Defining Structural Racism & Perinatal Care Impact #060

In this episode of the podcast, we are diving into another heavy topic as we explore structural racism.
How do we define it?
How do we recognize it?
And most importantly, how do we take action, when we see its impacts as they show up in our personal practices, in our organization, in our policies?

This conversation is so important.  There are horrific racism-driven disparities in perinatal health care. And all of us as birthworkers, as clinicians have a role in changing the way that the system is set up. One of the things that makes structural racism so insidious, is the ways that it has been embedded in healthcare and at times can make it difficult for us to see how standard practices and policies and ways that we've been educated and learn to do things are in fact, a part of a larger structure of racism.

I'm honored to have our guest, Dr. Deann Butler, CEO of Connected Consultants, on today to share with you her recent research into defining structural racism.

You will leave this conversation with a greater understanding of the different types of racism, how they pop up, how to recognize them, and particularly how we move forward with a shared understanding of structural racism, to create the change that we want to see in our healthcare system.

Tune in for:
~Moving the conversation around structural racism from research to applied practice
~The importance of language and defining types of racism
~The "iceberg" of structural racism and the layers involved in it
~Personal responsibility to address systemic & structural issues
~Battling the overwhelm of structural racism with action
~Creating REAL organizational change with Deann's framework


Learn more about Deann in her guest profile.

Transcript

Maggie, RNC-OB  0:03  
Welcome to Your BIRTH Partners, the podcast identifying gaps, acknowledging biases, and co-creating a trauma informed standard of birth care with change agents across the spectrum of birth work. I'm your host, Maggie Runyon. I'm a birth nurse, educator and advocate who has been searching since 2010. The answers to how to provide better care during pregnancy, birth and postpartum. Through my own pregnancies and supporting births in home and hospitals around the country. I've seen firsthand many the systemic flaws that exist in perinatal care. Through these conversations, I'm thrilled to share with you insights and inspiration as we work collectively to transform birth care.

So in this episode of the podcast, we are diving into another heavy topic as we explore structural racism. How do we define it? How do we recognize it? And most importantly, how do we take action, when we see its impacts as they show up in our personal practices in our organization, in our policies, this conversation is so important. As we've talked time and time again, there are incredible racism driven disparities in perinatal health care. And all of us as birthworkers, as clinicians have a role in changing the way that the system is set up. One of the things that makes structural racism so insidious, is the ways that it has been embedded in healthcare and at times can make it difficult for us to see how standard practices and policies and ways that we've been educated and learn to do things are in fact, a part of a larger structure of racism. I'm honored to have our guest, Dr. Deann Butler on today to share with you her recent research into defining structural racism, you will leave this conversation with a greater understanding of the different types of racism, how they pop up, how to recognize them, and particularly how we move forward with a shared understanding of structural racism, to create the change that we want to see in our healthcare system. Onto the show. 

Oh, well, welcome, Deann, I am just so excited to have the chance to talk to you today I have had the pleasure of being on Deann's podcast before The Healthcare Connector. And so I'm really excited to be able to trade places and learn a little bit more from you and have you share your wisdom with us. So if you can just kind of share a little bit with our audience about your, your background, your journey in healthcare and everything else you're doing and kind of where you're at right now.

Deann, CEO-Connected Consultants  2:40  
Yes, I've been in healthcare for a long time, I came out of college and just was one of those people that were lucky enough to get right into my field. So I worked in nonprofit, or the first part of my career actually, in reproductive health, I worked for Planned Parenthood for the first couple of years around delivering teen reproductive health and character building education. And they'll develop this team Peer Health program for them. And then I've done working there when I worked in and another nonprofit, and then I moved to health insurance. And I spent the bulk of my career there, really working with Medicare members, and I did a lot of care management helping to address those social determinants of health. We were on this front edge of like going into people's homes and doing assessments and addressing the social determinants of health. So way back in like 2008, before became a buzzword. So to do this, I did that for a while. Then I moved into the learning and development side. And so I began training nurses, and social workers how to do these assessments and how to do care management and build trust with members. I really enjoyed that. And then from there went to the healthcare startup, and if you've ever worked in healthcare startups, or thought about working, there's this entrepreneurial spirit, this bear because you're building something from the ground up. So everybody's there, because they liked like, bootstrapping it and, and building things from the very beginning. And so I did that for a while, but caught that entrepreneurial spirit and was like, I'm going to start my own consulting company. And so that's where connected consultants came from, although I always had the idea, because I found myself always working with really smart women, really smart people of color and us not knowing how to use our voice to make change within the organizations we were in. And so the original idea behind Connected Consultants was being able to collaboratively bring this knowledge together and go after consulting contracts or help others to start their own consulting business. And so that's what we do. We offer consulting services. We also work with women and people of color who wants to start a health care consulting business. And then we also have a podcast where we interview different people in healthcare that are examples of how they have used their knowledge and expertise to either make change, to monetize that expertise, and just use their voice.

