Speaker 1: I'm Tt and I'm Zakijah and from Spotify. This is
Speaker 1: Dope Labs. Welcome to Dope Labs, a weekly podcast that
Speaker 1: maxes hardcore science, pop culture, and how healthy does a friendship.
Speaker 1: This week is part two of our series on maternal health.
Speaker 1: If you haven't listened to last week's Lab yet with
Speaker 1: Simone Tape, we really recommend listening to that one. First,
Speaker 1: we talked to Simone about what services maternal health care encompasses.
Speaker 1: We learn that there's a lot of bottlenecks when it
Speaker 1: comes to getting good maternal healthcare here in the United States,
Speaker 1: and we also dug into disparities in maternal health among
Speaker 1: specific groups. This week, we're zooming out to understand more
Speaker 1: of the context around the state of maternal health care today,
Speaker 1: how we got here, and how to make it better. Okay,
Speaker 1: let's get into the recitation. What do we know? Well,
Speaker 1: you know, like you mentioned, we learned a lot from
Speaker 1: last week's Lab and sadly, we learned if you want
Speaker 1: good care, you basically need to move to Finland. But
Speaker 1: if you aren't trying to move to Finland, here are
Speaker 1: some of the major points from last week's episode about
Speaker 1: the state of maternal health care. Maternal health care in
Speaker 1: the United States is out of date and out of
Speaker 1: touch with the needs of today's birthing population. Yes, we're
Speaker 1: seeing rising rates of both morbidity so those are health
Speaker 1: issues and mortality that's death as it's related to complications
Speaker 1: following pregnancy and giving birth. Some of the major bottlenecks
Speaker 1: and maternal health care include the hurdles that you have
Speaker 1: to jump over making monthly appointments, the lack of options
Speaker 1: of both in person and virtual care, and maternal health
Speaker 1: care deserts. Also, mortality rates are disproportionate among women of color,
Speaker 1: so they are three to four times more likely to
Speaker 1: die from pregnancy or birth come implications. We also found
Speaker 1: out that fifty percent of the birthing population in the
Speaker 1: United States are on Medicaid, which means that they don't
Speaker 1: have equal and equitable access to healthcare. And at the
Speaker 1: end of the last episode, we started talking about the
Speaker 1: Omnibus legislation, which focuses on bringing preventable mortality rates closer
Speaker 1: to zero, and that takes us to kind of what
Speaker 1: we want to know for this lab. Yeah, so my
Speaker 1: first question is why is maternal healthcare in the US
Speaker 1: so bad. With the amount of money that Simone was
Speaker 1: telling us gets poured into our maternal health care system,
Speaker 1: you would think that that would mean that we are
Speaker 1: doing really great, but that's not the case, and I
Speaker 1: want to know why. And I want to know more
Speaker 1: about these programs. You know, So, how does insurance and
Speaker 1: the support that the federal government provides for birthing parents,
Speaker 1: how does that come into play? And why isn't it
Speaker 1: doing its job? It seems like that is such a
Speaker 1: good question. And I also want to know what makes
Speaker 1: maternal healthcare quote unquote good. And once we know but
Speaker 1: makes it good, how do we make it even better? Yes?
Speaker 1: And I think when we consider that, who is the
Speaker 1: weak right should it be nonprofits and private agencies? Or
Speaker 1: are there policies and programs that our government should sponsor
Speaker 1: that might improve outcomes? That's what I want to know. Okay,
Speaker 1: I think we've got enough questions. Yes, let's jump into
Speaker 1: the dissection.
Speaker 2: Let just ask you.
Speaker 1: Our guest for today's lab is doctor Sarah Benattar.
Speaker 2: My name is Sarah Benattar. I'm a principal research associated
Speaker 2: the Urban Institute in the Health Policy Center, So I
Speaker 2: do research mostly focused on maternal and child health.
Speaker 1: The first thing we wanted to know from doctor Benatar
Speaker 1: is why maternal healthcare in the United States is so poor.
Speaker 1: She said, it's not about money.
Speaker 2: The US spends more money on maternal health than any
Speaker 2: other country in the entire world, twenty five percent more
Speaker 2: per capita than the next highest spender. Despite all of that,
Speaker 2: we have some of the worst outcomes for pregnant people
Speaker 2: and infants.
Speaker 1: And let's talk about those outcomes. We learned from simone
Speaker 1: last week about increasing mortality rates, but what are the specifics.
Speaker 2: In twenty eighteen, the rate was seventeen per one hundred
Speaker 2: thousand births resulted in a maternal death. That went up
Speaker 2: in twenty nineteen to over twenty deaths per one hundred
Speaker 2: thousand pregnant people. In twenty twenty that was even higher
Speaker 2: at twenty three point eight. The next highest rate for
Speaker 2: a high income country is half that, so in Canada
Speaker 2: and France the rates are more around eight per one
Speaker 2: hundred thousand deaths.
