't even look at anything below the waist.

And I've had other dads help me catch the baby.

>> Yeah.

>> So I just meet everybody where they're at, and it's important to be very family centered in that respect, too, because they're all my patients.

It's the mom.

It's the her partner.

It's the the, you know, the baby.

Like it's a whole experience.

>> And is there a times where there's like a tension, right.

There's is there conflict between doulas and midwives at times between the clinic, the clinical practice and and being a supportive is there is there a moment where you remember that there was some type of.

>> Yeah, I'm just like, I don't think we're all on the same page here, but sometimes you got to step out of the room and say, okay, we need to regroup because something here is amiss.

Sometimes we get it right and sometimes we get it wrong.

and that's okay.

but that's how you also grow.

>> Yes.

>> but yeah, that can be a challenge.

>> And talking about tension, right.

Is there do you experience a tension between traditional medicine and midwifery?

>> I personally do not.

Yeah.

but yeah, that can be a challenge.

because we, we try to.

Okay.

So as a certified nurse midwife.

>> Give it to me.

Real?

>> Yeah.

>> The doctors.

>> The doctors are my backup.

Yes.

You know, they are my backup.

So when I have a postpartum hemorrhage, a retained placenta, my patient needs a C-section.

They need a vacuum delivery.

They need forceps or whatever.

Or complicated repair.

Whatever the case may be.

they got my back, so I make sure that I communicate with them every step of the way.

I just admitted a patient.

Oh, my patients.

I'm not really happy with her strip.

I'm keeping an eye on it just so that they know that I'm, you know, keeping them aware of what's going on.

Because the worst thing I would hate to do is to have an emergency.

And they not even know that I admitted a patient.

Right.

So, you know, I really try to keep them, the OB team and everybody aware of what's going on.

That's another trust building thing, right?

Yes.

They have to be able to trust me, but I also have to trust that they have my back.

And that has been my experience no matter where I work, like I've always operated in that way.

>> What are some of the biggest fears that you hear from from from women or C-section?

>> I do not want to have a C-section.

>> Because it feels like the complications occur with C-sections.

What's going on there?

>> hemorrhage, pain, you know, worried that you're going to lose your fertility if you hemorrhage and have an emergency hysterectomy and that type of thing.

>> How common is that?

Is that common?

>> it depends.

So like you know, if you're a patient who is determined to have that vaginal delivery and you push for 12 hours, that increases the risk of having a hemorrhage because your uterus is tired and not going to contract, as opposed to somebody who comes in and they're breech and they they decide, I'm not going to push.

I'm just going to have a C-section.

so I think it just kind of depends on the overall clinical picture for the patient.

as opposed to, just saying X amount of percent of C-sections ended hemorrhage because it's like so many things that you have to take into account.

>> So this explains why when people mothers are like, no, I don't want a C-section, right.

>> Because you don't know what to expect.

You don't know if you're going to be that patient who's pushing for 12 hours, or if you're that patient who comes in grossly ruptured, right.

Your your water broke and you come in and you're like, what do you mean?

My baby's breech?

You know, like you never know what to expect.

And I think the thing that people fear the most that I have to coach them through, especially in prenatal visits, is, you know, letting go of fearing the unknown.

>> Yeah.

>> I went through that when I was pregnant with my daughter.

Like, I was like, I don't know how I'm going to act.

I don't know what to expect.

And her dad was like, you'll be all right.

You'll be fine.

And I was I was okay.

>> Because my labor and delivery was ten minutes.

>> Oh, wow.

Yeah.

That person.

>> Yeah, my son was ready.

He was ready to come into the world.

I think he was fed up with me and my food options.

But he was ready to come into this world.

So ten minutes I was in and out.

Wow.

Meanwhile.

>> Meanwhile, I was 41 weeks and four days.

My daughter would not come out.

She's still glued to my hip to this day.

She's 18 and says that she's never leaving the house.

Like, that's that's that's my my baby.

But when it came time for me to push, I had a complete meltdown.

Mind you, I do this for a living.

It didn't even make any sense.

I told the doctor that I was not pushing.

I was like, absolutely not.

I'm not doing that.

And he just stood there and he rolled his eyes.

He said, you don't even need me here.

And guess what?

I pushed for three contractions and I had a baby, but I just needed to get out of my own way.

>> Yes.

Yeah.

>> To make it happen.

>> So what kind of things do you do?

You want women you wish more women knew before walking in to the hospital?

>> that's as well.

You know, once again, it depends on where she's at, you know, so like, you know, are you planning.

Is this your first baby?

Is this your second baby, or are you planning a vaginal birth after a C-section?

Or, you know, or not?

You know, what other things do you have going on during your pregnancy?

Like, is this a completely quote, unquote normal pregnancy, or are we concerned about your blood pressures?

are you going to need to be induced?