Maggie, RNC-OB  5:16  
Oh, yes, well, I'm sure you can all understand why I wanted Deann to be on here to share with you because I feel like you just have such an interesting background and like the way you have been on like, all sides of healthcare delivery, and obviously a recipient of yourself as well, like, you'd have such a unique perspective and vision about, like, how all these things work. You know, throughout this whole season, we're talking about change makers, who are the changes agent out here? How are people working against all of these flaws and holes and gaps in you know, our healthcare system to make change. And, you know, there's this huge piece of this system we work within and like the way you've been able to see so many people who like they see their their moment, this is a way that I can push forward to change the way I can make something happen. And I think that's just so powerful. I have loved listening to The Healthcare Connector and hearing all these stories, and really just being encouraged by everyone's doing it. One of the reasons I wanted to have you come on and talk about this is just because I think you have seen through all the different things from Medicaid and example social and health from Planned Parenthood, like as we look at all of the ways that our, our systems and our structures are set up to to support people or not, and in particular, talking through your recent doctoral work, and Congratulations, Dr. Deann Butler. Yeah, we're just earning that I want you to maybe just dive in a little bit, talk to us a little bit about what led you to pursue your PhD? How did you pick your topic? How is that how do you want to want to, like, move forward with that, and then we'll dive deeper.

Unknown Speaker  6:43  
So it really is, you know, around what you mentioned about change. So I saw all of the different parts of healthcare and worked, you know, both member facing and behind the scenes. And I began to say that what research already told us that you can control for socio economics, you can, you know, control for things, but there are still these disparities. And so how do we address that, and my specialty is learning and development. So I went back to school to get my doctorate in healthcare administration, about went to the Medical University of South Carolina and their program, I went there, because their program is very applied. And so everything that you're learning, you're taught to go out and implement it immediately. And so I really liked that, because a lot of times in research, people will do these research projects, they will publish these papers, but we have this large gap in healthcare between the research that we do and actually applying it to the world we live in. And so that's what I didn't want to happen. And so I wanted to combine all of that my specialty in learning and development, and working with nurses and doctors and social workers, with all this information that I was learning about racism in healthcare. And then as I began to dive into this work, and this research on racism and healthcare, I found that there was a gap, which I think we'll talk about a little bit more. But we learned a lot about the interpersonal level of racism, which is how we interact with one another. So you know, we already know it's a faux pas a bad thing to say that people can't go to start businesses or to call people derogatory names. And so we've addressed that, and we've done a good job of researching it. And then there's this intrapersonal level, which social sciences like psychology and sociology and anthropology, they've done a good job of researching, that's all about how we internalize racism and how that can show up in health outcomes. But where the gap was, is that there wasn't a lot of research on institutional and structural racism. And so if you think about, even after doing all this research on interpersonal racism, interpersonal racism, you know, there have been some improvements in income equality and things like that. There's still health disparities. So what's going on there? And so what is going on? There are the structures at play, and how that perpetuates racism. And so I said, Well, what can I do? What literally what they tell us and when you're pursuing your doctorate is what little small thing you could do, because we all have these grandiose ideas that we're going to change the world. And so the small thing that I could do was to try to help us we come up with a shared definition of structural racism, because I truly believe that language matters, the words we use matter when we talk about this, and then on the latter part of that, eventually be able to build a training, because we're not preparing our healthcare professionals to go out and work constructively in the communities that they're serving. When they don't know this background and this information.

