Episode 12SN: A Double Sided View: Pregnancy through the eyes of an OB: Dr. Rankins

P: Hi, welcome to the show. Can you introduce yourself and tell us where you’re from?

Dr. Rankins: Yes, I am Dr. Nicole Callaway Rankin’s I’m an OB GYN, and I live in Richmond, Virginia.

P: Dr. Rankin, thanks so much for coming on the show it’s very fun to have an OB, because your story will be super interesting for people listening.

Dr. R: Yeah,

P: the first question I usually ask people is what did you think pregnancy to be like. And for you, did you have your children after you were already a doctor?

Dr. R: That’s a good question… so I had my first daughter, when I was just out of my residency training so I had gone to medical school had done my four years of residency I was in the middle of a fellowship, when I got pregnant with my first daughter, and I was terrified.

P: That’s not what I was expecting to hear; but maybe you know too much. Maybe that’s what it is…

Dr. R: Yes, so, I as you might imagine, is that I’m a little bit of a type A ish person. And, number one, it took us longer to get pregnant than I thought it would. So, in this, please don’t, you know, crucify me for those who really seriously struggle with infertility, but at six months, I was like, this is, this is crazy like what’s going on what’s happening. And then I discovered I had been on birth control pills before then for a really long time. And once I came off birth control pills, like I had terrible ovulation pain like I would be like curled up in the corner on the floor like this hurts. So I just thought that there was wrong I thought I had endometriosis, I didn’t know what was going on. So when I found out that I was pregnant. It was like it was just as I was about to say, I need somebody to look inside my belly and see what’s going on because this isn’t right, and the pregnancy test popped up positive and I was like what am i Wait, what am I really pregnant. And then I immediately went to the dollar store because dollar store pregnancy tests work just as well. And I got like four more. I told my husband that we had to go get like a bunch more, and we did get a bunch more and they all confirmed that I was indeed pregnant.

P: That’s totally exciting I think most of us go through life with the myth that the minute you start trying you’ll be pregnant. We ultimately absolutely needed fertility help but I know that every month, up to the point at which that was discovered. You know I assumed I’d be pregnant because that’s the story that you’re told

Dr. R: exactly and it can feel like and you feel like there’s people around you who get pregnant like they sneeze and they get pregnant and you’re like, like why is this and then you look around and you see other people and you’re like why is it that me, it can be a lot.

P: Yeah, yeah, and you hear a lot of people who got pregnant by accident right anything

Dr. Rankins: Yes.

P: and you think, how’s that possible?

Dr. R: Yeah.

P: What was your pregnancy like?

Dr. R:  So I was like I said I was a little bit anxious from the start, and things were fine until like the summer we’re not, maybe like nine or 10 weeks I had an episode of bleeding, where I bled, like all the way through my clothes.

P: Oh wow

Dr. R: So, which of course terrified me. So I went in to the office, caught you know call my husband, he was out of town, it was like a lot everything ended up being fine, but that episode certainly made me nervous. And even before that I would like, you know, check to try and ultrasound myself here and there. But definitely like ultrasounded myself a couple of times to try to look and see what was going on so I was a little bit like just nervous and anxious about what was what was going on but, you know, physically I felt, I felt fine I didn’t have like nausea or vomiting or anything and other than that bleeding episode. Things were very reasonable and I had finally like, calmed down, but it was like, okay this is good, around about 24 weeks I had to have a follow up ultrasound because at my 20 week ultrasound. The doctor noticed that there was a little bit of extra fluid like not not a ton, but a little more than she would have liked to see so I went back for a follow up ultrasound. And that was the first ultrasound where I really felt like relaxed about everything. And it turns out that that was the ultrasound where our daughter was diagnosed with having a problem during the pregnancy so an intestinal malformation. So, ended up being something called duodenal atresia. So at that ultrasound. And you would think that I knew what I was looking at but I was trying to stay like fairly neutral and not. I was do a better job like not trying to be my own OB, so she was doing the picture that she took lots of pictures and she came in, and, you know, she said, the baby had a ton of I had a lot of extra fluid at that point because the problem that she had, it happens in about one in 10,000 pregnancies in, where the first part of the intestines is not connected together. Well, and though she can’t couldn’t swallow the amniotic fluid so it was like backing up so I had a lot of fluid they saw the issues and then, you know, we had to go from there. This is sometimes associated with chromosome problems particularly Down syndrome so then I had the next hurdle of what were we going to do about that. My husband and I decided that we wanted to know more information so I ended up getting an amniocentesis, and the chromosomes ended up being fine that she does not have Down syndrome but that was certainly a stressful time, waiting for that.

