WEBVTT - The Maternal Healthcare System Part I – Lab 062 0:00:00.440 --> 0:00:03.960 Oh my goodness, did you see Rihanna's latest look with 0:00:04.080 --> 0:00:07.800 that string going across that pregnant belly. Yes, she is 0:00:08.119 --> 0:00:11.080 putting out looks that I wouldn't dare to and she's 0:00:11.080 --> 0:00:13.600 doing it with a plus one in her belly. Yes, 0:00:14.000 --> 0:00:17.680 she is definitely that girl, that girl. You know, it 0:00:17.760 --> 0:00:21.320 feels only right that when our good friend Rihanna goes 0:00:21.320 --> 0:00:23.880 through the changes, that we go through them right beside her. Yes, 0:00:23.920 --> 0:00:26.880 I'm having sympathy pains, are you. Yes, I've been eating 0:00:26.880 --> 0:00:29.280 a lot more, you know, feel like I'm eating for 0:00:29.320 --> 0:00:31.800 two or maybe I'm just greedy. Who knows it could be. 0:00:32.000 --> 0:00:34.760 I'm not gonna say with one. I'm not gonna say 0:00:34.800 --> 0:00:37.600 what I think. Our age group we kind of grew 0:00:37.760 --> 0:00:40.839 up with Rihanna, so it feels like a family affair. 0:00:41.040 --> 0:00:44.240 So talking about all the motions that she's going through 0:00:44.320 --> 0:00:47.000 it feels therapeutic for us all. And so it's only 0:00:47.120 --> 0:00:49.640 right that we jump into what her new future will 0:00:49.640 --> 0:00:51.720 look like and what it looks like right now in 0:00:51.760 --> 0:00:55.640 the landscape of maternal health. I'm TT and I'm Zakiyah 0:00:55.760 --> 0:01:24.959 and from Spotify. This is Dope Labs. Welcome to Dope Labs, 0:01:25.000 --> 0:01:28.679 a weekly podcast that mixes hardcore science, pop culture, and 0:01:28.720 --> 0:01:31.280 a healthy dosa friendship. Now, we've already talked about our 0:01:31.319 --> 0:01:33.680 friend Rihanna, but we also want to remember that Mother's 0:01:33.760 --> 0:01:36.040 Day is right around the corner, so it's only fitting 0:01:36.080 --> 0:01:39.080 that we're talking all about maternal health this week. That's right. 0:01:39.160 --> 0:01:42.120 We specifically wanted to know about the current status of 0:01:42.160 --> 0:01:45.240 our maternal health care system, whether it's working, and what 0:01:45.280 --> 0:01:48.440 we can do to better support birthing parents. And because 0:01:48.480 --> 0:01:50.880 this is such a huge topic, we're going to have 0:01:50.920 --> 0:01:54.480 another episode next week, a Part two, to dig in 0:01:54.680 --> 0:01:58.240 even deeper into maternal health. Let's get into the recitation. 0:02:07.920 --> 0:02:10.320 So what do we know? Well, I know we already 0:02:10.360 --> 0:02:13.560 talked about reproductive health, and maternal health is kind of 0:02:13.560 --> 0:02:16.440 related to reproductive health, but a little bit different. The 0:02:16.480 --> 0:02:18.360 things that started coming up in that episode that we 0:02:18.400 --> 0:02:22.480 did on reproductive health is now coming to life on 0:02:22.680 --> 0:02:26.720 Monday of this week. So May second, it was leaked 0:02:26.880 --> 0:02:30.880 that Row versus Wade might be or probably is going 0:02:30.919 --> 0:02:33.600 to be overturned, which in my mind, I think I 0:02:33.639 --> 0:02:35.919 said this in the Reproductive Health episode. I just don't 0:02:36.440 --> 0:02:40.200 it feels like we are taking such large steps backwards, 0:02:40.480 --> 0:02:42.280 you know, even the fact that that was a draft 0:02:42.320 --> 0:02:46.119 opinion that uh doesn't feel good. It does not feel good. 0:02:46.120 --> 0:02:48.400 And hopefully we'll be able to update all of you 0:02:48.480 --> 0:02:52.840 all as more information comes out. I think we also 0:02:52.960 --> 0:02:57.600 know that having children is a long term commitment and 0:02:57.639 --> 0:03:02.120 it is very expensive, and so having the right resources 0:03:02.120 --> 0:03:05.120 in place is very important. And I also know that 0:03:05.280 --> 0:03:08.679 having children not only is expensive and a long term commitment, 0:03:09.000 --> 0:03:11.400 it's risky. Yeah, there are so many things that come 