(lively music) - Welcome to Generation Rising.

I'm Anaridis Rodriguez.

Here at Generation Rising, we host conversations that celebrate our diverse communities and also explore solutions to the challenges they face every day.

Tonight, we are highlighting a new Rhode Island PBS production, "The Risk of Giving Birth."

The docuseries examines the deepening maternal health crisis in the US where maternal death rates are 10 times higher than the rates of other high income countries.

The second episode of the series focuses on the mortality rate among mothers of color and what Rhode Island's healthcare system is doing about it.

From the documentary, we have nurse midwife Ana Sofia De-Brito, and Keesler Gomes, a local doula.

Welcome to you, both.

It's great to have you here.

- Nice to be here.

- Thank you.

Thanks for having us.

- Both of you I know have worked with many families, specifically families of color.

And I wanna start with you.

You were part of filming this documentary.

What was the experience like for you?

- Well, at first, it was strange.

I was very nervous being in front of the camera, but other than that, I thought it was a wonderful opportunity to raise awareness of not only what's happening in the country, but also what's happening here in Rhode Island.

Being someone who was raised here, immigrated to this country, stayed in Rhode Island, grew up in Rhode Island, then left, and now come back.

It was an amazing experience to be a part of it and talk about what I hold most dear in my heart.

- Tell us a little bit about your background and what brought you to being part of the docuseries.

- Yeah, so I'm Cape Verdean and was born in Cape Verde and then immigrated here as a young child.

Grew up in Pawtucket that I love dearly, and then went off to undergrad where I always knew I wanted to be in healthcare, specifically women's health.

And while there I recognized that my values and what I believed in and what I thought of birth and women's health didn't truly align with the medical model of being a doctor, which is what I was aspiring to be.

And at that time, I went back to Cape Verde and spent time with my grandmother who was a midwife there, and had been a midwife for over 40 years, both in the community and the hospital as laws changed there and where midwives could practice or not practice.

And then I came and I worked with midwives in the hospital, doing an internship there.

I came back here and questioned, where are the midwives?

Where are they?

And really couldn't find one to speak to and asked how they got there or what path they chose.

And that's what set me off on this path of midwifery.

I really found someone who I could talk to and their values and the way they see birth as normal physiologic birth and not a medicalized version of birth was what inspired me to continue down this path in midwifery - And Keesler, what about you?

You are the program manager for the Urban Perinatal Education Center in Pawtucket, which I've driven by many times.

It is a great space.

- [Keesler] Yes ma'am.

- How did you come about becoming a doula?

- I have supported friends.

So the first baby, the first birth that I attended, he is going to be 21 in February.

So I've been doing it for a while.

I was a doula before I knew what a doula was.

I've always been like a mom's helper.

So that's what doulas do.

So we support moms or birthing people for the majority, but we are also there for the entire family.

We make sure their partner is hydrated and sleeping and taking care of themselves so that they can then support their partner through the labor delivery process.

- I was able to watch the first episode of the docuseries, and one of the first people you sort of meet outside of the families is the executive chief of OB-GYN at Women and Infants.

And he said something that really stopped me in my tracks.

Ana, you mentioned this documentary bringing awareness and it really was an eye-opening experience for me, and I know will be for many women.

And he said in 2023, the maternal health crisis is not getting better.

It's getting worse.

And that just stopped me in my tracks.

Can you give us a snapshot of what is happening to women in Rhode Island?

- Yeah, so Rhode Island is such a small state that when we talk about mortality, we don't really have the numbers to back up what is happening across the nation of the United States.

Our morbidity numbers are higher, and we can talk about what that means as well.

But across the United States, Black women specifically are two to three times more likely to die from childbirth.

The number exactly from 2021 CDC report is 2.6 higher than what they usually term as the norm, which are white women or white birthing people.

And that is a big vast difference, right?

And in some states, and in some counties, in some cities, in some towns, it's even higher than that.

It can be even four times as more likely to die in childbirth because of the rising increases of deserts of OB-GYN or midwifery care in certain parts of the country.

