We are thrilled to share the thoughts of Dr Mimi Niles, PhD, CNM, MPH, Dr Neel Shah, MD, MPP, FACOG, & Krysta Dancy, MA, MFT with you this week! We asked these birth pros to share their experiences with you about finding hope in birth care through this pandemic and how we partner together to move forward.
We are thrilled to share the thoughts of Dr Mimi Niles, PhD, CNM, MPH, Dr Neel Shah, MD, MPP, FACOG, & Krysta Dancy, MA, MFT with you this week! We asked these birth pros to share their experiences with you about finding hope in birth care through this pandemic and how we partner together to move forward.
Welcome to Your BIRTH Partners. We're here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. Today, we are kicking off season two of the podcast. And this year has certainly thrown all of us for several loops. And we took a hiatus over the summer so we could kind of all collect ourselves and, you know, spend time with, you know, our loved ones and focusing on you know, the important work that we all do. And I'm really excited to come back together and start processing a little bit of that more out loud with you all, as we keep working to really improve perinatal health care. And so our vision for this first episode of the season was to bring in some more voices, some people who I consider to be you know, thought leaders within perinatal healthcare, who have really, you know, spoken out and taking action to change the way that we operate. And so I am really excited to bring them on today. And we're asking the three of them all the same questions. So I have Dr. Neel Shah, who was really one of the first voices as an OB-GYN, as a physician, who I heard really calling out some of the problems within our healthcare system. And then we also have Dr. Mimi Niles, on who I, you know, recently more recently became aware of, you know, her work and her voice within prenatal health care and have just been continually just impressed with the level of nuance that she brings to discussions around birth care and our work as birth professionals. And then our other guest is Krysta Dancy, who is someone who I also met in the last year or so. I love that the framework she brings to discussions around prenatal health care is really based in her background as a therapist, and she brings a really unique perspective to how we, you know, address clients and patients and care for their needs. So, I am so excited to share all of them here with you today. We are going to be asking them questions about hope through the pandemic, and then what they see as the future of really partnering together during birth care. So I am sure you will learn a lot from listening to them and the experiences that they've had over the last several months and gain a greater understanding about some of the steps that we hope to see as we move forward. On to the show! I am so excited to share this conversation with you all with Dr. Mimi Niles. Mimi is a certified nurse midwife. She is a researcher exploring midwifery care models and health equity in our country. She is an assistant professor at NYU, working on their school of nursing. She is on the board of directors for the National Association of Certified Professional Midwives. And she is a parent and an incredible voice for change in our country and in our perinatal health care system. So I'm delighted to have her here to share with us. With all of this, everything that has happened and these feelings of just unknown and loss that have been running so high through the pandemic, what is you know, what's the one thing that gives you hope for kind of birth care and continuing on?
Dr Mimi Niles :I would say...what gives me hope...is Black women.
Margaret Runyon :Mmmm
Dr Mimi Niles :All the Black mentors that I have in my life and the black midwives that have been my teachers and my sort of, I don't know, they give me so much hope because I see in them something that is so it's sort of spiritually strong and grounded when they have this kind of consciousness around what what the work that needs to happen, you know, and such clarity around that, I think really gets me out of my sort of existential kind of, "I'm just one person, what am I going to do?" And the narrative around the hero, or the American hero, I think is not true. We know that a lot of this work happens in community and it happens in partnership. It happens in sisterhood, and yeah, and I really that that has given I've had a lot of dark days during COVID and that has been I have been so blessed to have folks around me who said get yourself up and put your big girl underwear on and get, you know get back to work.
Margaret Runyon :Yeah. I mean Black women are certainly they are rising out of this and their resilience to continue to, to fight and push and it's inspiring. And like you said their style of leadership, typically when you're watching it is so it's so different from what we're, we're used to and so refreshing in just that openness and that collaborative nature.
Dr Mimi Niles :It's unapologetic, and I think we, that's what, we that's the fire we need.
Margaret Runyon :Yeah. And so then the last question is, so what is, you know, one thing be it, you know, practice, training, mindset shift, conversation that you believe can help birth professionals partner together to change birth care in the US?
Dr Mimi Niles :Mmmm. I believe that there needs to be... there has to be an unlearning and a relearning, so there has to be a re-learning about the history of medicine and obstetrics in the US. And there has to be an unlearning of what power looks like in this space. So I yeah, I think there has to be kind of a, that's how I feel. It almost is like everybody needs to, you know, when you have to turn your computer off completely?
