Today, Explained - Sit in a circle. Save your baby’s life.

Episode Date: November 13, 2018

South Carolina used to be one of the most dangerous places in America to have a baby. But now, it’s reducing infant mortality with an unconventional approach: having pregnant women talk to each other. Listen and subscribe to The Impact: Apple Podcasts | Google Podcasts | Spotify | Stitcher | Overcast | Pocket Casts | RadioPublic Learn more about your ad choices. Visit podcastchoices.com/adchoices

Not unlike the Wu-Tang Clan, KiwiCo is for the children. They make super cool hands-on projects for kids of all ages that make learning about science, technology, engineering, art, and math a lot more fun. Give the gift of creative confidence this holiday by going to KiwiCo. They're offering today Explained listeners a chance to try KiwiCo for free. KiwiCo.com slash explained. K-I-W-I-C-O dot com slash explained. Sarah Cliff, you're the host of the Impact podcast. You're also Vox's premier health care reporter. What is the second season of the Impact all about?

The second season is about America's most interesting policy experiments. So I've been a policy reporter for about a decade. And I think the biggest thing I've learned is Washington is actually super boring for policy. Congress does not pass things. But then you have all these states and cities that are doing like wacky, cool, interesting stuff and it doesn't get nearly enough attention. So we're giving it some attention. Let's give it some attention on Today Explained. Let's share an episode of the impact with the people. What policy should we focus on? What issue should we look at? There is a huge problem in the United States with infant mortality. How bad is it? There's this study that came out about a year ago that, like, I just can't get out of my

mind. It found that babies born in the United States are 76% more likely to die than babies born in other rich countries. Why is the United States underperforming so badly? So it seems to have a lot to do with babies being born too early, being born premature. That's actually, in some of the research research that is the leading cause of infant death is the fact that babies aren't spending enough time in utero. That means when they're born, their lungs aren't big enough. They can have trouble breathing.

Their hearts might not be fully formed. They just have less time to develop. When you look at what's different about the United States, you see that we have way more babies just being born way too early. Our premature birth rates, they look pretty similar to sub-Saharan Africa. So you set out to find a solution for this? Yes, we set out to find people who are trying to solve this problem. And we found this doctor named Amy Crockett who found this really unusual tool, this thing I did not think would work when I went into this reporting project, that's actually showing really, really promising results in convincing babies to stay inside the mom just a little bit longer.

So we went down to South Carolina to check it out. Take us there. I went to Amy's clinic on a Wednesday afternoon to see the tool in action. It sounds a little bit like this. And a lot like this. Megan, you cut your hair. And it looks like a very, very pink room with a circle of white chairs. When I get there, there are already two women, and they're chatting. They are super pregnant, eight months in, with these huge round bellies.

They're at the clinic for their 34-week checkup. These women are actually scheduled to see the exact same nurse at the exact same time with a dozen other pregnant women. A few have even brought along kids and husbands. But this is not a scheduling error. This is Amy's big experiment. A program called Centering Pregnancy. Before the visit starts, the women are catching up. And then... She's here.

She is Tiana, another patient. She strikes this really dramatic pose when she walks in through the door. Tiana makes a beeline for the nurse, who hands her a blood pressure cuff. I'm checking my heart rate and pulse. The nurse takes her weight, does a quick checkup, measures the baby's heartbeat. Then Tiana grabs a few snacks and comes over to the circle of chairs. We ask her some questions. It turns out pregnancy is not a new thing for her. Tiana already has two daughters. So why come to this class?

I wanted to try something new, something different and see how it was. And then I fell in love with it. So I kept coming. At this point, Tiana unwrapped some of her peanut butter crackers. You'll hear those kind of noises a lot in this episode. Pregnant women really need to snack. I thought it was going to be boring and a waste of time. What happened that was like, this is actually worthwhile? When we come here, we have fun, We trip, joke around, talk about everything. Everything.

To start the conversation, a nurse named Shannon has scattered these cards with adjectives all across the floor. So I'm going to ask you a question or say a statement, and then I want you to pick up one of the feelings on the floor. Okay. So, when I think about caring for my new baby, I feel... The women start bending over and picking up cards. Some of them need a bit of help. Remember, they are eight months pregnant. So, Tiana, you go first.

