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So far this season, we've been talking to moms
who advocate for individuals with disabilities
and behavioral health challenges. We've also
covered the unique sexual and reproductive health
needs for women over 40. Now we're taking a deeper
dive into a crucial issue related to women's
health equity, maternal and infant health equity.
As you know, I love going on these intellectual
and experiential journeys with you. But before
we get into today's topic, I want to set the
stage with some key terms that are essential
to understanding maternal health challenges.
These terms might not at all come up during today's
episode, but they will help provide context for
what's at stake when we talk about maternal and
infant health. Let's start with the pregnancy
-related mortality ratio, abbreviated PRMR. This
ratio estimates the number of pregnancy -related
deaths per 100 ,000 live births. Essentially,
for every 100 ,000 babies born, this ratio tells
us how many mothers lose their lives during or
shortly after childbirth. It's a painful statistic
that shows how dangerous pregnancy can be for
some women. Another term that may come up is
pregnancy -related deaths, which tracks deaths
within a year of pregnancy. Yes, that means we
start counting as soon as the pregnancy begins,
not just after the baby is born. The maternal
mortality rate is also key. You've likely heard
this term in the news, and we touched on it in
Season 2, Series 2, titled, I Called Out, But
They Didn't Hear Me, where we explored the harrowing
experiences of Dr. Marianne Faroe. She was not
just a patient. but a lead physician in the very
hospital where she gave birth. And even her colleagues
ignored her cries for help during her traumatic
delivery. Despite her medical expertise and knowledge
of her own body, it wasn't until she escalated
her calls for help to higher level administrators
and physicians that anyone intervened. Her story
is a powerful reminder of how crucial it is to
listen to Black women when they advocate for
themselves. Next is infant mortality, which represents
the number of babies who die before their first
birthday compared to every 1 ,000 live births.
This statistic explains why many parents go all
out for that first birthday. It's not just a
milestone. It's a survival story. Some parents
may seem over the top in their celebrations,
but the truth is that this is a big deal, especially
when you consider how fragile life can be in
that first year. We also need to talk about fetal
deaths or stillbirths, which refer to pregnancy
loss after 20 weeks. This is one of the most
heartbreaking topics, and it's something many
parents never talk about, even though it's more
common than people think. It's important to know
that in many cases, doctors and scientists don't
have clear answers as to why stillbirths happen.
That's why organizations like the March of Dimes
put so much effort into research to find answers
and hopefully prevent these tragedies. But even
with all the science in the world, sometimes
there's just nothing a mother or parent can do
to prevent it. Now. Let's dig into the disparities
in maternal and infant health, particularly for
Black women. A 2023 Kaiser Family Foundation
report found that Black women are over three
times more likely to die from pregnancy -related
causes compared to white women. This statistic
is beyond alarming and points to a serious issue
in the healthcare system. One of the primary
causes of these deaths is cardiovascular disease,
and the lack of adequate prenatal and postnatal
care only exasperates the problem. In fact, Black
women are almost twice as likely as white women
to have late or no prenatal care at all. Beyond
maternal deaths, we see a stark difference in
infant health outcomes. Black infants are over
twice as likely to die before their first birthday.
compared to white infants. The leading causes
of infant mortality include birth defects, preterm
birth, low birth weight, and complications during
pregnancy. But what's behind these disparities?
One explanation is the weathering hypothesis,
which suggests that the cumulative effects of
racism and stress take a toll on Black women's
health over time. The constant exposure to these
stressors wears down their bodies, leading to
poorer health outcomes. Connected to the weathering
hypothesis is the concept of allostatic load.
This term refers to the physiological wear and
tear that results from chronic stress over time.
Over time, this stress overloads the body's systems.
increasing vulnerability to illness, and making
pregnancy riskier for Black women. The weathering
hypothesis and allostatic load provide a framework
for understanding why Black women, regardless
of their income or education, often face worse
health outcomes than their white counterparts.
