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Speaker 1: I'm Tt and I'm Zakijah and from Spotify. This is

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Speaker 1: Dope Labs. Welcome to Dope Labs, a weekly podcast that

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Speaker 1: maxes hardcore science, pop culture, and how healthy does a friendship.

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Speaker 1: This week is part two of our series on maternal health.

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Speaker 1: If you haven't listened to last week's Lab yet with

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Speaker 1: Simone Tape, we really recommend listening to that one. First,

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Speaker 1: we talked to Simone about what services maternal health care encompasses.

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Speaker 1: We learn that there's a lot of bottlenecks when it

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Speaker 1: comes to getting good maternal healthcare here in the United States,

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Speaker 1: and we also dug into disparities in maternal health among

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Speaker 1: specific groups. This week, we're zooming out to understand more

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Speaker 1: of the context around the state of maternal health care today,

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Speaker 1: how we got here, and how to make it better. Okay,

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Speaker 1: let's get into the recitation. What do we know? Well,

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Speaker 1: you know, like you mentioned, we learned a lot from

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Speaker 1: last week's Lab and sadly, we learned if you want

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Speaker 1: good care, you basically need to move to Finland. But

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Speaker 1: if you aren't trying to move to Finland, here are

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Speaker 1: some of the major points from last week's episode about

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Speaker 1: the state of maternal health care. Maternal health care in

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Speaker 1: the United States is out of date and out of

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Speaker 1: touch with the needs of today's birthing population. Yes, we're

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Speaker 1: seeing rising rates of both morbidity so those are health

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Speaker 1: issues and mortality that's death as it's related to complications

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Speaker 1: following pregnancy and giving birth. Some of the major bottlenecks

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Speaker 1: and maternal health care include the hurdles that you have

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Speaker 1: to jump over making monthly appointments, the lack of options

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Speaker 1: of both in person and virtual care, and maternal health

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Speaker 1: care deserts. Also, mortality rates are disproportionate among women of color,

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Speaker 1: so they are three to four times more likely to

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Speaker 1: die from pregnancy or birth come implications. We also found

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Speaker 1: out that fifty percent of the birthing population in the

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Speaker 1: United States are on Medicaid, which means that they don't

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Speaker 1: have equal and equitable access to healthcare. And at the

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Speaker 1: end of the last episode, we started talking about the

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Speaker 1: Omnibus legislation, which focuses on bringing preventable mortality rates closer

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Speaker 1: to zero, and that takes us to kind of what

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Speaker 1: we want to know for this lab. Yeah, so my

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Speaker 1: first question is why is maternal healthcare in the US

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Speaker 1: so bad. With the amount of money that Simone was

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Speaker 1: telling us gets poured into our maternal health care system,

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Speaker 1: you would think that that would mean that we are

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Speaker 1: doing really great, but that's not the case, and I

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Speaker 1: want to know why. And I want to know more

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Speaker 1: about these programs. You know, So, how does insurance and

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Speaker 1: the support that the federal government provides for birthing parents,

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Speaker 1: how does that come into play? And why isn't it

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Speaker 1: doing its job? It seems like that is such a

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Speaker 1: good question. And I also want to know what makes

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Speaker 1: maternal healthcare quote unquote good. And once we know but

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Speaker 1: makes it good, how do we make it even better? Yes?

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Speaker 1: And I think when we consider that, who is the

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Speaker 1: weak right should it be nonprofits and private agencies? Or

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Speaker 1: are there policies and programs that our government should sponsor

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Speaker 1: that might improve outcomes? That's what I want to know. Okay,

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Speaker 1: I think we've got enough questions. Yes, let's jump into

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Speaker 1: the dissection.

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Speaker 2: Let just ask you.

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Speaker 1: Our guest for today's lab is doctor Sarah Benattar.

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Speaker 2: My name is Sarah Benattar. I'm a principal research associated

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Speaker 2: the Urban Institute in the Health Policy Center, So I

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Speaker 2: do research mostly focused on maternal and child health.

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Speaker 1: The first thing we wanted to know from doctor Benatar

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Speaker 1: is why maternal healthcare in the United States is so poor.

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Speaker 1: She said, it's not about money.

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Speaker 2: The US spends more money on maternal health than any

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Speaker 2: other country in the entire world, twenty five percent more

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Speaker 2: per capita than the next highest spender. Despite all of that,

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Speaker 2: we have some of the worst outcomes for pregnant people

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Speaker 2: and infants.

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Speaker 1: And let's talk about those outcomes. We learned from simone

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Speaker 1: last week about increasing mortality rates, but what are the specifics.

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Speaker 2: In twenty eighteen, the rate was seventeen per one hundred

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Speaker 2: thousand births resulted in a maternal death. That went up

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Speaker 2: in twenty nineteen to over twenty deaths per one hundred

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Speaker 2: thousand pregnant people. In twenty twenty that was even higher

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Speaker 2: at twenty three point eight. The next highest rate for

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Speaker 2: a high income country is half that, so in Canada

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Speaker 2: and France the rates are more around eight per one

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Speaker 2: hundred thousand deaths.

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Speaker 1: And Sarah told us historically this upward trajectory hasn't been

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Speaker 1: the trend.

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Speaker 2: The Commonwealth Fund has this terrific piece that worth looking at,

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Speaker 2: where they have a chart of maternal mortalit starting in

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Speaker 2: about nineteen eighteen, and you can see that it starts

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Speaker 2: really really high, and then by the nineteen thirties or so,

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Speaker 2: it's considerably lower, and it just keeps on going down

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Speaker 2: until about the nineteen eighties, and in the nineteen eighties

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Speaker 2: it goes up again, and now they just are creeping

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Speaker 2: up consistently.

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Speaker 1: So this chart is looking at death per one hundred

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Speaker 1: thousand pregnant people. In the eighties and nineties, you're only

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Speaker 1: seeing about seven to eight deaths. But it's really sobering

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Speaker 1: to learn that today we're up to about twenty three

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Speaker 1: deaths per one hundred thousand pregnant people. That's a problem huge.