P: A lot of people say they’re worried about the amnio Were you worried that it would have some kind of effect,

Dr. R: no, not really. Well for one thing I knew I had enough fluid, I think anybody could have reached like shot a needle from across the room and like flew it was the easiest aim, like, I probably will let a student do it because it was I had so much extra fluid that it was so easy to do. So the procedure itself I wasn’t worried about it was just more the anxiety of getting the result back.

P: So that sounds a little stressful. I assume there’s nothing during the pregnancy for that.

Dr. R: No, no, it’s all like you have to figure out, you have to wait until until after the baby’s born so then what happened is, then I got calmed down again because we met with a pediatric surgeon who said and I delivered at the same place where I did residency so at Duke, and we met with a pediatric surgeon and he was like, you know, this, this typically doesn’t end up being a huge problem. The most of these babies are born full term, they have surgery three or four days after after birth, and then we fix it, they stay in the hospital for a week or so go home and like things end up being fine. So I felt reassured that Okay like I know I have this issue but you know we have a plan and most of the time things end up being fine and I felt just a lot better and then having the amnio back the chromosomes and I just felt a lot more reassured that the things didn’t end up going the way that we thought,

P: well, so what happened then did you make it to 40 weeks?

Dr. R: No, I did not. So on a Friday, I had been having contractions, on and off, because I had the extra fluid can make you have contractions so I’ve been having contractions and then

P:  wait let me ask you one kind of silly question, did you know that it was contractions. Did you know what was going on?

Dr. R: I did, yeah, I did and I knew that they were not like they weren’t painful, they just, I could just, they would happen, cramping and then it would go away, so it wasn’t like anything major. And when I got put on the monitor for like testing and things like that, it, I could see that they were happening but I actually did know that they were, they were contractions. And I also knew that, on that Friday morning that they were different, so they started getting regular before they were like, here and there and then that they started getting regular and I was 32 weeks and zero days exactly, they started getting regular. They were painful and just consistent and I told my husband I was like you know something isn’t isn’t right, this is different, I need to go to, you know, I think we need to go to the hospital, and my husband is lovely. We’ve been married for 15 years, but he knew I was like, tending towards anxiety and he’s like, Are you sure do we really need to go, I was like no, I really think this is different. And he said that he knew that something was wrong because on the car ride he could see me clutching the door handle of the car. Yeah, yeah, yeah.

P:So what happens when you get to the hospital.

Dr. R: Yeah, so I got to the hospital and, again, I felt comforted, because I knew I knew the staff and this was so that helped a lot, but the where I work, they had midwives, they still do have no bias and she checked me in and she’s like, Oh yeah, you’re a centimeter dilated and your cervix is effaced, and I was contracting every two or three minutes, so I was definitely like going into labor so then I had an ultrasound, because the length of the cervix can help predict, like whether or not you’re going to go into preterm labor and my cervix was like, longer than two centimeters is good. Mine was like, millimeters like,

P: oh wow,

Dr. R: yeah so I was definitely like going in to labor…

P: so there’s nothing they can do to stop it at that point you can’t take medication or…

Dr. R: well they thought, well, they said like, Okay, let’s try. Let’s try taking off some of the fluid, like some of the amniotic fluid because I have a lot so they thought maybe if it decompressed the size of the uterus a bit that things will quiet down so then I had another. It’s like an amniocentesis except they connect the needle to a drain, and they drained off like a liter of fluid.

P: Wow.

Dr. R: Yeah, it doesn’t hurt you just kind of sit there and the fluid comes out, but it did nothing I just continued to keep having contractions and then they said, well that’s maybe, you know, then I got admitted, of course, and I don’t recall getting any medicine like I didn’t get magnesium or anything to try and stop the contract like I didn’t get a whole lot to try and stop

P: once your cervix is effaced that’s not game over?

Dr. R: No, not necessarily, no. Sometimes you can still, still try and stop it yeah I don’t remember getting a lot to try and stop the contractions but I don’t think anything would have worked like I just rapidly progressed to like six centimeters. So, I did get ended up getting an epidural, and that’ll kind of play into the story later. Not because I was in a terrible amount of pain, but they just kind of thought like, just in case and maybe it might help like slow things down because epidurals will slow down labor a little bit but not, not a lot but I think we were all just kind of like pulling it whatever we could to try and see if we could slow this slow this down. So I just progressed, my water broke and I got to eight centimeters, and then she started having these big drops in her heart rate, and of course I know what that, that means you know big drops in the heart rate so the doctor.

P: Wait, what does that mean?