In season two, series two, we touched on societal
stressors that impact Black women's health from
economic disparities to daily encounters with
racism and the cumulative impact of these stressors
is real and measurable. To give you a concrete
example, a 2023 Johns Hopkins study cited research
showing that the wealthiest Black women in California
face a higher risk of maternal mortality. than
the least wealthy white women. Income alone doesn't
explain these outcomes. Racism and discrimination
do. It's not just about individual health. This
is a community issue, a family issue, and yes,
even a men's health issue. When a mother dies,
it impacts fathers, partners, and children too.
Maternal health is family health, and family
health is community health. Take a deep breath
with me. I know this is heavy, but it's essential
that we understand the depth of these issues
if we want to create real change. Maternal and
infant health equity isn't just about health
care. It's about addressing societal structures,
supporting mothers and families, and making sure
that our systems don't fail the most vulnerable.
And with that, I'm excited to get into today's
conversation. You're in for a rich, informative
discussion about maternal and infant health equity
that will open your eyes to the real challenges
and hopefully inspire action. Let's get into
the heart of the matter with our guests, Melba
Perry and Jessica Burris. Melba Perry is a dedicated
community -based doula. with a heartfelt passion
for offering comprehensive support to individuals
and families. Her mission is to ensure that you
receive not only the medical care you need, but
also the compassionate guidance and understanding
that can truly make a difference during this
challenging time. Melba's approach to doula care
is rooted in a holistic perspective. She also
enjoys assisting families that are embarking
on the journey of high -risk pregnancies. affected
by genetic disorders, as she has personal experiences
with a high -risk pregnancy. Beyond the clinical
aspects, she provides emotional support, companionship,
and an open heart to listen. She understands
that each aspect of your journey is interconnected,
and she's committed to nurturing your overall
well -being. Melba firmly believes in the strength
of the community. Through a network of support,
Melba connects you with local resources, support
groups, and organizations that can enhance your
journey. You are not alone on this path. And
together, Melba will assist in building a network
that uplifts and empowers you. As your doula,
Melba is dedicated to helping you make informed
decisions that align with your values, beliefs,
and desires. She also offers educational sessions
that help demystify genetic disorders and high
-risk pregnancies, empowering you to understand
your situation more deeply. Jessica Burris is
a passionate advocate dedicated to improving
Black maternal health, with a particular focus
on enhancing the care, support, and resources
available to Black mothers, especially regarding
breastfeeding. At 44 years old, Jessica is not
only a wife and mother of three, but also a former
breastfeeding counselor who draws from both her
professional and personal experience to fuel
her advocacy. Having witnessed firsthand the
challenges that Black mothers face, from inadequate
health care access to societal barriers that
discourage breastfeeding, Jessica is committed
to driving change. She supports programs that
provide education and resources to empower Black
mothers to make informed decisions about their
health and their babies. Through her work, Jessica
is helping to build a stronger, healthier future
for families and communities. Thank you so much,
ladies, for joining me. So we're going to jump
right into this conversation with our first question.
And that is a little bit of a selfish question,
but a good question nonetheless for our audience.
Tell me, Melba and Jessica, why did you decide
to come on Questions You Didn't Ask to discuss
maternal health equity and related topics? So
for me, just the title itself, Questions We Didn't
Ask, there are so many questions that We didn't
ask because we didn't know to ask them. And that
I wanted to just put out there, here are some
questions to think about to ask. And if you don't,
because if you don't know that certain things
are available, you won't know to ask for it.