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Speaker 1: Twenty three sounds like it's small, but when you look

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Speaker 1: at like what it was significant, Yeah, yeah, anything increasing

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Speaker 1: by times three you need to check on it.

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Speaker 2: Yes, a good segment of that can be attributed to

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Speaker 2: discriminatory healthcare practices and systemic racism. I think because there

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Speaker 2: is just an incredible amount of us and I think

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Speaker 2: it's relatively well demonstrated that is not helpful for a pregnancy.

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Speaker 1: In addition to mortality rates, there are other stats that

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Speaker 1: doctor Benattar points to that indicate the US is not

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Speaker 1: up to par when it comes to maternal healthcare.

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Speaker 2: In the US. Some of the things that we really

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Speaker 2: pay close attention to our low birth weight, so that's

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Speaker 2: a baby that's born weighing less than five pounds eight ounces,

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Speaker 2: and pre term birth, which is being delivered before thirty

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Speaker 2: seven weeks gestation. So those are some of the bigger indicators.

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Speaker 2: Another thing are the CEA section rates. Approximately a third

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Speaker 2: of all deliveries are done by c section. Now the

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Speaker 2: who said that the ideal rate would be around fifteen percent.

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Speaker 1: Cesarean deliveries, which are also known as c sections, do

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Speaker 1: have more risk than delivering a baby baginally, but they're

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Speaker 1: often medically necessary in order to protect the health of

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Speaker 1: a birthing parent or a baby. There are some common

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Speaker 1: chronic health conditions that sometimes require section delivery, and those

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Speaker 1: include heart disease, high blood pressure, or gestational diabetes. And

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Speaker 1: the disparities we've been talking about permeate all of these

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Speaker 1: different areas.

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Speaker 2: If you look at this by race and ethnicity, the rates,

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Speaker 2: particularly for black women and birthing people, are much higher,

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Speaker 2: so maternal mortality rates can be three to four times higher.

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Speaker 2: Sea section rates are quite a bit higher low birth

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Speaker 2: rate and preach and birth rates are also higher for

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Speaker 2: Black women and birthing people.

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Speaker 1: The math ain't mathing. Okay, Rights spends the most money

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Speaker 1: on maternal healthcare but has the worst outcomes, especially for

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Speaker 1: Black women and birthen people. We need to understand more.

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Speaker 1: So we ask doctor Benettar, what is going on?

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Speaker 2: So many people who become pregnant and are then engaging

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Speaker 2: in prenatal care have not necessarily had access to high

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Speaker 2: quality care prior to that. And I have also experienced

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Speaker 2: all kinds of discrimination care. But you know, we're talking

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Speaker 2: about people coming into pregnancy maybe haven't had, especially prior

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Speaker 2: to the ACA, any medical insurance or coverage prior. Because

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Speaker 2: Medicaid pays for over forty percent of all births in

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Speaker 2: the United States, and for black women and breathing people

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Speaker 2: is hired more like sixty five percent of births.

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Speaker 1: Medicaid is a federal and state program that helps with

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Speaker 1: health care costs for Americans with limited income and resources,

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Speaker 1: and it's the largest source of funding for medical and

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Speaker 1: health related services for people with low income in the

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Speaker 1: United States. So Medicaid is such an important program to

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Speaker 1: have because it provides healthcare to a portion of the

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Speaker 1: population that wouldn't have it otherwise. But because it is

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Speaker 1: regulated at the state level as well as the federal level,

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Speaker 1: there are some parts of it that, you know, depending

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Speaker 1: on the state that you're in, have some pitfalls. Insurance,

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Speaker 1: I think is one of the trickiest things in adulting,

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Speaker 1: don't you think, Like for real, for real, it's really wild.

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Speaker 1: Doctor Benattar mentioned the ACA, or the Affordable Care Act,

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Speaker 1: which was passed in twenty ten under the Obama administration.

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Speaker 1: The ACA was meant to expand health care coverage for

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Speaker 1: millions of uninsured Americans. It also expanded Medicaid eligibility and

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Speaker 1: created the marketplace where people can purchase private insurance. And

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Speaker 1: that private insurance is very expensive, by the way, very

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Speaker 1: But before the Affordable Care Act, you had to basically

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Speaker 1: have a job if you wanted good health care. And

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Speaker 1: isn't that kind of wild when we stepped back from it,

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Speaker 1: Like it's like, Okay, you only have the right to

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Speaker 1: live if you are working, working, and not all jobs

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Speaker 1: provide health care. Exactly. I have health I have a

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Speaker 1: body whether I'm working or not, exactly, And that's something

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Speaker 1: that's unique to the United States. Because universal health care

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Speaker 1: is something that they have in Europe and Canada and

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Speaker 1: we're just slow to get on it. People are still

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Speaker 1: fighting the Affordable Care Act, also called Obamacare by folks

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Speaker 1: who want to make it seems like it's something that

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Speaker 1: is partisan, like people getting quality healthcare as a partisan thing.

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Speaker 1: It's not well. In my opinion, it shouldn't be. But

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Speaker 1: here we are. Here, we are at this big age,

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Speaker 1: this country, at this big age set up having a

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Speaker 1: temperate tantrum around healthcare. Get it together or you're not

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Speaker 1: getting anything. Yeah. Another answer to the question how did

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Speaker 1: we get here is what doctor Benattar calls a very

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Speaker 1: medicalized approach to pregnancy, one that values profit over people.

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Speaker 2: Many other places approach pregnancy from a perspective that's much

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Speaker 2: more normalized, where this is a natural process that maybe

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Speaker 2: sometimes requires a little bit of help, but most of

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Speaker 2: the time we can support women through it and have

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Speaker 2: a healthy outcome. The medicalized model also maximizes profit. Many times,

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Speaker 2: these visits are very short, maybe fifteen minutes. Like if

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Speaker 2: you think about a hospital based clinic where we're trying

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Speaker 2: to get as many people in, especially because Medicaid is

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Speaker 2: one of the largest payers there are often high nose

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Speaker 2: show rates.