Maggie, RNC-OB  9:55  
Oh, yes. Oh, it's such powerful work. I'm so excited to have you be able to share With us more about this shared understanding, because I think, you know, we've talked obviously, the inequities in health care and Perinatal health care, the consistent and growing disparities, particularly for Black birthing people, when we look at, you know, perinatal outcomes, infant outcomes, like there's pieces when we talk about this, absolutely, we've acknowledged the role and importance of you know, bias trainings to understand you know, yourself more that interpersonal piece of it, and intrapersonal piece, how have you taken in all this stuff? And it is helpful and necessary to do that work. But where we have sometimes we've had like, we're having these conversations, we acknowledge it's so much more than that. It is that and it's all the other pieces of it, and understanding how how do we move the needle? How do we create change when we're talking about these big systems and like the structural piece of racism, especially over the last five years, we've had way different conversations as a nation about the impacts of structural racism, I think there is still a lot of confusion, maybe misunderstanding. So I'm wondering if you could maybe share with us like, what are a couple of the common misconceptions, maybe that you think folks have about structural racism? What it is or isn't?

Unknown Speaker  11:08  
Yeah, so I think, you know, the biggest myths, misconception is people don't know what structural racism is. And they use the words, sometimes you'll hear people say, institutional racism, sometimes you'll hear them say structural racism, sometimes you'll hear those but systemic racism, they don't know what words to use, and they don't know what they mean. And so I like to clarify that from beginning. And so part of this research project was going out and interviewing a bunch of different experts to come to this shared definition. And so it's important to know that institutional racism when we talk about that, we are talking about racism, confined within one institution. So we think about healthcare as an institution. There are policies and laws and practices that are within healthcare, that perpetuate racism. And when we think about the health care institution, we're talking about hospitals, practices, health plans, clinical research, and development, pharmaceutical, so all of those live within healthcare. So for institutional racism, it's the policy laws, processes, workflows within that institution. When we think about structural racism, this is where it gets more complex, and it gets harder. And if you've ever heard that analogy of the iceberg, and that's the top are all the things that you can see it's out there, it's easy to chip away at those at the bottom is structure. And that's that really hard. I mean, it's hard to break. And so that's structural racism and structural racism is the interaction of processes and policies and laws across all those institutions that perpetuate racism is what makes it hard to address is when we're thinking when you're thinking about it, you have to think about well, it's the policies and walls and health care, that then interact with policies and laws within housing, that then interact with policies and laws within finance or banking that then interact with was within the educational system. And these are all supporting each other, and keeping a dominant power in place. And so that's what structural racism is. That's what makes it more complex, more insiduous. So I think that it's not knowing what it means is a misconception. And then the other one that I'll call out because it came out a lot in the interviews was the this idea around awareness. And so a lot of times when we used to talk about structural racism, we would say it is just covert. So it's really hard to say, Well, what a lot of the people that I interviewed said, that's not the case anymore, because we're really well educated. And we've been having these conversations. So sometimes it is hard to see. And you can unintentionally, a process or policy can unintentionally harm a specific group. But sometimes if you trace that policy or process back, it wasn't covert, the people, the institution that implemented it knew what they were doing. And so that means it's overt. So structural racism can be both covert or overt. It's all about whether we make the decision to actually look at it and address it. Oh, yeah, that's right there. There. Yeah.

Maggie, RNC-OB  14:16  
So much there. Thank you. I think that's so helpful and absolutely, like a reminder to me about being precise about the language we use and how we're calling it out. Because I think that also contributes to that like covert overt conversation. I think sometimes folks want to perhaps hide behind the idea that like, this is a systemic issue. This is a structural issue. So it's kind of like it's beyond our control. It's so many things. And I think when we're using our language to clearly identify it, and to call it for what it is it makes it a lot harder for folks in power folks with malintent to like, try to hide behind policy.

Unknown Speaker  14:54  
Yeah, I think and you know, so it does make it harder to hide behind, but I also think of it out, you know, another thing that we heard is when you something that you that may make it easier is when you're thinking about structural racism, it kind of a little bit takes the onus off the individual. So people get really defensive when you're talking about this topic. And a lot of times you'll hear him say, Well, I'm not racist, no, no, like, I don't do these things. And so when we are talking about structure or institution, we're talking about an organization's policies and laws. And so that, it doesn't mean you don't have to do anything or that there's no like ownership there. But it takes it off of you, the individual did this thing. Whereas is the organization's or that structures, policies and processes and laws? And so I don't know, there's some people that thinks this a little bit easier to have the conversations, if you take it from this individual perspective to a more broader institution, structural perspective.

