Cocoa Pods
Podcast - Cocoa Pods Series: A feature of the Birth Center Foundation.
We discuss all things' women, all things' pregnancy, all things' after. Reasons why women fall very sick ( morbidity) or die (mortality) before pregnancy (adolescent girls and young adults),during pregnancy and after are discussed in this maternal morbidity and mortality reduction academy; especially with an emphasis on minority women, all over the world; and ways for all involved in care to work together collaboratively and mitigate and or eliminate risks in women’s health.
Cocoa Pods
Maternity Deserts & Ice Skating Through a Broken System: Why Moms Are Still Dying in America
In this episode of CocoaPods, Dr. Bola Sogade hosts Dr. Julia Interrante from the University of Minnesota to discuss the alarming rise in maternal mortality in the U.S., particularly in rural communities. They examine the consequences of inadequate maternal healthcare access, the role of data in shaping policy, and how technology, such as telemedicine, can support rural healthcare providers. Dr. Interrante highlights the ongoing closure of birth centers and hospitals offering obstetric services, emphasizing that funding and policy changes are essential to prevent further losses. The conversation underscores the need for a systemic shift in healthcare financing and advocacy efforts to ensure safe childbirth for all women, regardless of location or socioeconomic status.Dr. Julia Interrante is a mentee of Dr.Katy Backes Kozhimannil,a Distinguished McKnight University Professor and Co-Director of the University of Minnesota Rural Health Research Center.
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I think, without any interventions, if we keep going the way that we have been going, we're going to continue to see more moms dying before, during and after childbirth.
Dr Bola Sogade:Hello and welcome to CocoaPods, a podcast of the Birth Center for Natural Deliveries Foundation. My name is Dr Bola Sogade. I'm a women's health specialist. On this podcast, we talk about all the issues relating to women's health and identify the problems and talk about ways in which we can mitigate the problems. Today, I'm very fortunate to have with me Dr Julia Interrante, phd, mph from the University of Minnesota.
Dr Bola Sogade:Now, delving back into our discussions from the last episode, there's probably a woman dying right now, as we're talking, in a rural community in the United States, either because she's driving in terrible winter weather to a hospital to deliver her baby, or she's just like, forget it, I'm just going to try to have this baby at home. Or she just had a seizure from preeclampsia. Now it's eclampsia. What do you see as the long-term consequences number one of these trends if no real intervention? Because there's a lot of talk Everybody wants to talk about a pregnant woman and her baby. So if there are no interventions made to improve access to care, what do we see as long-term consequences? And then, how can data from studies, like from what people like you guys have done, inform future healthcare planning and resource allocation for maternal health?
Dr Bola Sogade:And now, in this age of AI and technology. And now, in this age of AI and technology, what role does technology such as telemedicine or remote monitoring? What role could this play in improving access to obstetric care in underserved areas? I know that, even despite this, somebody has to lay hands on a pregnant woman and help her deliver a baby, so there's a limited. I mean, we don't have robots that will deliver babies yet, so there's a limit to what AI and technology can do. So can you wrap up what the long-term consequences of a lack of intervention and the long-term solutions could be to this problem?
Dr Julia Interrante:Yeah, I think without any interventions, if we keep going the way that we have been going, we're going to continue to see more moms dying before, during and after childbirth. I think we'll continue to see rural areas lose access to more and more services and more rural communities lose services that have been like hanging on by a thread, basically, which is terrible. There are solutions that we know exist, and part of that is putting our money where our mouth is right, like we show as a society what we value by how much we pay for it and if we're not willing to pay to make sure that services are maintained or brought back in rural communities where they are needed, and also, again, we may not be able to get back services that have been lost in every rural community, but to be able to provide some kind of connections of care. There has been a lot of work on regional partnerships, having like a spoken hub model where you maybe there is a local area for the lowest risk patients, but there are good connections and relationships with access to, like, more urban centers with higher acuity services for higher risk patients. That's really important too. How can the data help with future healthcare planning and resources? Like I said, we do a lot of our research to try to highlight where these challenges are, to make sure that that information gets into policymakers' hands and that, when they are developing policy, that our data is there to help inform the way policies are developed, to make sure that some communities aren't being left out or there aren't unintended consequences of policies, which we do see happen, even with well-intentioned policies. Again, I think, ensuring that there is a diversity of views, not just like racial diversity but also clinical diversity. So having obstetricians and midwives and family physicians and nurses, who are highly involved in a lot of providing maternity care, have a voice and say, and the communities who are impacted, so people who are giving birth being able to have a say in what's happening in their communities.
