During my research on last week's episode on post partum, I learned that my own state of Arkansas holds the #1 spot in the US for maternal mortality rates. I'm interviewing Dr. Zenobia Harris today, whose accolades in this field are numerous to try to understand what's not happening in Arkansas that needs to happen - and what states are doing it right and how. Dr. Harris heads up the Arkansas Birthing Project, and is an incredible force and national advocate for health equity and for improvements to family, child, and maternal health. The program as well as the national organization Every Mother Counts is reaching out to minority women and their families, who are much more likely to suffer severe medical problems both during and after pregnancy.

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Birthing Project USA

Dr. Krystal Caschetta as a victim of severe post partum depression

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Episode Transcript

This is SelfWork. And I'm Dr. Margaret Rutherford. At SelfWork, we'll discuss psychological and emotional issues common in today's world and what to do about them. I'm Dr. Margaret, and SelfWork is a podcast dedicated to you taking just a few minutes today for your own selfwork.

Speaker 2: Dr. Margaret

Hello and welcome or welcome back to SelfWork. I'm Dr. Margaret Rutherford, and I'm so glad you're here.

This week, we had another reminder of the seriousness of post partum depression - or the potentially fatal mixture of new motherhood and suicide.

Dr. Krystal Caschetta, an oncologist, is reported to have killed her 4 month-old daughter and then killed herself in New York. Current evidence seems to support that she was suffering from the most severe type of post partum, or what's called post partum psychosis, where the new mother is besieged with delusions or hallucinations that can govern her behavior and lead to violence against her baby and her self. It's another set of gruesome tragedies that demands our attention because these deaths can be prevented with the right care and understanding.

I'm sure there will be more to report. And our hearts go out to that family and others who've experienced such a harsh reminder of the mental and emotional toll pregnancy can take.

During my research on last week's episode on post partum, I learned that my own state of Arkansas holds the #1 spot in the US for maternal mortality rates. I'm interviewing Dr. Zenobia Harris today, whose accolades in this field are numerous. She heads up the Arkansas Birthing Project, and is an incredible force and national advocate for health equity and for improvements to family, child, and maternal health. The program as well as the national organization Every Mother Counts is reaching out to minority women and their families, who are much more likely to suffer severe medical problems both during and after pregnancy.

What's amazing is that those statistics can be reversed with support for that mom during pregnancy - provided by who Dr. Harris calls "sister friends." Here on SelfWork, we talk about what you can do about it. Dr. Harris is doing just that and creating a network of sister friends that are saving lives- and we want to support that mission here at SelfWork!

We want to welcome back Magnesium Breakthrough as a sponsor of SelfWork once again! In fact, Mag Breakthrough helped me avoid a side effect of another medication I needed to take for a few days simply by helping my colon function better. I love this product!

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Speaker 2:

So now I'd like to introduce you to Dr. Zenobia Harris, head of the Arkansas Birthing Project, and a highly respected advocate for improving the care and support that all mothers receive, but especially moms of color who are the most at risk.

Speaker 3: Dr. Harris

The Arkansas Birthing Project is located in the main office is in Little Rock, but we do have birthing projects in various counties around Arkansas and primarily in southeast Arkansas. We primarily work with African American women and women of color. Yes.

Speaker 2:

So, but tell me about how long have you been the head of the birthing project and what do y'all do and talk about some maternal mortality issues.

Speaker 3:

Well, the Arkansas Birthing Project is an affiliate of Birthing Project, USA, which is a 40 year old black maternal and child health organization that originally formed in California Uhhuh , but it was founded by a woman from Arkansas. Really? Her name is Catherine Trujillo, and she was from Moscow, Arkansas. Yeah. But she was actually working for the California Department of Health and Human Services and was spending a huge amount of money as a fiscal agent on preterm Babies Care. Okay. And so she decided to do, conduct a social experiment with several of her friends. They decided to provide support to pregnant women during their pregnancy. There were, were 10 of them, and they each got a mentee, a little pregnant woman who they provided material and physical supports to during pregnancy and social supports, and they were astounded by the outcomes.

Speaker 3:

Traditionally statistically, the young women that they partnered with should have had really poor outcomes, and they didn't. The babies were born close to term or on term, the baby's weighed more than 5, 6, 5 and a half pounds at birth. Wow. they had a non-eventful delivery, and they did quite well after birth. And so they replicated this in that community several times and ended up at one, at, at later time, actually establishing a health clinic in a really at-risk community in the Sacramento area. And this kind of just sort of spread through informal networks. The, the idea of doing this well I, I saw Catherine when she came to Arkansas about, oh, about 10 years after she had founded the birthing project. She did a, a program for the March of Dimes, and I was mesmerized by the work she was doing. And so I became involved with the birthing project at that time. Yeah. And have been, had been working on it part-time until I actually retired from my work as a administrator with the Arkansas Department of Health and have been doing the birthing project full-time now in Arkansas since 2016.

