Bonnie Boswell: For many people, having a child is one of the greatest joys in life.

And it should be.

But for too many American families, that happiness is shattered by the death of the mother.

Man: Every time I tell Kira's story, I'm right back in that hospital room.

I can hear the beeps of the monitors.

I can smell it.

I can see the look on her face.

Boswell: White moms in America die more often than women in countries like France, Germany, and New Zealand.

And when you add in racial disparities, well, the situation becomes even worse.

Black women in the United States experience 2 to 3 times the rate of maternal mortality than any other race or ethnicity.

Man: What we expected to be the happiest day of our lives, and we walked straight into a nightmare.

Boswell: I wanted to find out why maternal health had deteriorated from when my sons were born, what needed to change, and where there were signs of hope.

Announcer: Funding of this presentation is made possible by the California Wellness Foundation.

The Ralph M. Parsons Foundation.

And Liberty Hill Boswell: Several years ago, I read an article in "The New York Times" that said, "Why are Black mothers and babies in the United States dying at more than double the rate of white mothers and babies?

The answer has everything to do with the lived experience of being a Black woman in America."

As a Black woman in America, my hair was on fire.

I was like, "What is going on here?"

Something's going on here that's not making any sense.

And I just had to learn more.

Why is this happening and what can we do about it?

I was invited to a panel, and one person in particular really caught my attention, and that was Charles Johnson.

Johnson: This inability for the people that are being trusted with the lives of these precious women to see them and value them the same way that they would see their mother, their sister, their daughter.

Boswell, narrating: After that evening, Charles went back to Georgia.

Then the pandemic struck.

When he finally came back to L.A., we were able to talk about what he was going through.

Johnson: I tell this story nearly every day, and it hurts every single time nearly 6 years later.

I was fortunate enough, like I say all the time, to meet a woman that absolutely changed my life.

And so when we talk about my wife Kira, we're talking about literally the most amazing person I had ever met.

We're talking about, Bonnie, we're talking about a woman that raced cars, who ran marathons, who had her pilot's license, who spoke 5 languages fluently.

She was really sunshine personified, right?

She walked into a room, she lit it up.

We welcomed our first son Charles V in September of 2014.

And so we found out we were pregnant with Langston, our second son, we were over the moon.

So excited, so ecstatic.

It's important for everybody that's watching this or that hears the story to understand that throughout Kira's entire pregnancy, she was perfectly healthy.

All signs pointed to her being perfectly healthy, as well as our new son Langston being perfectly healthy.

So on April 12th of 2016, we walked into Cedars-Sinai Hospital for what we expected to be the happiest day of our lives.

And we walked straight into a nightmare.

We walked in-- we went in for what was supposed to be a routine scheduled C-section.

Very importantly, at our doctor's recommendation, there was--he recommended a caesarean because Kira had had a caesarean birth with our first son Charles.

And we trusted him.

Boswell: Yeah.

So let's see here.

Here I am pregnant with my first son.

And I guess this is my baby shower.

And here I am in the hospital getting ready to deliver, which was very nerve-wracking.

I began to think about my two high-risk pregnancies that I'd had many years before.

I started learning more about Black women and the fact that even educated Black women like myself who had resources were dying about the same rate as an eighth grade educated white woman.

And I just didn't understand that income and education were not safety nets for me.

There have been many studies that suggest that our lived experiences as Black women in America specifically are such that we have stress.

And I know this for a fact as myself as a mother, you're kind of always looking over your shoulder, and, you know, it is stressful.

And that can actually be passed down through the body to our children, that level of stress, the hypertension.

So it seemed that there were some systemic issues at play.

So, you know, the Black women and Brown women and their experiences were like the canaries in the coal mine, kind of signaling that something deeper was at hand here.

So I wanted to go further to talk to doctors in particular who are on the frontlines of this situation.

Strahan: Now to a GMA Health Alert.

A new report released overnight by the World Health Organization found maternal deaths have increased in nearly all regions of the world for the past 5 years, including in America.

Reporter: A global increase in women all over the world dying from pregnancy or childbirth.

A death is occurring every two minutes for a pregnant woman.

Boswell: So for people who don't know, talk about the challenges that America is having with maternal mortality.

Ramos: In the United States, we have one of the highest maternal mortality rates of developed countries.

And this is unacceptable because we are spending a large percentage of our gross domestic product, of all of the money that is coming in, almost a quarter of it, on health.

Yet we are not having the outcomes that you would expect.

We've seen here in California, it's when you identify the data, when you identify the opportunities for improvement, and you work together with partners from hospitals to health care providers, that could be physicians, that could be nurse practitioners, that could be doulas, and the community, we improve the outcomes.

Boswell: Hello, Miss Cutie.

So let's start talking about your personal experience in pregnancy.

