On today’s podcast, we have the pleasure to talk with our honored guests, Dr. Monica McLemore and Dr. Jamila K. Taylor, about postpartum justice and the need for Medicaid coverage for the entire postpartum year.
Dr. Monica McLemore is a tenured associate professor at the University of California-San Francisco in the family healthcare nursing department, an affiliated scientist with advancing new standards in reproductive health, and a member of the Bixby Center for Global Reproductive Health. She retired from clinical practice as a public health and staff nurse after a 28-year clinical nursing career in 2019. Dr. McLemore’s program of research is focused on understanding reproductive health injustice.
Dr. Jamila K. Taylor is a director of health care reform and senior fellow at The Century Foundation, where she leads TCF’s work to build on the Affordable Care Act and develop the next generation of health reform to achieve high quality, affordable and universal coverage in America. Dr. Taylor also works on issues related to reproductive rights and justice, focusing on the structural barriers to healthcare access, racial and gender disparities in health outcomes, and the intersections between healthcare and economic justice.
We talk about their collaborative work with additional authors for the article, “We Must Extend Postpartum Medicaid Coverage,” which discusses the importance of extending Medicaid coverage for postpartum individuals. We also talk about the implications for the disruption of postpartum Medicaid coverage 60 days after giving birth and the importance of creating holistic, community-based care in perinatal and postpartum support.
Content warning: We will talk about postpartum, perinatal/postpartum mortality, mental health, substance use disorders, health challenges, and COVID-19.
Learn more about Dr. McLemore here (https://profiles.ucsf.edu/monica.mclemore). Follow Dr. McLemore on Twitter here (https://twitter.com/mclemoremr) and Instagram (https://www.instagram.com/mclemoremr).
Learn more about the article, “We Must Extend Postpartum Medicaid Coverage,” here (https://www.scientificamerican.com/article/we-must-extend-postpartum-medicaid-coverage/).
Learn more about Scientific American here (https://www.scientificamerican.com/).
Learn more about The Century Foundation here (https://tcf.org/).
Learn more about the American College of Obstetricians and Gynecologists (ACOG) here (https://www.acog.org/).
Learn more about The American College of Nurse-Midwives (ACNM) here (https://www.midwife.org/).
Learn more about American Rescue Plan here (https://www.whitehouse.gov/american-rescue-plan/).
Learn more about Black Maternal Caucus here (https://blackmaternalhealthcaucus-underwood.house.gov/).
Learn more about Lauren Underwood here (https://underwood.house.gov/).
Learn more about Alma Adams here (https://adams.house.gov/).
Learn more about Momnibus here (https://blackmaternalhealthcaucus-underwood.house.gov/Momnibus).
Learn more about the Healthy MOMMIES Act here (https://pressley.house.gov/sites/pressley.house.gov/files/CAPS%20HEALTHY%20MOMMIES%20ACT_ONE%20PAGER_Final.pdf?fbclid=IwAR3TAykMRkuZv1F_sDGt2NvCJJXPytLPMMfOhLuydIZm6IbDhuj5BOWtuIo).
Learn about Roots Community Birth Center here (https://www.rootsbirthcenter.com/).
Learn more about CHOICES here (https://memphischoices.org/).
Rebecca Dekker: Hi, everyone. On today’s podcast, we’re going to talk with Dr. Monica McLemore and Dr. Jamila Taylor about postpartum justice.
Welcome to the Evidence Based Birth® podcast. My name is Rebecca Dekker, and I’m a nurse with my Ph.D. and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See EBBirth.com/disclaimer for more details.
Now, I’d like to introduce our honored guests, Dr. Monica McLemore and Dr. Jamila Taylor, who will be talking with us about postpartum justice and the need for Medicaid coverage of the entire postpartum year.
At the University of California, San Francisco, Dr. Monica McLemore is a tenured associate professor in the family healthcare nursing department, an affiliated scientist with advancing new standards in reproductive health, and a member of the Bixby Center for Global Reproductive Health. She retired from clinical practice as a public health and staff nurse after a 28-year clinical nursing career in 2019, however, continues to provide flu and COVID-19 vaccines. Dr. McLemore’s program of research is focused on understanding reproductive health injustice.
