S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG

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Speaker 15 Something Was Wrong is intended for mature audiences. This season contains discussions of medical negligence, birth trauma, and infant loss, which may be upsetting for some listeners.

Speaker 15 For a full content warning, sources, and resources, please visit the episode notes.

Speaker 15 Opinions shared by the guests of the show are their own and do not necessarily represent the views of myself, broken psycho media, and wondery.

Speaker 15 The podcast and any linked materials should not be misconstrued as a substitution for legal or medical advice.

Speaker 15 Origins birth and wellness owners and midwives Caitlin Wages and Gina Thompson have not responded to our requests for comment.

Speaker 15 Additionally, midwives Jennifer Crawford and Elizabeth Fuell have also not returned our request for comment.

Speaker 15 This season is dedicated with love to Malik.

Speaker 15 You make it known me, you don't know me.

Speaker 15 You don't know

Speaker 15 anybody

Speaker 15 until you talk

Speaker 15 to

Speaker 15 someone.

Speaker 15 Hi friends. Over the course of this season and especially over the past few weeks, we've had many survivors reach out to us with similar heartbreaking stories and new evidence.

Speaker 15 Because we need to fully follow up on these leads and fact check before airing our full findings in this season's finale, we need some extra time to make that happen.

Speaker 15 In the meantime, today's special bonus episode features Season 23 survivors Markita and Kristen, the Broken Cycle production team, and obstetric expert Dr. Shannon Clark.

Speaker 15 Together, we discuss Season 23, the maternal health care crisis, and more. Thank you so much to all who participated in this special bonus episode.

Speaker 15 We are excited to hear from Dr. Clark and really gather her expert advice.
She's been listening throughout the season and sharing her thoughts online.

Speaker 15 So, we thought it would be great to welcome her onto the show and have an open dialogue as well as hear from the survivors what the season has been like for them thus far, what it's felt like hearing their stories back, what the response from their loved ones has been like, what questions have popped up for them as they've been listening back to other people's stories, etc.

Speaker 15 So, I'm just really excited to host this roundtable. We also have on the call today two of our associate producers, Lily Rowe and Amy B.
Chessler, who worked alongside me on this season.

Speaker 15 And I am eternally grateful for all of their hard work as well. Why don't we start with introductions? You guys already know Kristen and Markita from this season and you've met them before.

Speaker 15 So why don't we, Dr. Shannon, hear a little bit about you and your professional background and how you got into this work.

Speaker 16 Hi, yeah, I am Dr. Shannon Clark.
I am a double board certified OBGYN and maternal fetal medicine specialist. That means after medical school, I did four years of OBGYN residency training.

Speaker 16 Then I decided to do more training to be a maternal fetal medicine specialist. So that is also known as perinatology or a high-risk pregnancy specialist.

Speaker 16 All of my patients are pregnant with either maternal fetal complications or both.

Speaker 16 I've been a faculty in maternal fetal medicine and OBGYN since 2007, and now I'm a professor at a large academic institution. That's my day-to-day.
And I'm actually right now, I'm post-call.

Speaker 16 So I've been up since about four o'clock yesterday morning.

Speaker 15 Oh my goodness. Do you get used to that?

Speaker 16 Yeah, I mean, I've been doing it forever.

Speaker 16 I'm older now, and I can tell you the recovery is not as smooth as it once was. We do the 24 plus hour shifts and that's just the lifestyle at at this point.

Speaker 15 Comes with the territory, I suppose. Since we're on that topic, is 24 hours for you the longest you feel confident in working a shift? What is that cutoff point for you personally?

Speaker 16 Honestly, I don't think I have a cutoff point because I think that as physicians, especially those of us that are in a surgical specialty like OBGYN and as a high-risk pregnancy specialist, we can be on at the drop of a hat.

Speaker 16 And while we're on call, we may have a chance to rest if things are kind of quiet. I can go from sleeping 30 minutes to being in the OR with someone hemorrhaging.

Speaker 16 I can't say that I've ever really felt that I couldn't function appropriately after being on call or being up because we just turn it on. It's the skill set we develop over years of doing this.

Speaker 15 I asked about the hours and like the cutoff of stamina, so to speak, because in some of these interviews that I've done, especially with ex-employees at the birth centers, they mentioned that midwives would sometimes be working 48 hour shifts.

Speaker 16 48 hours is a lot. I've done 48 hours as a resident back in the day.

Speaker 16 Not so much now, but I will say it's not only just the lack of sleep, it's being out of your home or being away from your family or being in that high-intensity environment for that period of time.

Speaker 16 Even if you're able to step away and go to your office or go to the call room and take a nap, you're in a hospital setting or a birth center setting.

Speaker 16 So I can imagine having someone cover for that period of time in a birth or in a hospital will take a toll. The most I will do now is probably about 36 hours, and that's very, very rare.

Speaker 16 But it's not always that I'm clinically active taking care of patients on labor and delivery. You have to be careful in what you're doing as far as what your call shifts are going to look like.

Speaker 16 There are some surgical specialties or even medical specialties where they may be on call from home for the weekend, but they're at home. So it's a little bit different.

Speaker 16 I can imagine being in a burstoner setting or a hospital setting for two to three days. That's a lot.
I don't know that I could do that.

Speaker 15 Yeah, it's a lot to ask of anyone, honestly. Kristen, are you fangirling hard over there? I know you're a huge Dr.
Shannon Clark fan.

Speaker 18 Hi, yes, Dr. Clark.
I heard your intro and I felt like I was watching another one of your reels on Instagram. It's wonderful to meet you.
Postpartum, I did a lot of searching for answers.

