WEBVTT
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Hello, today I have with me Dr Venice Haynes, phd.
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Dr Haynes is a social and behavioral scientist with over 15 years of public health experience.
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As a Senior Director of Research and Community Engagement at United States of Care, venice leads efforts to understand in advance the health care solutions people need, including the 100 Weeks Project, a groundbreaking initiative transforming postpartum care.
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Her research focuses on health equity, social determinants of health and disparities in underserved communities.
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She holds degrees from Tennessee State University, meharry Medical College and the University of South Carolina and is based in Atlanta, georgia.
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Dr Haynes, welcome and thank you so much for joining me.
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Thank you so much for having me.
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I'm really excited about this conversation today.
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Yeah, and I am just really excited about the work that you're doing.
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After talking to Natalie Davis, I am just so amazed that you're focusing on not just getting health care for all, but maternal health care, which is something that I'm super passionate about, because there's just not enough right now.
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Yes, indeed, that's why the 100 Weeks Project has been a journey in and of itself, this body of work, and it has uncovered so much, and I can't wait to talk more about that.
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That's amazing.
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I love that we're focusing so much on that, because I don't think people realize that for maternal health, like once a baby is born, we don't usually see a mom until their six-week checkup just to make sure everything is healing right, and we ask a few questions about how mom is feeling, but there's no real support in between that.
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So I'm really loving this idea of the 100 weeks project that starts with the prenatal care and continues, my understanding is, throughout the first year of the baby's life.
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First year and a little bit into the second, and that's exactly right.
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A lot of when we talk about this work and have come to this work, we realize in talking to people that their needs when it comes to maternal health they share things in their preconception and childbirth period, but they shared a lot of needs in the postpartum and so when you look at the totality of 100 weeks it was important to cover.
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You know what are that first four weeks.
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That first month look like when a woman is coming to that prenatal period, whether the pregnancy is intended and unintended.
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You know that experience with fertility, infertility, birth control there's a lot going on in that space too.
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But oftentimes the journey is really focused on that 40 weeks.
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But so much happens before and after and I'll talk a little bit more about what we found in terms of postpartum and our focus in particular in that area.
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But it's been a labor of love and ups and downs and reflections and building and thinking about this work and it is by no means exhaustive, I should say that, but quite enlightening in terms of what we have heard from people in this particular area.
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Yeah, I don't even know how it could start to be exhaustive, because we are so behind in this country when it comes to maternal care.
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I've interviewed people in other countries.
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One that stood out to me was Denmark, where they have a nurse that comes to the home once a week or twice a week to help mom kind of just figure out life and make sure that there's no risk factors for any postpartum depression or any of the PMADS and make sure baby is healthy.
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We just expect mom to take care of baby, go to the pediatrician by herself and just be okay during that period, and we need not just connection to resources but permission to connect to resources, because this lack of care has led to this culture of kind of what I like to call toxic independence oh my gosh when we feel like we have to do it all ourselves, otherwise we're doing something wrong, almost like we're not a real, we're not a good mother.
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Yes, I love that and if I could take a step or two back to kind of talk about a story and a journey personally, that has also kind of reshaped how I think about the work that we've done professionally leading up into that.
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From what we've heard on exactly that thing that toxic independence about my sister.
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She's three years, three and a half years, younger than me.
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We're very, very close and she had my niece in 2019.
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And at the time she got pregnant, she was also a caregiver for one of our family friends, a 96 year old.
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We call her grandmommy and we love her to pieces.
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But at the time, she was her sole caregiver and and she got pregnant and was progressing through her pregnancy.
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She was responsible for a lot.
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Right, adjusting to that pregnancy period like a full-time caregiver is a lot, especially if you're talking with someone who's got symptoms of dementia, and so I bring that up as a backdrop because she was doing it all by herself.
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Right, I would pop in and check on her.
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I wasn't in Atlanta at the time, but she was internalized and carrying a lot of stress.
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Well, as she progressed through her pregnancy, she started experiencing different symptoms and, long story short, she delivered her baby at 26 weeks and that experience was wild, scary for me.
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I happened to be in town at the time her war broke and it was like a.
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It was.
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I don't have any other words other than oh my gosh, I can't believe this is happening right now.
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And I almost had to do it with her baby like in her basement apartment.
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Oh my gosh, right.
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And so from then on it, lot of stuff happened.
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Within that two-day period she was fortunate to have a racially concordant provider who was tracking all of her symptoms very, very closely.
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She was going to be on bed rest for a couple of days and from the time her water broke we got her to the hospital.
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She had an amazing care team.
