What does it take to make birth safer with Dr. Vandana Arcot, MD.

In this episode of Ask the Doulas, Kristin Revere welcomes Dr. Vandana Arcot, MD, a philanthropist and global health leader who has spent more than 17 years working in maternal and reproductive healthcare across 13 countries. Through her work around the world, Dr. Arcot has seen firsthand that improving maternal and infant outcomes requires more than access to medical care alone—it depends on strong systems working together.

From roads and transportation networks to clinics, electricity, medication storage, emergency services, and well-trained providers, Dr. Arcot explains why infrastructure is often the foundation of safe birth outcomes. She shares lessons from countries including Bangladesh, Ethiopia, Rwanda, Sri Lanka, and Thailand, which have made significant progress in maternal health over the past three decades through sustained investments in healthcare infrastructure.

Kristin and Dr. Arcot discuss why maternal health systems remain underfunded in many areas, the impact this has on families and healthcare providers, and what communities and policymakers can learn from successful global models.

Whether you're preparing for birth, supporting new families, or passionate about improving maternal health, this episode offers valuable insights into the systems that help keep mothers and babies safe.

In this episode, you'll learn:

•  What maternal health infrastructure includes 
•  Why healthcare systems play a critical role in birth outcomes 
•  Global lessons from countries that have improved maternal health 
•  The consequences of underfunding maternal healthcare 
•  Strategies for creating safer births and healthier communities

This episode is sponsored by Cozy Earth. Use the code GOLDCOAST to receive a discount of up to 20 percent off.

Subscribe to our newsletter, check out Kristin Revere’s birth and baby book, and see more about our doula services & online courses below:

https://linktr.ee/goldcoastdoulas

Transcript

In this episode of Ask the Doulas, Kristin Revere welcomes Dr. Vandana Arcot, MD, a philanthropist and global health leader who has spent more than 17 years working in maternal and reproductive healthcare across 13 countries.  Through her work around the world, Dr. Arcot has seen firsthand that improving maternal and infant outcomes requires more than access to medical care alone—it depends on strong systems working together.

From roads and transportation networks to clinics, electricity, medication storage, emergency services, and well-trained providers, Dr. Arcot explains why infrastructure is often the foundation of safe birth outcomes.  She shares lessons from countries including Bangladesh, Ethiopia, Rwanda, Sri Lanka, and Thailand, which have made significant progress in maternal health over the past three decades through sustained investments in healthcare infrastructure.

Kristin and Dr. Arcot discuss why maternal health systems remain underfunded in many areas, the impact this has on families and healthcare providers, and what communities and policymakers can learn from successful global models.

Whether you're preparing for birth, supporting new families, or passionate about improving maternal health, this episode offers valuable insights into the systems that help keep mothers and babies safe.

In this episode, you'll learn:

•  What maternal health infrastructure includes 
•  Why healthcare systems play a critical role in birth outcomes 
•  Global lessons from countries that have improved maternal health 
•  The consequences of underfunding maternal healthcare 
•  Strategies for creating safer births and healthier communities

This episode is sponsored by Cozy Earth.  Use the code GOLDCOAST to receive a discount of up to 20 percent off.

Hello, hello!  This is Kristin Revere with Ask the Doulas, and I am so thrilled to chat with Dr. Vandana Arcot today.  You have so many amazing assets to your background.  You’re a physician; you’re a philanthropist; you’re a global public health leader and founder of KomselJ, a nonprofit consultancy focused on advancing women’s and children’s health and empowerment around the world.  For over 17 years, you’ve partnered with international organizations like the United Nations and UNICEF to strengthen reproductive health, nutrition, HIV care, wash, and girls’ education across 13-plus countries in Southeast Asia, Africa, South America, and North America.  Combining your medical background with your philanthropic leadership, you now educate organizations and donors on how to create meaningful change while honoring the communities they serve.  Welcome, Dr. Arcot!  You are making such a big difference in the world of maternal and infant health!  That is our topic today, the importance of infrastructure to improve maternal and infant health and really touching on what you’ve seen firsthand in clinics and the available medicine in other countries and what they are doing to keep mothers and babies alive.  Certainly, we can compare what’s going on in the United States.  I would love your tips on how to make birth safer and why the shift more recently in focusing on maternal health is finally coming to the spotlight in the media especially. 