Maggie, RNC-OB  15:58  
Yeah, yeah. It's so interesting. So I think part of it is, gosh, I don't know if there's that piece of like, needing to have ownership of it. You know, and I say this, as a white woman who benefits from many of these systems in our country that are set up, people who look like me, like, there's a part of acknowledging, yeah, acknowledging that piece of it, knowing that piece of it, and absolutely agree with you, sometimes it is so much easier to like, have those conversations with people when you can kind of hold up like, oh, it's the it's the policy, we're trying to change, you're probably a great person. But the policies the issue, like sometimes I can help, like, get into those, those conversations. And, you know, we've also talked so much about like how, like, I struggle with how we have those conversations that also owns up to the fact that like people make policies in teams are made up of, of these large groups of people. And this is about racism, and also about, like so many other issues in perinatal. Yeah, we're on the podcast over the last couple of years, because it's so often it feels like, okay, that's not a you issue. It's a system issue. That's not a you issue. It's a policy issue. But also, these things are not inanimate objects, you know, they weren't made aware. So I don't know if you can dive into that. because I think that's something like we've talked about a lot and struggled with how we like help folks step into, like, agency and action.

Unknown Speaker  17:11  
I think that and maybe to clarify, in taking all the individual, I'm not saying that relieves you of your responsibility to address these issues to talk about these issues to to do something about them. I think for me more. So what I'm talking about is, you know, this idea when war people will be like, Well, I didn't make that policy, or you know that. So, no, you didn't, you as an individual didn't, or it may have been unintentionally done, but they're still ownership around the action that we have to take to address it. So I think that's more of what I'm talking about when taking like the individual aspect away from his and being able to say, Okay, I may not have implemented this policy, or I may not have known that it was going to have these unintentional effects. But I still got to do something about it. Yeah, still got to open my eyes and see that it's there. If I'm going to address it.

Maggie, RNC-OB  18:07  
Yeah. Oh, no, that's so important. I'm glad like you're calling out that piece of it. Because I think that's easy for folks to not take necessary steps forward.

Unknown Speaker  18:14  
When when you're talking about structural racism. And I went back and forth in my interviews with this feeling of, yes, there's something to do. And then also this feeling of not really hopelessness, but man, what can you do, because when you're talking about structural racism, it is complex, and it is insiduous and you're talking about multiple different institutions that somehow you got to corral all together to see these effects in order to actually change it. And I know, we'll talk about this action, how do we do this? It's not going to be easy. It's not going to happen overnight. I do think there are things that we can do. But it's definitely going to be hard, because we've never taken ownership across all these institutions of the things that have happened. Certain organizations have done things and, you know, one hospital will do something one bank may, you know, have a initiative, but to all come together. We haven't done that. And that's what it's going to take to address structural racism. They can't be scattered all about it's have to be a multifaceted approach.

Maggie, RNC-OB  19:24  
Yeah. Yeah. I appreciate that. I know when we talk about this, it is easy for it to feel really like it and overwhelming and like you said, I think folks vacillate between that feeling of like, yes, these are the things I do, and I'm gonna take action. I'm feeling like empowered by all of this. And then that feeling of just like, these are all the things I need to do. Yeah, move forward. I wonder I know, we've talked it every step. So we jumped to Meredith Strayhorn, who is a Black midwife, student and she has her she's really dedicated her whole career to like being the other side of it. How is she going to operate her practice so that there are not disparity so that at, you know, Black birthing people are centered in her practice and that you know their needs are met and that we she really just avoids altogether. Some of the just inherent like structural racism issues that have been present in perinatal health care. And I don't know if you know, in your I certainly know, you've spoken a little bit about like in your personal experiences, and then in your research did how this shows up in like perinatal care, which is one of the areas now that we see just such incredible disparities. Did that show up as you kind of examined like structural racism in that particular aspect of health care?

