- Hi.

I'm Kylie Ambu, and welcome to "Mutually Inclusive."

Today's topic is difficult, but important to talk about.

Maternal deaths in the US have more than doubled over the past two decades, and Black mothers are dying at the highest rate.

While these statistics may seem shocking, they're not exactly new.

And the communities behind them have been making serious strides over the past few years to create better care, support, and overall outcomes for Black birthers.

Today, we'll take a look at some of the history and highlight organizations in our own backyard working to make change.

(upbeat jazz music) For generations, race-based medicine has altered the way patients get treatment.

I mean, take Dr. James Marion Sims, known as the father of modern gynecology.

In developing his surgical techniques, Sims experimented on enslaved Black women without anesthesia.

Popular rumor at the time, being Black women didn't feel pain as intensely as white women.

While there has been progress, the National Institute of Health shows Black women are still systematically undertreated for pain, and when it comes to childbirth, are three times more likely to die from pregnancy-related causes than white women.

The CDC cites quality healthcare, underlying conditions, structural racism, and implicit bias as factors.

So, what do we do?

A collective of local birth workers say representation and understanding could make the difference.

- Day One Doula Collective is a community-based doula program located right here at in Grand Rapids, where we recruit and train women of color who have a desire to become a community-based doula, and then in turn, those folks are out in community serving families.

- I always wanted to be an OB/GYN, so I thought I wanted to deliver babies, but then I became pregnant and I got to see that it was not as hands-on as I would like to be.

You know, the quick 15 minute visits.

And I didn't know that I actually wanted to be a doula.

And I remember Kiara when she launched her Bump to Birth doula services and I know she had the city buzzing.

- So when we think about equity and specifically health equity, we know that these particular communities, you know, are having really difficulty in accessing doula, just training.

So for us, we wanted to remove that barrier and provide the training completely at no cost.

We also provide stipends to our participants because we know that most of our folks are already operating in caregiving roles.

So to ask them to then step outside of that and then come take care of your community is a lot to ask of our folks.

In relation to the maternal mortality and morbidity rates locally, women are still three to four times more likely to die in comparison to their white counterparts.

For Black women in particular, our babies are often born too small, too soon, and we often don't have the resources necessary to be able to have safe spaces where we can talk about the things that we're experiencing in these clinical settings or just out in community.

- I was pretty young.

I was 21 when I first had a child and I didn't really know too much about the experience or the birthing process, so my first experience was horrible.

I got this not so nice nurse.

She didn't listen to me when I told her I was in pain.

She kind of just like ignored me.

And then it was like I didn't have any like time to like make any other decisions because they got me there and it was kind of like they were gonna do whatever they wanted to do.

So, my son's heart rate ended up dropping twice.

The room just got really, really quiet 'cause I told my doctor from day one, like, I really don't wanna have a C-section, but if it comes down to the point of where it's life or death, I'm gonna have to have a C-section.

I had no idea about the laws, my rights, and I was a little bit confused.

So I felt like next time around, if I did decide to have a baby, I would need more support in and out of the laboring room.

- We really create this experience where they have this menu of options and they get to pick and choose what they would like.

And a lot of that conversation is surrounding, you know, what type of care provider would you like?

Do you have any care providers that you have had an experience with that you think would be a good fit for you during this time?

Do you feel comfortable in saying no, this isn't a good fit?

- Day One Doula Collective was actually brought to me by one of my caseworkers that I had as a support system through the WIC office.

She thought it would be in my best interest to have that extra support.

- It's extremely important simply because a lot of women don't know that they have the right to say no.

There's that pressure because a lot of women are either there alone or they don't have supports.

This might sound a little cocky, but I actually like when I walk into a hospital and then they sit up straight, you know?

So because they know that we know.

We know what can be done.

- We hit it off right away.

Immediately when I met her, I was just like, her vibe is just different.

Like, I could just tell.

So I hugged her like immediately as soon as I met her.

Like, I didn't even know her.

Like, this was our first time seeing each other and I gave her the biggest hug 'cause I'm like, you're here to help me, this, that, and the third.

- You know, you can become nervous sometimes.

You know, are they gonna like me?

Are we gonna click?

And it was so natural and I appreciated that so much.

I don't know if we were like on the same brainwave or something, but she just knew, like the stuff that I would ask for, she knew without me even telling her.

Like I remember my lips got really, really chapped and I was like, man, I forgot my chapstick.

She had chapstick.

And then I started itching.

She had lotion.

She had everything.

I initially wanted a vaginal birth the first time around.

The second time around, I got a vaginal birth.

The last time I kind of like felt like I was kind of forced into things.

This time, it was kind of like I got to be the ringleader of my experience.

- It's just amazing to be able to witness her in that element and actually have her fulfill what she wanted to fulfill.