Today, she has 81 peer-reviewed articles, op-eds, and commentaries, and her research has been cited in the Huffington Post, Lavender Health, three amicus briefs to the Supreme Court of the United States, and two national academies of science, engineering, and medicine reports and a data visualization project entitled, “How to Fix Maternal Mortality: The First Step is to Stop Blaming Women,” that was published in the 2019 Future of Medicine edition of Scientific American. Dr. McLemore’s work has appeared in publications, such as Politico, ProPublica, NPR, and she has made a voice appearance in Terence Nance’s HBO series, “Random Acts of Flyness.” Dr. McLemore is the recipient of numerous awards and currently serves as chair for sexual and reproductive health section of the American Public Health Association, and she was inducted as a fellow of the American Academy of Nursing in 2019.
Dr. Jamila K. Taylor is a director of health care reform and senior fellow at The Century Foundation, where she leads TCF’s work to build on the Affordable Care Act and develop the next generation of health reform to achieve high quality, affordable and universal coverage in America. A renowned health policy expert, Dr. Taylor also works on issues related to reproductive rights and justice, focusing on the structural barriers to access to healthcare, racial and gender disparities in health outcomes, and the intersections between healthcare and economic justice.
Throughout her 20 plus year career, Dr. Taylor has championed the health and rights of women of color and other marginalized communities, both in the U.S. and around the world, promoting policies that ensure access to reproductive and maternal healthcare, including building support for insurance coverage of abortion. Before TCF, Taylor served as senior fellow and director of women’s health and rights at the Center for American Progress, where she led their efforts to advance policies that ensure women have an equal opportunity to live healthy and economically secure lives.
Prior to CAP, she was a senior policy advisor at Ipas, a global NGO dedicated to ending preventable deaths and disabilities from unsafe abortion. Dr. Taylor has published and presented extensively on topics related to reproductive justice, maternal health, and health policy. Her work has been seen in numerous academic and peer-reviewed journals, as well as in media outlets such as The Hill, U.S. News & World Report, Scientific American, Yale Journal of International Affairs, and a host of other publications. Dr. Taylor has testified before Congress and has provided commentary on top media networks, including NPR, Al-Jazeera, BBC and so many more.
Today we are just completely thrilled that the two of you are joining us here and welcome to the Evidence Based Birth® podcast.
Dr. Monica McLemore: Yay. Thank you for having us. Yay.
Dr. Jamila K. Taylor: Thank you for having us.
Rebecca Dekker: It is just our honor to speak with you. Our team at Evidence Based Birth®, the team that works here, was just, “We want Dr. McLemore,” and Dr. McLemore was like, “I want Dr. Taylor too.” We were like, “Yes, that sounds like a dream team.” So, thank you so much for both of you for agreeing to join us and for being here together, because we think it’s so important that, you know, there’s teams working on these issues because it’s not something that any one individual can fix by themselves. Tell us, how did you two meet and start working together?
Dr. Jamila K. Taylor: Well, Monica and I have the pleasure of serving on the board of directors of Black Mamas Matter Alliance, which is a national organization that focuses on centering Black women in the response to America’s maternal health crisis. Even before that, I had admired Monica from afar and followed her work and research over the years. It was when we became co-board members that we got to work more closely together and that launched a whole host of other opportunities, including the article that we co-wrote for Scientific American that we’ll talk about today.
Dr. Monica McLemore: Yeah. I was trying to think back when we actually really started working together, because I too have been an admirer from far of Dr. Taylor’s work. I knew about your work at Ipas and I think we didn’t actually meet, though, until you were transitioning from the Center for American Progress to The Century Foundation. I think that’s when we actually interfaced together, but your work is legendary in our field, and I was like, “Oh, wow. That’s a Black woman scientist, oh my God, who does political policy work. Oh my goodness.”
I think we’ve had sort of a mutual respect and admiration for each other’s work for way longer than we’ve actually worked together, but now we’re being more intentional, I think, in terms of the kinds of work that we’ve been doing. Our Scientific American piece is just one piece we can talk about. We’re actually guest-editing a journal around reproductive health rights and justice in the fall, which is going to be so much fun. I’m just a huge… Honored and humbled to be able to be on the board of the Black Mamas Matter Alliance and to serve with Dr. Taylor and our other colleagues.