Unknown Speaker  20:31  
Definitely it has. And so I mean, so when we think about structural racism, one of the things that constantly came up as a way that it shows up is around access. One of those is like access to care, do people have access to the right facilities that are open at the right time that are staffed with the right type of people. And so that can definitely come up in perinatal care? I, you know, I think about myself, I am pregnant right now. And I wanted to find a OB GYN that looked like me. And it was hard to one, find one. And then because there is such low supply, find one that had an opening that was taking new patients, and that matters, and so forth, structurally, that access to care. And then when we think about how that is perpetuated across different institutions, so within healthcare, there's Do you have access to those facilities? Do you have access to someone that looks like you? So that moves into like the educational institution, because are we graduating doctors of color, those programs had their funding cut for HBCU, one of the things that our interviewees talked about was funding getting cut to HBCU, medical and like nursing programs, that were historically turning out a lot of doctors and nurses of color and medical professionals of color. So now that we don't have those that have reduced the number of people of color in those positions, which then made this harder for me to find a doctor that looks like me. So why does this matter? Because we know race concordance matters. And so race concordance means that I'll have better health outcomes, if the doctor looks like me. But if I don't have access to that, then what am I to do? And again, you can control for socioeconomic status, you can control for education, and that still doesn't matter. How does it show up anecdotedly. So again, I am with child, I suffer from severe morning sickness, I mean, the type where you don't get out of bed for weeks, and you end up in the hospital getting fluids. I've been told, for all of my pregnancies that it was something to deal with. It'll be over after the first semester, couldn't really find any help. It wasn't until I found a doctor that looked like me. That said, Deann, you don't have to suffer. Here's a medicine that you can take in Well, one of the medicines I heard about it. But here's another medicine that was a lot more expensive, but had never been offered to me before. She's like this, you don't gotta struggle anymore. She talked like me, she understood me, I felt comfortable sharing with her. And so my health outcomes change, I was able to get out of bed, I was able to go back to work, I was able to function. So that matters. So that's one way that structural racism shows up that we don't always think about, again, it's more, you know, insiduous, because it's not that those other doctors were providing less quality care. But I couldn't relate to them, or there was some bias there. And it wasn't until I had a doctor that look like me that improved my health outcomes. And so again, that goes all the way back to someone having access to the facilities that are staffed at the appropriate hours that have diverse employees that look like the community they serve. They've been educated on how to communicate with them. And so all of that together. 

Maggie, RNC-OB  24:09  
Oh, my Yeah, all of that

Unknown Speaker  24:11  
makes it a lot because you can't just address one part of that, you know, you can't just put a facility in a community and think that you've addressed structural racism because it's not just the facility being there so many other different parts of that story. Oh, my

Maggie, RNC-OB  24:27  
gosh, yeah. Yeah, thank you for sharing that, like personal experience that I think that absolutely illuminates this issue, like the micro level about how all of each of those pieces of structural pie from like you said, from the education system, and then the access in terms of like location and how neighborhoods are built and how where hospitals decide to put resources and you know, what areas attract which kind of physicians or other medical providers like there are so many elements of that, that tie into whether someone is able to function during their pregnancy,

Unknown Speaker  25:02  
yeah. So I'll add it in. So someone that able to function because I mean, I still had a good because I am still financially well off, I'm still educated I worked in healthcare, so I know how to advocate. So to me, it just made me think of all the people who are, you know, not as blessed, or I don't know how to advocate for themselves can't shop around and have the luxury to look for a different provider than to they find the one that they like, like what happens to them, they should not have a lesser version of a healthcare experience, just because of their circumstance. That may not be any fault of their own because of structural racism, right?

Maggie, RNC-OB  25:45  
Yes. Did you keep coming back to that? Absolutely. And I think that's where when we've talked about in the past, I think sometimes people want to people want to be, you know, dismissive or try to equate issues with poor perinatal outcomes, with socioeconomic factors with education levels, they want to try to pretend that that is the issue, instead of acknowledging the fact that this is something that is it's pervasive, even when we account for education levels, and socioeconomic status, and you know, support systems and all of these other things, it is still something that because of structural racism, shows up again, and again and again.

Unknown Speaker  26:19  
And I think, you know, so in doing this research, I interviewed nine different experts, they were all senior leaders within health care doctors for multiple years that are passionate about this topic. I mean, these were the people that you want to talk to about structural racism. And they had all had experiences of structural racism, where it didn't matter about their status or their education. So one other thing I love, tell the story so that we can move on. So we had interviewed a senior leader from one of the best medical teaching institutions in the world. And him and his wife got COVID. And they went out and they bought an oximiter, because they told us by oximeter, whereas if you have COVID, they get back home, and they open the oximeter. And they take out the instructions, and they read the fine print. And the fine print says this has not been calibrated for people of color. So it's only been calibrated to white scan. So be careful with the readings. So something as simple as a medical device does not work for people of color. So why does that matter where they would have gotten the wrong reading may not have known when they go to the hospital would have had a worse health outcome? Where did this stem from where there's not enough inclusion in people of color in clinical trials? Those clinical trials are not staffed by enough people of color. And so then you have these downstream effects of things like that. And so what are you to do this is like, you know, someone that's a very senior leader makes lots of money of a medical teaching institution, and here he is still affected by structural racism.