Woman: My pregnancy was not a smooth one, and it was not an easy one.

And my birthing story was also not a smooth one or an easy one.

So my OB-GYN was African American, and I was intentional in choosing an African-American OB-GYN.

There have been studies that have demonstrated that as a Black person in America, having a physician who is also Black, it impacts your outcome.

And so knowing this, understanding that even in my high education, my high socioeconomic status, I'm still at risk for having those bad outcomes, I opted to have an OB-GYN who was culturally understanding of the nuances and the challenges that Black women face when pregnant.

Boswell, narrating: A game changer helping California reduce its maternal mortality by more than 50% was the creation of the California Maternal Quality Care Collaborative.

Man: We found that there was no simple answer.

We feel that maternity care has been under-resourced for many years.

Insurance companies, including Medicaid, pay a very small amount of reimbursement for maternity care.

Yes, there were increases in hypertension and diabetes, but there was a lot of issues beyond that.

One of the things that stands out perhaps the most about maternal mortality is the disparity of outcome among different races or ethnicities.

Black women in the United States and Black women in California have 2 to 3 times the rate of maternal mortality than basically any other race or ethnicity.

Gateau: Late in my third trimester, started to have changes in my blood pressure, and those changes didn't technically meet the standard definition of preeclampsia.

Boswell: What is preeclampsia?

Gateau: So preeclampsia is a blood pressure condition that happens for, you know, still a lot of research and not fully understood, but usually you have really, really high blood pressure, and the only cure is to get the baby out.

But my OB-GYN was very astute and she was like, "Your blood pressure trend has been going up and I'm concerned."

And so she actually made the decision to have me monitored more closely with a plan to induce my labor if anything was not going how it was supposed to.

Luckily, I went into labor on my own, but during labor, I then developed full-blown preeclampsia, and she was hyper-vigilant knowing that I'm at higher risk because I'm a Black woman and monitored me and then made sure that during the birthing process that, you know, we had what we needed to make sure that I was safe and my baby was safe.

I think it made all the difference.

Johnson: 2:00 in the afternoon, Langston was born perfectly healthy.

This beautiful, amazing, healthy baby boy.

Everything that we had prayed for.

And it was finally here.

This was it.

Everything we had hoped for.

So I'm sitting there.

Kira is resting.

Langston is in the little newborn toaster oven incubator thing.

And I'm just sitting there just watching them and just thinking about just how tremendously blessed I am.

And as I'm watching Kira rest, I look down by her bedside, and I can begin to see the Foley catheter turn pink and red with blood.

This is around 4:00 in the afternoon.

So I brought it to the attention of the nurses and the doctors at Cedars.

They came and they examined her, they ordered bloodwork and some other tests.

And very importantly, they ordered a CT scan that was supposed to be performed stat.

And when they said stat, I'm thinking that means right now.

9:00 comes, I'm still trying to advocate, I'm trying to get answers.

I'm trying to get them to take action.

And the nurse came in to change Kira's bag of IV fluids, and when she got done, I just pulled her aside and I said, "Look."

And I held--I just--I was just--I was desperate.

And I pulled her to the side and I took both of her hands and I squeezed them tightly.

And I just looked her and I said, "Look, can you please help me?

Please.

My wife has been here for hours.

They said that a CT scan was coming hours ago.

It still hasn't come.

They mentioned they might take her back for surgery.

Nobody's come to take her back for surgery.

She doesn't look good.

She's in excruciating pain.

Can you please help us?"

The nurse snatched her hands back from me, and she said words that to this day still haunt me.

She said, "Sir, your wife just isn't a priority right now."

Boswell: Do you remember your first time when you had a patient die who was a mom?

Main: Yes, I do.

It was a woman with severe hypertension.

And we tried to do everything that we could, but she had a stroke.

And strokes are very hard to recover from.

This happened about 10 years ago.

About 3 years ago, I did an interview that was a radio interview that was broadcast nationally.

And the husband of that woman actually tracked me down and called me.

He had moved to an entirely different state.

We lost track.

And he was thankful that things were moving forward to improve the care of women.

And that really made a--that was a big deal for me and our colleagues that there was that kind of support for these efforts.

My training is as a high-risk obstetrician in maternal fetal medicine.

And so I saw very challenging cases, mothers with severe hypertension, mothers with major hemorrhages, mothers who had who had 3 or 4 babies, triplets or quads.

And so I was always attuned to complications of pregnancy.

But then we started seeing them in low-risk patients.

Johnson: It wasn't until 12:30 a.m. that they finally made the decision to take Kira back to surgery.

Kira's the closest thing that I've ever known to a superhero.

And as we're making the walk down that hall towards the operating room and I'm walking next to her bed and I'm holding her hand and I'm doing the only thing that I know how to do, and that's just tell her that everything is going to be OK. Everything's going to be fine.