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Speaker 1: And that could be because of the factors we talked

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Speaker 1: about last week with simone, lack of access to childcare

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Speaker 1: and transportation, no telehealth options, and maternal health care deserts.

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Speaker 2: So there are these short visits in which maybe there's

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Speaker 2: been no pre existing relationship, and many people will express

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Speaker 2: that they aren't being listened to. And lots of people

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Speaker 2: have all kinds of other social determinants that are affecting

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Speaker 2: their health like housing, insecurity, food and security, anxiety, depression.

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Speaker 2: The list is long.

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Speaker 1: Another trend that directly correlates to worsening prenatal care in

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Speaker 1: the United States is the growing OBGYN shortage, and we

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Speaker 1: mentioned that last week, but to help you understand it

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Speaker 1: a little bit better, let's think about it from the

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Speaker 1: entire national perspective. So not just rural areas. If you

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Speaker 1: look at all the counties in the United States, half

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Speaker 1: of them do not have a single obgyn. That's major.

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Speaker 1: That's wild, that is major. My whole county. Yeah, when

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Speaker 1: I think about going to another county for anything, a

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Speaker 1: specific grocery store because of a specific shop that I like,

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Speaker 1: Oh my gosh, so far, so far, this is going

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Speaker 1: to be a trek. Now, imagine doing that pregnant mm

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Speaker 1: hm ugh. In part one of this series, Simone said

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Speaker 1: that fifty percent of the birthing population is on Medicaid.

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Speaker 1: And now we know that Medicaid is one of the

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Speaker 1: largest payers of maternal healthcare in the United States, covering

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Speaker 1: about forty percent of all births in the United States

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Speaker 1: and sixty five percent of births for Black women and

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Speaker 1: birthing people. So let's break down Medicaid more in the

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Speaker 1: context of maternal health.

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Speaker 2: In the nineteen eighties, Medicaid expanded to include pregnant people.

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Speaker 2: So prior to that, Medicaid was almost exclusively a program

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Speaker 2: for children and for adults with very, very low incomes,

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Speaker 2: so it was really pretty restrictive.

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Speaker 1: Eligible to receive Medicaid, most people have to meet an

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Speaker 1: income requirement.

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Speaker 2: Each state decides how high the income threshold goes for

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Speaker 2: pregnancy related Medicaid coverage. So in one state, you could

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Speaker 2: make a certain amount of money and qualify for pregnancy

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Speaker 2: related Medicaid, but in another state you could make thirty

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Speaker 2: percent more and still qualify for pregnancy related Medicaid.

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Speaker 1: Let's break that down. So when doctor Benetar mentions qualifying.

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Speaker 1: What she's talking about is the income level, how much

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Speaker 1: income you make as it relates to the federal poverty level.

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Speaker 1: And so the federal poverty level is thirteen thousand, five

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Speaker 1: hundred dollars annually for individuals and around eighteen k for

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Speaker 1: families of two. And the gotcha, gotcha with all of

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Speaker 1: this is exactly what doctor Benattar said. It changes between states.

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Speaker 1: So we looked up what it would be for Maryland.

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Speaker 1: So let's say it's you and your partner and one

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Speaker 1: of you is pregnant. You qualify for Medicaid if you

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Speaker 1: make up to four thousand, twenty nine dollars per month. Okay,

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Speaker 1: so that's for Maryland. For Alabama, same situation, you your partner,

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Speaker 1: one of you is pregnant, You qualify if you make

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Speaker 1: up to two two and twenty eight dollars per month.

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Speaker 1: That's a lot lower. That is a lot lower. I

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Speaker 1: would want to move to Maryland if I could. Right,

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Speaker 1: You think about the quality of life of the pregnant

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Speaker 1: folks in Alabama who are looking to qualify for Medicaid.

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Speaker 1: That annual income, when you do the math, that's not

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Speaker 1: a lot of money. I mean, I think that's the

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Speaker 1: interesting thing that this is state by state, you know,

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Speaker 1: and this is a much higher percentage of the federal

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Speaker 1: poverty level that's allowed, and so this is gracious for

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Speaker 1: maternal health care. We won't even get into what it

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Speaker 1: looks like how little income you can make if you

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Speaker 1: want to qualify for Medicaid and you're not pregnant right now.

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Speaker 1: And this is where I think we see these insurance gaps,

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Speaker 1: and when people are pregnant, they show up and they

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Speaker 1: haven't had good health care leading up to this. Absolutely,

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Speaker 1: I think this is how we get that vicious cycle

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Speaker 1: of complications and increase morbidity and mortality. Absolutely, because all

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Speaker 1: of these things touch Every aspect of your life is

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Speaker 1: touching this. So if you have to make below a

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Speaker 1: certain amount, that means that's going to affect do you

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Speaker 1: have a car, do you have access to technology, The

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Speaker 1: quality of your food, and all of these will affect

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Speaker 1: your pregnancy, all of it. Where you can live, air

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Speaker 1: quality because of where you're living. Yes, yes, I was

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Speaker 1: gonna say, this is just tying back to so many

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Speaker 1: episodes what doctor Tate said about if you're living with

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Speaker 1: somebody else, if they make a little bit more income,

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Speaker 1: it may not even be yours to spend. But what

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Speaker 1: does that mean for your household amount? Right? And if

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Speaker 1: you qualify or not, and then what does that mean

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Speaker 1: for your support throughout your pregnancy? Absolutely, it's just oh

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Speaker 1: my goodness, there are so many, so many ways to

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Speaker 1: look at this. Yeah, because I mean even when we

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Speaker 1: think back to our sleep episodes with doctor Jean Louis

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Speaker 1: mm hm and talking about the quality of your health

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Speaker 1: is dependent on your zip code. Now, compound that with

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Speaker 1: access to proper health care, access to maternal health care

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Speaker 1: exact A is also dependent on your existence, dependent on

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Speaker 1: your zip code. You're just stacking those things up.

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Speaker 2: In many states now, the threshold for eligibility is pretty high.