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She was on Medicaid at the time and she just had everybody in it situated to kind of walk her through everything they do.
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But that doesn't take away from the crazy and the scariness of what's happening in the situation.
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Positives outcome all the way around.
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My niece was born one pound 13 ounces, spent three months in the NICU.
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She had not one setback.
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The NICU nurses were amazing and I just think about, like when all of that came, you know, my sister came home.
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She was well, but I think about what I knew about the maternal mortality rate for Black women in this country and in the Atlanta Georgia area, and I fell apart after that, like after we figured out everybody was okay, because I knew it could have gone markedly different.
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That we heard that crafted and made up the journey map Not having racially concordant providers, not having people listen to her concerns or their concerns, having to go it alone.
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And to your point about that toxic independence, not feeling like they had somebody to be there to advocate to them when they started to see something going left.
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Or they were concerned if they were getting the best care because of their skin color, because they have experienced stereotyping and racial profiling and other aspects of the healthcare system.
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So a lot of that came to bear as we were building out this journey map and understanding experiences.
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And the premise for building this was not just to chronicle and capture stories right, we wanted to understand A what were the critical gaps in failure?
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Where were Black women in particular falling through the cracks when it comes to this journey?
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What's supposed to happen, ie the clinical recommendations, what was actually happening?
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What her ideal experience is, because it's not enough that we just not do these things, but how can we pull the whole care system and priority up to a standard writ large right?
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And then what were some of the bright spots?
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Because there are plenty of organizations, community-based in particular, that are filling in and addressing some of these gaps that women are experiencing so that they do not have these near-miss events, these risky situations, to have someone advocating for them.
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And so these are all of the layers that we put in that journey map for each preconception, pregnancy, childbirth and labor and postpartum experience.
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So I just kind of wanted to talk a little bit about my journey personally to this work, some of the stories that we're hearing, the reason we built the journey map, the way that we did, and then a little bit later, I'll talk about, you know, why we zoned in on the postpartum period.
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I can guess.
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I think that's amazing because a lot of what I have.
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I started off this podcast trying to help moms understand birth in the medical system as it is yeah, and I interviewed a lot of people that have been a part of the medical system as well, from different standpoints, right, and I've turned it into the experience, yes, which.
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Let's back up and talk about how the medical community views the experience of childbirth.
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Congratulations, you're both alive.
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That's it Right.
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Yeah, that's not the way we need to be doing this, that's right.
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And there's still this attitude of if a mom feels traumatized by their labor experience, they're dismissed, because this is an overgeneralization, but I still very much hear this.
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The medical staff says, well, you're lucky because you're alive and your baby's alive.
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That is some severe gaslighting, yeah.
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And also, where are we as a country if that's our bar?
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I think that we looked back on childbirth over centuries and got to the point where we're like, okay, well, we have technology to keep most of the people alive, but childbirth in its normal physiological state doesn't have to be an emergent event.
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It can actually, and should be the happiest day of your life.
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So how do we get to?
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Congratulations, you're both alive to.
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Let's make this a great experience and I'm not saying that everybody like.
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I'm not saying that when I'm in the hospital and delivering someone, that everybody feels that way right, or that that's everybody's experience.
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We try to make the experience great for everyone.
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However, with the resources we're given and the education we're given, we have to fill the gap ourselves.
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So how wonderful would it be if we all started rowing in the same direction and working towards a positive experience, because just because we have a birth in the hospital doesn't mean that it has to be treated as an illness.
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Right, we can have a different state of mind and we can also partner with different resources like birth centers, home birth, midwives, and have this wonderful array of experiences where people, based on their health and their needs and their desires, go where they need to be, based on those things, not just shuffled into the hospital or good luck with that home birth.
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Yeah, I think, as you're talking, I'm thinking a lot about the narrative that we currently have in this country, and I'm not saying this is everybody that works in the maternal health space, with midwives, nurses, obgyn, but it seems kind of like it's just okay, this is another patient.
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We got to get you in and get you out.
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It's exactly how it is.
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I'm an attention given it's.
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It really is dismissive oh, I'll get to it, or oh, it's fine, or oh, you're being dramatic, or right, and we get that.
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You see this, day in and day out, right, all you do is deliver babies and it's the same thing and the same thing and the same thing.
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But it's not the same thing for that patient.
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It's not the same thing for that mom, especially if they're a new mother or if they've had repeated pregnancies and they know what to expect.
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But then that doesn't guarantee that every birthing experience is the same.
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Right, you can have a great first one and a very bad second one, and vice versa.