And Kira said to me at that moment words that I don't think I've ever in all the years that I've known her heard her say.

She said, "Baby, I'm scared.

I'm scared."

And I'm telling her and I'm holding her hand and I'm looking at her eyes and I'm telling her everything's going to be OK.

It's going to be fine.

The doctor that was responsible for the delivery of Langston and who is taking her back to the operating room for the second surgery overheard this conversation between me and Kira.

And here's the thing that I want people to understand is it wasn't just--there's failures of systems.

There's failures of protocol.

But the greatest failure that happened to Kira is a failure of humanity.

And what that doctor said to me is he said, "It's not a big deal.

It's not a big deal.

Sometimes these things happen.

I'm going to go back into the same incision I made during the cesarean.

I'm going to find out what's going on.

I'm going to fix it, and she'll be back in 15 minutes.

She'll be back in 15 minutes."

And so I'm walking next to Kira's bedside and I'm holding her hand, and I finally get to the set of double doors to the operating room, and they open and then they closed behind her.

And when those doors closed behind Kira, that was the last time I saw my wife alive.

Boswell, narrating: Kira's doctor was placed on probation by the Medical Board of California.

I reached out to Cedars-Sinai Hospital and got this statement.

Gateau: Yeah, I mean, I think the unfortunate reality is that, you know, no matter where I go, my Blackness is first.

You know, so, for example, we'll be, you know, in spaces, doctor spaces, you know, where it's just us and, you know, comments about patients, how many kids they've had, you know, whether or not there's a father present, asking questions about, you know, pain and if they're actually really in pain or if they're here for certain pain medications, even in something like when we do hand-off and we're supposed to be a very sort of prescriptive clinical time where we're just passing off information about our patient.

And so I distinctly remember getting a hand-off from one of my colleagues, you know, where they were describing a family and how, you know, they came in and they were so aggressive and we had to call security.

And, you know, we were just, you know, they were really difficult and adversarial.

And so if you don't have to go in that room at all tonight, I wouldn't.

And so to me, you know, I was sitting there being like, there's so many problems with what was just told to me.

Right?

We're physicians.

I should--I have to go in the room.

I always have to go in the room.

The fact that I, as the only person of color on the team, the care team, am being told about this, I am the same ethnicity as the family, my teammates aren't.

Like, am I now the translator, the cultural translator, and I'm being put in a role that, you know, no one else really has to ever step into?

Boswell: So, Charles, you're in this horrific situation.

But you're looking at this from the standpoint of an African-American man.

How do you--how are you processing all of this?

Johnson: Even at that time, having no idea what I would go into, I was acutely aware of the fact that if something were to happen, as a Black man, the way that I was viewed could potentially make a difference in the care or the respect that my family received.

The thing that Kira kept saying to me was, "Baby, stay calm.

Please stay calm.

Please stay calm."

Because even though she was in excruciating pain, even though she was scared and as vulnerable as a human being could be, she knew that as a Black man, that if her husband raised his voice, if he became too aggressive or too assertive, if I became any of those things, I would no longer be seen as a husband that was adamantly advocating for his wife.

I would be seen as a threat and I would be potentially removed from the situation.

And so that's a very tough pill to swallow because I live every day with the fact of like, what could I have done more?

Should I have raised my voice?

Should I have grabbed one of those doctors by the collar?

Should I have slammed my fist on the nurse's station?

Should I have, you know, slammed some monitors?

What could I have done for them to take her seriously?

But the reality of the situation in the country we live in, I don't have the same latitude that a white father has to yell, to scream, to say that I'm going to sue.

I don't have that.

So I had to suppress my instincts and as humbly and as gracious as I know how, beg people.

Beg them to simply prioritize my wife's care.

And even with all that, it still failed.

And so that's a hard pill for me.

I have to live with that every single day.

That the simple color of my skin prevented me from advocating for my wife to my fullest ability, and that the bass in my voice would not have urged somebody, it would have made somebody fearful.

Boswell: Listening to Charles' experience made me reflect when my own son was going into a hospital to become a father for the first time.

And what struck me was that Taylor, my son, decided that it wasn't enough for him as a Black man just to go in in his regular clothes.

He needed something to protect himself, to have blink tests be in his favor.

So he asked my husband, who had been to Princeton, to borrow his dad's hat, that he needed that logo.

And what it caused me to do was to think as I was going out to the hospital myself in my regular clothes, it was like, well, maybe I need that too, just to be on this team.

I'm a Black woman in a hospital, so maybe I need a little bit of extra armor, if you will, just so that people will give us the benefit of the doubt in an uncertain environment.

So I went, turned around and got on my MIT sweatshirt.

Tell me about the work of the Collaborative.