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Speaker 2: You could be to two hundred ish percent of poverty

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Speaker 2: and qualify for pregnancy related Medicaid coverage, and then Medicaid

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Speaker 2: covers all of your pregnancy related healthcare needs. It also

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Speaker 2: covers any other healthcare related needs you have.

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Speaker 1: Since nineteen eighty nine, pregnant women with incomes at or

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Speaker 1: below one hundred thirty three percent of the federal poverty

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Speaker 1: level have been a mandatory Medicaid eligibility group. So that

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Speaker 1: means you can make up to one hundred percent of

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Speaker 1: the poverty level plus an additional thirty three percent. They're

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Speaker 1: giving you a little bonus area there, you know. So

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Speaker 1: if you may up to one hundred thirty three percent

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Speaker 1: of the poverty level, then your mandatory, like it's mandatory

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Speaker 1: that you are included in Medicaid coverage.

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Speaker 2: Every pregnant individual in the United States who becomes pregnant

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Speaker 2: should qualify for either Medicaid or the Children's Health Insurance Program.

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Speaker 1: The Children's Health Insurance Program OR was part of the

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Speaker 1: Balanced Budget Act of nineteen ninety seven, and so this

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Speaker 1: program was created to provide low cost health coverage for

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Speaker 1: children who wouldn't qualify for Medicaid but are still relatively

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Speaker 1: low income. Like Medicaid, each state is still determining the

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Speaker 1: eligibility requirements for CHIP, so really it's plugging a gap.

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Speaker 2: If the Children's Health Insurance Program covers some pregnancies that

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Speaker 2: undocumented people are experiencing because it is focused on the

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Speaker 2: unborn child in that situation because they would not otherwise

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Speaker 2: qualify for a federally funded health insurance program.

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Speaker 1: It's like, we have some stop gaps, but it's not

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Speaker 1: one hundred percent. So in the case of CHIP, you know,

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Speaker 1: if you imagine an undocumented person that's pregnant, they're not

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Speaker 1: eligible for Medicaid, but their unborn child is eligible for CHIP,

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Speaker 1: the Children's Health Insurance program, Right, but the birthing parent

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Speaker 1: still isn't covered by either of those two things. Right,

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Speaker 1: So we have some stop gaps, but it's still leaky.

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Speaker 1: It's still leaky. Yeah, let's take a break and when

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Speaker 1: we come back, we'll talk about postpartum care and some

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Speaker 1: legislation that's coming out to hopefully improve maternal health in

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Speaker 1: the United States. Plus stick around to hear about a

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Speaker 1: special episode that we're working on. We're back, but before

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Speaker 1: we get back to the lab, two things. Next week,

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Speaker 1: we're talking all about our therapy and how art can

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Speaker 1: be utilized to help us in our mental health journeys.

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Speaker 1: And we're also reaching out to ask for your input

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Speaker 1: and feedback. We are doing a special episode calling out

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Speaker 1: the lgbt QIA community in stem. If you are a

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Speaker 1: member of this community, we want to hear from you.

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Speaker 1: Call us at two zero two five six seven seven

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Speaker 1: zero two eight and tell us about your work, what

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Speaker 1: you do. We want to hear it all. Let's get

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Speaker 1: back to the lab. We've been talking with doctor Benattar

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Speaker 1: about Medicaid CHIP, which is the Children's Health Insurance Program.

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Speaker 1: And these are two programs meant to expand maternal health

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Speaker 1: care coverage in the United States, and how complicated it

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Speaker 1: can be to qualify for these programs. So let's say

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Speaker 1: you do qualify, You've jumped through all the hoops to

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Speaker 1: get there. Medicaid coverage includes, you know, pregnancies with complications

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Speaker 1: and postpartum healthcare. Two. So remember how simone said that

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Speaker 1: typically there is a six week post birth follow up

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Speaker 1: and then that's it. If you have Medicaid. The minimum

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Speaker 1: requirement is that pregnant people remain covered for up to

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Speaker 1: sixty days postpartum. Now I'm gonna let you do the math.

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Speaker 1: For six weeks time seven days. That's not giving you

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Speaker 1: a lot of room if you miss that right hitting

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Speaker 1: on the nose at six weeks, you know what I'm saying.

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Speaker 1: Tt Yeah. And so in many states there are now

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Speaker 1: postpartum extensions of Medicaid that would let you stay covered

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Speaker 1: up to a year after giving birth. And we want

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Speaker 1: to pause and really take a moment to talk about

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Speaker 1: postpartum care.

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Speaker 2: Sometimes we'd refer to the first three months postpartum as

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Speaker 2: a fourth trimester, and I think that more attention paid

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Speaker 2: to that fourth trimester would be really valuable.

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Speaker 1: When it comes to maternal health. So much focuses on

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Speaker 1: the time leading up to birth and then the birth itself,

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Speaker 1: and then there's just a huge drop off in care.

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Speaker 1: But having good medical care and a strong support system

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Speaker 1: is just as crucial, if not more so, after birth

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Speaker 1: when the baby is here.

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Speaker 2: Yes, there are a few things to think about. One

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Speaker 2: is the safety of the mother or the birthing parent,

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Speaker 2: because there are a number of sequela that could happen

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Speaker 2: that could really endanger the life of the person who

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Speaker 2: just delivered a baby, and that is generally around hemorrhage

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Speaker 2: and basequela.

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Speaker 1: She just means a condition resulting from a previous condition,

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Speaker 1: so think of it as like another domino in a

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Speaker 1: sequence of conditions or effects. Hemorrhage is a rare but

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Speaker 1: very serious condition when a person has heavy bleeding after

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Speaker 1: giving birth. It's usually treatable as long as you have

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Speaker 1: access to good medical care, and if you don't and

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Speaker 1: it's not treated, it can be fatal.

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Speaker 2: Then there's support around breastfeeding if that is a choice

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Speaker 2: that has been made and even if it's not, then

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Speaker 2: there's like making sure that there is enough formula available.

