♪ ♪ ♪ ♪ ♪ ♪ Sierra Artemus> Women of color in South Carolina are nearly twice as likely to die during pregnancy or postpartum than White women, and nearly 90% of these deaths are preventable.

Saving Mom Part two builds on last year's conversation by moving from awareness to action, spotlighting how South Carolina is working to change protocols, educate providers, and provide and protect mothers.

My name is Sierra Artemus, the newest host of Palmetto Perspectives.

Today's conversation isn't just about disparities.

It's deeply personal.

I'm joined by leaders driving real solutions to improve maternal health across our state.

Before we introduce our panelists today, I do want to let you all know this is an interactive show.

It is live, and there will be a portion where we'll be able to hear from our guests in our audience, and we'll be sure to let you all know when that part comes into the show.

But without further ado, we're going to introduce our panelists today.

Starting from left to right, we have Ladrea Williams, Dr.

Ladrea Williams-Briggs.

She's the executive director and founder of (hashtag) #Not Us S.C.

Next we have Dr.

Faith Polkey.

She is a doctor working with Beaufort, Jasper-Hampton Comprehensive Health Services.

Next we also have Dr.

Deborah Billings.

She is with the, She's a senior research associate with the Institute of Families in Society at the University of South Carolina.

Then we have Lamikka Purvis Samuel.

She is a director of Family Solutions.

And we finally we have Ms.

Maria Martin.

She's the executive director of PASO.

So thank you all so much for being here.

We are looking so forward to hearing your professional perspectives and learning more about ways that we are improving this experience for mothers and the futures of our children right here in the state of South Carolina.

But before we get into our subjects and things we'll be discussing today, I also want to share that this is deeply personal to me, because in 2019, I nearly became a statistic.

We talked about 90% of these deaths being preventable.

We're going to talk a little bit more about that, but my son and I experienced a traumatic birth, a traumatic pregnancy.

Let's start before the birth.

There was a traumatic pregnancy, traumatic birth and just the postpartum was also very traumatic.

I survived, my son survived, but there's so many that do not.

And that is why it is so important for us to have this...conversation.

So I want to just jump right into it.

I know many people have seen the headlines of Dr.

Janelle Green Smith.

She was a nurse and a midwife in the upstate, and tragically, at the age of 31, she passed away due to complications because of pregnancy.

And so, I want us to, to talk about her story and why it's important for us to have these conversations, not just when things like that make headlines.

So if anyone feels free and wants to start, please do so.

Dr.

Deborah Billings> I mean, I'll start First of all, just acknowledging what a loss, you know, to her family, to our state, to her newborn.

Right.

And so that's, that's just the, I think the most important point.

As a certified nurse midwife, she provided respectful, person centered care that is sort of at the core of what all of us are working on.

And I think to talk more about that is really important.

As well as the really important role of certified nurse midwives in our state, which I know when we turn to the audience, we've got some experts here, and there's a program even in the College of Nursing.

Sierra> Absolutely.

And for those who are not familiar with, you know, what a midwife does, could you explain?

Or we can have Dr.

Polkey.

<Yeah> Please.

Dr.

Faith Polkey> So, yes, I, I am a pediatrician, actually a pediatrician and preventive medicine doctor, but have worked so closely with midwives and also with obstetrician gynecologists.

And so they are a part of a team that takes care of moms and babies, and babies.

You know, I can say during my training, during medical school, some of my best training was with the midwives because we, there was just so much patience and time taken and getting to know, you know, the, the families and getting to know the moms and kind of waiting on that baby to arrive.

Now, that's not to say, listen, Ob-Gyns are very important.

You know, I work at a health center.

We have Ob-Gyns and certified nurse midwives, but I think it's important to have all those members of the team in order to care for moms and babies well.

Sierra> Thank you so much for that.

I think it's also important for us to note that there are many birthing options.

You know, we have the nurses, we have midwives, but we also have doulas as well.

Let's, let's kind of talk about the difference between a doula and a midwife.

Just while we're on that subject.

Dr.

Ladrea Williams-Briggs> So my understanding, midwives are medical practitioners.

They are advanced practice registered nurses.

They have to undergo nursing training, and then they get additional training to become midwives.

In my experience, midwives are able to give a different level of continuity and care that you don't always see in traditional obstetrics.

Whereas doulas, they aren't necessarily medical professionals, they are more of a peer support.

They're able to provide that more home based care.

In my personal experience, my doula was able to fill in those gaps.

She really was a member of the team.

Unfortunately, in South Carolina, though, midwives are not allowed to practice without being under the direct supervision of a medical provider.

So when we're talking about barriers to access to care, that's one thing that keeps a lot of people from being able to access midwifery care and from being able to get that continuity in care.

It's just the rules on who's able to provide it.

But doulas are a great asset.

They're a great way to ensure that the information is being relayed in a way that's understood by the patient, and a great way to fill in some of those gaps that we see in traditional obstetrics.

Sierra> Thank you so much for that.

