Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / Doulas For All: How Senator Samra Brouk is changing birth in New York

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Doulas For All: How Senator Samra Brouk is changing birth in New York · Wellness, Actually with Emily Oster & Perry Wilson, MD

0:00
Speaker 1: This is parent data. I'm Emily Ost. When my daughter
0:07
Speaker 1: was born.
0:07
Speaker 2: When I was in labor, I had two people in
0:10
Speaker 2: the room most of the time, my husband and my doula, Molina,
0:15
Speaker 2: and if I had had to pick one, it would
0:17
Speaker 2: not have been close. At some point, my husband, who
0:23
Speaker 2: I want to be clear as a wonderful person, left
0:27
Speaker 2: to eat a bagel because it was covered in onions
0:29
Speaker 2: and he needed a break and was hungry. Molina did
0:32
Speaker 2: not take a break. She didn't go eat a smelly bagel.
0:35
Speaker 2: She sat in the shower with me and sprayed my
0:38
Speaker 2: back with warm water. She had me move into different positions.
0:41
Speaker 2: She encouraged me to push in different ways, and she
0:44
Speaker 2: was there when the baby came out after two and
0:47
Speaker 2: a half hours of pushing, which I definitely would not
0:50
Speaker 2: have been able to do without her support. She was
0:53
Speaker 2: there before the birth to help us get prepared, and
0:56
Speaker 2: she came afterwards. She was one of the first people
0:58
Speaker 2: when we got home to and tell me that, in fact, yes,
1:02
Speaker 2: the baby was swallowing, and I could stop freaking out
1:06
Speaker 2: quite so much. I had a doula because the evidence
1:15
Speaker 2: said that it was a good idea, and this is
1:17
Speaker 2: a place where both my own experience anecdotally, and the
1:21
Speaker 2: data really lines up.
1:22
Speaker 1: There's a tremendous amount.
1:24
Speaker 2: Of randomized trial evidence of other information that tells us
1:29
Speaker 2: that doulas can improve birth outcomes. They can improve birth outcomes,
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Speaker 2: especially for vulnerable groups. I have tried shouting many times
1:38
Speaker 2: from the rooftops, Hey, everyone should have a doula. It's
1:43
Speaker 2: cost effective, it would improve people's lives. Hey, people doulas.
1:50
Speaker 2: But one of the things about being a writer is
1:52
Speaker 2: that you just write this and.
1:53
Speaker 1: You hope people read it. You hope people do something
1:55
Speaker 1: about it.
1:57
Speaker 2: My guest today is one of those people who is
1:59
Speaker 2: actually doing things about this.
2:02
Speaker 3: State Senator Somer Bruke, who represents Rochester and the legislature,
2:05
Speaker 3: has been an advocate for DULA services. Brooke and others
2:08
Speaker 3: have repeatedly pointed to the life saving benefits of having
2:11
Speaker 3: these certified healthcare advocates during and after pregnancy. Brook says
2:16
Speaker 3: one positive takeaway for the Senator.
2:18
Speaker 2: Sama Brooke is a state senator in New York State,
2:22
Speaker 2: and one of the bills that she has pushed forward
2:27
Speaker 2: is a bill that will cover doula care for women
2:31
Speaker 2: in New York State un Medicaid as of January first,
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Speaker 2: twenty twenty four, Medicaid will cover dulas for births.
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Speaker 4: In New York State.
2:39
Speaker 2: It becomes one of thirteen states where that's true. The
2:42
Speaker 2: hope is that there will be more.
2:45
Speaker 1: Samara and I.
2:46
Speaker 2: Today talk about the importance of Doula's, about her own
2:49
Speaker 2: experience as a black woman working with ADULA and why
2:52
Speaker 2: she felt that was so important, and then we talk
2:55
Speaker 2: about how she convinced the other senators, not all of
2:58
Speaker 2: whom are themselves users of doulas, to actually pass and
3:03
Speaker 2: fund this legislation. She is a delight to talk to,
3:08
Speaker 2: and we get serious and we also get funny, and
3:10
Speaker 2: we talk about our personal stories, and it is refreshing
3:15
Speaker 2: to speak to someone who's doing the work out there.
3:18
Speaker 2: I hope you enjoy this conversation after the break, Senator
3:23
Speaker 2: Samra Brooke. Senator Samra Brooke, I am so thrilled that
3:39
Speaker 2: you're joining me. Thank you so much for being here.
3:41
Speaker 4: I'm so glad to be here with you.
3:43
Speaker 2: So, Senator, i'd love to ask you to just introduce.
3:45
Speaker 4: Yourself absolutely so, I'm Senator Samra Brooke. I proudly represent
3:51
Speaker 4: the fifty fifth Senate District in New York State. So
3:54
Speaker 4: that is the Rochester area in western New York for
3:57
Speaker 4: anyone who might be familiar, and some of the rounding suburbs.
4:01
Speaker 4: So that's my, you know, as you'd say day job,
4:04
Speaker 4: but I'd say probably my even more important job that
4:07
Speaker 4: I hold DearS also being mother to a near two
4:10
Speaker 4: year old little girl who definitely keeps me even busier
4:14
Speaker 4: than being a state legislator. And I also had the
4:17
Speaker 4: honor of sharing the Mental Health Committee in the state Senate.
4:21
Speaker 4: And as I've dubbed myself the resident DOULA advocate and
4:27
Speaker 4: champion in New York State.
4:30
Speaker 2: I'm really excited to talk about Doulah's because, as we've
4:34
Speaker 2: talked before, and this is something I think we both
4:37
Speaker 2: really believe in care about.
4:40
Speaker 1: I think it's crazy everyone is not obsessed with.
4:42
Speaker 2: So it's always fun to get to talk to someone
4:45
Speaker 2: else who loves the same thing that you love.
4:48
Speaker 1: Before we get into.
4:49
Speaker 2: The specific issue of doula's, I want to step back
4:52
Speaker 2: a little bit to maternal health challenges.
4:56
Speaker 1: I mean, this is something we've both thought a.
4:58
Speaker 2: Lot about, talked about different venues, and Black maternal health
5:04
Speaker 2: is a particular issue.
5:06
Speaker 1: If we look out at the data.
