Welcome to Our Voices, Our Future, the podcast
where we amplify the voices driving change and
equity within medicine and beyond. Brought to
you by the Gender Equity Task Force, a committee
of the American Medical Women's Association,
we're here to challenge norms, break barriers,
and ignite conversations that matter. I'm Megan
Etsy, and in each episode, we'll bring you candid
discussions with leaders, change makers, and
advocates working to create a more inclusive
and just world. No more silence, no more waiting.
Listen to Our Voices, Our Future. Let's get into
it. Today we are welcoming Dr. Janelle DeJesus.
Dr. DeJesus is a passionate OB -GYN, content
creator, women's health advocate, and brand new
port mom. She completed her medical degree at
Nova Southeastern University College of Osteopathic
Medicine, followed by a transition year internship
in Middletown, New York, in her OB -GYN residency
in Gainesville, Florida. She now practices in
San Juan, Puerto Rico, where she combines bedside
care with a broader mission, empowering women
through education and advocacy. On her public
platforms, Dr. De Jesus engages patients, colleagues,
and the general public on topics ranging from
patient autonomy and consent to social determinants
of health, obstetric violence, and gynecologic
pathology. She hopes to use her voice to shift
the culture of women's healthcare toward greater
equity, respect, and empowerment. Thanks for
being here, Dr. De Jesus. Thanks for having me.
Yeah. So just to start off, can you kind of share
your journey in medicine and what led you to
an interest and maternal health and that kind
of perinatal care? For sure. So in high school
and college, it all started more so with an interest
in the sciences, anatomy and physiology, how
the body works. For me, it was super interesting
to see how the body is able to literally just
keep itself alive for such a long period of time
and seeing how the body works both in health
and in disease, how a tiny little cancer cell
can grow to potentially cause so much damage.
So that kind of peaked my interest in medicine
overall. In medical school I started, I had no
idea what specialty I wanted to go into. Ironically,
I was completely uninterested in OB -GYN. They
put a C -section on the big screen in medical
school and I was like, oh, not this, this is
not it. And then I went to an ACOG conference,
that's the American College of Obstetrics and
Gynecology. And I did a bunch of simulations
and practice first, you know, simulations for
deliveries, ultrasound procedures. And I just
absolutely loved how hands on it was. And when
I started my clinical rotations, I just fell
in love with the patient population. The things
that came to kind of attract me the most was
the fact that, you know, when it came to delivering
babies, for instance, it was the only potentially
good reason that you're going to be in a hospital
setting, which was awesome. a universal but still
such an intimate and mysterious part of so many
people's lives. And I knew I wanted to be a part
of that each delivery felt like, oh my god, you
were winning a Super Bowl or something. I loved
being able to also follow patients from like
their first period to their first baby to perimenopause
to menopause and everything in between most most
patients kind of feel like close friends or almost
like they can be my best friend. And honestly,
that's something that I feel like is so unique
to this specialty specifically. And then later
on, I came to fall in love with, like the advocacy
aspect, the fact that, you know, sadly, there's
still so much work to be done within the realm
of like, women's health and in terms of pharmaceutical
and diagnostic research, patient advocacy, maternal
morbidity and mortality, obstetric violence,
like you mentioned, and those are things that
I can talk about all day. And I knew I wanted
to be a part of, you know, improving that, improving
those metrics and, you know, improving women's
lives in turn. It's incredible. So from your
experience and the path you've had, how would
you describe the current state of the pre and
peri and postpartum care that we have in the
United States right now? It's abysmal. It's abysmal
and having experienced, I mean, I knew having
experienced it as a physician. I knew how difficult
it was for myself and my colleagues kind of like
navigating it. But having also experienced it
just recently from a personal standpoint, I just
had my baby seven weeks ago now. And yeah, and
experiencing it from the patient's end was just,
it was a completely different experience. I really
thought I knew, but yeah, it's tough. and for
a myriad of reasons. To start, you know, insurance
issues amongst both the patient side and the
physician side. You know, compensation of maternity
care as a whole indirectly cuts the time for
prenatal visits. So this is going to give clinicians
minimal time to address questions, concerns,
pathologies. follow -up plans for a lot of very
high -risk pregnancies doesn't give us a lot
of time to obtain consent in the proper way so
that, in other words, so that the patient understands,
you know, what we're talking about. And then
from a physician standpoint, you know, our average
time with the patient is anywhere from 10 to
30 minutes, usually on the lower end of that
and sometimes even less. So that's going to give
us minimal time really to address all of that,
which further leads to issues down the line with
patient trust, you know, adherence to treatment
plans, that sort of thing. Today's day and age,
we have so much information that is openly accessible
to the patient. Unfortunately, it's not all correct
information or truthful information or information
that is evidence -based. And so I would argue
that we need even more time to kind of combat
that, build a sense of trust and rapport with
our patients so that they're able to make these
informed decisions. So, you know, really it's
us against the clock, us against insurance companies,
us against a lot of misinformation online, you
know, and unfortunately a lot of patients have
been traumatized by obstetric violence and having
procedures done on them where they weren't properly
consented and they've been traumatized by it
and rightfully so that does form their experience
or their perception of obstetricians. So there's
a lot of work to be done internally, both myself
and my colleagues on that end as well. I think
we've kind of hit on the next question, but if
you have anything else to add, what would you
say some of the biggest challenges for patients
during pregnancy and after childbirth, and where
do you kind of see the gaps that are within care?