0:03:11.400 --> 0:03:13.480 along with it. And as more of my friends are 0:03:13.480 --> 0:03:16.120 having kids, I'm like, that's a risk, that's something that 0:03:16.120 --> 0:03:19.640 could happen. It's wild, honestly. And I guess that gets 0:03:19.639 --> 0:03:22.280 into what do we want to know? And I want 0:03:22.320 --> 0:03:25.760 to know why after all this time? You know, people 0:03:25.760 --> 0:03:28.560 have been having babies forever. Yes, I know we say 0:03:28.560 --> 0:03:30.960 since the beginning of time as just like a phrase 0:03:31.040 --> 0:03:33.679 or turn phrase, but literally, since the beginning of time, 0:03:33.919 --> 0:03:36.520 people have been having babies. And so I want to 0:03:36.560 --> 0:03:40.280 know why we're still having all of these issues with 0:03:40.400 --> 0:03:44.360 maternal health care and not just blanket issues. So it's 0:03:44.400 --> 0:03:48.960 blanket risky, but then within that risk disparities whereas riskier 0:03:49.040 --> 0:03:52.760 for certain groups? Right? Why? Yes? And then I want 0:03:52.760 --> 0:03:55.000 to know about the stuff that is not making front 0:03:55.000 --> 0:03:58.000 page news or is not you know, associated with some 0:03:58.080 --> 0:04:01.560 of these really big names celebrities, that has happened to them. 0:04:01.960 --> 0:04:03.520 I want to know about some of the stuff that 0:04:03.600 --> 0:04:05.840 you might not know about. Yeah, day to day swept 0:04:05.920 --> 0:04:08.960 under the rug. Absolutely, and then once we understand that 0:04:09.080 --> 0:04:12.120 TT then what if we know all this stuff, what's next? 0:04:12.200 --> 0:04:13.720 What can we do? I want to know what the 0:04:13.720 --> 0:04:17.400 future of maternal health looks like. Fuja. All right, let's 0:04:17.440 --> 0:04:31.000 jump into the dissection. Our guest for today's lab is 0:04:31.040 --> 0:04:31.760 Simone Tate. 0:04:32.120 --> 0:04:35.920 I'm Simone Tate. I'm the founder and CEO of poppy 0:04:35.960 --> 0:04:36.640 Seed Health. 0:04:36.960 --> 0:04:40.120 Poppy Seed Health is a telehealth app that connects birthing 0:04:40.120 --> 0:04:44.640 people to duelas midwives or nurses for one on one support. 0:04:44.839 --> 0:04:47.279 And the fact that an organization like poppy Seed Health 0:04:47.640 --> 0:04:52.240 exists already points to some gaps in our maternal health 0:04:52.240 --> 0:04:55.039 care system, you know, absolutely. So the first thing that 0:04:55.080 --> 0:04:57.800 we asked Simone was to help us understand maternal healthcare 0:04:57.839 --> 0:05:00.640 in the United States right now? Where do we stand? 0:05:00.960 --> 0:05:05.960 Maternal healthcare in the US is what I like to 0:05:06.040 --> 0:05:12.120 call perfectly antiquated. We haven't evolved in the same ways 0:05:12.240 --> 0:05:16.960 as some of the other developed countries we are still addressing, 0:05:17.640 --> 0:05:22.800 especially populations that are underserved in a lot of the 0:05:22.839 --> 0:05:25.960 same ways that we were doing twenty thirty and forty 0:05:26.040 --> 0:05:26.600 years ago. 0:05:27.040 --> 0:05:29.400 So basically, it's still the game of Thrones if you're 0:05:29.560 --> 0:05:31.640 on the maternal healthcare journey. I wish I knew a 0:05:31.640 --> 0:05:36.479 game of Thrones reference shame. That's the one that I 0:05:36.520 --> 0:05:39.960 think of all the time. Shame on the healthcare system. 0:05:39.600 --> 0:05:43.160 For being like that what we see happening in maternal 0:05:43.160 --> 0:05:47.120 healthcare today as it leads to the rise in maternal 0:05:47.160 --> 0:05:51.279 mortality and morbidity cases, especially for women that look just 0:05:51.400 --> 0:05:53.800 like us, right, black and brown women in the US, 0:05:54.240 --> 0:05:59.240 and in near misses, which means that you might have 0:05:59.320 --> 0:06:03.720 complications or something that's literally a near miss that could 0:06:03.720 --> 0:06:04.200 be fatal. 