When you think about caring for your new baby, how do you feel? Tired. Tired. Anxious. My first one, I was anxious. I feel loving. But anxious is a good one. I didn't even say that word.

Okay. That's Jennifer. And I really appreciated what she said because there's often this expectation that you're just supposed to be happy and delighted about your new baby. But Jennifer is a first-time mom, and she knows the dad isn't going to be involved. I'm the girl in the class that doesn't have a baby daddy. God gave me my baby. In Amy's clinic, Jennifer gets to talk to other moms

and see that it is okay to be exhausted by her baby or even a bit scared. She doesn't have to feel perfect and loving all the time. All right, next one. When I think about being in labor, I feel not loving. There's lots of built-in time for moms to ask questions and clarify issues. I had this pain. There were some pretty useful tips about where to buy cheap baby bathtubs or where to put a pillow to help with pain.

It was like $11. But there were also so many tangents. Like this one really long conversation about astrology. Not prenatal care or blood pressure or nutrition. Astrology! I came away from this group with two pretty strong emotions. I only believe they exist because minds have always been true about me. So that's the only reason why. I came away from this group with two pretty strong emotions. One was honestly jealousy. I was 28 weeks pregnant during this reporting trip,

and I really wished I had a group like this where I could talk about all these issues. It would have made pregnancy so much less stressful. So I was personally jealous, but I was also professionally skeptical. Talking to other pregnant women sounded nice, but remember this group was supposed to be a healthcare intervention. How were conversations about astrology going to stop babies from arriving early? It turns out I am not the only person who has had these doubts. I just thought, like, that's some craziness.

That is Amy Crockett, the doctor you heard from earlier. She is the reason that centering pregnancy exists in South Carolina. But when she first heard about these group visits back in graduate school... The idea that having women sit together in a circle for their medical visits would somehow improve their birth outcomes, like, I just didn't understand

how that could possibly be a thing. We are going to take a quick break, but when we come back, how Amy Crockett went from a complete centering skeptic to one of its biggest champions. And the research that convinced her that women sitting around talking was a tool that could save lives. KiwiCo wants to make learning fun for you, and they want to do it so badly that they're willing to let you try out their projects for free.

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KiwiCo's projects teach you how to apply the principles of science and math to engineer solutions and make awesome stuff that you'll enjoy using every day. Check out KiwiCo and all of their learning projects at kiwico.com slash explained. Welcome back to The Impact. In the first half of our show, we learned about centering pregnancy, a tool that South Carolina hopes will bring down its infant mortality rate. Amy Crockett is centering's biggest evangelist, but she did not start out that way. Amy's training was pretty focused on more cutting-edge technology. But one day, back when Amy was in graduate school, a midwife spoke to her class. The midwife talked about these women sitting in circles, having conversations, and she said they were seeing fewer early births.

I was really skeptical. I kind of tucked it away after I heard about it. Fast forward a couple of years. Amy moves to South Carolina. She sees that her clinic has lots of premature births. The fancy machines that she loves can't fix this problem. So she focuses on a problem she can fix. It's a really high volume practice. So when you walk through the waiting room at about two o'clock in the afternoon, it's

just, you know, like misery as far as you can see. Nobody likes waiting, you know, when the office is running behind. Amy thinks, you know, those conversational visits that I learned about back in grad school, they would really clean out my waiting room. Women wouldn't have to wait as long if they just did their visits together. So she gets a grant to start doing that. But grants involve research. So Amy works with one of her medical students. They design a study, talk through the research process.

Here's how you fill out your spreadsheet. I mean, it was a lot of just really the basic building blocks. The medical student fills out the spreadsheets and does her science very carefully. Then she comes back to Amy a few months later with her report. And she starts flipping through the pages and I was like, wait a minute, wait a minute, look at these rates. At the time, more than 12% of South Carolina babies were being born too early. But Amy's results? They showed that only 8% of her study patients had the same problem. You know, looking at 8%, I was like, that is a big deal.