Speaker 18 Part of that was done on social media platforms, looking at people who specialized in birth trauma and things of that nature.

Speaker 18 And I stumbled across your social media platform and was just really enamored by the integrity and the mission to provide pregnant people with accurate information, breaking down some of the negative stigma around hot topics such as interventions, epidurals,

Speaker 18 or even being inside of a hospital. That was healing for me to see a medical professional and OBGYN take a part of this movement that's happening to really safeguard pregnant people and their babies.

Speaker 18 So yes, I'm geeking out over here and I'm very excited.

Speaker 15 Dr. Clark, what was it like for you listening to the season thus far? I'm curious if you could give us some of your key takeaways.

Speaker 16 It was hard to listen to. It's almost like watching a medical TV drama and you're screaming at TV.
But this is real life.

Speaker 16 And listen, I'm not here to say that giving birth in a hospital is perfect and we have no issues. We do.
But my overall feeling is that being in a birth center is for patients that are lower risk.

Speaker 16 And that means throughout their pregnancy, all the way coming up to delivery, and if they're getting care in pregnancy that's maybe not what it should be, and then they're delivering in a birth center setting, that just compounds on the potential for complications with a couple of these stories.

Speaker 16 You know, I saw red flags in their antenatal care and their prenatal care. And then now they're in a birth center.

Speaker 16 I wish that some things had been picked up earlier on and they could have gotten those medical consults earlier on in their pregnancy that were needed. Maybe things could have been avoided.

Speaker 16 If they're not getting all the information they need or full transparency, that's not allowing them to make an informed decision. And I feel like that was what was at play as well.

Speaker 16 We are choosing to give birth to our babies in this setting. We should be able to trust that what we're being told is the truth and that they're telling us everything we need to know.

Speaker 16 That's whether it's in a birth center or a hospital setting.

Speaker 16 But in a birth set or setting, the risks are higher because if something goes wrong, time is everything, whether it's a maternal complication or a fetal or neonatal complication.

Speaker 16 So I just wish that there was more transparency on the providers who are taking care of the survivors. I have a lot of feelings about this.

Speaker 16 But again, I want to emphasize that I'm not doing this this to so that I could say, well, giving birth in a hospital is perfect and there's no issues there. I'm not saying that at all.

Speaker 16 But when someone chooses to be in a birth center and they are considered to be low risk, they should actually be low risk because that's what a birth center is for.

Speaker 15 That's what's concerning with all of the survivors I interviewed on the record for the season and behind the scenes.

Speaker 15 For me, what felt like a lack of urgency, a lack of awareness that this is life or death,

Speaker 15 and just a lack of ability for the patient to consent to what was happening.

Speaker 12 Yeah, Dr.

Speaker 18 Clark, you say a lot of things that I talk about often whenever I am conversing with other professionals in the field.

Speaker 18 And something that I noticed about my care and every other survivor that I have encountered is that we are not given all of the information that is needed for us to make good, well-rounded decisions for ourselves.

Speaker 18 That's the key part. You go into a birth center, and let's say I had a previous cesarean section.

Speaker 18 We're being told that this is pretty low risk. But what they're not saying is one in 200 women have a rupture.

Speaker 18 And if you rupture in an out-of-hospital setting, we may not be able to get you to the care that you need in time to save your life and your baby's lives.

Speaker 18 And that's imperative information for us to know. I was a first-time mom.
I knew nothing about what was happening to my body. I knew nothing about pregnancy, labor, and delivery.

Speaker 18 I trusted my providers to tell me everything that I needed to know. And when red flags started to pop up throughout my care, I was always told by my providers that this was some variation of normal.

Speaker 18 My providers chose not to refer me to a higher level of care where I could have had informed decision-making.

Speaker 15 Dr. Clark, would you like to respond?

Speaker 16 I want to say that I am not anti-midwifery model of care as long as it still applies to the patient.

Speaker 16 They may walk in at point A, being low risk, where the midwifery model of care completely applies, but pregnancy is a dynamic state. You have a lot of physiological changes, anatomical changes.

Speaker 16 A whole new being is being grown inside of someone's body. And we have to respect that.
And I say this all the time. A lot of things have to go absolutely perfectly for there to be no complications.

Speaker 16 And there's a lot of room for error just innately by being pregnant. We can't dismiss those, as Kristen said, red flags.
And red flags develop, not in every pregnancy, but in a lot of them.

Speaker 16 I feel like the stories that I heard on this season, They were being forced into that box where they were low risk.

Speaker 16 And even though red flags kept popping up, they weren't willing to acknowledge that they're starting to move out of that low risk box.

Speaker 16 As physicians, we get criticized all the time for dismissing patients. It also happens in Malwaifery model of care, just as it has happened with us OBGYNs who deliver in a hospital setting.

Speaker 16 We have to understand and respect pregnancy for what it is. There is a lot of room for things to go wrong.
We have to listen to red flags when they pop up.

Speaker 16 We have to appropriately evaluate them and do what we need to do to manage them in order to ensure the best outcome for both the patient and the fetus in neonate.

Speaker 16 If we keep trying to dismiss them so that they stay in that low-risk box, that's going to do a huge disservice to the patient and their care.

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Speaker 15 One topic that kept coming up this season in many of the survivors' stories was meconium. I'm curious, Dr.
Clark, what your opinion on this matter is. When is meconium serious?

Speaker 15 At what point when meconium enters the situation, does a person need to be transferred and is that considered high risk?

Speaker 16 I am an OBGYN and high-risk pregnancy specialist. I do all high-risk pregnancies.
So I am in a different setting dealing with a different acuity of care at baseline with my patients.