Dr. R: It’s a sign of distress. So when babies, yes on the heart rate monitor it was, it should normally stay in the range of like 110 to 150 and hers would drop down to like 80 or 90 beats per minute, you know, so it was dropping low and coming back up dropping low coming back up. So the doctor on call was like well maybe you can go ahead and just try and push, because I was like eight or nine centimeters and at 32 weeks we knew she was going to be smaller. So maybe just try and push through not a completely dilated cervix, but that just made the heart rate changes worse. So then, decision was made to go to C section, and at the C section so normally in a C section we do something where we, we, we test where we do a little clamp test to see if the patient is numb and making sure they can’t feel well I shouldn’t say… that makes sure they can’t feel pain like you’ll feel pressure and you’ll feel touching, but you shouldn’t feel like pain and they did the clamp and I was like no, I feel that like it felt like a distinct, it was pinching, but because her heart rate had been low, they went with the C section anyway and I, and I completely felt it,

P: Yikes!

Dr. R: yeah. Yeah, it was it to this day I will never…. It makes me stop whenever someone says they can feel it because it’s a, it’s not, it’s obviously a terrible feeling. And my husband just said I was just clutching, you know his hand saying like, you know, wait wait wait wait wait wait wait, but they just, you know, kind of went, and it doesn’t take long to get a baby delivered.

P: Yeah,

Dr. R: especially you know, for first time C section, It can be easily, a minute or two. That’s it. But it’s during that time it was very painful and then I remember they gave me something through the IV to help, to help with the pain medic, you know, help with the pain, and it was like, made me all like woosey. I remember I said, You just gave me some happy drugs that. And then the next thing I remember distinctly is like the surgery being over, and being transferred to the bed and I should take that back, I do remember before that because they don’t give you the medicine until after the baby’s born, so I do remember the moment when she was born. And I said I have to see her, I have to see her and they held her up over like the surgical drape. She looked like a monster. She had like her hands like up and claws and she just like she was like ready and she was like fighting and ready she was a little skinny squirrely big headed thing, but she looked pretty vigorous so that made me feel better and then I got the medicine and then like I said, next thing I remember it was, it was over.

P: So as a doctor. Do you think he would have proceeded with a patient like you in the same way.

Dr. R: You know that’s that’s a great question and I don’t think anybody’s ever asked me that. Probably yes, honestly because you feel like the anesthesia is telling you like we can get it under control. You know the baby’s heart rate is low, you want to get the baby dellivered so you’re trying to find the right balance so Yeah, honestly I probably probably would probably have, you know, before. So, yeah, but if I can at any moment like pause and say hey we need to work on this if there’s time then yes for sure. I pause and like we need to do something different

P: for your daughter’s condition does she produce a normal apgar or does

Dr. R: she, you know, do so yeah so she came out fine she came out bigger she never needed to be intubated. So she had she, she was fine, I should say I had had steroids betamethazone which is a steroid medication that you get that can help mature the baby’s lungs I had that the week before, only on a hunch, from my doctor that well, you’re at this point in pregnancy you are starting to have some contractions, let’s do it just in case, and it ended up being needed. So she came out, she was fine and she went to the NICU, she had surgery. Three days after she was born. When she came out of it and I first saw the pictures that were added as far as immediately. She went to the NICU my husband went and saw her and got pictures. I was like, is she okay, because like her ears don’t look like they’re in the right spot and like her aid so like, what is going on with that is that look to me. I don’t know if I was just anxious just again she ended up being fine she’s a beautiful girl but those first moments when I looked at that preterm baby I was like, Okay. And I should also say that in the recovery room. After the C section, I was so hungry I had not eaten all day, and I had Chick fil A like one chicken tender and like five french fries that was the best meal, I have ever had in my life

P: How much did she weighed.

Dr. R :Okay, so she weighed. Three pounds seven ounces or, I remember the grams because it was 1555 grams, because a very low birth weight baby is 1500 grams and I was excited that she was over 1500 grams at 1555 grams.

P: Well Well done for her the first hurdle is 32 weeks like I know that for preterm babies. They’re there kinds of markers of like early preterm and late preterm like where’s 32 weeks is that …

Dr. R: it’s, it’s kind of in the middle, like late preterm for sure is after like 34 weeks so it’s not like super duper early survival is great at 32 weeks but they’re gonna spend a little bit of time in the hospital

P: and she because she had the beta metazoan like her lungs were fine or…

Dr. R: she never needed any additional like oxygen  she was fine breathing on her own.

P: So she’s in the hospital just to grow them and like gain body fat and

Dr. R: grow gain body fat and to have certain have the surgery to fix her intestines.

P: So we had surgery on our daughter to for the heart problem. The day after she was born and that’s kind of a terrifying thing, but our daughter was a whopping six pounds.

Dr. R: Okay,

P: I’m imagining three pounds is a little stressful.