You know, I'm so glad we, we are explaining because I know sometimes when you hear midwife or you hear doula, people are thinking of someone coming in your home, 1800s, you know, the, the outdated idea of what that is.

So I'm so glad that we are dissecting what that is.

And I'm glad we also mentioned that there are people that are able to fill in those gaps.

So when I think of that, I honestly, I go straight and I like to talk to you, Lamikka about this.

There are areas, you know, when you're growing up in inner city or if you're planning to have a child in inner city, there are things that you plan.

But then when you live in a rural area like in Orangeburg or, you know, different counties, Allendale, there are so many things that a person who lives far away from medical help has to plan when they are making their birth plan.

So I want to talk a little bit again to you about that Lamikka and what that looks like, what planning looks like when you live in a rural area.

Lamikka> Yeah, absolutely.

But if you don't mind, <Yeah> before I answer that, I did want to add a little bit to what Ladrea just said about doulas.

We can't forget that doulas are also advocates for the women they serve and for the families, as well.

You know, doulas do play a key role in that labor and delivery process.

But the preparation, preparing that family for giving birth, preparing that family for going into the hospital, and then after what happens when they come home from the hospital.

So when we think about our doulas, no, they are not a part of the clinical team all the time, but they are a key part of that support team for those families.

And being in rural South Carolina, doulas are, are oh my gosh, we, we really love having doulas with us at Family Solutions simply because a doula is that one consistent person that a lot of pregnant women see.

When you're in rural South Carolina, not only do you oftentimes have to travel a great distance for your OB care, but you also have to travel a distance to deliver your baby.

So when you go to your OB appointments, you get acquainted with the doctor's office.

You get acquainted with that staff, the nursing staff there.

But then when you go to the hospital, which could potentially be in another city, there's a new team, there's a different team that you have to become acquainted with.

So having that doula, but also having that community health worker who is a consistent person in your life to go with you and to support you in your journey is key to women living, especially in rural parts of South Carolina.

But in addition to that, you know, sometimes we take for granted the things have in the city.

We oftentimes want pregnant women to have a particular type of diet.

we want them to eat certain types of food.

But when you consider where women live, sometimes there is not easy access to those kinds of food.

And it's not necessarily that they don't want to do what their physician is telling them to do, it's just that they can't do it.

It's hard for them to do it.

Everyone knows transportation is a barrier, and we oftentimes hear about those services that are available to women if they meet certain income guidelines.

But there are barriers that come with that as well.

I always like to use the example of someone, of someone who has children, who has other children, and they're pregnant and they are using a transportation service in order to get to their appointments.

Well, they have to make sure that their other children are cared for, or someone is able to provide child care for their other children so that they can then access the transportation that's available to them so that they can travel outside of their county for their prenatal care or outside of their county to deliver their baby.

I could go on and on.

Sierra> This is your passion.

Lamikka> I'm telling you, I could, I could, but I will pause and allow you to ask another question.

Sierra> We'll definitely, we'll definitely come back to you on that because, well, speaking of barriers, there are barriers.

I mean, generally in many of the communities that we'll be discussing today.

And Maria, I want to speak with you.

Talk about the barriers like language and also status in other communities here in South Carolina.

Maria> And so Lamikka mentioned community health workers.

PASOs utilizes the community health worker model.

And really these are natural born leaders from within the community that are supporting women in making sure that they have the access.

Right?

By that I mean that there is a language there met.

Right?

For them that transportation, all the things, but there's that layer of, fears that happen sometimes because of the sentiment that is out there right now in our political climate.

And so there's fear of what can happen to me.

Can I leave my home?

Will I be received well?

There's a lot of uncertainty.

And so with the community health workers and the doulas, there is that established trust that I'm going to do warm handoffs for this person, for this woman that are trying to access the health, the help that they need and, you know, health needs.

And so it's a very vital it's a very that community health workers and doulas are people that are very much needed right now, because for folks that are providing the service, it's that bridge that connects the two in a trusting way, in a safe way for everyone.

Sierra> Absolutely.

Thank you so much for that.

I want to jump back.

In the introduction, we talked about there being a 90% or 90% of the maternal morality... excuse me, mortality rate is preventable.

And my thoughts are if 90% are preventable, why are we failing to prevent them?

Dr.

Billings or Dr...?

Dr.

Ladrea> Yeah.

So yeah.

So the rest of that statistic is almost 90% of pregnancy related deaths are preventable with timely and appropriate care.

So that's, that's the part is making sure that one, women are getting access to the care that they need.

Last year, the Institute for Medicine and Public Health released a report.

I believe they had some copies out earlier today that focused on rural health.

And they talk about the lack of access to care.

There are six counties in South Carolina that don't have an OB or birthing unit, and so it's making sure that women are getting the care that they need in a timely way, and also making sure that when they're getting to that care, that they're being heard, that they're being believed and that they're getting the treatment that they need.

Sierra> Thank you for that.

And I want us to also talk about, you know, I know we've talked about the statistics and, you know, the different challenges that many people are facing as it relates to being an expecting mom.