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Speaker 2: It's the wrong formula if it doesn't taste good. If

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Speaker 2: your child has allergies, it can be a real struggle.

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Speaker 2: And not being able to provide adequate food for your

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Speaker 2: child is just heartbreaking. And diapers the same thing.

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Speaker 1: If you make the decision to breastfeed, there are all

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Speaker 1: kinds of things to deal with, like getting a newborn

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Speaker 1: to latch, sore chapped nipples, really painful infection of milk

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Speaker 1: ducks called mestitis, just to name a few. And with formula.

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Speaker 1: Next time you go to the pharmacy, go look at

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Speaker 1: those formula prices and diapers. All of it is so expensive.

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Speaker 1: They even have in formula behind those little clear cases

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Speaker 1: so that you have to call a salesperson over to

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Speaker 1: unlock it for you. And so there are some programs

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Speaker 1: like Women Infants, Children or WICK that will cover the

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Speaker 1: cost of formula for low income families. Postpartum depression is

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Speaker 1: also a huge health risk during the fourth trimester. Remember

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Speaker 1: someone said that according to the CDC, about one in

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Speaker 1: eight women experience symptoms of postpartum depression.

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Speaker 2: Of course, all the other things that a new parent

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Speaker 2: might need like housing, and there could be intimate partner violence.

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Speaker 2: So there are programs out there that are designed to

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Speaker 2: help support new parents, and sometimes duela care will extend

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Speaker 2: to the postpartum period as well.

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Speaker 1: All of this on top of very little sleep and

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Speaker 1: pressure of keeping this little animal alive. It's no wonder

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Speaker 1: that postpartum care is advised for up to a year

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Speaker 1: after giving birth. That single six week appointment just doesn't

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Speaker 1: cut it. And you know, all of this information is

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Speaker 1: really powerful, and it's important to remember that even though

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Speaker 1: we're seeing this really concerning trend of increasing mortality rates

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Speaker 1: among pregnant people, we're also now talking about it in

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Speaker 1: a way that we haven't seen before.

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Speaker 2: There's a lot more attention to this topic now than

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Speaker 2: there has been for many, many decades.

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Speaker 1: So what are some elements of maternal healthcare that might

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Speaker 1: help improve these statistics? Doctor Benettar and our colleagues at

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Speaker 1: the Urban Institute did a project that looked at some

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Speaker 1: different interventions or enhancements to existing maternal care and there

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Speaker 1: were some positive results.

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Speaker 2: Ultimately, what we found is that models of care in

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Speaker 2: which there is more time to spend with patients and

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Speaker 2: where there's a relationship that is built tended to be

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Speaker 2: associated with better outcomes. From an impact standpoint, we found

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Speaker 2: that birth center care was positively associated with improved birth

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Speaker 2: weight and gestational ages and reduced c sections. If you

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Speaker 2: feel like your provider understands you, listens to you, and

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Speaker 2: cares about you, the quality of the care will be

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Speaker 2: improved and as a result, so will the outcomes.

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Speaker 1: This reminds me of the hybrid remote in person model

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Speaker 1: Simone was talking about. Spending more time talking to healthcare

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Speaker 1: providers can be really beneficial in some cases, and for

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Speaker 1: some people, you don't have to be in person to

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Speaker 1: do it. It can be online or telephone appointments. Those

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Speaker 1: are all options for talking through things like what to

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Speaker 1: expect from labor, measures to maintain your health during pregnancy,

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Speaker 1: and just fielding up any questions that are arising throughout

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Speaker 1: your pregnancy. And it doesn't even have to be with

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Speaker 1: a doctor or a midwife. Doctor Benatar mentioned doulas and

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Speaker 1: care coordinators as other potential support systems.

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Speaker 2: JULA care is like an ingredient that you can add

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Speaker 2: to prenatal and delivery care. It's the lay person who

436
00:24:47,880 --> 00:24:52,520
Speaker 2: comes and can be your advocate during the birthing process.

437
00:24:52,200 --> 00:24:55,880
Speaker 1: And this is such a great option for additional coaching

438
00:24:56,400 --> 00:24:59,960
Speaker 1: through all these different stages of pregnancy, labor, and beyond.

439
00:25:00,320 --> 00:25:02,760
Speaker 1: Another type of support role that doctor Benatar mentioned is

440
00:25:02,800 --> 00:25:04,720
Speaker 1: being part of group prenatal care.

441
00:25:05,000 --> 00:25:08,480
Speaker 2: You have a short interaction with your obstetric provider, who

442
00:25:08,480 --> 00:25:11,600
Speaker 2: could be a midwife or a nurse practitioner or an obgion,

443
00:25:11,840 --> 00:25:14,359
Speaker 2: but you're also part of a group of people who

444
00:25:14,440 --> 00:25:17,160
Speaker 2: are approximately at the same stage of pregnancy as you are.

445
00:25:17,359 --> 00:25:20,840
Speaker 2: You always meet together. It's a two hour block of time.

446
00:25:21,280 --> 00:25:25,399
Speaker 2: You learn, you talk about what your concerns are. You

447
00:25:25,480 --> 00:25:29,680
Speaker 2: have social support in addition to the education and then

448
00:25:29,760 --> 00:25:31,040
Speaker 2: the medical support.

449
00:25:31,320 --> 00:25:35,880
Speaker 1: A major part of improving outcomes is collecting data understanding

450
00:25:35,920 --> 00:25:39,440
Speaker 1: where we are now. We ask doctor Binettar about how

451
00:25:39,520 --> 00:25:41,280
Speaker 1: we collect data around births.

452
00:25:41,480 --> 00:25:44,960
Speaker 2: We have birth certificate data and that's pretty well collected,

453
00:25:45,000 --> 00:25:47,280
Speaker 2: although there are some things on the birth certificate that

454
00:25:47,320 --> 00:25:50,040
Speaker 2: are really highly reliable and some things that aren't. We

455
00:25:50,160 --> 00:25:54,720
Speaker 2: have data from Medicaid claims, but there's like no race,

456
00:25:54,760 --> 00:25:58,720
Speaker 2: ethnicity data on Medicaid claims, so that makes it really

457
00:25:58,760 --> 00:26:04,040
Speaker 2: hard to disaggregate and see how the disparities are entrenched.