Dr. R: It was, it was, it was an, she, it definitely was she had born on Friday had surgery on Monday, And at the surgery went great. But then after the surgery, they extibated her or took the tube out a little too quickly, and I happened to be we happened to be visiting and at the bedside when that happened, so that was another stressful moment, you know, watching as I could, You know hear her oxygen level, dropping and see that she’s not breathing and they tried to usher me out of the room and I like refused to move like I couldn’t move I just like, No, I need to stand here, so they re-intubated her, and then kept her on the ventilator a little bit longer just took a little bit longer to recover from the the anesthesia than they had anticipated. Um, so that was a scary moment but thankfully that was the last of the scary moments.

P: That’s great. I’m assuming that the surgery is required for her to like metabolize food,

Dr. R: so she could nothing can pass through her intestines I mean babies back in the day before they knew about this with, I mean if you can’t, if your intestines aren’t connected and they, you can’t eat you can’t absorb any nutrients while she’s inside of me she’s getting all the nutrients through the placenta so she doesn’t really, you know, babies don’t need their intestines but on the outside they need their intestine so literally they just made a little incision cut her open and connected the intestines back together.

P: That’s amazing.

Dr. R: It is it. The surgeon, the surgeon, he was, he was, we remember he was German, because my husband’s mother is German, and he was very like, you know, like, he comes out and he says, the child did very well in the surgery. Okay. You clearly you call them all the child, so you don’t have to remember, who’s the boy who’s a girl but it was, like, the child did very well.

P: that is was very funny. The German version of like Captain.

Dr. R: Yeah.

P: Very funny. Yeah, also to call her the child since she’s like a teeny baby whose five minutes old

Dr. R: Yes, but exactly he said the child.

P: It’s very funny but, you know, thank God he did a good job. So, yeah, so how long do they have to keep her in the NICU.

Dr. R: So she was in the NICU for a month, just feeding growing getting bigger and I will say, NICU nurses are some of the most remarkable people on the planet, period. Like, don’t get me wrong, my colleagues, the doctors, the nurse practitioners people who round we saw them like maybe once it you know they come through, they check and do things but it’s the NICU nurse who is like, they are with you know come visit when you call they talk to you. They’re the ones who were like come on you’re going, bathe This baby because you need to take care of this child. You’re gonna change these diapers. Come on, we can do this here we go, and they are just, they just, they’re remarkable.

P: In our experience, they were the most competent people I’ve ever met and my when we were kicked out of the hospital which is the way we see it, we were willing to stay… that you know we were like trying to get someone to adopt us, we were like, what, how can we just go home with you.

Dr. R: They are amazing. They are amazing, and it was a similar sort of like one day the NICU doctor was like, if you guys want to have any more time alone and you should go out this weekend because she’s going home next week, and we were like, What, wait What,

wait a minute, like wait a minute.

P: You’re like didn’t this baby just have surgery?

Dr. R: like didn’t like what happened, like what, and people would always say, like, Yes, I’m a doctor and, but I’m an OB GYN, I don’t know what to do with a little person like. Please stop, like, just forget I’m a doctor like I’m just so scared mothered figure out what’s what, but she went home exactly a month after she was born she weighed a little over five pounds when, when she went. When she went home and home, you know since then she’s been she’s been she’s 13 Now, 13, and five and a half inches taller than me and the year ahead and school. So very very very smart yes yes but in the beginning it was a little bit like you were and I’m sure you had the same thing when you go home you worry like every little thing like one time she threw up, and it was just like, oh my god, something’s happened where the connection is, it’s bad. We’re going in. We went it was almost like a snowstorm a snowstorm was about to start and I was like no, no, no, we’re going to the pediatrician. When you look when I look back at it, it was like, you know, it was like a little like terrible, but you just until you, they get a little bit bigger, It just, you have that like anxiety for a while, I think,

P: Oh, for sure, for sure, and I remember my daughter had a heart condition and I would call the nurses and say, she seems really tired and they’d say, put her to asleep. Like, there’s no magic like

Dr.R: Right. Right. Right. Right, yeah, you know, And we had to feed her every three hours.

P:  Oh wow.

Dr. R: For a long time, like the doctor was like you have to scout, you have to feed her every three hours social growth, so we had to do that whole schedule and pumping and supplementing and all of those things. So yeah, I mean, ultimately you figure it out if you get you get past it, I’ll tell I’ll tell everyone. When I share my experience because occasionally I’ll share it with patients when they have preterm babies, I don’t like to push my whole story but like you never ever, ever forget. Having a child who’s in the NICU just never forget it. But you do get past it.

P: I think that’s totally true. Totally true. Yeah, yeah. So what she into now?