Speaker 2:

I should add, you have your doctorate in nurse practitioner,

Speaker 3:

But we what we do is we go into local communities and train community women to provide support to women during their pregnancy.

Speaker 2:

What did those in initial mentors do? Or what is that? What does that support look like?

Speaker 3:

Well we primarily focus, of course, on social supports because many of the women that we interact with are women who identify as people who fall through the cracks. Perhaps they don't have a, a permanent place to live, or they have food insecurity, or they don't, they're not seeking prenatal care for various reasons because they don't know how to access it or they don't know have transportation, all those kinds of issues.

Speaker 2:

Too Expensive. They don't have insurance. Yeah, exactly.

Speaker 3:

Exactly. And some of them don't have family members to support them. They don't have close, you know people in their lives that will provide that support during this really special time in their lives. And so, our sister friends who are our mentors, we encourage them to become really familiar with the resources in their local communities. Okay. And to work with their little sisters to access those resources that she needs to have a good outcome. Okay. We require that the sister friends work with the little sisters to make sure they get a source of prenatal care and that they keep their prenatal appointments. If they have need transportation, help them work on identifying that we encourage our sister friends not to make your little sister dependent on you, but to encourage her to be independent.

Speaker 2:

That's an important point, isn't it? Wow. Yes.

Speaker 3:

Yes.

Speaker 2:

So what about postnatal care? Because I mean, you know, last week I did this episode on postpartum depression and found out that suicide and drug overdose is accounts for about 25% of the mortality deaths. Is that right? The maternal deaths? Is that correct?

Speaker 3:

Maternal? Yes, that's correct. Mental health related issues certainly have a huge impact. And unfortunately, some physical health issues also impact our maternal mortality issues such as undiagnosed health conditions such as diabetes, right. Cardiac disease, hypertension, which can lead to eclampsia, preeclampsia, and eclampsia, and which can be very fatal. And unfortunately for many African American women it is,

Speaker 2:

I'm so sorry. And the, the couple of articles, 84% of those deaths were preventable.

Speaker 3:

Yes. That is a, that is a huge tragedy for our communities. Huge, huge, huge tragedy and a huge loss of potential of human potential that could you know, be at work in these communities helping to improve the status of our communities. So it's a, it's a huge loss that we experience when these things happen.

Speaker 2:

Yes, it is. And as well as the children they bore, you know, so Yes.

Speaker 3:

Right. And unfortunately, sometimes we lose the babies as well. You know, we have the fourth highest infant mortality rate in the United States as well.

Speaker 2:

Do we really,?

Speaker 3:

Arkansas.

Speaker 2:

Wow.

Speaker 2:

Which are the states that are doing it better? What are the states that are doing it better and, and how are they doing it better?

Speaker 3:

Well as you, you may or may not be aware many states, over 30 of our states in the United States have extended the coverage for Medicaid for women postpartum. You know, in Arkansas, their postpartum coverage cuts off for women who are Medicaid eligible after the second, after two months after delivery. Oh my goodness. Well, many states - about 30 states - have extended that coverage for the first year of life because these deaths can often occur during the postpartum period. Many of them occur during the postpartum period when women don't have coverage. And what we, what they have found is that women will put off going to the doctor because they don't have money to pay for their care. And so they put off their symptoms and they'll deny their symptoms or delay, you know, seeking care until it's unfortunately too late.

Speaker 2:

What do you know for the mental health aspect of things?

Speaker 3:

Well, I think we, we do have a real acute shortage of mental health providers in our state, as you probably are very well aware mm-hmm. , and there's some parts of our state that are worse than others. And so dealing with that, in addition to some of the stigma that is associated with seeking psychological care and support is something that we've got to address as a society.

Speaker 2:

Now, if I read some of the articles disagreed with one another about this, so let me ask you... I read in one article that the mental health problems, suicide and drug overdose were more prevalent in minority women than white women. And then another article, it said, no, they're about the same.

Speaker 3:

They're about the same. Okay. In my experience. Okay.

Speaker 2:

Okay. Yes.

Speaker 3:

Yeah, yeah. You know, we have the first trimester, second trimester, third trimester is, you know, when during the time the baby is born. Sure. And then, of course, that fourth trimester, which is the period, the immediate period after birth, actually that first year after birth of the baby. I think something that we need to make some distinctions about, or what we call baby blues. Have you heard that terminology, baby blues?

Speaker 2:

Oh, yes, of course.

Speaker 3:

Have, mm-hmm. versus postpartum depression. And I think sometimes people get those things confused. In the baby blues, you know, a little bit of melancholy and uncertainty and perhaps a little depression after birth because of all this tremendous hormonal and body changes that are occurring. If it lasts longer than two weeks, then we're really talking about postpartum depression.

Speaker 2:

And speaking of that, there is a, a, a medication that has just been FDA approved for postpartum depression, specifically for postpartum depression. Now I'm real excited about that. But, you know, my, my podcast goes well, I have listeners from all over the world, but certainly all over the United States. What, what could a woman do or, or a friend of someone who's pregnant? What are all these, is it called the Tennessee Birthing Project? Is it called the Mississippi Birthing Project? What, what are the, or the California, whatever it is, how can people plug themselves in or plug people in that they, that they know and love into these kinds of programs?

