Something Was Wrong - S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG

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Starting point is 00:00:30 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 cycle media, and wondering. The podcast in any linked materials should not be misconstrued as a substitution for legal or medical advice.

Starting point is 00:01:07 Origins' birth and wellness owners and midwives, Caitlin 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. Hi friends. Over the course of this season, and especially over the past few weeks, we've had many survivors reach out to us with similar heartbreaking stories and new evidence. Because we need to fully follow up on these leads and fact check before airing our full findings in this season's finale, we need some extra time to make that happen.

Starting point is 00:02:28 In the meantime, today's special bonus episode features season 23 survivors Marquita and Kristen, the Broken Cycle Production Team, and obstetric expert Dr. Shannon Clark. Together we discuss season 23, the maternal health care crisis, and more. Thank you so much to all who participated in this special bonus episode. We are excited to hear from Dr. Clark

Starting point is 00:02:59 and really gather her expert advice. She's been listening throughout the season and sharing her thoughts online, so we thought it would be great to welcome her onto the show, and have a open dialogue as well as hear from the survivors what the season has been like for them thus far, what it's felt like hearing their stories back, what the response from their loved ones has been like, what questions have popped up for them as they've been listening back to other

Starting point is 00:03:25 people's stories, etc. So I'm just really excited to host this roundtable. We also have on the call today two of our associate producers, Lily Roe and Amy B. Chessler, who worked alongside me on this season and I am eternally grateful for all of their hard work as well. Why don't we start with introductions? You guys already know Kristen and Marquita from this season and you've met them before. So why don't we, Dr. Shannon, hear a little bit about you and your professional background and how you got into this work. Hi, yeah, I am Dr. Shannon Clark. I am a double board certified OBGYN and maternal fetal medicine specialist. That means after medical school, I did four years of OBGYND residency training. Then I decided to do more training to be a maternal fetal medicine

Starting point is 00:04:15 specialist. So that is also known as perinatology or a high risk pregnancy specialist. All my patients are pregnant with either maternal fetal complications or both. I've been a faculty in maternal fetal medicine and OBGYN since 2007. And now I'm a professor at a large academic institution. That's my day to day. And I'm actually right now, I'm post-caly. So I've been up since about 4 o'clock yesterday morning. Oh my goodness. Do you get used to that? Yeah.

Starting point is 00:04:46 I mean, I've been doing it forever. I'm older now, and I can tell you, recovery's not as smooth as it once was. We do the 24-plus hours shifts, and that's just the lifestyle at this point. Comes with the territory, I suppose. Since we're on that topic, is 24 hours for you the longest you feel confident

Starting point is 00:05:07 in working a shift? what is that cutoff point for you personally? Honestly, I don't think I have a cutoff point because I think that as physicians, especially those of us that are in a surgical specialty, like OBGYN and as a high-risk pregnancy specialist, we can be on at the drop of a hat. And while we're on call,

Starting point is 00:05:26 we may have a chance to rest if things are kind of quiet. I can go from sleeping 30 minutes to being in the OR with someone hemorrhaging. I can't say that I've ever really felt that I couldn't function appropriately after being on call or being up because we just turn it on. It's the skill set we develop over years of doing this. I asked about the hours and like the cutoff of stamina, so to speak, because in some of these interviews that I've done, especially with ex-employees at the birth centers, they mentioned

Starting point is 00:05:56 that midwives would sometimes be working 48-hour shifts. 48 hours is a lot. I've done 48 hours as a resident back of the day. Not so much now, but I will say it's not. only just the lack of sleep, it's being out of your home or being away from her family or being in that high intensity environment for that period of time, even if you're able to step away and go to your office or go to the call room and take a nap. You're in a hospital setting or a birth center setting. So I can imagine having someone cover for that period of time in a person or

Starting point is 00:06:28 in a hospital will take a toll. The most I will do now is probably about 36 hours. And that's very, very rare, but it's not always that I'm clinically active, taking care of patients on labor and delivery. You have to be careful in what you're doing as far as what your call shifts are going to look like. There are some surgical specialties or even medical specialies where they may be on call from home for the weekend, but they're at home. So it's a little bit different. I can imagine being in a birth center setting or a hospital setting for two to three days. That's a lot. I don't know that I could do that. Yeah, it's a lot to ask of anyone, honestly. Kristen, are you, You fan-girling hard over there?

Starting point is 00:07:07 I know you're a huge Dr. Shannon Clark fan. Hi, yes, Dr. Clark, I heard your intro, and I felt like I was watching another one of your reels on Instagram. It's wonderful to meet you postpartum. I did a lot of searching for answers. Part of that was done on social media platforms, looking at people who specialized in birth trauma and things of that nature. And I stumbled across your social media platform.