458
00:26:04,200 --> 00:26:06,560
Speaker 2: I think we need to get more data on how

459
00:26:06,600 --> 00:26:09,879
Speaker 2: people actually feel about the care that they're getting.

460
00:26:10,000 --> 00:26:11,960
Speaker 1: And with all of this new data that we might

461
00:26:11,960 --> 00:26:14,800
Speaker 1: be able to get our hands on, that will inform

462
00:26:15,320 --> 00:26:17,679
Speaker 1: the laws and policies that aren't put in place.

463
00:26:17,840 --> 00:26:21,960
Speaker 2: I can't remember a time when maternal health had so

464
00:26:22,160 --> 00:26:24,280
Speaker 2: much attention in Congress.

465
00:26:24,680 --> 00:26:27,600
Speaker 1: Recently, we've seen some stories about the racial inequities for

466
00:26:27,680 --> 00:26:31,080
Speaker 1: Black women in maternal health care, and those stories have

467
00:26:31,200 --> 00:26:34,040
Speaker 1: prompted many of these conversations that are now happening in

468
00:26:34,080 --> 00:26:36,600
Speaker 1: Congress and on a larger stage, and they've mobilized a

469
00:26:36,600 --> 00:26:39,240
Speaker 1: lot of these new policy proposals. When things happen to

470
00:26:39,320 --> 00:26:43,000
Speaker 1: rich people, they listen, also known as yes.

471
00:26:43,760 --> 00:26:46,560
Speaker 2: We're not just talking about people who haven't had access

472
00:26:46,640 --> 00:26:50,480
Speaker 2: to care. We're talking about people who exist in more

473
00:26:50,520 --> 00:26:55,760
Speaker 2: privileged spaces. I mean, Serena Williams has access to the

474
00:26:55,880 --> 00:26:59,640
Speaker 2: highest quality care and still almost died.

475
00:27:00,119 --> 00:27:02,359
Speaker 1: This is such a good point. So if you don't

476
00:27:02,400 --> 00:27:07,800
Speaker 1: know Serena Williams. The Serena Williams delivered her baby by

477
00:27:07,960 --> 00:27:11,160
Speaker 1: emergency sea section in September of twenty seventeen. The sea

478
00:27:11,200 --> 00:27:14,520
Speaker 1: section went smoothly, but then she felt short of breath,

479
00:27:14,600 --> 00:27:18,120
Speaker 1: and immediately worried because she has a history of blood clots.

480
00:27:18,359 --> 00:27:20,480
Speaker 1: She advocated for herself and asked for a c T

481
00:27:20,640 --> 00:27:23,720
Speaker 1: scan and blood thinners, and the nurse just thought that

482
00:27:23,800 --> 00:27:25,960
Speaker 1: she was kind of just like confused because of the

483
00:27:26,000 --> 00:27:28,960
Speaker 1: pain medication that she was on from the sea section.

484
00:27:29,280 --> 00:27:32,679
Speaker 1: Serena Williams then went on to develop blood clots in

485
00:27:32,720 --> 00:27:37,199
Speaker 1: her lungs and her sea section incision ruptured because of

486
00:27:37,280 --> 00:27:40,360
Speaker 1: the coughing from the clots that she had in her lungs.

487
00:27:40,680 --> 00:27:43,159
Speaker 1: When the doctors went to close the sea section wound again,

488
00:27:43,240 --> 00:27:46,600
Speaker 1: they discovered a hematoma in her abdomen. She also had

489
00:27:46,600 --> 00:27:49,439
Speaker 1: another procedure to insert a filter in a vein to

490
00:27:49,480 --> 00:27:52,760
Speaker 1: prevent further clots in her lungs. Serena stayed in the

491
00:27:52,800 --> 00:27:56,200
Speaker 1: hospital for another week and was confined to her bed

492
00:27:56,400 --> 00:28:01,040
Speaker 1: at home for another six weeks. And this is a

493
00:28:01,080 --> 00:28:06,800
Speaker 1: world class athlete, right who knows her body with constant monitoring.

494
00:28:07,640 --> 00:28:10,400
Speaker 1: Can you imagine? I can't. You're going to tell somebody

495
00:28:10,440 --> 00:28:14,960
Speaker 1: who her body is, her job, that is her livelihood,

496
00:28:14,960 --> 00:28:16,680
Speaker 1: and you're gonna tell me you think you know better

497
00:28:16,680 --> 00:28:19,359
Speaker 1: than she does when she's in pain. It just doesn't

498
00:28:19,400 --> 00:28:23,919
Speaker 1: make sense. Recently, Congress unanimously passed a bill that authorized

499
00:28:24,240 --> 00:28:28,040
Speaker 1: sixty million dollars over the next five years to prevent

500
00:28:28,200 --> 00:28:31,560
Speaker 1: maternal mortality in the United States. That money is going

501
00:28:31,640 --> 00:28:34,800
Speaker 1: to go to funding maternal health review committees in all

502
00:28:34,840 --> 00:28:38,120
Speaker 1: fifty states, and that helps them to collect that data

503
00:28:38,120 --> 00:28:40,840
Speaker 1: that we were talking about earlier on what is killing

504
00:28:40,880 --> 00:28:44,840
Speaker 1: women during or after childbirth. Doctor Bennittar also mentioned another

505
00:28:44,960 --> 00:28:47,440
Speaker 1: law that was introduced last month during Black Maternal Health

506
00:28:47,440 --> 00:28:50,760
Speaker 1: Week by Senator Corey Booker and others, called the Mama's First.