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But why do we treat this as and we see this throughout the healthcare system generally get you in, get you out, not taking time to listen to concerns, not taking time to get to the root cause of issues, and so, when it comes to the maternal health space, it's.
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I didn't get my questions answered.
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I had so much more I wanted to know about.
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I just felt rushed through my appointment and so, from a systemic perspective, I think about okay, well, what's going on in that clinician's mind?
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Do they have?
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Are they under a quota?
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Do they have to see so many patients per day and they don't have time to spend, you know, 30 minutes to an hour with every patient to go to all of that stuff.
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So what kind of models do we have designed systemically that the clinician has to practice the way they do and they don't have the time to get support?
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I'm thinking about both sides of the coin here, but we have heard good stories about physicians and OBGYNs that have taken the time, that did answer their questions, that were caring and kind.
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So it's not that it can't happen, right.
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It's not like it's not possible.
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Yeah, I think there's an awareness that needs to happen, a mindset that needs to shift, that this is a human bringing a human into the world, right?
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Where did the humanity in that process go, especially when you're talking about women of color and you know their experiences, where they feel like they're not heard, they're just treated as another person, another body, I should say, because the personhood gets removed out of that and I keep thinking about, like the historical injustices, right.
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So there's a lot that's brought to bear in this, and so there's a narrative thing, there's a mindset thing that we have to be aware of and start to shift.
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And to your point about how low the bar is, that's exactly why we have tools like this journey map, because the bar cannot.
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We can't exist at that low level.
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We need to pull the whole thing up across the board so everybody can have more positive experiences.
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And near misses are a thing of the past and rare, not the norm.
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Yeah.
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Well, and I think that too, I mean from our perspective there is a push people through because there's like we have this induction scheduled for tomorrow.
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We don't have this many nurses tonight.
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We can't really share that information, right.
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So there's like I need you to schedule your induction for this morning because tonight I know you need the NICU staff at your delivery Tonight.
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They're bare bones.
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I need you to have your induction this morning because we only have like six nurses on at night.
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What if somebody calls out that kind of stuff, I know, in the office, especially when you have just the variation in insurance payback, you know providers feel it because they're trying to pay the office rent, they're trying to pay their workers fair.
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And I know that when, like I have friends that have gone to work in offices, they don't get paid as much as nurses at the hospital, right, like I have friends that have gone to work in offices, they don't get paid as much as nurses at the hospital.
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And so it's like then everybody's having to compromise when they're dealing with office versus hospital, versus how to collect payment and all of those things.
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And it's not only that but it starts off with doctors going to medical school and then accruing this debt that's just impossible to pay down.
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And they don't get a degree in business and they're expected to go into private practice and it's just, it's nonsense.
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And so then these people that go I mean these people, me included get beat down and expected to perform magic without the training.
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And I mean I can speak for myself and say that there are times when I provide amazing patient care and there are times when I'm like I do not click with this patient and I don't know how to make this experience great for them.
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And then there's times when I'm feeling rushed and when I want to provide excellent patient care.
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I'm feeling rushed and when I want to provide excellent patient care, I'm bouncing between patient to patient to patient and maybe not picking up on, although I kind of thrive on the adrenaline.
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So I feel like I could do better patient care.
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When I'm like boom, boom, boom, boom, boom and I can just move through, I can just kind of like be happy in every room, but not everybody's like that.
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And also, what am I missing, you know, like if I'm not taking that time?
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So it's just, it's all of it.
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It's all of it and the and the need to get the people that hold the purse strings in the hospital, to see that it's not just about how many rooms are profitable and how we can reduce our C-section rate, which is a huge thing.
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And we have checklists like why aren't you going up on the Pitocin?
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And we have timers like why was it the first medication given within 90 minutes of the patient walking in the door?
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Stuff like that, which, yeah, we shouldn't be dilly-dally, and part of that is has the doctor or the anesthesiologist or whoever it is shown up to do that crucial work?
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But also, why are we focusing so much on numbers and speed instead of actual patient care?
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Yes, and that's what I mean by that awareness and narrative, because it becomes, yes, a checklist and I have to get so many things done and then where's the priority?
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Right, can't both things be true?
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Right, you want to get these things done, you can be quick and efficient, but also remember that, okay, did I miss anything?
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Because it's the not asking yourself that question where things start to fall through the cracks.
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Right, and I think you know the stats are over 60% of maternal deaths happen in the postpartum period, mostly between what is it?
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Days one and seven, and then progressively lower.
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But again, you're talking about 60 something percent in just after birth.
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That's a lot.
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That's a lot, right?
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So what?
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Right?
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So what is falling through the cracks in that timeframe?
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Okay, to your point.