That’s a long story about how we met and how we started working together, but I think we both function from this perspective that science is… It builds on itself, and I think a lot of people historically have interpreted that as competition or some weird thing. This is where I don’t think the translation of science from the life sciences or from bench science is really helpful because I don’t think it has to be a competition. I think it’s more of an alignment and an endorsement and then an amplification. I love Dr. Taylor’s work, so I’m glad I get to work with her.
Rebecca Dekker: It’s interesting you bring up research often has these aggressive paternalistic male-dominated, white-dominated aspects. It must mean a lot to you both to be able to find somebody who’s not from the dominant culture to work with together towards mutual goals.
Dr. Jamila K. Taylor: Yeah, absolutely. I think one of the things that I was thinking about as Monica was talking too, is that it’s been so important for I think the movement of Black women that are working in maternal health and reproductive justice to also lift each other up and promote our scholarship as a unit because we don’t get the shout-outs and the proclaim that our white counterparts do.
Oftentimes we also have to deal with our white counterparts co-opting our work and our strength is in this space, and so I think a big part of our mission and goals and just how we do the work is also to lift each other up and make sure that folks know that we’re here, we’re doing the work, we’re out in front, and essentially we are the leaders of this movement, and we should be respected as such.
Dr. Monica McLemore: Yeah, no, I completely agree with that and the only thing I would add is that our ideas, I think when they collectively come together, this was very clear when we were doing the Scientific American piece, that curating a culture or a space where Black women can think together and think differently about dominant culture narratives is crucial to innovation. That piece would have never been I think as fabulous as it is if we did not have learners and if we weren’t able to bring in the actual experts.
It would have been really ridiculous for me to lead an invited piece on postpartum justice and not include Dr. Taylor’s work. She had just presented on postpartum Medicaid. I just finished a whole research project. I want us to start to think differently, and this is how we also try to embody RJ principles and not only how we do and design our studies and how we report them and who’s on the team, but also knowing when there’s expertise that’s missing, if you can share the mic or pass the mic, that’s what you’re supposed to do. I want that to be normalized. That’s how I think about why it’s so important to people to engage in this way.
Rebecca Dekker: This March of 2021 you published an article in Scientific American that you’re mentioning called, “We Must Extend Postpartum Medicaid Coverage,” and it was a team effort. It looks like there were other people, important people, on your team as well. Can you tell us a little bit about how that article came to be, what led you to come together as a team to publish that article?
Dr. Monica McLemore: The story behind this is hilarious. ACOG, the American College of Obstetricians and Gynecology tweeted out something around how postpartum coverage was being discussed as part as the American Rescue Plan, and I retweeted it. That resulted in my tweet catching the attention of Laura Helmuth, who is the editor-in-chief of Scientific American, and she wrote me a direct message that said, “Duh.” She was like, “Do you think you’d be willing to do a piece on this?” She says, “I’m going to have one of my editors reach out to you, and Michael will work with you to be able to pull this together, but this just seems like a no-brainer. Why don’t you do it?”
When Michael reached out to me, I said, “Well, okay,” and I have a long history of working with Scientific American to push them to do stuff differently. I said, “Well, can I have some more people on here? I have trainees who are looking at these issues. There’s an expert in the field we have to have in this piece, otherwise, I’m not doing it.” They were like, “oh.” I’m at the point now when I ask for these kinds of things, people are like, “Oh, okay. Yeah, we going to figure out how to make that work.” Did I text you, Jamila, or I emailed you? I was like, “She has to lead this. I hope she can do it.”
Dr. Jamila K. Taylor: She’s leaving out some key pieces here. While she is, like, a Twitter maven, if you don’t already follow her listeners, please do because it is an absolute treat. She sends the tweet, but it’s also getting so much attention on Twitter, and so I’m sure that’s part of the mindset behind Scientific American reaching out because Monica’s tweet really helped to elevate the issue and the tweet from ACOG. That’s a part of it too. She has this huge following, and she’s such a trusted voice in the field that that’s also part of it too, and so as all of that was happening, I get a text from her. I’m like, “Of course, I’m in.” Any chance to write a piece with Monica, I’m in. Then we got on an email chain with everyone else, and we started writing right away.