Margaret Runyon :Yep. Off and back on again? [laughter]
Dr Mimi Niles :I know there's a word for that. A reboot or something. Yeah, we need that kind of reboot or rewiring. That needs to deeply happen. And it's going to take truth telling, and reconciliation and that means everybody's going to have to be at the table. And it's going to get super uncomfortable and messy. And people need to know that it's not personal, you know, that this is about system, and institutions and histories and legacies of colonization and imperialism and American sort of westward Ho. expansionism that has left a lot of us behind. So that I feel like it's going to take some deep, deep work around not. It's more than just like, it's nice to talk about interdisciplinary learning spaces. And I always tease physicians, like, "I know how to work interprofessional game because I've had to do it since day one. You all are the ones who don't know how to work into professionally because you've never had to do it. What you says go what you say goes right?" So like those are the conversations I want to be having, you know. And I am, you know, there are physician leaders in the space where I think, why aren't you talking about midwifery care? You're a leader in this space. You need to be calling out your physician colleagues and saying "why do we have so many physicians doing physiologic, not doing physiological labor as our C section rates rise, as our induction rates rise, as our epidural rates rise?" Those are all related to health disparities because Black women get more c sections, and Black women get more inductions, and Black women get more epidurals so you need to be, they're all connected, you know. And so let's have those conversations. I don't know how that's going to happen. Maybe they need to happen in pods or maybe they happen...I don't know how to operationalize it. But this is aspirational to me there needs to be like serious unlearning and relearning that needs to happen.
Margaret Runyon :Yes, I cosign that 100%. That is that is what needs to happen. Well, thank you so much, Mimi, for sharing all of this with us today. I really appreciate your insight and clarity around these issues we're facing. And next I am going to bring you over to the conversation I got to have with Dr. Neel Shah. All right, well, I am joined here with Neel Shah, who is a physician, a parent, a assistant professor at Harvard University. He is the founder of nonprofits March for Moms and Cost of Care. And really just a huge vocal advocate for talking about our perinatal health care system, and speaking out about ways that we can improve and work to change it. So I'm really excited to have him join us here to give us a couple of answers to these questions. So Neel, welcome. Thank you so much for being here.
Dr Neel Shah :Thanks, Maggie.
Margaret Runyon :So we'll dive right in. In a time where concerns over the unknown and feelings of loss have run really high. What is giving you hope, as we continue to navigate birth care through the pandemic?
Dr Neel Shah :A lot honestly, you know, during every humanitarian crisis, which is what this is, maternal health suffers, so whether it's, you know, warfare or a natural disaster, like a hurricane, or in this case a pandemic, we see that, you know, maternal health suffers. And in many ways maternal health is sort of a bellwether for the well being of all of us. And there are many ways that we're seeing that now, too. And just to lay it all out, I mean, there's a pandemic, there's a deepening economic recession, there's political upheaval, there's civil unrest, I mean, that's a lot existentially for anybody. But what I'm also seeing is all of the seeds of innovation. So you know, there are a number of things that people have been working very hard to change and progress in our maternal health system for a long time, that weren't really on the table as being possible until now. So whether it's telehealth, which wasn't getting reimbursed and wasn't getting payments. to honestly, if you can get a facility fee, put a tent in a parking lot and care for people in their communities, you should be able to get the facility fee for a birthing center. We've had to create new capacity in the healthcare system. So we're relaxing licensure in ways that allow midwives and other advanced practice nurses to partner in the profession in ways that, you know, were harder to do before the pandemic. But fundamentally, what I'm seeing is that there are a core set of challenges that everybody's dealing with across the country. And then we've got all of these inventive ways of solving them, which are really the seeds of innovation, like we've had a 90 year old model of prenatal care that's been rigid and fixed, and based on nothing. And now we've got all of a sudden, like, 1000 experiments on how to do prenatal care. And from that a better way will emerge. I know it.
Margaret Runyon :Wow. Yeah, absolutely. You touched on so many really important things. And I completely agree with you definitely, you know, necessity is the mother of invention. And this has probably been kind of the catalyst that maybe the system needed to really start addressing some of these issues that have been long standing and this has really shone a light on so that's great. And then, you know, the other question that we had for you was, you know, what's the one thing and that could be anything, it's a practice, a training, a mindset shift, a conversation. What's the one thing that you think really that birth professionals can, can do can partner together right now to really change birth care in our country?