Main: So California Maternal Quality Care Collaborative was established in 2006 with the first purpose to analyze maternal mortality cases in detail and then to establish what we could learn from those and translate that into quality improvement actions in all the hospitals in California.

That involves working in a collaborative to teach people how to establish new standards and new guidelines and to incent those to occur.

So we noted several years ago that while we had success in lowering the C-section rate for everyone in California, while we had success in lowering the maternal mortality rate for everyone in California, we still were not closing gaps between Black mothers and white mothers or Native American mothers and white mothers or Asian mothers.

It was really about treating everyone with dignity and respect and being listened to, being heard.

And that was not happening everywhere.

And so we wanted to go back to basics and help hospitals address those needs in changing culture.

One of the lessons that we learned from the Maternal Mortality Case Reviews was that there were themes that followed most of the deaths--denial, delay, and dismissal.

Denial is when physicians or nurses want to overlook vital signs or overlook statements or overlook things that they're seeing, trying to write them off from another cause.

Delay is related to dismissal, is that you're delaying the treatment based on either poor diagnosis or the lack of awareness.

The biggest one that we've really become aware of more recently is dismissal.

And dismissal is not listening to the patient herself.

But something that patients have been telling us for many, many years, that we're not listening enough and we're dismissing her complaints and focusing on something else.

And that's--that can be deadly.

Ramos: I can't tell you what's happening within each hospital, but in general, there is a culture shift to empower everyone on the healthcare team to be able to speak up, especially when they see that things are not right.

I can tell you that what is being promoted is that culture of being able to speak up because your voice matters as part of the team.

Main: Everyone--nurse, midwife, physician--need to be able to speak up and say, you know, let's reexamine this.

Let's look more closely.

Let's maybe take a different course.

That's a change.

Medicine for a long time has been very hierarchical, very much a command structure that doesn't function well, particularly in emergencies, doesn't function well in terms of hearing all sides or listening.

And we're moving as fast as we can toward collaborative care, which means that everybody gets to speak up.

Boswell: Tell me what is going on in the world of maternal mortality with regard to Black women.

Gregory: We're implementing the bundles.

We are definitely seeing a drop in maternal mortality rate.

So, for example, if you see a high blood pressure, you don't--you don't even have to call the doctor.

In some hospitals, we've made it so that nurses can work to scope and say, "Oh, blood pressure's high.

I'm going to push this medicine.

While I'm pushing the medicine, I'll call the doctor and tell them about it."

But it used to be you'd have to find the doctor.

Then the doctor would have to come and evaluate the patient, and then the doctor would have to push the medication themselves.

And significant amount of time could have passed.

Boswell: So you're standardizing some of this, the warning signs?

Gregory: Yes.

Yes.

So now we're having to educate not only OBs, but the ER doctor and the family doctor that if a pregnant lady or a recently postpartum pregnant woman comes and they're complaining of shortness of breath, don't just assume it's a cold.

Don't just assume it's asthma.

Maybe you should do a workup for cardiovascular disease.

Boswell: Smaller towns, maybe, or smaller communities, rural communities, how can this be reproduced?

Ramos: CDC actually has a whole new protocol on collecting the maternal mortality data, and they based a lot of that on what California did.

For those women who were covered by Medi-Cal when they were pregnant, it is now extended for one year postpartum.

Preliminary data has already shown that for those states where the Medi-Cal has been expanded, Medicaid has been expanded up to one year, the morbidity, the mortality is going down.

Boswell: What has been successful for you?

What have you learned?

Main: One thing we learned from the Maternal Mortality Reviews is there are some simple things that can be done that would make a difference.

So we have really made a big effort for everyone to treat severe range hypertension in the state.

And we've cut deaths from preeclampsia, and that's a big success.

We were able to show that adoption of standardized approaches to hemorrhage actually markedly narrowed the gap between white mothers and Black mothers in their outcomes from hemorrhage.

Once you remove any biases involved by moving to a standardized protocol, the differences between races disappear.

We used to think that Black women did more poorly than white women because of more hypertension, more obesity, or other characteristics, but that's not really true.

Black women who have hypertension do worse than white women with hypertension.

Black women who are poor do much worse than white women who are poor.

So there are--we have to move beyond blaming the patient.

We have to move to making it more equitable for everyone in our system.

And that will in turn lead to more resources being applied to make it a equitable environment for all of our patients, not just an equal environment.

We're also working on microaggressions.

If you're a person of color, there--they add up in a very big way.

Boswell: What has surprised you the most?

Main: That little things do matter.

And, you know, jokes that we might have made are painful or, you know, offhand comments, you know, saying things like, you know, "You're really articulate" is insulting, you know.

So we've learned that.

Said, oh, my God, I've been doing that for a while.

Shame on me.

Boswell: And now do you--are you more sensitive when you hear other people say this in other-- in other settings as well, right.