But I want us to talk about the change.

What are some things that are happening within your organizations, your advocacy or things that you know of that is that is helping us to take that step in the right direction?

Dr.

Billings> First of all, I can't wait till we go to the audience because every single in the audience has something to say.

That's how rich the efforts are, right.

At the state level.

At more local levels.

I'll just speak a little bit about the work that we've been doing since 2020 on a project called Voices/Voces.

So it's in English and in Spanish.

What I love about being here at SCETV is reading the, the writing on the wall, literally of SCETV, you know, being a space for advocating for the voices of people.

So that's really the grounding of this work, Institute for Families and Society has had a long term partnership with the Medicaid Data Systems through DHH-, Department of Health and Human Services.

So the numbers are there, the trends are there.

And I was really honored to be able to join the team in 2020 to...to work on who are the people that are connected, who are those numbers.

Right.

And that is something that we really constantly need to understand.

We can create wonderful graphs and trends and the trends are alarming.

And then we have to ask, but who are the people, right?

What are their multiple needs in their lives?

And healthcare cannot address everything.

Right?

But I think that we have been headed in a direction of in healthcare education, public health education as well, recognizing what's called social determinants of health, right.

Those different areas.

It's not just about what you eat.

It's where you live.

Is there pollution, where you live?

Is there transportation?

Do you have access to certain foods that not only are healthy according to some sort of, you know, objective barometer, but that you enjoy, that are familiar to you, that you are going to eat, that are part of your culture.

Right.

And understanding all of those different dimensions is something that we aim to do through this voices project.

And so we were able to do over almost 40 interviews with women, and then a number of interviews with community leaders, including health care providers in the audience, is a colleague of mine who created she's a playwright and helped us turn all of this into a theatrical production so that the voices of the people that we interviewed, especially the women, could be heard in a more dynamic way.

Right?

And a multidimensional way.

And I'll just close with saying so we're turning that now into what we're calling learning modules and interactive participatory trainings with healthcare providers.

And what I want to say there with, with a whole team of people providing obstetric related care, community health workers, midwives, nurses, family physicians, Ob-Gyns, the whole range.

And how to work collaboratively, right.

But not approaching it from, "Let's tell you what to do."

It's, "hear what we heard from women that we interviewed, right.

And we got to interview them thanks to the collaboration of so many of you.

Right.

The trusted organizations.

And reflect on that and learn from that and create plans in your own practice of how to address some of the barriers that you've been facing.

But that's not a, that's not an individual kind of effort that can be done alone.

The institutions that people are working in have to support this approach of respectful maternity care.

Sierra> Wonderful.

And I would like to add to that, I actually had an opportunity to review some of those modules.

And I mean, just hearing some of those stories.

I was actually in the gym and I was listening to them, and I mean, some of those stories from the women who had experienced the things that they did during their pregnancy and their birth was kind of triggering for me.

As I mentioned earlier, I had a very challenging pregnancy, birth and postpartum.

And, you don't realize just how not unique your situation is until you start hearing these stories.

And I don't think that there are enough conversations.

I think these conversations are really happening more in a health care space when they really need to be happening more in our community, which is why I'm so grateful that we have the platform that we have today to be able to discuss, to discuss these topics with a panel of distinguished ladies in their respective field.

But there's a few more things that I also want to discuss as well.

I know we are talking about programs that are showing promise, and this is one, you know, artistically.

And Maria?

Maria> I'd love to share.

<Yes> The PASOs model really is amazing in terms of our affiliate partners.

So we partner with organizations, agencies that want to better reach and serve the population in a way that makes sense for the populations, for communities.

And so what we have is community health workers that are co-branded with PASOs within systems that help be that advocate and understanding and be that really bridge from the community directly into that agency so that they can learn how to do that, how to better serve, how to better, you know, just really expand reaching the community and working with them.

And so that to me is very innovative in terms of, you know, the agencies and organizations themselves learning it firsthand and having that person, you know, <that support>, that support.

Sierra> Yeah, absolutely.

Ladrea, would you like to add?

Dr.

Ladrea Williams-Briggs> Yeah.

So I am with #NotUsSC.

We create and distribute culturally responsive maternal health education materials specifically to Black women, their support network and the community at large, because no one should die giving life.

Not me, not her, not us.

We focus on the idea that it takes a village, right?

So it's not just important for mom to recognize the signs of a problem, but it's important for dad.

It's important for grandpa, grandfathers, for the pastor, at the church, for the grocery store worker to be able to recognize when something is wrong, and to advocate for mom to go get that timely and appropriate care that we know saves lives.

We really focus on speaking languages that people understand.

So we have an item called the Pop-Pop playbook.

Becoming an auntie because we understand again that those support networks are so vital.

And then we distribute our materials in places where Black women already frequent and trust at the hair salon, at the beauty supply store, at the church.

And so, again, taking the education to the people instead of waiting on the people to come to the education, because like we discussed, that timely and appropriate care is what saves lives.

Sierra> Wonderful.

Would anyone else like to add?

Lamikka?