Speaker 1: And Sarah told us historically this upward trajectory hasn't been
Speaker 1: the trend.
Speaker 2: The Commonwealth Fund has this terrific piece that worth looking at,
Speaker 2: where they have a chart of maternal mortalit starting in
Speaker 2: about nineteen eighteen, and you can see that it starts
Speaker 2: really really high, and then by the nineteen thirties or so,
Speaker 2: it's considerably lower, and it just keeps on going down
Speaker 2: until about the nineteen eighties, and in the nineteen eighties
Speaker 2: it goes up again, and now they just are creeping
Speaker 2: up consistently.
Speaker 1: So this chart is looking at death per one hundred
Speaker 1: thousand pregnant people. In the eighties and nineties, you're only
Speaker 1: seeing about seven to eight deaths. But it's really sobering
Speaker 1: to learn that today we're up to about twenty three
Speaker 1: deaths per one hundred thousand pregnant people. That's a problem huge.
Speaker 1: Twenty three sounds like it's small, but when you look
Speaker 1: at like what it was significant, Yeah, yeah, anything increasing
Speaker 1: by times three you need to check on it.
Speaker 2: Yes, a good segment of that can be attributed to
Speaker 2: discriminatory healthcare practices and systemic racism. I think because there
Speaker 2: is just an incredible amount of us and I think
Speaker 2: it's relatively well demonstrated that is not helpful for a pregnancy.
Speaker 1: In addition to mortality rates, there are other stats that
Speaker 1: doctor Benattar points to that indicate the US is not
Speaker 1: up to par when it comes to maternal healthcare.
Speaker 2: In the US. Some of the things that we really
Speaker 2: pay close attention to our low birth weight, so that's
Speaker 2: a baby that's born weighing less than five pounds eight ounces,
Speaker 2: and pre term birth, which is being delivered before thirty
Speaker 2: seven weeks gestation. So those are some of the bigger indicators.
Speaker 2: Another thing are the CEA section rates. Approximately a third
Speaker 2: of all deliveries are done by c section. Now the
Speaker 2: who said that the ideal rate would be around fifteen percent.
Speaker 1: Cesarean deliveries, which are also known as c sections, do
Speaker 1: have more risk than delivering a baby baginally, but they're
Speaker 1: often medically necessary in order to protect the health of
Speaker 1: a birthing parent or a baby. There are some common
Speaker 1: chronic health conditions that sometimes require section delivery, and those
Speaker 1: include heart disease, high blood pressure, or gestational diabetes. And
Speaker 1: the disparities we've been talking about permeate all of these
Speaker 1: different areas.
Speaker 2: If you look at this by race and ethnicity, the rates,
Speaker 2: particularly for black women and birthing people, are much higher,
Speaker 2: so maternal mortality rates can be three to four times higher.
Speaker 2: Sea section rates are quite a bit higher low birth
Speaker 2: rate and preach and birth rates are also higher for
Speaker 2: Black women and birthing people.
Speaker 1: The math ain't mathing. Okay, Rights spends the most money
Speaker 1: on maternal healthcare but has the worst outcomes, especially for
Speaker 1: Black women and birthen people. We need to understand more.
Speaker 1: So we ask doctor Benettar, what is going on?
Speaker 2: So many people who become pregnant and are then engaging
Speaker 2: in prenatal care have not necessarily had access to high
Speaker 2: quality care prior to that. And I have also experienced
Speaker 2: all kinds of discrimination care. But you know, we're talking
Speaker 2: about people coming into pregnancy maybe haven't had, especially prior
Speaker 2: to the ACA, any medical insurance or coverage prior. Because
Speaker 2: Medicaid pays for over forty percent of all births in
Speaker 2: the United States, and for black women and breathing people
Speaker 2: is hired more like sixty five percent of births.
Speaker 1: Medicaid is a federal and state program that helps with
Speaker 1: health care costs for Americans with limited income and resources,
Speaker 1: and it's the largest source of funding for medical and
Speaker 1: health related services for people with low income in the
Speaker 1: United States. So Medicaid is such an important program to
Speaker 1: have because it provides healthcare to a portion of the
Speaker 1: population that wouldn't have it otherwise. But because it is
Speaker 1: regulated at the state level as well as the federal level,
Speaker 1: there are some parts of it that, you know, depending
Speaker 1: on the state that you're in, have some pitfalls. Insurance,
Speaker 1: I think is one of the trickiest things in adulting,
Speaker 1: don't you think, Like for real, for real, it's really wild.
Speaker 1: Doctor Benattar mentioned the ACA, or the Affordable Care Act,
Speaker 1: which was passed in twenty ten under the Obama administration.