0:06:04.279 --> 0:06:06.919 In a lot of ways, morbidity and mortality are often 0:06:06.920 --> 0:06:10.720 grouped together. Morbidity refers to health issues, and when we 0:06:10.760 --> 0:06:14.159 say maternal morbidity, we're referring to health issues due to 0:06:14.200 --> 0:06:18.080 pregnancy you're giving birth, whereas mortality is death and that's 0:06:18.160 --> 0:06:21.200 death from health issues during pregnancy or given birth, or 0:06:21.240 --> 0:06:25.120 within six weeks after a pregnancy ends. The US spends 0:06:25.160 --> 0:06:28.960 the most money on maternal health in the world, but 0:06:29.080 --> 0:06:32.680 has one of the highest mortality rates among developed countries. 0:06:32.839 --> 0:06:35.640 According to the CDC, each year, around seven hundred birthing 0:06:35.680 --> 0:06:39.080 people die from pregnancy or birth complications, and that risk 0:06:39.240 --> 0:06:41.880 is three to four times more likely for black women. 0:06:42.160 --> 0:06:45.320 So we ask simone to break down what is included 0:06:45.560 --> 0:06:46.479 in maternal health. 0:06:46.800 --> 0:06:49.719 As soon as you go to see your doctor, which 0:06:49.839 --> 0:06:54.359 is typically somewhere between eight to nine weeks pregnant, you 0:06:54.720 --> 0:06:57.880 are then in the maternal healthcare system in the US, 0:06:58.160 --> 0:07:00.880 and that doesn't matter who you are right where you 0:07:00.920 --> 0:07:04.480 are on the spectrum of health insurance, commercial health insurance, 0:07:04.680 --> 0:07:08.159 or medicaid. As soon as you're identified in the system, 0:07:08.240 --> 0:07:12.560 there is a maternal healthcare journey that you are immediately 0:07:12.600 --> 0:07:12.960 put on. 0:07:13.240 --> 0:07:16.360 For most people, this looks like twenty minute monthly appointments 0:07:16.360 --> 0:07:18.320 with your OBGYN. 0:07:17.960 --> 0:07:22.240 That might include having a sonogram. There's some major milestone 0:07:22.320 --> 0:07:25.440 tests that you're also getting along the way. One of 0:07:25.440 --> 0:07:28.000 the big ones that most people know of is the 0:07:28.080 --> 0:07:32.240 anatomy scan, when they scan and measure the entire baby. 0:07:32.520 --> 0:07:36.880 There's your gestational diabetes test, which is another big milestone, 0:07:36.960 --> 0:07:41.200 and then there's labor and delivery. Once you have that baby, 0:07:41.520 --> 0:07:44.840 you are effectively out of the maternal healthcare system. 0:07:45.080 --> 0:07:48.800 It happens really fast. The federal requirement for insurance coverage 0:07:49.040 --> 0:07:52.360 after the delivery of a baby is only sixty days, 0:07:52.600 --> 0:07:55.600 so that's a really short window to get your things 0:07:55.640 --> 0:07:58.840 together and to have appointments. You know. Yeah, And on 0:07:58.960 --> 0:08:01.600 average the points are to minutes twenty minutes over ten months. 0:08:01.640 --> 0:08:03.880 It's only two hundred minutes worth of time eyeball to 0:08:03.920 --> 0:08:07.720 eyeball with a doctor. And that's if it's eyeball to eyeball, girl. Hello, 0:08:08.160 --> 0:08:11.520 If it's eyeball to eyeball, that would make me very nervous. 0:08:11.560 --> 0:08:14.840 That doesn't seem like enough time, especially considering all the 0:08:15.000 --> 0:08:17.520 changes that are happening to your body. And now it's 0:08:17.560 --> 0:08:20.360 a whole new person here too, exactly, like who go 0:08:20.560 --> 0:08:22.840 look out for this thing? They just got here. 0:08:23.640 --> 0:08:28.160 Once you have the baby, the entire thing shifts and 0:08:28.680 --> 0:08:32.160 you have follow up appointments for your baby. But the 0:08:32.200 --> 0:08:36.600 birthing person typically is only going to see their doctor 0:08:37.000 --> 0:08:40.880 at that fateful six week mark when you get to 0:08:40.920 --> 0:08:42.800 find out if you can have sex again or not. 0:08:43.360 --> 0:08:47.000 That's what most people know that appointment for. And then 0:08:47.080 --> 0:08:49.360 you're back into your normal health care. 0:08:50.280 --> 0:08:53.400 I think I would have a lot of follow up questions. Yes, 0:08:54.040 --> 0:08:56.600 I would want that doctor to move in with me, 0:08:56.840 --> 0:09:00.160 And I think that's what Simone is advocating for. Holistic care, 0:09:00.240 --> 0:09:02.640 a doctor or provider to look after your body and 0:09:02.760 --> 0:09:06.080 mind considering the major event that just took place. Yes, 0:09:06.480 --> 0:09:09.760 birth pushing a whole body out of your body. 0:09:10.320 --> 0:09:15.480 Yes, the maternal health care system is really focused on 0:09:15.559 --> 0:09:19.520 the baby. We want to focus on both the baby 0:09:19.600 --> 0:09:23.959 and the person. So your emotional mental health support, which 0:09:24.120 --> 0:09:28.800 is healthcare, is just as important as your physical care. 0:09:28.960 --> 0:09:33.599 And also having the kind of evidence based information and 0:09:33.840 --> 0:09:38.600 knowledge that helps you to understand what's actually happening with 0:09:38.720 --> 0:09:43.439 your body as you go through one of life's biggest milestones. 0:09:43.679 --> 0:09:47.199 That's a cultural shift that's going to take time, and. 0:09:47.160 --> 0:09:50.800 These opportunities for birthing people to get that emotional mental 0:09:50.800 --> 0:09:55.200 health and support should happen throughout a pregnancy, not just 0:09:55.360 --> 0:09:58.160 during the twenty minute appointments with their doctor. It's also 0:09:58.160 --> 0:10:01.160 important to have continued support after birth too. 0:10:01.480 --> 0:10:06.000 That first year of postpartum is so critical. For example, 0:10:06.040 --> 0:10:08.840 if you look at the Nordic countries or even the UK, 0:10:09.480 --> 0:10:12.400 you get sent home from the hospital after having a baby, 0:10:12.559 --> 0:10:16.640 and within just a day or two, a nurse or 0:10:16.679 --> 0:10:20.160 a doula shows up on your doorstep and they are 0:10:20.280 --> 0:10:23.720 with you for the first four to six weeks, sometimes 0:10:23.760 --> 0:10:26.960 eight weeks after you have the baby, just showing up 0:10:27.200 --> 0:10:31.520 taking care of you and also taking care of the baby. 0:10:31.679 --> 0:10:34.240 So there are so many points that we can improve 0:10:34.320 --> 0:10:37.640 on for the whole person for the best of health outcomes. 0:10:38.000 --> 0:10:40.120 We've been talking about what maternal health can look like 0:10:40.160 --> 0:10:42.959 if everything goes right with pregnancy and birth birth and 0:10:42.960 --> 0:10:45.880 people are looking at ten monthly appointments, a six week 0:10:45.960 --> 0:10:48.520 follow up, and then they're pretty quickly back into their 0:10:48.520 --> 0:10:51.760 regular health care. But we know healthcare access and quality 0:10:51.800 --> 0:10:54.560 are not equal for all people in this country. According 0:10:54.559 --> 0:10:57.160 to Simone, there are three main bottlenecks when it comes 0:10:57.200 --> 0:11:00.000 to accessing care within the maternal health care system. 0:11:00.320 --> 0:11:04.360 So the first one is when we think about showing 0:11:04.440 --> 0:11:08.760 up to appointments. That means that you are able to 0:11:09.000 --> 0:11:11.960 leave your job, take the time off. If you have 0:11:12.080 --> 0:11:15.840 other children, you're able to get child's care. It also 0:11:16.040 --> 0:11:20.320 means that you have a car or transportation, and I'm 0:11:20.320 --> 0:11:23.320 talking about these twenty minute appointments. But let's be honest, 0:11:23.360 --> 0:11:25.720 we show up to the doctor's office and we're usually 0:11:25.760 --> 0:11:27.800 there for way more than twenty minutes. 0:11:27.960 --> 0:11:30.480 If you think about taking two hours out of your 0:11:30.559 --> 0:11:34.160 day every month for ten months, that's around twenty hours. 0:11:34.360 --> 0:11:36.600 That's a lot of time spent not working. Not everyone's 0:11:36.640 --> 0:11:39.000 allowed to do that. Not everyone is allowed to do that, 0:11:39.320 --> 0:11:41.800 and even if they're allowed, not everyone can afford to 0:11:41.800 --> 0:11:44.720 do that, exactly because time off is money lost. So 0:11:44.760 --> 0:11:46.560 then we have to ask what are the outcomes for 0:11:46.600 --> 0:11:51.119 a birthing person who's unable to attend those monthly appointments exactly. 