Starting point is 00:07:34 platform and was just really enamored by the integrity and the mission to provide pregnant people with accurate information, breaking down some of the negative stigma around hot topics such as interventions, epidurals, or even being inside of a hospital. That was healing for me to see a medical professional and OBGYN take a part of this movement that's happening. to really safeguard pregnant people and their babies. So yes, I'm geeking out over here and I'm very excited. Dr. Clark, what was it like for you listening to this season thus far? I'm curious if you could give us some of your key takeaways. It was hard to listen to. It's almost like watching medical TV drama and you're screaming at TV. But this was real life. And listen, I'm not here

Starting point is 00:08:34 to say that giving birth in a hospital is perfect, and we have no issues. We do. But my overall feeling is that being in a birth center is for patients that are lower risk. And that means throughout their pregnancy, all the way coming up to delivery. And if they're getting care in pregnancy that's maybe not what it should be, and then they're delivering in a birth center setting, that just compounds on the potential for complications. With a couple of these stories, you know, I saw red flags in their antenatal care and their prenatal care. And then now that's a lot of the enderneral care. And then now, they're in a birth center. I wish that some things have been picked up earlier on and they could have gotten those medical consults earlier on in their pregnancy that were needed. Maybe things could have

Starting point is 00:09:14 been avoided. If they're not getting all the information they need or full transparency, that's not allowing them to make an informed decision. And I feel like that was what was at play as well. We are choosing to give birth to our babies in this setting. We should be able to trust that what we're being told is the truth and that they're telling us everything we need to know. That's whether it's in a birth center or a hospital setting. But in a birth set or setting, the risk or higher because if something goes wrong, time is everything, whether it's a maternal complication or a fetal or neonatal complication. So I just wish that there was more transparency on the providers who are taking care of the survivors. I have a lot of feelings about this. But again, I want to emphasize that I'm not

Starting point is 00:09:57 doing this just so that I could say, well, giving birth in a hospital is perfect. and there's no issues there. I'm not saying that at all. But when someone chooses to be in a birth center and they are considered to be low risk, they should actually be low risk because that's what a birth center is for. That's what's concerning with all of the survivors

Starting point is 00:10:17 I interviewed on the record for the season and behind the scenes. For me, what felt like a lack of urgency, a lack of awareness that this is life or death, and just a lack of ability for the, patient to consent to what was happening? Yeah, Dr. Clark, you say a lot of things that I talk about often whenever I am conversing with other professionals in the field and something that I noticed about my care and every other survivor that I have encountered is that we are not given all of the

Starting point is 00:10:52 information that is needed for us to make good, well-rounded decisions for ourselves. That's the key part. You go into a birth center and let's say I had a previous cesarean section. We're being told that this is pretty low risk. But what they're not saying is one in 200 women have a rupture. And if you rupture in an out-of-hospital setting, we may not be able to get you to the care that you need in time to save your life and your baby's lives. And that's imperative information. For us, to know. I was a first time mom. I knew nothing about what was happening to my body. I knew nothing about pregnancy, labor, and delivery. I trusted my providers to tell me everything that I needed to know. And when red flags started to pop up throughout my care, I was always told by my providers that this

Starting point is 00:11:51 was some variation of normal. My providers chose not to refer me to a higher level of care, where I could have had informed decision-making. Dr. Clark, would you like to respond? I want to say that I am not anti-midwifery bottle of care, as long as it still applies to the patient. They may walk in at point A, being low-risk, where the midwifery model of care completely applies, but pregnancy is a dynamic state.

Starting point is 00:12:21 You have a lot of physiological changes, anatomical changes. A whole new being is being grown inside of someone's body. And we have to respect that. and I say this all the time, a lot of things have to go absolutely perfectly for there to be no complications. And there's a lot of room for error just innately by being pregnant. We can't dismiss those, as Kristen said, red flags. And red flags develop. Not in every pregnancy, but in a lot of them.

Starting point is 00:12:50 I feel like the stories that I heard on this season, they were being forced into that box where they were low risk. And even though red flags kept popping up, they weren't willing. to acknowledge that they're starting to move out of that low-risk box. As physicians, we get criticized all the time for dismissing patients. It also happens in Moiffrey model of care, just as it has happened with us OBGYNs who deliver in a hospital setting. We have to understand and respect pregnancy for what it is.

Starting point is 00:13:21 There is a lot of room for things to go wrong. We have to listen to red flags when they pop up. We have to appropriately evaluate them and do what we need to do to manage them. in order to ensure the best outcome for both the patient and the fetus and neonate. If we keep trying to dismiss them so that they stay in that low-risk box, that's going to do a huge disservice to the patient and their care. One topic that kept coming up this season in many of the survivors' stories was maconium. I'm curious, Dr. Clark, what your opinion on this matter is.

Starting point is 00:14:02 When is maconium serious? at what point when mconium enters the situation, does a person need to be transferred, and is that considered high risk? I am an OBGYN and high risk pregnancy specialist. I do all high risk pregnancies. So I am in a different setting dealing with a different acuity of care at baseline with my patients. But shit happens, right? There's a saying that says maconium happens.