Hi, Kristin.  I’m absolutely honored to be talking to you today.  I definitely come with a very international perspective on what reproductive healthcare access and justice means to different parts of the world.  Not just North America, but I think around the world, it’s generally considered that if you have healthcare, you’ve solved the problem.  But many countries and many public health institutions still fail to recognize that access and justice as just as important pillars of reproductive health that have to be services, not just as an extraneous benefit.  But as a doctor, you find them to be extremely useful for a woman to advocate for her own health.  And those are aspects that doctors themselves, unless they’re in policy making, have very less access to, and there’s nothing that you can change about it. 

What I ended up seeing – I would go into clinics, and there’s no geographic restriction on this.  I would go into clinics and I would see the same patient over and over again.  It wasn’t just the lack of care.  They had access to care.  It was lack of proper housing, lack of infrastructure in getting to the appointment, domestic violence situations that were uncontrollable, cultural societal norms.  You could go see a doctor on this day because this is the phase of the moon.  Those kinds of things play a huge impact on maternal health.  And programming does not necessarily cover those things.  It shouldn't, either, but when you’re on the field and you see infrastructure problems that are underfunded, then you start thinking about what we as doctors, what we as humans, what we as philanthropists, what we as individuals can do to make structurally underfunded invisible infrastructures into actual mobilized versions with political voices and measurable returns that give a very high leverage to antenatal care and maternal care in some of the countries. 

Yes, and even in the United States, we are seeing issues with access, especially in rural areas.  I live in Michigan, and a lot of the smaller regional hospitals have closed their maternity units.  Midwives aren’t always an option for everyone.  Some of our clients in Northern Michigan especially are traveling hours to have their baby. 

Yes, it’s called a fragility multiplier where there’s institutional fragility or a conflict of fragility.  About 61% of global maternal health are dedicated or because of institutional fragility, and it is an important frame for your audience that birthing is not necessarily dangerous.  But when the systems around them have come down or have broken down, especially within communities that are already established or where their health system is accessible but does not provide the kind of care that a mother needs, we see something called institutional fragility.  And I think it’s important that we set that right because we’re living in America.  I mean, Michigan, not Michigan – it’s in America.  And to consider that aspect of it takes a lot of thought, and it’s very provocative, right?  There are so many reasons that might have contributed to it, but irrespective of the reasons, maternal healthcare is still a human right.  And if you have a politician or a policy within your county, it should include your care.  It shouldn't be politicized, and I think there should be a level of care that comes within this to prevent women from falling into the loophole of having a difficult, complicated pregnancy or a fatal one. 

Right.  The maternal mortality rates are certainly not where they need to be.  And also the infant mortality rates.  Do you want to speak on what happens after delivery and some of the challenges worldwide that we’re facing? 

So postpartum hemorrhage is probably one of the most leading causes of death for mothers.  We have had hypertensive disorders, preeclampsia, hemorrhage, sepsis, obstructive labor, complications from unsafe abortions.  None of them are mysteries.  But postpartum hemorrhage is like the world’s leading killer for mothers.  We’ve had the drug since 1906, I believe.  It’s oxytocin.  But the reason why women still die from it in 2026 is not because we don’t have the drug; it’s because of system inequities, and the clinic just doesn’t have power to keep the drug cold or the clinic doesn’t have access to the power.  Almost always, there are no deciding factors or a curriculum if you must for a physician or the nurse practitioner or the doula or the midwife seeing the patient to administer the drug in a timely manner.  And all of this is influenced by literacy, the women’s autonomy in the household, what prior facility experiences they’ve had, how traumatic or respectful they were, what was the cost of the drug itself, but also the cost of the clinic visit to the household, and whether there were warning signs recognized in advance or not.  And I think dignity first care in a community of health workers matter enormously at those points of time.  A skilled traditional birth attendant was being trained to recognize these danger signs and comes from that trusted community and can also help in bringing those things down. 