Dr. R:  she is into reading, so she is a very avid reader, she is into smart comments back to her parents.

P: that sounds like 13

Dr. R: She is, she is she really is smart, she’s interested to get interested in like social justice issues, she’s not quite into athletics yet. I think she’ll run track once things have like settled down with, you know, COVID times she’ll probably run track she’s, bless her heart, she’s not the most coordinated of people always asked if she played basketball, I was like no, she’s I don’t think she’s like

P: do they say that because she’s tall?

Dr. R: yeah, because she’s tall, but I think that track she can run fast in a straight line so she’ll probably run track but she loves to read. She loves to read, we have another daughter, and their younger daughter and they’re their best friends so that’s all healthy happy.

P: That’s awesome.

Dr. R: Yeah.

P: So what was the second pregnancy and getting pregnant and being pregnant, and the birth easier?

Dr. R: Funny story, the second time. I’m grateful that the second time around I was like okay, if I can go through all that, like, I can, this, this is going to be okay, like we’re, we can handle whatever kind of comes our way so I was much, much, much more relaxed about the whole process, and then I felt like I had done some like personal work like meditation and things to try to like to calm myself down so I posted a totally different way so the way that I found out we were like, Okay, our first daughter’s a year old like okay let’s start trying, you know I was 32 to 33 when the first one was born so I wasn’t getting any younger. So we started trying and then I was at work one day and I was like, I don’t think I’ve had my period in a while, like, I don’t think it happened and my husband was like, he literally texted him I was like, I haven’t seen my period in a while and he’s like, genius, this is genius. You’re an OB GYN go take a pregnancy test.

Like, oh yeah, I should probably do that. And lo and behold, yes. I was indeed pregnant.

P: Oh good, that’s a nice, it’s a nice way to slide into it the second time, right?

Dr. R: yes yes and that pregnancy was fine except I did have nausea and vomiting, a bit with that pregnancy and like weird food intolerances, I don’t know why we can tolerate some food to something, some things like Cheerios would make me vomit like profusely, it was just weird. Once at work in the bathroom. I’m not lying. I threw up. And it went on three walls like, I don’t know what it was, it was awful. I felt so bad I told the cleaner I’m so sorry I’m so sorry I just said, is terrible and she’s like it’s fine I’ll fix it so that only lasted the first trimester, but otherwise the pregnancy was completely fine, I didn’t have any issues at all ultimately ended up having a scheduled repeat C section, which to some degree, I regret because I did it more so because it was convenient for work, you know, and looking back like when you make those decisions for work like it’s never worth any more than a job anymore, you know,

P: yeah, yeah,

Dr. R: it wasn’t worth it I think I would maybe try for for the back but otherwise the pregnancy itself and the repeat C section was, was marvelous like it was, there was no pain or, or anything and it’s how I knew that I wasn’t crazy because honestly thought for a second like was that just exaggerating like was I crazy to think that I felt this way at my first C section, you know, it was definitely what I had this second one, that it’s solidified that no this is a completely different experience than what I had the first time,

P: I’m impressed that you went for this C section the second time after the first experience.

Dr. R: Yeah, yeah, I don’t, I don’t know what just so I think the, the type eight is still up like I can schedule it on a certain day was just. And then I pick, I’m not gonna lie hand picked like everybody who I wanted to be there so that’s I see so for the anesthesiologist was like can you be there, you know, so that the nurse everybody so that made me feel better.

P: Well, that totally makes sense that actually in that context if you can control that element then that seems just wise, yeah. And so if you have an early birth, you’re not at risk to have it again or?

Dr. R: you are actually you are that’s one of the biggest risk factors to have another preterm birth, but for me it didn’t, didn’t, the second one was full term,

P: and is there anything they do to monitor you for the second time around.

Dr. R: So they do have links at measure the length of your cervix, during the pregnancy, that’s the most the strongest predictor, sometimes we do progesterone in order to help reduce the risk the second time around, I did not do progesterone, the second time around it wasn’t as in favor, then I mean my younger one is 11, so that was a while ago

P: that birth what sounds like a day at the office because it’s. scheduled I’m assuming there’s no contractions and

Dr. R: yeah I had just started like literally that that morning starting to have a few contractions but nothing terrible but that but that was like. Easy peasy lemon squeezy. Like the C section itself was straightforward. I stayed in the hospital two days. Today I hate hospitals that Yeah,

I hate being a patient. So I went home two days afterwards, and I felt fine.

P: Wow. That’s amazing.

Dr. R: Yeah, yeah, yeah,

P: and what’s the 11 year old into.