Starting point is 00:14:28 But we can't dismiss mcconium and just say, oh, well, it happens because there are a lot of consequences to mconeum. It's associated with abnormal fetal heart rate tracings, maconium aspiration syndrome, increased admission to the NICU for the neonate, need for neonatal ventilation. In really bad scenarios, it can even lead to hypoxic, eschemic, and cephalopathy of the neonate. It can cause an increased risk of cesarean delivery for the patient, infection, fever. The consequences of mcconium aspiration syndrome or having HIE are so significant and profound that we can't dismiss it. When we start seeing maconium, the first thing we need to do is once a patient in labor starts showing signs of maconium passage during the course of their

Starting point is 00:15:11 labor, we need to let the neonatal resuscitation team know, hey, patient in room 321 has maconium. If you don't have a neonatal resuscitation team, how can we put them on alert? Because they had to be ready in case when the neonate is born, there are complications. One of the other things that can happen is having an abnormal fetal heart rate tracing. Well, if we're not doing continuous fetal monitoring, how are we going to pick up? There's an abnormal fetal heart rate tracing. And having done this for a gazillion years,

Starting point is 00:15:37 I could tell you, there are certain signs in a fetal heart rate tracing that can tell me that there's mconeum there and that there could be a complication if we continue laboring in this patient. So I look at the big picture and say, how close is she to delivering? If she comes in at two centimeters

Starting point is 00:15:52 and I'm already seeing some issues, I'm not going to wait until she's completely dilated. There's a lot of clinical nuance at play with the individual. So we need to consistently document what the maconium looks like because it can evolve over time. There's a lot of things we need to do. What protocols does a birth center have if there is maconium noted during labor and delivery? That's a question that they should be able to answer. And if they just say, oh, well, mconium happens.

Starting point is 00:16:15 That's not a good answer, in my opinion. Because they should have protocols on what to do. Season 23 survivors, Marquita, Kristen, and Amanda have created a nonprofit called Marquit. moms advocating for moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive. Mama has helped to create a Texas bill called Malik's Law or House Bill 4553, which is intended to improve data reporting requirements for midwives in Texas. While some data is collected via birth certificate filing,

Starting point is 00:16:57 the bill is intended to gather more data that could help improve both maternal and pediatric care, as well as aid consumers and more easily accessible data to make more informed decisions on their own care. To find out ways you can help support Malik's Law, please visit moms advocating for moms.org. Marquita, I am curious if you could share a little bit with us about Malik's law and what we can do to support?

Starting point is 00:17:28 Malik's law is actually HB-4553. It was introduced since the House in March. It's basically requiring midwives to report outcomes related to like transfer, mortality, morbidity rates, because currently they are not required to report any of these. It's not a mandatory thing. It's a voluntary thing. and the reporting that they do is within like a closed system. So it's only available to the midwives.

Starting point is 00:17:58 It's not open to the public. The everyday consumer cannot view these statistics. So it leaves these birthing centers and these midwives to create, per se, their own statistics. We don't have anything to really back it up. That's basically what the law is for. Malik's law provides us with information that we previously don't have. We're often, as consumers of midwives, met with slogans such as we are just as safe as any hospital and any OBGYN.

Starting point is 00:18:35 And then it is up to the provider or the birth center to give us statistics, statistics that cannot be found through any national database. It leaves consumers really just relying on the word of their midwives or their providers or the community to tell them how safe or unsafe certain things are in these settings. Malik's law would allow us to garner information for any indicators leading up to a mortality or severe morbidity, such as decelerations or previous cesarean section or history of preeclampsia and other high-risk conditions that can occur during pregnancy, labor, and delivery that can lead to adverse outcomes. So this will all be compiled through vital statistics, which compiles the information for our yearly maternal and infant mortality reports. And they will have a

Starting point is 00:19:37 separate report or a report that goes alongside of current mortality statistics that are produced right now. Currently, we're seeing only hospital statistics. And it is a little deceiving because how can we do better and out of hospital settings when we don't have the data to see what's actually happening in the field. Thank you. Dr. Clark, I see you want to share something. people say just like what Kristen said, it's just as safe. Well, I cannot say that about where I work, unless I have receipts. In the state of Texas, we have maternal levels of care. And we have state guidelines that we have to meet in order to get designated. Any place in the state of Texas that provides inpatient labor delivery care has to have a designation without it being one, two,

Starting point is 00:20:25 three, or four. We are a level four. We have to provide receipts in order to have that designation. That means a robust quoppy plan. Quopi is qualified. quality assurance, policy improvement. And that means we have certain triggers on labor delivery that are mandatory for case review. We chart audit thousands of charts per year. We are gathering data on a continual basis. We have levels of escalation, primary review of certain cases, secondary, tertiary, and beyond. This is something that I do daily with my colleagues. Why aren't birth centers required to do that because it's easy to say everything is okay when you don't have to provide receipts to prove it. So I agree this should be done anywhere that is providing obstetrical care.

