Something Was Wrong - S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ

Episode Date: May 22, 2025

*Content warning: birth trauma, medical trauma, medical neglect, racism, death of an infant, infant loss, death, maternal loss, mature and stressful themes.*Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources    Center for Black Maternal Health & Reproductive Justice:https://blackmaternalhealth.tufts.edu/Center for Black Maternal Health & Reproductive Justice Instagram:https://www.instagram.com/cbmhrj_tufts/Center for Black Maternal Health & Reproductive Justice Facebook:https://www.facebook.com/CBMHRJTufts/Center for Black Maternal Health & Reproductive Justice LinkedIn:https://www.linkedin.com/company/cbmhrjtufts/Sources: Addressing Transportation Barriers to Improve Healthcare Access in Arizonahttps://repository.arizona.edu/handle/10150/674794 Advancing Health Equity and Value-Based Care: A Mobile Approachhttps://info.primarycare.hms.harvard.edu/perspectives/articles/mobile-clinics-in-the-us-health-system#:~:text=Mobileclinicsareaproven,thecriticalweeksafterbirth American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/  Birth Centers in Massachusettshttps://baystatebirth.org/birth-centers A Brief History of Midwifery in Americahttps://www.ohsu.edu/womens-health/brief-history-midwifery-america Clinical outcomes improve when patient’s and surgeon’s ethnicity match, study showshttps://www.uclahealth.org/news/article/clinical-outcomes-patients-surgeons-concordanceThe Controversial Birth of American Gynecologyhttps://researchblog.duke.edu/2023/10/27/the-controversial-birth-of-american-gynecology/ 'Father Of Gynecology,' Who Experimented On Slaves, No Longer On Pedestal In NYChttps://www.npr.org/sections/thetwo-way/2018/04/17/603163394/-father-of-gynecology-who-experimented-on-slaves-no-longer-on-pedestal-in-nyc Governor Healey Signs Maternal Health Bill, Expanding Access to Midwifery, Birth Centers and Doulas in Massachusettshttps://www.mass.gov/news/governor-healey-signs-maternal-health-bill-expanding-access-to-midwifery-birth-centers-and-doulas-in-massachusetts#:~:text=GovernorHealeySignsMaternalHealthBillCExpanding,ExecutiveOfficeofHealthandHumanServices  Governor Murphy Signs Bill Establishing Maternal and Infant Health Innovation Centerhttps://www.nj.gov/governor/news/news/562023/approved/20230717a.shtml Helping Mothers and Children Thrive: Rethinking CMS’s Transforming Maternal Health (TMaH) Modelhttps://www.milbank.org/quarterly/opinions/helping-mothers-and-children-thrive-rethinking-cmss-transforming-maternal-health-tmah-model/#:~:text=TheTransformingMaternalHealth(TMaH)Model&text=TheTMaHModelfocuseson,midwiferyservicesanddoulacare  The Historical Significance of Doulas and Midwiveshttps://nmaahc.si.edu/explore/stories/historical-significance-doulas-and-midwivesInfant Health and Mortality and Black/African Americanhttps://minorityhealth.hhs.gov/infant-health-and-mortality-and-blackafrican-americans#:~:text=In2022%2Ctheinfantmortality,Figure2  Legislature Passes Comprehensive Maternal Health Billhttps://malegislature.gov/PressRoom/Detail?pressReleaseId=136Life Story: Anarcha, Betsy, and Lucyhttps://wams.nyhistory.org/a-nation-divided/antebellum/anarcha-betsy-lucy/Management of Postpartum Hemorrhage in Low- and Middle-Income Countries: Emergency Need for Updated Approach Due to Specific Circumstances, Resources, and Availabilitieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC11643001/#:~:text=EtiologyandRiskFactorsof,insufficienttreatment%E2%80%9D%5B50%5D March of Dimeshttps://www.marchofdimes.org/peristats/about-us      Maternity Care Deserthttps://www.marchofdimes.org/peristats/data?top=23 Maternal deaths and mortality rates by state, 2018-2022https://www.cdc.gov/nchs/maternal-mortality/mmr-2018-2022-state-data.pdf  Maternal Mortality in the United States After Abortion Banshttps://thegepi.org/maternal-mortality-abortion-bans/#:~:text=In2023%2CTexas'smaternalmortality,suffermaternaldeathin2023  Maternal Mortality in the U.S Declined, though Disparities in the Black Population Persisthttps://policycentermmh.org/maternal-mortality-in-the-u-s-a-declining-trend-with-persistent-racial-disparities-in-the-black-population/Maternal Mortality Is on the Rise: 8 Things To Knowhttps://www.yalemedicine.org/news/maternal-mortality-on-the-rise Maternal Mortality: How the U.S. Compares to Other Rich Countrieshttps://www.usnews.com/news/best-countries/articles/2024-06-04/how-the-u-s-compares-to-other-rich-countries-in-maternal-mortalityMaternal Mortality Rates in the United States, 2021https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm#:~:text=In2021%2C1%2C205womendied,20.1in2019(Table) Medical Exploitation of Black Womenhttps://eji.org/news/history-racial-injustice-medical-exploitation-of-black-women/National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery     National Counsel of State Boards of Nursinghttps://www.ncsbn.org/North American Registry of Midwives (NARM)https://narm.org/        Outcome of subsequent pregnancies in women with complete uterine rupture: A population-based case–control studyhttps://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.14338#:~:text=outcomesarerare.-,1INTRODUCTION,experienceacompleteuterinerupture.&text=Completeuterineruptureisdefined,completeruptureofthemyometrium  Pregnancy-Related Deaths: Data From Maternal Mortality Review Committees in 36 U.S. States, 2017–2019https://www.cdc.gov/maternal-mortality/php/data-research/mmrc-2017-2019.html Preterm Birthhttps://www.cdc.gov/maternal-infant-health/preterm-birth/index.html#:~:text=Pretermbirthrates&text=In2022%2Cpretermbirthamong,orHispanicwomen(10.1%25)   Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Themhttps://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/The Racist History of Abortion and Midwifery Banshttps://www.aclu.org/news/racial-justice/the-racist-history-of-abortion-and-midwifery-bans Reducing Disparities in Severe Maternal Morbidity and Mortalityhttps://pmc.ncbi.nlm.nih.gov/articles/PMC5915910/#:~:text=Severemorbidityposesanenormous,ofseverematernalmorbidityevents  State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef      The State of Telehealth Before and After the COVID-19 Pandemichttps://pmc.ncbi.nlm.nih.gov/articles/PMC9035352/ Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/     U.S. maternal death rate increasing at an alarming ratehttps://news.northwestern.edu/stories/2024/03/u-s-maternal-death-rate-increasing-at-an-alarming-rate/Which states have the highest maternal mortality rates?https://usafacts.org/articles/which-states-have-the-highest-maternal-mortality-rates/  Why Equitable Access to Vaginal Birth Requires Abolition of Race-Based Medicinehttps://journalofethics.ama-assn.org/article/why-equitable-access-vaginal-birth-requires-abolition-race-based-medicine/2022-03 Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications  *SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag’s original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Wondery Plus subscribers can listen to Something Was Wrong early and ad free right now. Join Wondery Plus in the Wondery app or on Apple Podcasts. Something Was Wrong is intended for mature audiences. This season contains discussions of medical negligence, birth trauma, and infant loss, which may be upsetting for some listeners. For a full content warning, sources, and resources, please visit the episode notes. Opinions shared by the guests of the show are their own and do not necessarily represent the views of myself, Broken Psycho Media, and Wondery. The podcast and any linked materials should not be misconstrued as a substitution for legal or medical advice.