Dr. R: She is also into reading as well, she is into drawing, so actually painting like she likes to paint. Sometimes she’s into pushing back against her older sister can smell her oldest is was a little bit bossing sometimes, but they’re actually in many ways very similar and the things that they like she also likes racecar driving. So,

oh wow, that’s cool.

Dr. R: Yeah, yeah,

P:  hopefully that will mellow by the time she gets her license.

Dr. R: Yes,

P: a little runway

Dr. R: Yes, yes, yes.

P: So, that’s an amazing story I’m glad the second time it was totally smooth. Yeah, it is, um, the bar is set so kind of low after the first one right, like anything less than that kind of high pitched excitement seems very easy.

Dr. R: Yes it does, it does

P: so that’s nice.

It’s lucky to get the opportunity to interview and OB about her pregnancy experiences. I also want to ask her about her work in educating women about pregnancy, and about her perceptions of the way the field of obstetrics manages issues like racial inequality when it comes to maternal mortality. Obviously you have a podcast called all about pregnancy and birth, which I listen to religiously.

Dr. R: Oh thank you,

P: It’s fabulous. on your web page, you have stuff about a birth course and a birth plan, and the birth plan is particularly interesting to me because most people I’ve spoken to have said like, oh, I had a birth plan but then X happened. I’m interested in your birth plan, what the theory is behind that and do people get to use it and like how does that work.

Dr. R: Yeah, so I say birth plan this because what people commonly use but like one of the first things I say in that free class is that we have to change it to birth wishes, because birth is a completely unpredictable process, and none of us can control birth, even if physicians tell you like, oh, we can just induce you and it’s, we don’t actually have control over what ultimately happens it’s, it’s unpredictable. So it’s really about wishes and things that you want, want for your birth experience and how to get that and then also just understanding, like the two biggest factors that will influence your birth and that’s the hospital where you give birth, and whoever is caring for you during your pregnancy and birth. so it is really asking questions so you’re informed about the way that they practice and that it’s in line with what you want for yourself so one of the biggest things I say and stress is that birth is unpredictable, this is really about riding the waves of that unpredictability, because when people aren’t satisfied with their birth experience it’s most often because they were not prepared for the fact that it could then it may not go as they, they saw that they wanted it to go or as they thought it was gonna go. So when you’re prepared for the unpredictability then you, you feel good about the experience, either way and you don’t blame yourself or feel guilty if things don’t go exactly like you anticipate

P: that sounds super smart That’s good advice. And the other thing I’m wondering about is, you know, if you read the statistics about black women and maternity. It’s like, it’s like criminal, like I don’t know what word would better describe that situation. do want to talk about that a

 little bit.

Dr. R: Sure, so yeah I mean, black women are three to four more times likely to die in relation to childbirth compared to white women and that is completely due to racism, there’s, you know like, full, full stop.

P: To get a broader view of this issue, I talked with a senior policy analyst, at a think tank in Washington DC. Hi, thanks so much for coming on the show, can you introduce yourself and tell us about your professional background.

OA: Sure. Well thanks for having me so much Paulette, so my name is Osub Ahmed, I’m a Senior Policy Analyst for women’s health and rights on the women’s initiative team at the Center for American Progress, I work on all issues around women’s health and rights including birth control, abortion, and of course maternal health,

P: good Lord You must be busy.

OA: We’re very busy team. Yeah.

P: So first I wanted to have you lay out the statistics for us

OA:  in terms of looking at the US versus other developed countries, there was a recent study from the Commonwealth Fund, that looked at the US is rate compared to attend other developed countries and in 2018 The US is rate with 17 maternal deaths per 100,000 live births, and that is about double what other high income countries, rates are that distinction is not a good one, we’ve been having this conversation around our maternal mortality crisis for years, but this rate hasn’t gotten better, and I think it’s something that we really really need to develop policy solutions around in order to ensure that women don’t have to be scared when they get pregnant and face you know the childbirth or it should be a joyous experience,

P: and I’m guessing that that number hides this racial disparity issue where the 17 doesn’t really reflect the rate for everyone.

OA: Absolutely yeah there is a racial disparity embedded in that larger rates, women of color and black men specifically are three to four times more likely to die from pregnancy related complications compared to white woman. And so, there, there are many reasons for that of course first and foremost is that racism is embedded in our healthcare system, and it affects the quality of care that black women receive their ability to access coverage and the resources they need to have healthy pregnancies, and even in the postpartum period, there are many issues that prevent women from having healthy perinatal experience

P: when I have looked at the numbers before it looked like white women in the US have almost the same number as white women in other countries that are doing well so literally, black women and people of color are really the ones who are mostly impacted by this terrible maternal mortality rate.