5:08
Speaker 2: Maternal health in the US is very poor relative to
5:12
Speaker 2: the world globally, Maternal health for black women in the
5:15
Speaker 2: US is appallingly bad, comparable to places that where the
5:21
Speaker 2: healthcare infrastructure is substantially worse. And so I'm curious coming
5:25
Speaker 2: from from your policy angle, and not even sure how
5:30
Speaker 2: to ask, like, how are we going to fix that?
5:33
Speaker 1: Maybe is like maybe is the first way I would
5:36
Speaker 1: ask it.
5:37
Speaker 4: I think about that question all the time, and I
5:40
Speaker 4: also think it's so important to share that. Certainly, I'm
5:45
Speaker 4: you know, privileged really to be in a position today
5:48
Speaker 4: where I can make policy decisions and write laws and
5:53
Speaker 4: you know, fight for budget resources every year. But this
5:58
Speaker 4: has been a problem for so long, and I just
6:00
Speaker 4: want to share a quick story because every time I've
6:02
Speaker 4: told people this, they've been just as shocked as I was.
6:06
Speaker 4: But I remember, so I worked in nonprofits, many nonprofits
6:09
Speaker 4: before I ran for office, and I remember being at
6:12
Speaker 4: this event that was supposedly around supporting moms and maternal health,
6:16
Speaker 4: and I just happened to be there. I think, you know,
6:18
Speaker 4: I was a nonprofit employee, so I think like a
6:20
Speaker 4: corporate sponsor had put it on or something like that.
6:22
Speaker 4: So we were attending and I remember seeing this graph
6:26
Speaker 4: that had maternal mortality. And up until that point, I
6:29
Speaker 4: think I was, you know, probably in my early mid twenties.
6:31
Speaker 4: It's not something I had thought about. Maternal mortality just
6:34
Speaker 4: wasn't in my vernacular. And I remember seeing this graph
6:36
Speaker 4: and it had the US at the very top for
6:40
Speaker 4: maternal mortality, which is a bad thing, right, that we
6:43
Speaker 4: have such a high rate of maternal mortality. And I
6:45
Speaker 4: kid you not, I believed so deeply and wholeheartedly in
6:48
Speaker 4: our healthcare system here in the US that I assumed
6:51
Speaker 4: this woman had the graph wrong. I assumed she had
6:54
Speaker 4: accidentally inverted it. And I said, that has to be impossible.
6:59
Speaker 4: And so I remember from that first shock that I
7:02
Speaker 4: had at this point that was over ten years ago,
7:05
Speaker 4: to now being in a position where I'm digging deeper
7:08
Speaker 4: into it, not just on a national level, but in a
7:12
Speaker 4: state level and then in a local level as well,
7:15
Speaker 4: and just realizing that this is something that's not getting better.
7:19
Speaker 4: And so I, you know, I may be biased. I
7:22
Speaker 4: came into office because I'm trying to change so many
7:24
Speaker 4: of these things. So I do believe that through policy decisions,
7:29
Speaker 4: we can write the ship on these things. And we
7:32
Speaker 4: have seen very modest improvements based on policies that we make.
7:38
Speaker 4: And so when you ask the question, right, how do
7:41
Speaker 4: we change this, there's we'll get into more detailed reasons
7:45
Speaker 4: but or ways to do it. But I think at
7:47
Speaker 4: the very thirty thousand foot view, there are policy decisions
7:53
Speaker 4: that we can make that can make it easier for
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Speaker 4: birthing people and their partners to go through this prout
8:00
Speaker 4: process to have access to quality care. Right, we can
8:03
Speaker 4: do things like that. And then on the other hand,
8:06
Speaker 4: what we can do is we can actually fund things
8:09
Speaker 4: that are working. And so we have been able to
8:12
Speaker 4: identify positive trends when it comes to maternal health and
8:16
Speaker 4: maternal health outcomes, and in many ways it's incumbent on
8:20
Speaker 4: us every budget cycle and we're in a budget cycle now,
8:24
Speaker 4: every budget cycle to continue to fund things that are
8:27
Speaker 4: working and to increase funding for things that could have
8:30
Speaker 4: an even greater and more positive effect.
8:34
Speaker 2: This is where for me, we can see some of
8:37
Speaker 2: the on the ground value of data, because that is
8:41
Speaker 2: how we figure out what's working. And if we think
8:43
Speaker 2: about a budgeting cycle, which is you know, I'm an economist,
8:48
Speaker 2: everything is constrained optimization. Every dollar that you spend on
8:52
Speaker 2: one thing is a dollar you're not spending on something else.
8:54
Speaker 2: So figuring out what are the interventions that are going
8:58
Speaker 2: to work the best is part of that challenge. I
9:02
Speaker 2: actually think it's a very frustrating part of that challenge
9:05
Speaker 2: because when you step back and you think, we're talking
9:07
Speaker 2: about people dying in childbirth, we're talking about something which
9:11
Speaker 2: we should be willing to spend.
9:13
Speaker 1: All of the money on. Like what are you what
9:15
Speaker 1: are you saying that? Like we have to find that
9:17
Speaker 1: the small number of things that work, why don't we
9:19
Speaker 1: do all of the things? And that, of course is.
9:21
Speaker 2: Not the that is not the political reality, but I
9:24
Speaker 2: can imagine that piece of it must frustrate you sometimes.
9:27
Speaker 4: Also, Oh frustrates me all the time. And you know,
9:31
Speaker 4: I think one of the things is I'm three years in.
9:35
Speaker 4: I guess this is my fourth legislative session that I'm starting,
9:39
Speaker 4: So this has not been the bulk of my career.
9:41
Speaker 4: So my brain still works very logically the way everyone
9:44
Speaker 4: else does. Before you get into.
9:46
Speaker 2: They haven't sucked you in yet, not some kind of disaster.
9:50
Speaker 4: Not yet, and people are waiting for it. They're waiting
9:53
Speaker 4: to say, Okay, oh, you know, albody's going to get
9:55
Speaker 4: to you, and I said, no, always is not going
9:57
Speaker 4: to get to me. And so I can say this
10:00
Speaker 4: as I still consider myself somewhat of an outsider, right
10:03
Speaker 4: because I spent more time doing other things in my
10:06
Speaker 4: career than I have in this part of my public career.
