Maternal Health and Birth Equity

Speaker: The following program is a PBS Wisconsin original production.

Angela Fitzgerald: Hi, I’m Angela Fitzgerald and this is Why Race Matters.

According to the CDC, Black infants die at a higher rate in Wisconsin than any other state. Nationally, the death rate of Black mothers is nearly three times as high as white women. These truths are horrifying. On this episode of Why Race Matters. We’ll talk with certified doula, Tracey Russell, about her work. We’ll discuss some of the stereotypes surrounding Black physical pain, as well as the importance of representation within the medical field. So, join me as we explore why race matters when we talk about Black maternal health.

Angela Fitzgerald: Hi Tracey, and thank you for joining us today.

Tracey Russell: Good afternoon.

Angela Fitzgerald: So tell us about your story and what has brought you to the profession that you’re in.

Tracey Russell: Okay. Well, I’m a mother, I am a Nana. Two beautiful boys, Jace and Jayden. And throughout the years, I have been actually volunteering as a doula, not knowing that, that’s what I was doing. And over the last three to five years, I’ve gotten more involved in the doula role, and aspects of a doula, and learning how significant it is. And so, in researching history, and looking at doulas and midwives, and realizing that in our community, they were just so prominent, necessary, at the time, and realizing that they’re needed and necessary even still today. And so I wanted to be able to be an asset to my community and to leave a legacy.

Angela Fitzgerald: Okay. And so for those of us like myself who have not experienced a birthing process, what exactly is a doula and what’s the distinction between a doula and a midwife? I follow some Instagram accounts, but I don’t fully know the difference. Can you tell us that?

Tracey Russell: Okay. A midwife would have more clinical services and can deliver a birth their selves, just like a doctor could. They could also do home births. Where a doula is support to the midwife and the doctor. So a doula would come in and support the mother, and it’s a concentration around the mother, her pregnancy, her birth, whether it be during the birthing process, active birth, and sometimes even postpartum birth. So there are postpartum doulas as well.

Angela Fitzgerald: Wow. So literally they’re in support of the mom as she is giving birth.

Tracey Russell: Yes. Yeah. Mm-hmm (affirmative).

Angela Fitzgerald: Okay. And is she there during the entire pregnancy process or it could vary?

Tracey Russell: It could vary.

Angela Fitzgerald: Okay.

Tracey Russell: Most people tend to get their doula around three to four months within their pregnancy, and that doula will stay until the mother births and goes into active labor, and actually births. And then some doulas who are postpartum doulas will stay even after the birth for the mother for a period of time. So right now my focus is primarily on birthing, so I’ll be considered a birthing doula and working on postpartum doula.

Angela Fitzgerald: Gotcha. Okay. And so you’ve mentioned historically the significance of doulas and midwives, you said in our community. So tell us more about that. Why in the Black community, specifically, are doulas and midwives so crucial?

Tracey Russell: The infant mortality rate with African-American women, Latino, and just women of color, has just significantly rised within our country, within our nation, it’s astounding how many mothers are losing their lives, are losing their babies. We’re a great support. And unfortunately as time has gone on, it’s become a business within the medical field for mothers to give birth. And it’s a natural process, mothers aren’t sick. And I think unfortunately is seen as a sickness, it isn’t. Your body knows what to do when it’s pregnant and we want to support the mother through that change, through that transition.

Angela Fitzgerald: And so why do you think there are these distinctions? You mentioned that infant mortality rates, even other pregnancy conditions that there’s disparities in terms of women of color, Black women. Why do you think that is? Why are there these differences based on race and birth outcomes?

Tracey Russell: Well, for one, culture matters a lot. Each woman’s body is different. And culturally there are differences between our bodies, how we handle pain, what we perceive as pain, and what people will perceive as pain from us. So to give you an example, I had a mom who was in pain, and the perception from the nursing staff was that she wasn’t in as much pain as she was because she didn’t project how they thought in their mind that she should, or that she would. So she’s internalizing the pain. I see the tension in her face, but because she, again, because of what they think pain should sound like, act like, they’re like, “Oh, but you’re good. You can handle this. And you can do this without pain.” or they go to the extreme and do an epidural. And so with an epidural you can have a longer labor because the mother is basically numb from the waist down at that point.