So that's basically my reason to wanting to be
a part of the show. Jessica, what stood out to
you when I reached out and asked for you to join
me today on questions you didn't ask to discuss?
maternal health equity and related topics. Well,
I knew when I met you for the first time almost
a year ago, and I learned about what you did
for your profession and the different topics
you talk about, especially relating to Black
women. Black maternal health is something I've
never given a lot of thought about when it comes
specifically to Black women. But the older I've
gotten, I'm 44 now, I have friends and family
that I've witnessed go through certain things
and not receiving the care that they should or
the answers that they need. And I'm looking it
up on Google, Dr. Google, just do this, do that,
but they're not getting the same feedback from
their doctors. But also I had kids, I had my
last two kids at 35 and 37 and I already knew
I wanted to breastfeed. I knew about breastfeeding,
but what I didn't know until I became a counselor
is how breastfeeding is so important. to not
just the baby, but to the recovery of the mother
postpartum. And that really fascinated me. And
that just knowing that and seeing how that wasn't
even education wasn't provided across the board,
especially to, you know, black women. It just,
it blew my mind and it made me want to just dive
in and find all the ways that I could support
and be a part of, of making that better. Yeah.
Well, I appreciate you both for answering the
call. I can share that, you know, we met at a
time when we were trying to connect as mothers,
right? And trying to get some respite from mothering
and being able to learn more about how to take
care of ourselves, how to take care of our families.
And in that space, we were surrounded by... women
that came from all different types of backgrounds
and walks of life. And we recognize that maternal
health, breastfeeding, high -risk pregnancy,
genetic disorders, and a variety of other things
are common to, you know, concerns about that
are common to so many different women. But in
our space, in our time, you know, we really got
a chance to kind of dive into our shared identity,
right? As women of color, women of African or
African -American ancestry, and recognizing that
as much as we relate to all of the women that
were at that retreat, there were certain unique
experiences that we had that were different.
And so while we have this discussion, we're going
to talk about. maternal health and breastfeeding
as it relates to a broad population, right? And
what women need to know in general. But we'll
pay a little bit more close attention to our
Black and African -American sisters because we
know all too well about these personal stories
of people not getting what they need and being
able to witness health. inequities, being able
to witness health disparities, and recognizing
that women of all ethnicities deserve the best
care possible. But when you see that women in
general are struggling to get that care, and
then Black women in particular are especially
struggling. It kind of pulls us in because we
can relate to these women. And I think that,
you know, that's really important in terms of
what motivates us to have these discussions is
that if there's things that we have learned on
our journey that we can pass on to help the next
person and the next healthcare system and the
next health policy and the next, you know, administration.
then let us do that. We're not here to just make
an impact in one space, but we're hoping that
our voice and what we've learned from other women
can be used in a number of different spaces that
can drive change. If you're enjoying the show
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you for your continued support and let's keep
the conversation going. So Melba. I introduced
you as the doula of our trio. And so can you
explain what a doula is and what motivated you
to become one? So, and I'm sorry, you might hear
my kids in the background because my daughter's
amazing. So a doula is a non -medical support
person that helps moms. You know, when they are
preparing for labor, birth and postpartum and
more so help them advocate through the health
care system. You know, African -Americans, our
maternal mortality is three to four times higher
than our counterparts. We have a higher risk
of having premature labor. We have a higher risk
of C -sections. And there's things that we can
ask for that we don't know that we can ask for.
And I myself, as a now doula and educated on
the health system, and I've been working as a
medical assistant for 20 plus years, didn't realize
some of the stuff that a mom can ask for. During
that prenatal care and labor. So, you know, helping
them navigate through that is very important
to me, especially the way statistics are. The
recent March of Dimes report came out. They were
hoping we'll get a better grade, but here in
North Carolina, we're actually in the worst grade.
We're a D plus. And North Carolina is not a huge
state. So to say you're a D plus in comparison
to other larger states says a lot right there
on its own. One of the things that brought me
into this is back in 2020, my son, we lost him
to a car accident. He was hit by a car and it
was like, okay, I have the two other kids that
I have to lift. for and I had to find something
to refocus on and and that's going to bring life
into me and what more what better way to help
bring life back into myself and help other moms
bring life into this world and so for me it's
like you know what I always wanted to go to be
a midwife. And I'm like, okay, I'm 44, almost
45 years old. I'm not about to go to nobody's
nursing school right now. What's the best way
for me to get this going? And so that's what
I did. And my grandmother was a town midwife
back home in Jamaica. So she helped actually
deliver babies within the town of Jamaica. those
babies were her own grandchildren. She delivered
one of my sisters and several of my cousins.