So it's a proud moment.

You know, it was all amazing.

- I always like to joke that our families never fall off.

So we really are walking alongside them throughout their entire journey.

We've gone to kindergarten graduations, we've gone to baby showers, we've gone to high school graduations.

- Still to this day, I can call her and ask her questions.

She helps me a lot when it comes to breastfeeding.

She comes and check on this little guy quite a bit to make sure that he's doing good developmentally.

So it's been a great experience.

- We know that with Black and Brown community members, having them go into a clinical space isn't always safe.

So we wanna make sure that they, again, have access to support services that are needed for them.

I really hope in the next five years that we have some of those safety net services in place for our families and communities.

- I wouldn't mind building a doula legacy and just keeping it going and continuing to inspire other Black women or women of color as a whole.

Opportunities have been amazing.

I've literally met amazing women and I feel like I'm becoming a better woman just being around women who are doing the work.

- There is no such thing as having too much support.

So if you feel like you're overdoing it, don't.

Take in the knowledge, the education, and just decide what benefits you personally.

You don't have to follow everybody's rules.

You get to set the tone for how you want your experience to be.

(inspiring piano music) - Doulas of color are spreading in West Michigan, such as How YOU Birth Doula Initiative in Muskegon and Rooted Birth Justice in Kalamazoo.

But big news happened this year when the state of Michigan approved doula services to be covered by Medicaid insurance, expanding access to care.

"Mutually Inclusive's" Jennifer Moss caught up with Vanessa Greene from Grand Rapids African American Health Institute, also known as GRAAHI, to talk about the impacts.

- Vanessa Greene, CEO of GRAAHI.

We wanna welcome you to "Mutually Inclusive" today and we really do appreciate you taking time to be here with us.

- Well, thank you for inviting me, and I'm so happy to be here.

- So, you know, before we talk more about doulas and the growing representation in the African-American community, we're gonna take a little bit of a deeper dive into maternal mortality overall among persons of color, specifically African American women to start.

And we've got some devastating and kind of astounding statistics and they have been cured and curated by GRAAHI.

So I just want to list a couple of things.

Pregnancy related deaths among Black women, three to four times higher than among white women, regardless of income or educational levels.

In Michigan, maternal mortality, the rate there doubled from 2018 to 2019.

That's a rate of 23.3 pregnancy-related maternal deaths per 100,000 live births.

And here's the thing, according to the Michigan Maternal Mortality Surveillance Program, more than 63% of that increase were preventable.

- [Vanessa] Correct.

- And then one more.

There's a 2021 report published by the University of California Los Angeles.

The United States is the most, says the United States is the most dangerous country in the developed world for pregnant Black women.

These are astounding numbers, astounding statistics, and quite actually devastating and depressing statistics, to be honest.

So GRAAHI is known for looking deeper, taking a look.

You do your own studies, you have information, and you even offer hope to persons of color and to the community at large.

Let's just say that as well.

What have you discovered recently, 'cause you're doing current studies as well, behind some of these numbers?

What is the reason why?

A lot of people want to know because there's no income or educational separation.

What would we look at as to the numbers behind maternal mortality in the African American community?

- Yeah.

Well, I really applaud you for having this conversation because it is critically important in the African American community and any community because the fact is that maternal health and maternal mortality race is significantly affecting women of all races.

The challenges is that it's impacting African American women at even a higher rate than other racial ethnic groups.

And so there's not one, there's not one factor, but it's really multidimensional and multifaceted.

And one of the things that we hear constantly, because we're in the committee, we're talking to pregnant women all the time, and most of them say, they talk about their discomfort and how they're treated when they go into healthcare, and particularly, they feel rushed through.

So there's not a holistic evaluation of what their experiences are.

And for people who know the African American community, we laugh when we feel like crying, right?

And so we carry stress in a whole different way.

And so if we're not, if our medical care providers are not looking at us holistically in terms of our lived experiences and the trauma that we experience on a daily basis when we are in pregnancy and carrying, you know, babies in our womb, they're also carrying, you know, the stressors that we are, you know, dealing within our lives.

And when that's not part of the care process, then it can significantly impact the outcome of women.

For example, when you think about aneurysms and a woman going to the doctors, I've been having severe headaches, you know, for weeks and it's not thoroughly examined.

And then you go into, you know, situations where you have an aneurysm during pregnancy, and then we're losing women.

So it's just a number of factors, being listened to, being understood, probing when we go into the visits and so forth to find out, you know, what kind of symptoms that we may be having that we may not even realize it's important to share.

So there's just a number of factors that's affecting these disparities and these outcomes.

- And where do you think, or what do you think the reason perhaps is behind those factors?

Is it a systemic look or retrospective of racial disparities?

I mean, systemic racism?