Speaker 1: The ACA was meant to expand health care coverage for
Speaker 1: millions of uninsured Americans. It also expanded Medicaid eligibility and
Speaker 1: created the marketplace where people can purchase private insurance. And
Speaker 1: that private insurance is very expensive, by the way, very
Speaker 1: But before the Affordable Care Act, you had to basically
Speaker 1: have a job if you wanted good health care. And
Speaker 1: isn't that kind of wild when we stepped back from it,
Speaker 1: Like it's like, Okay, you only have the right to
Speaker 1: live if you are working, working, and not all jobs
Speaker 1: provide health care. Exactly. I have health I have a
Speaker 1: body whether I'm working or not, exactly, And that's something
Speaker 1: that's unique to the United States. Because universal health care
Speaker 1: is something that they have in Europe and Canada and
Speaker 1: we're just slow to get on it. People are still
Speaker 1: fighting the Affordable Care Act, also called Obamacare by folks
Speaker 1: who want to make it seems like it's something that
Speaker 1: is partisan, like people getting quality healthcare as a partisan thing.
Speaker 1: It's not well. In my opinion, it shouldn't be. But
Speaker 1: here we are. Here, we are at this big age,
Speaker 1: this country, at this big age set up having a
Speaker 1: temperate tantrum around healthcare. Get it together or you're not
Speaker 1: getting anything. Yeah. Another answer to the question how did
Speaker 1: we get here is what doctor Benattar calls a very
Speaker 1: medicalized approach to pregnancy, one that values profit over people.
Speaker 2: Many other places approach pregnancy from a perspective that's much
Speaker 2: more normalized, where this is a natural process that maybe
Speaker 2: sometimes requires a little bit of help, but most of
Speaker 2: the time we can support women through it and have
Speaker 2: a healthy outcome. The medicalized model also maximizes profit. Many times,
Speaker 2: these visits are very short, maybe fifteen minutes. Like if
Speaker 2: you think about a hospital based clinic where we're trying
Speaker 2: to get as many people in, especially because Medicaid is
Speaker 2: one of the largest payers there are often high nose
Speaker 2: show rates.
Speaker 1: And that could be because of the factors we talked
Speaker 1: about last week with simone, lack of access to childcare
Speaker 1: and transportation, no telehealth options, and maternal health care deserts.
Speaker 2: So there are these short visits in which maybe there's
Speaker 2: been no pre existing relationship, and many people will express
Speaker 2: that they aren't being listened to. And lots of people
Speaker 2: have all kinds of other social determinants that are affecting
Speaker 2: their health like housing, insecurity, food and security, anxiety, depression.
Speaker 2: The list is long.
Speaker 1: Another trend that directly correlates to worsening prenatal care in
Speaker 1: the United States is the growing OBGYN shortage, and we
Speaker 1: mentioned that last week, but to help you understand it
Speaker 1: a little bit better, let's think about it from the
Speaker 1: entire national perspective. So not just rural areas. If you
Speaker 1: look at all the counties in the United States, half
Speaker 1: of them do not have a single obgyn. That's major.
Speaker 1: That's wild, that is major. My whole county. Yeah, when
Speaker 1: I think about going to another county for anything, a
Speaker 1: specific grocery store because of a specific shop that I like,
Speaker 1: Oh my gosh, so far, so far, this is going
Speaker 1: to be a trek. Now, imagine doing that pregnant mm
Speaker 1: hm ugh. In part one of this series, Simone said
Speaker 1: that fifty percent of the birthing population is on Medicaid.
Speaker 1: And now we know that Medicaid is one of the
Speaker 1: largest payers of maternal healthcare in the United States, covering
Speaker 1: about forty percent of all births in the United States
Speaker 1: and sixty five percent of births for Black women and
Speaker 1: birthing people. So let's break down Medicaid more in the
Speaker 1: context of maternal health.
Speaker 2: In the nineteen eighties, Medicaid expanded to include pregnant people.
Speaker 2: So prior to that, Medicaid was almost exclusively a program
Speaker 2: for children and for adults with very, very low incomes,
Speaker 2: so it was really pretty restrictive.
Speaker 1: Eligible to receive Medicaid, most people have to meet an
Speaker 1: income requirement.
Speaker 2: Each state decides how high the income threshold goes for
Speaker 2: pregnancy related Medicaid coverage. So in one state, you could
Speaker 2: make a certain amount of money and qualify for pregnancy
Speaker 2: related Medicaid, but in another state you could make thirty
Speaker 2: percent more and still qualify for pregnancy related Medicaid.
Speaker 1: Let's break that down. So when doctor Benetar mentions qualifying.
Speaker 1: What she's talking about is the income level, how much
Speaker 1: income you make as it relates to the federal poverty level.