Lamikka> Of course.

Sierra>Yes, We made eye contact.

I was like.

Yes.

(laughter) Lamikka> But yeah, collaboration is really the key.

And we heard that from Dr.

Billings when she started talking.

But with Family Solutions, we collaborate with the community.

We are in, the community.

We deploy our social workers, our community, health workers, our doulas, male involvement coordinator, lactation consultants, all of them to the pregnant women in the community and to the partners in the community as well.

But then we also bring in community leaders, community organizations, lived experts to be a part of a consortium to, to provide some insight into how we can continue to serve the population that we are responsible for taking care of.

In addition to that, though, I mentioned collaboration.

So we're not just community collaborating with community, We're community collaborating with clinical professionals, as well.

So we do have a subset of clinical professionals that we meet with on a regular basis.

In order to discuss some of the needs of the women we're seeing to discuss their medical regimen, and then to help them to determine what sort of changes need to be made within their systems to better suit the population that they are tasked with serving.

So it's all about collaboration.

And I will tell you, we've been around since 1997 under the South Carolina Office of Rural Health.

So we've been doing something right since 1997 as it relates to collaboration.

Yeah.

Sierra> Wonderful.

And Dr.

Polkey, I want to pull you in, but I just want to, to learn more about what you all are doing from more of the medical standpoint.

So in health care leadership, what current protocols are actually in place to provide this, this sort of support?

Dr.

Polkey> So I'm going to back up and go a little a little bit, larger picture.

So in the state of South Carolina we have something that people may think is innovative.

But it's been around for 45-50 years.

So community health centers.

So I am the CEO of a community health center.

We have the South Carolina Primary Health Care Association, which is our trade association, but they're also our technical assistance advocacy that works with and for community health centers.

Community health centers are not for profit organizations that provide comprehensive medical care.

Sometimes we'll hear it be called Federally Qualified Community Health centers.

That just means that we have all these requirements by the federal government to get this designation.

And one of them is that we have to provide maternal health care.

Now, you may not have to provide it directly, but you have to ensure that your patients have it.

And so around our state, we have 25 community health centers.

We take care of 450,000 people in the state, We're one of the largest primary care providers in the state.

And within that, about 87% of our health centers actually provide maternal health care.

I can talk about ours.

Beaufort, Jasper, Hampton Comprehensive Health Services.

We are in the Lowcountry of South Carolina in some of those counties.

So Hampton County is one of those counties that does not have a delivering hospital, as well as Allendale, Bamberg and Barnwell, which are served by Lowcountry health systems.

And so our model of care really is all of the things that they're talking about.

So yes, we have Ob-Gyns that still deliver at hospitals.

We have nurse midwives that work with them and deliver at the hospitals.

But we also have our nurses who are trained in OB.

We have community health workers, most of which have been trained in the PASOs model.

We also are working with doulas.

We have parents as teachers which are home visitors that go and check on moms and check on the kids up to age three.

And so other things nutrition, behavioral health, radiology, pharmacy services.

So health centers are all around the state in every county providing this care.

And we're working together to be a part of the solution.

So working with everybody here so that we can go a little deeper and help with what we're seeing in terms of maternal health care.

Sierra> And everyone is doing wonderful work in their respective areas.

Thank you all so much for sharing.

And I want to switch gears a little bit.

I believe all of us here on the stage today, we're all mothers.

I just remember when I was pregnant I didn't have ChatGPT, I wish I did.

I had Google, I had Google, I know some people didn't have that either, but I know many people use the what to expect when expecting.

But what we don't expect is for things to go wrong.

That's not something that you can ever plan for.

And so what I want to kind of talk about is what are some things that you can prepare yourself for?

And I know one for me was self-advocacy.

You know, I had I thought when I had my son that I fully put my trust in the team that was taking care of me.

But there were some things that I needed to do to ensure that I was care that getting the was specific to my needs.

I had hyperemesis gravidarum.

I had a very serious, high risk pregnancy.

There were things that my, my pregnancy didn't look like everyone's.

So I want to talk about like self-advocacy, ways you can do that, that won't counteract with the team that's taking care of you, and also how your family can help support you.

Because we've talked about the way these organizations can support you.

But for a person that needs that support outside of these organizations, outside of the medical field, what options and what, how can they plan?

Ladrea?

Dr.

Ladrea Williams-Briggs> I always tell women, one, you know your body.

Right.

You have lived in this body.

You went through puberty with this body.

You had your first drink with this body.

You know, you.

So really building that confidence and understanding that you, you might not have had a baby before, but you know your body.

Also, I like that you said team, but understanding that you're the leader of that team.

One thing that I told my OB, you're on the team.

It's me, you, my mom, the, my doula, my husband.

It's a group of us.

It's a team but, but I'm the head of that team.

Having that confidence in yourself that you know that something is wrong.

And when someone's not listening, keep pushing until you get an answer.

I love that you mentioned parents as teachers.

Oh I have my parent educator is actually in the audience.