I mean, is is it ingrained in society to look and, eh, maybe they don't need?

I mean, what is it?

Because a lot of people have their different stories.

I mean, these things, these stories aren't made up.

Things happen.

- [Vanessa] Correct.

- And there's no slight to the medical profession because we have wonderful doctors everywhere.

- And I want to start with that because this is not an indictment against doctors.

I mean, we know that they enter the professions because they care about the particular discipline that they are serving in.

So definitely no attack against them, but it's really important to understand that these dynamics exist and that the experiences are real and women are dying, obviously, at significant rates compared to other women.

But I think that part of it is that when you think of systemic like racism and the way we're socialized, we typically are more comfortable with people who look like us, with people who have a shared culture, a shared background and experience.

And so, for example, if a white woman going into a doctor's office and the physician is white, they have like a mutual like experience in some way that allows them to interact and engage differently.

And so if there aren't like African Americans, significant African Americans in the healthcare profession, OB and so forth, then Black women don't have that same comfort level when they go in and are meeting with their physicians.

And so therefore, there's a lot of information, a lot of experiences that they're having that they may not comfortably share just organically and automatically because they have that shared, you know, cultural context.

- And also, in your studies, have you found that there is, has been proven out perhaps maybe a distrust?

I mean, you've had your own situation.

I mean, so it doesn't come from the wayside.

I mean, you know personally some things that have occurred.

Kind of share your story about that because there, in some cases, and again, we wanna make sure that we understand that it's not all cases.

And we have wonderful people in the medical profession, no doubt.

But the numbers still speak volumes.

The statistics, the studies that have been done.

And so you yourself have had a situation during your first pregnancy.

Give us an example of what happened there.

- And to your question, also, distrust is one of the first things that come up when we are having conversations with Black women about their experience with healthcare.

And we are working really hard to build.

And I think that that's one of the ways that doulas can help as well, is help to build trust between the patient as well as the care provider.

And so I did have an experience my first pregnancy.

I was in my mid-20s and my husband had gotten a promotion and gotten transferred.

We were living on the East Side of Michigan and he got transferred to Grand Rapids.

And so I was going to my doctor visits, you know, alone.

And I had developed a really bad flu and a fever that had lasted for over a week.

And so there were concerns, you know, being in my trimester.

And so there was pressure from my husband, pressure from my family to go and get it checked out.

And so I called my doctor's office, made an appointment, and when I got there, he totally humiliated me and said, you know, this is a waste of my time.

Why are you here?

A lot of women get the flu during pregnancy and so there was no need for you to come in.

And he just walked out.

So he didn't evaluate me, didn't examine me, didn't try to learn anything more about, you know, what symptoms I was experiencing.

- [Jennifer] Just walked out.

- He just walked out.

And at 26, I didn't know how to advocate for myself.

And so I just left feeling like even more stressed.

I was stressed that I had the flu and a fever and then also now I'm stressed because, you know, I'm totally humiliated.

And so I just decided that I don't trust the system.

You know, if this is the way that, you know, physician's gonna treat me, then I just won't go back.

- [Jennifer] So what did you do?

- I was still working on the East Side and waited until my eighth month when I moved to Grand Rapids and then I got a new physician and he was fantastic.

So to your point, not all experiences are negative experiences, but when you have those kinds of horrible experiences, then it does prevent you from trusting any other physician.

- But you're pregnant and you're in your third trime- You went months without care.

- [Vanessa] Right.

- [Jennifer] Which is a danger in and of itself.

- It's a danger, absolutely.

Prenatal care is like so incredibly important.

And because of the humiliation, I denied myself to have that ongoing care and which in turn I could've put myself, you know, in a significant at-risk situation.

And fortunately, everything turned out well and, you know, my daughter is now an adult and so.

But yeah, but it did create significant distrust in me.

And so the new physician when I came here had actually served numerous of my family members.

And so, you know, they all had a great experience.

And I did have trust going into that situation, yes.

- Absolutely.

And it's not just local people that do that.

I mean, we have celebrities who have caused.

You have a story there as well, Serena Williams.

- [Vanessa] Right.

- [Jennifer] I mean, it's been brought public.

It's publicized.

- Well, her story was that she had a history of blood clots and she was having like symptoms and she knew her body, she knew her story and she tried to tell the nurses and the doctor that something was going wrong and she wanted to, you know, be tested and so forth.

And they pretty much ignored her and said she's just reacting to the medication that they had given her.

And because, you know, she knew how to advocate for herself, she pushed and advocated and they had to, then they were forced to examine her and realized that she was having blood clots that really could've led to, you know, significant, you know, fatal experience.

And she did have a near-death experience.

But because she advocated for herself and they finally listened, then yes, she did end up having a safe pregnancy.