No, definitely. I think one of the biggest gaps
that I see is just an overall lack of resources.
One of the things that I see very, very often
is that a lack of resources can sometimes be
simply disguised as like postpartum depression,
like a patient will come into the office. She's
really, really sad. She doesn't have a whole
lot of help. She doesn't have the ability maybe
to come to all of her postpartum appointments
in spite of all of the issues that she's having.
And, you know, she writes on her questionnaire
that she's feeling all types of sadness and she's
not sleeping well and she's not eating well.
And she doesn't have a whole lot of help. um
for whatever reason um and many times that you
know she meets the criteria for postpartum depression
a lot of the times this lack of resources gets
um kind of disguised as postpartum depression
but they're not necessarily the same thing um
one can lead to the other surely um i can't argue
that but at times these things can be completely
isolated issues one is treated with a medication
and the other one doesn't necessarily need to
be every single time. And then other challenges,
I would say, affordable healthcare, of course,
Medicaid, almost 50 % of deliveries that happen
or patients that we're seeing are actually Medicaid
patients, affordable childcare. I mean, I'm looking
at childcare myself and it's like, in certain
states, it's like a rent basically. So access
to mental health, of course, pelvic floor, physical
therapy. I mean, you know, you go get a knee
replacement in the first place you're gonna get
sent is physical therapy. I don't understand
why, you know, delivering a baby anywhere from
five to 10 pounds doesn't warrant the same thing.
And then contraceptive counseling, of course,
50 % of pregnancies are actually unplanned. and
many of those happen in the almost the immediate
postpartum period. Oh wow. So kind of building
off of those challenges you see, how would you
say social determinants of health like race,
socioeconomic status, geographic location, kind
of impact the maternal outcomes that we have?
So this is a tough, this one is a really really
tough topic in part because I think that there
are many populations and many demographics that
can look at objective data and still deny that
this is an issue. But we do have pretty well
-documented literature that states that these
social determinants of health impact maternal
outcomes, that systemic racism is still affecting
maternal outcomes. Access to care and geographic
location is also a huge issue plaguing the country
right now. Labor and delivery units are shutting
down all over the place, which essentially will
leave people without care, without a place to
deliver their babies. Where I attended residency,
we had people traveling up to two hours just
to come to a hospital to be able to give birth.
Um, I've worked out in, you know, rural areas
of New Mexico and people would have to take helicopters
and planes over to, you know, either the next
facility or in Texas, um, just to be able to
see, for instance, a high risk specialist. Um,
and of course, you know, these, these lead to
delays in care, delays in management, um, and
can sometimes lead to very catastrophic results
within the pregnancy. Um, so. Definitely all
of these things play into maternal outcomes in
this country. So could you share with us kind
of an example of a program policy or initiative
that you've seen successfully improve pre and
postpartum care? Yeah, so my favorite one, and
I'm so proud of California, even though I'm not
Californian and I don't claim anything Californian,
however, the California Maternity Quality Care
Collaborative, CMQCC is what it's called. Essentially
what this was, this was a state or what it is,
it was a statewide initiative. where they wanted
to implement very standardized protocols and
trainings and simulations and things like that
in order and as well as collecting data for outcomes.
in order to be able to see how they were doing
in terms of improving maternal morbidity and
mortality. And this was a huge, huge deal because
they found that from the years 2006 to I think
it was 2013, they saw a 50 % decrease in maternal
mortality while the rest of the country's rates
were actually on the rise. The reason this is
such a big deal is because in all of the developed
nations, the United States is actually one of
if not the highest in maternal morbidity and
mortality. I think I read as far as statistics
is concerned, we have more women who die in childbirth
than police officers, like active duty police
officers here in the United States. That's a
big deal. That's basically saying it's more risky
to give birth in the United States than to be
a police officer in the active line of duty.
So the CMQCC essentially What it did was it set
a huge example and it displayed the importance
of having these systems in place in order to
decrease morbidity and mortality. And in my opinion,
the rest of the state should follow suit. Many
hospitals in different states nationwide have
kind of followed their example. I know the hospital
from my residency program kind of adapted a lot
of the things from that. quality initiative.