Dr Julia Interrante:You also asked about the role of technology. You also asked about the role of technology and I do think that there is an important role here for telemedicine. It is not a fix-all right. You talked about that touchpoint being important and it's true.
Dr Julia Interrante:One of the things that we talk about a lot in rural maternity care is especially having provider-to-provider telehealth so that rural clinicians have that connection to another hospital with potentially more resources, who see a higher volume of patients that maybe see more complications more often and have more clinical skill in those areas, have that support back to the local community so that when there is a challenge that arises that might be able to be taken care of in the local rural community, that those clinicians can reach out to their partners through provider-to-provider telehealth and get that support and then again have those relationships set up if they do need to transfer a patient who needs higher level of care.
Dr Julia Interrante:So again, I think there's a role for it and also, again bringing back the financing part of it, that when that telemedicine is set up that there's some kind of pay equity, because again, the financing of maternity care is really challenging where if a rural hospital transfers their patients to an urban hospital for childbirth to make sure that that rural hospital has been doing all of the prenatal care who will probably be involved in the postpartum care is still reimbursed adequately for the services that they have provided and the role that they have played, so that all the childbirth reimbursement doesn't only go to the urban hospital where the actual delivery takes place. If that is the case, if that makes sense.
Dr Bola Sogade:Yeah, it makes sense. Yeah, and you did, you know? Started my next topic, which is about advocacy and awareness. You know, how can healthcare providers, policymakers and the public work together to raise awareness about the importance of maintaining obstetric services in these rural areas? What are the most pressing gaps in the current research on maternal healthcare access and how can they be addressed? And the third part of my question is what advice would you give to healthcare providers or advocates looking to influence policy changes in this area?
Dr Julia Interrante:Yes, thank you for those questions, let's see. So how can healthcare providers, policymakers and the public work together to raise awareness? We have been trying to do that in our work. As I mentioned, when we do research, we're an academic institution, so often part of our research goes through the peer review processes and published in peer review journals, but a lot of those are behind paywalls and so that can create a big barrier for community members and even policymakers and providers for accessing a lot of the findings from that we publish as policy briefs or publicly facing documents that are written and presented in a way that is less jargony and complex and just straightforward. I'm not always perfect at that, but we do really try to make things accessible and absorbable and done through like visualizations rather than complicated statsy tables and things that are not easily absorbed. Also, working with the media we do work with the media a lot and they do play an important role telling individual patient stories and individual healthcare provider stories and making those connections with policymakers, and we even have a few states have done this now, and it's a policy that has passed in Minnesota that when a hospital plans to close a service line and specifically an obstetric unit, that they have to report that to the department of health and they have to have a policy community conversation. And setting where community members can come in and discuss their concerns and having people show up to those is really important and having people stand up and discuss how important having maternity care in their community is and what their challenges are when they can't access that service.
Dr Julia Interrante:In terms of some of the gaps in current research, there's a lot of challenges with what data is even available and again, this is something that I am acutely tied to because I'm a quantitative researcher.
Dr Julia Interrante:That's something that there are sometimes questions that are asked of us by policymakers that we can't answer because there's no data that exists to be able to analyze it no data that exists to be able to analyze it. So things like at the beginning of our discussion I talked about how it's actually really complicated to figure out which hospitals are and aren't providing obstetric care. That's even more challenging when you're trying to figure out which freestanding birth centers exist in which communities which, like the number of midwives that practice in rural and urban communities, like the number of midwives that practice in rural and urban communities and different types of midwives too. A lot of that stuff isn't just nationally publicly available, so it can get really challenging to even point out what the issues are. So again, a lot of the data.