10:09
Speaker 4: So I still think like that too, And I remember
10:11
Speaker 4: being faced with those questions, and to be very frank,
10:14
Speaker 4: a lot of those questions came up in last year's
10:17
Speaker 4: budget in New York, where I nearly changed my middle
10:21
Speaker 4: name to Doula because every room I was in I
10:25
Speaker 4: was I mean, I won't say I was yelling, but
10:27
Speaker 4: I was speaking very sternly and assertively and sharing my
10:31
Speaker 4: data points and you know, making sure that people understood
10:36
Speaker 4: how important these policies were and how important this funding was.
10:41
Speaker 4: And one of the things I'll say is that I
10:45
Speaker 4: think that it is easier to ignore this topic when
10:49
Speaker 4: you don't have a black mother, like new Mom, black
10:54
Speaker 4: woman legislator in the room fighting for it. You couldn't
10:57
Speaker 4: tell me it wasn't worth it, couldn't tell me that
11:01
Speaker 4: it doesn't work, because I had experienced what some of
11:04
Speaker 4: these interventions can do to promote healthier outcomes for me
11:07
Speaker 4: and my daughter. So I mean none of it comes easy, definitely,
11:12
Speaker 4: and it's always you know, trade off when it comes
11:16
Speaker 4: to policy and obviously budget decisions. But I think we
11:21
Speaker 4: have to always consider where have we historically ignored and
11:26
Speaker 4: where have you historically not funded and thought about the
11:30
Speaker 4: outcomes for certain people? Because we have a lot to
11:33
Speaker 4: make up for, and I think about that a lot,
11:34
Speaker 4: like I have ten twenty years to make up for
11:37
Speaker 4: when it comes to maternal mortality and especially when it
11:39
Speaker 4: comes to black mortality.
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Speaker 1: Yeah, and I think.
11:42
Speaker 2: I mean the maybe the slightly positive frame on that
11:46
Speaker 2: is the fact that we haven't spent any time thinking
11:47
Speaker 2: about this investing in it means that there are things
11:50
Speaker 2: we can do that there's maybe there's a little low
11:53
Speaker 2: hanging fruit or low ish Oh, So let's talk about
11:57
Speaker 2: duelist because I think it is an example of some
12:00
Speaker 2: effectively low hanging fruit if we could just get it done.
12:04
Speaker 1: So let's just start by, like, can you give me
12:07
Speaker 1: the rundown on what a doula is?
12:10
Speaker 2: Explain it to me, Like I am a sixty seven
12:13
Speaker 2: year old male legislator from upstate.
12:18
Speaker 4: I have a lot of experience with just that, Like
12:20
Speaker 4: that's a good audience for you. This is most of
12:24
Speaker 4: my even my family gatherings all time. I've heard you
12:26
Speaker 4: on the radio. Again, what is this doula you're talking about?
12:30
Speaker 4: So first you know, the basic definition of a doula
12:36
Speaker 4: is these are non clinical. And I want to be
12:39
Speaker 4: clear that people understand that because this was actually a
12:41
Speaker 4: question that I got just at a grocery store actually
12:44
Speaker 4: a couple months ago. A constituent came up and asked
12:46
Speaker 4: me and said, you're not going to use an ob anymore,
12:48
Speaker 4: or you're not going to use a midwife here, And
12:51
Speaker 4: I said, doulas are non clinical, so they are in
12:53
Speaker 4: addition to your regular medical team. Just so that we're
12:56
Speaker 4: all clear. So they're non clinical providers that offer physical, emotional,
13:01
Speaker 4: and informational support both to the birthing person and the partner.
13:07
Speaker 4: And this support can occur before, during, and after childbirth.
13:12
Speaker 4: And so a quick example is, for example, for myself,
13:15
Speaker 4: I hired a doula. I think I was probably sometime
13:19
Speaker 4: in my second or third trimester. We did a lot
13:22
Speaker 4: of birth education and met and talked about birthing plans
13:27
Speaker 4: and all of that, and then she was there continuously
13:30
Speaker 4: during my birthing process and then afterwards, she was one
13:33
Speaker 4: of the first people to you know, check in on
13:36
Speaker 4: me and make sure we were doing okay postpartum.
13:39
Speaker 2: So there's like two ways we could talk about there
13:41
Speaker 2: are many ways you could talk about dulas. So one
13:43
Speaker 2: is what this is like, and one is what the
13:47
Speaker 2: data says. So I want to start with, like, what
13:49
Speaker 2: is it like? I mean, you had a doula. You
13:52
Speaker 2: want to tell me about your experience? You tell you,
13:54
Speaker 2: you tell yours, I'll tell mine.
13:56
Speaker 4: Yeah, let's do it. It's literally my favorite thing to
13:59
Speaker 4: talk about birth stories. Do list stories. So the best
14:03
Speaker 4: way I could describe it and specifically for me, what
14:05
Speaker 4: I was looking for is and I interviewed several people
14:09
Speaker 4: for a do to see who would be a good
14:11
Speaker 4: fit right, because anyone who knows me knows that's very
14:15
Speaker 4: on par with who I am is I want to
14:17
Speaker 4: make sure I have the best right for this little
14:19
Speaker 4: child and bringing into the world. And so I interviewed
14:22
Speaker 4: several people and I really thought about it, as listen,
14:25
Speaker 4: I know I am a very strong old person. I
14:27
Speaker 4: know you know I have very you know I know
14:30
Speaker 4: what I want when it comes to this birth plan.
14:33
Speaker 4: But I also knew enough about quite honestly, maternal mortality
14:38
Speaker 4: and what I might encounter as a black woman in
14:40
Speaker 4: that hospital that I knew I needed someone who would
14:43
Speaker 4: stand up for me, and that was really important to me.