Speaker 16 But shit happens, right? There's a saying that says meconium happens, but we can't dismiss meconium and just say, oh, well, it happens because there are a lot of consequences to meconium.

Speaker 16 It's associated with abnormal fetal heart rate tracings, meconium aspiration syndrome, increased admission to the NICU for the neonate, need for neonatal ventilation in really bad scenarios.

Speaker 16 It can even lead to hypoxic ischemic encephalopathy of the neonate. It can cause an increased risk of cesarean delivery for the patient, infection, fever.

Speaker 16 The consequences of meconium aspiration syndrome or having HIE are so significant and profound that we can't dismiss it.

Speaker 16 When we start seeing meconium, the first thing we need to do is once a patient in labor starts showing signs of meconium passage during the course of their labor, we need to let the neonatal resuscitation team know, hey, patient in room 321 has meconium.

Speaker 16 If you don't have a neonatal resuscitation team, how can we put them on alert? Because they have to be ready in case when the neonatal is born, there are complications.

Speaker 16 One of the other things that can happen is having an abnormal fetal heart rate tracing.

Speaker 16 Well, if we're not doing continuous fetal monitoring, how are we going to pick up that there's an abnormal fetal heart rate tracing?

Speaker 16 And having done this for a gazillion years, I can tell you, there are certain signs in a fetal heart rate tracing that can tell me that there's meconium there and that there could be a complication if we continue laboring in this patient.

Speaker 16 So I look at the big picture and say, how close is she to delivering? If she comes in, at two centimeters and I'm already seeing some issues, I'm not going to wait till she's completely dilated.

Speaker 16 There's a lot of clinical nuance at play with the individual. So we need to consistently document what the meconium looks like because it can evolve over time.
There's a lot of things we need to do.

Speaker 16 What protocols does a birth center have if there is meconium noted during labor and delivery? That's a question that they should be able to answer.

Speaker 16 And if they just say, oh, well, meconium happens, that's not a good answer, in my opinion, because they should have protocols on what to do.

Speaker 15 Season 23 survivors Marquita, Kristen, and Amanda have created a nonprofit called Moms Advocating for for Moms in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive.

Speaker 15 MAMA has helped to create a Texas bill called Malik's Law or House Bill 4553,

Speaker 15 which is intended to improve data reporting requirements for midwives in Texas.

Speaker 15 While some data is collected via birth certificate filing, the bill is intended to gather more data that could help improve both maternal and pediatric care, as well as aid consumers and more easily accessible data to make more informed decisions on their own care.

Speaker 15 To find out ways you can help support Malik's Law, please visit momsadvocatingformoms.org.

Speaker 15 Markita, I am curious if you could share a little bit with us about Malik's Law and what we can do to support.

Speaker 33 Malik's Law, it's actually HB 4553.

Speaker 18 It was introduced into House in March.

Speaker 33 It's basically requiring midwives to report outcomes related to like transfer, mortality, morbidity rates, because currently they are not required to report any of these.

Speaker 33 It's not a mandatory thing, it's a voluntary thing, and the reporting that they do is within like a closed system. So it's only available to the midwives.
It's not open to the public.

Speaker 33 The everyday consumer cannot view these statistics. So it leaves these birthing centers and these midwives to create, per se, their own statistics.
We don't have anything to really back it up.

Speaker 33 That's basically what the law is for.

Speaker 18 Malik's law provides us with information that we previously don't have. We're often, as consumers of midwives, met with slogans such as, we are just as safe as any hospital and any OBGYN.

Speaker 18 And then it is up to the provider or the birth center to give us statistics, statistics that cannot be found through any national database.

Speaker 18 It leaves consumers really just relying on the word of their midwives or their providers or the community to tell them how safe or unsafe certain things are in these settings.

Speaker 18 Malik's Law would allow us to garner information for any indicators leading up to a mortality or a severe morbidity, such as decelerations or previous cesarean section or history of preeclampsia and other high-risk conditions that can occur.

Speaker 18 during pregnancy, labor, and delivery that can lead to adverse outcomes.

Speaker 18 So this will all be compiled compiled through VITAL Statistics, which compiles the information for our yearly maternal and infant mortality reports.

Speaker 18 And they will have a separate report or a report that goes alongside of current mortality statistics that are produced right now.

Speaker 18 Currently, we're seeing only hospital statistics, and it is a little deceiving because how can we do better in out-of-hospital settings when we don't have the data to see what's actually happening in the field?

Speaker 15 Thank you. Dr.
Clark, I see you want to share something.

Speaker 16 People say just like Kristen said, it's just as safe. Well, I cannot say that about where I work unless I have receipts.

Speaker 16 In the state of Texas, we have maternal levels of care and we have state guidelines that we have to meet in order to get designated.

Speaker 16 Any place in the state of Texas that provides inpatient labor delivery care has to have a designation, whether it be one, two, three, or four. We are a level four.

Speaker 16 We have to provide receipts in order to have that designation. That means a robust COPI plan.
QWAPI is quality assurance policy improvement.

Speaker 16 And that means we have certain triggers on labor delivery that are mandatory for case review. We chart audit thousands of charts per year.
We are gathering data on a continual basis.

Speaker 16 We have levels of escalation, primary review of certain cases. secondary, tertiary, and beyond.
This is something that I do daily with my colleagues. Why aren't birth centers required to do that?

Speaker 16 Because it's easy to say everything is okay when you don't have to provide receipts to prove it. So I agree, this should be done anywhere that is providing episturgical care.

Speaker 16 They have to be able to back up what they're saying.

Speaker 16 And they cannot do that if they're not collecting stats, if they're not reporting their outcomes, their transfer rates, their emergent transfer rates, their complications.