And yeah, many hospitals have seen a decline
in morbidity and mortality as a result of implementing
a lot of those systems. So how would you say
that health providers as like a single person
and then institutions as a whole can adapt to
kind of better support patients with mental and
physical health when their these women are in
their postpartum period? Yeah, so postpartum
honestly is a really difficult, I mean, I'm going
through it right now so I can say this. If this
is the hill I would die on, but it's a really
difficult time because we as physicians, I don't
necessarily think that it's just a healthcare
kind of thing. It's such a unique aspect of of
medicine and healthcare as a whole, because it's
not just healthcare that happens after that,
right? Like your life has changed forever. But
it's a hard time because we, as healthcare providers,
we tend to fixate on the medical aspects. You
know, your postpartum hemorrhage, your severe
preeclampsia, those sorts of things. When postpartum
really is so much more than that, obviously.
This is where I think the lines get blurred a
lot. So for example, like I mentioned before,
there's just this notorious lack of resources,
which, you know, in an ideal world, I would love
to see more of these things implemented that
are able to kind of allow for these resources
to be more accessible outside of the realm of
healthcare, things, and within healthcare as
well. things like more affordable child care,
insurance coverage for wider aspects of postpartum,
not just your postpartum visit. I mean, that
just goes in the global fee or whatever, but
pelvic floor therapy for longer chronic issues
like painful intercourse after delivery or pelvic
organ prolapse or incontinence or these issues
are very, very common. and mental health, things
like lactation counseling, which I'm learning
firsthand, breastfeeding is not easy, pumping
is not easy, and that in and of itself is enough
to take a toll on like your mental health. And
so I think that it's more all encompassing. And
until we acknowledge that postpartum is more
than just a relationship with your obstetrician,
I think until we can acknowledge that, it's not
going to improve. So what role would you say
advocacy, education, and community engagement
could play in improving this pre - and post -mortem
care for women? Like I said, we won't get better
outcomes without acknowledging that there's a
problem like to begin with. So we need to have
these conversations. We need to be less afraid
to critique both each other, like, you know,
colleagues, physicians, health care clinicians
overall. And we need to be able to critique ourselves.
We need to be able to kind of question our own
practices and ask ourselves whether or not they're
affecting our patients in a way that's healthy
and positive and uplifting, which is fine, which
is why honestly I find myself on social media
you know engaging in these conversations with
both my colleagues and my patients all over the
country because if we don't have these conversations
then we're not gonna get anywhere and so that
is both advocacy and education for me just because
I'm I'm seeing so much misinformation on social
media. My stance is that if people will find
misinformation on social media, I also need to
be on social media so people can find information
and education there as well. So definitely. And
community engagement, of course, the only points
of view that I see are from the perspectives
that I have had as a patient. those of my patients.
But honestly, actually, content creation as a
whole, not only did I do it for advocacy, but
I also wanted to be able to hear from the stories
of people all across the United States to be
able to talk about these experiences. It's really
interesting because sometimes people will kind
of almost, I don't want to say trauma dump. Sometimes
they do, but a lot of people will kind of like
share these horrific experiences that I would
never imagine are actually still happening in
this country. And, you know, as I alluded to
before, we have to be able to acknowledge that
these things are still an issue. The history
of obstetrics and gynecology in and of itself
is not a pretty one. It's one that at times,
you know, we've made a lot of advances, but at
times you know, it's hard to be proud of. And
so and some of those elements kind of weave themselves
into still the care that we give today can sometimes
be a little bit paternalistic in nature. So we
definitely need to keep having those conversations.
So just as a whole, what general piece of advice
would you give to either aspiring physicians
or health care professionals who want to make
that meaningful impact in maternal health? Yeah,
no. The one thing I would say is that we have
to keep making noise, especially within the realm
of women's health. If it took patients posting
on TikTok about their experiences with IUD insertions
in order to change guidelines, for pain control,
for IUD insertions and office procedures as a
whole, that's proof that, you know, silence and
complicity does not elicit any sort of change.
And sometimes in the most unexpected ways that
you're able to kind of make waves, you know,
now there are a lot of conversations centering
around, you know, the Women's Health Initiative
and why it's so important to have studies centered
around women specifically as a patient population
as a whole, because we are still, we make up
50 % of the population, but when it comes to
the research, we are still the minority. And
that definitely plays a role as well. And we
have to acknowledge that. So we have to make
noise. Ultimately, if we don't know it's a problem,
and we can't acknowledge that it's there, there's
no way we're going to be able to fix it or improve
it. And we're here. And that's why we're doing
things like these podcasts and you have your
social media. Yeah, I love it. Thank you so much
for this talk today. It's been very nice. Of
course. Thanks for having me. Yeah. So that's
a wrap on this episode of Our Voice is Our Future.
We hope today's conversation inspired you, challenged
you, and reminded you the power of raising your
voice. The fight for equity doesn't stop here.
Join us in the movement. Subscribe wherever you
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