14:46
Speaker 4: I have a very very supportive partner, but this is
14:49
Speaker 4: also potentially traumatizing for him to have his partner, you know,
14:52
Speaker 4: and all this pain and going through this process. So
14:54
Speaker 4: for me, it was really important to have someone who
14:56
Speaker 4: I knew could really stick up for me with my
14:58
Speaker 4: medical team, and who could quite honestly give me hard
15:02
Speaker 4: truths that I might need to understand because my goal
15:06
Speaker 4: at the end of the day was to walk out
15:07
Speaker 4: of the hospital healthy with a healthy baby. That was
15:10
Speaker 4: my goal. And for so many black women like me,
15:15
Speaker 4: instead of worrying about the colors and the nursery and
15:17
Speaker 4: what kind of crib and what kind of cute nursing
15:20
Speaker 4: tops we want to buy, we are faced with the
15:25
Speaker 4: fact that in New York State, we no matter how
15:29
Speaker 4: much money, how much education you have, it doesn't matter,
15:32
Speaker 4: we are still five times more likely to die in childbirth. So,
15:35
Speaker 4: you know, I think a lot of people understand maternal
15:38
Speaker 4: mortality is bad in the US. It is worse for
15:40
Speaker 4: black and brown women, and so here I am a
15:43
Speaker 4: legislator working on these policies, and my day job tremendously
15:48
Speaker 4: you know, fearful, you know every night when I'm thinking
15:52
Speaker 4: about how I'm going to go through the process. So
15:54
Speaker 4: really having someone that I could build rapport and trust
15:57
Speaker 4: with was really crucial for me. So before I went
15:59
Speaker 4: in to the hospital, what that support looked like is,
16:02
Speaker 4: you know, I remember, I still have piles and piles
16:05
Speaker 4: of paper, not paperwork, but reading material that my doula
16:10
Speaker 4: gave me, lactation support, an app Gar score, what's that?
16:15
Speaker 4: Which I know you've probably covered in a million other ways,
16:19
Speaker 4: things that you know, most people have no idea what
16:21
Speaker 4: these are. And she we actually did like a four
16:24
Speaker 4: hour private lesson four hours where we were on zoom
16:30
Speaker 4: because it was still kind of COVID times, and you know,
16:32
Speaker 4: my husband and I sat on the couch and we
16:33
Speaker 4: sat with this doula, our doula, and she educated us
16:37
Speaker 4: about all these things that we should be expecting, things
16:42
Speaker 4: that we should you know, plan for the understanding that
16:46
Speaker 4: a birth plan is just that it's a plan. It's
16:48
Speaker 4: a wish. You never know what's going to happen. And
16:51
Speaker 4: so that was that was really needed for me, you know.
16:55
Speaker 4: I remember one day, I was feeling very panicky, and
16:58
Speaker 4: I was starting to get very nerve, and I felt
17:00
Speaker 4: like something was going on with a baby. And for
17:03
Speaker 4: many of us, we don't have, you know, an on
17:05
Speaker 4: call doctor or nurse at all times. It's really hard
17:08
Speaker 4: in our current healthcare system. And so who did I
17:11
Speaker 4: text at eleven o'clock at night, My do la? And
17:15
Speaker 4: who answered me at eleven o'clock at night, My doula,
17:17
Speaker 4: and she, you know, quickly assessed kind of how I
17:20
Speaker 4: was feeling. And that was the point where I trusted
17:22
Speaker 4: her to tell me, you should really call the nurse
17:25
Speaker 4: hotline at your OB's office, or why don't you try this,
17:29
Speaker 4: like here's some breathing exercise, to have some water, tell
17:31
Speaker 4: me about what happened today, what might be happening, you know.
17:34
Speaker 4: And so having that support and then going into the
17:37
Speaker 4: birthing process was really helpful because I was essentially bringing
17:41
Speaker 4: this second person who I had such a close relationship
17:44
Speaker 4: with and who had experience at the hospital with these nurses,
17:48
Speaker 4: with these doctors, and so it was just it was
17:51
Speaker 4: an incredible support and I know, we'll get to the
17:55
Speaker 4: data and I'm like itching to get there because I
17:57
Speaker 4: love sharing the data with people because it all sounds nice, right,
18:01
Speaker 4: it's all anecdotal, and you know, I didn't have a
18:04
Speaker 4: perfect birthing experience, but my doula helped me get through
18:07
Speaker 4: it so that I didn't feel so bad about the
18:10
Speaker 4: fact that it didn't go the way I had planned.
18:12
Speaker 4: But also that all feeds into the data that actually
18:15
Speaker 4: shows overall that they improve maternal outcomes.
18:23
Speaker 5: After the break more parent data.
18:40
Speaker 2: Yeah, let's get to the data, and then I want
18:41
Speaker 2: to come back to how what you were saying about
18:44
Speaker 2: the personal experience kind of feeds into the data, because
18:47
Speaker 2: I think part of what's so interesting about this data
18:49
Speaker 2: is how much data we have on efficacy, but actually
18:53
Speaker 2: how little in some ways we have about mechanisms, which
18:56
Speaker 2: isn't really important for policy, but it's an interesting question
18:59
Speaker 2: to think about, what is it about that relationship that
19:02
Speaker 2: you had that delivers these these outcomes. So let's put
19:06
Speaker 2: a pin in that piece and come back to it
19:08
Speaker 2: after we talk about the data. So you give me
19:11
Speaker 2: you want to give me your your data, and then
19:13
Speaker 2: give me your data. I can see if people this
19:15
Speaker 2: is mostly audio, and so people are not gonna be
19:17
Speaker 2: able to see that. You're basically like in the camera,
19:20
Speaker 2: and I feel like if I talk first, we're going
19:22
Speaker 2: to be in trouble.
19:23
Speaker 1: So please come out of your camera and do the data.
19:26
Speaker 4: Well, listen, now, I'm a little nervous, right, Like this
19:29
Speaker 4: would be like you coming on and like writing a
19:31
Speaker 4: bill in front of me, or we're.
19:33
Speaker 1: Trying to talk to some of these senators. Yeah, why
19:36
Speaker 1: are you so loud?
19:37
Speaker 4: So I mean, here's what I'll say, and then you
19:39
Speaker 4: go because the truth is, like you are the data person.