And so here in Rhode Island, we don't have...

I don't, it's weird to say as many maternal deaths as other states because of the number of population here, but that's just one piece of the puzzle.

It's the morbidity as well, which includes preeclampsia, high rates of C-section, postpartum or perinatal mental disorders.

All of those things are part of the morbidity as well.

- Yeah, why is this happening?

Why are women of color dealing with such a high mortality rate in the United States?

You mentioned some of those health factors.

Can you dive into those a little bit more?

- That is a very loaded question.

- [Anaridis] It could take a long time to get there, right?

- Yeah, it can take a long time.

And please interrupt me and chime in, Keesler, as you see fit.

I like to look at it from a more macro systemic view and then dive into the little pieces because if I knew the answers, then we'd have solutions, right?

But it's a little bit of everything.

And the number one thing right now, if we're talking about Black maternal health is structural racism.

Like the United States was built on racism, on enslaved people's, profiting off of their bodies, profiting off of the Black body, profiting off of the Black woman's body to create more folks for chattel slavery, to create basically the income for this nation.

Why we are a higher income right now.

And the legacy, or I should say the enduring trauma of slavery has trickled down to what we see today.

One thing that I really like to talk about is Black midwifery or the lack of Black midwifery that exists in the United States right now.

And the change from grand midwives in the south and immigrant midwives and Caribbean midwives in also spanning from the 1800s to 1950s and more and even now, there's a rise in Black midwives coming back into the fold as well.

And the changes in community midwives versus what we're doing mostly now, which is certified nurse midwifery, the biggest group out of all the midwives.

And we're mostly seeing in the hospitals, right?

And we're mostly providing outpatient care in clinics.

But the true community midwives who are the certified professional midwives or the traditional midwives, the numbers are much lower.

And I think that piece of community not being there anymore, the piece of you can't access care directly anymore, that you have to go through insurance companies, that you have to go through referrals, that when you first get pregnant, you're not seen here in Rhode Island until maybe even the second trimester where we've missed the opportunities to talk to you about preconception, which is before you get pregnant, how to get healthy or healthier during that time so that you can have a successful, hopefully less morbidity pregnancy.

That's my main focus of looking at this all is that it's not just right now, but it's what we've done over the hundreds of years of getting rid of community midwives, of structural racism, seeping into healthcare, medical bias.

All of that has contributed to where we are today.

And so that's a much bigger question.

and a much bigger answer of how can we essentially stop being racist.

- In medicine, and find a solution to that.

And you talk about this overall, Keesler, I'll fold you into the conversation.

This overall infrastructure that's not serving everyone the same.

How does that manifest in the work that you do?

How does a pregnant people, a pregnant person rather, meet you?

- So I just wanted to first piggyback off of what Ana said.

It is about money.

It's always about money, right?

So that's how we got the doula bill passed here in Rhode Island because we presented it to the insurance companies as like a business proposition.

They found out they could save money if doulas were in the mix.

And there's less likelihood of cesarean sections and higher chance of birth satisfaction rates, right?

With doulas.

So all of those things, the data shows that those things happen with dual services.

But at the same time, I don't feel like it was an accident that there are now a higher rate of inductions, right?

And so inductions are forcing the body to do something that they're not ready to do yet.

And the higher rate of inductions is a higher chance of C-section, and higher chance of c-section is then a higher chance of morbidity or mortality.

Do you know what I mean?

- Complications.

- So I don't think that was an accident.

It all plays into the money part.

- So this is how you're seeing this disparity manifest itself, right?

And even as a result of advocating for service to be protected for expecting mothers.

Any other examples you can share with us on how these disparities manifest in your work and what you do to try to bridge that gap?

- So the services that we provide at UPEC or Urban Perinatal Education Center, Ana mentioned that the folks don't see the provider for like the first 10 weeks or so, like right after they get pregnant.

So they can come to us.

We have our Easy Access Care model clinic.

So what that is a gap filler.