Starting point is 00:21:11 They have to be able to back up what they're saying. And they cannot do that if they're not collecting stats, if they're not reporting their outcomes, their transfer rates, their emergent transfer rates, their complications, the number of postpartum hemorrhages they have, anything like that. We have to have a way to find what those stats are for every birth center, just like I have to do, for where I work and a lot of hospitals do. This has been proven to improve patient care and outcomes. The fact that it's that standard that birth centers are required to do that is a disservice to

Starting point is 00:21:42 the community because they deserve to know what these stats are. Another thing to consider is if there is a complication in the birth center and they go to the hospital, that stat falls on the hospital if there's a death or patients up in hysterectomy or X, Y, and Z. That's going to be on my stats. it's easy to not have to report it if it's not following on your stats. A lot of patients don't even realize that when they're looking at where they're going to give birth. And I'm not trying to throw birth centers under the bus. I do think there is a role for them, but they should be required to do reporting just like we are

Starting point is 00:22:13 because patients deserve to know all of those stats and they should be able to see the receipts. Changing medical records, that was another issue throughout. You can go back and change a medical record. But in our hospital system, if you change something, it's going to be known. Epic logs every edit. If somebody's requesting medical records, they're going to see that. There's an audit trail. One of the things about some of these systems, and I don't know if it was true in this situation, but when you do certain types of record keeping, they will charge for the number of users you have. So I don't know if it was at play in this

Starting point is 00:22:46 situation that it was a way to cut cost, but depending on how many different usernames you're issuing, that is a cost. And I can tell you in a hospital setting, if you were to chart under somebody else's username or you were to go into a chart that you did not actually care for, that is grounds for dismissal, termination of your job. I've heard of people getting fired because they went into somebody's chart or they did X, Y, and Z that was not their documentation. It happens. And that's certainly one of the elements that drew me to work on this season. I tend to gravitate towards stories where areas of the law, there's these significant gaps. Because it really perplexes me how they still exist in so many situations. And what I continually see in all

Starting point is 00:23:33 settings, in all seasons that we have worked on is that when there is a lack of oversight and accountability, this is where abuse flourishes and this is where abusers flourish. And as much as it might not be the majority, unfortunately, those, quote, bad apples in these sorts of parameters can really thrive. And so it's concerning because, again, these are life and death situations. When we looked at the data in certain states and areas of the U.S., it's certainly concerning. From your perspective, what are the elements causing this maternal health care crisis if you agree that that's what's occurring? I've actually talked about this a lot on my platform. When you look at worldwide mortality, we're actually very, very low. It's when you look

Starting point is 00:24:27 at us compared to other higher income developed nations where we are not having a lower maternal mortality rate over the years. Ours is increasing yearly. And do I think we're in a crisis? Yes, I do. And I think there is a few reasons for that. The one's going to be a rise in maternal mortality. There has been a steady rise since around 2000. We've had a few peaks here and there. During COVID, we had a peak, which they're still trying to tease out the data on exactly why that happened. But we're not where we should be for a high-income developed nation. The other reason is because there are clear and proven racial disparities. And we know that our black patients are disproportionately affected.

Starting point is 00:25:07 Why is that? They're having consistently higher rates and maternal mortality compared to their white counterparts. And that is even if a black patient has a college education, they are still five times more likely to die in childbirth than a white counterpart. part. So even education isn't protective in that patient population. The next thing is going to be systemic issues. We have limited access to care. A lot of our patients don't get any care in between pregnancies. A lot of my patients don't get care until they're pregnant. And so then we're playing catch up with any preexisting medical conditions they have while they're pregnant,

Starting point is 00:25:37 which is not the ideal time to do that. We have a lot of social determinants of health that affect patient outcomes like poverty, transportation issues, unstable housing, nutrition, those are all affecting pregnancy as well. Mr. delayed diagnoses. And that's just because, in general, anyone with the uterus isn't always taken seriously. And that's even from when they're not pregnant. If they're not pregnant and they're having a complication, oh, they're just being dramatic. If they're pregnant, then, oh, it's just because you're pregnant.

Starting point is 00:26:09 So there's always traditionally has been a tendency to downplay any concerns that a pregnant individual may have. So there's so many reasons why we are in a maternal mortality crisis. It's not where we should be. We can do a better job. And now that we're having laws that are affecting access to reproductive health care, there's going to be maternal health care deserts because people are going to leave those states. It's already happening. My residents are not going to get the training they need because they're in a state with restrictions of bans. Abortion bans and restrictions in the United States, it actually affects pregnancy care. So unfortunately,

Starting point is 00:26:42 we are taking steps back in recent years and it's only going to get worse. I'm in this. I'm in every day. I don't see anything being done right now that's going to help the maternal mortality crisis in this country. And I don't see anything that's going to help improve health equity and equality for our patients of color. Everything that's being done is doing the exact opposite. And it's something that I think about every day. It's something that I'm seeing the consequences of more. I've seen things in the past three years that I have not seen in my entire career. Thank you so much for sharing that. What solutions would you offer that you feel like would help this crisis?