Kristin, at this point, I want to talk about the three delays: recognition, transport, and arrival of care.  They have just as much of higher stakes in the U.S. system especially than just access to the drug itself.  Because I find that mothers who are wavering away from traditional allopathic medicine to integrative medicine, having midwife assist in delivering in home births, et cetera, and I appreciate them so much for doing it.  I think you have to be completely aligned with your way of thinking when you’re giving birth.  But again, the person whom you choose to have while giving birth should be able to recognize danger signs.  

Exactly.  Transfer policies, and it sometimes is a matter of minutes. 

Because reaching a facility here is not a problem.  You have good roads.  You have security.  But you definitely have the transport to do it.  We have ambulance services, et cetera, as compared to other areas of the world where it could just be a bike or an auto rickshaw or a car that someone has to transport the person in.  But reaching the facility definitely matters and whether the weather – snowstorm, excessive rains, hailstorms, climate changes, the distance, and the transport matter in these areas. 

Also, since you mentioned North Michigan previously, I think that’s a large part of the current delay which is the layer the public understands the least because we expect to find a hospital that’s dedicated to caring for mothers, but instead we reach hospitals where there is inability to sterilize equipment, which means sepsis.  Or blood bank transfusions not available or not having the manpower or the facilities to conduct an emergency C-section, which means they have to be transferred to a tertiary care system, which might be further away.  So all of those things matter, and I think the public definitely has the authority to have an awareness about it.  But a large amount of these three delays is not just public awareness.  It’s also advocating for the health and reproductive health of these people, and that largely falls on the policy makers. 

It sure does, absolutely.  And there are so many maternal health bills that have either recently passed or are in the process.  It certainly is something that seems to be on the forefront of people’s minds.  Now with groups like March of Dimes, for example, advocating and organizations and consultants like yourself who are speaking out worldwide about the issues facing maternal mortality, infant mortality, and maternal health as a whole. 

Yeah.  For sure.  I think a lot of it falls on also training the communities, midwives, doulas, and assistive healthcare representatives in advocating for these women as well.  Because it doesn’t necessarily fall – it shouldn't necessarily fall on the public health experts only.  I think a lot of pushback from the communities in general seem to find better results.  And for me, I think it was a very clear line between money and the way infrastructure was built and the ways public health solutions were found.  And when I work with philanthropists, I think one of the things we fund the most is maternal and child healthcare.  And one of the things that I found is that when we measure outcomes instead of actions, it anchors – it avoids distraction into statistics and things like that.  But what you want to do is not lead with despair and land on solutions rather than evolve more problems.  What that means – usually, what it translates into is whether they understand maternal health or whether the systems that fund them function to understand maternal health.  And when you center the agency on the communities that you’re describing – like the midwives, the doulas, the assisted reproductive health personnel, the nurses, the technicians, primary and secondary hospitals – I think we empower a large group of people to recognize and nurture a sentiment of public health for care that is an emergency and not necessarily approved because the mother in those situations is in an emergency.  The care, the burden of care, usually falls on either the nearest relative or their significant partner, and I think at those points of time, the mother is capable of giving authority to a different person but then still advocating for her own health should not be her priority.  It should be the priority of everyone else around her at that point. 

I agree.  It definitely takes a strong family and friend network.  And oftentimes if you’re able to hire professionals, like lactation consultants or postpartum doulas or even nurses and home nurses to help with a NICU baby, for example – but that is not something that is accessible to everyone.  

We spoke about postpartum hemorrhage as one of the complications post-care.  One of the other things that I want to bring to the forefront is postpartum depression.  I think a lot of it goes unnoticed, mostly because in America, the recovery after for a mother is individualistic, whereas in a lot of other communities around the world, it’s community-based.  You have a support system.  You have a network of women.  I find that new mothers here are left to – I wouldn't say fend for themselves; it almost feels animalistic at that point.  But it’s usually about four to six weeks, and then after that, they’re cooking; they’re cleaning; they’re taking care of a baby in under two hours of sleep.  They’re breastfeeding, waking up in the night.  It’s really stressful. 

I remember my postpartum being so different from the rest of my family’s postpartum experiences because the rest of my family is in India, and I grew up thinking that that would be the care that I would need, and I was fine dealing with six weeks of rest, but it really does take a good understanding of your health and your own abilities and the abilities of your partner to take care of you and the baby at that time to hold that space for yourself and recognize postpartum depression, recognize the signs and symptoms, and advocate for yourself and reach a facility or a therapist or a doctor’s office early enough to get some help. 