19:42
Speaker 4: But the overall because you know, what we were looking
19:46
Speaker 4: at is things like reducing a C section rate so
19:51
Speaker 4: to sarian sections, right, they reduce those, the length of labor,
19:55
Speaker 4: they can reduce that, they reduce even Here's an interesting
20:00
Speaker 4: one for New York that I'll share from my perspective
20:05
Speaker 4: is in New York State, we do have a Maternal
20:08
Speaker 4: Mortality Review Board and they do review outcomes. And one
20:14
Speaker 4: of the things that we found is that discrimination actually
20:20
Speaker 4: can be has been identified as a large contributor to
20:26
Speaker 4: some of the pregnancy related deaths. So in forty six
20:29
Speaker 4: percent of all pregnancy related death discrimination was identified as
20:32
Speaker 4: a probable or definitive circumstance surrounding the death. So when
20:37
Speaker 4: you look at something like that, we also know that
20:40
Speaker 4: doulas can really interrupt that discrimination. And so, you know,
20:45
Speaker 4: when I talked about being a black woman in this process,
20:49
Speaker 4: I had to think about things like my pain is
20:53
Speaker 4: not seeing the same as a non black woman. I
20:57
Speaker 4: also had to think about things like my black husband
21:00
Speaker 4: bind if he were to get assertive on my behalf,
21:04
Speaker 4: that may be perceived through un you know, implicit bias
21:07
Speaker 4: that may be perceived differently than someone else's partner. And
21:12
Speaker 4: so when I look at some of the things that
21:14
Speaker 4: DOS do, that was one of the things that this
21:16
Speaker 4: woman was able to do is interrupt and really show
21:20
Speaker 4: up in you know, to intervene where those potential points
21:24
Speaker 4: of contention could have could have been created. So those
21:27
Speaker 4: are like overall things that we see, and specifically when
21:30
Speaker 4: you look in New York data, it's really alarming that
21:34
Speaker 4: that's nearly fifty percent of all debts they cited discrimination.
21:39
Speaker 4: So when we talk about the fact that overall deaths
21:43
Speaker 4: seventy eight percent of them were preventable in New York State,
21:47
Speaker 4: you start to see why we say, okay, you know,
21:50
Speaker 4: adding a doula to this birth, birthing and care team
21:54
Speaker 4: really could make a difference. And I'll shoot it back
21:56
Speaker 4: to you because now I want to hear the rest
21:57
Speaker 4: of your data.
21:58
Speaker 1: Yeah.
21:58
Speaker 2: So, so the data piece of this I find so
22:04
Speaker 2: interesting and compelling is okay, So when we think about
22:10
Speaker 2: data like this, I think people have this in mind,
22:12
Speaker 2: like I'm going to.
22:12
Speaker 1: Compare people who have a duela and people who don't.
22:14
Speaker 2: And see differences in birth outcomes, and that approach would
22:17
Speaker 2: be terrible because, of course, it is still the case
22:20
Speaker 2: that richer people are more likely to have dulas and
22:24
Speaker 2: their birth outcomes are better for other reasons.
22:27
Speaker 1: What's amazing about.
22:28
Speaker 2: These data, though, is that we have large scale, randomized
22:32
Speaker 2: studies in which we can see that women who are
22:35
Speaker 2: randomized to having a doula have better birth outcomes. Less
22:39
Speaker 2: use of cesarean sections, less use of epidurals, typically higher
22:43
Speaker 2: UPGAR scores, is a bunch of other things that point
22:46
Speaker 2: in that direction, and some of that evidence is just
22:50
Speaker 2: from women who are assigned.
22:52
Speaker 1: Dulas at the hospital.
22:54
Speaker 2: Like you show up, You've never had any of this
22:56
Speaker 2: back end support that you're describing. It's just come to
23:00
Speaker 2: the hospital and they're like here's this extra person and
23:02
Speaker 2: still that has a positive impact.
23:05
Speaker 1: The other piece of it, the data that I love, is.
23:10
Speaker 2: That there's a there's this randomized trial in which what
23:13
Speaker 2: they do in the treatment group is they ask people
23:15
Speaker 2: to find a friend. So they actually ask them like
23:18
Speaker 2: pick a female friend, and we'll give them some basic
23:21
Speaker 2: DULA training, like some basic training and what to do,
23:23
Speaker 2: and they see that that improves outcomes. So having a
23:28
Speaker 2: like taking a friend, giving them a little bit of
23:30
Speaker 2: training and how to be supportive, how to be you
23:33
Speaker 2: know there whatever these ways are that that turns out
23:36
Speaker 2: to have a higher app CAUR scores trending towards a
23:41
Speaker 2: lower SA section rate. So there's a bunch of things
23:43
Speaker 2: on this which make you think many ways.
23:46
Speaker 1: To look at it.
23:48
Speaker 2: There are positive benefits and and then people are happy,
23:51
Speaker 2: And I guess that's the piece.
23:52
Speaker 1: Like don't about these data.
23:55
Speaker 2: We're always like and then it costs less, which we're
23:56
Speaker 2: going to get into because it does cost less. But
23:59
Speaker 2: when you call people later, they're happier with the experience,
24:03
Speaker 2: and like that's.
24:05
Speaker 1: Like that matp that really matters.
24:08
Speaker 2: I mean, all these things matter, but that that's like,
24:10
Speaker 2: you know, we don't want to forget that that also matters.
24:13
Speaker 4: Yeah, and I'm so glad you brought that up, because
24:15
Speaker 4: you're right, I think so often and of course as
24:17
Speaker 4: a legislator, I understand, you know, the dollars and cents
24:20
Speaker 4: of it all, and so being able to tell a
24:22
Speaker 4: hospital or even an insurance company, hey, you know, here's
24:26
Speaker 4: a plug for the rate I think they should be
24:28
Speaker 4: getting as nineteen thirty you know, on thy nine hundred
24:30
Speaker 4: and thirty dollars per birth is what I think it
24:32
Speaker 4: should be. It's a little bit lower with the Medicaid
24:34
Speaker 4: rate in New York State, but it's something. But either way,
24:37
Speaker 4: either of those numbers is less than paying for an
24:41
Speaker 4: entire cesarean, or is less than an extra day in
24:44
Speaker 4: the hospital, right, because duelis can also lower the length
24:48
Speaker 4: of or decrease the length of labor. But aside from
24:52
Speaker 4: all of that, you're absolutely right, it's also about the joy.
24:56
Speaker 4: And this is actually something that has come up a
24:59
Speaker 4: lot in the doulah community in New York State, and
25:02
Speaker 4: we have a lot of what we call community doulas,
25:05
Speaker 4: and community doulas are really those who are really rooted
25:08
Speaker 4: in their own communities, right, so they're not necessarily someone
25:12
Speaker 4: like you mentioned. You know, if you're very wealthy, you
25:14
Speaker 4: could fly out a doula from you know, California or
25:16
Speaker 4: wherever you are. And no, but these people are actually
25:19
Speaker 4: rooted in the community. They're more reflective of the language
25:24
Speaker 4: and culture and race and ethnicities that are in that community.