Origins birth and wellness owners and midwives, Kaitlyn Wages and Gina Thompson, have not responded to our requests for comment. Additionally, midwives Jennifer Crawford and Elizabeth Fuell have also not returned our request for comment. This season is dedicated with love to Malik. You don't know anybody until you talk to someone Hi friends, this is Amy B. Chesler. As season 23 has progressed, and especially over the last couple weeks, many additional brave survivors have reached out to us to share their experiences. With that comes a lot of new evidence, and because we need to follow up on and fact check every lead before airing the season finale, we need some extra time. In the meantime, today's special episode features a conversation between the Broken

Cycle Media team and Dr. Nididia Maka, Amuta Onukaga, founder and director of the Center for Black Maternal Health and Reproductive Justice. This season, it was extremely important to have an honest conversation about the state of maternal health in America, especially for black birthing people and other marginalized communities. We deeply appreciate Dr. Omuta Onukaga for sharing her time and expertise with us. Please don't forget to show your support for her and her organization by visiting the episode notes

and finding out more about what they're doing to improve maternal and neonatal health in America. Good afternoon, everybody. My name is Dr. Muta Onokaga. I am the founder and director of the Center for Black and Eternal Health and Reproductive Justice, as well as the founder and director of the MOTHER Lab, which is a large research lab dedicated to training

the next generation of maternal health scholar activists. I have 35 students in that lab. I'm also a dean here in the School of Medicine, and I have a consulting company. Thanks for having me. Thank you so much for your time and expertise today. Can you share with us what led you to this work? A lot of my professional journey was shaped by personal tragedies. So I lost a friend