She's...she's out, she's out there somewhere, my parent educator, parents as teachers really works to work with moms one on one to build that confidence, to give them confidence in their bodies and what they have going on.

That's I think it's just a matter of knowing your body and knowing that you are the leader here.

(indiscernible conversations) Sierra> Oh, this is a good question Dr.

Polkey> You did, kind of you kind of hit on something because, "Okay, I'm a doctor, right?

<Yeah.> So, my first baby was good.

Great pregnancy.

Everything went great.

I had at that time, I believe it was through DHEC.

There was a home visiting nurse that came to my house.

Now I'm a doctor, right?

Maybe she doesn't need that, but I did need it.

And every woman in our county at that time, if they wanted it, was able to get that.

Things went great.

They helped me with breastfeeding.

I was worried I was going to give up.

I was like, "I can't do this, I can't do this."

And she said, "No, you can."

She laid hands on me and like, milk appeared.

It was amazing.

It was amazing.

Sierra> The milk whisperer.

Yes, my second pregnancy, I was a little older.

I was advanced maternal age by then.

Great prenatal care.

But I too had some postpartum complications.

I did not have a home visitor that came, and although I knew something was wrong, I do remember one day my mother and my husband looking at me and going, "You can't stay here, you have to go."

And thank goodness, because I did have eclampsia and I ended up back in the hospital, had the best OB.

I'd actually seen her the day before and things were going okay and was going to follow up the next day, but something wasn't right and I knew I needed to go at that time.

So it really is that village that takes care of you.

And if people don't have that village, then it really is up to us to help create that for them.

Sierra> Absolutely.

Dr.

Ladrea> And programs like parents as teachers really do become that village for a lot of people.

And it also fills the gaps for people that don't have transportation to get to the care.

It brings the parents as teachers... Nurse Family Partnership is another really great one.

It brings the care to them so it makes the care even more accessible.

Dr.

Billings> Yeah, I was just going to say.

(indiscernible conversations) Dr.

Billings> I'm going to go back even further in our time in our lives.

And something that is very frustrating to me is that for many children, like we want people to understand, women to understand our bodies.

Right?

We don't have a grounding for that in this state.

And we can go deeper into that topic if we want to.

But it's really hard, I think, and a bit unfair, to ask to expect that women, when they become pregnant, to then know all about even how they got pregnant and we do a real disservice, I think, to our community in general, to not have these conversations where that gets located.

Is it in schools, is it in the family?

Is it in multiple places?

That's a different conversation.

But the point is that we don't have them.

And I see that in my students in public health, those who are educated in South Carolina versus, let's say, New York or something, there's a real difference in the basic knowledge that people have.

Young people have about their own bodies.

And so if you don't have that as a starting point, it's really hard to even advocate for yourself.

Again, going back to the importance of the community health worker, the doula, the physician, the certified nurse midwife who are all part of this team.

But we also have systems that are profit oriented.

And so you in a lot of places, you've got, what, 15 minutes to see someone and it's not enough time to really be able to listen, even with the best intentions.

I feel like we need to understand the systems in which people are working as well, right, who want to do a good job, but the systems place barriers in the way of being able to do that in a way that's people centered, caring and really focuses on listening and hearing.

Sierra> Absolutely.

And I, when you started speaking and we're going to I'm going to make sure we get a chance to hear from everyone as well.

And I'm going to open the floor after this as well.

Since this was such a hot topic.

I felt what you said because I lived it.

The time that you go because you're so scared.

This is such a new, especially when you're a first mom.

And for many moms that have had multiple children, I even though my son was born six years ago, I've forgotten many things that if I were to have a child again, I'd be...oh my gosh, ...I am starting over.

My brain is starting from scratch.

But the time that you spend in the doctor's office, your OB, it's like, I feel like I'm in an assembly line.

Like it felt like, okay, next, it's almost like, do I matter or am I just another person that you just deal with?

It's almost like, this is I don't want to use the word, desensitized, but I think that's kind of like the best way I can describe it.

But it's really like just that, that feeling of when I need, I need, I need more support from the people that are going to be in the room when I deliver my child.

Because especially as we talked about the disparities there is already, when you're a Black woman and I speak for myself and I'm sure many people here can relate, you already have in the back of your, your mind, the statistics.

You know them, you've seen them, you hear them.

So there is sort of like a distrust.

And it's like, I need you to reassure me that this will not happen to me.

And I got chills.

It's like, I need, I need you, but I don't get you.

And that is the reason, again, why it's so important for us to have this conversation.

Because we're naming all of these resources, but many people don't know about them.

You go to a doctor's office, they're not explaining the pamphlets they're giving to you.

They'll just give you a folder.

It's filled with everything you need to know, but you don't know where to start because you don't even know what you're looking at.

So I definitely value your input right there, because I felt that.

And I and I do want to again, be sure that I get, get to the two of you as well.

But I just had to like just interject right there.

And I appreciate you guys being open for me to be able to do that.

Lamikka> But you know, believe it's, it's an authentic flow because I was going to build off of what Ladrea started, And then, you know, Dr.