 Absolutely, and the lack of sleep can affect mental health, certainly, and not having that support built in.  Women feel like they need to do it all themselves and are not confident in asking for help, even if it’s something as simple as unloading the dishwasher or cutting up some fruit.  An easy task while they’re visiting baby because the mother also needs to be nurtured and cared for.  And as you mentioned, a lot of cultures, that is the norm.  And in America, it is not.  You’re just supposed to get back into your old jeans, get back to work, and not ask for any help.  And that is wrong. 

In my honest opinion, I just feel that mothers can do it all.  They certainly can.  They certainly have.  But they shouldn't have to.  And apart from the narcissistic mother-in-law, the sister-in-law who doesn’t care – I agree, all of those character traits exist, but they also happen to be your nearest community who can help you.  So I think instead of – it’s one thing to want peace of mind, and I completely agree with that, if you can have peace of mind during your first few postpartum weeks, please advocate for yourself.  But it also helps when mothers or new mothers give their community or the people around them a list of tasks.  This is what you’re going to do.  Instead of putting the burden of claim on the mother – “If you need any help, let me know” – that’s not necessarily help. 

They won’t ask for it.  And so I love having a list on the refrigerator or a notepad when visitors come in or the grandparents, for example.  And just knock a few tasks off while you’re over.  It makes a big difference.  Certainly, if there are older siblings, they can help fold baby clothes or be given some tasks to make an impact on the family, as well. 

Absolutely.  I think those kinds of things really do help mothers claim their own peace of mind and sanity during those first few weeks but also later on in life.  You know, there’s a saying where we come from that anything that happens during births, deaths, and marriages gets recorded in your mind, and we tend to hold on to those things.  So when mothers feel rested and well looked after, we tend to hold on to those spaces, and we would do anything for them going forward because that was a safe space.  Someone took the time and effort to create a safe space for us, and I think that needs some kind of celebration.  Even if you don’t name the relationship, even if it’s the neighbor who’s like 90 years old coming and just walking your dog with hers at the same time, it still counts. 

Absolutely.  I agree.  You never forget your birth story.  It’s like a rite of passage like your wedding day.  You don’t get a do-over of that particular birth, and what I like to focus on from the Ask the Doulas podcast is that postnatal time.  And you don’t get a do-over of your maternity leave or those first 40 days, for example.  So if you do planning and communicate your needs during pregnancy – and even budgeting for the postnatal time for a meal delivery service, diaper service, housekeeping – other things, rather than the expensive stroller and all of the onesies that never get used – to think about what services could make a big impact, even if they’re gifted. 

Yeah, I think just as much as we keep an antenatal kit that’s ready to go to the hospital – I’ve seen so many influencers’ antenatal kits.  There are very few who actually talk about postnatal care and what they have done for their friend or what a friend has done for them.  And that would be an interesting ask, actually, to your listeners, to see what their birth story was like and what was the one thing that stood out during their postnatal care. 

In communities across the world, we have times where it’s almost about 60 to 90 days where you’re in the mother’s home.  You’re completely rested.  Even in some populations, you have something called wet nurses if you’re unable to breastfeed or for several reasons, you can always hire or outsource it to a wet nurse to look after your baby.  In postnatal care in America, it’s a little different.  You visit a pediatrician, which is fantastic.  Formula is great.  As long as they’re fed, it’s great.  But the mothers should stop beating themselves over the fact that they’re not able to breastfeed, period. 

I 100% agree, and there’s nothing wrong with supplementing.  Certainly seek out lactation consultants if they are accessible to you.  But there is no shame in how you feed your baby.  Fed is best, in my mind. 

Fed is best, absolutely.  I think a lot of talk around women’s care and around decision making about when to seek care and the financial independence of the care or how much she’s been to school or her education level – all of them portray well when advocating for her own health during delivery and postpartum, and I think it always benefits the mother to feel safer when she has all of those things under her control.  But there are conditions and there are areas where you do have mothers, new mothers, facing domestic violence or financial abuse because they’re a stay at home mom now and they don’t have their own method of earning or they’re dependent on their significant other or partner or spouse to provide for them.  And there’s a significant amount of abuse that comes to light during some of these sessions.  And I think it’s important to talk about it.  I think if we could advocate for new mothers to just go to therapy, whether they have postpartum depression or not, whether they feel safe or not – whatever the case might be, to just establish, like, a baseline for normalcy at postpartum – I think it would be helpful in advocating for herself for the future. 