of mine in childhood. She died from complications after giving birth. She had lupus and the pregnancy exacerbated her lupus. The hospital she delivered in was not equipped to handle a high-risk pregnancy. I think experiencing that as a young person, I was 16, she was 15, and then experiencing the death of a colleague and friend in my adulthood, Dr. Shalane Irving, who was also a preventable case, had been seen eight times after delivery, should have been readmitted and prioritized, was not, and also died from complications after her delivery. These types of events solidified my professional expertise and passion in black maternal health. I also have training in this area. My doctorate

is in maternal child health. I'm a woman with lived experience. I have children of my own and I can firsthand see how the healthcare system does not prioritize and frankly fails to listen to black women in the pregnancy and birthing process. So that is both the personal and professional overview of how I came to do this work, addressing these systemic inequities and really questioning why do we see the disproportionate maternal mortality morbidity around black women. I've been coupling that with the research aspect of it, so both quantitative and quantitative research, really trying to document how pervasive

the impact of racism, environmental stressors, and unequal access to care is on black women's bodies and birth outcomes. And then a lot of my work also includes authoring studies and being a principal investigator of research studies where I'm able to either one contribute to the healthcare and clinical pieces of it or two, we've developed curriculum and done a lot of advocacy work. Really, these are the reasons that I founded the Center for Black Maternal and Rebuctive Justice and also the reasons why the center does so much work to confront the disparities that we see for Black women and their families.

The United States is in the middle of a maternal health crisis. It is one of the most dangerous high-income countries in the world in which to give birth. During the pandemic, we looked at our maternal mortality rates. It was 32.9 for every 100,000 live births. But for Black women, the rate is actually more than double, 69.9 deaths at its highest peak in 2021, that's abhorrent. So it's declined a little bit for black women, but there's

still a very large racial gap. We know that black women are still two to three times more likely to die from pregnancy related causes than white women. The maternal health crisis is compounded by the fact that 84% of maternal deaths in this country are actually preventable. So I think when you look at the data, you look at it by race, you look at it aggregate for all women, we are in the middle of a really bad place that will only get worse as we see structural racism, bias, systemic dismissal of black women during the birthing process continue to exist. And the another thing I really want to be clear about is that these inequities for black women persist even with black women with a higher education or socioeconomic status.

A black woman with a college degree is still more likely to die from childbirth complications than a white woman with a college degree is still more likely to die from childbirth complications than a White woman with a high school diploma. Black infants are more than twice as likely to die before their first birthday compared to White infants, so we still see a really tremendous gap in racial outcomes for infant mortality. Preterm birth, which is defined as a birth of an infant before 37 weeks of station, is 50% higher among Black women than

white women, which also has a lot of implications for long-term care and long-term health outcomes for the infant. Black women are also more likely to experience severe maternal morbidity. So morbidity is illness, mortality is death. Even the things that are considered to be SMM events, severely maternal morbidity events, we still see higher rates in Black women. This is during childbirth, this is after childbirth, and these include hemorrhage. The majority of maternal deaths due to hemorrhage, 90 percent actually, are preventable. So are

a lot of the complications we see from preeclampsia, which is hypertension and cardiomyopathy. Thinking about what it means for Black women, for all women, the maternal mortality rate for all women increases with age. And black women are more likely to delay childbirth due to socioeconomic barriers. This disproportionately impacts age-related risks. We are in a really dire place when you can say comfortably that 84% of maternal deaths are preventable. We're not fulfilling black moms, although we're failing them even more. But we're failing all birthing people, all mothers. No one is really faring particularly well in this current healthcare environment. These statistics are jarring.

They should make us angry. These statistics, individually and cumulatively, really highlight the urgent need for systemic change in our country. And this includes policy reforms, clinical accountabilities at the provider and hospital level, Medicaid expansion and the maintenance of Medicaid as a program overall, workforce diversification, having community-based models of care, thinking about the quality of health care that women in this country receive. This season we were focused a lot on Texas and we know that black women in Texas as of 2023 were 2.5 times more likely than white women to suffer maternal death. In your opinion, what are the factors contributing to this?