25:27
Speaker 4: And we talk a lot. So it's a lot of
25:30
Speaker 4: black and brown women, and we talk a lot about
25:32
Speaker 4: how the joy has been stolen from childbirth. And even
25:36
Speaker 4: in the way we talk about it, we talk about
25:38
Speaker 4: black maternal death, we talk about black maternal mortality. Even
25:42
Speaker 4: the talking about that the ripple effects are it's creates
25:46
Speaker 4: this kind of secondary trauma to women who have not
25:48
Speaker 4: experienced the trauma like myself, who can imagine it so
25:52
Speaker 4: clearly because of how much it's talked about. So I
25:55
Speaker 4: love that you talked about the actual joy and how
25:57
Speaker 4: you feel when you leave that hospital or the birthing
26:00
Speaker 4: center with your child. Because what we also know is
26:04
Speaker 4: what's the number one most common pregnancy complication, at least
26:07
Speaker 4: in New York State. It's maternal mental health conditions and so,
26:11
Speaker 4: and that's more right than postpartum depression. There are a
26:13
Speaker 4: plethora like I didn't know you could get OCD on
26:17
Speaker 4: set high anxiety postpartum, and so all of these things
26:22
Speaker 4: are working together, right because we're not siloed human beings
26:25
Speaker 4: that we can compartmentalize. Okay, this was the physical part
26:27
Speaker 4: of birth. Now that's over. I'm going to go home
26:29
Speaker 4: and be a different person. That's not how it works.
26:32
Speaker 4: And so and I share that you know about my
26:34
Speaker 4: story that it did not go according to plan. I
26:36
Speaker 4: was in the hospital for four days, did not expect
26:38
Speaker 4: to be there for four days. And yet I felt
26:43
Speaker 4: more positive actually about my experience because I had a
26:48
Speaker 4: doula that at least I understood what was happening along
26:51
Speaker 4: the way. And you know, if we want to talk
26:54
Speaker 4: about this decrease in cesarean rates, I saw it in
26:57
Speaker 4: action because I was a blink away from getting an
27:00
Speaker 4: emergency C section. And my DULA is the one who
27:02
Speaker 4: intervened and allowed you to have the birth that I
27:05
Speaker 4: wanted to have with my child. So you know again
27:07
Speaker 4: that just leaving and I think you said this right
27:10
Speaker 4: like at the end of these trials, and we did
27:13
Speaker 4: the same thing with our DULA pilot here in Erie
27:15
Speaker 4: County in New York, where we asked these questions, and
27:19
Speaker 4: one of the major pieces of data was satisfaction higher
27:22
Speaker 4: satisfaction with the birthing process when you had a dula.
27:27
Speaker 2: And I think it is worth noting that in the
27:30
Speaker 2: great swath of human history, this is a thing people had,
27:35
Speaker 2: right the sort of maybe in call it dula's will.
27:37
Speaker 2: Actually doula is a Greek, very old Greek word, but
27:41
Speaker 2: you know, people would have babies surrounded by other women
27:45
Speaker 2: who had done this before, and so that idea of
27:49
Speaker 2: a support person is doesn't seem crazy.
27:52
Speaker 1: And then of course after you have the baby, there
27:53
Speaker 1: was a support person. And we've sort of moved into a.
27:55
Speaker 2: World that's like much more much more sort of single nucular,
27:58
Speaker 2: family based, much less community based, and I think some
28:01
Speaker 2: of that gets some of that gets lost there.
28:05
Speaker 4: Yeah, so where's talk.
28:07
Speaker 1: About who's got this new fangled doula idea.
28:09
Speaker 2: It's like, well, cave people came up with it, and
28:12
Speaker 2: so we're just sort of like continuing the trend from
28:15
Speaker 2: the cave.
28:16
Speaker 1: When we used to use this.
28:18
Speaker 4: Literally there's you know, there's everyone's talking now, Like you
28:22
Speaker 4: just said, right, there was this village and you know
28:25
Speaker 4: a lot of millennial parents and we're all like where's
28:27
Speaker 4: our villains? Where's right? And where did it go? What
28:30
Speaker 4: happened to it? Can I get it back? But you
28:33
Speaker 4: know this is you know, this is probably another podcast
28:37
Speaker 4: worth of uh you know, gripes here about how we've
28:40
Speaker 4: really changed how childbirth is supposed to be right. For
28:47
Speaker 4: so long, like you said, you had your supports, you
28:50
Speaker 4: had your people. It wasn't this super medical experience. Now
28:54
Speaker 4: it is right. And what I hope that we can
28:59
Speaker 4: do both kind of on the level of society, and
29:03
Speaker 4: of course, you know, until we get there in our
29:06
Speaker 4: collective consciousness, I'll keep passing bills to force us into
29:10
Speaker 4: that shift. But you know, I hope we learn to
29:14
Speaker 4: take what worked right. Obviously, there are many things that
29:18
Speaker 4: are helping mothers and babies live, birthing people and their
29:22
Speaker 4: children live longer and have better outcomes. And there's you know,
29:26
Speaker 4: science and there's so many great things out there, but
29:28
Speaker 4: we can't forget some of the very basic kind of
29:32
Speaker 4: it's almost like human connection if you think about it, right,
29:35
Speaker 4: the data you had about just having a friend. We
29:37
Speaker 4: can't forget some of the very very simple things that
29:40
Speaker 4: worked and as we put them into a modern society.
29:43
Speaker 4: Now I'm getting on my soapbox. For real, As we
29:45
Speaker 4: put them into a modern society, we have to fund
29:49
Speaker 4: them the way we fund every other part of the
29:52
Speaker 4: birthing world.
29:53
Speaker 2: Okay, so let's talk about this funding piece, because I
29:55
Speaker 2: think one thing I will say, and I will and
29:57
Speaker 2: then I want you to tell us about your legislat
30:00
Speaker 2: I think one of the things that's most striking for
30:03
Speaker 2: me is dulas are often not covered by insurance, and
30:07
Speaker 2: they are often definitely often not covered by public insurance,
30:10
Speaker 2: which is the insurance that many people who most need
30:13
Speaker 2: a doula have, so duelers are not typically covered by Medicaid.