Dr. Monica McLemore: Right away.
Dr. Jamila K. Taylor: Yeah, we all stopped what we were doing.
Dr. Monica McLemore: Well, when you assemble the right team… You really took it to the… Dr. Taylor is being humble, but she already had the bullet points, the rule book. That’s why I was like it would be so perfect to be able to write with her. Truth be told, you pulled the skeleton of that together and was just like, “Oh no, no, this is how we need to do this, we need to do that, we need to do this.”
Dr. Jamila K. Taylor: I think a big part of it too, Monica mentioned the American Rescue Plan, which I think we want to shout out the Biden-Harris administration and folks on the hill for setting in motion having this important provision included in the bill, but I think part of the process as we were writing this too, is that once we got to digest what the provision looked like, it’s a step in the right direction, but it wasn’t all that we want. The provision is an optional provision for states to take up postpartum coverage extension. It doesn’t have any federal matching funds to support states in terms of funding because to be quite honest, this is something that is expensive.
We’re talking about adding on additional enrollees to the Medicaid program, and so it is expensive. This period where states are still struggling and grappling with financial hardship due to COVID-19 and so it was a mixed bag, but I think the piece was so important because it also helped to explain one, why this step is important, but also how it falls short. Then also what we’re going to be doing over the long term, which is to continue to push for this to be permanent for all states and for states that have the funding support that they need to do this and to do it right.
Dr. Monica McLemore: Yeah. The other thing that this piece allowed us to do was the Black Maternal Caucus in Congress led by Lauren Underwood and Alma Adams, two of my sheroes, they have re-introduced the Momnibus. People forget that there was nine bills in the116th Congress that got introduced, I guess, was the Monday or the Tuesday before the nation went on lockdown for COVID-19 that really had some of the provisions that we really… Were visionary. People who’ve worked in reproductive health rights and justice for years have asked for, have advocated for, then you got the pandemic, then you got the national lockdown and all that mess.
The first thing that Lauren Underwood and Alma Adams did in the 117th Congress of which we are in right now, was not only to re-introduced the Momnibus, but to also add another three bills that were very specific to COVID and so in the midst of us writing this op-ed, which we pulled together, what was that like three days? They were like, “You got 750 words, and we need it ASAP.”
Dr. Jamila K. Taylor: It was over a weekend. Yeah, it was over a weekend.
Dr. Monica McLemore: It was over a weekend. As we were doing that, we also got to tell the story of the Momnibus. We got to say, this is a step toward actually what RJ people have really been asking for, for a long time. Then we got word… How did we hear? Maybe you sent me a note. We heard that Biden was going to sign the American Rescue Plan, earlier than when Scientific American was going to run the piece, and so we actually ended up having to write to the editors to say, “Hey, you all. You all might…” Because they were going to run it on a Saturday, and I think he was set up to have a press conference where he was going to sign the American Rescue Plan on a Tuesday, I think it was or a Wednesday. So we wrote them.
Again, they’re a very responsive group of people. That’s why it’s so good to work with them. We wrote them and said, “Look, I wouldn’t wait until Saturday to publish this, because we believe, and we’ve heard from the administration, that they’re actually going to sign the American Rescue Plan that has this provision in it today.” They were like, “Oh, okay.” Then they just moved it up on the production schedule. We edited it a little bit because we did have to say, “signed into law by President Biden earlier today,” or something like that, but they were really responsive in terms of helping us to continue to shape that narrative. That’s the other reason why I like working with Dr. Taylor. We have a very synergistic way of thinking about how to be strategic in helping to continue to use data to shape narratives.
Rebecca Dekker: For our listeners who aren’t familiar with this legislation and with the Momnibus, so the Momnibus was originally, one of its provisions was going to be to extend postpartum Medicaid coverage and since that bill has not yet been passed, you were able to get the postpartum Medicaid extension in this… They were able to get it in this American Rescue Act this spring of 2021.
Dr. Monica McLemore: I would defer to Dr. Taylor because she probably knows more.
Rebecca Dekker: Correct me if I’m wrong.