Speaker 16 the number of postpartum hemorrhages they have, anything like that.

Speaker 16 We have to have a way to find what those stats are for every birth center, just like I have to do for where I work and a lot of hospitals do. This has been proven to improve patient care and outcomes.

Speaker 16 The fact that it's not standard that birth centers are required to do that is a disservice to the community because they deserve to know what these stats are.

Speaker 16 Another thing to consider is if there is a complication in the birth center and they go to the hospital, that stat falls on the hospital.

Speaker 16 If there's a death or patient ends up in hystrectomy or X, Y, and Z. That's going to be on my stats.
It's It's easy to not have to report it if it's not following on your stats.

Speaker 16 A lot of patients don't even realize that when they're looking at where they're going to give birth. And I'm not trying to throw birth centers under the bus.

Speaker 16 I do think there is a role for them, but they should be required to do reporting just like we are because patients deserve to know all of those stats and they should be able to see the receipts.

Speaker 15 Changing medical records. That was another issue throughout.

Speaker 16 You can go back and change a medical record, but in our hospital system, if you change something, it's going to be known. Epic logs every edit.

Speaker 16 If somebody's requesting medical records, they're going to see that. There's an audit trail.

Speaker 16 One of the things about some of these systems, and I don't know if it was true in this situation, but when you do certain types of record keeping, they will charge for the number of users you have.

Speaker 16 So I don't know if it was at play in this situation that it was a way to cut costs, but depending on how many different usernames you're issuing, that is a cost.

Speaker 16 And I can tell you in a hospital setting, if you were to chart under somebody else's username or you were to to go into a chart that you did not actually care for, that is grounds for dismissal, termination of your job.

Speaker 16 I've heard of people getting fired because they went into somebody's chart or they did X, Y, and Z that was not their documentation. It happens.

Speaker 15 And that's certainly one of the elements that drew me to work on this season.

Speaker 15 I tend to gravitate towards stories where areas of the law, there's these significant gaps because it really perplexes me how how they still exist in so many situations.

Speaker 15 And what I continually see in all settings, in all seasons that we have worked on is that when there is a lack of oversight and accountability, this is where abuse flourishes and this is where abusers flourish.

Speaker 15 And as much as it might not be the majority, Unfortunately, those, quote, bad apples in these sorts of parameters can really thrive.

Speaker 15 And so it's concerning because, again, these are life and death situations. When we looked at the data in certain states and areas of the U.S., it's certainly concerning.

Speaker 15 From your perspective, what are the elements causing this maternal health care crisis if you agree that that's what's occurring?

Speaker 16 I've actually talked about this a lot on my platform. When you look at worldwide mortality, we're actually very, very low.

Speaker 16 It's when you look at us compared to other higher income developed nations where we are not having a lower maternal mortality rate over the years, ours is increasing yearly.

Speaker 16 And do I think we're in a crisis? Yes, I do. And I think there is a few reasons for that.
The one's going to be a rise in maternal mortality. There has been a steady rise since around 2000.

Speaker 16 We've had a few peaks here and there. During COVID, we had a peak, which they're still trying to tease out the data on exactly why that happened.

Speaker 16 But we're not where we should be for a high-income developed nation. The other reason is because there are clear and proven racial disparities.

Speaker 16 And we know that our black patients are disproportionately affected. Why is that? They're having consistently higher rates of maternal mortality compared to their white counterparts.

Speaker 16 And that is even if a black patient has a college education, they are still five times more likely to die in childbirth than a white counterpart.

Speaker 16 So even education isn't protective in that patient population. The next thing is going to be systemic issues.
We have limited access to care.

Speaker 16 A lot of our patients don't get any care in between pregnancies. A lot of my patients don't get care until they're pregnant.

Speaker 16 And so then we're playing catch up with any pre-existing medical conditions they have while they're pregnant, which is not the ideal time to do that.

Speaker 16 We have a lot of social determinants of health that affect patient outcomes, like poverty, transportation issues, unstable housing, nutrition. Those are all affecting pregnancy as well.
Mr.

Speaker 16 Delayed diagnoses. And that's just because in general, anyone with a uterus isn't always taken seriously.
And that's even from when they're not pregnant.

Speaker 16 If they're not pregnant and they're having a complication, oh, you know, they're just being dramatic. If they're pregnant, then, oh, it's just because you're pregnant.

Speaker 16 So there's always traditionally has been a tendency to downplay any concerns that a pregnant individual may have. So there's so many reasons why we are in a maternal mortality crisis.

Speaker 16 It's not where we should be. We can do a better job.

Speaker 16 And now that we're having laws that are affecting access to reproductive health care, there's going to be maternal health care deserts because people are going to leave those states.

Speaker 16 It's already happening. My residents are not going to get the training they need because they're in a state with restrictions and bans.
Abortion bans and restrictions in the United States.

Speaker 16 It actually affects pregnancy care. So unfortunately, we are taking steps back in recent years, and it's only going to get worse.
I'm in this every day.

Speaker 16 I don't see anything being done right now that's going to help the maternal mortality crisis in this country.

Speaker 16 And I don't see anything that's going to help improve improve health equity and equality for our patients of color. Everything that's being done is doing the exact opposite.

Speaker 16 And it's something that I think about every day. It's something that I'm seeing the consequences of more.
I've seen things in the past three years that I have not seen in my entire career.

Speaker 15 Thank you so much for sharing that. What solutions would you offer that you feel like would help this crisis?

Speaker 16 One of the things I teach medical students and residents, there's a difference between health equality and health equity.