507
00:28:50,560 --> 00:28:55,160
Speaker 2: Act, and that is also designed to address the maternal

508
00:28:55,280 --> 00:29:00,960
Speaker 2: mortality crisis. Maternal mortality is tragic and preventable in almost

509
00:29:01,000 --> 00:29:05,920
Speaker 2: all cases, but maternal morbidity happens to way, way way

510
00:29:05,920 --> 00:29:12,160
Speaker 2: more pregnant people. And that's like gestational diabetes, hypertension, preclampsy,

511
00:29:12,760 --> 00:29:16,560
Speaker 2: postpartum hemorrhage, you know, things that don't kill pregnant and

512
00:29:16,560 --> 00:29:20,440
Speaker 2: birthing people, but are still very serious and can have

513
00:29:20,560 --> 00:29:25,680
Speaker 2: long term So I think Senator Booker's legislation wants to

514
00:29:25,720 --> 00:29:29,880
Speaker 2: expand Medicaid to include Dulah midwiffree and tribal midwif freecare.

515
00:29:30,200 --> 00:29:34,080
Speaker 1: It's clear that a combination of all these things, better care,

516
00:29:34,440 --> 00:29:37,720
Speaker 1: more data, and more legislation is going to be required

517
00:29:37,760 --> 00:29:40,760
Speaker 1: to make the transformative change that we need. In the

518
00:29:40,840 --> 00:29:41,560
Speaker 1: United States.

519
00:29:41,880 --> 00:29:46,640
Speaker 2: Medicaid is an incredible lever because Medicaid pays for so

520
00:29:46,960 --> 00:29:52,680
Speaker 2: many pregnancies. I think the opportunity to affect change through

521
00:29:52,720 --> 00:29:56,440
Speaker 2: Medicaid is pretty remarkable. And there's you know, talk about

522
00:29:56,560 --> 00:29:59,600
Speaker 2: changing payment structure. You may have heard this term called

523
00:29:59,680 --> 00:30:04,800
Speaker 2: value based payment, where basically health plans are paid more

524
00:30:04,920 --> 00:30:08,280
Speaker 2: for good outcomes. This is a conversation that is definitely

525
00:30:08,320 --> 00:30:10,880
Speaker 2: being had, and I think a lot of people are

526
00:30:10,920 --> 00:30:16,000
Speaker 2: asking hard questions and that's really important and I'm pretty hopeful.

527
00:30:16,440 --> 00:30:19,680
Speaker 2: What concerns me is that what probably needs to happen

528
00:30:19,920 --> 00:30:24,479
Speaker 2: is something that's really pretty transformative. The US healthcare system

529
00:30:24,600 --> 00:30:26,520
Speaker 2: does not transform quickly.

530
00:30:26,720 --> 00:30:29,880
Speaker 1: It is this behemoth of a system. It kind of

531
00:30:29,880 --> 00:30:32,600
Speaker 1: feels like when people talk about racism, right, how we're

532
00:30:32,640 --> 00:30:35,120
Speaker 1: going to change that in the United States. It is huge.

533
00:30:35,240 --> 00:30:38,880
Speaker 1: It's because the progress is so slow and incremental, and

534
00:30:38,920 --> 00:30:42,200
Speaker 1: sometimes incremental in the wrong directions. You have to think

535
00:30:42,480 --> 00:30:47,000
Speaker 1: of these transformative ideas and principle so you can make

536
00:30:47,120 --> 00:30:51,040
Speaker 1: any movement right. You have to shoot for the next

537
00:30:51,440 --> 00:31:01,880
Speaker 1: galaxy to move to the move. All right, it's time

538
00:31:01,920 --> 00:31:04,040
Speaker 1: for one thing TT I want to hear from you.

539
00:31:04,080 --> 00:31:07,040
Speaker 1: What's your one thing this week? It is read dying

540
00:31:07,240 --> 00:31:10,440
Speaker 1: some of my old clothes. Oh, yes, you've been doing

541
00:31:10,480 --> 00:31:15,320
Speaker 1: that again. I'm too excited. On the show, we talk

542
00:31:15,360 --> 00:31:19,120
Speaker 1: a lot about reduced reuse, recycle, and it's a really

543
00:31:19,160 --> 00:31:21,600
Speaker 1: great way for me to give clothes new life. So

544
00:31:21,680 --> 00:31:25,000
Speaker 1: I've been using writ dye and is it dylan d

545
00:31:25,240 --> 00:31:30,720
Speaker 1: y l o n dialon dalon dion. But you can

546
00:31:30,720 --> 00:31:33,840
Speaker 1: search it pretty much anywhere and it's super super easy.

547
00:31:34,120 --> 00:31:36,440
Speaker 1: You just put your clothes in really hot water, you

548
00:31:36,480 --> 00:31:38,240
Speaker 1: put some of the dye in there and it dies

549
00:31:38,240 --> 00:31:39,800
Speaker 1: your clothes, or you wash it and you got a

550
00:31:39,840 --> 00:31:42,800
Speaker 1: brand new shirt. I've died about five or six items.

551
00:31:42,800 --> 00:31:46,200
Speaker 1: You could do genes. I've seen people do sneakers, anything.

552
00:31:46,480 --> 00:31:49,440
Speaker 1: It's so much fun. And when you're thinking about donating

553
00:31:49,520 --> 00:31:52,520
Speaker 1: some clothes or cutting up a shirt because you know

554
00:31:52,560 --> 00:31:54,360
Speaker 1: it's old, now you might be able to give us

555
00:31:54,360 --> 00:31:56,840
Speaker 1: some new life an old T shirt. You dyet black,

556
00:31:56,880 --> 00:31:59,560
Speaker 1: you dyet orange, you diet green, you die purple? Ooh,

557
00:32:00,000 --> 00:32:04,440
Speaker 1: how's a look. What's your one thing? Z? My one

558
00:32:04,480 --> 00:32:06,400
Speaker 1: thing this week is a book. So a couple of

559
00:32:06,400 --> 00:32:08,840
Speaker 1: weeks ago, I asked people, what are you reading? And

560
00:32:09,240 --> 00:32:11,240
Speaker 1: if you go to my Instagram, you'll still see there's

561
00:32:11,240 --> 00:32:14,240
Speaker 1: a highlight that says book club. And one of these