I think racism is the root cause of a lot of the disparities that we see. Racism defined structurally is not just one bad actor. It's a system that shapes maternal care that was not built to serve Black birthing people equitably. If we think about just the field of obstetrics and gynecology and how it was developed, it really was built on exploitation and dehumanization of Black women. We know that a lot of the policies that Texas and other states are adopting are not in the best interest of birthing people as far as having hospitals closed,

having to travel further to hospitals, having more difficulties with transportation, being able to access timely prenatal care. We know that that increases the risk of people not being able to get to care, particularly if it's a high risk pregnancy. So this is just a bad series of events, policy decisions, racism, healthcare access, proximity to providers,

lack of highly trained skilled providers in rural parts of the state. All of those things cumulatively are why we're seeing the higher rates that we're seeing in Texas and other parts of the country. Also, the systems that are training and educating doctors are rooted in so many ways around the centering of white persons' experiences. You touch on something that I just want to illuminate, which is the field of such gynecology, how clinicians are trained. I think if you ask the average first or second year medical student, do you think people of color, black people, have thicker layers of skin, have higher pain thresholds, all these types of questions. They'll tell you yes, which we know is not accurate. But when they're being trained in racist ideologies, up until recently, the person I was

considered the godfather of obstetrics and gynecology was an inhumane racist criminal who essentially perfected his surgical techniques on the bodies of black enslaved women without anesthesia, without consent. There were up to 12 women that he did these things to. We only know three of their names, Lucy, Betsy, and Anarka. Jay Ramson perfected these techniques how to repair fistula, how to perfect the c-section, how to create a speculum. All these techniques and procedures were perfected on the bodies of black enslaved women with no pain medicine, no consent. This is the history of obstetrics and gynecology in this country. So clinicians who are trained in these racist

ideologies will perpetuate them, particularly for clinicians who may not come from diverse communities, may not have a lot of overlap and interaction with people of color, may not be comfortable in those spaces, may have preconceived notions, may have racist and biased stereotypes, gender stereotypes. These things all exacerbate the ability to deliver quality and timely care to birthing people of color. You know, it's very problematic that these things exist. And frankly, if you talk to most OBGYNs today, they'll tell you that's the history, but all of us are not doing it now. Up until pretty recently, people thought J. Ram Sims was a wonderful person and there's an algorithm called the VBAC. So it essentially calculated the likelihood

of someone being able to labor vaginally after having a prior C-section. And it subtracts from your likelihood of success if the person is a person of color. So this is not something that has any medical accuracy. It's literally putting in someone's race into an algorithm and then telling the patient, I think you're going to need another C-section, even though the person may not actually need that. Thinking about the historical context of the discipline of obstetrics and gynecology, thinking about this VBAC algorithm, which up until quite recently was still in use by many obstetric practices around the country, these are racially based and racially motivated practices that have very dire implications for black birthing people and other birthing people of color.

There's no one isolating situation. It's the culmination of all these racist practices and tendencies that are now working together to, unfortunately, undermine the quality of care that black women get and frankly impact their ability to safely birth in hospital settings. The field of midwifery also has its own problematic beginnings. First of all, the field of midwifery started because black women were not able to deliver in hospitals that were considered to be white led. And so in a lot of parts of the country, particularly the south, we had our own models of care. And that was the granny midwives. And these midwives were community leaders, traditional

birthing attendants that really safely and successfully delivered infants for a long time. And then once I think we started to see the credentialing of the field, the certifying bodies started to pop up in midwifery. It became largely problematic for black women. They were criminalized for doing things they'd done for years. Supporting births and home settings in birthing centers now became a criminal offense. We know that the midwifery model is a successful one, but we know that this is problematic because just like

the history of esoterics and gynecology, black women who were not prioritized in that space were pushed out and really a whole generation of midwives was seemingly obliterated. Once we went to the credentialing process, you had to be a nurse midwife or you had to be some type of credentialed midwife. It removed a lot of the autonomy that black midwives had had. The field of midwifery also became very whitewashed and very white led. And I think that's where we lost a lot of it. The irony about this whole maternal health crisis is that by pushing black midwives out of a discipline that we created when we were in need, now we need more Black midwives. And so there's a whole push for getting more midwives back to the

table and training more midwives and getting more midwives credentialed. We would not have had to do that if it had not been usurped by white women and, frankly, the healthcare system. And finding another way to push Black people out of organically delivering safely and supporting births. We need more black midwives because we know that when patients and providers are congruent, so you have a provider and a patient from the same racial background, there's better outcomes. This cycle is all predicated in racism. It's similar to what we saw in obstetrics. This is why we don't have a lot of OBGYNs of color. We need a more diverse, perinatal and maternal health care workforce, which includes doulas, midwives, nurses, OB-GYNs, maternal fetal medicine, doctors, which is a specialized obstetric

provider. We need more of them to be from communities of color, to be from underserved backgrounds, to be immigrants, have different language abilities and come from different backgrounds. We need all these people at the table because ultimately, when we are trying to figure out how to reduce unnecessary and completely preventable deaths, we need people that have lived experience in that space. Something that was highlighted by other experts that we've spoken to is the benefit of universal healthcare and how that impacts data typically when we look at other countries. I'm curious if you would agree with that. I think it would and I think we also would have to do a really intentional targeted recruitment

to make sure that while we are providing universal health care, which ideally should level the playing field for all birthing people, it should reduce bias, it should elevate the experience for everyone, make it more equitable across the playing field. Then we're also making sure that we are intentionally not only recruiting from communities of color and prioritizing that, but we're able to make sure that we have providers that come from these communities and backgrounds as well. I think that's a very, very important part of the conversation. So if we have universal healthcare, who is providing the healthcare? What do they look like? What's their background?

