Pebbles of Hope speaks with Miriam Zoila Pérez, a doula, writer, social activist and TED speaker, in the latest episode of the Bridging the Gap podcast
Pebbles of Hope releases today the fourth episode of its podcast series, Bridging the Gap, in which we explore the health disparities that affect NICU families. This latest episode features Miriam Zoila Pérez, a gender columnist for Colorlines and the founder of Radical Doula, a blog that covers the intersections of birth activism and social justice. In this episode, Cheryl Chotrani, Executive Director of Pebbles of Hope, speaks with Miriam to discuss the social factors that impact women’s health during pregnancy and during the newborn period. A condensed version of our conversation is below.
Please share with us your path as a doula, now activist and how you found yourself focusing your life’s work on maternal health issues.
Miriam: I was inspired to start on this path through a course I took in college called The Anthropology of Reproduction. I had always been interested in medicine and initially planned to go on to medical school, but that course exposed me to the different types of birthing environments in the US and the issues that affect pregnant women. I began researching the US medical system, particularly as it affects maternal health. I completed a doula training program while I was in college and that is what launched me in this direction.
From your experience as a doula, how do you think coming from a disadvantaged background affects a woman’s experience during pregnancy?
Miriam: In the United States today, I believe the biggest factor affecting women’s health during pregnancy is race. If you look at the research about health disparities, the women who suffer the most and have the worst outcomes during and after pregnancy are women of color, particularly African-American women. Beyond that, indigenous women as well as some groups of Latina and Asian-American women also have poorer outcomes than White women. So, while class is an element, there is research that shows that even middle-class Black women still have worse pregnancy and birth outcomes than their middle-class White counterparts. The primary factor, then, is not about class, it’s about race. I saw that as a doula volunteering at a public hospital in North Carolina. As a Spanish-speaker, I worked with some Latina women there and I saw firsthand how they were treated differently than their White, English-speaking peers who had private insurance. I don’t think it comes as a surprise that racism affects the way people receive medical care. But, even racism outside of the medical system has a really significant impact on pregnant women’s health. So, when we see that Black women are four times more likely to die due to pregnancy and birth-related causes than White women, the reason for that is racism.
Are women who are native-born to the US affected differently than women who immigrate here? Are these issues endemic to the US or do these racial/ethnic disparities transcend country borders?
Miriam: It would be interesting to look at a similarly developed country to the US and investigate what the race-based maternal health disparities are like, perhaps somewhere like the UK. I am not familiar with the statistics internationally, but what I do know is that there is something called the immigrant health paradox, a phenomenon in which health outcomes for immigrants worsen the longer they stay in the US. Fiirst-generation Latina immigrants, for example, tend to have fairly decent outcomes when it comes to maternal health, but their children and their children’s children have worse outcomes. That points to something in the US environment that is making people sick, and I would argue that it’s racism. There are 80+ countries around the world that do better than the US at keeping their pregnant women and new mothers alive and healthy, despite the fact that the US spends more per capita than any other country on maternal health. So, there really is huge room for improvement.
For Latina women and other non-English speaking women, how much do you think language plays a role in the quality of care they receive?
Miriam: Language is a huge barrier, and I saw that firsthand in my work. Even in a situation in which the head resident speaks Spanish, there is a lot of power in deciding what information gets translated and what does not. In North Carolina, where I worked, interpreters were only legally required to be present when paperwork was being signed, but the rest of the time during labor and delivery, an interpreter often was not there. So, a lot of conversation was happening about the pregnant woman in English that was not translated to the patient, and therefore, she did not have access to that information. You could imagine what it might feel like to be in labor and to have people around you talking about your situation and your health and you can’t understand anything they’re saying. So, while the statistics for recent Latina immigrants, who are more likely to be Spanish-speaking, aren’t horrible, that doesn’t mean that their experience during the birth process is positive.
What happens after the baby is born? What role do these factors then play in the health of the baby after birth?
Miriam: My doula work has been focused primarily on labor and delivery, but from a research perspective one of the outcomes we see for women of color, particularly African-American women, is a higher incidence of preterm birth and low birth weight babies. That is a major factor for developmental issues throughout the baby’s life. Baby’s born prematurely and/or underweight are much more likely to have a whole host of problems that can affect them over their lifetime. We also know that preterm birth is itself linked to stress, and racism plays a role in that.
You spoke in your TED talk about a new model for prenatal care called “The JJ Way”. What does that model entail and why has it had such positive results?
Miriam: The JJ Way is a prenatal care model pioneered by a midwife named Jennie Joseph based near Orlando, FL. She’s been doing this work for about 12 years and has been able to get almost all of the women that she’s worked with to term with healthy babies. Her program specifically reaches out to low-income, Black and Latina women and many of them are at high-risk for the problems we’ve been talking about.
So, what’s the secret of her model? I think the bottom line is that it offers a buffer to the stress that the women are facing in their daily lives. No one is turned away due to lack of insurance or ability to pay, so that’s one huge barrier removed that a lot of low-income women face. Another big part of her model is that she treats everybody with respect and believes that all of her women, regardless of what the statistics say, can get to term with a healthy baby. She also integrates all of her staff into her model so that the nurses, receptionist and everyone else that works at her clinic is an important part of the care that is provided. All staff members are empowered and available to answer questions, provide patient education or offer emotional support. Those are just some of the things that make her model unique and have let to some really great outcomes.
How can at-risk women who do not live in close proximity to a JJ clinic access the support and resources they need to improve their odds for a healthy baby?
Miriam: The good news about the research is that it suggests that the approaches providers can take do not require expensive technology or complex interventions. It’s really about creating an environment where all pregnant women feel supported, respected and heard. For the women herself, she can look for ways to find this type of support, whether it be in her family system, a friend circle or a healthcare provider. Also, being aware of what’s going on in your body when a stressful event occurs is also important. Things like meditation, therapy, and adopting all sorts of mindful practices can be useful to help women become more attuned to the responses in their body when they face discrimination or other harmful triggers.
How can healthcare providers do a better job of serving all women and helping their patients navigate these issues of race and discrimination?
Miriam: I think our healthcare system is missing respect and integrity. One thing that Jennie does differently is that she treats the mom as part of the team in her own care. Many times, providers operate through a top-down approach in which instructions are given and the patient is expected to follow them and then blamed for any negative outcome if they do not follow everything exactly as they were told. For Jennie and other providers like her, they very much use a team approach instead. Providers also need to do a better job of working with patients where they are, considering the realities of their lives and the resources they have access to. Instead of chastising a patient, for example, for not adopting a healthier diet, understand that they may not have access to transportation to get healthier food options. So, finding ways to tailor recommendations so that they consider these types of barriers is also important.
The full audio copy of this episode as well as all other episodes of the Bridging the Gap podcast is available on iTunes, Google Play or wherever you get your podcasts.