So we see them when they first find out they're pregnant, we can confirm pregnancy, they can listen to the baby's heartbeat, we can talk about nutrition, talk about how they feel about the pregnancy 'cause not everybody is excited or happy.

Some people are stressed out and some people just need to cry, right?

They need somebody to talk to.

And then after baby's born, they need to wait another maybe six weeks for mom to see somebody.

And so they can come to the Easy Access Model Care Clinic that we have.

We can weigh the baby for them, make sure that breastfeeding's going well, make sure their mental health is okay.

And we can also check their blood pressure and make sure that there is no type of postpartum eclampsia going on.

And if there is, we can refer them to their care provider sooner rather than later.

So that's something that we're doing.

We also have free childbirth education classes.

We provide those Tuesday night, Friday night, Saturday night, 5:00 PM to 7:00 PM, 7:00 PM to 9:00 PM It's free to the public.

Everybody's welcome.

The birthing person can bring whoever they want.

We also have the first Rhode Island depository and dispensary of human milk.

So that right there is also super exciting.

- You are an entire education center bringing awareness to so many families.

You were sharing with me off camera a recent experience where a grandmom and a mom came, and after having had five children, they were just in awe of the information that they were learning from just being part of a birthing class.

Talk to us about how important it is to have access to resources like that for birthing people.

- That is, it's incredible.

So many of our families, especially the ones that do the five-class series.

So we have a pregnancy class.

We have a birth class, postpartum, lactation, breastfeeding, and then newborn care.

They can take one class or all five classes.

And the more information they get, the more empowered they feel so that they can make those choices and advocate for themselves and their families to make the best decision for everybody.

And it's just when they leave, well, most times they don't wanna leave.

(chuckles) So they come to the class and yeah, we're there for sometimes, half hour, 45 minutes, an hour after class is over.

And they love the information.

It's so empowering to them.

- And this is free.

This is a free service.

- Yes.

- Let's go back to talking about the difference between morbidity and mortality.

Because that was something to me as a mom of two, I didn't even really understand that distinction.

And it is having access to resources like the ones you offer that could make a difference, right?

In lowering those rates.

Ana, let's start with you.

What is the difference between morbidity and mortality, and how does it present itself in a woman who is pregnant?

- Yeah.

So in very simple terms, mortality means death, right?

So this is, we look at what has happened to the person who gave birth from during the birth or antepartum or during the prenatal period to one year postpartum.

And then morbidity are all the other complications that rise during a pregnancy or in the postpartum period.

So things that we've heard about such as high blood pressure, like preeclampsia.

Things that we have heard, maybe our sisters or friend or mother gone through, like postpartum hemorrhage, for example.

Things that are both preventative, but also things that are harder to prevent, but we're trying our hardest to do.

All of those things get wrapped up into this one category of morbidity.

And a lot of those things are influenced by social determinants of health.

So as we hear what Urban Perinatal Education Center as a nonprofit organization, they're trying to fill the gaps that this capitalistic society has allowed people to fall under, right?

So the donor human milk depository is a great way to help folks who maybe don't have money to buy formula all the time 'cause that's expensive, or do want to continue breastfeeding that we know gets labeled as free, but isn't really free because you have to take a lot of time as a person who is lactating or chest feeding or breastfeeding to do that.

To pump, to feed your child.

To have- - A full-time job.

- Full-time job, to go to work and find time in between your work activities to do that.

And if your work doesn't provide a space to do that, what are you doing?

You're not pumping, you're creating a loss of supply.

And also our policies for maternal, paternal, or any sort of parental leave isn't up to par to other high income countries either.

So then people are going back to work before even puppies are released from their mothers or to dog who has given birth, right?

So we're less than that as humans in the United States, I know some folks, specifically undocumented patients, who have to go to work after the first week or second week of giving birth.

And that's a travesty.

You're not getting any bonding.

They choose not to chestfeed or breastfeed because they just don't have the time.

And their work conditions are such that they don't have breaks to do so.

So they immediately go to formula.

And we know the benefits of breastfeeding.

We know the benefits can help generational population health, which can then come back to when you're giving birth yourself, being that baby who was born, right?