Starting point is 00:27:27 One of the things I teach medical students and residents, there's a difference between health equality and health equity. You walk onto a lever delivery unit and they say, everybody in rooms 1,310 get equal care. Everybody gets the exact same care. That's great. Nobody's going to get anything somebody else doesn't get. But that's not appropriate because a patient may walk. into room three already had a disadvantage based on social determinants of health, based on the tone of their skin, based on other complications. So being equitable also applies, meaning you have to be

Starting point is 00:27:59 able to allocate resources to the ones who need it the most. Giving just equal health care may not cut it for that patient in room three. They may need more. Being able to recognize what about that patient in room three is already putting them behind the eight ball and fixing that is a place to start, but starting on labor delivery is not going to do a whole lot. It starts way back. It starts during the preconception period. It starts during pregnancy. We can't fix everything when they hit the doors for labor and birth. So we need to focus on equitable health care. We also need to focus on acknowledging the roles that social determinants have and the outcomes are our pregnant patients. The other important thing is we got to continue research and data collection. We got to keep

Starting point is 00:28:41 researching this. We can't just keep saying we have a maternal mortality crisis and we you have to throw out stats. Well, why is that happening? And what are we doing to fix it? We need research on that. And if we keep cutting funding through the NIH, that's not going to happen. We have to acknowledge that racism and health care is an issue. We especially have to acknowledge it that racism and obstetrical care is an issue. And we have to start holding people accountable for that and doing more education. And providers have to recognize both their implicit and explicit it biases. And if we're not willing to do that, it's never going to be fixed. It starts with the individual provider and then it balloons out from there. So we have to acknowledge that racism and

Starting point is 00:29:23 obstetrical care has a huge impact on pregnancy outcomes and birth outcomes and neonatal outcomes. We have tons of stats to back that up. We need to fix it. Those are probably the top three things that I think really need to be addressed first. Thank you so much. Switching gears a little bit, Marquita and Kristen, I'd love to hear about the nonprofit that you have started with Amanda, who wishes she could be here today, but unfortunately she couldn't. But I'd love to hear what that process was like for y'all and what's next for you guys. Marquita, I remember in the early days us sitting in coffee shops and talking about how there is a need for more awareness around what is happening in and out of hot.

Starting point is 00:30:11 hospital settings, to recognize patterns, to recognize faults and gaps in care, and also a need to bridge out of hospital and in hospital care. That's how Mama was born. Mama was born to assess some of those disparities, to protect mothers and their babies, and to help provide them with information to make informed decisions for themselves. We're really big on education, beforehand, the more knowledge you have will better serve you throughout your pregnancy, labor, and delivery, and even beforehand in helping you determine what provider is best for you. The nuances and types of midwives in the U.S. is often confusing for the consumer. And so really making sure that we give foundational education on that and what that means for you

Starting point is 00:31:08 and how that could potentially affect your care. Questions you should be asking you're out of hospital providers, what you should be looking for when you're looking at a birth center, and what you should know if you're going to be choosing a home birth. Because this affects everybody. This doesn't just affect us. We're just the survivors. You never know if that's going to be you.

Starting point is 00:31:30 Low-risk pregnancies are known to become unpredictable and become high risk. And so preparing mothers for that, I think, is paramount. Doing what we can to make sure that out-of-hospital options are held to a high level of professionalism is super important, especially if we are considering out-of-hospital deliveries and out-of-hospital care to be a bridge to the obstetrical deserts. that we face here in Texas. There really needs to be catch up and making sure that these providers are held

Starting point is 00:32:13 to very high and similar standards that we hold our doctors, our nurses, and our hospitals to and ensuring that there is collaboration. We've done a lot of research on this, and what we have found is the best outcomes come from environments where there were respectful and collaborative relationships between providers. and there is a continuity of care.

Starting point is 00:32:39 Like Kristen said, we originally thought that this was just a origins thing and these unfortunate events happened to us and then realizing that this was definitely happening all over and it has been for a while. Many people are unaware that you can become a midwife without being a nurse or without even having medical background or knowledge. So we just really want to ask. advocate for mothers, for babies. And then as far as moving forward with creating bills and the

Starting point is 00:33:13 legal aspect of everything, we talked about it and it rolled into place and happened very quickly. We are so, so excited about the bill that was introduced this past month. And for the future of Mama, we are hoping to host support groups. We are looking to. host events, provide more resources, more education, more tools for moms, and just provide a safe place for moms and their babies. Even when it comes to mental health, postpartum is a very real thing, grief, losing your child, losing the idea of what your birth was supposed to be like. So we're hoping to also help with the mental aspect as well. Mama's definitely growing and we are excited about providing these resources to moms.

Starting point is 00:34:13 I love that you brought that up, Marquita, because that's really what we're focusing on this year 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. I know that freshly postpartum, I've never felt more isolated in my life. Unless you have adequate child care and you have a good support system and you are more than financially stable, you don't have access to important mental health resources. You don't have access to a community that can help you recover and heal through your postpartum period. And birth trauma happens everywhere.