Speaker 16 You walk onto a lever delivery unit and they say, everybody in rooms one through 10 get equal care. Everybody gets the exact same care.
That's great.

Speaker 16 Nobody's going to get anything somebody else doesn't get. But that's not appropriate because a patient may walk into room three already at a disadvantage based on social determinants of health.

Speaker 16 based on the tone of their skin, based on other complications. So being equitable also applies, meaning you have to be able to allocate resources to the ones who need it the most.

Speaker 16 Giving just equal health care may not cut it for that patient in room three. They may need more.

Speaker 16 Being able to recognize what about that patient in room three is already putting them behind the eight ball. And fixing that is a place to start.

Speaker 16 But starting on labor delivery is not going to do a whole lot. It starts way back.
It starts during the preconception period. It starts during pregnancy.

Speaker 16 We can't fix everything when they hit the doors for labor and birth. So we need to focus on equitable health care.

Speaker 16 We also need to focus on acknowledging the roles that social determinants have and the outcomes of our pregnant patients. The other important thing is we got to continue research and data collection.

Speaker 16 We got to keep researching this. We can't just keep saying we have a maternal mortality crisis and we can throw out stats.
Well, why is that happening? And what are we doing to fix it?

Speaker 16 We need research on that. And if we keep cutting funding through the NIH, that's not going to happen.

Speaker 16 We have to acknowledge that racism and healthcare is an issue. We especially have to acknowledge it that racism in obstetrical care is an issue.

Speaker 16 And we have to start holding people accountable for that and doing more education. And providers have to recognize both their implicit and explicit biases.

Speaker 16 And if we're not willing to do that, it's never going to be fixed. It starts with the individual provider and then it balloons out from there.
So we have to acknowledge that racism.

Speaker 16 and obstetrical care has a huge impact on pregnancy outcomes and birth outcomes and neonatal neonatal outcomes. We have tons of stats to back that up.
We need to fix it.

Speaker 16 Those are probably the top three things that I think really need to be addressed first.

Speaker 15 Thank you so much.

Speaker 15 Switching gears a little bit, Marketa and Kristen, I'd love to hear about the nonprofit that you have started with Amanda, who wishes she could be here today, but unfortunately she couldn't.

Speaker 15 But I'd love to hear what that process was like for y'all and what's next for you guys.

Speaker 18 Markita, I remember in the early days, us sitting in coffee shops and talking about how there is a need for more awareness around what is happening in out-of-hospital settings to recognize patterns, to recognize faults and gaps in care, and also a need to bridge out-of-hospital and in-hospital care.

Speaker 18 That's how Mama was born. Mama was born to assess some of those disparities to protect mothers and their babies and to help provide them with information to make informed decisions for themselves.

Speaker 18 We're really big on education beforehand. The more knowledge you have will

Speaker 18 better serve you throughout your pregnancy, labor, and delivery, and even beforehand in helping you determine what provider is best for you. The nuances and types of midwives in the U.S.

Speaker 18 is often confusing for the consumer. And so really making sure that we give foundational education on that and what that means for you and how that could potentially affect your care.

Speaker 18 Questions you should be asking your out-of-hospital providers.

Speaker 18 What you should be looking for when you're looking at a birth center and what you should know if you're going to be choosing a home birth. Because this affects everybody.
This doesn't just affect us.

Speaker 18 We are just the survivors. You never know if that's going to be you.
Low-risk pregnancies are known to become unpredictable and become high-risk.

Speaker 18 And so, preparing mothers for that, I think, is paramount. Doing what we can to make sure that out-of-hospital options are held to a high level of professionalism is super important,

Speaker 18 especially if we are considering out-of-hospital deliveries and out-of-hospital care to be a bridge to the obstetrical deserts that we face here in Texas.

Speaker 18 There really needs to be catch-up in making sure that these providers are held to very high and similar standards that we hold our doctors, our nurses, and our hospitals to.

Speaker 18 and ensuring that there is collaboration.

Speaker 18 We've done a lot of research on this and what we have found is the best outcomes come from environments where there were respectful and collaborative relationships between providers and there is a continuity of care.

Speaker 33 Like Kristen said, we originally thought that this was just an origins thing and these unfortunate events happened to us.

Speaker 33 And then realizing that this was definitely happening all over and it has been for a while, many people are unaware that you can become a midwife without being a nurse or without even having medical background or knowledge.

Speaker 33 So we just really want to advocate for mothers, for babies.

Speaker 33 And then as far as moving forward with creating bills and the legal aspect of everything, we talked about it and it rolled into place and happened very quickly.

Speaker 33 We are so, so excited about the bill that was introduced this past month. And for the future of MAMA, we are hoping to host support groups.

Speaker 33 We are looking to host events, provide more resources, more education, more tools for moms, and just provide a safe place for moms and their babies.

Speaker 33 Even when it comes to mental health, postpartum is a very real thing.

Speaker 33 Grief, losing your child, losing the idea of what your birth was supposed to be like. So we're hoping to also help with the mental aspect as well.

Speaker 33 Mama is definitely growing and we are excited about providing these resources to moms.

Speaker 18 I love that you brought that up, Markita, because that's really what we're focusing on this year.

Speaker 18 As legislative session is soon to come to an end, We are really hoping to focus on community because that is something that we have all felt at some point in time.

Speaker 18 I know that freshly postpartum, I've never felt more isolated in my life.

Speaker 18 Unless you have adequate child care and you have a good support system and you are more than financially stable, you don't have access to important mental health resources.

Speaker 18 You don't have access to a community that can help you recover and heal through your postpartum period. And birth trauma happens everywhere.
It happens in hospitals.