Speaker 3:

Well, the birthing project is just one of many opportunities I think we have available in our local communities to provide support to women during this really critical time. You know, there's been a lot of discussion about community doulas as well, and the supports that they provide. Yes. And I think there's room for everyone. The birthing project specifically, we identify people who are lay people. They don't necessarily have to be trained medical people, and they don't necessarily have to have any kind of certification, but we work with them and support them so that they can in turn, feel free and empowered to support a, an individual person basically like becoming a, a good friend of that person. Okay. A reliable and trustworthy friend. And Birthing Project USA, which is based out of Albuquerque, New Mexico is sort of the hub where people go to get information to establish birthing projects in other states. There are even some international birthing projects in Cuba in Ghana and other foreign nations.

Speaker 2:

Can you tell the audience what, what a doula is?

Speaker 3:

Well, a doula is an individual who is specially trained and experienced to provide to women at doing support during very critical times, either during their pregnancy, during labor and delivery postpartum. And there are even some some bereavement doulas who actually provide specialized support to real, recognize important needs that women and their families have as well. Mm-Hmm. , and to provide those supports to them to make sure that they have good pregnancy outcomes. So they are right there with women in the delivery area. They're that other voice in that other set of eyes and hands in that area and space that women need often when they're going through this real critical period, because as you know, it's very stressful and often, sometimes decisions have to be made pretty quickly, and it is good to have someone there who is very focused on the needs and the desires of the woman involved Right. During this real critical period.

Speaker 2:

Right. So if people wanted to either volunteer or donate, they could go to the Birthing Project, USA

Speaker 3:

Or the Arkansas Birthing Project if they're in Arkansas.

Speaker 2:

Sure, sure, sure. Mm-Hmm. . Well, yeah. Most, a lot of my listeners are New Yorkers and California people. So

Speaker 3:

Birthing Project USA. it's listed they do have a web, there's a website Birthing Project USA, and we'd be happy, they can indicate that they're interested in more information, and we'd be happy to get in touch with them. Arkansas has been asked to do some of the training for Birthing Project U S A because they appreciate the model that we have in our state. We're the only state that has multiple birthing projects in different counties compared to some of the other, you may have just one birthing project in one particular area in their state.

Speaker 2:

I have a sneaking suspicion that's about you,

Speaker 3:

. Well, I'm, I'm very passionate about this work. I'm very committed to it. And I just want to make sure that our next generation is prepared to provide supports that women need during this really important time in our lives. We're building our communities and we want to make sure that we get the full benefit of every person, the full humanity of every person in our communities safely delivered into this in our communities, and safely ensconced in our communities empowered to achieve the goals that God has set before them so that they can be full functioning citizens in our society.

Speaker 2:

I, I couldn't, well, very well said and eloquently said, by the way, so I'm so glad you could come on. And I hope to, again, it's Birthing Project USA or in if you live in Arkansas, it's the Arkansas Birthing Project. This is Dr. Zenobia Harris, and I'm delighted, absolutely delighted that you've joined me today. Thank you so very much,

Speaker 3:

Dr. Margaret. Can I do one more plug You regarding Every Mother Counts. Every Mother Counts has been very generous working with us. They actually have produced a film called Giving Birth in America, Arkansas. Oh. And we are encouraging people to access that film. It can be accessed on Every Mother Counts website to schedule viewings of the, of the film. And if you are interested in having a discussion groups set aside, we can certainly arrange that for you too, because we want people to talk about this very important issue of maternal mortality in our state and come together on solutions for this very important issue.

Speaker 2:

What is the name of it again? Because I will put it in the show notes.

Speaker 3:

Giving Birth in America, Arkansas, and it's on the Every Mother Counts website.

Speaker 2:

Okay. I got it.

Speaker 3:

Thank you. And thank you to Every Mother Counts too, for their support.

Speaker 2:

Yeah. They seem like an incredible organization.

Speaker 3:

Well, thank you so much, Dr. Margaret.

Speaker 2:

Of course. Of course. Anytime.

Speaker 3:

All right, let's stay in touch.

I'm sure you were as impressed with Dr. Harris as I am and was. Please reach out to her and all the organizations. Most states are gonna have some sort of support group like this as well as Every Mother Counts. That's a national organization, and I bet there are others. I know that not everyone who listens to SelfWork is from the United States, so please look around for help that you might need and benefit from. As usual, thank you for being here. It's an exciting week. My TED Talk has reached a hundred thousand views and many of you are probably those who have viewed it. So I want to thank you very much. We've got a lot of plans for the fall, and I can't wait to begin to introduce them to you. Thank you. Thank you for being here. Please take care of yourself, your family, and your community. I'm Dr. Margaret, and this has been self work.

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