So then that changes what type of labor that the mother would have. And what doula want to do is we want to support the mother to have the best birthing experience that she wants to have. And if that’s a natural birth, then we’ll want to help her do that. So there’s walking you can do, there’s steps you can do. There’s massages you can do to allow the mother’s body to just gradually go into active birth, where she can have the birth that she wants. And if she needs medication, what mild medications can she have. So it’s about being informed too, and helping the mother be informed to make the best decision for herself at that time.

Angela Fitzgerald: Mm. And so you raised a good point about the medical industry, it’s a business, right? And so decisions might be made during the birthing process that aren’t necessarily of the most benefit to the mom and the infant, but more like, okay, we’ve got to get you in and out. So how we can do that in the most efficient way possible may not be what the mother wants, which is where it sounds like the doula steps in an advocacy role. Do you think there are other factors too in place that might be contributing to these differences? I understand that in Wisconsin too, we’re leading the nation, and not in a good way in terms of infant mortality rates for Black women. Can you speak at all to that?

Tracey Russell: So I think there’s two folds, because it’s been taken out of the community and commercialized, not a lot of women are familiar with the roles of a doula, or the roles of midwives for them, or even recognize that, that’s an option. So it’s about educating our people. It’s about educating the community, that here are other options. It’s also about educating women again about their bodies. We are working machines and combating the fears of births because unfortunately, a lot of women hear about hard births and it frightens them. So you got to combat that fear, you got to combat, again, like you said, the financial situation, and whether or not that doula will be even accepted within that hospital to come in with the birthing mother during COVID has changed a lot of that.

And so mothers had to choose between their doula and their birthing partner, so their spouse’s. So it was either, or. And then there was a time where there were the doula can’t come in at all. Then you’ve had all of this support and then you go in and you’re alone birthing, and it already can be stressful as it is. And then it’s even more stress because you don’t have that support that you initially had. So there’s a lot of things, I think, that’s working against the support of the mother, but that could be changed, and that could be easily changed, if we just put some effort into seeing it again as a team effort. I don’t want the doctors to feel, or a midwife to feel that I’m competing, but I’m part of the team with them when I come in.

And the doctors can’t be there all the time, the nurse can’t be there all the time, the nurses got to go out and they got a chart, or they may have another mother that’s in labor.

Angela Fitzgerald: Ready to roll.

Tracey Russell: I’m with that mother the whole time until she delivers. So I’m able to give her ice chips, I’m able to help her relax. I’m able to help her do her breathing. That support in of itself, no matter what the birthing outcome ends up being, is where the mother has a better birthing experience. And it really helps in infant mortality rate because if she’s experiencing pain, I can help advocate for her on that. I could help her understand if the doctor’s saying, “You know what? Things have changed. And you may really need to do more medicine, or you may even have to have a C-section.” These are conversations that she could work through and have with me and her family, someone that’s in her ear, in her corner that she trusts, that helps her make that decision.

Angela Fitzgerald: And thinking more about the disparity side of things, Tracey, I’m wondering if you can unpack some more about what that means, and how that may be playing out in Wisconsin, because it’s so layered, right? When we think about access to doula, there’s a financial piece to that.

Tracey Russell: Yes.

Angela Fitzgerald: And the financial piece plays out in other ways like general access to health care, diet, where you live, air quality. But even when we take that part of the argument away, we’re still seeing disparities among Black women. You’ve had Serena Williams, Beyonce, others, where that’s not an issue, still having stories similar to Black women who, or maybe having more financial challenges. So what do you think, in your opinion, from a professional standpoint, what is it? What is the undercurrent that is driving this trend.

Tracey Russell: I think it’s cultural. Again, there’s an assumption that we can handle pain, that we don’t experience pain the same way, that we’re less educated, like you said, even to have Serena Williams to experience what she did. And you have to realize each individual person, whether you’re pregnant or not, is different. What a doctor needs to take in account, what a midwife needs to take in account, what doula need to take into account, is that each mom is going to be different, how she handles pain different, and she knows her body. So when I come in to meet with a mother, the first thing I want to ask is, “How do you feel? How are you feeling? How does this pregnancy feel to you?” And if you’re getting a sense that something may be wrong, then we need to explore that.

So, from my understanding, you mentioned Serena Williams, she said, “I don’t feel good. This is what I think is happening.” And she wasn’t heard. So, that’s why I keep on speaking about it has to be a team effect. You have to listen to the mother. We want to make sure that the mother is being heard. We want to make sure that you’re listening to what she’s saying her body is experiencing, and what she’s going through. We’ve gone through, and now, you go into the hospital, it’s you lay back in the bed, and I don’t want to get too graphic, you’re sitting a certain way.