Speaker 18 It happens in out-of-hospital settings. It happens even if you don't have a life-threatening issue that happens during your pregnancy, labor, and delivery.
And all of those moments are important.

Speaker 18 Birth trauma, I wholeheartedly believe, affects the mother you're going to be and the person you grow into after.

Speaker 18 So we're making a huge effort to collaborate.

Speaker 18 with professionals from all different walks of this healthcare system to help us us come up with some awesome solutions that would help us be able to reach people

Speaker 18 who previously did not have access to resources that could really help them recover and take the best foot forward in their postpartum and motherhood journey.

Speaker 15 Amazing. I'm just in awe of you, three, and the things that you are working on.
We have linked in the episode notes this season the website and their Instagram and more information.

Speaker 15 And the same will be true for this episode. So please check out, support, contact your legislators.

Speaker 15 Also, Markita is a real estate agent in the DFW area. And I'm just going to plug that.
We want to support her. So if you're looking for a house in the DFW area.

Speaker 33 I appreciate the shameless plug. I appreciate it.

Speaker 15 I'm curious, having known each other's stories, Markita, Kristen, and shout out to Amanda, who's not here, was there anything that you heard back on the podcast that brought new understanding?

Speaker 18 I will

Speaker 33 say that hearing the stories on the podcast was hard, even though I have already heard Kristen's and Amanda's story. Kristen dove into a few more details that I haven't heard as well as Amanda.

Speaker 33 And although I already knew these stories, they still made me tear up and it still made me think, how did this happen?

Speaker 33 Even hearing the other stories from Brittany, the surrogate for Caitlin.

Speaker 15 What an episode. I could not believe that interview with her.

Speaker 33 I couldn't either. And that was really an eye-opener to just the character of these people at this birthing center and the facade that they put on for people.

Speaker 18 This episode actually made me cry, which is really strange because it was about Brittany and her experience as an ex-employee with origins.

Speaker 18 But when she said, we had a mom in the ICU and I didn't even know it, I knew she was talking about me.

Speaker 18 And to hear how she spoke about how this center, these people,

Speaker 18 didn't care about neonatal death, about babies dying and me being in the ICU, I knew they didn't care. That's been very clear to me from the beginning.

Speaker 18 But to hear it from someone else that she was the executive director of Origins and she didn't know I was in the ICU was just heartbreaking to think that my life and my son's life, all of our lives were treated just so callously.

Speaker 18 It's awful to relive it and to hear it, but also it just gives me so much hope.

Speaker 18 There's something very unique about hearing our stories on this kind of platform, even hearing my own story.

Speaker 18 Because living through it, being three years postpartum now, in a lot of ways, I feel detached from the person that that happened to. I feel almost like it's a movie in a way.

Speaker 18 Listening to Marquita's story anytime always has me in ugly sobs. Malik holds a very large part of my heart, and I think about him every single day.

Speaker 18 It reminds me every day of why I get up and I do this and why I'm so invested in mama and learning more and trying to help. My mission is to help other moms and to prevent this from happening again.

Speaker 18 This podcast is a dream come true.

Speaker 18 I'm incredibly grateful because what has been silenced and what has been pushed behind closed doors is now open into the light and people can make their own choices and they can make their own judgments on what happened and maybe this sparks conversation to make changes.

Speaker 15 The wide reach of the people that you are going to help, you'll actually never know how broad that is, which is what is so beautiful and wonderful about sharing in this forum.

Speaker 16 I just wanted to commend you all for sharing your stories because I'm in the medical complex, if you will, and I'm a highly skilled physician. I've dedicated my life to this work.

Speaker 16 And what I found since being on social media, and I'm sure you will understand when I say this, people are very willing to share their experiences with OBGYNs, whether it be during their pregnancy care or labor and delivery care or postpartum care, when it's not what it should be.

Speaker 16 They're very, generally very open about it. But the same is not necessarily true for those who have chosen to do an out-of-hospital birth in a different setting.

Speaker 16 I do think there is a hesitation to talk about when things don't go right in those settings.

Speaker 16 And I think for some people, there's a level of guilt about it, or they don't want the criticism saying, well, you should have given birth in a hospital, which I don't think is ever an appropriate thing to say to anybody, no matter what choices they made.

Speaker 16 So coming forward and talking about this on such a public forum is very commendable because you guys will give other people a voice and maybe prompt them to share their stories as well.

Speaker 16 Things can happen in any setting, but it's expected at hospital birth settings that things should be right and there's they fit in that perfect Instagram square and they have the beautiful pictures and all that and things don't always go right.

Speaker 16 We just don't see it and you guys are bringing it to light.

Speaker 16 So I hope you know that as difficult as it may have been for you to do this, You are going to change somebody's life and you are going to change somebody's outcome by helping them better make informed choices.

Speaker 15 Could not agree more.

Speaker 18 Thank you so much, Dr. Clark.
I mean, it brings tears to my eyes just to hear you say that. This started with, if we could just help one person,

Speaker 18 it would be enough.

Speaker 18 And I think we've done more than that.

Speaker 18 There seems to be this unequal scale for how we judge hospitals as opposed to how we judge out-of-hospital settings. There is something very unique about trauma that comes out of hospital birth.

Speaker 18 Someone probably told you that you shouldn't do that, that you should do what you are quote unquote supposed to do and just go to a hospital and just go see an OBGYN.

Speaker 18 So when you have this really bad outcome, you blame yourself.

Speaker 18 And depending on the people that you interacted with, you may have been judged or treated differently during your care because of what you chose previously.

Speaker 18 And if something really bad happens, there's a lot of blame and a lot of guilt. I know personally, I'm relieved of that blame today.