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Congratulations, you're both alive.
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You made it until it's time to go home and you're getting symptoms.
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You're at home and there's no follow-up and you've got questions.
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And is this normal that I'm bleeding?
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Is this normal that I'm feeling this pain?
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Is it normal that I've got this massive headache?
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Is it normal that my baby, right, like all these questions that wait?
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I have to wait till six weeks until my postnatal checkup, and I can't get anybody on the phone before that.
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There's just a lot happening in that critical period of time, and so, yes, congratulations, speed and you got the work done.
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But then what is falling through the cracks in the meantime?
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And the quality seems to be that thing, but as a result, we're losing people, we're losing lives.
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Right.
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I mean it's great that you can stay in the hospital for a C-section up to four days, but, like you said, up to seven days is the 60%.
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And the other problem with that is nobody feels good, no matter what.
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You're going to feel like crap in that first seven days, so it's hard to distinguish what's real and what's not, and you're going to bleed an amount that you're not used to and it's scary whether it's normal or not.
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So then once you've called one or two times and said I'm not sure if this is normal, and then you're marked as someone that's anxious and we start to dismiss that anxiety because we don't necessarily have the staff or the beds to continue to see someone during that postpartum period over and over again.
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Maybe we need to look into making sure somebody sees that person Exactly, instead of taxing the hospital's emergent care areas for things that may not be emergent, yep, so that somebody that's a professional can see and decide if that is emergent or not or if that patient just requires some support to understand what's normal and how to take care of themselves.
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That's exactly right Part of some other research we did.
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We heard a lot about that from the women we have spoken with, and that was access to information, whether that be their OBGYN, a midwife, a lactation consultant, a doula, a birthing coach, whatever the case may be, they felt like they could not or did not know where to go other than to their online community or community they had built themselves to ask these types of questions, but they're not medical questions that they can often answer right.
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Sometimes you need that expertise to be able to say, hey, is this normal?
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Or I've been feeling this for X number of days.
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And so to your point about not taxing the emergent system or are there other systems or people in place we can put in?
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Like not only put in place, because we've also heard, yeah, I can't access these people, but my insurance won't cover it and I can't afford it out of pocket, yeah, so then there's that, and so there's that gap in connection with that information.
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What are some other ways we can do that?
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And so this is probably part of the bright spot that we talk about, where technology has come to bear, where community-based organizations fill in some of these gaps.
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They have dual programs, community health workers to be able to supplement some of that, but this shouldn't be like pulling teeth either.
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There's other issues right Addressing social needs that can add to stress and raising blood pressure, and return to work, in some instances too early.
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Right Mostly.
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Most instances, like unless you're out for six months, it's too early.
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I'm sorry, mom and baby are not ready.
00:22:25.134 --> 00:22:28.345
Everybody doesn't have the same, is not afforded the same thing.
00:22:28.345 --> 00:22:31.570
I just my heart bleeds for women to have to go back at six weeks.
00:22:31.570 --> 00:22:32.275
That's ridiculous.
00:22:32.275 --> 00:22:40.963
So much is happening at eight weeks, nine weeks, you know, 20 weeks even, and heaven forbid you've had a pregnancy loss.
00:22:40.963 --> 00:22:50.845
We've heard a lot of some stories in that regard of how they have no support Right, still experiencing their postpartum body and having to return to work as if nothing happened.
00:22:50.845 --> 00:22:55.097
The mental support, the bereavement leave, all of those things so systemically.
00:22:55.097 --> 00:23:00.762
There's a lot that we need to re-evaluate and just I feel like we could solve this.
00:23:01.494 --> 00:23:03.482
Oh, other countries have, so I know we can.
00:23:03.482 --> 00:23:04.961
I feel like we could solve this.
00:23:05.154 --> 00:23:07.865
It's just in the current situation, where's our priority?
00:23:07.865 --> 00:23:12.005
To be able to put resources behind actually saving people's lives.
00:23:12.365 --> 00:23:14.281
Yeah, and I see people trying to do it.
00:23:14.281 --> 00:23:17.861
They're just trying to do it in private practice, which is my experience.
00:23:17.861 --> 00:23:26.469
That has been hard because, like you said, not everybody can afford it and I consider myself middle class but there's so many nuances to being able to afford it.
00:23:26.469 --> 00:23:27.734
I mean, it's not black and white.
00:23:27.734 --> 00:23:37.563
It's like, yes, if you're lower, if you're lower income, you can absolutely say no, I can't afford the $300 public floor physical therapy appointment.
00:23:37.623 --> 00:23:43.122
If you're middle class, you're like what am I sacrificing to afford this appointment?