0:11:51.240 --> 0:11:53.839 And this relates to the second bottleneck in our current 0:11:53.880 --> 0:11:57.760 maternal health care system, the lack of remote care options. 0:11:57.880 --> 0:12:01.160 Our infrastructure and maternal health care is not set up 0:12:01.320 --> 0:12:04.840 for both the digital space and the in person space. 0:12:05.120 --> 0:12:09.640 I take a strong stance that holistic care and a 0:12:09.679 --> 0:12:13.760 new care model is both in person and not in 0:12:13.800 --> 0:12:18.719 person to make sure that people are taken care of 0:12:19.040 --> 0:12:21.160 wherever they are. 0:12:21.480 --> 0:12:24.800 So we've seen COVID increase access to telehealth right, but 0:12:24.880 --> 0:12:26.959 that's a double edged sword because there are still these 0:12:27.000 --> 0:12:30.520 disparities that exist. For example, who has a computer right 0:12:30.600 --> 0:12:32.800 and who feels like they're able to connect with their doctor. 0:12:33.040 --> 0:12:36.280 So on one hand, it may be beneficial to have 0:12:36.320 --> 0:12:38.560 some appointments over telehealth. On the other hand, it may 0:12:38.559 --> 0:12:40.360 be beneficial to have them in person. And so I 0:12:40.360 --> 0:12:43.880 think that's why Simona is suggesting a blended model absolutely, 0:12:43.920 --> 0:12:47.240 because there are some things that are lost through, you know, FaceTime. 0:12:47.600 --> 0:12:50.200 We know that just from our social interactions with people, yes, 0:12:50.440 --> 0:12:54.080 and sometimes just being able to be like physically in person, 0:12:54.160 --> 0:12:56.439 looking your doctor in the eye gives you a certain 0:12:56.520 --> 0:12:59.760 level of comfort in your ability to explain what's going 0:12:59.800 --> 0:13:02.959 on with you and the service that you may require 0:13:03.000 --> 0:13:05.360 from them, And that leads us right to the third point. 0:13:05.640 --> 0:13:08.840 Simon says, the third bottleneck is maternal health care deserts. 0:13:09.000 --> 0:13:11.280 That means someone lives ninety miles or more from their 0:13:11.320 --> 0:13:13.359 closest healthcare provider or hospital. 0:13:13.520 --> 0:13:16.160 If you live in an urban area or major city 0:13:16.200 --> 0:13:19.240 in the US, we're all in bubbles. It's hard to 0:13:19.400 --> 0:13:23.760 imagine that your home is that far away from a 0:13:23.800 --> 0:13:30.080 hospital or your closest provider. So this is rural America. 0:13:30.160 --> 0:13:35.240 It's also the majority of where people are living that 0:13:35.480 --> 0:13:39.800 need paternal health care. We also are seeing a decrease 0:13:40.200 --> 0:13:45.960 in obgyns in these areas and also in doctors who 0:13:46.040 --> 0:13:48.840 go through med school and decide to become obgyns. 0:13:49.000 --> 0:13:51.600 This is all really interesting, but one thing that jumped 0:13:51.640 --> 0:13:55.440 out to me is the obgyn shortage. Why is there 0:13:55.480 --> 0:13:57.840 a shortage? It seems like there's a lot of factors. 0:13:57.960 --> 0:14:01.640 It's a supply and demand kind of thing. You know. Interestingly, 0:14:01.960 --> 0:14:05.200 when we look at our population over time, the number 0:14:05.280 --> 0:14:09.640 of women over eighteen has really increased, but the number 0:14:09.679 --> 0:14:12.560 of positions when we think about obgyn training, so first 0:14:12.640 --> 0:14:16.080 year residency positions, is not growing at the same scale. 0:14:16.120 --> 0:14:19.920 So you're having fewer obgyns even able to push through 0:14:19.920 --> 0:14:21.720 the training, and then you have more women who need 0:14:21.760 --> 0:14:24.920 to be served. That's just the baseline, the basic layer. 