Main: I must say my young adult children were helpful in straightening me out.

But I am--it is--once you are attuned to it, you pick it up very quickly when others say it.

And that's changing the culture.

And that's what we want to have happen on labor and delivery, where there's enough people who are saying, "Oh, that wasn't a nice thing to have said," or, you know, "You should have framed that differently."

That's the culture change that we're looking for.

Boswell: I think some of the root causes here are racism, sexism, and a hierarchical structure where some people are valued as more important than others.

And we have to really dismantle that thinking in our own lives.

All these systems are connected, and at the foundation of all of them is the thinking that I think really needs to be addressed to become much more humanistic.

We're better than this, and we're living with systems that are really outmoded and outdated.

Looking at how the past is influencing the present that we have to be really honest about and then think, OK, let's make a change.

What can we do now to make things better?

And most clearly is to treat every human being with respect.

That's the bottom line.

Boswell, narrating: So it seems like one of the problems we have here in America is that when compared to many countries, we have a shortage of maternity care providers, people like doulas and midwives.

This when a third of our counties are considered maternal deserts with little or no obstetric care.

But in some places, places like California, people are starting to reach out to these providers, giving them the opportunity to be involved in the birthing process.

So I wanted to visit Kindred Space L.A., a birthing center in South Los Angeles owned and operated by licensed African-American midwives Kimberly Durdin and Allegra Hill.

Durdin: Hello.

Boswell: Kim?

Durdin: Are you Bonnie?

Boswell: I am.

Durdin: Hey, nice to meet you.

Boswell: Nice to meet you.

Yes.

Durdin: I'm a hugger.

Boswell: I'm a hugger, too.

So we're good.

Durdin: Come on in.

Boswell: Let's continue to hug.

Durdin: Welcome to Kindred Space L.A. Boswell: Thank you.

Durdin: And you know, you don't see a lot of medical supplies out, but they're all tucked away in the cabinets.

We have a tray over there that we have medical supplies with our herbs, our medications, blood pressure cuffs, the bowl we use to kind of catch the placenta, all those types of things.

This is a sling, actually, that we use to weigh the babies.

We attach a scale to these rings, and I'll show you.

This opens up.

The baby gets weighed in this beautiful-- Boswell: Wow.

That is lovely.

Durdin: Right?

And then we attach--we put the baby in here like this, and then we attach a weight, and we just kind of hang and we get the baby's weight.

So we have a shower that our laboring mamas get in during the labor to--it's super comforting.

The water is amazing for pain relief.

They can bring in their birth ball into the--into the shower.

A lot of times we're using the toilet for sitting when they're having contractions because that helps bring the baby down.

Also, we have our great birth tub.

It's deep enough, it's wide enough, and it's really beautiful.

Here's the-- Boswell: Oh, wow.

Durdin: You know, and so it's just a beautiful-- Boswell: Yeah.

Durdin: comforting.

Boswell: Makes you feel good, right?

Durdin: Makes you feel good.

And you can really submerge your body deeply into it.

Boswell: It's great.

Durdin: Yeah.

Boswell: Beautiful.

This is a fabulous space.

Thank you for sharing that.

Durdin: You're welcome.

Here's some beautiful white sage.

You can bring that home and let it dry, and you can burn that.

Boswell: Lovely.

OK. Durdin: A little bit of green in this--in this concrete jungle.

Boswell: A little bit of green goes a long way.

Durdin: Yep.

You know, midwifery is as old as time.

So basically a midwife is a person who attends and helps with the birth of another human being.

So a lot of people don't know that in the United States, you know, almost everyone was born in the hands of a midwife.

I mean, we have to remember that when folks were taken from Africa starting in the 1600s, you know, they also came from a tradition of midwifery.

So midwives were targeted to bring over.

They brought their healing traditions, they brought their herbs, and midwives caught all the babies--Black, white and otherwise, you know, and they were very valued.

So we had thousands of midwives over the next couple of hundred years that populated the Southern states.

So there became an opportunity for white doctors who had actually started creating the obstetrics profession, developed techniques and tools and surgeries, experimented on slave women, and then took those techniques to the white women.

Dr. Marion Sims, who is credited as being the father of modern obstetrics gynecology, he is called that because he developed obstetrical techniques and tools that are still used till today by experimenting on 3 Black enslaved women and, you know, repeatedly did surgeries on them without anesthesia.

I think we're in a big time of resurgence.

I think that in the United States, you know, the Black midwife legacy has never truly been lost.

Boswell, narrating: Kindred Space L.A. is also home to Frontline Doulas who do their work here as well.

Riley: I think throughout our programs we have engaged, supported about 70 doulas, and out of that we've also had over 400 families that we've served.

Boswell: And that's been what, how long now we're talking?