Speaker 1: And so the federal poverty level is thirteen thousand, five
Speaker 1: hundred dollars annually for individuals and around eighteen k for
Speaker 1: families of two. And the gotcha, gotcha with all of
Speaker 1: this is exactly what doctor Benattar said. It changes between states.
Speaker 1: So we looked up what it would be for Maryland.
Speaker 1: So let's say it's you and your partner and one
Speaker 1: of you is pregnant. You qualify for Medicaid if you
Speaker 1: make up to four thousand, twenty nine dollars per month. Okay,
Speaker 1: so that's for Maryland. For Alabama, same situation, you your partner,
Speaker 1: one of you is pregnant, You qualify if you make
Speaker 1: up to two two and twenty eight dollars per month.
Speaker 1: That's a lot lower. That is a lot lower. I
Speaker 1: would want to move to Maryland if I could. Right,
Speaker 1: You think about the quality of life of the pregnant
Speaker 1: folks in Alabama who are looking to qualify for Medicaid.
Speaker 1: That annual income, when you do the math, that's not
Speaker 1: a lot of money. I mean, I think that's the
Speaker 1: interesting thing that this is state by state, you know,
Speaker 1: and this is a much higher percentage of the federal
Speaker 1: poverty level that's allowed, and so this is gracious for
Speaker 1: maternal health care. We won't even get into what it
Speaker 1: looks like how little income you can make if you
Speaker 1: want to qualify for Medicaid and you're not pregnant right now.
Speaker 1: And this is where I think we see these insurance gaps,
Speaker 1: and when people are pregnant, they show up and they
Speaker 1: haven't had good health care leading up to this. Absolutely,
Speaker 1: I think this is how we get that vicious cycle
Speaker 1: of complications and increase morbidity and mortality. Absolutely, because all
Speaker 1: of these things touch Every aspect of your life is
Speaker 1: touching this. So if you have to make below a
Speaker 1: certain amount, that means that's going to affect do you
Speaker 1: have a car, do you have access to technology, The
Speaker 1: quality of your food, and all of these will affect
Speaker 1: your pregnancy, all of it. Where you can live, air
Speaker 1: quality because of where you're living. Yes, yes, I was
Speaker 1: gonna say, this is just tying back to so many
Speaker 1: episodes what doctor Tate said about if you're living with
Speaker 1: somebody else, if they make a little bit more income,
Speaker 1: it may not even be yours to spend. But what
Speaker 1: does that mean for your household amount? Right? And if
Speaker 1: you qualify or not, and then what does that mean
Speaker 1: for your support throughout your pregnancy? Absolutely, it's just oh
Speaker 1: my goodness, there are so many, so many ways to
Speaker 1: look at this. Yeah, because I mean even when we
Speaker 1: think back to our sleep episodes with doctor Jean Louis
Speaker 1: mm hm and talking about the quality of your health
Speaker 1: is dependent on your zip code. Now, compound that with
Speaker 1: access to proper health care, access to maternal health care
Speaker 1: exact A is also dependent on your existence, dependent on
Speaker 1: your zip code. You're just stacking those things up.
Speaker 2: In many states now, the threshold for eligibility is pretty high.
Speaker 2: You could be to two hundred ish percent of poverty
Speaker 2: and qualify for pregnancy related Medicaid coverage, and then Medicaid
Speaker 2: covers all of your pregnancy related healthcare needs. It also
Speaker 2: covers any other healthcare related needs you have.
Speaker 1: Since nineteen eighty nine, pregnant women with incomes at or
Speaker 1: below one hundred thirty three percent of the federal poverty
Speaker 1: level have been a mandatory Medicaid eligibility group. So that
Speaker 1: means you can make up to one hundred percent of
Speaker 1: the poverty level plus an additional thirty three percent. They're
Speaker 1: giving you a little bonus area there, you know. So
Speaker 1: if you may up to one hundred thirty three percent
Speaker 1: of the poverty level, then your mandatory, like it's mandatory
Speaker 1: that you are included in Medicaid coverage.
Speaker 2: Every pregnant individual in the United States who becomes pregnant
Speaker 2: should qualify for either Medicaid or the Children's Health Insurance Program.
Speaker 1: The Children's Health Insurance Program OR was part of the
Speaker 1: Balanced Budget Act of nineteen ninety seven, and so this
Speaker 1: program was created to provide low cost health coverage for
Speaker 1: children who wouldn't qualify for Medicaid but are still relatively
Speaker 1: low income. Like Medicaid, each state is still determining the
Speaker 1: eligibility requirements for CHIP, so really it's plugging a gap.