Polkey.

So it's about integrative care.

It's not, it's not just collaboration but integrative care as well.

We know that everyone has a role to play.

Your doctor is your doctor.

Your doctor does not have 30 minutes to spend in a room with you.

As much as we would love that to happen, they don't have that, that type of time to, to spend with you.

But why not bring in a community health worker?

Why not bring someone in who does have that time?

They can sit with you.

They can help you.

They can talk through different things with you.

And if you can't integrate the care into your practice, then referring to one of those community based organizations like Family Solutions, to go out and then provide that support to those women.

So I do understand that, you know, there is a frustration.

I am a Black female.

Of course, I am a Black female.

We all see that.

And of course, we would love to have more attention than we get in our doctor's office.

But the reality is that we just can't.

We can't get it that way.

So why not utilize those other resources that are available?

And the other thing that I was going to add to is we were talking about the education, you know, women not necessarily knowing their bodies the way that we think they should know their bodies.

And so that's why with our program, with Family Solutions and with the other healthy start sites that are in South Carolina, because, back up, we are one of three healthy start sites in South Carolina in addition to being an NFP site.

Got to throw that in there.

With our Healthy Start programs, we do provide preconception education.

And so we have a reproductive health specialist who go into school systems.

We have to do it under the guise of something else.

We call it hygiene.

And you know, all of the creative words that we use.

But then we also connect with our, our sororities, our fraternities, any community organization that we can connect with or school that we can connect with to provide that preconception education so that women and men learn their body parts.

They learn how those parts work so that if something starts to go awry, they do have an idea that something is going awry.

And then the last thing that I'll say is, within our program, we educate our families to take notes.

We're speaking, and we may be comfortable having conversations with the medical team, but everybody does not have that same level of comfort.

So we suggest you write those questions down.

Write them down, take them with you to the doctor's office and give them to the nurse so that those things can be addressed.

If the nurse can address them, then the doctor will address them, but at least you will have your questions answered before you leave your appointment that day.

Sierra> Very great suggestions.

Dr.

Ladrea> I think that's where, the gap that you kind of identified there.

I think that's where the doula comes in, right?

The doula is, your doula is that consistent person.

Your doula is the person that you can go over your questions with before your appointment.

I do remember I used to get on the phone after every appointment.

She said this, this, this and this.

What does this mean?

That's where the doula is able to come in and kind of fill in some of those gaps that, unfortunately, are just a consequence of the way that we practice obstetrics in our country.

I think, like Lamikka said, it's important that we utilize certain services to fill in those gaps, and doulas are definitely one of them.

Sierra> And, and I'll go to you as well.

But on the topic of doulas, for those who are not familiar with how the practice of doulas, how the doulas practice, is it, is it covered by insurance?

Is there like a out of pocket like or is it like a culmination of both?

Like because I wouldn't know how to even initiate that.

Lamikka> It depends.

Sierra> Okay.

Jump in there.

Yeah, that's what I like.

(indiscernible conversations) Lamikka> ...for the audience.

Yeah.

There are doulas in the audience.

But what I will say is for family solutions for our service area, any pregnant woman who enrolls in our Family Solutions program is given a doula is offered a doula free of charge.

We don't charge for any of our services.

The doula service begins at five months gestation, and we follow them up through the postpartum period.

So it all depends on, on that particular doula.

Dr.

Ladrea> Prisma Health also has the Black Doula Project, where they offer grants to their Black patients to get doula services.

There was a group out in the hallway earlier today that mentioned that they now offer free doula services to residents in Richland County.

So although doulas are not covered by insurance, at least not in South Carolina yet, there are several programs out there that are able to provide that assistance in getting a doula for someone that wants it.

Sierra> Thank you for that.

Maria?

Maria> CHWs are also not covered.

And but there is no cost to services from CHWs.

And so, I think that, you know, our CHWs do the education as well.

They do you know, they have that trust built to be able to share to be able to, our participants, to have that trust, to be able to share what's going on with them, the questions that they have.

And so they practice going to, you know, the doctor and having all the things ready.

But, you know, the only thing I could add to this is that, you know, if you haven't heard of a CHW you know, in your doctor's office, like you said, you walk in and you don't really know that these services are available.

I'm a woman of color.

You know, back when I was having children, both of my pregnancies were difficult.

One was traumatic.

And so, you know, I have my own stories about that.

And so, you know, I wish I had known and had all these things.

Right, understood what was going on with my body, knew how to even possibly do meditation so that I could get in tune with my body so that I could explain to my husband what's going on and what I was feeling.

And, you know, I had the supportive husband and supportive family.

I had my mom I could call not all women have that, but you probably can identify one person in your life that you can go to, that you can lean on that together, you can learn and that you can search.

And so, you know, for me, it's like CHWs, doulas, these folks are the connection directly to the community.

There's just not enough of us.

Sierra> Yeah, absolutely.

And we're getting ready to, to take some answer or some questions from our audience.

But for those who may not know what a CHW is, explain.