Starting point is 00:34:56 It happens in hospitals. It happens in out-of-hospital settings. It happens even if you don't have a life-threatening issue that happens during your pregnancy, labor, and delivery. And all of those moments are important. Birth trauma, I wholeheartedly believe, affects the mother you're going to be and the person you grow into after. So we're making a huge effort to collaborate with professionals from all different walks of this health care. system to help us come up with some awesome solutions that would help us be able to reach people who previously did not have access to resources that could really help them recover and take the best foot forward in their postpartum and motherhood journey. Amazing. I'm just in awe of you three and the things that you are working on. We have linked in the episode notes this season. the website and their Instagram and more information, and the same will be true for this episode.

Starting point is 00:36:03 So please check out, support, contact your legislators. Also, Marquita is a real estate agent in the DFW area, and I'm just going to plug that. We want to support her. So if you're looking for a house in the DFW area. I appreciate the shameless plug. I appreciate it. I'm curious, having known any. each other's stories, Marquita, Kristen, and shout out to Amanda, who's not here. Was there anything

Starting point is 00:36:32 that you heard back on the podcast that brought new understanding? I will say that hearing the stories on the podcast was hard, even though I have already heard Kristen's and Amanda's story. Kristen dove into a few more details that I haven't heard as well as Amanda. And although I I already knew these stories. They still made me tear up and it still made me think, how did this happen? Even hearing the other stories from Brittany, the surrogate for Caitlin. What an episode. I could not believe that interview with her.

Starting point is 00:37:13 I couldn't either. And that was really an eye-opener to just the character of these people at this Berth and Center and the facade that they put on for people. This episode actually made me cry, which is really strange because it was about Brittany and her experience as an ex-employee with origins. But when she said, we had a mom in the ICU and I didn't even know it, I knew she was talking about me. And to hear how she spoke about how the center, these people didn't care about neonatal death, about babies dying. And me being in the ICU, I knew they didn't. didn't care. That's been very clear to me from the beginning, but to hear it from someone else,

Starting point is 00:38:01 that she was the executive director of Origins and she didn't know I was in the ICU. It was just heartbreaking to think that my life and my son's life, all of our lives were treated just so callously. It's awful to relive it and to hear it, but also it just gives me so much hope. There's something very unique about hearing our stories on this kind of platform, even hearing my own story, because living through it, being three years postpartum now, in a lot of ways, I feel detached from the person that that happened to. I feel almost like it's a movie in a way. Listening to Marquita's story anytime always has me in ugly sobs. Malique holds a very large part of my heart and I think about him every single day. It reminds me every day of why I get up and I do this, why I'm so invested in mama and learning more and trying to help.

Starting point is 00:39:05 My mission is to help other moms and to prevent this from happening again. This podcast is a dream come true. I'm incredibly grateful because what has been silenced and what has been, pushed behind closed doors is now open into the light and people can make their own choices and they can make their own judgments on what happened and maybe this sparks conversation to make changes. The wide reach of the people that you are going to help, you'll actually never know how broad that is, which is what is so beautiful and wonderful about sharing in this forum. I just wanted to commend you all for sharing your stories because I'm in the medical complex,

Starting point is 00:39:58 if you will, and I'm a highly skilled physician. I'm dedicated my life to this work. And what I found since being on social media, and I'm sure you will understand when I say this, people are very willing to share their experiences with OBGYNs, whether it be either during their pregnancy care or labor and delivery care or post. is part of care when it's not what it should be. They're very generally very open about it. But the same is not necessarily true for those who have chosen to do it out of hospital birth in a different setting. I do think there is a hesitation to talk about when things don't go right in those settings.

Starting point is 00:40:36 And I think for some people, there's a level of guilt about it or they don't want the criticisms saying, well, you should have been birth in a hospital, which I don't think is ever an appropriate thing to say to anybody, no matter what choices they made. So coming forward, and talking about this on such a public forum is very commendable because you guys will give other people a voice and maybe prompted them to share their stories as well. Things can happen in any setting, but it's expected at hospital birth settings that things should be right and they fit in that perfect Instagram square and they have the beautiful pictures and all that and things don't always go right. We just don't see it. And you guys are bringing it to light. So I hope you know that as difficult as it may have been for you to do this,

Starting point is 00:41:19 you are going to change somebody's life and you are going to change somebody's outcome by helping them better make informed choices. Could not agree more. Thank you so much, Dr. Clark. I mean, it brings tears to my eyes just to hear you say that. This started with if we could just help one person, it would be enough. And I think we've done more than that. There seems to be this unequal scale for how we judge hospitals as opposed to.

Starting point is 00:41:49 to how we judge out of hospital settings, there is something very unique about trauma that comes out of hospital birth. Someone probably told you that you shouldn't do that, that you should do what you are quote unquote supposed to do and just go to a hospital and just go see an OBGYN. So when you have this really bad outcome, you blame yourself. And depending on the people that you interacted with, you may have been judged or treated differently during your care because of what you chose previously. And if something really bad happens, there's a lot of blame and a lot of guilt. I know personally. I'm relieved of that blame today.