OA: Yeah, absolutely. There’s so many issues I mean it’s a very complicated issue. And I think that, you know, of course, like I said, racism and sexism is at the core, but when you break it down, you know you’d look at for instance issues around health coverage, you know, that is very important especially, you know, childbirth and pregnancy is very expensive.

P: Yeah,

OA: out of pocket, and so having insurance is critical to make sure that you can go for your prenatal visits that when you go to the hospital and come out with, you know, come back with your baby that you’re not gonna be saddled with these incredible bills, and that in the postpartum period that you can still go and seek out that health care. I think that that is, that is one very very important area, of course, other things related to weathering and impacting literally a person’s physical health and their body, their mental and physical health, they’re all things that cause black woman to ultimately experience these higher rates of mortality, when they’re pregnant and after they give birth,

P: and we’re talking about insurance, which to some degree, is a reflection of income, but black women across the spectrum face this higher mortality rate it’s not just income right so there’s many other things going on right it’s not like, If only everyone was insured this wouldn’t happen.

OA: Absolutely. So that’s a really important point to make, and there’s a lot of research that suggests that, whether it’s your income, your class where you live in the country. These things are not protective factors I think that there are some statistics that show that black woman who are more highly educated tend to have higher rates of preterm birth compared to white women that are not as well educated, so it just again shows that it doesn’t matter if you’ve been able to, you know, achieve all the things that you think would make sure you’re in a safe position, it ultimately your interactions with the healthcare system are going to put you at a disadvantage literally because of the color of your skin.

Dr. R: And it’s hard for people to wrap their heads around that because they think of racism and they think of like slavery or the KKK or things like that or maybe what we saw at the capitol for God’s sakes, but it’s but it’s actually more tends to be more more subtle, where people have implicit bias, they’re, they’re treating people differently and they don’t realize it.

P: Let’s talk about the insidious ways that race plays a role in these cases.

OA: If you look at this from a sort of, at different levels at the individual level, you can look at people’s interactions with the healthcare system, and with providers for instance, it can be very very subtle interactions that indicate to you that you aren’t valued, that you won’t be heard or listened to, there is the story which, you know, I think is a very important story but you also have to remember there’s many other stories around Serena Williams and her where she knew that there was something wrong, and she, she insisted to her doctor and they didn’t listen and she had to insist again and again. That is just an example of so many other black woman’s experiences that they have higher pain tolerance, and so they’re just, you know, or they’re being aggressive or, or just dramatic or just that what they are telling you is not true. And that is not only dangerous in terms of health consequences but it is, it impacts you on a deep emotional level as well. Looking more on a structural level, everything from access to doulas and midwives, it is difficult to pay out of pocket for a doula.

P: Yeah,

OA: and oftentimes doulas will lower their rates to make sure that women can afford their services but you know that hurts ends up hurting both the woman and the doula access to doulas is critical because they help to navigate the healthcare system and be an advocate, but if you aren’t able to afford a doula, because your state has decided not to allow for Medicaid reimbursement for example, that puts a woman at a disadvantage, and I fully believe that if black women had more doula support, that there would be better outcomes around maternal mortality, there’s a lot of issues around the health care system where we don’t ensure that women can access the things that they need, particularly women who are on some public insurance programs like Medicaid, there are a lot of things that can be done to reform Medicaid. And these are very clear things and yet, policymakers and legislators haven’t made those moves yet. And I think that that its clear that black woman in particular will need some of those reforms.

Dr. R: One of the biggest things is that our concerns aren’t often taken seriously enough. There’s story after story of concerns not being addressed not taken seriously enough pain not being addressed. And when you look at the factors and this is even for educated, black women, then that leads to sad outcomes related to bleeding after birth related to high blood pressure issues after birth so it’s really related to just not listening. So this is why I say especially honestly the way our maternity system in the US in particular is the patriarchal is based on, you know patriarchy and taking away power and control and choices from women about what to do in their own bodies and we’ve gotten better. We’ve definitely gotten better, we’re not like where we were in the 50s or 60s or whatever you know where everyone was like knocked out you couldn’t have anybody in the delivery room, but we still have some room to go and I say all that to say like, everyone actually needs to have someone who can advocate for them on their behalf during pregnancy and birth, and the idea is hopefully you don’t need it because you end up being in the supportive system, but sometimes you don’t know until you get there, but it’s really important for black women and people of color to have advocates for you to be educated and empowered with information so you can both advocate for yourself or if you’re not in a position to do so you have someone there who can advocate for you on your behalf, that’s really key.

P: So like a doula would be a good thing to bring to the

Dr. R: 100% Yeah 100% A doula would be a great thing to have.

P: Oh, you know, I was gonna ask about if there’s any data about doulas and our measured impact.