Are you not going to be, you know, need to be induced?

And can we just wait for natural labor to occur?

So, you know, in terms of coaching women, you know, about what to expect, it kind of depends on the course of their pregnancy.

Overall.

>> Do you have a story where the collaborative care, the health care system, it just worked well for a mother.

>> Oh my gosh, all the time.

On a weekly basis, every vaginal delivery to me, even for patients who have preeclampsia or you know what?

That bleeding was a little crazy.

Or, you know, we're worried about blood sugars or, you know, I delivered once at 11 pound, ten ounce baby.

I'm so proud.

>> Wow.

Wait, wait.

Hold on.

11 pounds.

>> Ten ounces.

That was my biggest.

But was.

>> That a vaginal delivery?

>> Sure it was.

Yes.

>> Wow.

>> So.

But just in terms of, like, the newborn care, because that baby needed a little extra surveillance just to make sure.

Because when they're that big, their blood sugars tend to drop and they don't feed as well.

And, you know, different things, but everybody, including we can't leave pediatrics out of this conversation.

Everybody comes together to make sure that that mother and that baby goes home together.

Yeah.

Happy and healthy.

And those are the success stories.

Every time I see somebody walking out of the hospital with their baby, I'm like, great.

>> Is that why you chose midwifery?

>> I don't know.

>> Well, let's call you Urmc.

>> I know.

>> Right?

>> So I told you this before, but my I just had since being a little girl, like an obsession with childbirth.

That was not to be explained.

And but I detoured, right?

So I decided I wasn't going to medical school.

I saw some documentary about people who are career changing into medical school, and they were at Harvard and they were getting beaten, like it was just really brutal.

But this was back in in the 80s, right.

So I said, I'm not doing that.

Like, I don't think I have the intestinal fortitude for that.

Like that's just not for me.

So I decided to go into healthcare administration.

So those were my former degrees were in.

But then after, you know, eight years of working for city government, I decided to become a nurse and then a midwife.

So just and for my master's degree, I did a research project with midwives.

So, you know, long story short, someone said to me, you ever thought about becoming midwife?

And I was like, whoa, right?

Oh yeah.

And then as soon as I made that decision, though, talk about the universe, the doors, just like lined up.

I'm not going to say it was easy, right?

Like nursing school.

Midwifery school is hard, but I would never have it any other way.

>> So why not a ob gyn?

>> I didn't want to go to medical school, and when I decided to go into this profession, I was older, like I entered nursing and midwifery school.

I was like 31 or so and I said, okay, like I could have a midwifery degree in three years.

I had to quit my job and I relocated out of state to go to school and that type of thing.

But I knew that OB-GYN degree would take me eight and I would be nearing 40.

And I was like you know, I don't know about that.

>> I want to be younger.

Yeah.

>> I want to start like, I just need to get this because it took me so long to make a decision, you know?

So I was just like, you know, and I'm happy with my decision.

And I work with.

Amazing, you know, ob-gyns.

So you know, I'm fine with not doing lots of complicated surgeries and things, but I love listening to their stories about the things that they do.

And I learned so much from my ob gyn colleagues.

So it works really well for me.

>> Oh, so what kind of clinical practices and guidelines do you think right after hearing these stories, and in your experience as a midwife, what do you think should be in place to improve pregnancy care?

>> It would great.

It'd be great to have longer appointments.

Yeah.

You know, but it is.

>> What to touch on that.

And staff shortages.

Right.

Yeah.

And how, how how that plays in because our first hour we were talking about PA and NPS and.

Yeah.

And the need for that type of, provider.

>>, more midwives and more ob gyns of color.

but that's not to say that OB GYNs of color don't also get themselves into trouble.

Right?

Because remember I said I worked in New York City?

but the one thing that I need everybody to understand is that nursing and medical school education was all built upon that, that framework that stands on the backs of slavery and enslavement.

So, you know, some of the the paradigms that we were taught in need to, to shift and people need to recognize that when they see it in their own practice beyond graduation.

So case in point, I was in nursing school and we were learning about circulation very early in nursing school.

So the instructor was teaching us about skin blanching.

And if you press down on the skin and it blanches, it turns pink around it.

So I'm sitting there now.

Black people's skin doesn't do that.

So she had us all doing it.

And it was for black people in the class out of, I think, 75 of us and four of us were black in our in our class.

So I turned around and I'm looking at my friends and shrugging.

So I raised my hand.

I was like, I'm sorry, but how do you how do you assess that in skin that has more melanin in it?

And her answer was, I don't know.

And she moved on to the next question.

That's a problem.

>> Wow.

>> Especially going outside of you know, we're talking about black maternal health.

But if you look at skin breakdown in people of color, by the time they realize that we have pressure ulcers and wounds and that type of thing, they're far advanced, whereas they're easier to recognize in white skin, but in black skin, the the indicators for skin breakdown, like the things you need to look for, are completely different.