00:23:43.122 --> 00:23:49.884
It's going to come at another cost, exactly, and so that I mean personally that was what I was looking at.
00:23:49.884 --> 00:24:00.426
And then, when you go back to that toxic independence, you're like I'm not going to pay $300 for something for myself when I have this new baby to take care of and I'm going to have to save for daycare so I can go back to work.
00:24:00.426 --> 00:24:05.678
Or I'm right now only getting 60% of my income because I'm on maternity leave.
00:24:05.678 --> 00:24:10.238
I can't actually put that money towards this because I still have to pay the mortgage this month.
00:24:10.238 --> 00:24:20.696
So the needs that you have that are outside of the general six-week scope of maternity care are categorized although they shouldn't be as a luxury.
00:24:21.417 --> 00:24:25.807
That's right when they're definitely a necessity A necessity, exactly right.
00:24:25.807 --> 00:24:33.028
And then it begets more poor health outcomes as you go, depending on what resources you have.
00:24:33.028 --> 00:24:40.308
I mean, unfortunately, in this country it costs to be healthy and we see it a lot in this space.
00:24:40.308 --> 00:24:42.943
I'm sure you see it a ton in this space, right?
00:24:42.943 --> 00:24:44.861
Yes, I would love to have a doula.
00:24:44.861 --> 00:24:50.185
I can't afford it, so I will have to figure it out by myself or I'll get your tips and strategies.
00:24:50.185 --> 00:24:51.619
Or what are you doing at home?
00:24:51.619 --> 00:24:57.508
What are the home remedies or hacks or whatever you're coming up with to kind of cope through this?
00:24:57.508 --> 00:25:01.640
Hacks or whatever you're coming up with to kind of cope through this?
00:25:01.640 --> 00:25:04.409
And that is if you take the time or feel like you can reach out and ask for help and ask questions.
00:25:04.409 --> 00:25:06.217
That's a whole nother thing too.
00:25:06.718 --> 00:25:10.928
The isolation of it all, particularly when it comes to postpartum mental health.
00:25:10.928 --> 00:25:12.938
I think about a focus group we had.
00:25:12.938 --> 00:25:24.925
We were in rural South Carolina and we literally stopped the conversation, the focus group format and structure of it, because so much sharing was happening in that moment.
00:25:24.925 --> 00:25:44.579
And when we got to the question around, like what is it that you feel like you need most, you know, in your postpartum period time and they said stuff like this so if we can sit around, I don't have my family, I don't have my child, but we can sit around with other women that are going through similar things.
00:25:44.579 --> 00:25:53.698
Like I had no idea, I thought I would be only one, and when they have that discovery that they're not and there's a space held for them to talk through stuff, it's amazing.
00:25:53.758 --> 00:26:04.292
Right Like that is so easy, that is so simple, but it's taking the time away to be able to do that when you have so many other obligations.
00:26:04.292 --> 00:26:15.334
You're trying to put food on your table, you're trying to take care of all of the other family members that are now in your health and the ones that are not right, and so we heard a lot, particularly among Black women.
00:26:15.334 --> 00:26:16.758
It's like that strong Black woman.
00:26:16.758 --> 00:26:22.516
You got to hold it together, you got to be there for everybody and, as a result, your health suffers.
00:26:23.076 --> 00:26:24.219
Yeah, absolutely.
00:26:24.219 --> 00:26:26.913
And that, the internalization of the stress.
00:26:26.913 --> 00:26:29.854
Yes, the normalization of all of it.
00:26:29.964 --> 00:26:32.093
Again back to the change in conversation.
00:26:32.093 --> 00:26:34.715
Yeah, you know, we talk about, I know, my generation.
00:26:34.715 --> 00:26:41.671
Now we're talking about that transition perimenopause and menopause and it's like, well, why did my mom tell me, or why did anybody tell me?
00:26:41.671 --> 00:26:44.314
Or we didn't have these conversations, it's the same thing.
00:26:44.314 --> 00:26:45.615
Oh well, we just did it.
00:26:45.615 --> 00:26:48.459
Oh well, this is just how it is.
00:26:48.459 --> 00:26:49.901
Oh, this is just.
00:26:50.000 --> 00:26:55.365
And it's like we don't take the time to actually talk through and pass that information on from generation.
00:26:55.365 --> 00:26:56.365
And sometimes it does happen just.
00:26:56.365 --> 00:27:02.711
And sometimes it does happen just from what I'm hearing from people, it's usually after something has happened.
00:27:02.711 --> 00:27:05.755
Oh well, I went through this.