It's a big deal for two reasons. First, it showed a noticeable difference from the state average. It really looked like Amy's patients were faring better than other pregnant women. Second, South Carolina had a really big racial disparity in preterm births. It really looked like Amy's patients were faring better than other pregnant women. Second, South Carolina had a really big racial disparity in preterm births, and that also disappeared in the centering patients. Black women in Amy's program had preterm birth rates identical to white women. Amy made it clear to her young researcher this might be a small sample size,

but this was really promising. And she was like, oh my gosh, that's so cool. And that was where I was like, I know it's really cool. Like we gotta, we're going to have to redo this. Amy did redo the work with even more women and she got the same result, a big drop in early births. And for me, the cool thing about it is that, you know, it's potentially like a primary prevention for preterm birth. This is really exciting because doctors right now, they don't feel like they have a reliable tool to keep babies from coming early. But I was still confused. Like, OK, what is it about these conversations about postpartum depression and horoscopes that actually reduces early births? What's going on with centering?

So I don't, yeah, so I don't think we know what exactly is causing it. There are a couple different theories that I have based on the changes that we see for women. To be exact, Amy has three theories. Theory one, pregnant women have important questions and in normal visits, they don't get to ask them. They spend all this time waiting and worrying about the baby, if it's okay. And so by the time I get in there and I'm like, hey, everything looks great. They're just like, thank God, get me out of of here and they forget to ask the stuff they need and they're so fast yeah well you're not sick so there's nothing to talk about and so when the goal

of the visit is to make sure you're not sick that takes a very short period of time but when you change it to the goal of the visit being to prepare pregnant women to become mothers it's a totally different game plan, right? My best friend was showing me a video. I don't know if y'all have seen it. I saw this in Amy's centering program. Tiana starts talking about a video that she saw on Facebook. On Facebook, his mom was sitting on the floor.

Her oldest child had the newborn baby on the floor, and she was telling the child to kick the baby. Everyone has an opinion. And if he was in his right mind, he should get more time than the person who's crazy. But one of the pregnant women, Megan, also has a question. Can somebody come get help for you? Yes. That's Shannon, the nurse.

If you're having any of these feelings, call me. Call here and tell them you need to talk to me. In a five-minute doctor's visit, you are probably not going to bring up a video that you saw on Facebook. But actually taking the time to talk through the video, that gave Shannon a chance to make it really, really clear to her patients that she wants to hear from them if they're feeling badly. She was able to share important advice that could help her patients become better moms.

We'll be more than happy to talk to you. So this is theory one on what makes these visits effective. Pregnant women get answers to questions. Any other questions? Then there is theory two. Patients who attend centering visits develop a connection to the clinic. Instead of saying, oh, maybe this is nothing, I don't want to bother somebody with this, that you feel more like, you know, Lynn told me to call if something happened.

She'd want to hear from me. I better go in and see about this. The idea here is that patients are more likely to call the clinic if they're having a problem, and that could also lead to healthier deliveries. Then there is Theory 3, which is Amy's leading theory, the thing she thinks is really driving the decline in preterm births. The way she sees it, these visits create a social support network that reduces stress. I think reducing psychosocial stress may help mute some of the pathways that lead to preterm birth.

Amy's research shows that high-stress pregnant women who go through this program become lower-stress pregnant women. A less stressed-out body might be a place where a tiny, growing human wants to hang out a little bit longer. You can see this pretty clearly with Tiana, who we ended up calling after the visit. Hi, it's Cortese. I'm on the phone. We learn that she has a lot of instability and stress in her life. Hey, can y'all be quiet a little bit? She moves around a lot. When we called her a week before her due date, she was staying with somebody that she knew.

It's a relative. Well, we consider each other relatives. Tiana was expecting her baby to show up at any moment. That was already a lot to handle. But she also wasn't sure if the father was going to be involved. I mean, he say he will, but he say he will. But I mean, you never know what somebody will do. The centering group made the experience of having a new baby less daunting and less stressful. It's just being able to talk to people that actually would listen and not cut you off or not make assumptions or not judge you. People that were going through some of the same things that I was. So yeah, Tiana is probably learning things about taking care of babies,

but she already knows a lot of that. This is her third kid. What she's really getting out of this class is a chance to laugh and to cry and complain with a bunch of other pregnant women. I feel like the people makes the center, and it's not, the center don't make the people. Hanging out with other pregnant women

probably won't eliminate all stress for Tiana or for anybody. But it might dial down stress enough. Enough to help moms deliver healthier babies. If that's true, it means these two-hour meetings are a pretty powerful drug. Because of Amy's work, South Carolina is now the only place in the country where thousands of low-income women receive care like this. Medicaid now pays lots of clinics to do their visits this way.