>> So are you saying providers some providers need to go back.

We just need board.

>> Yeah.

We just need to go back and say, hey, like I learned it this way.

I need to kind of unlearn it a little bit because now I'm speaking to, you know, black people.

I'm speaking to brown people, I'm speaking to indigenous people, and also the cultural competence there as well.

Right.

I'm speaking to Christians.

I'm speaking to Muslims.

Like I've had conversations with my patient, and I know that they're Muslim, and I'm looking in their chart and I'm like, oh, you know what I'm going to add in here?

That you need a pork free diet.

Like, those are the things that are pretty obvious to me.

That may not be obvious to somebody else, so that when they're admitted in labor, I don't want anybody to bring bacon to their to their room.

Like that would be offensive, right.

Or I've had patients where I know that culturally bringing cold products to their room is not acceptable.

They only want warm things after delivery.

Like, these are all the things that I learned and what I don't know.

Guess what I do ask, right?

So the same is true for you know, LGBTQ patients, for our deaf patients.

Like we just have to figure it out.

I asked lots of questions like, I'm a very nosy provider.

Tell me more about, you know, your religious practice and what it is that I need to know to best serve you.

>> Yeah.

>> I asked them and they always appreciate it.

This house.

Am I going to know and not offend?

>> Yeah, I think providers are just moving so quickly, right, that we're not establishing that rapport.

Right between provider and patient.

That is necessary.

>> And that's what's important.

>> I did that.

Thank you I appreciate this.

This is why I'm here.

but if you could change one thing about how institutions handle maternal health right now, what would it be?

>> One thing.

Wow.

>> so there's plenty of there's plenty of there's plenty of things.

What would be your top three?

>> Accountability.

>> That was my word.

I think you.

Yeah, yeah.

>> Hold people's feet to the fire.

and it doesn't mean people need to be fired.

Right.

But sometimes really difficult conversations need to happen.

And I tell people all the time in those difficult conversations, when you're uncomfortable, that is your period of growth.

that's where you're going to grow.

So sit with that.

Like, sucks to be you.

I'm sorry, but sit with that.

And then let's talk about how to get you out of the muck and mire of what you stumbled yourself into.

So definitely accountability.

education.

Yes.

And community building.

mm-hmm.

>> And how how are we how are we community building.

>> With our groups.

>> Yes, yes.

>> So I'm really excited about the group and can't wait for them to get back from Detroit.

Dr.

Pressman and I were grounded for different reasons, but just building from that more conversations about maybe opening a birth center.

How can we expand midwifery?

How can the different health systems between U of R Anthony Jordan and Rochester Regional Health come together to serve our communities better so that we're just not all, you know, looking back at each other and, you know, not operating in a way that we're trusting.

Right.

Because we want to do right by the community.

But we just have to work in a more collegial way.

>> Yeah.

And the advisory group has a lot of heavy hitters on that on that panel.

Right.

In that in that group.

And what are we hoping to accomplish ultimately?

>> Yeah, just exactly what we've been saying.

Like, you know, building becoming more of a united force and more community facing in that way, you know, because as it is right now, nobody knows where to look.

But if we are all on the same page and, you know, coming together to say, hey, we hear you, we see you, then that's important.

>> And the resources.

Yeah.

Can we, can you do you have some resources that you think black mothers and black and brown mothers should, should tap into?

>> Yes.

There is a black doula collective, I believe, still here in Rochester.

There's a healthy baby network.

there's common ground health.

There is the Rochester Black Nurses Association.

There is the Rochester Black, I think is a physicians group where people can find providers who look just like them based on what it is that they're looking for.

there's also different organizations for brown women here.

This organization's for indigenous women here.

I'm still learning who they all are.

I would love to get the latter two that I just mentioned.

Also, at the table.

Yes.

because we really need to earn their trust, especially given what's been going on politically.

I fear that we're going to start seeing more women who are immigrant coming to the hospital in distress because they may be afraid to seek prenatal care.

So just understanding that we can earn their trust.

And, heck, maybe I need to come to you and do that prenatal visit.

If you're afraid to leave your house.

Like we need to just figure out ways to to bridge those gaps to make sure that that people aren't falling through the cracks.

>> so how ultimately, how do we end this crisis here in Monroe County?

>> It's going to take another hundred years.

>> Oh my gosh, it's going to take.

>> A long time.

>> I was hoping we didn't end on that note.

>> We just have to keep working together, that's all.

And not lose the momentum.

>> Thank you, Tracy Weber.

Thank you for sharing your expertise and having this conversation with me.

I really appreciate you.

And to Dr.

Eva Pressman, thank you for joining us earlier.

That's it.

We talk about maternal morbidity here on WXXI Connections.

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