Maggie, RNC-OB  28:06  
It is unbelievable. Although I believe it is inconceivable that that's still 2022 Yeah, that that's where we're at with this. And like you said, that is even someone who, with all this knowledge with the understanding, even read the fine print, who even if they didn't know next steps to take now that he has that information, and what you know what he does with that, but how many people have have no idea whenever even they consider it aren't gonna know what that like travesty been travesty, how we have neglected to include, but also to center the needs of people of color the needs of people who have darker skin, within our medical research within our healthcare development, like Yeah,

Unknown Speaker  28:47  
so when you tell those stories, it does get it gets very aggravating, it is easy to get upset. But I do believe that there are actions that we can take as individuals, and as organizations to help move this forward. Again, it's gonna be a long road, it's not going to change overnight, but there are definitely things that we can do to address structural racism and healthcare. And that was also what I was able to walk away with from this research.

Maggie, RNC-OB  29:15  
Yeah, absolutely. Well, I, you know, I think as we think about this piece of it, and, you know, for all of us and for our audience spans folks who are, you know, clinicians within you know, within the perineal system outside and working in like community, you know, groups focusing and then obviously, we have like birthing people who listen here too. So, you know, we have this really like diverse group of stakeholders, who are all really motivated to see things change to see a different system is that is created that really honors that that like let's all of us work together from these different positions. We have the different power dynamics that we work with in different you know, ways that we interact with the world. So, are there are there pieces of it that you can share for your research that like, each of us can take or and maybe if it's helpful to differentiate where there are ones those of us who like work within a hospital system, if there's steps we take versus those of us who work more in, you know, out in the community that what that looks like.

Unknown Speaker  30:07  
Yeah, so I think it will be for both. And so the title of my research project was, let's get real. So I'll walk you through what real means. Because it's the four things that I think that you know, that we can do. And so when we think about the so the are in the Al, and real stands for resources and leadership. And so this is more on the organizational level that we need to advocate for leadership within organizations to address health equity. And these resources, the leadership are really decision makers. And so what what we want to do is change this concept around, okay, yes, we have a champion for diversity within our organization, or we have a chief diversity officer, this fits over in HR that doesn't have any power, we want to advocate for a role within our organization that has the same decision making ability as a CEO or a CFO. And so we had one of the participants in the interview, that you will KNOW IT organization is real about this, when they have a role that sits right next to the CEO and right next to the CFO, whose role is to look at every single policy, look at every single budgetary item and see who is intentionally or unintentionally hurt by these processes and policies and workflows. So if you see an organization doing that, or if you can get your organization to do that, then that's when you'll know that it's real. So this is different than what you have heard. Some other organizations that have come out with so for example, the American Medical Association, they came out just saying to have a champion within your organization, that that is not what we're asking for, can't be someone's added responsibility. They can't sit in like some outside department where they don't have any power, they need to be right within senior leadership and your senior leaders and your board needs to make health equity a priority when they tie health equity, to your financial outcomes to your bonuses to every single strategic goal that they would normally have, then that's when they are real about addressing health equity. So if you're in a position to advocate for that, and to look for that, then that's definitely what we want. If you are a leader in an organization, that that is thinking about having a chief equity officer or you know, medical equity, that we have to have all these different titles now for the roles, the advocate for them to be in a senior leadership position where they have real power. And then the second letter that we'll talk about is a so which is access. So advocating all of us can be advocate going out and advocating for increased access to care if you're in a state that has not expanded Medicaid. And so I happen to live with one of those states that you are advocating get involved in policy, one of the participants had a real powerful quote, she said, from the moment we stepped off the boat, we were not humans, we were policies. And so if we're going to address this, we have to address it at the policy level, which means you've got to get active in your local state and federal elections is not enough to go out and vote when it's time to vote for the president. I need you out voting when they are talking about the school board when they're talking about where municipal funds go when they are the state election. So getting involved in that advocating for increased access for diverse workforces. And so there are lots of organizations that have a DI diversity, equity and inclusion efforts. I encourage people to look at the makeup of the organization, but not just look. And I don't like saying lower levels. So entry levels, not just looking at entry level, but looking throughout the whole organization. So why does this matter? I work for a lot of organizations who've gotten diversity awards. But all of that diversity was bunched at the bottom. So it was entry level, first level managers. And so what we need to do is look at the diversity when you get to that director level and above. And a lot of times what you'll see his desk not where's that I know organization, that their percentage of that diversity was 25%, which is good. But when you looked at director level and above, it was 1%. And so that matters. Because again, those are the people that are making decisions around where you place your facilities where the budget isn't lined who's getting money to do different activities in the community. So if there's not someone that looks like the community at that level Who, then that's how we get unintentional things. Because even the best person in the world doesn't have the lived experience of someone else, they have to be able to see and connect. So advocating for that diverse workforce. And then the last one that I'm really passionate about is addressing the gaps in education. So if you are a healthcare professional, you need training. And not just this to say happy go lucky, but not just this surface level multicultural competency training, that's usually a standard buy from some accreditation organization that we've all had to take. Those are great, it's good to, you know, be culturally aware, that is not enough to have an understanding of how racism shows up in healthcare. And so we all need to have training. And so going out and taking trainings yourself or advocating for your organization to have training, I believe that these training should include information around the shared understanding of the terminology. So just the very basic level of training, you should be able to know the different levels of racism, and how that shows up. So we're talking about interpersonal racism, I should know that, okay, this probably shows up in patient communication. If I'm talking about internalized racism, then I should know that that may show up in how people exhibit mental health issues or behavioral health issues. So things like that, and knowing how institutional and structural racism show up that training, or what you should also educate yourself is on the historical context of racism, structural racism within healthcare. And so one of the things I talk about is, if we're going to train the J Marion Sims is the godfather of gynecology, then we also need to train the other side of that, that he got that information by researching on unconsenting enslaved black women. And so we need to tell both sides of the story, which I think that we have a tendency to not want to do right now in this country, we want to only want to gloss over things. And then the last thing is to make sure that we know that we're doing some self reflection, and understanding that this is going to take lifelong learning, you can't learn all this in one hour or understanding in one hour, you have to constantly be having these conversations with our co workers, with our families with our friends, we can't be scared to have the conversation and think that we can just push it onto the rug is still there. And so continuing to have these conversations. And so that's the E education. So we need resources, education, access, and leadership.