Maria> A community health worker is someone that comes directly from the community that you're trying to reach, and is a person who is able to connect and understands the needs and the barriers that the community has and works with the organizations and agency services that are trying to reach them in order to open up that access and to have that enabling of, you know, having that integration of community and services, being able to be provided to them.

Sierra> Thank you for that.

Do we have any questions?

Anyone from the audience, would you like to add anything?

Ask any questions.

Make statements.

Yes, ma'am.

>> Hi, my name is Dr.

Alicia Harris.

Sierra> Yep.

We'll make sure you all get a mic.

Dr.

Alicia Harris> Hi, my name is Dr.

Alicia Harris, and it's so great to be here.

I thank you for this conversation because I think it needs to happen more often.

I was listening to everything that was said about the services, the collaboration, the resources.

But one thing I want to know is for a woman who experiences pregnancy loss, we all know that 1 in 4 pregnancies will end in loss, and unfortunately, my daughter was 1 in 4.

She lost triplet daughters.

So I have three heavenly angels Genesis, Journey, and Jordan.

And I was in the delivery room with her when she had to vaginally deliver those babies deceased.

And at the time, I'm a licensed clinician.

So in my mind, I'm thinking the social worker should be coming.

Someone should be coming to assess her, to support her.

And no one came.

And my daughter left the hospital without any resources.

In terms of emotional support, in terms of grief support.

And it really thrust me into the work that I do now.

And that is providing education, support and materials.

I interviewed nine participants from my qualitative dissertation, and one thread that was common for the women was we, We left.

We had no resources.

We didn't know where to turn now that we've experienced pregnancy loss, and one that was so profound.

One woman said, you can't have life insurance for a baby that has not been born.

So now when my baby is almost full term, it's delivered, but deceased, how do I handle that?

So can you tell me from that perspective?

Has there been any collaborative work that you've seen or done, or provided resources to make sure women and families are educated and supported in that way?

Dr.

Polkey> I would say that's...thank you, Alicia.

Thank you.

That is, and thank you for your story.

And thank you for the work that you're doing.

That's a gap.

That's a gap.

It is, we definitely spend a lot of time kind of getting moms to that point.

You know, as a pediatrician, I'm there after the baby is born.

But I'd say that is definitely a gap that, that we don't focus on enough or provide enough support.

And thank you for that inspiration too.

Sierra> I'd also like to say thank you for sharing and being transparent.

And also, I'm so sorry for your loss and for your daughter's loss as well.

I definitely love conversations like this.

I hate that the topic is very sad.

I'm so sorry, but it's great to have these conversations because it allows people to know what that gap is and how we can stand in the midst of that gap.

What we can do.

Because I think, again, it goes back to the main theme having the conversations.

People don't know what they don't know.

Sometimes the routine gets in the way, and people don't think or don't know if there's a way that they can help in that area.

And, and I hope that whoever may be watching, or if there's someone in the audience that may have a solution that they will, you know, have the courage to, to make or, you know, step in and help to create change in that area.

Dr.

Polkey> I can just say, I'm sorry.

Oh, no, I was just going to say, I will say though, our obstetricians, our certified nurse midwives do step in and although we can do better, I know that they deal with that.

They feel that.

They want the babies to come.

And so I know that there's like resources, behavioral health type resources that people will get referred to.

But I would just say as a system we can do better.

Maria> Right.

Exactly.

And that's what I was going to go to, is that a community health worker following, supporting someone will definitely do all the follow up and, you know, do the connections to behavioral health and, and all of the things.

But... Sierra> And I want to segue before we take another question from the audience, as well.

With everything that we've talked about, especially with the, the last subject that we discussed, how can health care systems rebuild trust in these communities?

I mentioned that I was scared the entire process, you know, with the filling dismissed, feeling unsupported, not necessarily knowing what to do next.

But I felt, I feel now, and I know many people who had experienced traumatic pregnancies.

They don't want any children anymore.

They don't want any more children, let me say, because they're traumatized.

And so in order for us to and there's some people I've, you know, I made a post on Facebook about this show and someone commented and said, this is the reason I don't want children because I am traumatized.

It's not even their own trauma.

They're, they're traumatized by.

It's the of others that has traumatized them.

It is something that our bodies do naturally, but people are afraid to experience it because they're afraid that they're going to become a part of the statistics that we've been talking about.

So again, my question is, how can our health care systems rebuild that trust?

Dr.

Ladrea> I think it's about, one, being honest, right.

Being honest in that recognizing that the problem is systemic, that the problem is in the way that we practice obstetrics, that the problem is in the built environments around us.

And then two, not being afraid to bridge the gap between clinical and community.

It's getting, getting us out of this space where MDs and OBs are here and everyone else is here.

I think one of the projects that Lamikka and I collaborated on is Project ECHO: SC Pregnancy Wellness.

One thing that they're really intentional about is making sure that the providers - it targets physicians that the providers are learning about the community health resources, that they're connecting the Ob-Gyns and the APRNs to the doulas and the community health workers.