Speaker 2: If the Children's Health Insurance Program covers some pregnancies that
Speaker 2: undocumented people are experiencing because it is focused on the
Speaker 2: unborn child in that situation because they would not otherwise
Speaker 2: qualify for a federally funded health insurance program.
Speaker 1: It's like, we have some stop gaps, but it's not
Speaker 1: one hundred percent. So in the case of CHIP, you know,
Speaker 1: if you imagine an undocumented person that's pregnant, they're not
Speaker 1: eligible for Medicaid, but their unborn child is eligible for CHIP,
Speaker 1: the Children's Health Insurance program, Right, but the birthing parent
Speaker 1: still isn't covered by either of those two things. Right,
Speaker 1: So we have some stop gaps, but it's still leaky.
Speaker 1: It's still leaky. Yeah, let's take a break and when
Speaker 1: we come back, we'll talk about postpartum care and some
Speaker 1: legislation that's coming out to hopefully improve maternal health in
Speaker 1: the United States. Plus stick around to hear about a
Speaker 1: special episode that we're working on. We're back, but before
Speaker 1: we get back to the lab, two things. Next week,
Speaker 1: we're talking all about our therapy and how art can
Speaker 1: be utilized to help us in our mental health journeys.
Speaker 1: And we're also reaching out to ask for your input
Speaker 1: and feedback. We are doing a special episode calling out
Speaker 1: the lgbt QIA community in stem. If you are a
Speaker 1: member of this community, we want to hear from you.
Speaker 1: Call us at two zero two five six seven seven
Speaker 1: zero two eight and tell us about your work, what
Speaker 1: you do. We want to hear it all. Let's get
Speaker 1: back to the lab. We've been talking with doctor Benattar
Speaker 1: about Medicaid CHIP, which is the Children's Health Insurance Program.
Speaker 1: And these are two programs meant to expand maternal health
Speaker 1: care coverage in the United States, and how complicated it
Speaker 1: can be to qualify for these programs. So let's say
Speaker 1: you do qualify, You've jumped through all the hoops to
Speaker 1: get there. Medicaid coverage includes, you know, pregnancies with complications
Speaker 1: and postpartum healthcare. Two. So remember how simone said that
Speaker 1: typically there is a six week post birth follow up
Speaker 1: and then that's it. If you have Medicaid. The minimum
Speaker 1: requirement is that pregnant people remain covered for up to
Speaker 1: sixty days postpartum. Now I'm gonna let you do the math.
Speaker 1: For six weeks time seven days. That's not giving you
Speaker 1: a lot of room if you miss that right hitting
Speaker 1: on the nose at six weeks, you know what I'm saying.
Speaker 1: Tt Yeah. And so in many states there are now
Speaker 1: postpartum extensions of Medicaid that would let you stay covered
Speaker 1: up to a year after giving birth. And we want
Speaker 1: to pause and really take a moment to talk about
Speaker 1: postpartum care.
Speaker 2: Sometimes we'd refer to the first three months postpartum as
Speaker 2: a fourth trimester, and I think that more attention paid
Speaker 2: to that fourth trimester would be really valuable.
Speaker 1: When it comes to maternal health. So much focuses on
Speaker 1: the time leading up to birth and then the birth itself,
Speaker 1: and then there's just a huge drop off in care.
Speaker 1: But having good medical care and a strong support system
Speaker 1: is just as crucial, if not more so, after birth
Speaker 1: when the baby is here.
Speaker 2: Yes, there are a few things to think about. One
Speaker 2: is the safety of the mother or the birthing parent,
Speaker 2: because there are a number of sequela that could happen
Speaker 2: that could really endanger the life of the person who
Speaker 2: just delivered a baby, and that is generally around hemorrhage
Speaker 2: and basequela.
Speaker 1: She just means a condition resulting from a previous condition,
Speaker 1: so think of it as like another domino in a
Speaker 1: sequence of conditions or effects. Hemorrhage is a rare but
Speaker 1: very serious condition when a person has heavy bleeding after
Speaker 1: giving birth. It's usually treatable as long as you have
Speaker 1: access to good medical care, and if you don't and
Speaker 1: it's not treated, it can be fatal.
Speaker 2: Then there's support around breastfeeding if that is a choice
Speaker 2: that has been made and even if it's not, then
Speaker 2: there's like making sure that there is enough formula available.
Speaker 2: It's the wrong formula if it doesn't taste good. If
Speaker 2: your child has allergies, it can be a real struggle.
Speaker 2: And not being able to provide adequate food for your
Speaker 2: child is just heartbreaking. And diapers the same thing.
Speaker 1: If you make the decision to breastfeed, there are all
Speaker 1: kinds of things to deal with, like getting a newborn
Speaker 1: to latch, sore chapped nipples, really painful infection of milk
Speaker 1: ducks called mestitis, just to name a few. And with formula.