Angela Fitzgerald: Right.

Tracey Russell: It’s okay to stand up. It’s okay to squat. It’s…

Angela Fitzgerald: I was going to say, I think in other countries, right? It’s a different position.

Tracey Russell: Yes.

Angela Fitzgerald: Because gravity wise that’s not even supportive of how, yeah.

Tracey Russell: It should happen.

Angela Fitzgerald: Right. Right.

Tracey Russell: Yes. Yeah. You’re exactly right. We liken it to going to the bathroom.

Angela Fitzgerald: Right. Mm-hmm (affirmative).

Tracey Russell: And that works.

Angela Fitzgerald: Right. But that’s not how the system is set up.

Tracey Russell: Exactly. It’s set up for you to be in the bed and we know moms need to be active. It needs to be active so the body can know that it’s working, it’s working to help to get this baby out. So the more you lay in the bed, the harder it is that your labor is going to be, we want to get the mom up and moving and active. And that position may not work for the mother to just sit up in the bed like that, and she may need to squat. She may need to lift her leg up and that’s okay, and that’s natural. So I think part of the… Just given the disparities that we have within our healthcare systems, and what we get is part of it, but we also are not listening to the patients more. We’re not listening. We need to take the knowledge that the doctors have of the books, and the knowledge that I know of my body, that I’ve been with all my life.

Angela Fitzgerald: Exactly. And the thing is if you’re already approaching your patient as one that you said has less knowledge than you. And we think about the history, especially of Black Americans in this country, how we historically not been listened to when it comes to our care, not been cared about period, much less listened to, and even how the gynecological field came out of work that was done on Black women with no anesthesia.

Tracey Russell: Yes.

Angela Fitzgerald: Our pain levels, who cares. Right? And so we are seeing manifestations of that continue in a way that’s really harming our health and infant health. And so there has to be some changes, right?

Tracey Russell: Exactly.

Angela Fitzgerald: And so it sounds like the doula being there as a part of it, but also who else is in the room. I think it’s that representation part.

Tracey Russell: Mm-hmm (affirmative), exactly.

Angela Fitzgerald: Like if you are connecting culturally with your patient, then your understanding of different ways in which they may express pain.

Tracey Russell: Exactly.

Angela Fitzgerald: And then you’re able to attend to those needs as opposed to, I don’t register that, that’s painful. So I’m going to keep doing business as usual, and that could result some negative outcomes. I feel like all of that goes in together. So it’s not like just a one size fits all approach, but it sounds like doulas are one step towards that resolve.

Tracey Russell: Well, and it takes time. And so we had the time, like I said, to be there, the doctors, the nurses have other patients, charting to do, other mothers that may be delivering. So they don’t have the time to put in that a doula does to be there with that mother through that entire birthing experience. And one mother may be in labor 10 hours. One may be in labor for five, one may be 15, or 20, and her active labor…

Angela Fitzgerald: I commend.

Tracey Russell: Yeah. Her active labor.

Angela Fitzgerald: Continue, I’m just, that amount of time.

Tracey Russell: Her active labor may be four hours or five hours. Some of us could push for an hour, or could be pushing for two hours. And second births are typically easier, but it’s time consuming, and you may not have that time, or the doctor, the nurse may not feel as though you have that time when you go in. And additionally, if you are in labor that long, and you’re in a hospital setting, they may have changed shifts by then.

Angela Fitzgerald: Wow.

Tracey Russell: So now you have a whole new staff, a whole nurse that’s…

Angela Fitzgerald: That’s a good point.

Tracey Russell: …coming in, right? So you started jelling with this one nurse and then they’re done, my shift is done our heat, your doula’s not gone. Your doula is there with you still, and until baby is in your arms, your doula is there. And also just the importance of having that mother have that skin to skin contact with that baby, we traditionally take the baby away, clean the baby up, and what we’re finding is mom and baby need that skin to skin. They need that contact, that bonding is significant and the life of the baby and the health of the baby and the connection for the baby and the mother. And just to see a baby, smell its mother. I look up at his mother for the first time. I’m about to cry.

Angela Fitzgerald: Awe that’s okay.

Tracey Russell: It’s beautiful. And you’re interrupting that process that’s so natural to have for a mother. And so my goal is that, like I said, that mothers will have the best birthing experience that they can and that they want for their selves based off of their culture, their needs, their wants, and their desires.