What's their ideology around labor and delivery and birth? And how do they prioritize patients of color, people from underserved backgrounds, et cetera. It's both, yes, universal healthcare is a card to play in this conversation and also diversifying the healthcare workforce is huge to me. Absolutely. I'm curious if you could shed any light into how Medicaid and insurance policies are influencing the maternal health outcomes

for black birthing persons. Medicaid plays a huge role. The type of insurance you have really dictates the quality of care you're going to be able to get, how long it takes to get into the care, can you see a specialist, do you get the bells and whistles, do you get a nutritionist, do you get a lactation consultant coming to your house, do you get sent home from the hospital with a remote blood pressure monitoring kit. If you have good private insurance, these are the things that you should have. Even if you have pretty decent public insurance, these are some of the things you should have. Medicaid has a huge role to play because they cover so many births. And there is a current

model on the street. CMS just released something called TEMA, Transforming Maternal Health. It's a 10-year project that is funding 15 states to reimagine, redevelop, revamp their maternal health, clinical care, and Medicaid policies. It's an incredible initiative and commitment. It's just starting now. So we don't have a lot of data, but I am excited to see this type of commitment. I really hope that we're able to see it through for the 10-year duration as it was slated to be. I hope that we're able to actually launch it and get it off the ground and that it actually has the resources and personnel to be meaningful because that's how it was conceptualized.

Something that has been highlighted for me when speaking with other doctors specifically in Texas who are working in these maternity deserts is the reason why a lot of birth centers are being created and why they can be really positive for the community given how many maternity deserts there are. Do you guys study that within your work? And could you share a little bit more with us about how that impacts maternal healthcare? The maternal healthcare deserts are significantly having an impact on US families and also healthcare systems. When we see spaces that are maternal health deserts, they really are limiting access to a central prenatal delivery and postpartum care. These are really pronounced

in rural areas, like you just mentioned, or underserved communities in Texas and other parts of the country. And these maternal healthcare deserts are in areas where there is a lack of maternity care services, including hospitals with obstetric care, OB-GYN certified nurse midwives. These deserts are why we need more birthing centers. These hospital closures, OB unit closures, exacerbated by the pandemic, et cetera, are causing tremendous shortages and causing people to look to other birthing options to be able to have safe and joyful birthing experiences.

As maternity care does continue to grow across the country, we're seeing real changes in how people experience their pregnancy and child birthing journey. Fewer hospitals are offering maternity services, families are turning to new and alternative ways to get the care that they need and frankly that they deserve. One of the biggest shifts that we've seen is the increased use of telehealth services. So there's nothing that's going to replace the quality of in-person care when it's truly needed,

but virtual options like online birthing classes, prenatal consultations, postpartum mental health support, they're really helping to bridge this gap. And for many people, these services can mean all the difference between getting help or going without. We're also seeing a rise in mobile maternity clinics. Programs like March of Dimes, Better Starts, are bringing prenatal care directly to families in places like Washington DC and Ohio, places where traditional service models may no longer exist in certain parts of those places.

And it's also an important step towards making care more accessible. We're also seeing the opening of birth centers. We're doing a lot of advocacy around that here in Massachusetts, really trying to be very clear with our legislators about why we need more birthing centers in the state. We only have one open birthing center right now. I'm actually on the board of another one that we're trying to get our doors open, called Neighborhood Birth Center here in Boston. That's fighting an uphill battle. These birthing centers are a ship. They offer a more personalized, with-free-led approach that many families find comforting, empowering, and reassuring.

Some of the work that we're doing here at the center is tied through advocacy and being a huge proponent and a huge part of why we got the Massachusetts Maternal Health Mammal Buzz Pass in August 2024, which is helping to peel back some of our very outdated regulations, which is going to make it easier to both build and operate birth centers here in the Massachusetts Commonwealth. We're also seeing greater access to doulas in certain parts of the country, more lactation consultants, more community health workers who are really here to support pregnancy labor and postpartum recovery.