To lessen your risk of diabetes, to lessen your risk of asthma, to lessen your risk of other comorbidities you might have in your lifetime.

And food insecurity is a big issue.

How are we going to expect people to have healthy, fulfilling lives if there's no access to healthy foods?

Right?

We have food deserts.

Housing is such a healthcare crisis and a public health issue.

How do we expect people to house their families and have a safe space for their families to grow up?

They can't even find a space to rent, right?

And these issues are so hard to grapple with when you're a provider like me, because technically, I am seeing you for a medical issue, right?

That's what they want you to believe.

And midwifery doesn't believe that.

Midwifery believes in holistic care.

Understanding where the person is coming from and meeting them where they're at.

And a lot of times, midwives will try to be the savior, but we're not saviors, right?

We're trying to connect you to this resource, trying to connect you to that resource.

But we're against a system that doesn't have that capability.

And so when we're seeing a patient and they're having all of these different social determinants of health are impacting their ability to carry and gestate this child safely and healthy, it can be so hard to be that one clinician.

That's why policymakers, lawmakers, the doula bill being put into effect was so important.

I've seen such a wonderful increase of people getting doulas, insurance paying for it.

And the outcomes that I've seen personally, anecdotally, has been amazing at Women and Infants Hospital.

- And when you think about, let's talk about the solutions that you guys are working in this space, right?

You work at Women and Infants and there are a lot of changes in how you're taking care of patients to try to get ahead of those issues so they can become more empowered in their own journey.

Essentially, pregnancy is a huge stress test on the body.

And the first episode I learned that you're giving away blood pressure machines so women can check their blood pressure when they get home.

That's such an important measure and metric into understanding whether or not they're going to have a complication after giving birth.

- Yeah.

At Women and Infants Hospital, there's been a lot of programs by different individuals who have come in, in the last five years, like Dr. Tooley who spoke on the first episode, Dr. Miller, who is a maternal fetal medicine specialist, where we're trying to find funding through grants and trying to build sort of a health equity structure at Women and Infants Hospital, which has been missing.

And trying to answer the demands that were put forth by Sister Fire and their birth justice demands as well, and cleaning up our own house and creating community engagement as we can.

And so one of those programs is the Postpartum Hypertension Equity Program, because we know that Black women suffer the most from undiagnosed preeclampsia and not understanding what the signs and symptoms are, leaving without education.

So that was one thing that we have implemented where if someone does have blood pressure issues during the pregnancy or during the birth, then we can connect them to, again, it's a two-person step.

The group who will give them the blood pressure cuffs, teach them how to use it 'cause just because we have access to a blood pressure cuff doesn't mean you know how to use it.

So you are in charge of your own vital signs.

And understanding what to do if your vital signs are abnormal.

And so, I was just on a meeting today where we have seen a decrease in postpartum readmission rates from being in the 70th percentile to 42.

That's a big drop.

And we just started this program last year.

We're also trying to get, it's called Rhode Island Comms, which is a maternal bundling services.

So all of the things I just talked about, trying to get community orgs who are on the ground already doing this work.

I'm not saying that we're inventing this, but connecting the hospital to these organizations and giving them money.

So being able, as a non-profit organization, that's what Women and Infants Hospital is, having all these people who know how to write grants, who know how to get big funding to get that money and disperse it and invest in the community orgs who are actually doing that.

That's one thing that's coming down the pipeline.

We're having censoring pregnancy coming back into the fold, which is group prenatal care.

I'm hoping that that starts in April, May.

What else are we doing?

We're having Compass Plus, which is this grant that we're trying to teach clinics in Providence area first before we expand to all of Rhode Island, how to properly screen for postpartum depression and postpartum anxiety, and then connecting a collaborative care model aspect to that so that there's a team to follow that person for the whole year and not just for six weeks.

- It's interesting progressing that you mention that because there was the CDC report that is often attributed in the docuseries found really starling statistics, like more than half of deaths happened between the first week and year after pregnancy.