I agree.  And it’s also helpful to be around people who are going through the same thing at the same time as you, whether you go to a free breastfeeding support group, like I did, or story time with my children, and be able to relate to other people and not feel so isolated and alone.  And social media shows a completely different picture of the postnatal phase and pregnancy, even, with influencers and showing the highlight reel and Pinterest perfect homes.  So it’s great to have a community, even if they weren’t your best friend before.  I’ve found that taking childbirth classes, I made great friends, and we would take our babies to a botanical garden together and go to a farm and I’m still friends with a lot of the women that I had in the Lamaze classes that I took with both of my pregnancies. 

Isn’t that amazing?  Kristin, something else that comes to mind, and I say this with all humbleness: women always gravitate towards your common denominator, irrespective of your stage of life.  I think if you’re in postpartum, you tend to gravitate towards other women who are postpartum, too.  If you are menopausal, you tend to gravitate towards other women who are going through menopause.  I think at the end of the day, women just want to see what normal looks like, and helping women feel that normal is key, irrespective of where they find it.  Whether it’s through religion, whether it’s through a Lamaze class, whether it’s through story time, as you say, or whether – even if you did not have friends who are going through the same thing – like, I was quite young when I had my first child, and none of them in my friend group went through it.  So I felt isolated from my friend group, but then I found a common denominator in the child classes that I would take with my son, with my newborn son.  And I found friends there.  I think there’s a level of care that is different from a community that’s going through the same thing.  And you’re absolutely right.  When you gravitate towards those people, you just feel like what you’re going through is normal.

And if you’re struggling with feeding, then there is someone who is likely up at 2:00 a.m., the same time you are that you can chat with.  And certainly that does not replace therapy, and if there isn’t a therapist or a postnatal support group in your area, then you can look at Postpartum Support International.  They even have dad groups.  But they have so many virtual groups for everything from mental health to feeding support to grandparents and challenges.  Grandparents are now caregiving because we’re in a childcare crisis, and it’s hard to afford daycare or a nanny.  Grandparents are coming out of retirement to care for their family, and so that is a big change.  We have a Grandparents class at Gold Coast Doulas, and we try to update grandparents on all of the changes in safe sleep and car seat safety and feeding.  There’s so much to catch up on.  Those conversations can be uncomfortable for our clients and students, so they’d rather have us as the experts help them with that transition. 

That is something that’s a very big responsibility, and I’m so glad you’re fulfilling it.  I think grandparents were very vital in my life growing up.  I can see how communities would gravitate towards grandparents, not just as caregivers, but also as someone who’s seen what comes after.  What to expect when you’re teething, while you’re caregiving for a gassy infant, or when you’re caregiving for tummy time.  Grandparents are an excellent resource.  Experience beats medical knowledge any day if you have gone through the same thing.  But it also brings a new level of cognizance that you’re acknowledged and the problem is acknowledged, and I think for women or even parents who are going through this, it is important to get that perspective instead of just relying on TikTok. 

Exactly, or a mom’s group where you can get misinformation.  And now with the prevalence of these AI healthcare chatbots, I wonder how that’s going to impact care down the road. 

Yeah, the fourth trimester is completely underfunded.  But I think it is extremely influential in deciding whether a parent wants to be a parent again.  Because I know a lot of people who have had miserable first pregnancies who have sworn off pregnancy because they just don’t want to be pregnant, and their pregnancy was extremely traumatic for them. 

Exactly, and there is so much talk in the media right now about how we need to grow our population and people need to have more kids.  But as you said, if there’s not the infrastructure, if there’s not the support, if there isn’t the care, then there’s no incentive to expand the family.  And there’s also – women are still dying in childbirth.  I mean, there’s that fear.  I had preeclampsia with my first and a NICU baby, and with my second, I was fortunate to be in a hospital when I had a mild hemorrhage, and luckily I avoided a transfusion, but I was thankful for the care that I had.  I certainly knew that having kids later in life and some challenges, that it was not safe for me to continue to have children. 