I think in places like Arizona, for instance, there's a program that's helping make sure that people are tackling transportation barriers, so they're helping people get safely to their appointments. In my hometown of Trenton, New Jersey, they're breaking ground on a birthing center. Trenton is a very high need urban community with very high severe maternal morbidity and maternal mortality and putting a lot of resources and money and advocacy behind it. This is what we need. This is how you focus on community-based solutions and meet people at their place of need. And we know that people are seeking to get what they need to change their circumstances.

That can be online, be in a mobile space, that can be through local community-based networks. But it's really a reminder that when our hospital and our larger systems fall short, communities will find ways to step up and get what they need. What are your thoughts about birth centers working with hospitals in some capacity when there is an emergency and there needs to be a transfer?

I think it's a great idea. I mentioned I'm on the board of Neighborhood Birth Center here in Boston that is being spearheaded by our SHIRO and the Sheriff of Arill. And we are in a transfer agreement. We have a hospital here that's close to where we will be opening and that's our transfer hospital. It's like a fire extinguisher. You only use it if you need it. The fire extinguisher is on the wall and you make sure that it's up to date and it hasn't expired. But if your house is on fire, you're going to be very happy that you have one. That's the best way that I can think about this birth center hospital relationship for people who

are considered low risk and have that ability and desire to deliver in a birth center. They should be able to do that. And for people that need a little bit more intervention or something happens in the labor delivery process, if you don't have a transfer hospital, it could be a disastrous event. So I'm a huge proponent of birth centers. Obviously, I'm on the board of one. And I also think it's never a bad idea to have an agreement with the transfer hospital in case of those situations. We don't pray for those, but you do want to be prepared if and when it does happen.

For parents-to-be who are seeking perhaps a birth center or an alternative method of birthing out of the hospital, what are some things that they could look for that would be a sign that this is potentially a successful place to birth? I think choosing the right midwife and birthing facilities like choosing any healthcare provider, you want to make sure their philosophy of care is in alignment with your values and what you need.

I always tell expecting parents to be really clear about what is the midwife's credentials in the scope of practice. Is the midwife a certified professional midwife or they're certified nurse midwife or any other type of credentialed midwife? How many births do they do in a year at the birthing center? What is their natural birth success rate? What is the birthing center's facilities overall approach to pregnancy and childbirth? What is their tangible support look like during the prenatal period, the labor, and the postpartum periods? How long have the midwives who practice there been in practice? What factors would lead to a transfer? What's their protocol for non-emergency

or emergency transfers? What hospitals do they actually have these privileges with? There's some hospitals you don't want to deliver to there. Do they work with OBs? What OBs are part of the board of birthing centers? Even on our board here at neighborhood birth center, we have a number of OBs who are on our board. We have midwives on our board. What is the model for that? And I think for expecting families and parents, you want to keep going until it feels right. I always advise interviewing multiple providers, getting a second and third opinion. you keep looking until you find the right fit. What actions at the care level do you think physicians, midwives, any other providers

could take to make maternal and postnatal health more equitable as well? So many things. The birthing process, being in labor, there's so much that happens in that timeframe. It can be fast, it can be precipitous labor, it can be elongated labor, there's so much that happens in that timeframe. It can be fast, it can be precipitous labor, it can be elongated labor, it could be a brief birth. There's so many things that are happening moment by moment. The best thing clinicians can do is to be present and attentive to the needs of their patients. It sounds very duh, but you have to be tuned in. You have to be attentive, make eye contact, check on your patients,

respond to their requests, prioritize their needs, listen to them, listen to their family members. You will get a lot of information that can help to deliver better quality, more accurate care that is congruent with their needs. And when you have a better patient provider relationship, they'll tell you more, hey, I'm having a headache. Oh, that could be preeclampsia. Oh, I just passed a large blood clot. Oh, that could be preeclampsia. Oh, I just passed a large blood clot. Oh, that could be a hemorrhage. So that's one thing I would say is just to hold space for

your patients and be available to them. That's the biggest thing that providers, nurses, anybody that's bedside, that's patient facing can do. All of us are human and clinicians are people just like anybody else. Yes, they went to school. Yes, they have highly specialized training and skills and certifications. There's so much bias and prejudice built into the way that they interact with patients. Do you introduce yourself? Do you acknowledge your family members in the room? Do you give a nod to the doula who's watching the situation play out? Do you check in with the birth and person? How are you feeling? How's your pain management? These are small things that clinicians and nurses who are bedside can do to really create an atmosphere of safety.