Dr Julia Interrante:Again I mentioned the challenges of maternity care financing. A lot of that data is not publicly available and not available to the level where we can see, like, how much each hospital is spending on maternity services specifically, let alone like on which types of maternity services that they're providing. And so without being able to dig into the weeds on the financing of it, it can be challenging to say did this policy actually solve this problem or did it not, and why did it not, if that makes sense.
Dr Bola Sogade:It does, it does.
Dr Bola Sogade:Yeah yeah, I'm glad you mentioned even the fact that if service line is closing, specifically maternity service line, that hospital needs to notify the health department, because, as I'm speaking to you, we're broadcasting from Forsyth, georgia. We do have a rural hospital here close to obstetric services. About 40, maybe 45 years ago, we opened a freestanding birthing center providing care for the women. So it's important to know, you know for the community to know that this service is not available in this hospital and they need to know their alternatives. You published paper Changes in Hospital-Based Obstetric Services in Rural US Counties between 2014 and 2018, in which you underscored the systemic challenges in maternal health care access and their implications for you know maternal and infant outcomes. So you know, and I know we've talked about this and this even preceded your 2010 paper. So you guys have been, like you said, looking at this for a long time. So, if we're just going to summarize that paper I believe you did this with Dr how would you summarize that paper?
Dr Julia Interrante:Yeah. So again, this one was somewhat similar to our more recent publication, but we were really looking at our like unit of analysis, which again it's a very jargony turn, but we were looking at counties, whereas our newest one was looking at actual hospitals. So we were looking at counties and we were looking at were these counties rural or urban? And if they were rural, did they border another county that was urban or were they not? So again, these are like thinking about more isolated, further driving distance if you need to get to an urban center.
Dr Julia Interrante:So that's where we were really just documenting what did it look like in counties for maternity care services? And that's where we were seeing, again, the loss of obstetric services was much higher in those that were the most remote and rural. And again, our newest paper was just documenting again that those challenges have continued. Those losses have continued. Despite some of the policies that have been implemented and despite the awareness that has been raised, it hasn't been enough yet to curb this trend that have been implemented and despite the awareness that has been raised, it hasn't been enough yet to curb this trend that we're seeing.
Dr Bola Sogade:So we have been talking to Dr Julia Interante with the University of Minnesota. You know you said that some of the data actually about freestanding birthing centers and how midwives practice can be obtained from the American Association of Birth Centers and the Commission of Accreditation of Birth Centers. So all accredited birth centers are under this umbrella and these organizations collect data and we actually submit data to them. You know they give us a criteria of data to submit and we submit data to them. So that's a good place to get some data on these free birthing centers. But as we close, Dr Ntaranti, this problem is a big problem. I'm happy that you are doing the research, at least quantifying some things that we can look at in the past and look to the future for but it's still a big problem.
Dr Bola Sogade:Women do live in rural areas of America. A lot of families are in rural areas of America. They are living their lives having babies and doing the things people do in urban America as much as possible. You know what can be done. You know, when you reflect on some of the insights from Dr Cozy Manuel's paper and your paper and your studies, what are the lessons learned from this research and how can healthcare providers implement the research findings to improve care delivery and what can we as a country do to help this vulnerable group, you know, which is pregnant women and their newborn infants? What can we as a country do? Because, like you said, this problem has been around for a long time and it's still you happening, and this is America. I'm not talking about a third world country, I'm talking about the United States of America, where women are still dying, compared to other developed countries, at an alarming rate, from pregnancy and childbirth. What are the lessons learned from research and what can we do to somewhat improve this problem? And what can we?
Dr Julia Interrante:do to somewhat improve this problem? Yeah, maybe I can even start by answering this question by talking about my own experiences, if that's okay. So I know we have talked in our emails before this. I gave birth to my first child in Georgia and I had a midwife, which was wonderful. There were no birth centers that took insurance in the time where I was, and so I ended up giving birth in a hospital, and that hospital is now closed. It doesn't exist anymore.