Speaker 18 I don't fault myself for the choices I made with the knowledge that I had then, but now I know better and I can help other people. Our stories are so important.

Speaker 18 If we are going to start making change in this part of the maternal health field, people are silent. And sometimes your providers are a part of your silence.
And that is also a problem.

Speaker 18 And so I think collectively as a whole, survivors, people who had good outcomes in out-of-hospital settings, midwives, doctors, doulas, nurses, anybody who has a hand at this needs to really look at these stories and become introspective.

Speaker 18 And instead of saying, I'm sorry this happened to you, say, what can I do? How can I make sure that this happens to no one else? Because this is absolutely unacceptable. We need to do better.

Speaker 18 That has been really awesome to see is how medical providers are reacting to our stories.

Speaker 18 And I think there's a certain amount of validation that is happening in obstetrical wards and maternity wards throughout the state. I know several hospital systems that are listening.

Speaker 18 Every medical system in the DFW area is listening to this podcast.

Speaker 18 Every resident, every postpartum nurse, even anesthesiologists are listening to this podcast, and I think there's some amount of validation there that is happening.

Speaker 18 I could not be more grateful to be able to be a part of this.

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Speaker 16 I've talked about this a lot on my social media platforms.

Speaker 16 I have readily acknowledged that the obstetrical traumas that can happen in a hospital setting, whether that be pregnancy trauma, birth trauma, postpartum trauma, at the hands of providers is real.

Speaker 16 I know it's happening.

Speaker 16 Autonomy being taken away, no explanation about what's being done and why it's recommended, no follow-up, having a traumatic birth and then going home with questions about what happened because nobody actually explained what happened.

Speaker 16 I understand the role. that all that plays in patients choosing out of hospital birth.

Speaker 16 So if there's any obstetrical care provider listening to this, we have to do better because we are, as a profession, one of the reasons why patients are making this choice and why they may be willing to make a choice for an out-of-hospital birth before being fully informed because they don't want to go back to that hospital that caused them trauma.

Speaker 16 Trauma can happen at the fault of no one, but we can also add to it or we can cause it. We should never be adding to or causing trauma.

Speaker 16 And we have to acknowledge that that does happen and we need to do a better job as a profession of stopping that.

Speaker 16 Going to an out-of-hospital birth is not the answer to experiencing in-hospital trauma if we can't ensure that the care is going to be what it should be and that birth centers have receipts.

Speaker 16 The people doing the home births have appropriate credentials to manage complications because it can still happen there. So it starts with us in the hospital setting.

Speaker 16 We have to make sure the patient is a part of their care and the decisions being made.

Speaker 16 Just sitting someone down and explaining, you had this postpartum hemorrhage because of X, Y, and Z, and this happened, and not sending them home where they just don't have answers, that goes a long way.

Speaker 16 Yes, it takes time, but we have to do it.

Speaker 16 When I hear about patients choosing an out-of-hospital birth because of things that happened to them in the hospital, to me, that's not the answer, but I understand why they do it.

Speaker 16 Knowing that some of these patients go to birth centers, like the one talked about on this podcast, and that they're not placed in better hands, that's even more alarming to me.

Speaker 16 And I I know it just doesn't happen in Dallas. It happens all across this country.

Speaker 15 It seems like statistically from what we've gathered that there can also be really positive results of having midwifery care in hospitals. Do you have any insight there?

Speaker 16 Yes. Since 2000 was my first year of residency, I've always worked alongside midwives on a labor and delivery unit.
Where I work, it's a little bit of a different model.

Speaker 16 Maternal fetal medicine specialists staff labor and delivery 24-7,

Speaker 16 but we also have midwives there to take care of patients, but they're on the floor with us. And if they need us, they let us know.
If they don't, they don't, but we're there.

Speaker 16 It's still a hospital setting, but if something goes wrong, they have what they need. I love that model.
I wish we had midwifery care on all labor delivery units.

Speaker 16 I wish we had doula services available on labor delivery units. So that's another place to focus on is what can we do on labor and delivery units to get the best of both worlds.

Speaker 15 Yeah, it seems like to me, people a lot of times are trying to avoid intervention, and that's one of the motivators for out-of-hospital births.

Speaker 15 But those interventions are really essential when things go wrong. Kristen, I see you want to add.

Speaker 18 Something I often see when people are talking about the benefits of out-of-hospital birth versus hospital birth are that physiological birth cannot be achieved in hospital settings and OBGYNs are not trained in physiological birth.

Speaker 18 I was just wondering if Dr. Shannon Clark could speak to that a little bit.

Speaker 16 The first thing is, what exactly is physiological birth? What's the definition? Because there is no one definition. It's pretty much going to be according to whoever's talking about it.

Speaker 16 If you think about it, maternal physiology is what the body does during the course of birth, the physiological changes in the blood volume, the uterine blood flow, the elevation of the diaphragm, all that still happens in a hospital birth.

Speaker 16 Managing labor and delivery by having a spontaneous fascist delivery, that's still physiological physiological birth. There are a lot of OBGYN practices who are very hands-off.

Speaker 16 They do interventions when they need to. It's hit or miss.
I'm not going to pretend that it's an option for everyone. I know that it's not.

Speaker 16 But there is a very common misconception that if you want to have a physiological birth, you need to be in an out-of-hospital birth setting.

Speaker 16 And that's simply not true because we really don't even know what that means. I think interventions should be done when they're indicated.

Speaker 16 If something is recommended, it should be explained to the patient. The most most important thing is a good maternal and fetal neonatal outcome, whatever that looks like.