0:14:25.280 --> 0:14:27.440 The other part is when we consider we have aging 0:14:27.520 --> 0:14:31.280 populations that are retiring, and additionally, when you look at 0:14:31.280 --> 0:14:35.120 surgical residencies, obgyns are not getting paid a lot. And 0:14:35.280 --> 0:14:36.960 you know the other part is that they want to 0:14:37.000 --> 0:14:39.360 live in urban areas too, So then this doesn't help 0:14:39.640 --> 0:14:43.080 that shortage that we see in rural areas. Most of 0:14:43.120 --> 0:14:45.240 the training is in urban areas. Like when you think 0:14:45.240 --> 0:14:48.840 about where med schools are right and where major hospitals 0:14:48.880 --> 0:14:51.160 are I think I saw something that said people are 0:14:51.400 --> 0:14:53.880 likely to stay in the same place where they did 0:14:53.880 --> 0:14:54.680 their residencies. 0:14:55.440 --> 0:14:59.400 So these maternal healthcare deserts are becoming a major concern 0:14:59.440 --> 0:15:02.480 in the US. And just to put that in perspective 0:15:02.560 --> 0:15:07.480 for you, that affects about seven million birthing people in 0:15:07.560 --> 0:15:08.000 the US. 0:15:08.400 --> 0:15:12.880 That's wild. Ninety miles is the lower limit. Twelve miles 0:15:12.920 --> 0:15:15.880 in DC is forty five minutes, truly, and you could 0:15:15.880 --> 0:15:19.280 speak on Atlanta. Oh, I know that traffic is wild. 0:15:19.680 --> 0:15:19.960 Man. 0:15:20.520 --> 0:15:23.360 They're doing crash cars on the highway right, They're doing 0:15:23.400 --> 0:15:26.360 monster trucks. And so even if you think about how 0:15:26.360 --> 0:15:28.280 long is it going to take? Is there public transit? 0:15:29.400 --> 0:15:31.600 What I feel safe getting in like a car service, 0:15:31.680 --> 0:15:33.720 you know, like Luber or Lyft? Can I afford to 0:15:33.760 --> 0:15:37.040 do that? There are so many compounding factors. Absolutely. I 0:15:37.080 --> 0:15:40.480 recently saw a TikTok of a woman who was pregnant 0:15:40.520 --> 0:15:42.200 and she was trying to get to a doctor's office. 0:15:42.200 --> 0:15:45.160 She doesn't have a car, and to use public transportation 0:15:45.600 --> 0:15:48.400 it would probably take her half of a day a workday, 0:15:48.440 --> 0:15:50.840 so like four hours just to get to the doctors. 0:15:51.320 --> 0:15:53.880 And so she was saying that she kept asking friends 0:15:53.920 --> 0:15:56.400 for help, and every time they would say yes, and 0:15:56.440 --> 0:15:58.960 then it would eventually fall through. So she had already 0:15:59.080 --> 0:16:02.960 missed two two months of appointments, and she was very 0:16:03.000 --> 0:16:05.520 nervous that this would negatively impact her health and the 0:16:05.520 --> 0:16:07.720 health of her baby. And when you think about stories 0:16:07.800 --> 0:16:10.240 like that, Simone is basically telling us that this is 0:16:10.360 --> 0:16:13.960 not just a one off. This is happening to millions 0:16:14.000 --> 0:16:18.160 of Americans that are pregnant. And this really makes me 0:16:18.200 --> 0:16:21.320 start thinking about how all these bottlenecks can then be 0:16:21.400 --> 0:16:26.480 further exacerbated or directly linked to socioeconomic status. Absolutely, if 0:16:26.520 --> 0:16:28.880 gas prices are up and your doctor is ninety miles 0:16:28.880 --> 0:16:32.400 away or more, maybe that's adding up. It now costs 0:16:32.440 --> 0:16:33.720 way more to get to the doctor. 0:16:33.960 --> 0:16:38.400 Furthermore, fifty percent of the birthing population in the US 0:16:38.600 --> 0:16:43.160 are on Medicaid, which means they don't have equal and 0:16:43.320 --> 0:16:46.680 equitable access to the best care. 0:16:47.240 --> 0:16:49.320 This is a really important point that Simone is making, 0:16:49.360 --> 0:16:51.840 and we are going to do an even deeper dive 0:16:51.920 --> 0:16:56.040 into Medicaid and access to equitable care in next week's 0:16:56.080 --> 0:16:58.800 episode in our part two. Okay, so back to the 0:16:58.840 --> 0:16:59.960 population on Medicare. 