OA: So yeah, there actually is, is data out there about doulas and their impact on birth outcomes. So there are studies that have found that when birthing people have doula support, they have better maternal infant health outcomes so that includes lower rates of preterm birth, lower rates of C sections again having an advocate in the room to, you know, if it does fall into an emergency C section conversation they can be there to push back if necessary. Also, higher rates of breastfeeding initiation. So there’s a lot of really great things that come out of doula support during the birthing and postpartum, as well as really prenatal experience, it’s all part of the woman’s sort of journey and when a doula is present, the woman does better, and her baby does better too.

Dr. R: And I tell people its hard because you don’t want to be seen as like the difficult person or like make a scene or those kinds of things but ultimately it ends up being like, your, your life, potentially, you know, you start from a place of kindness and human connection and saying hey I’m scared I’m worried, help me, those things that if that doesn’t work, then you may need to elevate it to a level of like I am demanding that you come see me and you can do something about this. You have to actually like involve people in their care, you can’t make those, those choices for them in that case of consent in, in particular, this comes up with things like breaking people’s water without consent or stripping membranes without consent, those are things that just, that just shouldn’t happen and it all comes down to whether it’s listening to the patient or explaining things it’s like really just putting that birthing person at the center of the experience and if you work from that, then you’ll be fine.

P: It’s probably most acute in OB work because it’s so intimate and so, you know everyone remembers their birth forever like, as opposed to like a gallstone, exactly.

Dr. R: Yeah, exactly, exactly. Yeah,

P: so it is super important. So, is there any other suggestion you have other than getting a doula is there anything else we can do.

Dr. R: Yeah childbirth education, I think is really important, we’ve gotten away from childbirth education and people routinely doing time with education, I think that’s key. It’s not, obviously not going to give you the same level of knowledge and expertise that I have it, you know 15 years of experience, but you will be able to communicate intelligently about things when you go through a good childbirth education class and there’s lots of options you have to find something that works for you, you know, as you said I have an option for online classes geared particularly for women who plan to give birth in the hospital, but do something like that’s my plea to please do some childbirth education because that really makes a difference, and your partner should do it too.

P: Oh that’s a good suggestion. So you can definitely, either you can be your own advocate or he or she can, because

Dr. R: yeah, yeah, yeah. Yep.

P: I think that’s another thing you don’t know before your first pregnancy is how compromised you’ll feel in the moment right you’re, you were in extreme pain right so how can you possibly kind of steer the ship.

Dr. R: Right, exactly, yeah,yeah, for sure.

P: Well, I totally appreciate your amazing story and your podcast and your, your website with the birth course and the birth plan that seems super helpful. And hopefully it will do, do people good to have more kind of knowledge to get the pregnancy and birth they want.

Dr. R: Yeah, thank you thank you I certainly appreciate that and if you to anybody who’s interested in my website is it okay if I mentioned it, absolutely. So the website is Dr. Nicole Rankin’s comm so that’s pretty easy to remember and you can find all the stuff there for the podcast and free downloadable resources like the warning signs to look out for after birth the free birth plan class and then as far as social media Instagram is my favorite place to be. So I’m there at Dr. Nicole Rankin’s also.

P: Okay, great. Well, I will put that in the show notes also so people can find you.

Dr. R: Yeah. Well thank you so much for having me on. I appreciate it.

P: Thanks so much for coming on. I really appreciate this conversation. Thanks again to Dr Rankin’s for coming on the show and sharing her experiences, both as a new mother and as an OP. Thanks also to also, for giving us an insight into the scope of the maternal mortality problem facing women of color and black woman in particular, and for giving us a sense of what’s being done and what needs to be done to resolve these long standing issues. Our conversation was longer than the clips included here. We talked about some of the progress that’s been made in particular, Miss Hoffman, talked about the federal package of legislation that was introduced by Congresswoman Lauren Underwood, Congresswoman Alma Adams, Congresswoman, all the Adams and former senator Kamala Harris and the members of the Black maternal health politics. It’s called the Black maternal health omnibus of 2021. It’s a package of wonderful bills they tackle a number of different issues around maternal health, including the 12 month postpartum Medicaid coverage investments in rural maternal health, the promotion of a diverse perinatal workforce and the implementation of implicit bias training. If you want to get involved in this issue, see the show notes for episode 12 on the war stories from webpage. In the shirts I also included links to Dr Rankin’s work, and to some of the studies that this aspect talks about. If you liked the show, we could really use your reviews, because these help other people to find the show. If you’d like to share your story, go to war stories from the womb. COMM And sign up. Thanks so much for listening. We’ll be back soon with another story of overcoming.