Starting point is 00:42:33 I don't fault myself for the choices I made with the knowledge that I had then. But now I know better and I can help other people. Our stories are so important if we are going to start making change in this part of the maternal health field. People are silent. And sometimes your providers are a part of your silence. And that is also a problem. And so I think collectively as a whole, survivors,

Starting point is 00:43:01 people who had good outcomes in an out-of-hospital settings, midwives, doctors, doulas, nurses, anybody who has a hand of this needs to really look at these stories and become introspective. and instead of saying, I'm sorry this happened to you, say, what can I do? How can I make sure that this happens to no one else? Because this is absolutely unacceptable. We need to do better. That has been really awesome to see is how medical providers are reacting to our stories. And I think there's a certain amount of validation that is happening in obstetrical wards and maternity wards throughout the state. I know, several hospital systems that are listening. Every medical system in the DFW area is listening to this podcast. Every resident, every postpartum nurse, even anesthesiologists are listening to this podcast. And I think there's some amount of validation there that is happening. I cannot be more

Starting point is 00:44:04 grateful to be able to be a part of this. I've talked about this a lot on my social media platforms. I have readily acknowledged that the obstetrical traumas that can happen in a hospital setting, whether that be pregnancy trauma, birth trauma, postpartum trauma, at the hands of providers is real. I know what's happening. Autonomy being taken away. No explanation about what's being done and why it's recommended. No follow-up. Having a traumatic birth and then going home with questions about what happened because nobody actually

Starting point is 00:44:52 explained what happened? I understand the role that all that plays in patients choosing out of hospital birth. So if there's any obstetrical care provider listening to this, we have to do better because we are as a profession one of the reasons why patients are making this choice and why they may be willing to make a choice for an out of hospital birth before being fully informed because they don't want to go back to that hospital that caused them trauma. Trauma can happen at the fault of no one. But we can also add to it or we can cause it. We should never be adding to or causing trauma.

Starting point is 00:45:27 And we have to acknowledge that that does happen and we need to do a better job as a profession of stopping that. Going to an out-of-hospital birth is not the answer to experiencing in-hospital trauma if we can't ensure that the care is going to be what it should be. And the birth centers have receipts. The people doing the home births have appropriate credentials to manage complications. because it can still happen there. So it starts with us in the hospital setting.

Starting point is 00:45:56 We have to make sure the patient is a part of their care and the decisions being made. Just sitting someone down and explaining, you had this postpartum hemorrhage because of X, Y, and Z, and this happened, and not sending them home where they just don't have answers, that goes a long way. Yes, it takes time, but we have to do it. When I hear about patients choosing an out-of-hospital birth

Starting point is 00:46:18 because of things that happened to them in the hospital, to me, that's not the answer, but I understand why they do it. Knowing that some of these patients go to birth centers like the one talked about on this podcast and that they're not placed in better hands, that's even more alarming to me. And I know it just doesn't happen in Dallas. It happens all across this country. It seems like statistically from what we've gathered that there can also be really positive results of having midwifery care in hospitals.

Starting point is 00:46:45 Do you have any insight there? Yes. since 2000 was one of my first year of residency. I've always worked alongside midwives on a labor and delivery unit. Where I work, it's a little bit of a different model. Maternal fetal medicine specialist staff labor and delivery 24-7. But we also have midwives there to take care of patients, but they're on the floor with us. And if they need us, they let us know. If they don't, they don't, but we're there. It's still a hospital setting, but if something goes wrong, they have what they need. I love that model. I wish we had midwifery care on all labor delivery units. I wish we had

Starting point is 00:47:17 Dula services available on labor and delivery units. So that's another place to focus on, is what can we do on labor and delivery units to get the best of both worlds? Yeah, it seems like to me people a lot of times are trying to avoid intervention, and that's one of the motivators for out-of-hospital births, but those interventions are really essential when things go wrong. Kristen, I see you want to add. Something I often see when people are talking about the benefits of out-of-hospital birth versus hospital birth are that physiological birth cannot be achieved in hospital settings and OBGYNs are not trained in physiological birth. I was just wondering if Dr. Shannon Clark could speak to that a little bit. The first thing is what exactly is physiological birth?

Starting point is 00:48:07 What's the definition? Because there is no one definition. It's pretty much going to be according to whoever's talking about it. If you think about it, maternal physiology is what the body does during the course of birth, the physiological changes in the blood volume, the uterine blood flow, the elevation of the diaphragm, all that still happens in a hospital birth, managing labor and delivery by having a spontaneous vaginal delivery. That's still physiological birth. There are a lot of OBGYN practices who are very hands-off. They do interventions when they need to. It's hit or miss. I'm not going to pretend that it's an option for everyone. I know that it's not. But there is a very common misconception that if you want to have a physiological

Starting point is 00:48:50 birth, you need to be in an out-of-hospital birth setting. And that's simply not true, because we really don't even know what that means. I think interventions should be done when they're indicated. If something is recommended, it should be explained to the patient. The most important thing is a good maternal and fetal neonatal outcome, whatever that looks like. If a cesarean section is needed, that's what it's needed. If potocin augmentation is needed, that's what's needed. I've talked about this on my platform. I actually even made a video in response. to one of the episodes for this season about physiological birth and what that means. I wish we could say physiological birth is X, Y, and Z, but we simply cannot.