Right.  I think a lot of action has been taken, but a lot of action has been taken in the last decade and a lot of resources.  As public funding goes away, a lot of infrastructure – philanthropists have actually come forward to do their bit to fill the gap between what safe birthing could look like and just to balance out birth equity, almost.  And that’s probably a very good silver lining.  I would say it’s definitely there in the right place.  There is Black Mamas Alliance.  A lot of workplace action has been taken.  If you’re a manager, if you’re in HR, you would know that parental leave, lactation support, accommodations, and reentry into the workplace are all areas of support that an HR can help with, especially in global companies.  And then there is the state and federal advocacy where Medicaid has the extended 12-month postpartum restructuring, and they have maternal mental health hotlines that are available 24-7.  So we do have public funding going to the right places.  I think it’s a matter of us individuals and policy-makers recognizing what the gaps are and advocating for them to be filled in a timely manner. 

Absolutely.  And I’m also very thankful for the employer benefits that are focused on fertility but also include birth and postpartum doulas, like Carrot, Progeny, and Maven.  They’ve made it more accessible for families to have that support, not only at their birth, but in the critical postnatal phase. 

I think the pitfall to navigate around is to stay out of partisan framing and just advocate it as a health right rather than to see it through any other lens.  Because at the end of the day, we are a global population, and we deserve healthcare just as much as anyone else.  And I think advocating it in those lines would take it away from the despair trap that leaves us feeling powerless.  We have so many disparities, but naming them or framing them, it shouldn't be a competition of who gets more.  It should be a healthcare right that all of them are covered during this incredibly lifechanging experience. 

Exactly.  Well, I could talk to you forever, Dr. Arcot!  Thank you for sharing all of your wisdom!  Any final tips for our listeners? 

If you’re pregnant or you’re going to get pregnant and you’re worried, you should know that advocating for yourself is one of the best things that you can do, whether it’s for a C-section or if you feel loss of motility or if you feel you’re going into a dangerous phase or if you feel that you need extra support during your birthing and post birthing – then you should definitely have the right to advocate for yourself.  And if there is anything else that I would like to leave your listeners with, it should be: enjoy the moment if you can.  And you will, but as the moment happens, it is something that is magical.  It’s transformative.  I think mothers, parents, make the best warriors in the world because we advocate for people who are us but the smaller versions of us, and there is so much love to give.  And if you can ever – if you are ever in doubt about whether you can do it or not do it or how am I going to bear this extra, whatever comes into your life, even if you think it’s an inconvenience at that point, just know that you’re strong enough to carry this forward.  It’s an incredible experience.  Enjoy it as much as you can because they don’t stay that little.  

Exactly.  My kids are teenagers.  It just flies by.  I agree.  Enjoy every moment, and there might be tired nights, but it’s so worth it. 

It is worth it.  If you find the right people around you, then kudos to that.  But if you don’t find it, and if you think you’re single and you’re out there, definitely call for support.  Definitely use the health lines and the hotlines and the resources available or reach out to any of us and get some help because at the end of the day, women are a community.  We, just as much as a village – it takes a village to raise a child.  I think it takes a community to raise the woman into different stages of her life as she grows, and you’ll find your tribe. 

Exactly.  They are out there.  You just have to connect.  And sometimes that means leaving your home.  Social media is all right, but it doesn’t replace in person connection and groups of women gathering together to change the world. 

For sure. 

Well, thank you, Dr. Arcot.  How can our listeners connect with you? 

I am available through Instagram, through LinkedIn @drvandanaartcot.  You’re welcome to chat with me if you’re a philanthropist who’s looking to create change in any of these areas, and if this made sense to you, please feel free to contact me.  If you’re a nonprofit that’s already creating this change and you’re looking for guidance on how to structure your next campaign or how to navigate the political system right now around reproductive access, healthcare, and justice, we do have resources for nonprofits, and I would love to be able to assist you with that. 

Fantastic.  Well, thank you for the work that you’re doing.  I so appreciate this time today. 

Thank you so much, Kristin. 

IMPORTANT LINKS

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