0:17:00.480 --> 0:17:05.399 So for that population specifically, those folks aren't even showing 0:17:05.520 --> 0:17:08.880 up into the maternal health care system until they're somewhere 0:17:08.880 --> 0:17:13.840 between twenty to twenty three weeks pregnant, so almost half 0:17:14.040 --> 0:17:18.119 or more than half of your pregnancy without prenatal care 0:17:18.680 --> 0:17:23.440 definitely affects health outcomes. But we need to stop blaming 0:17:23.800 --> 0:17:28.399 and shaming the person and look at the systems and 0:17:28.440 --> 0:17:31.720 the infrastructure that are lacking to begin with. 0:17:32.119 --> 0:17:34.280 Those are a lot of cars to have stacked up 0:17:34.320 --> 0:17:36.960 against you. Yeah, that seems like more than just one deck. 0:17:37.000 --> 0:17:39.679 It seems like a few decks of cards stacked against you. 0:17:39.920 --> 0:17:49.960 Blackjack six dicks, mm hmm. We wanted to learn more 0:17:49.960 --> 0:17:52.920 about some of the disparities in maternal health and why 0:17:52.960 --> 0:17:56.800 black and brown communities face more challenges in receiving care. 0:17:56.760 --> 0:17:59.959 So the CDC was not reporting on maternal health care 0:18:00.160 --> 0:18:03.399 outcomes for a decade, and when they did report on 0:18:03.480 --> 0:18:07.119 maternal healthcare outcomes and morbidity rates in the US, it 0:18:07.280 --> 0:18:10.480 showed that black and brown women are three to five 0:18:10.680 --> 0:18:14.280 times more likely in some parts of our country who 0:18:14.280 --> 0:18:18.480 have died from preventable deaths. That means that there were 0:18:18.560 --> 0:18:24.359 medical interventions that happened that escalated and resulted in a 0:18:24.480 --> 0:18:27.440 preventable death. The other side of that is that there 0:18:27.480 --> 0:18:32.840 were no medical interventions that happened and resulted in preventable deaths. 0:18:33.080 --> 0:18:35.480 Things can go bad if people get involved, and then 0:18:35.600 --> 0:18:38.280 things can go bad if they don't. Right, It's a 0:18:38.320 --> 0:18:41.280 scary situation to be in because you see two doors 0:18:41.320 --> 0:18:43.480 and there might be some bad behind both. 0:18:43.760 --> 0:18:48.680 Yeah, not only was it shocking, but it was truly unexpected. 0:18:48.840 --> 0:18:52.080 And that is because when we look at how our 0:18:52.160 --> 0:18:56.639 neighboring countries are doing, we see that maternal mortality rates 0:18:56.760 --> 0:18:59.920 are really low or non existent. 0:19:00.440 --> 0:19:02.920 So my question is why is this happening in the 0:19:03.040 --> 0:19:06.320 United States. Simon told us that the US pours the 0:19:06.359 --> 0:19:09.560 most money in the world into the maternal healthcare system. 0:19:09.640 --> 0:19:11.639 Clearly something isn't working. 0:19:11.920 --> 0:19:15.359 And as we know in our maternal healthcare system, in 0:19:15.400 --> 0:19:20.360 our healthcare system as a whole, the deep, deep racial 0:19:20.400 --> 0:19:22.119 bias that exists. 0:19:22.520 --> 0:19:25.439 There are these myths when it comes to black people 0:19:25.720 --> 0:19:29.240 and birth right about black women being able to withstand 0:19:29.240 --> 0:19:31.480 a lot of pain, or that all black people are 0:19:31.520 --> 0:19:35.399 all medicaid, and we know Medicaid isn't giving equal and 0:19:35.520 --> 0:19:38.800 equitable care, and we'll talk about that more next week. 0:19:39.119 --> 0:19:41.800 But I think all of that stuff just distracts us 0:19:41.840 --> 0:19:45.119 from these disparate health outcomes that black and brown people 0:19:45.160 --> 0:19:48.000 are experiencing in the healthcare system. 0:19:48.080 --> 0:19:54.359 And historically speaking, we also know that black women were 0:19:54.480 --> 0:19:59.400 used for experiments. We know that black women, pregnant black 0:19:59.440 --> 0:20:04.840 women's specifically were used in the medical industry to create 0:20:05.280 --> 0:20:11.080 all sorts of life saving surgeries. Yet these same things 0:20:11.200 --> 0:20:13.880 aren't being used today to save our lives. 