Dr Julia Interrante:I moved to Minnesota shortly after and where I gave birth to my second and third child at a freestanding birth center with midwives. It was the most wonderful experience I could have ever imagined. I was able to have the birth that I had dreamed of having for both of those, and that birth center is also now closed. They just announced that they closed just in December 2024. So every place now that I have given birth no longer exists, which is heartbreaking. And again, to know that this is happening to rural communities and in some urban communities all over the country is just unacceptable.
Dr Julia Interrante:So we know that offering obstetric care is a financial challenge for hospitals and for birth centers, and a lot of the revenues don't cover the cost that is required in our system to maintain those services.
Dr Julia Interrante:There's dedicated space that's needed, equipment and trained staff that are available to support labor and delivery whenever pregnant patients need that care.
Dr Julia Interrante:So again, I think paying for those services that we need is essential and treating health as a human right is also essential. We talk about, again, the health of people before they give birth, during and after, and paying for all of that to maintain those services is really necessary. So some of the actions that we can take again are funding standby capacity to cover the fixed costs of providing maternity services, standby capacity to cover the fixed costs of providing maternity services. Making sure that Medicaid is fully resourced and reimburses at a rate that is financially reasonable and like covers the cost of actually providing that care. And, again, paying more for all services and not leaving out things like the postpartum period and interpregnancy periods. And, again, really tying in quality and safety that is available to all patients, regardless of where they live, the color of their skin, what their income is. All those other factors that we know have deep systemic issues and result in inadequate and inequitable outcomes in maternal and infant health.
Dr Bola Sogade:Wow, I like the way you tie the fact about your deliveries, because this is a thing Anytime. There's a personal experience like that, people listen, people are like, wow, you know this is a professor, you know she's done all this study and you know this is her story. You know people relate a lot like that and you know I'm on several forums and on several boards about this birth center and I see the problem and a lot of birth centers, especially for the accredited ones like ourselves. You know we go through a rigorous process of accreditation. We want a safe delivery too. Accredited ones like ourselves, you know we go through a rigorous process of accreditation. We want a safe delivery too. You know the compensation for the facilities is less than the hospital.
Dr Bola Sogade:So a lot of us do it out of the fact that we do see a need, we see a better way of doing these things and we want to help women actualize and realize their dreams of how they want to have their babies. So I feel so fortunate, so blessed to actually have had you, in particular, as a guest on this podcast, because this is going to resonate to a lot of women, because it's a problem. We want it solved, we don't want to give a life for a life. We want to make sure that women deliver safely in the United States of America, like in other developed countries. We want women to have that option, regardless of, indeed, the color of their skin, their ability to pay. It should be a human rights issue.
Dr Bola Sogade:So I'm just so grateful to you for coming to this CocoaPod podcast, and we always ask our guests to say one fun fact about themselves. You have a lot of degrees. I'm curious to hear what is the fun fact about you. You have a BA, you have a PhD, you have a mom times three. That's the biggest thing I think you know. We just want to really thank you for coming and, you know, is there a fun fact about you that you want to share with us?
Dr Julia Interrante:Yeah, I can share. It's silly, but I live in Minnesota where, like, it's cold and people go ice skating. I grew up in New Mexico where it's a desert and there's no outdoors ice skating there, but my kids have all been ice skating since they could stand. My husband is Canadian, so he plays hockey and has skated his whole life. I finally, this year, took my first skating lesson, so I'm learning how to ski. That's my totally not related fun fact that.
Dr Bola Sogade:I'm very proud of. Dr Interrante, I just want to thank you very much and I want you to please extend our appreciation to Dr. Kozhimannil because she made the introductions. We're very grateful for the work that you guys are doing.
Dr Julia Interrante:I'm not as eloquent as Dr Kozhimannil is she's a great mentor to me.
Dr Bola Sogade:And I just want to thank you very much for the time spent here. I know you have a busy schedule, but I am very grateful and thank you so much for coming to CocoaPods podcast.
Dr Julia Interrante:Thank you so much for coming to CocoaPods podcast. Thank you so much for having me.