Peprah-Wilson: Two years?

Riley: Two years?

Yeah.

And then over 270 people have called our Frontline Doula hotline to get support from a Black doula.

So that's a lot of doula care right there.

The evidence on doulas is that it lowers interventions, it lowers cesarean rates, it shortens the length of the labor, it increases birth satisfaction.

Boswell: And how did you come together to decide to open up the Frontline Doula work that you do together?

Peprah-Wilson: We came together as supervisors of one of the first pilots in Los Angeles to have community doulas really serve, particularly in the Black community.

The classic doula experience has been individual doulas that are out there in the community, serving families who can afford to pay them.

And typically that means higher socioeconomic families.

And even if they are families of color, it's not the same as working with people who would otherwise never be able to hire a doula, who wouldn't have even heard of a doula unless we created a program right there in the community where they're giving birth.

Riley: We would never have known that we would be in this position now with so much success in our program and the doulas even having a doula benefit now through the state with Medi-Cal.

But I think that when you think about the maternal and the infant mortality rates and what is necessary in order to meet that emergency, to meet that crisis and what we have to reclaim in order to relevel set so that way we can really create kinship circles and community circles.

Durdin: One of our biggest supportive hospitals is MLK Community Hospital in Willowbrook, and they are led-- their maternity floor is led by a team of 3 Black midwives right now who work in hospital.

So for us, we've built that relationship, we've cultivated it.

There's so much work to be done, and I have my work cut out for me.

It's about building a legacy that's not only just about me, but is about like, how I can use my life to discover how I can support people in the community and how I can train others to do what I do.

So I am excited about just teaching for the next generation, and I hope that our work continues to grow long after I'm gone.

Main: It takes more than a village to make this effort work, and we want to maintain that momentum going forward.

It is a magic that happens when you have a collaborative.

You get to see and experience what other people in other hospitals are struggling with, realize it's similar, and you get to learn from other folks in other hospitals about what has worked well there.

And that allows you to implement that more easily in your current setting.

Boswell: So when you look at with the medical profession now and birthing writ large, are you seeing any shift taking place in the more traditional communities?

Peprah-Wilson: I think there's a lot of curiosity.

What actually I see us doing is that we're on the front lines with people who have higher health conditions, who also have higher social determinants.

And we're as interested in a symbiotic outcome that works for the family and works for all the people in their system, and these families don't typically have a choice to come out of the hospital system.

Riley: I think that doulas and birth workers reposition the birth back to the person who's actually giving birth and what that family wants and they choose, as opposed to the medical system, it's about their needs and their choices.

Boswell: Hello.

Welcome.

Good morning.

Woman: Hi.

Good morning.

Boswell: Good to see you.

Hello.

Hi.

Hi, there.

She said, "I'm not so sure."

Woman: That's theirs.

Man: All right.

Woman: And I actually trained to become a doula with Kindred.

So once I, like, kind of became a part of that family, when it was time for me to deliver my daughter Indigo, I knew that this was the route.

Will: I've always kind of looked for alternative means for going through certain experiences in life because I'm a very analytical person and I like to look at systems and how they served people and what I want from an experience.

Ashanique: It was beautiful.

It was honestly a blessing to be in the hands of the midwives because I felt like if I had been anywhere else, things could have gone really differently.

I labored for a long time with her.

She came 3 days--well, she was 8 days behind the due date in general, but 3 days of laboring.

Will: I didn't really have time to think about how I felt.

My role was to be there in support of her and make sure she was all right.

Ashanique: So I was at home Wednesday, Thursday.

Friday we came to the birth center because at that point they knew, OK, it's probably time.

The warm-up phase is probably over.

And so we got here at 3:00, and she didn't come until 9:00.

You know, fortunately, her heart beat was fine and all the vitals and medical element was taken care of.

But even still, it's up to the practitioners at a certain point to really like trust you.

And I felt like they trusted me and my body and her to get here safely.

Boswell: And what was it about your knowledge about this process?

Ashanique: For me, I really wanted to be in a space where I felt safe and, you know, having practitioners that look like me, having practitioners that were going to be open to allowing me and my body to do what it's--to me, what's made organic and what's naturally-- what it's naturally able to do.

Boswell: So it sounds like being here was really comfortable.

Will: It's obviously--it's smaller, so it's a more personal experience.

I get to be there for all the appointments, and we have more of a say really on the energy that our child is brought into.

Boswell: Will, what's the experience been like for you as a father?

Will: They kept me included in the system.

It wasn't like a process where it was mommy here and father just off in the corner, go fetch something when you need to fetch something.

I was very--it was a very inclusive and family-oriented environment, and we got to have a say over the energy that Indigo was brought into when she was born.

And it just gave me peace because as long as my family is healthy and safe, as a father, as a man, that's the only thing I really care about.