Dr Neel Shah :That's a great question. I mean, I think the existential issue for civil society is the same one that we have as birth professionals, which is trust. At this moment. All of us who work in the professional space at the end of the day to differing degrees are institutional actors. I'm the ultimate one, I'm an obstetrician. I'm a Harvard professor, I'm male. But all of us who have worked on behalf of our professions and institutions have been part of a system that's left a lot of people out. And among those who have been historically oppressed and marginalized, they have rightfully, not really trust in the system. And at this particular moment, they're seeing a lot of tough things that are continuing to leave them feel left out. And when you look at who's being disproportionately affected by the pandemic, or who before the pandemic was being disproportionately affected by inequities in maternal health. So we need to work on being trustworthy, collectively. And that does mean partnering together. And it probably means figuring out ways of using our professional privileges and power and sharing it, in some cases ceding it, maybe in some cases, showing up less as experts and more as learners, you know, less as speakers and more as amplifiers of other voices. And particularly from those voices that don't have platforms and are being most impacted by what's going on right now.
Margaret Runyon :[cut out]....That's perfect. I think we missed the very end of what you said. And if you want to repeat that, I think you were saying trust and...
Dr Neel Shah :Yeah, we need we need to work on trust. That's the point.
Margaret Runyon :Yes, ok.
Dr Neel Shah :It's something we take for granted so it felt worthy of explaining because like people are like "work on trust, what does that mean?"
Margaret Runyon :Yeah.
Dr Neel Shah :There's a deepening divide between health systems and communities that we serve. It's getting wider. That is what we need to work on.
Margaret Runyon :Yeah. Yeah, that's been that. So, you know, our organization starting up was really because we've felt like there is this, just this widening gap and this feeling that we don't people don't always know how to work together. We don't know how to find the people who we actually can trust and can partner together because there's just historically been people doing a lot of untrustworthy stuff. And unfortunately, people haven't lived up to that [expectation]. And so it's hard now both for you know, for professionals within care settings, and then also for the people were caring for to know, "okay, when I tell this person, this is an issue, are they going to, are they going to care? Are they going to do the right thing to help to fix it?" And it's, yeah, it's been really overwhelming but I there is, I think as we keep working together as we keep doing more trainings together and talking more and just having more, you know, our obviously our whole end is like have more conversations about it talk about the issues, call it out, don't let it be, you know, the elephant in the room that everyone kind of avoids because it doesn't, it doesn't get us, you know, anywhere. Our tagline is like "be, inspired, respected, trusted, heard," which spells out like for birth, and because we felt like that's like, that's what we need, like we need those and we need it on all sides of the table. You know, everyone needs to there needs to be respect and trust going back and forth. And not just kind of this one way relationship that I think as healthcare professionals, we kind of are trained to think we have respect and trust automatically, like earned for us. So, it's a big one.
Dr Neel Shah :I love that, Maggie. That's great.
Margaret Runyon :Well, Neel, thank you so much for taking the time to share with us today. And, you know, speak into your vision of what you're hoping the future continues to evolve into. So I really appreciate it. And now I will be leading us into our last conversation with Krysta Dancy. So it's my pleasure to introduce to you all today Krysta Dancy. Krysta wears many hats. She is a licensed Marriage and Family Therapist, a certified birth doula. She's the founder of the Birth and Trauma Support Center. She also co directs the nonprofit, The Place Within Counseling Center. She's a parent, and she is a just tireless advocate for us tuning into what our clients individually need to support them through birth. So I'm so excited to have her here with you all. So, Krysta, let's just dive right in with the heavy question. So in a time where concerns over the unknown and feelings of loss run high, what has given you hope as we continue to navigate birth through the pandemic?