It all sounds great. But there's a catch. Take Jennifer, for example. Do you have insurance? I have Medicaid. Will you have it after the pregnancy? Um, I will have it for a little bit, but I'm not sure how that works. Here's how it works. Under the Affordable Care Act,

all states had the option to give Medicaid to more low-income people. South Carolina chose not to do that, which means about 92,000 people who might qualify for health insurance don't. They're making just a bit too much money. Jennifer is paid to look after her grandmother, so she's at risk of falling into that category. She's on Medicaid now because the state gives low-income women coverage when they're pregnant. But a lot of women lose coverage a few months after giving birth. Are you scared about losing it?

Yeah, a little bit. A little bit. What do you think you'll do for health care? Um, I don't know. Yeah, a little bit. A little bit. Um, I don't know. So, great as centering is, it is not the simplest thing that South Carolina could be doing to help babies. There is a new report that shows a correlation between Medicaid expansion and a decline in the infant mortality rate. States that expanded Medicaid reported a larger decline in infant mortality rate than states that did not. Why did infant deaths fall faster in states that expanded Medicaid? Researchers think it has to do with women staying healthy before and after getting pregnant. Medicaid expansion seems like a kind of obvious fix.

So why hasn't South Carolina done it? I asked Brian Amick, a top state Medicaid official. And why not expand Medicaid? I think South Carolina has largely been consistent with sort of the rest of the Southeast, or with much of the Southeast in or with much of the Southeast, in terms of sort of political position, et cetera. And, you know, those decisions happen above my pay grade, and it's my job to sort of implement the MediPay program that we have today,

and so really that's where we focus. I did not get much of an answer from Brian Amick. It's been a couple of months since I was in South Carolina. And when I think about centering, I usually smile. I think about that room full of very pregnant women talking and laughing and snacking together. I think about the nurse guiding them through the final exercise. Ready? All the women stood up and faced a sign on the wall. I am a strong woman.

I am a good mother. My baby and I make a great team. I am a strong woman. I am a good mother. My baby and I make a great team. I am a strong woman. I am a good mother. My baby and I make a great team. I am a strong woman. Megan had a baby boy, Augustus. Tiana had a boy named Marcin Rahim. Jennifer had a girl, Charlotte, nicknamed Charlie, and still has her Medicaid coverage. I am a strong woman.

None of these babies came early. This program, this fellowship, maybe it helped with that. Maybe it helped them feel better prepared, or maybe it just helped them relax at a really stressful time. Amy's work suggests that centering is a tool that could be just as effective as fancy drugs or beeping machines. Social support might be just what the doctor ordered. But there are other tools in South Carolina's toolbox. Tools like expanding Medicaid.

If the state is serious about keeping babies alive, it should also be looking at those tools. Sarah Cliff hosts The Impact from Vox. Jillian Weinberger, Bird Pinkerton, Amy Drozdowska, and Jared Paul help her. The Impact's second season is in full swing right now, so open up your podcast apps and type in the impact and subscribe. You're going to hear several more episodes in which Sarah and her team travel the country and take a look at how cities and states are using policy to solve some of the biggest problems in the United States. I'm Sean Ramos firm. This is Today Explained. Before we go today, one last shout out to the people at KiwiCo. KiwiCo wants to help Thank you. math way more fun check out kiwico's gear at kiwico.com slash explained there's a free trial

and also just one more shout out to the shadows podcast the shadows is a new fictional podcast series that like satisfies your your voyeuristic inclinations you get to basically be a fly on the wall of a stranger's relationship you get to listen as two people fall in love, as they fight, as they make up and break down all over again. Why wouldn't you want to listen to that? The Shadows comes from award-winning audio artist Caitlin Prest, creator of the acclaimed series The Heart. The entire six-episode series is out now

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