Boswell: We can't overcome the problems that seem to be coming up all the time unless we look to the root causes, because if we deal with the causes, then we can change them.

People don't want to look backwards, but it's not backwards.

It's like looking at how the past is influencing the present that we have to be really honest about and then think, OK, let's make a change.

What can we do now to make things better?

And most clearly is to treat every human being with respect.

And California is leading the way.

But how do we make sure that we don't get back to this pecking order kind of situation where some people are judged as more worthy than others?

Herrera Beutler: So why is this bill important to you, Mr. Speaker, or to those who are listening?

Well, you either are a mom or you've got a mom.

This bill impacts you.

I stand in strong support of the Preventing Maternal Deaths Act.

Boswell: So tell us a little bit about how often it's happening, what you've learned about it.

Johnson: The Friday before Mother's Day in 2017, a little bit more than a year after the anniversary of Kira's passing, I decided to share Kira's story publicly for the first time.

But as I began to raise awareness, one of the things that was becoming troubling for me is I felt like I was just scaring women and that it was making women and families fearful to have children, fearful to bring babies into this world.

And so in 2017, started writing letters to Congress.

I found out there was one piece of legislation in Congress called the Preventing Maternal Deaths Act, introduced by a congresswoman named Jaime Herrera Beutler from Washington State.

Herrera Beutler: Today, in the 21st century United States of America, the U.S. is ranked 47th globally for maternal mortality.

Johnson: Who is a mother who nearly died in childbirth herself.

And when she got to Congress, she wanted to do something about it.

I've made probably 20 trips to Washington, D.C., to Capitol Hill, meeting with senators, having phone calls, telling my story over and over and over again.

The thing is, is that when data lands on your desk and you see numbers, you can--they might be startling, but you can turn the page.

But if you see the faces of these women, if you see the faces of their children, if you hear their names, if you hear from these families and you hear how their worlds have been devastated by something that is preventable, it touches people's hearts and particularly our elected officials' hearts.

Charmaine Gibson should be here with her son Corey, and her daughter Inari.

She deserves so much better.

Boswell: Tell me about the Momnibus Act.

Johnson: So in 2017, I was honored to be a part of an effort to pass the first-ever federal piece of legislation to prevent women from dying in childbirth, which is the Preventing Maternal Deaths Act.

If and when you were asked by your colleagues why we need specific legislation for Black women.

The clear response is because if and when we fix this for Black women, we fix it for all mothers.

And what this bill did is it created--it gave federal funding to create what are called Maternal Mortality Review Committees in all 50 states.

So the way that works is that anyplace in the country, whenever a mother does pass away from childbirth or childbirth related complications, there is a committee made up of diverse individuals from the community, OB-GYNs, even sometimes medical inspectors, public advocates that review all the factors that contributed to that mother's death.

And what we do is we gather all that data so that we can better understand the maternal mortality crisis, right?

In 2021, we went back to Capitol Hill with a legislative effort that I am extremely proud of and extremely passionate about.

We went back with a package of different pieces of legislation that comprise what we call the Momnibus.

We have a piece of legislation that addresses social determinants of health.

We have a bill in there addressing the specific needs of our servicewomen, a bill addressing incarcerated women and mothers.

We have bills that address how technology and innovation can better support this crisis.

Also within this set of legislation is the Kira Johnson Act, which is a bill specifically named for Kira and that is introduced by Representative Alma Adams, who was one of my sheroes from the great state of North Carolina.

It's going to take steps to diversify the perinatal workforce.

So we're going to make sure that women of color and Black and Brown people who want to have a path towards being a service provider can have the support.

It's going to make investments in, specific investments, in African-American women led, community based organizations, right?

So we're talking about the doulas who are on the ground, on the front line, catching the babies.

We're talking about the WIC programs.

We're talking about the community service organizations that are doing reproductive health, that are doing family planning.

Lots of these organizations are under--or doing the absolute most with the absolute least.

And many of these organizations for the first time will have access to federal funding because of this bill.

And so what we're going to do is it's going to provide funding to create dignified standard of care compliance offices within hospitals.

So our hope is that the transparency is going to be a hammer to hold hospitals accountable, right.

And once again, these are first steps, but they're critical first steps towards transparency and provider accountability.

And that's why I have committed my life to making sure that these things do not continue to happen.

And so what we're going to do is I'm the chairman of what's called the Fairness for Injured Patients Act.

It's not about the doctors.

It's really about these greedy insurance companies.

So imagine right here in the state of California since 1975, these huge, powerful insurance companies have been collecting premiums, malpractice insurance premiums from doctors hand over fist every month in one of the biggest states in our country and almost never having to pay out medical malpractice claims.

Right?

They're raking in record profits while families are suffering, suffering, not able to be compensated.