Keesler, hearing a statistic like that, what does that tell you?

- It's heartbreaking.

We've had in last year, in 2023 UPEC hosted a Black maternal mental health summit, which Ms. Ana Sofia was part of.

And in trying to do the research and trying to get that event together, I reached out to mental health specialists to see if there was anybody who specialized in PMDD or postpartum mood disorders.

And we don't have anybody in Rhode Island.

And so if birthing people do run into the those situations, who do we refer them to?

We have Postpartum Support International who came and did a conference last year that UPEC hosted.

And so most of the doulas came out.

Well, a lot of the doulas came out to take that training.

And so we can recognize those things, those issues.

If birthing people come into those situations, we can recognize it, but who do we refer to?

We have the day hospital that they have at Women and Infants, but that is like a nine-to-five.

And so after hours, we're kinda stuck, you know?

And I reached out to Butler and I asked them, what happens after hours if there's a mental health crisis that a birthing person is going through, what do they do with their babies?

They don't have any childcare or anything at Butler.

And so that family could be separated.

And so if that birthing person knows that their baby's gonna get taken away from them, that's going to deter them from masking for help.

Yes, yes.

And so it's a whole thing, so.

- This is such a fascinating conversation and it's hard to believe, and I told you this would happen.

We're running out of time.

I told you this would happen.

Let's talk about what are you hopeful for as people watch this documentary that they learn and engage to try to create some change?

- We need more community support.

We need more folks who know pregnant people to send them to Urban Perinatal Education Center so that we can give them that information so that we can provide those resources to them so that hopefully, they do advocate for themselves.

There are better outcomes if they know all the information and they're comfortable speaking up, you know.

We also need some funders, you know.

We need monthly funding from whoever can spare some extra cash.

You know, if you're maybe save yourself a coffee one day or two days a week and you know.

- Donate.

- And donate, right.

Because while we love providing the services and we love what we do, it's not sustainable for the grants that we, so we do do grants, but that's not a sustainable situation for us.

- What about you, Ana?

What are you hopeful for?

- Yeah, the one thing I'm hopeful for when people watch this series is to start advocating and asking for more, right?

So for more midwives, investing in hopefully a school here in Rhode Island that can turn out certified nurse midwives, certified professional midwives, certified midwives, understanding what midwives are, what doulas are, what your OB-GYN is, how to utilize all of those different facets of your birth care.

And furthermore, like in investing in community resources.

So you thank you for that wonderful call out for people that if you're really serious about making sure more people aren't dying from childbirth, then invest in the people who are doing the work with this, right?

And understanding your options.

I think that one thing that I noticed that patients don't know and hope that their provider can tell them is the differences, right?

Like, what is a doula?

What is a midwife?

What is an OB-GYN?

And it's not happening.

And there aren't that many options here in Rhode Island for birthing people to even access on top of that, right?

So Women and Infants Hospital does 80% of the births in Rhode Island, and a lot of those 80% don't even know that we have an alternative birth center that's staffed by midwives, that is not a standalone birth center, but can sort of replicate the different protocols that birth center have.

So an unmedicated birth, low interventions, cared by midwives and some family medicine doctors who utilize the space as well, but it's only one room.

And you know, we need more spaces.

We need another birth center in Rhode Island.

We need the laws to change to allow that birth center to exist.

And we need more midwives and other options of care for different folks.

- Folks also don't know that we have more than one birthing hospital in Rhode Island.

We have five.

And a lot of people don't know that.

- I did not know that myself.

- Right, see?

- Exactly.

- It's just eyeopening.

I know that with you two at the helm, I know a lot of change is going to come.

Thank you so much for the work that you do.

Thank you for kind of peeling the curtain back and telling us what's really going on and advocating for all women.

Thank you.

- Thank you.

- Thank you.

- We have run out of time.

I would like to thank tonight's guest, Ana Sofia De-Brito and Keesler Gomes.

You can watch this episode and all our past episodes and anytime and watch.ripbs.org.

And be sure to follow us on these social platforms for the latest updates.

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