30:18
Speaker 2: There is a cost effective argument for dulas to be
30:21
Speaker 2: covered by medicaid, which is that if you reduce the
30:24
Speaker 2: c section, if you reduce the time in the hospital
30:26
Speaker 2: that those time, that time is very expensive and so actually,
30:29
Speaker 2: in principle you might well break better than even you
30:34
Speaker 2: might make money by paying for everybody to have a doula,
30:36
Speaker 2: which I mean is just like like it's it's.
30:39
Speaker 1: Free free money.
30:40
Speaker 2: Free money is so rare, the money tree is so
30:42
Speaker 2: rarely giving out it's free money. And so tell me
30:45
Speaker 2: about your legislation.
30:47
Speaker 4: Yes, so it's actually a whole package of legislation, because
30:52
Speaker 4: of course it's not you know, you can't do everything
30:53
Speaker 4: in one bill. But basically what we started was a
30:59
Speaker 4: couple of years yars ago. We started with a work
31:01
Speaker 4: group that would essentially have the Department of Health decide,
31:05
Speaker 4: you know how much and really study, you know, how
31:08
Speaker 4: much should adula reimbursement be. And the reason we started
31:12
Speaker 4: there is because in New York State about forty six
31:16
Speaker 4: percent of births are covered by medicaid, and so we thought,
31:20
Speaker 4: what better way to really jump start this right than
31:24
Speaker 4: have the Department of Health really figure out how much
31:27
Speaker 4: this reimbursement would look like through Medicaid. And then what
31:30
Speaker 4: happens a lot of times in states is once Medicaid
31:33
Speaker 4: has a rate, commercial insurers will kind of follow that rate,
31:37
Speaker 4: maybe make it a little bit higher, but that kind
31:39
Speaker 4: of becomes the base level where usually nothing will be
31:43
Speaker 4: lower than that. So we started with that work group.
31:46
Speaker 4: We held a hearing on DOLA care and what it
31:49
Speaker 4: would look like in New York State to be statewide,
31:52
Speaker 4: and as part of that, advocacy grew. It really became
31:55
Speaker 4: a priority item for the State Senate, probably because I
31:59
Speaker 4: was educating everyone on dulas were, But then also the
32:01
Speaker 4: governor took notice as well, took notice and really created
32:04
Speaker 4: it as a priority of her own governor hocals. And
32:07
Speaker 4: so starting this year January versus twenty twenty four, we
32:12
Speaker 4: finally have statewide Medicaid reimbursement for doulas. Before that, we
32:18
Speaker 4: had two pilot programs that were just simply not funded
32:21
Speaker 4: nearly where they should have been, which made it hard
32:23
Speaker 4: to recruit doulas. But we had somewhat success in Erie County,
32:27
Speaker 4: as I mentioned earlier, with that pilot program, and really
32:30
Speaker 4: based our statewide Medicaid reimbursement on that. And so right
32:35
Speaker 4: now in New York State, and we are actively working
32:38
Speaker 4: to get more dulas online to do this. But right now,
32:41
Speaker 4: if you are Medicaid recipient in New York State, you
32:45
Speaker 4: can have Medicaid cover the cost of your doula, and
32:51
Speaker 4: that we hope is going to make a huge difference
32:54
Speaker 4: obviously for birthing people. But the next big thing we
32:57
Speaker 4: have to do is to have commercial insures cover this
33:01
Speaker 4: as well. I'm really happy to share that several insurance
33:05
Speaker 4: companies have reached out. They don't reach out to me
33:07
Speaker 4: on a lot of things, but they know for when
33:10
Speaker 4: it comes to maternal health. I can't tell you how
33:12
Speaker 4: many people have reached out to me, have wanted to
33:14
Speaker 4: talk about this process because they want to do what's
33:17
Speaker 4: right as well. And also it can't be ignored. As
33:19
Speaker 4: you pointed out, it is also a cost saving measure,
33:22
Speaker 4: which is fine for a profit seeking entity. That's fine.
33:25
Speaker 4: If we're going to save moms and babies. I'll stand
33:28
Speaker 4: with you, right, we will get this done. And so
33:31
Speaker 4: the hope is that I might not need to legislate
33:34
Speaker 4: to get commercial insurance, but we have the legislation there
33:37
Speaker 4: just in case. And then I'll just you know, add
33:40
Speaker 4: because I said, it's not just one and done. Now
33:42
Speaker 4: we have to really build this field of doulas. And
33:45
Speaker 4: so are we now have legislation around a doula workforce
33:50
Speaker 4: fund because what we found it's oftentimes just a single
33:53
Speaker 4: woman maybe who is a doula, who simply does not
33:56
Speaker 4: have the administrative backing right to be able to fill
33:59
Speaker 4: out Medicaid claims to make sure she's getting paid so
34:01
Speaker 4: she could support her family and so on. And so
34:04
Speaker 4: we have a workforce fund that would really go to
34:06
Speaker 4: a lot of the community based organizations who house doulas
34:10
Speaker 4: and help them with a lot of the administrative work
34:12
Speaker 4: to really make sure that folks can stay in these roles.
34:16
Speaker 4: And then the second pieces, we have legislation around doulah
34:21
Speaker 4: friendly designated areas. So, for example, there's a lot of
34:25
Speaker 4: hospitals that are starting to learn how to be more
34:28
Speaker 4: quote unquote doula friendly, and so we really want to
34:31
Speaker 4: make sure that we can study that at a state
34:33
Speaker 4: level and put forward recommendations so in the future hospitals
34:36
Speaker 4: can actually be designated as a doula friendly place.
34:40
Speaker 2: I think that's awesome, and I hope that other states
34:43
Speaker 2: do it. I mean, I think this is a model, right.
34:46
Speaker 2: The hope is that it's not just in New York,
34:49
Speaker 2: but that other places figure this out as a model
34:53
Speaker 2: maybe the I mean, yeah, that would make hope.
34:57
Speaker 4: I mean, federal government, if you're listening, you too can
35:00
Speaker 4: do this, and then you can do this.
35:01
Speaker 2: Although the states control Medicaid, so it's a little.
35:05
Speaker 4: So essentially the states have to ask for waivers to
35:08
Speaker 4: use Medicaid for these different things. So if the federal
35:11
Speaker 4: government says, hey, you should all do this, then probably
35:14
Speaker 4: more states would do it. And we've definitely they've been supportive.