Angela Fitzgerald: And I understand given that, that that’s your intention behind how you support mothers. There’s a particular demographic within the larger group that you want to focus on specifically.

Tracey Russell: Yes, yes yes.

Angela Fitzgerald: Can you tell us about this?

Tracey Russell: Yes. I’m just, well, for one it’s twofold. One is teen pregnancy. I don’t feel as though that a lot of teenage moms get the care that in addition to our ready, they’re combating the care that we would receive in our communities because they’re young. And just because you’re a young mom and a young teenager, that’s having a baby doesn’t mean that you don’t deserve a doula as well. Doesn’t mean that you don’t deserve the best birthing and experience, as well. And I may need to spend a little bit more time with you because, you don’t understand, you’re excited or you’re scared, you’re nervous, or you’re all of it. And so you’re just like in a doula, what? And a lot of teenagers may not know even with their bodies going through as they’re pregnant.

So, I want to be there to support even that teenage mom, that this is a beautiful thing. And it’s okay. And however anyone perceives how you got to where you are, doesn’t matter. You’re about to be a mom, and you deserve the right to have the best experience as you can, as well as a mom. So that’s, that’s one of my passions.

 

One of the areas I want to specifically address is, is teen pregnancies, because I’ve found that a lot of teenagers that I have mentored who’ve become young adults or teens have all had some cesareans. One in particular, I’ll share with you a story of a young lady, because she was in so much pain and making so much noise that they were like, this is probably the best option for you because you just can’t handle being in birth. And I’m like, but if a doula was there to teach her breathing techniques, to massage her, to, help her. Yeah, it would have been different to help her get, to give her tools that would help her with her birthing and with her pain. Now would she still have had a cesarean? Maybe, maybe not, but we don’t know because she didn’t have…

Angela Fitzgerald: She’d had those options.

Tracey Russell: She didn’t have those options.

Angela Fitzgerald: And it sounds like the listening part might be even more important for teenagers because thinking about healthcare professionals, seeing them as like, “Oh, you’re a kid.” Like I absolutely know more than you. So I’m going to make the decisions if there is no one else in the room advocating for you.

Tracey Russell: Well, and then, in all honesty, culturally we’re one or two things. We’re believing totally what the doctor’s saying, because they’re the doctors.

Angela Fitzgerald: Right? They’re the experts they’ve gone to school for all these years.

Tracey Russell: They’re the experts. And, or we’re fearful because what we have experienced throughout our culture with doctors and how we’re being treated. And then that anxiety comes in and then you respond to that and then they respond back to you. And then before, you know it, you’re in a situation where you didn’t want that to happen all based off of perceptions, as opposed to a clean slate and coming in and seeing me as an individual, as a person, taking my culture in hand.

Angela Fitzgerald: Mm-hmm (affirmative)

Tracey Russell: But are you culturally competent?

Angela Fitzgerald: Hmm. That’s a good question.

Tracey Russell: And that matters.

Angela Fitzgerald: Right.

Tracey Russell: To be culturally competent matters in any form of medical care, any form of medical care. And I feel as though that’s so much more important that we get back to that because our mothers and children are dying and it’s not making news. This should be… I mean, we are in like a crises and a lot of people don’t know that, they don’t know that.

Angela Fitzgerald: You’ve mentioned a couple of times about the cesareans and those being the decision of the medical professional and not necessarily decision of the mom, but can you, for those of us who don’t know, can you explain, why that matters, why the fact that it’s a cesarean was chosen over maybe a vaginal birth, why that matters in the conversation of health disparities, infant mortality, all of that.

Tracey Russell: Well, I mean, it’s surgery, right? I had some cesareans with my children and I thank God for that, and I thank God for the medical staff, but I don’t know if it would have been different had I had a doula there that would have been able to help me with my birth in a different way. I’ll never know that it’s already happened. Some cesareans are necessary. They really are. To save the life of the mother or the child. But, what we want to do is we want to make sure that it’s at the point that it’s necessary and not, because the mother’s been birthing too long, because another team has come in, because there’s other moms that’s in labor because a COVID and we need to keep everybody’s spaced out, and the timing, and so many mothers in labor room at the same time. You know? So, I’m not against the cesarean sections, but we do want to make sure that they are safe, but it is surgery is a major surgery.