Speaker 16 If a cesarean section is needed, that's what's needed. If pitocin augmentation is needed, that's what's needed.
I've talked about this on my platform.

Speaker 16 I actually even made a video in response to one of the episodes for this season about physiological birth and what that means.

Speaker 16 I wish we could say physiological birth is X, Y, and Z, but we simply cannot. So it can look a lot of different ways.

Speaker 16 And so I don't want anyone who's listening to this podcast to think that there is one way to have a physiological birth and that's it, because it's simply not true.

Speaker 18 I'm so glad that you spoke about this on the podcast because I think it's really important.

Speaker 18 Physiological birth really feels like an enigma in a way, or like a carrot that we're dangling in front of pregnant mothers going, you can have physiological birth, but when intervention happens or a birth didn't go as planned and you have to have a C-section for whatever reason, that it almost seems like this unobtainable thing.

Speaker 18 And there's a certain amount of judgment. So I think it's really important

Speaker 18 to note and really make it clear that physiological birth is a lot of things. The definition changes based off of who you are talking to.

Speaker 18 And I think that mothers, what they should take away from this is that you should do what is best for you and your baby.

Speaker 18 If that means that you said you didn't want an epidural, but you're 30 hours into your labor and you're not progressing or whatever, and you just need that epidural.

Speaker 16 Get the epidural.

Speaker 18 There are options for you that can make labor and delivery easier for you or still get you to the mode in which you want to birth. And sometimes that doesn't happen, right?

Speaker 18 Sometimes we don't get what we want. And I think that there's this really big emphasis right now on satisfaction versus safety.

Speaker 15 Well, there's so much pressure and guilt put on us as women, right? To get pregnant and then to deliver a certain way, behave a certain way, and then fit into this box.

Speaker 15 And it's just like, we can't win. I'm just so glad you highlighted it because having three emergency C-sections myself that I didn't desire to have, I did feel like less of a woman at that time.

Speaker 15 I was very young and I just felt like a failure. It's just a lot of pressure we put on ourselves and a lot of pressure that's put on us.

Speaker 15 And I'm so thankful that we are advocating for people to do what's right for them, what's safest for them and their child, because there's a lot that we need to destigmatize here.

Speaker 15 Dr. Clark, is it common for medical professionals to add their clients on social media and communicate with them that way?

Speaker 16 No, that should not happen. Keep in mind, how I work, I don't have my own patients.
I have them for the time that they're here, either admitted antipartum or they're delivering in a postpartum.

Speaker 16 I don't have my own patient schedule, but I've had patients who have reached out to me on social media and I don't respond because it's inappropriate. I feel like there is this thought

Speaker 16 or feeling, both on some providers and also on patients, that we are supposed to be friends. I'm not your friend.
Can I be friendly to you? Absolutely. Can I be cordial? Can I be respectful?

Speaker 16 Can I be empathetic? Yes. But being friends and being on that kind of level is not appropriate because you will lose your objectivity in order to take care of that patient.
And that cannot happen.

Speaker 16 And it's an expectation sometimes on the provider's part and on the patient's part.

Speaker 16 Just remember, you want your doctor or your provider to always be objective and do what standard of care is based on what's indicated for you and not because they're friendly with you and they know your family or you guys just had lunch or you guys are friends on social media.

Speaker 16 That's not how it's supposed to be. And it shouldn't be that way.
I hope that doesn't make me sound like I'm not being a nice person, but there is a line that can be crossed.

Speaker 18 This is something that really bothers us. My therapist, my OBGYN, my insert medical professional is not in these support groups that I'm a part of on Facebook.

Speaker 18 They're not friends with me on Facebook or they're not direct messaging me on Facebook.

Speaker 18 What seems seems to be really common practice here is these professionals being in these groups that consumers use

Speaker 18 to get advice or even need to get recommendations on midwives, and they patrol those groups.

Speaker 18 And when someone tells their story in one of these groups to just warn other moms, other midwives will get on that post and they will make comments about it, invalidating someone's lived experience, but also it's unethical to sit there and patrol what should be private safe spaces for these moms.

Speaker 18 There's just a lot of crossing in ethical patient provider relationships. There's not a whole lot of regulation there.

Speaker 18 So if your midwife wants to call you and text you and harass you about you posting your story online and telling people about it, there's nothing really to stop them from doing that.

Speaker 15 Dr. Clark, did you want to add to that?

Speaker 16 I can tell you, I don't belong to any Facebook groups, whether it's for personal reasons or medical reasons. Groups like that can be problematic at baseline.

Speaker 16 Reddit groups can be problematic at baseline because there's a lot of confirmation bias and quite an echo chamber there. So that has to be taken with a grain of salt.

Speaker 16 I've chosen to educate on social media the way I do, and that works for me. But I think it should be a red flag.

Speaker 16 It's unprofessional, but as Kristen said, it's borderline unethical, and it could definitely be problematic. problematic.

Speaker 15 I'm just so glad we're highlighting much of this. Thank you all so, so much once again for being here.
I appreciate everybody's energy and thoughtfulness. We will certainly link to Dr.

Speaker 15 Shannon Clark's Instagram and her socials that we mentioned. We will link to Marquita's real estate pages.
So please go follow and support her. We will have links to petition.

Speaker 15 more information about mama and malik's law, all that good stuff in the episode notes.

Speaker 15 thank you all so much for being here and again shout out lily amy everybody on our team who has worked on this season our audio editor becca and our social media manager lauren nobody does anything great alone as they say thank you thank you all thank you so much tiffany and thank you so much dr clark for being here today Thank you so much, Dr.

Speaker 33 Clark, for being here and for listening to our stories.

Speaker 16 Thank you.

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