35:17
Speaker 4: I'll actually say VP Harris tweeted back when it was
35:20
Speaker 4: Twitter tweeted about our bill, and I almost lost my
35:23
Speaker 4: whole mind because I was so I was just so honored.
35:26
Speaker 4: I couldn't believe she knew what we were doing about
35:28
Speaker 4: dulas in New York. But I've gotten to talk to
35:30
Speaker 4: her about some of the DULA work and she's incredibly,
35:33
Speaker 4: incredibly supportive. And a few states have done this as well.
35:36
Speaker 4: We became the thirteenth state to do it, and I'm
35:38
Speaker 4: really hoping others. I mean, here's the playbook. Just go online,
35:42
Speaker 4: you know, copy our bills. You know it's okay, and
35:45
Speaker 4: they can do it there as well.
35:47
Speaker 1: It's so exciting.
35:48
Speaker 2: Okay, I am going to end by asking you a
35:55
Speaker 2: personal question. You could say, what is the most joyful
36:01
Speaker 2: moment of your birth story?
36:04
Speaker 4: Oh? Wow, that is capital P personal. The most joyful
36:10
Speaker 4: moment of my birth story. Oh actually, that's quite simply so.
36:18
Speaker 4: As I said, I had a difficult birth, and when
36:24
Speaker 4: she was finally out, she didn't cry right away, and
36:28
Speaker 4: when I first heard her cry, that was one hundred percent.
36:32
Speaker 4: I tear up thinking about it, but that is one
36:34
Speaker 4: hundred percent the best, most joyful moment of my whole life.
36:39
Speaker 1: Yes, there's nothing better than that. I will tell you.
36:42
Speaker 1: Here's an example of what I'm like. I'll tell you.
36:45
Speaker 2: I don't think I described this as the most joyful moment,
36:47
Speaker 2: but this is a moment that involved my doula with
36:50
Speaker 2: my second child. So I was pushing, and because of
36:54
Speaker 2: the position of this, I could see like my water
36:58
Speaker 2: had like sort of.
36:59
Speaker 1: Broken right at the at the end, and so I.
37:02
Speaker 2: Could see that it was like like green, which is
37:05
Speaker 2: a sign of maconium, and in the middle, like I'm pushing,
37:07
Speaker 2: the baby's like head is coming out, and I.
37:09
Speaker 1: Was like, is the water clear? And my dueler was
37:12
Speaker 1: just like push like this isn't like.
37:15
Speaker 2: Stop thinking about this, Like it was just like, come on,
37:18
Speaker 2: get focused on your job, like other people are worried
37:21
Speaker 2: about the science, Like that's not your job.
37:23
Speaker 4: Right now, the occupational hazard, you know, just like excuse me,
37:28
Speaker 4: I need a little more data here I can decide
37:31
Speaker 4: what I want to be doing about this situation.
37:34
Speaker 2: I just want to know how hard I should be working,
37:35
Speaker 2: Like is this more of like a push hard or
37:37
Speaker 2: are we like is it like we have time to try?
37:40
Speaker 4: You're being efficient with your energy is what I heard exactly.
37:43
Speaker 1: I'm just trying to I'm trying to save it. But
37:45
Speaker 1: my duel was to was just like it just keep going.
37:48
Speaker 4: Keep going. It's like how they say doctors are the
37:51
Speaker 4: worst patients, right, you know, way too much totally.
37:54
Speaker 2: Yes, I'm not a doctor, but I play one on
37:56
Speaker 2: TV and I'm definitely the worst patient.
38:04
Speaker 1: This was such a treat Thank you for all your work,
38:06
Speaker 1: and I just this topic is.
38:10
Speaker 2: It's one of the ones I like the best because
38:12
Speaker 2: it feels solutions oriented.
38:14
Speaker 1: I feel like when we talk about a lot.
38:16
Speaker 2: Of these issues, it's easy to feel defeated and to
38:19
Speaker 2: look at those graphs of maternal mortality or whatever the
38:23
Speaker 2: outcomes and be like, how are we going to make progress?
38:27
Speaker 1: This is like, hey, I got something for you. Like
38:29
Speaker 1: it's not all the progress, but it's something that would help.
38:31
Speaker 2: And so it must feel good to get to be
38:33
Speaker 2: a person who actually does make some of that happen, oh.
38:38
Speaker 4: One hundred percent. And I'll just you know, I'm so
38:42
Speaker 4: glad you said that, because all of this is doable.
38:44
Speaker 4: And I think a lot about how we got ourselves
38:47
Speaker 4: into this predicament with the maternal mortality crisis. And in
38:50
Speaker 4: many ways it is a human made predicament. These are
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Speaker 4: not naturally occurring factors that are leading to mortality. Therefore,
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Speaker 4: we absolutely can change it. And we're doing a good
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Speaker 4: job in New York, and there's more to do, and
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Speaker 4: I really hope that other states get inspired to continue
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Speaker 4: this work as well.
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Speaker 1: Thank you so much, Senator book, Thank you.
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Speaker 2: Parent Data is produced by Tamar Avishai with support from
39:24
Speaker 2: the parent Data.
39:24
Speaker 1: Team and PI Rex.
39:26
Speaker 2: If you have thoughts on this episode, please join the
39:28
Speaker 2: conversation on my Instagram at Prof Emily Ostro, and if
39:33
Speaker 2: you want to support the show, become a subscriber to
39:35
Speaker 2: the parent Data newsletter at parentdata dot org, where I
39:39
Speaker 2: write weekly posts on everything to do with parents and
39:42
Speaker 2: data to help you make better, more informed parenting decisions.
39:46
Speaker 2: For example, last year, for Black Maternal Health Week, we
39:49
Speaker 2: invited doctor Quintrilla Ard to talk about her experience as
39:52
Speaker 2: a black mother and what she can share with others.
39:55
Speaker 2: You can read about it at parentdata dot org. There
39:58
Speaker 2: are a lot of ways you can help people find
40:00
Speaker 2: out about us. Leave a rating or review on Apple podcasts,
40:04
Speaker 2: text your friend about something you learned from this episode,
40:07
Speaker 2: debate your mother in law about the merits of something
40:09
Speaker 2: parents do now that is totally different from what she did.
40:13
Speaker 2: Post a story to your Instagram debunking a panic headline
40:16
Speaker 2: of your own. Just remember to mention the podcast too.
40:19
Speaker 2: Write Penelope right mam. We'll see you next time.