Krysta Dancy :So not surprisingly, the pandemic has really exposed cracks and flaws in the system, right? We see that anytime there is stress placed on a foundation that has cracks in it. The cracks show and that's definitely happening. We're seeing that the pandemic is revealing a lot of systemic issues. Why do I still remain hopeful? Because every time I look deeper to see the professionals who are rising to the occasion, I am inspired. I am seeing mental health providers suddenly become increasingly aware of perinatal mental health traumas of the isolation of new parents. The conversations are being refreshed and renewed and drawing in more eyes than ever before. I am seeing institutions I never thought that would say this suddenly recognising the importance of birthing options. So now I'm seeing institutions to talk about how important it is to have freestanding birth centers, how important it is to support home birth for good candidates. Everybody in my area, who offers birthing alternatives, cannot keep up with the demand. There's suddenly this increased awareness of how important it is for there to be options. I think that's going to have a long term positive effect on this conversation. The other thing I'm seeing that's inspiring me is the way that doulas are coming together nationwide. They are connecting with each other. They are becoming politically active in a way that I've not seen happens in such widespread ways. They are petitioning governments to support the rights of birthing people to address issues, like doula bans or racial disparities or income disparities and outcomes. I'm watching them do things like find creative solutions in virtual doulaling, which is not only making sure that doulas will be here to stay, but it's also making sure that areas of the country and clients who couldn't probably access this care before suddenly have access to it in a new way, hospitals or facilities that would have never even heard the word doula suddenly have a virtual doula there. I think that the exposure in the long term to all of these things and the ways in which people are rising to the occasion, makes me hopeful that although right now is pretty hard and stressful for everybody involved, the long term is going to become this amazing conversation. That is, if you'll pardon the pun, there's this thing being born in this hard time, right? And so the pressure that we're under is forcing us to be creative and collaborate in ways that we got away with not doing before. So that's where my hope lies.
Margaret Runyon :Yes, Krysta, I, you have just highlighted so many incredible things that have come from this pandemic. And I, especially that piece of just this awakening that is happening to issues that have been here for a very long time, that really need our attention collectively and individually to make change. And that does give me tremendous hope as well. And then, you know, the next thing we're kind of asking everybody is, what do you think is the one thing and be that a mindset shift, a training, a conversation? What is that one thing that needs to happen in order for us to really partner together as well? as professionals and change birth care in the US?
Krysta Dancy :if I could pick one thing that I think will be revolutionary to the field of perinatal care, it would be cross disciplinary learning. I come from a mental health background, I moved into birthing background after. What has always been amazing to me is the ways that no matter how well educated you are, no matter how prestigious the institution or how well mentored you were, or how much work you've done to learn, we have all received lenses from our institutions that are often specific to our professional role and we don't even realize it. And as soon as you get people from other disciplines in the room together, talking about the same problem together, all offering their different lens and being able to connect with and empathize with the different lenses looking at 360 degrees of the same picture. magical things happen. It's incredible. When we have you know experts in the room on psychology psychosocial models, racism, health disparities, medical care, midwifery, hospital administration, the list goes on when we get these people who are generally very siloed as they are in the birth world, and we put them in the room together in a collaborative model, we suddenly come up with something we could have never thought of the sum is greater than the parts, right? And so that for me, cross disciplinary training is the future. It is where growth happens, and I'm very excited every time I get to take part of it.
Margaret Runyon :Krysta, I can attest to that power of collaboration. Having taken your courses before I too have been struck by really just the the new ways that we can think about things when we share perspectives. And obviously so much of that is what we hope to have happen here through this podcast. You know, we look forward to more challenging discourses about what is happening in perinatal care? And how do we actually take that and come together with all of the different perspectives we bring, and our experiences and really create something that is better than any of us can, you know, imagine on our own. So thank you so much for contributing and sharing your thoughts with us. Thanks for tuning in. We love to talk birth, and would love to talk about it with you. So, please join the conversation by finding us on Facebook, Instagram or Twitter, we're your birth partners on all platforms. And you know this episode, we were blessed to hear from, again, people who I really consider to be you know, thought leaders and great vocal advocates for change. But even you know, more important than those couple of voices are hearing from all of you. And so I would love for you to, you know, come and find us, the posts that we're sharing this week on social media, and comment and let us know about your experiences, share what is going on in your world, in your profession, in your community, and how you are finding hope through this pandemic and what you want to see as next steps as we all try to collectively move forward to something better. So we look forward to hearing from you. If you want more resources about the guests we had on the show today and anything we talked about, you can check out our show notes on our blog at yourbirthpartners.org and we will look forward to hearing more from you. Till next time! Transcribed by https://otter.ai