Dr. Jamila K. Taylor: Let’s start with the Momnibus first. Monica gave a great overview of that. Basically, it’s one of the most comprehensive pieces of legislation to date that focuses on addressing Black maternal health. At this point, I think it’s 12 bills that make up the package, and it covers everything from maternal vaccinations to addressing the climate impacts on pregnancy and birthing to ensuring access to health insurance coverage. There are provisions in there that focus more on the quality of coverage if we were to get a postpartum coverage extension, but the bill in itself does not operationalize that. There are other pieces of legislation that actually focus on getting the postpartum coverage extension, so want to be clear on that.
The American Rescue Plan is basically Biden’s first flagship piece of legislation that focuses on responding to COVID-19 and so in the context of shaping that legislation, advocates were really clear about the impacts of COVID-19 on pregnant and birthing people and how important it would be to ensure continuous coverage for birthing people in the postpartum.
Rebecca Dekker: Dr. Taylor, you were explaining the Momnibus when we got briefly interrupted. Can one of you talk a little bit about… You talked about how comprehensive it was, and what pieces then got put into the Recovery Act in 2021 since the Momnibus is not yet passed?
Dr. Jamila K. Taylor: We were talking about the American Rescue Plan and the Momnibus, and they’re two different pieces of legislation. The Momnibus is this comprehensive package of 12 bills that really, I think, is probably one of the most comprehensive approaches to addressing the Black maternal health crisis in this country. It covers everything from maternal vaccinations to the climate impacts on pregnancy and birthing to issues like insurance coverage, ensuring access to insurance coverage.
The Momnibus does not include the postpartum coverage extension, which we have talked about a lot in today’s broadcast, but there are other pieces of legislation that do include the postpartum coverage extension. There are different iterations of that. Some bills would make it an option for states, which is similar to what we’ve seen in the American Rescue Plan, and there are other pieces of legislation like the MOMMIES Act, for example, that would make it mandatory for states.
Part of the conversation around the America Rescue Plan was really because that bill is focused on addressing or recovering from COVID-19, those of us that are advocates in the maternal health space really talked to members of Congress as well as the administration about why it was important to ensure continuous coverage for pregnant and birthing people on the Medicaid program. That’s how we ended up getting a provision into the American Rescue Plan that focuses on the extension. Again, we were very much focused on making this permanent in terms of the continuation of coverage, and we did come to a compromise with the optional provision that is also temporary. It would only be for five years coming out of the pandemic.
Rebecca Dekker: Okay. What does this coverage mean? What’s a normal coverage postpartum for somebody on Medicaid, and what does the extension mean and who does it cover?
Dr. Jamila K. Taylor: Right now, under Medicaid policy, for people that enter into the Medicaid program through the pregnancy pathway, they are covered through their prenatal care, birthing, postnatal care up to 60 days after giving birth. At that point, they’re cut off from coverage and so what we’ve been advocating for as part of this extension is that for postpartum people to have coverage through the full year of the postpartum period, to ensure that they have the coverage and healthcare they need in this sensitive postpartum period.
The fact that we have an option implemented means that states have the option to take it up or not, and the option was there even before the American Rescue Plan. There are some states who opted to apply for Section 1115 waivers with the Department of Health and Human Services. These are really proposals for states to put out an idea or an innovation in terms of Medicaid policy in order to advance coverage under the Medicaid program. Illinois, which is one of the states that I wrote about in the report, one of the states that issued one of those waivers, and it was just approved under the Biden-Harris administration.
There are different avenues for states to be able to take this up. I think for the advocacy community, it’s really important for us, I think to advocate for it to be mandatory. We think that all women and birthing people deserve to have this coverage for the full one year. Again, this is just the Medicaid population, so it doesn’t cover those on private insurance or other insurance sources, which Dr. McLemore also mentioned before the break.
Rebecca Dekker: Yeah. Dr. McLemore, can you tell us what are the implications for disruption of coverage? If somebody loses their Medicaid coverage 60 days after giving birth, what are the potential harmful effects of that?