Maggie, RNC-OB  37:40  
Thank you so much. I think that it's so obviously everyone loves a good acronym or background Dilek spell out that so that we can have that sense of like checking through it. As we're having interactions with our patients as we're examining like our own personal practices, as we're thinking about how does this show up in in your community groups? You know, if you're a doula out there, how are you talking about this with your local? How are you connecting with folks? How are we having these conversations in kind of whatever your your community or your organization your institution looks like? Because this is something that has to happen, and it's going to look different? In all these pieces. I feel like continuing to understand that I know Dr. Deirdre Cooper Owens, her Medical Bondage book is such a powerful examination of the history of modern obstetrics, and think she does such a good job of grounding, what we see explaining a lot of those connections, understanding how this came up understanding like the legacy of SIMS and the like, because I think she does a great job of explaining how like, this is not you know what this was, again, not like one bad actor. Yes. Well, many folks who thought this was okay, who thought this was the way to do stuff. And so understanding like how all of that works together, and that is the underpinnings modern obstetrics.

Unknown Speaker  38:54  
And they're not taught that like, to me, it's just crazy that you would not teach this part because then at no fault of their own, you're releasing, you know, medical students, residents or whatever out into a community, and then they don't understand why that community doesn't trust them. They don't understand why that community may not keep their appointments or be adhere to certain medications, because they don't understand the historical context, because you didn't teach them. And, you know, that's where, again, the structural racism, so why don't you teach them because we don't want to talk about that, or whatever reason?

Maggie, RNC-OB  39:29  
Yeah, yeah, absolutely. No, you know, we always say, you know, we're trying to villainize one group like this is powerful. This is across as a nurse like this across the nursing education, you know, like we were trained up to be the handmaidens of these physicians who are doing this stuff. So that is very much incorporated into us. It plays out with doulas, like out in the community midwifery of any of these different roles, perspectives that come together and prenatal care-none that are immune to this. Now, you know, that's the structural piece like,

Unknown Speaker  39:55  
Yeah, I do go as far to say what I've advocated for is that every single person that we're works in healthcare. If you're in a health care profession, if you aren't coming in contact with any patient, if you're in the background making policies or processes, then you need training on how racism shows up in health care. Because you say, I mean, everything that we do in healthcare affects the patient. So you can't just train doctors because nurses interact with patients. Midwives do doulas do the person at the front desk. When someone comes into a doctor's office done, the people who write processes around billing and claims and collection, they need this education because structural racism has seeped into all of these different parts. So everybody needs it, if you want to be in healthcare, in my opinion.