Starting point is 00:49:25 So it can look a lot of different ways. And so I don't want anyone who's listening to this podcast think that there is one way to have a physiological birth and that's it, because it's simply not true. I'm so glad that you spoke about this on the podcast because I think it's really important. physiological birth really feels like an enigma in a way or like a carrot that we're dangling in front of pregnant mothers going, you can have physiological birth, but when intervention happens or a birth didn't go as planned and you have to have a C-section for whatever reason, that it almost seems like this unobtainable thing. And there's a certain amount of judgment.

Starting point is 00:50:06 So I think it's really important to note and really make it clear that physiological birth is a lot of things. The definition changes based off of who you are talking to. And I think that mothers, what they should take away from this, is that you should do what is best for you and your baby. If that means that you said you didn't want an epidural, but you're 30 hours into your labor and you're not progressing or whatever, and you just need that epidural. Get the epidural. There are options for you that can make labor and delivery easier for you or still get you to the mode in which you want to birth. And sometimes that doesn't happen, right? Sometimes we don't get what we want. And I think that there's this really big. emphasis right now on satisfaction versus safety. Well, there's so much pressure and guilt put on us as women, right, to get pregnant and then to deliver a certain way, behave a certain way, and then fit into this box. And it's just like, we can't win.

Starting point is 00:51:19 I'm just so glad you highlighted it because having three emergency C-sections myself that I didn't desire to have, I did feel like less of a woman. at that time. I was very young and I just felt like a failure. It's just a lot of pressure we put on ourselves and a lot of pressure that's put on us. And I'm so thankful that we are advocating for people to do what's right for them, what's safest for them and their child because there's a lot that we need to destigmatize here. Dr. Clark, is it common for medical professionals to add their clients on social media and communicate with them that way? No, that should not happen. Keep in mind, how I work, I don't have my own patients.

Starting point is 00:52:02 I have them for the time that they're here, either admitted antipartum or they're delivering in a postpartum. I don't have my own patient schedule. But I've had patients who have reached out to me on social media. And I don't respond because it's inappropriate. I feel like there is this thought or feeling, both on some providers and also on patients, that we are supposed to be friends. I'm not your friend.

Starting point is 00:52:26 can I be friendly to you? Absolutely. Can I be cordial? Can I be respectful? Can I be empathetic? Yes. But being friends and being on that kind of level is not appropriate because you will lose your objectivity in order to take care of that patient. And that cannot happen. And it's an expectation sometimes on the provider's part and on the patient's part. Just remember, you want your doctor or your provider to always be objective and do what standard of care is based on what's indicated. for you and not because they're friendly with you and they know your family or you guys just had lunch or you guys are friends on social media. That's not how it's supposed to be and it shouldn't be that way. I hope that doesn't make me sound like I'm not being a nice person, but there is a line that can be crossed. This is something that really bothers us. My therapist, my OBGYN, my insert medical professional is not in these support groups I'm a part of on Facebook. They are

Starting point is 00:53:26 They're not friends with me on Facebook or they're not direct messaging me on Facebook. What seems to be really common practice here is these professionals being in these groups that consumers use to get advice or even to get recommendations on midwives and they patrol those groups. And when someone tells their story in one of these groups to just warn other moms, other midwives will get on that post and they will make comments about it. Invalidating someone's lived experience, but also it's unethical to sit there and patrol what should be private safe spaces for these moms.

Starting point is 00:54:12 There's just a lot of crossing in ethical patient provider relationships. There's not a whole lot of regulation there. So if your midwife wants to call you and text you and harass you about you posting your story online telling people about it, there's nothing really to stop them from doing that. Dr. Clark, did you want to add to that? I can tell you, I don't belong to any Facebook groups, whether it's for personal reasons or medical reasons. Groups like that can be problematic at baseline. Reddit groups can be problematic at baseline because there's a lot of confirmation bias and quite an echo chamber there. So that has to be taken with a grain of salt.

Starting point is 00:54:49 I've chosen to educate on social media the way I do, and that works for me. But I think it should be a red flag. It's unprofessional, but as Kristen said, it's borderline unethical, and it could definitely be problematic. I'm just so glad we're highlighting much of this. Thank you all so, so much once again for being here. I appreciate everybody's energy and thoughtfulness. We will certainly link to Dr. Shannon Clark's Instagram and her socials that we mentioned. We will link to Marquita's real estate pages, so please go follow and support her. we will have links to petition more information about Mama and Malik's Law, all that good stuff in the episode notes. Thank you all so much for being here. And again, shout out Lily, Amy, everybody on our team who has worked on this season, our audio editor Becca and our social media manager, Lauren.

Starting point is 00:55:44 Nobody does anything great alone, as they say. Thank you. Thank you all. Thank you so much, Tiffany. And thank you so much, Dr. Clark for being here today. Thank you so much, Dr. Clark, for being here and for listening to our stories. Thank you.

Something Was Wrong - S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG

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