Their lives will never be the same.

Reporter: Governor Newsom has signed legislation that raises the limit on how much money people can be awarded in medical malpractice lawsuits.

The new law raises that limit to $350,000 for those who were injured and 500,000 for the relatives of people who've died.

The cap has long been 250,000.

It's the first time in almost 50 years California has increased the limit.

Johnson: But we're standing on the side of justice.

We're standing on the side of what's right, and we're going to fight.

And we're going to send a loud message not only to California, but to this country, that you cannot ruin people's lives and not be held accountable.

Because also what's happening as these families are suffering and will suffer for the rest of their lives, these doctors are continuing to practice.

Boswell: What is the state doing, can the state do, to really encourage specifically the development of more community workers and the support, this team we're talking about?

Even, again, in hospitals, you know, how can we build this out?

Ramos: So California is leading the way.

Just recently, there were $4.7 billion invested in reimagining what healthcare is going to be looking like through the Community Youth Behavioral Health Initiative.

And that was through Governor Newsom.

And part of those $4.7 billion is funding to increase community health workers by 40,000.

40,000.

There are grants to increase students to go into social work, into psychology.

There are fellowships.

So there is a huge investment here in California to build that workforce.

Boswell: What can ordinary people who are out there listening to this do to really help Black women have better outcomes?

Gateau: Well, in the state of California, it's now a law, right?

You have to have implicit bias training.

So that's in medical schools and hospitals.

And I think that it's getting done.

You know, people are checking the box, but studies have shown that you'd probably go further if you actually diversify the workforce, right?

And that it's the relationships that are developed.

To some extent, going through medical school or this whole training process is like pledging, right?

And so to the extent that you bond and that you learn someone else's experiences and see how they see something differently, that's really the way we're going to make a difference.

Boswell, narrating: And here's another development.

I sit on the Dean's Advisory Council of a recently accredited 4-year medical school in South Los Angeles.

Charles Drew University College of Medicine will train a diverse group of doctors to serve under-resourced communities.

Carolyn Johnson: Big celebration today in South L.A., where Charles Drew University became the first historically Black university west of the Mississippi to offer a 4-year medical degree.

Prothrow-Stith: It means we can accept applications.

We will have a class of 60 in 2023.

[Cheering] James: To serve the underserved who can't--who don't always have that opportunity, it really means a lot to me.

Ramos: There are several organizations that are focusing specifically on that.

The National Medical Association, the American Medical Association are just a couple that are focusing on physicians specifically.

Gateau: You know, there's a lot more awareness just from, you know, public conversation and it being so present with high-profile individuals.

With regards to formal education, I think that there are efforts and attempts being made, which is the world that I live in, outside of California, in spaces that aren't as progressive, spaces that aren't as open, how are you teaching future doctors about the realities of medical racism?

So I think that because we're at a critical period where we know but there's still so much resistance to even having the conversations, it's difficult to really try to make the standardized changes in education for doctors and trainees to learn what they need to learn with regards to taking care of diverse patient populations.

All you need is best good intentions and wanting to move the needle.

And I think that that is enough of a start for us to start making change in this space.

Boswell: You've become a role model to others who've lost their wives.

Johnson: Solitude is an understatement, right?

But just feeling alone, even though I had my family and extended family that rallied around myself and my boys, I still didn't have anybody that could truly understand what this journey was like, right?

But as I began to advocate and share Kira's story publicly, I began to hear from other men that had the same experience.

And little by little, I developed these relationships one by one, whether families would reach out through a mutual friend or families would reach out through social media.

And I've just tried my best to try and create community within brothers.

And I say brothers without regards to racial background or ethnicity or walk of life.

Like, we're all brothers.

Kira's death has really sparked what we are seeing and what has really become a maternal health revolution in this country.

And so I've had the opportunity to share Kira's story literally all across this country.

And that's really a testament to even though Kira's not here in the physical, we're still partners in this, right?

Kira is present in every single thing that we do.

Every time I show up, we show up.

Boswell: The takeaway for me is that we have to remember the words of Martin Luther King who said, "What happens to one happens to all.

We are caught in the web of mutuality."

And it's true.

The DNA that we have is almost identical to the person standing in front of us.

So we have to take this issue of maternal mortality seriously and simply make up our minds to address it.

Charles Johnson said on a recent panel that we have a problem with empathy here at its root.

And I actually come to that same conclusion myself, because, you know, when you lose this ability to care about other people's children, then you have a deeper problem than you might think because you're losing your capacity to really become a fully engaged human being.

And so how do we get to the root of that issue is what we have to think about in the deepest sense of it.

We have to love other people's children as though they were our own.

Music Announcer: Funding of this presentation is made possible by the California Wellness Foundation.

The Ralph M. Parsons Foundation.

And Liberty Hill.