And then obviously delivering the highest best quality healthcare. If someone is experiencing blood loss, it could be a hemorrhage. We should consider it as such. It's just the delays in care. It's the wait and see. It's the we'll put an order later, it's we'll look into this at another time. All these seemingly small occurrences in labor and delivery and postpartum can have life altering consequences. That's the interesting thing about this work. It's not one person, it's not a policy, it's a system. The system is inherently broken and biased. Some people say the system is operating quite fine for who is designed to operate for, and I can agree with that as well, but it's just a dysfunctional system. And I think our ability to penetrate that at different

places through advocacy, training, building relationships with clinicians, centering lived experiences, honoring people's birthing requests, collaborating with doulas and midwives. That's really what we need to be doing. It's not one place we can target. It's this more multifaceted blanket approach that takes everybody tapping in at your level of need, your level of expertise, what's within your wheelhouse. All of that is necessary in this conversation. I'm curious what suggestions you would make to policymakers about what we could do to contribute to make these rates improved. I think the best thing for policymakers is to listen to their base. We have really powerful lived experience stories that we hear.

We do a lot of advocacy here at my center, not only at the local level, at our state house where they're all the time supporting legislation that's being introduced, but also at the federal level. I think that's really where the rubber meets the road. Are we able to talk to our elected officials that we put in office that worked for us about what our needs are? I tell people all the time, advocacy is skill and it's an art, but anyone can do it. So if you're in a position to call your legislative office, I'm a constituency, I live in your zip code,

here are the issues I'm prioritizing. They have staffers that will take that call that will make that note. They're public officials, they're public servants. So I think that's one way that I really implore people to get in the fight is through channeling your relationship with your elected officials and using advocacy for good. Can you highlight for the listener a little bit more about what the center is doing in

order to promote more racial equity in the maternal health field and the neonatal health field. I started this center here, it's the Center for Black Maternal Health and Reproductive Justice about three years ago. We're an academic-based, but community-facing research center

that is focused on advocating for quality, equitable and respectful care. And this is before, during, and after the pregnancy period. Some of our accomplishments are based in our six units of the center. So we have the Mother Lab, which is our student-run, student-led research lab that engages both current students in public health,

social work, nursing, medicine, anthropology, law, economics, to really think about maternal health. And we do this through webinars, publishing research, anthropology, law, economics, to really think about maternal health. And we do this through webinars, publishing research, advocacy, anything that can really amplify maternal health. One of the initiatives that the mother life students came up with, they're called Nurture Kids. We're partnering with a number of domestic violence shelters and women's centers in

the area and donating postpartum kits and resources after their patient population delivers. We know that's an important entree into that parenting journey, the ability to support yourself during the postpartum period. There's no shortage of ideas or needs that the students have and that we have as a center. We also have a unit that focuses on data. How do we serve as a hub for research and put our finger on a pulse of where the opportunities for intervention lie. We analyze a lot of data. We have epidemiologists or statisticians who can analyze disease trends and look at current data and say, okay, here are the places of intervention and here's where we can subsequently support birthing people in the inter-pregnancy period. So if

a person had a previous SMM event and we're looking at the data, we can say, okay, here's where the points of opportunity are to kind of interrupt that. We also have a focus on policy, a focus on education and training, being very intentional about building a culturally responsive workforce. We work with students, practitioners, doulas, midwives, focusing on racial bias, cultural competency, and a very clear focus on patient-centered care. And then our community-engaged research unit, which is our face of the center, focuses on building and maintaining partnerships with our community stakeholders, OB-GYNs, public health leaders, doulas, other academics, community health workers, policymakers, to really co-create

solutions that are going to reduce maternal health inequity. So the center is a small but mighty think tank. We're very intentional about our ability to hold space for communities, because ultimately that's where the answers lie. And we are researchers and scholars who have a passion for this, but we would not be frankly able to move our mission forward

if we did not co-create it with other community partners who are able to assist us in this work. This is why the center is so unique. Half of my lab is 19 years old because that's the next generation of scholars. They are 19 today and then tomorrow they're in medical school and then after that they're in law school and they're on the floor for LND as a training as a nurse

and they are on the ground doing public health programming. If you're not investing in next generation, what are we doing? Clinicians only focus on individual level treatment. Public health people, we focus on population level prevention, but we need each other. Clinicians don't have the training, a lot of them to run large academic studies, and we as researchers don't have access to a patient population. We're not bedside. So herein lies the solution and the challenge.