So it's kind of like in the genes almost. I couldn't
run away. You only can run away from your calling
for but so long. There you go. And you were inching
toward it. Anyway, do you mind sharing with our
audience a little bit more about your academic
training and your professional training? And
how did you What did you have to do to become
a doula? Because you are a lot of different things.
I am. So I did my initial training during COVID.
You know, everything was available online. So
I paid for training through an organization called
Maternity Wives. And so I did that training and
I'm like, okay. Here we go. I'm going to start
this up. And I did it and started doing birth.
And then I came across UNC, had a project called
A Cure for Moms that was just getting ready to
get started. So I signed up to be a part of that
project and did some community -based training
with them to be more on the community -based
side as well. And so things happened. I was not
in a good space mentally at that time when it
was time to start the project and do the dual
portion of the project. And for me, it was very
important that I'm in a good mental space when
I'm helping these moms transition their baby
into the world. You don't want any type of energy
that's not good to be in a space like that. That's
so sacred, in my opinion. So I stepped back from
the doula portion of the project and started
working on some training and recruitment. And
then I did another training with Dona through
a project with ECU. And so now I'm working, you
know, with them on some stuff as far as doula
training. So I did several types of training
as a doula and then to become a doula. And then
I also have a background of being a medical assistant,
which helped out a lot in this journey because
I do have some sense of what's going on in the
medical field and in the health care system in
that space. And it sounds like you have a lot
of experience working with two major health care
systems, UNC Health and then ECU. Yes, yes. That
is true. It's a lot, but to me, it's all worth
it. No matter how many more trainings I have
to go through, I'm going to do it. What keeps
you committed to this work, Melba? And then I'm
going to turn to you, Jessica, with another question.
Oh, what keeps me committed is seeing the numbers.
not going in the right direction. Once I see
those numbers going in the right direction, I
be like, okay, I can breathe now. But I still
would not stop. I would want to say, okay, now
they see why it's important to have a doula within
the healthcare system. Now moms see why it's
important to have a doula in the room. Now dads
see, now grandmas see. Now everyone see that
doulas are not an accessory. It's necessary.
You know, people think, oh, you got a doula.
What you got a doula for? You done had four or
five kids. Yeah. But how many of those births
was traumatic? How many of those births could
have been more beautiful births if you would
have had a doula? So I don't. Just my drive is
to keep going until everyone accepts doulas.
Until the health care systems and insurance companies
start paying for doulas, that's the goal. Because
the people that actually need the doulas can't
really afford doulas. And that's my problem.
Right, right. Because we're talking about, you
know. Black women, we're talking about women
in the South, you know, and oftentimes, you know,
we know in general, most people don't have enough
insurance to go around. Right. And so that is
a problem. Even if you're insured, you might
not have enough insurance. And then for those
who are not insured, there's definitely not enough
coverage to help them get the. the comprehensive
healthcare and the holistic healthcare that you
advocate so valiantly for. So Jessica, I want
to talk with you a little bit about your journey.
I see in your bio that, you know, you're a former
breastfeeding counselor. And I remember from
our conversation, you mentioned something about
peer support. Can you tell us more about your
experience in that role and how you got there?
Okay. So I worked as a breastfeeding peer counselor
with my local WIC office and I knew I was a,
I was a, a mom on the program when I had, I started
when I had my daughter, I was approached in the
hospital when that was with my son, actually
they're two years apart, but a peer counselor
with the, they are, it's just like, it's kind
of like a doula, like it's non -medical. So you
have guidelines of how much you can talk to a
mom about or about breastfeeding counseling.