Dr. Monica McLemore: I think it’s really important that we contextualize this for your listeners because it’s estimated that 45% of births in the United States are covered by Medicaid, so it’s a huge number of individuals. I always like to remind people that childbirth prior to COVID-19 was the number one reason that people were hospitalized in the United States. We have four million births a year and so when we think about what a huge existential experience that is for people, becoming a parent is a huge deal, so it changes your relationship with the adult that’s involved in the pregnancy. If you have other children, it changes your relationship to them with the new person plus the adult that’s involved in the pregnancy.
It’s a huge period of transition, but some of the unintended consequences of discontinuing coverage, people forget that for folks on Medicaid, you’re talking about their health insurance. You’re talking about their dental coverage. You’re talking about their eye coverage. You’re talking about all the primary care things that people don’t have access to. I think for all of those different transitions… You’re also talking about lactation and the human milk or in chestfeeding. You’re talking about if you have a cesarean section, that’s major abdominal surgery.
These are big transitions and to not give people the time that they need in order to be able to adjust those transitions and to work on those health issues that are associated with being a postpartum person, I think we end up paying for it down the long run because we’re not allowing people to access those preventative and those screening services that are so crucial at a very, very pivotal time point.
The other statistics that the listeners need to really understand is we estimate that between 60 and 70% of maternal deaths are preventable and that between 40 and 50% of those deaths happen in the postpartum period. When we think about not just these physical pieces, but then you also have behavioral and mental health, as Dr. Taylor talked about earlier. This is a huge transition and to not have coverage to be able to get different care needs met, I quite frankly think is unethical, and I think we need to start calling it out as such.
Rebecca Dekker: When you go through… You’re in the middle of this huge transition and all of a sudden your Medicaid insurance drops, which it would theoretically for about half the U.S. population 60 days after giving birth, does that make it more difficult to access clinics and healthcare, and other services?
Dr. Jamila K. Taylor: Yes.
Dr. Monica McLemore: Dr. Taylor has data on that.
Dr. Jamila K. Taylor: Yes, absolutely. Based on the research that The Century Foundation conducted last year, it causes a disruption in healthcare services, so you’re losing your coverage, and then you’re also losing your healthcare, the healthcare that you need, and we saw this be particularly problematic for high-need moms. These were women who were also grappling with mental health challenges, substance use disorders, even something as simple as having access to family planning. When you lose your coverage, you also lose access to those services. I think also too, for those that are high need, they also work very closely with care coordinators.
These are people that help make sure that all of their healthcare providers are talking to each other. They’re making sure that mom is getting to her various health care appointments. They’re also helping to make sure that she’s also getting her infant to its health care appointments. It really is just a perfect storm I think in terms of experiencing a whole host of challenges in that period. One thing I’ll also mention too is that some of the moms that we talked to also mentioned just the fact of losing coverage also triggered mental health challenges for them, not knowing when they could go to the doctor, grappling with diabetes and other health challenges created a triggering of mental health challenges.
It really is, I think, something simple for us to address and fix. We’re talking about just taking that coverage drop from 60 days to a year. I think also a key part to mention in this too, is making sure that we’re supporting these birthing people and families with the support that they need in terms of any transitions, even beyond the year of coverage like ensuring that they have access to some other source of insurance, even after a year of coverage, I think is also the responsibility of our healthcare system and social services system to support families and making sure that they do that.
Rebecca Dekker: Really, our postpartum care has been pretty abysmal in the United States. On average, there’s the one six to eight-week check-up. For decades that was all that was really accepted, and it’s really only been recently that ACOG called for more comprehensive care. While it’s something that midwives have known for a long time that you need to do a lot of checkups in the weeks and months following birth and the days following birth, instead of waiting six to eight weeks. In addition to midwifery care, what are some solutions that healthcare workers and birth workers, and other people in the community who serve families can do to lower the impact of perinatal mortality and complications and all of those problems that can happen in the first year?
Dr. Monica McLemore: Midwives are definitely a solution. I think doulas as well. I think team-based care is really important. I would also add on nurse innovations like centering pregnancy, which is group prenatal care model or nurse family partnership, where you have nurse home visiting partnering with communities to be able to make sure that different needs are getting met.
I also think we as a country really need to wrestle with paid family leave because I think paid family leave is super important.