So I think it's about first being intentional and being honest about what the change, what changes are needed, but also not being afraid to cross over and, and work closely with the community organizations to rebuild that trust.

Lamikka> I believe that, that crossover is the key, because once trust is broken, it's hard for the person who broke the trust to get that back.

So you do need support.

You do need help from a trusted individual.

And those trusted individuals are those community health workers and those doulas.

Sometimes we've seen where some of the clinical professionals are resistant to working with community health workers and doulas because they, they feel like they're going to lose control.

But it's not, that's not the case.

We work collaborat-, collaboratively, and I say we because I'm a social worker, but I'm also a community health worker, and we work collaboratively.

Our focus is on the women.

Our focus is on the families.

So whatever they need to be whole and healthy, that's what we want to do.

So Ladrea is absolutely, I'm sorry, Dr.

Williams-Briggs is absolutely correct when she talks about not being afraid to cross over.

And if there's anything that we can do, if there are any clinicians who are in the audience or who may be watching, and you have a desire to cross over, but you're not sure of how to do that, we would love to help.

We would love to provide some insight into how you can do that.

Dr.

Polkey> As one who has used all these resources, she has.

Listen.

It has to do with trust.

...right.

It has to do with building trust in your community.

And that's what health centers do.

We're in the communities.

We're in Hampton, We're in Varnville, Estell, Ridgeland, Hardeeville.

We're in all the places where people live.

There are people who come to the health center, that work at the health center.

The people who go to church with the people each day.

Every one of my providers in Hampton County is from Hampton County.

And so that's what creates that trust.

You're going to see us at the parade.

You're going to see us at the health fairs like we are within the community.

And I think that's what continues that trust so that we do, knowing that we're all a team working together.

So, you know, as providers and having providers who are very community minded, that's why they come to a community health center, because it is about how we care for our community and how we make our communities healthy.

Sierra> Wonderful.

Well, we are coming to a close on our time, so I want to give everyone an opportunity to provide us with some closing remarks.

We have a minute.

So we're going to start with Maria and then we're going to work our ways down.

So Maria, any final thoughts today?

Maria> Well I just want to thank you for this space.

And I want to thank everyone here and everyone who's watching.

And thank you for your bravery.

Thank everyone, including myself, for being here and, and being brave enough to talk about getting real.

Getting real.

Thank you.

Sierra> You're more than welcome.

Thank you.

Lamikka?

Lamikka> Again, thank you.

Thank you for the opportunity.

If I could leave with one thing I would say, I would encourage everyone to not treat maternal health like a trending topic.

It's a crisis.

It's not a trending topic.

And, and that's what has been happening.

We treat it like the newest pair of jeans or the newest shoes that came out.

Everybody wants to get on it because it's new and fresh.

And maternal health, women are dying.

And we, it's time for us to really, really take a step back.

And no matter how awesome I may think that we are, all of us are up here.

We can all take a step back and look at what we can do a little bit differently, or how we can help someone else to improve the outcomes in our state.

We are too rich of a state to have the outcomes that we have in maternal health.

Sierra> Well said.

Thank you.

Dr.

Billings?

Dr.

Billings> Just, I thank you again.

I wish we had time to really dig into the richness of, of the audience members.

Right.

So I hope there'll be a space where we can feature their work on the website and such, because that's where the work is happening.

Fully agree with what both of you have said.

And, and we need to, we just need to work, not just harder, but fearlessly, because there are a lot of barriers being put in place, unnecessarily by, certain powers.

And we need to be fearless.

Dr.

Polkey> Yeah.

The only thing I would say is that I'm actually excited because we are having these conversations, and I think our state is, I think we are poised, we are small enough that we are one degree of separation.

Like I know probably, I know, each person, somebody you know.

Right.

And so we're small enough to make a difference, but we're large enough that we have the resources, that we can make a difference.

So, this is a great time right now in South Carolina.

So it's time to, to keep it moving.

Dr.

Williams-Briggs> Uh, I'm last.

(laughs) So I'll say this.

Thank you, one.

Thank you Dr.

Billings, for the opportunity to be here.

I want to give a nod to the people that are at home watching or in the audience that aren't necessarily familiar with the maternal health world.

You don't have to be.

Two.

You don't have to have a doctorate of public health, or be an Ob-Gyn or an MD to advocate for Black mothers in South Carolina.

Educate yourself.

Learn about the data.

Visit the local health department's website to learn more about what's happening.

Listen to Black mothers.

Listen to mothers of color to learn more about their stories.

Share and post on social media, donate to your local community.

Donate or volunteer with your local community organizations that are really doing that work.

I don't want people to think that you have to be a mom, or you have to know a mom, or you have to be directly involved in this space to advocate for maternal health.

It's all the, it's the small things that collectively make a difference.

Sierra> Thank you.

Well, I want to thank you all for joining us for this discussion today.

Thank you so much for your input.

We'll have this on our website for you all to review if you'd like to go back and watch and share.

But thank you all for joining us for "Saving Moms: Part Two".

I'm Sierra Artemus.

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