562
00:32:14,280 --> 00:32:17,360
Speaker 1: books was from a friend of the show. Now I

563
00:32:17,360 --> 00:32:18,560
Speaker 1: say a friend of the show. I don't know if

564
00:32:18,600 --> 00:32:20,840
Speaker 1: she's listening, but we talk about her a lot because

565
00:32:20,840 --> 00:32:23,000
Speaker 1: in the past we read things that she wrote about

566
00:32:23,040 --> 00:32:25,720
Speaker 1: movies and TV shows that we like. And so I'm

567
00:32:25,760 --> 00:32:28,120
Speaker 1: reading a book by Brooke Ovi who went to Hampton

568
00:32:28,200 --> 00:32:31,080
Speaker 1: with me, absolutely and she wrote this book called Book

569
00:32:31,080 --> 00:32:34,200
Speaker 1: of Artists Cradled Embers. Now it's a novel. It's so

570
00:32:34,360 --> 00:32:38,160
Speaker 1: good and it really is a testament that talent exists

571
00:32:38,200 --> 00:32:41,200
Speaker 1: because we went to the same school. I'm not able

572
00:32:41,200 --> 00:32:45,680
Speaker 1: to write like that. It's so good, Hampton putting out

573
00:32:45,680 --> 00:32:49,600
Speaker 1: the best mind. I'm highlighting passages. It's so so good

574
00:32:50,080 --> 00:32:51,920
Speaker 1: and if you're looking for a book to read, I

575
00:32:51,960 --> 00:32:55,080
Speaker 1: think it is a great read. It is about love,

576
00:32:55,280 --> 00:32:58,520
Speaker 1: loss and liberation, but a lot of love and I'm

577
00:32:58,560 --> 00:33:00,800
Speaker 1: really enjoying it. I can't wait. I'm going to add

578
00:33:00,800 --> 00:33:04,080
Speaker 1: that to my kindle right now. Yes, if you have

579
00:33:04,160 --> 00:33:08,000
Speaker 1: Kindle Unlimited. Yes, you can get it for free, Perfect Brook,

580
00:33:08,160 --> 00:33:19,080
Speaker 1: We love you. That's it for Lap sixty three. This

581
00:33:19,120 --> 00:33:21,640
Speaker 1: has been a two parter, so we always love being

582
00:33:21,640 --> 00:33:24,320
Speaker 1: able to tackle these ideas and really pull them apart

583
00:33:24,360 --> 00:33:26,400
Speaker 1: with a little bit more time. What'd you think? You

584
00:33:26,480 --> 00:33:28,680
Speaker 1: like two parters? You like single episodes? Let us know.

585
00:33:29,080 --> 00:33:31,440
Speaker 1: Call us at two zero two five six seven seven

586
00:33:31,520 --> 00:33:33,280
Speaker 1: zero two eight and tell us what you thought. You

587
00:33:33,320 --> 00:33:35,120
Speaker 1: can also call and give us an idea for a

588
00:33:35,160 --> 00:33:37,320
Speaker 1: different lab you think we should do the semester We

589
00:33:37,560 --> 00:33:39,840
Speaker 1: like to hear from you. That's two zero two five

590
00:33:39,960 --> 00:33:42,560
Speaker 1: six seven seven zero two eight. You can also text,

591
00:33:42,840 --> 00:33:45,240
Speaker 1: and don't forget that there is so much more to

592
00:33:45,280 --> 00:33:47,960
Speaker 1: dig into on our website. There'll be a cheat cheap

593
00:33:47,960 --> 00:33:51,400
Speaker 1: for today's lab, additional links and resources in the show notes.

594
00:33:51,640 --> 00:33:53,880
Speaker 1: Plus you can sign up for our newsletter. Check it

595
00:33:53,920 --> 00:33:57,960
Speaker 1: out at Dope labspodcast dot com. Special things to today's

596
00:33:57,960 --> 00:34:01,640
Speaker 1: guest expert, doctor Sarah Bennett. You can find and follow

597
00:34:01,680 --> 00:34:04,360
Speaker 1: her on Twitter at Sarah C. Benattar. That's s A

598
00:34:04,720 --> 00:34:08,000
Speaker 1: r a h C b E n A t A R.

599
00:34:08,160 --> 00:34:10,319
Speaker 1: And you can find us on Twitter and Instagram at

600
00:34:10,360 --> 00:34:13,520
Speaker 1: Dope Labs Podcast TT's on Twitter and Instagram at d

601
00:34:13,719 --> 00:34:16,439
Speaker 1: R Underscore t s h O, and you can find

602
00:34:16,480 --> 00:34:20,320
Speaker 1: Zakiya at z said So Dope Labs is a Spotify

603
00:34:20,360 --> 00:34:23,520
Speaker 1: original production from Mega Owned Media Group. Our producers are

604
00:34:23,600 --> 00:34:27,000
Speaker 1: Jenny ratlck Mast and Lydia Smith of Wave Runner Studios.

605
00:34:27,160 --> 00:34:30,280
Speaker 1: Our associate producer from Mega Oh Media is Brianna Garrett.

606
00:34:30,520 --> 00:34:35,040
Speaker 1: Editing in sound design by Rob Smerciak, mixing by Hannes Brown.

607
00:34:35,320 --> 00:34:39,200
Speaker 1: Original music composed and produced by Taka Yasuzawa and Alex

608
00:34:39,280 --> 00:34:45,120
Speaker 1: Sugier from Spotify. Executive producer Corinne Gilliard and creative producer

609
00:34:45,280 --> 00:34:50,200
Speaker 1: Miguel Contreras. Special thanks to Shirley Ramos, Jess Borrison, Jasmine A,

610
00:34:50,320 --> 00:34:55,200
Speaker 1: Fifi Kamu, Elolia, Till krat Key, and Brian Marquis. Executive

611
00:34:55,239 --> 00:34:57,960
Speaker 1: producers from Mega Own Media Group are us T T

612
00:34:58,080 --> 00:35:02,680
Speaker 1: Show Dia and Zakiah Wattley taking