Dr. Jamila K. Taylor: Yes, as Dr. McLemore mentioned, all of those things are critically important. I think another piece of this too, and this just piggybacks off of what Monica is saying, is having this holistic approach to care. Particularly for marginalized populations and women of color, particularly Black women who are most harmed by these pregnancy-related challenges, healthcare challenges, making sure that health providers are, in their approach to healthcare, they’re doing it in a way that takes into account their lived experience, not only of themselves but also their families. There may be unique non-traditional family structures at play, supporting our LGBTQ+ families in their approach to healthcare, so really being holistic in the approach to care.
Then, another thing that we haven’t had the chance to talk through today is also ensuring that the approach to healthcare is being done in an anti-racist way. I know that the United States is still behind in making sure that we train and support healthcare providers in order to be able to offer health care in this way, but this is also a big part of the advocacy and the work that we’re doing as a community to make sure that Black women are listened to in the context of their experiences with the healthcare system. This is still a major problem and how not just pregnancy-related care, but all healthcare is delivered, particularly for Black folks. We’ve seen it play out in COVID-19. Some of the health equity issues there, and it’s really a problem in this country.
I think folks are starting to talk about it more and recognize that it’s an issue, but we need to do much more to address racism in the healthcare system because it’s causing lives, and we see it play out for decades, some would say centuries if you look back to the historical foundations of medical racism in this country. We continue to see it play out today.
Dr. Monica McLemore: Yeah, I agree with that. I would also say that at some point we really want to reimagine how we provide pregnancy-related care in the country. Group prenatal care came out of a frustration of one person behind a closed door with a patient, and they really wanted to have that relational care, that peer-to-peer learning, in the same way that home visiting really was necessitated and came out of this desire to meet people where they’re at.
Maybe we can look to some of the models we have around the country, like the Roots Community Birth Center in Minneapolis, run by midwife Rebecca Polson. Everyone knows that’s like a community center. Yeah, it might be a birth center, but it’s a whole lot of other things. They have artists. They have musicians. They got DJs. They got nutritionists that come in and teach people how to cook. It’s a whole different thing. When you think about CHOICES in Memphis, Tennessee. They have co-located birth and abortion services and trans care for trans-identified individuals. They have a whole… But that’s also like a community center. It is a place where people gather and people convene.
Maybe what we need to think about is put more care back into healthcare and redesigning spaces where we can really lift up what are those essential services that people need in the postpartum period and design the services around using a community focus because one thing that I think has fallen apart… I was glad to see ACOG and ACNM and a whole lot of other professional organizations really affirm the fourth trimester as the postpartum period, but what I really wanted to see was a community focused on that, not just, “I’m just a postpartum individual.”
No, you’re not. You’re a family unit and that you could have grandmamas and aunties and all these other folks. It is a bigger thing and so maybe we need to treat postpartum care like community care and really acknowledge that it’s not just about a birthing person, the baby that emerges, and whatever other adult is involved in the pregnancy. Maybe that’s the first place where we could actually combine health care with community care.
Rebecca Dekker: I love that suggestion of just re-imagining it as a community event and as community care and putting the care back in healthcare. That’s just perfect and so powerful. Are there any upcoming projects that either of you are working on that you’d like to share with our audience that we can keep our eye out for or that we can support or follow?
Dr. Jamila K. Taylor: Yeah. I think one of the things… There are lots of things that we’re working on, but one of the things that I wanted to share with listeners is that The Century Foundation is planning an event for this fall that will focus on gains made in maternal health policy under the Biden-Harris administration and the 117th Congress. If folks are interested in learning more and joining us for the event, they can keep track at TCF.org, our website, or follow us on Twitter at T-C-F-D-O-T-O-R-G, but we’ll have more information coming up on that hopefully soon.
Dr. Monica McLemore: For me, it’s this bigger idea of there are a lot of really interesting and cool research products that are going to be started that’s coming down the pike to really understand the path to midwifery. What does care in a year of postpartum actually look like? I don’t think we’ve actually mapped what should we be doing? What do community members need? So we are starting to think about doing some listening tours to find out, okay, so if we are going to extend coverage, is it just connection of primary care? No. How do we meet people’s spiritual needs? How do we get at their mental health needs? I think this is such an exciting time to think about, okay, if we now have an extended period of coverage for postpartum people, it shouldn’t just be driven by a health complaint.