But she ended up being in the hospital like six weeks, you know, after her baby.

And, you know, and how hard that is for any new parent when, you know, if she'd been listened to and treated and responded to sooner, then that experience could've been significantly different.

- And so, again, we go back to trust and gaining that trust and getting that trust.

And this is where, in Kylie's story, we looked at doulas playing a significant role in the birthing of African American babies lately.

There's a growing desire from some.

- Absolutely.

- And the start of the year, Governor Gretchen Whitmer indicated that, and they, it moved through the state legislature that we can now, that Medicaid can now pay for doula services.

Your opinion on that.

Is that a good thing so that that can help other people?

How do you feel about that?

- [Vanessa] I mean, we celebrated.

- [Jennifer] Did you?

- Absolutely.

We thought that that was a really, really great thing.

It's so important.

I mean, when you look at the numbers and, you know, just the deaths per year and there's evidence that doulas significantly impact the experience of, you know, pregnant women and provide the kind of like resources and support, you know, throughout the pregnancy emotionally, like physically and just being able to provide them with the advocacy that they may not.

Because when you're pregnant, I'm telling you, like when you're pregnant, it is quite the experience.

And sometimes as you're going through, you really don't know what the resources are, you don't know what the needs are.

And just to have someone walk alongside you who is well-knowledged about, you know, the resources and how to navigate and so forth.

And it's incredibly helpful.

I mean, our men, the husbands are great.

- Right, right.

- But, you know, just having a doula, you know, with that kind of experience to walk alongside you.

I know I wish I'd had a doula to support me during my, you know, especially during the first pregnancy.

- [Jennifer] Especially the first pregnancy.

- You learn a lot from the first pregnancy.

- Yes, you do.

We all do, yes.

- But definitely doing that the first pregnancy.

I'm a huge advocate.

I love what we do and we work with a lot of doulas and the heart and the passion that they operate under is incredible.

It's just an incredible resource for women.

And when you look at the disparities and you have like an opportunity to like provide this type of support and then for, you know, the governor to, you know, approve Medicaid reimbursement, it's a big move for the communities and we're just looking forward to like how it can impact, you know, these outcomes.

- And on a final note, impacting outcomes.

That's key.

And that is, again, what GRAAHI intends to do through supporting things such as the Doula Initiative as well as you have a current study.

We can't touch a lot upon that, but you do have new studies coming out.

- We do have new studies.

- That will give information to hopefully creating better health circumstances for people in our community.

- Absolutely.

Yes, yes.

So we're constantly doing research, having focus groups, learning about the experiences, and then using that information to improve our services and the ways that doulas can continue to enhance, you know, their support of women, pregnant women.

So really excited.

- Absolutely.

And we look forward to that report.

Vanessa Greene, CEO of GRAAHI.

Thank you so much for joining us today.

We greatly appreciate your time.

- Thank you.

I appreciate you doing this story.

It's incredibly important.

(upbeat R&B music) - Well that was quite the interview with lots of information.

Jen, thanks so much for bringing in Vanessa Greene from GRAAHI.

She just shared so much I think personal experience, but also really important facts.

- It's very important, and that's exactly what GRAAHI does.

They glean and pull all those facts together.

And not only that, though, she used her personal experience to kind of enhance the points of what we're making about, you know, the information about maternal mortality, how important and devastating it can be in the African American community and of course other communities as well, and then strides and steps of the information they're gleaning and pulling together to maybe, you know, A, make an awareness, B, put it out there so people can understand what's happening right in their own community, not only someone famous, but people right here in West Michigan, which is important, as well as the information you brought along about doulas and what they're doing and all of that information kind of comes together to try to become a resource for everyone.

- Absolutely.

And I think in talking with everyone, there's a beautiful sense of unity, but there's definitely a sense of concern because we have Tiani who we talked to in our package about doulas who had an unfortunate, you know, first experience with her first born.

And then you go to Vanessa, somebody who has like medical background and works with GRAAHI and you'd think, oh, she must be, you know, a pro.

She must know everything to say.

And she didn't on the first go around 'cause she was just a woman trying to give birth and who had some really unfortunate experiences.

- And it was important for her to learn to advocate as well.

And that's important and key.

We can pass that information along as well.

- [Kylie] Yeah, absolutely.

And we definitely have lots of information coming at you today.

We know that can be a lot to take in.

- [Jennifer] It sure can.

And on the screen are a few resources, though, that may help you as you continue your own journey.

- [Kylie] And we will have a recap of all of this information on our website as well at wgvu.org/mutually-inclusive.

- [Jennifer] But don't forget to also follow us on our social media pages to stay up to date on all our future topics.

- Absolutely.

Thank you for the reminder, Jen, and thank you for helping us be mutually inclusive.

We'll see you next time.

(upbeat R&B music)