The moms have to, they have to sign up for the
program because they can sign up after birth
or before birth, but we just provide counseling
like breastfeeding counseling. So there's certain
things I can't say, even though I might know
as an experienced breastfeeding mom, and then
I have to refer to the in -house IBCLC or did
I say that right? Is that obvious, CLC? Yeah,
you said it right. Because you're one, right,
Melba? No, I was in the process of doing it through
a Pathway 3 program. So I stopped and now I'm
on the CLC track. Okay, I remember talking about
that. But anyway, so I - And so what is that?
Because I have no idea what you're talking about.
I'm sure some of our listeners don't. That's
like the highest level of - being able to give
the highest, the highest level for breastfeeding
support. They can get hired, you know, in hospitals
or, and Melba might know more, but it is the
highest level, right? Yes. So there are a internationally
board certified lactation counselor or consultants.
Yes. And they can have their own practice or
be hired through the hospitals and they can build
insurance companies as well. And COCs is just
like a certified lactation counselor. Some insurances
pay for them like TRICARE and stuff like that.
But as far the difference is COCs cannot like
diagnose. tongue ties, lip ties and stuff like
that. So they might see, oh, it looks like your
baby have a tongue tie or a lip tie. I need to
refer you to an IBCLC to have a more comprehensive
exam. Yeah, when I was a peer counselor, that's
when I learned about both of those. And I was
fascinated and right away I wanted to be an IBCLC.
But when I saw the training. that was needed.
Not that I couldn't do it, but I had two kids,
one with a disability. There was no way I was
going to, you know, but the CLC one was just
as good. So that's like, actually, that's still
one of my goals. But anyway, the peer counselor,
I worked at the local, so it was the local health
department, low -income moms, pretty much 100
% of the moms were Medicaid moms, a majority.
women of color, Black moms, young moms, first
-time moms. And so the way WIC works now, you
know, back in the day when WIC used to, you just
used to go in, I don't know if y 'all, I was
a WIC child. And so I know. I was a WIC mom.
Okay. I was a WIC mom too. Yay, lived experience.
Well, when I had my first child as a teen mom,
As a way I would go into the health department
and all you would see is like advertisements
for formula. You know, there no one ever talked
to me about breastfeeding. I just knew I was
going to breastfeed because of my mom. And so
I didn't have to have anyone talk to me. But
that was I think I was probably a unique situation
in 1995 with that as a 15 year old. But now there
is the World Health Organization did they are
successful in preventing the commercial. commercialization
of, or advertising of formula. So you don't see
formula commercials a lot. You don't see any
advertisements in your health department or WIC
office or formula. Now they still provide it,
but they don't, they don't start there. They
always start with breastfeeding, which I was
very impressed with. My, my role was very limited
and it was hard because I was so experienced
with breastfeeding. So when I wanted to go. that
extra step. I knew I couldn't, like I had to
refer to the, to someone higher, but I also learned
so much because I had to do training. I thought
I knew everything about breastfeeding. I didn't
know half of stuff about breastfeeding just because
it was easy for me. I didn't know, you know,
everything. And that's what made me really start
to look at the people who do need extra support
in education. It's not that. I'm not saying anything
bad about, you know, WIC or the health department
because they are state funded. So they only can
go so far with the money they have. But just
actually it was really unlike the back end, like
the doc where it starts at in the hospital or
the pediatrician's office or the oncologist's
office, or even at home, just the lack of education,
the lack of support. And when you have a young
mom, a mom who comes from maybe, you know, low
income, you know, single mom. They already are
insecure about their ability to feed their baby.
So there was just a lot of things that they just
needed so much more education and support. And
that was where, if I ever do become a certified
lactation counselor. When you become. When I
become. You're right. Thank you so much. That's
going to be my focus is moms of color, you know,
black moms and low income moms. Thank you for
joining us on Questions You Didn't Ask with me,
Naisha Frey, and my guests, Melba Perry and Jessica
Burris. Tune in next week as we continue our
series, From Birth to Beyond, unveiling challenges
of maternal and infant health.