0:20:14.160 --> 0:20:16.640 We've talked about racism and medicine on the show before, 0:20:16.800 --> 0:20:19.720 and so you got to understand that obstetrics and gynecology 0:20:19.760 --> 0:20:24.800 are no exception. Take us back intom TT. James Marion Simms, 0:20:24.880 --> 0:20:29.520 who's been called the father of modern gynecology, performed experiments 0:20:29.560 --> 0:20:34.280 on enslaved black women without anesthesia in the eighteen forties 0:20:34.400 --> 0:20:38.440 until the procedures were safe enough for white women. Later, 0:20:38.480 --> 0:20:42.679 he became the president of the American Medical Association in 0:20:42.720 --> 0:20:44.960 the American Gynecological Society. 0:20:45.359 --> 0:20:48.280 I want to relate this to this narrative that I 0:20:48.520 --> 0:20:52.320 would love us to smash. We are not stronger than 0:20:52.520 --> 0:20:58.640 every other woman out there. We absolutely feel pain, we 0:20:58.760 --> 0:21:02.919 know pain and were reporting pain. We need that to 0:21:03.119 --> 0:21:09.440 be taken seriously and currently because of racial bias, we 0:21:09.560 --> 0:21:12.199 know that Black women are not getting the kind of 0:21:12.320 --> 0:21:15.480 pain control or the kind of attention what we say 0:21:15.960 --> 0:21:21.200 that we are in discomfort, So being disregarded in that 0:21:21.280 --> 0:21:24.800 way can be fatal. There's a higher rate of pre 0:21:24.960 --> 0:21:28.280 eclampsia that happens for Black women. 0:21:28.520 --> 0:21:32.199 Preclamsia is a pregnancy complication that usually occurs during the 0:21:32.280 --> 0:21:35.680 second half of pregnancy, after twenty weeks. If left untreated, 0:21:35.760 --> 0:21:38.480 it can be fatal for the birthing parent and baby, 0:21:38.840 --> 0:21:42.280 so it needs to be carefully monitored and managed until delivery. 0:21:42.400 --> 0:21:46.120 The most common symptoms are high blood pressure and excess 0:21:46.160 --> 0:21:51.440 of protein in your urine. Some people also experience headaches, dizziness, nausea, 0:21:51.520 --> 0:21:52.439 and blurred vision. 0:21:52.760 --> 0:21:55.359 If there are any symptoms that you feel that just 0:21:55.480 --> 0:21:59.280 don't feel great, you're swelling or bloating, or something that's 0:21:59.600 --> 0:22:02.600 very out of the norm for you, make sure that 0:22:02.680 --> 0:22:07.400 you're calling your doctor immediately, but keep a pulse, keep 0:22:07.440 --> 0:22:11.320 a check on your own body, and make sure that 0:22:11.720 --> 0:22:15.320 you know that you're not the only person responsible for 0:22:15.400 --> 0:22:19.520 your health, but that you have places and partners and 0:22:19.560 --> 0:22:22.560 that kind of network that can really support you. 0:22:22.840 --> 0:22:25.040 And thinking about what Simone just said, it really ties 0:22:25.080 --> 0:22:27.439 back to those bottlenecks we talked about earlier, and if 0:22:27.480 --> 0:22:30.040 we think about do you have social support, do you 0:22:30.119 --> 0:22:32.960 have somebody else that's responsible for your health or is 0:22:33.000 --> 0:22:35.320 it just you? Right? Do people believe you when you 0:22:35.320 --> 0:22:37.280 say things? Are you able to get to a doctor 0:22:37.720 --> 0:22:40.199 to address all of these concerns? I mean, because so 0:22:40.240 --> 0:22:41.919 many changes are happening, how do you know if it's 0:22:41.960 --> 0:22:44.560 a normal change that comes with pregnancy or a life 0:22:44.560 --> 0:22:47.720 threatening change? And twenty minutes once a month is not 0:22:47.800 --> 0:22:50.000 a lot. Let's take a break and when we come back, 0:22:50.040 --> 0:22:52.480 we'll talk about what we can do to support birthing people, 0:22:52.600 --> 0:22:55.720 maternal health policy, in the future of maternal health care. 0:23:15.240 --> 0:23:18.520 We're back. We've been talking with Simon Tate about maternal 0:23:18.520 --> 0:23:21.000 health and some of the challenges facing birthing people in 0:23:21.040 --> 0:23:24.399 the US. Next week, we're continuing this conversation because this 0:23:24.520 --> 0:23:26.439 is such a big topic, and we're going to be 0:23:26.480 --> 0:23:30.560 focusing on the historical and political context to help us 0:23:30.640 --> 0:23:33.560 understand these disparities more. All right, so let's get back 0:23:33.600 --> 0:23:36.240 to the lab. Let's talk about maternal health in a 0:23:36.440 --> 0:23:39.040