Maggie, RNC-OB  40:42  
Yeah, no, absolutely. I mean, I obviously I, we've talked a lot about like how, you know, I think there are ways to change the system, like I don't necessarily think it all needs to be burned to the ground, but we need to do some serious work on the foundation, like, these are the things that have become the underpinnings of how we move forward. Like we cannot continue to build off of this without examining all of that. And I think it's truly like it's one of the things we need to see a racism in health care class in every education program for health care workers needs to have that has to be explicitly addressed in your in your doula training and your lactation training in any of these other you know, pieces that you get into because it just we can't get away with continuing to like think that we have skimmed over it, or we're post racial or that, like you said that a kind of cultural competency or bias training is like enough to understand how we make change on this level. And I obviously I like to keep diving into this, like you are such a wealth of information of this, but is there anything else from you know, from your research from your work that you want to kind of share with our audience as we like, as we move forward to,

Unknown Speaker  41:45  
you know, I would just say, you know, because I know this is perinatal maternal focus podcast, this is one of the areas that they are really doing the work that I you know, that I am proud of, there's not a lot of research on how you measure structural racism. And researchers in maternal fetal growth, what is it looked at, it looked at infant mortality and preterm births, they are one of the only place that I know that has looked at how you measure structural racism. And if we can measure it, and then we can find that we can figure out how to address it or what to address. And so I am very proud of this area of healthcare, because you are doing the work a lot more so than other areas. So I did see that in there. And just, you know, you all just educate yourself. There's a ton of information out there, read, talk, Congress conversate have the discussions.

Maggie, RNC-OB  42:46  
I would also add I'm sure you're familiar Dr. Karen Scott, her work with Birthing Cultural Rigor for everyone else is like looking to look into this more and the promo the scale that they developed to understand like patients reported experiences. obstetric racism in particular is like very, very powerful for understanding how this shows up in the perinatal space, in particular, for those of us who were like hearing this and feeling overwhelmed and wanting to understand that, that their research event did a lot to like, pull those pieces together on like the systemic level and how it shows up.

Unknown Speaker  43:15  
And then the last thing I'll say is one thing that I have tried to do is advocate for the accreditation organization. So if you work in health care, the organization you work for, is probably accredited by the Joint Commission or car or NCQA advocate for them to add a standard that requires just like they require multicultural competency training, advocate for them to add a standard for racism and healthcare training. I think that's the easiest way for us to capture most people in health care roles to get this type of training. So that that's what I would leave you with and just be on the lookout I am from this research. Our goal is to develop a training and so a summer fall of this year, we'll be working to develop this training that has all the components that are talked about, and then we will be releasing it to healthcare organizations that they can use

Maggie, RNC-OB  44:06  
with their staff. Oh, fantastic. I was hoping that's how you would be leaving this week because it is it is definitely needed. And I look forward to that. So well. Thank you so much. I am just honored to you for coming on and sharing so much of your work with us and helping us to develop more of a deeper understanding about structural racism and how racism shows up in perinatal care and I absolutely look forward to when your training comes out and something that we can push forward and advocate for folks to continue to delve in and take action and practices. Thank you

Unknown Speaker  44:33  
and you keep doing what you're doing these Conversations Matter. And again, that's that's how we begin change. So thank you for having this show and for bringing me on and for all the conversations that you have around perinatal care. I have learned a lot myself. It is helping me right now. So

Maggie, RNC-OB  44:53  
thank you, Deann. Thank you for being here and congratulations on your pregnancy wishing you all the best for your work. 

Deann, CEO-Connected Consultants  44:58  
Thank you 

Maggie, RNC-OB  45:01  
Well, I hope this conversation was as illuminating for all of you as it was, for me. I think it's helpful to be able to have these more concrete definitions and explanations of how we can identify structural racism and then take actions to change it. As Deann says, Let's get real. So as you go to take this out into your personal practice as you pull together the resources, education, access and leadership that is needed to change the landscape of perinatal care under the harm of structural racism, we invite you to join us and your birth partners community, where you can share with other like minded change agents on the journey. Till next time