Speaker 1: Next time you go to the pharmacy, go look at
Speaker 1: those formula prices and diapers. All of it is so expensive.
Speaker 1: They even have in formula behind those little clear cases
Speaker 1: so that you have to call a salesperson over to
Speaker 1: unlock it for you. And so there are some programs
Speaker 1: like Women Infants, Children or WICK that will cover the
Speaker 1: cost of formula for low income families. Postpartum depression is
Speaker 1: also a huge health risk during the fourth trimester. Remember
Speaker 1: someone said that according to the CDC, about one in
Speaker 1: eight women experience symptoms of postpartum depression.
Speaker 2: Of course, all the other things that a new parent
Speaker 2: might need like housing, and there could be intimate partner violence.
Speaker 2: So there are programs out there that are designed to
Speaker 2: help support new parents, and sometimes duela care will extend
Speaker 2: to the postpartum period as well.
Speaker 1: All of this on top of very little sleep and
Speaker 1: pressure of keeping this little animal alive. It's no wonder
Speaker 1: that postpartum care is advised for up to a year
Speaker 1: after giving birth. That single six week appointment just doesn't
Speaker 1: cut it. And you know, all of this information is
Speaker 1: really powerful, and it's important to remember that even though
Speaker 1: we're seeing this really concerning trend of increasing mortality rates
Speaker 1: among pregnant people, we're also now talking about it in
Speaker 1: a way that we haven't seen before.
Speaker 2: There's a lot more attention to this topic now than
Speaker 2: there has been for many, many decades.
Speaker 1: So what are some elements of maternal healthcare that might
Speaker 1: help improve these statistics? Doctor Benettar and our colleagues at
Speaker 1: the Urban Institute did a project that looked at some
Speaker 1: different interventions or enhancements to existing maternal care and there
Speaker 1: were some positive results.
Speaker 2: Ultimately, what we found is that models of care in
Speaker 2: which there is more time to spend with patients and
Speaker 2: where there's a relationship that is built tended to be
Speaker 2: associated with better outcomes. From an impact standpoint, we found
Speaker 2: that birth center care was positively associated with improved birth
Speaker 2: weight and gestational ages and reduced c sections. If you
Speaker 2: feel like your provider understands you, listens to you, and
Speaker 2: cares about you, the quality of the care will be
Speaker 2: improved and as a result, so will the outcomes.
Speaker 1: This reminds me of the hybrid remote in person model
Speaker 1: Simone was talking about. Spending more time talking to healthcare
Speaker 1: providers can be really beneficial in some cases, and for
Speaker 1: some people, you don't have to be in person to
Speaker 1: do it. It can be online or telephone appointments. Those
Speaker 1: are all options for talking through things like what to
Speaker 1: expect from labor, measures to maintain your health during pregnancy,
Speaker 1: and just fielding up any questions that are arising throughout
Speaker 1: your pregnancy. And it doesn't even have to be with
Speaker 1: a doctor or a midwife. Doctor Benatar mentioned doulas and
Speaker 1: care coordinators as other potential support systems.
Speaker 2: JULA care is like an ingredient that you can add
Speaker 2: to prenatal and delivery care. It's the lay person who
Speaker 2: comes and can be your advocate during the birthing process.
Speaker 1: And this is such a great option for additional coaching
Speaker 1: through all these different stages of pregnancy, labor, and beyond.
Speaker 1: Another type of support role that doctor Benatar mentioned is
Speaker 1: being part of group prenatal care.
Speaker 2: You have a short interaction with your obstetric provider, who
Speaker 2: could be a midwife or a nurse practitioner or an obgion,
Speaker 2: but you're also part of a group of people who
Speaker 2: are approximately at the same stage of pregnancy as you are.
Speaker 2: You always meet together. It's a two hour block of time.
Speaker 2: You learn, you talk about what your concerns are. You
Speaker 2: have social support in addition to the education and then
Speaker 2: the medical support.
Speaker 1: A major part of improving outcomes is collecting data understanding
Speaker 1: where we are now. We ask doctor Binettar about how
Speaker 1: we collect data around births.
Speaker 2: We have birth certificate data and that's pretty well collected,
Speaker 2: although there are some things on the birth certificate that
Speaker 2: are really highly reliable and some things that aren't. We
Speaker 2: have data from Medicaid claims, but there's like no race,
Speaker 2: ethnicity data on Medicaid claims, so that makes it really
Speaker 2: hard to disaggregate and see how the disparities are entrenched.
Speaker 2: I think we need to get more data on how
Speaker 2: people actually feel about the care that they're getting.
Speaker 1: And with all of this new data that we might
Speaker 1: be able to get our hands on, that will inform
Speaker 1: the laws and policies that aren't put in place.