It's really just about breaking down our silos, checking your ego at the door, and working collaboratively to save lives. How and where can listeners support the Center? One of the things I want listeners to leave with is our goal here at the Center is to strengthen our partnerships, deepen our commitments, work in service of maternal health with an urgency and an intention. And if listeners want to get involved in our efforts, we are a self-funded center, so we really rely on financial support to fund our research, to stipend our students, to provide trainings, to support our advocacy efforts. So people are welcome to partner

with us, whether that's through collaboration, shared research projects, or any other form of engagement. Partnership really does help us advance our mission of equitable maternal health care. We do an annual conference every year on Black Maternal Health. So our ninth annual conference will be April, 2026, which is focusing on the role of women's health in addressing maternal health inequities.

That's a big financial endeavor, and we make it cost effective. We bring in the best speakers in the country. This year, April 4th and 5th, 2025, we brought in a number of black male fathers and other leading experts who would either, one, are doing policy and advocacy, working in a space, or two,

had experienced the preventable loss of their partner during labor and delivery or postpartum complications. A's a really powerful conference so that's an opportunity for engagement. Another way is to sponsor a Mother Lab student. Mother Lab is addressing maternal health research and training the next generation of scholar activists and these scholars are really really ambitious. They want to go to conferences, they want to publish research, they want to do advocacy work, they want to work with community. All those things are expensive. And what keeps me up at night is getting that email that inevitably will say, hey, Dr. Mutai,

I want to go to this amazing conference. I want to get a training. I want to get a certification. They're students. They're ambitious. They're hungry. As their mentor, I want to be able to support them because I know that these students are going to get that training through my lab and they're going to go on to do great things

and save lives. We are small and scrappy but we're committed and I think everybody that works here has some type of personal tie to the work. Either they're a birthing person or one of their family members have something like everybody has skin in a game which makes us work harder. There's so much need that if you're a researcher we need you. If you're fundraiser great, if you're a researcher, we need you. If you're a fundraiser, great. If you have marketing, great. If you have relationships, awesome. We need everything.

I really do want to just implore people to reach out. We're very, very, very willing, open, appreciative of all the support that we get. I know that our work is so successful because we have such strong relationships and partnerships, so we could always use more. All of our information is on our website, blackmaternalhealth.tufts.edu, or on Instagram, cbmhrj.underscore.tufts. We also have a LinkedIn site. We have Facebook or email, blackmaternalhealth.tufts.edu. In this current landscape, now more than ever, we do have to be creative in our fundraising efforts and our strategies and our resources. We will be sure to put all of the links for everything you've just listed in the episode notes.

We are so grateful for all the work that you're doing and also all the time and energy that you gave us today. Oh, you're so welcome. Thank you for this opportunity. for this opportunity. Next time on Something Was Wrong. At some point I'm on the floor kneeling and I feel this distinct large and painful movement in my uterus. They're just excruciatingly painful, more painful than the contractions. She was like, oh, your baby's just turning around. I'm like, no, a baby can't move that way.

And it was all very downhill from there. It turns out that was the pop of my previous scar starting to open. It came to light that the hygiene practices were pretty abysmal. The fact that we used to have multiple different women's placentas drying in the same dehydrator at the same time. Sometimes you would mix up whose placenta was whose. I do believe that part of Gina's shortcut method that she presented to me on Here's

How You Could Become a Midwife So Quickly, that just from the get-go was you can make a lot of money. And their birth centers grew and their clientele grew because the seemingly perfect portrayal of births and the herbal baths and the pictures and the videos. Underneath that, if you looked behind the pretty, was just a whole undercurrent. Not good for anyone. We are so, so excited about the bill that was introduced. And for the future of MAMA, we are hoping to host support groups, events, provide more resources, more education, more tools for moms, and just provide a safe place for moms and their babies. As legislative

session is soon to come to an end. We are really hoping to focus on community because that is something that we have all felt at some point in time. Something Was Wrong is a broken cycle media production created and produced by executive producer Tiffany Reiss, associate producers Amy B. Chesler and Lily Rowe, with audio editing and music design by Becca High. Thank you to our extended team, Lauren Barkman, our social media marketing manager, and Sarah Stewart, our graphic artist. Thank you to Marissa, Travis, and our team at WME, Wondry, Jason, and Jennifer, our cyber

security team, Darkbox Security, Jason and Jennifer, our cybersecurity team, Dark Box Security, and my lawyer, Alan. Thank you endlessly to every survivor who has ever trusted us with their stories. And thank you, each and every listener, for making our show possible with your support and listenership. Special shout out to Emily Wolf

for covering Gladrag's original song, "'You Think You' for us this season." For more music to Emily Wolf for covering Gladrag's original song, You Think You, for us this season. For more music by Emily Wolf, check out the Episode Notes or your favorite music streaming app. Speaking of Episode Notes, there every week you'll find episode-specific content warnings, sources, and resources. Until next time, stay safe, friends. resources. Until next time, stay safe, friends.