And so your recovery is different with cesarean. It’s an operation. You go in a room, your body responds different. Your recovery after that is different. You’re limited on some of the things that you can do with your baby after cesareans. They are finally open now more to even having a skin to skin with a cesarean, but you have to be even more careful with that because the mother is open. It’s like an open wound at that point for mom and baby. So I don’t want to put out there that I’m against them. Like I said, they are a godsend there are individuals who wouldn’t have been able to have their children without cesareans. But what we want to do is not have unnecessary cesareans because the staff is rushed, because the mother is in pain, no one can handle her being in pain.

So education is the key and teamwork is the key, so that everyone is on one, one accord. And that if you do say to the mother that she has to have cesarean, she fully understands her options and why this cesarean is needed.

Angela Fitzgerald: Right. Absolutely. You’re right. So not leaning towards an unnecessary surgery and for a specific group of women, more likely for the reasons that you’ve already stated.

Tracey Russell: Yeah, yeah, yeah. And then, I mean, if, if your doctor, typically comes in and tells you this, and you have no prior knowledge of a cesarean or even no prior knowledge of your birth and that what you’re experiencing is natural in happening in birth. You’re just going to go along with what the doctor says, because you’ve not been educated.

Angela Fitzgerald: Right. And that could create extra anxiety and stress on top of the stress of like, I’m having a baby and now I’m going to be undergoing surgery that I did not anticipate needing and like all of that. So, absolutely. Okay. Thank you for adding that piece, that piece, that I just wanted to make sure that, our audience understood that.

And so in terms of those who are watching this conversation, who either can relate absolutely to the stories that you’ve shared or who were like, I’m hearing about this for the first time, I didn’t know this was an issue much less in our state that we are like higher than the nation in terms of infant mortality rates. How many of us know that where’s, that statistic being played out? So for those who are in either camp, either learning for the first time that this is an issue, or potentially like, yes, I’ve experienced that. Like what do you want them to take away from what you’ve shared?

Tracey Russell: I think we need to specifically, I’m going to speak specifically to Wisconsin. We need to make sure that we’re getting out there foot’s on the ground, having conversations and allowing people and showing people alternatives to health care broad, but specifically to moms and doulas that there are midwives out there, there are doulas out there. This is an option and really push for doula to be able to use the insurance, so mothers won’t see another financial strain. We should be, and I just can’t say this enough, we should be part of that clinical care. That should be an option for every mother. For every mother.

And I believe that’s the way that we can come back to infant mortality and it needs to be women of color. It needs to be Latino women. African American women, Asian women. You, you need to see someone that looks like you, that can relate to your culture as well as explain to you about the birthing process and be there to support you. So you can have that option. And so I’m not saying that the dominant culture shouldn’t be there, but when I am saying is it needs to be an option.

If, if you look up and look for that now, you’re like you said, I didn’t even know this was in existence we’re not known, or you don’t see anyone that looks like you, and you should be able to have that option.

Angela Fitzgerald: Absolutely. Especially in a state like Wisconsin, where we are the numbers that we are statistically, but having that representation, that familiar face, that shared culture during that particular moment of your life, that there’s, this healthcare need, beautiful moment having that person there.

Tracey Russell: I get a lot of people that say, “Why? Why? “You know it’s like “Well, why should I pay for a doula?” Or “why?” Less stress can help to combat fears that you may have, can be your coach and your advocate, with family and friends, as well as for your birthing partner for the dad, that’s there, the mom that’s there, the grandma, the Nana, whoever else you have on your team, that’s there to support you. We’re there to support them as well. So to really get back to a holistic approach, not just in birth, but in everything that we do, but especially within healthcare that relates to our community.

Angela Fitzgerald: I appreciate being there for that reason. You’re making my job easier as a part of the birthing team.

Tracey Russell: Exactly. Exactly.

Angela Fitzgerald: Thank you so much for your time today, Tracy.

Tracey Russell: Thank you.

Angela Fitzgerald: The birth of the child is a time for celebration, but for Black women, it comes with risk. Racial disparities in birthing and complications and deaths have persisted over time. The sooner we address why race matters when we talk about maternal health, the sooner we as a society work to fix it. For more info on Why Race Matters and to hear and watch other episodes, visit us online at pbswisconsin.org/whyracematters

Speaker: Funding for why race matters is provided by CUNA Mutual Group, Park Bank, Alliant Energy, Madison Museum of Contemporary Art, Focused Fund for Wisconsin Programming and Friends of PBS Wisconsin.