Speaker 2: I can't remember a time when maternal health had so
Speaker 2: much attention in Congress.
Speaker 1: Recently, we've seen some stories about the racial inequities for
Speaker 1: Black women in maternal health care, and those stories have
Speaker 1: prompted many of these conversations that are now happening in
Speaker 1: Congress and on a larger stage, and they've mobilized a
Speaker 1: lot of these new policy proposals. When things happen to
Speaker 1: rich people, they listen, also known as yes.
Speaker 2: We're not just talking about people who haven't had access
Speaker 2: to care. We're talking about people who exist in more
Speaker 2: privileged spaces. I mean, Serena Williams has access to the
Speaker 2: highest quality care and still almost died.
Speaker 1: This is such a good point. So if you don't
Speaker 1: know Serena Williams. The Serena Williams delivered her baby by
Speaker 1: emergency sea section in September of twenty seventeen. The sea
Speaker 1: section went smoothly, but then she felt short of breath,
Speaker 1: and immediately worried because she has a history of blood clots.
Speaker 1: She advocated for herself and asked for a c T
Speaker 1: scan and blood thinners, and the nurse just thought that
Speaker 1: she was kind of just like confused because of the
Speaker 1: pain medication that she was on from the sea section.
Speaker 1: Serena Williams then went on to develop blood clots in
Speaker 1: her lungs and her sea section incision ruptured because of
Speaker 1: the coughing from the clots that she had in her lungs.
Speaker 1: When the doctors went to close the sea section wound again,
Speaker 1: they discovered a hematoma in her abdomen. She also had
Speaker 1: another procedure to insert a filter in a vein to
Speaker 1: prevent further clots in her lungs. Serena stayed in the
Speaker 1: hospital for another week and was confined to her bed
Speaker 1: at home for another six weeks. And this is a
Speaker 1: world class athlete, right who knows her body with constant monitoring.
Speaker 1: Can you imagine? I can't. You're going to tell somebody
Speaker 1: who her body is, her job, that is her livelihood,
Speaker 1: and you're gonna tell me you think you know better
Speaker 1: than she does when she's in pain. It just doesn't
Speaker 1: make sense. Recently, Congress unanimously passed a bill that authorized
Speaker 1: sixty million dollars over the next five years to prevent
Speaker 1: maternal mortality in the United States. That money is going
Speaker 1: to go to funding maternal health review committees in all
Speaker 1: fifty states, and that helps them to collect that data
Speaker 1: that we were talking about earlier on what is killing
Speaker 1: women during or after childbirth. Doctor Bennittar also mentioned another
Speaker 1: law that was introduced last month during Black Maternal Health
Speaker 1: Week by Senator Corey Booker and others, called the Mama's First.
Speaker 2: Act, and that is also designed to address the maternal
Speaker 2: mortality crisis. Maternal mortality is tragic and preventable in almost
Speaker 2: all cases, but maternal morbidity happens to way, way way
Speaker 2: more pregnant people. And that's like gestational diabetes, hypertension, preclampsy,
Speaker 2: postpartum hemorrhage, you know, things that don't kill pregnant and
Speaker 2: birthing people, but are still very serious and can have
Speaker 2: long term So I think Senator Booker's legislation wants to
Speaker 2: expand Medicaid to include Dulah midwiffree and tribal midwif freecare.
Speaker 1: It's clear that a combination of all these things, better care,
Speaker 1: more data, and more legislation is going to be required
Speaker 1: to make the transformative change that we need. In the
Speaker 1: United States.
Speaker 2: Medicaid is an incredible lever because Medicaid pays for so
Speaker 2: many pregnancies. I think the opportunity to affect change through
Speaker 2: Medicaid is pretty remarkable. And there's you know, talk about
Speaker 2: changing payment structure. You may have heard this term called
Speaker 2: value based payment, where basically health plans are paid more
Speaker 2: for good outcomes. This is a conversation that is definitely
Speaker 2: being had, and I think a lot of people are
Speaker 2: asking hard questions and that's really important and I'm pretty hopeful.
Speaker 2: What concerns me is that what probably needs to happen
Speaker 2: is something that's really pretty transformative. The US healthcare system
Speaker 2: does not transform quickly.
Speaker 1: It is this behemoth of a system. It kind of
Speaker 1: feels like when people talk about racism, right, how we're
Speaker 1: going to change that in the United States. It is huge.
Speaker 1: It's because the progress is so slow and incremental, and
Speaker 1: sometimes incremental in the wrong directions. You have to think
Speaker 1: of these transformative ideas and principle so you can make
Speaker 1: any movement right. You have to shoot for the next
Speaker 1: galaxy to move to the move. All right, it's time
Speaker 1: for one thing TT I want to hear from you.