What else could we be offering people in that time period that will help to bolster their transition, their family role transition? How can we be thinking about that in a way that I don’t think we’ve had the freedom to do so in the past? Yes, you want to do that important connection to primary care, and you want to make sure that chronic diseases are being managed, and you want to make sure if contraception is what people want, they can get it. That’s great. But what else could we be doing in terms of health education and health promotion? Building trust. I would love to convene some stakeholders to talk about that because we know what to do in the six-week postpartum visit, and we want to do this, this, this, and this, but now that we have a chance to vision around what a year of extended coverage could look like, what are we prepared to offer postpartum people?
Rebecca Dekker: Yeah. I know parents. They’re often viewed as an event. Your pregnancy and your birth and your postpartum visit, but there’s so many anxieties that go into that first year of raising a baby and becoming a parent and feeding your baby and watching for your baby’s milestones that they’re… We hear from so many parents at Evidence Based Birth® who are very anxious about that role. They don’t know how to do it. We’ve lost a lot of that community connection and passing down of how you care for infants and how you care for yourself as a new parent, so I love that idea of re-envisioning how we care for families during that first year.
Dr. Jamila K. Taylor: Yeah. I also think from the cultural side and as you all talk it made me think about even my own experience after I had my son. I think for communities of color, it’s typical for it to be a community experience. You got grandma, aunties, neighbors, everyone is gathered around, not just baby, but also making sure mom is taking care of herself, offering support. I know for me, when I gave birth to my son, I had no clue about how to breastfeed and what that entailed. My mom and older sister were there along the way and helped to guide me through it, and we need to get back to, I think, that approach.
I think there is a lot that, particularly our white brothers and sisters, can learn from our communities when it comes to that approach to just supporting families in the postpartum period and to be quite frankly, the postpartum period beyond a year.
Rebecca Dekker: The struggles don’t end.
Dr. Jamila K. Taylor: Yeah. The struggles do not end. My son is now 16, and I still feel like there’s some postpartum things that I grapple with and so it’s really about… I love the community approach and I think we need to get back to that, and it’s really a way of teaching or helping others to also where that this is how we do birth and how to support families in that way.
Dr. Monica McLemore: Agree.
Rebecca Dekker: Wonderful. Thank you so much, Dr. Taylor and Dr. McLemore, for sharing your wisdom and your power with us. What’s the best way for people to follow your work? I know Dr. Taylor, you mentioned @TCF D-O-T org on Twitter.
Dr. Jamila K. Taylor: Yeah. That’s our organization and my personal Twitter account is @Dr. D-R-T-A-Y-L-O-R 09. Then again, also, folks can find some of my work on TCF.org, the website.
Rebecca Dekker: Dr. McLemore.
Dr. Monica McLemore: Yeah. I’m myself everywhere. So I’m McLemore MR, McLemore M for Monica, R for Rose, which is my middle name on all socials, and my work is prolifically available in multiple outlets and I try to be really intentional around open source so that research is not behind a firewall but if you do find that’s the case, you can hit me up, and I’ll send you a PDF.
Rebecca Dekker: Yeah. I encourage our audience to follow both of you on social media and, like Dr. Taylor said, Dr. McLemore is very educational and entertaining-
Dr. Monica McLemore: Try to be.
Rebecca Dekker: … to follow on Twitter.
Dr. Jamila K. Taylor: On a whole host of topics, not just maternal health.
Rebecca Dekker: Exactly. Thank you both for sharing your time with us.
Dr. Monica McLemore: Thank you for having us.
Dr. Jamila K. Taylor: Thank you.
Rebecca Dekker: This podcast episode was brought to you by the book, Babies Are Not Pizzas: They’re Born, Not Delivered! Babies Are Not Pizzas is a memoir that tells the story of how I navigated a broken healthcare system and uncovered how I could still receive evidence-based care. In this book, you’ll learn about the history of childbirth and midwifery, the evidence on a variety of birth topics, and how we can prevent preventable trauma in childbirth. Babies Are Not Pizzas is available on Amazon as a Kindle, paperback, hardcover, and Audible book. Get your copy today, and make sure to email me after you read it to let me know your thoughts.
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