Speaker 1: What's your one thing this week? It is read dying
Speaker 1: some of my old clothes. Oh, yes, you've been doing
Speaker 1: that again. I'm too excited. On the show, we talk
Speaker 1: a lot about reduced reuse, recycle, and it's a really
Speaker 1: great way for me to give clothes new life. So
Speaker 1: I've been using writ dye and is it dylan d
Speaker 1: y l o n dialon dalon dion. But you can
Speaker 1: search it pretty much anywhere and it's super super easy.
Speaker 1: You just put your clothes in really hot water, you
Speaker 1: put some of the dye in there and it dies
Speaker 1: your clothes, or you wash it and you got a
Speaker 1: brand new shirt. I've died about five or six items.
Speaker 1: You could do genes. I've seen people do sneakers, anything.
Speaker 1: It's so much fun. And when you're thinking about donating
Speaker 1: some clothes or cutting up a shirt because you know
Speaker 1: it's old, now you might be able to give us
Speaker 1: some new life an old T shirt. You dyet black,
Speaker 1: you dyet orange, you diet green, you die purple? Ooh,
Speaker 1: how's a look. What's your one thing? Z? My one
Speaker 1: thing this week is a book. So a couple of
Speaker 1: weeks ago, I asked people, what are you reading? And
Speaker 1: if you go to my Instagram, you'll still see there's
Speaker 1: a highlight that says book club. And one of these
Speaker 1: books was from a friend of the show. Now I
Speaker 1: say a friend of the show. I don't know if
Speaker 1: she's listening, but we talk about her a lot because
Speaker 1: in the past we read things that she wrote about
Speaker 1: movies and TV shows that we like. And so I'm
Speaker 1: reading a book by Brooke Ovi who went to Hampton
Speaker 1: with me, absolutely and she wrote this book called Book
Speaker 1: of Artists Cradled Embers. Now it's a novel. It's so
Speaker 1: good and it really is a testament that talent exists
Speaker 1: because we went to the same school. I'm not able
Speaker 1: to write like that. It's so good, Hampton putting out
Speaker 1: the best mind. I'm highlighting passages. It's so so good
Speaker 1: and if you're looking for a book to read, I
Speaker 1: think it is a great read. It is about love,
Speaker 1: loss and liberation, but a lot of love and I'm
Speaker 1: really enjoying it. I can't wait. I'm going to add
Speaker 1: that to my kindle right now. Yes, if you have
Speaker 1: Kindle Unlimited. Yes, you can get it for free, Perfect Brook,
Speaker 1: We love you. That's it for Lap sixty three. This
Speaker 1: has been a two parter, so we always love being
Speaker 1: able to tackle these ideas and really pull them apart
Speaker 1: with a little bit more time. What'd you think? You
Speaker 1: like two parters? You like single episodes? Let us know.
Speaker 1: Call us at two zero two five six seven seven
Speaker 1: zero two eight and tell us what you thought. You
Speaker 1: can also call and give us an idea for a
Speaker 1: different lab you think we should do the semester We
Speaker 1: like to hear from you. That's two zero two five
Speaker 1: six seven seven zero two eight. You can also text,
Speaker 1: and don't forget that there is so much more to
Speaker 1: dig into on our website. There'll be a cheat cheap
Speaker 1: for today's lab, additional links and resources in the show notes.
Speaker 1: Plus you can sign up for our newsletter. Check it
Speaker 1: out at Dope labspodcast dot com. Special things to today's
Speaker 1: guest expert, doctor Sarah Bennett. You can find and follow
Speaker 1: her on Twitter at Sarah C. Benattar. That's s A
Speaker 1: r a h C b E n A t A R.
Speaker 1: And you can find us on Twitter and Instagram at
Speaker 1: Dope Labs Podcast TT's on Twitter and Instagram at d
Speaker 1: R Underscore t s h O, and you can find
Speaker 1: Zakiya at z said So Dope Labs is a Spotify
Speaker 1: original production from Mega Owned Media Group. Our producers are
Speaker 1: Jenny ratlck Mast and Lydia Smith of Wave Runner Studios.
Speaker 1: Our associate producer from Mega Oh Media is Brianna Garrett.
Speaker 1: Editing in sound design by Rob Smerciak, mixing by Hannes Brown.
Speaker 1: Original music composed and produced by Taka Yasuzawa and Alex
Speaker 1: Sugier from Spotify. Executive producer Corinne Gilliard and creative producer
Speaker 1: Miguel Contreras. Special thanks to Shirley Ramos, Jess Borrison, Jasmine A,
Speaker 1: Fifi Kamu, Elolia, Till krat Key, and Brian Marquis. Executive
Speaker 1: producers from Mega Own Media Group are us T T
Speaker 1: Show Dia and Zakiah Wattley taking