The three-part docuseries, “The Risk of Giving Birth,” examines the deepening maternal health crisis in the United States where maternal death rates are 10 times higher than the rates of other high-income countries. The second episode of the series focuses on the mortality rate among mothers of color and what Rhode Island’s health care system is doing about it.
Below is an edited and condensed version of host Anaridis Rodriguez interviewing nurse midwife Ana Sofia De-Brito and Keesler Gomes, a local doula. You can watch the in-depth conversation here.
ANARIDIS: Both of you I know have worked with many families, specifically families of color. Ana, I want to start with you. You were part of filming this documentary. What was the experience like for you?
ANA: Well, at first, it was strange. I was very nervous being in front of the camera, but other than that, I thought it was a wonderful opportunity to raise awareness of not only what’s happening in the country, but also what’s happening here in Rhode Island. Being someone who was raised here, immigrated to this country, stayed in Rhode Island, grew up in Rhode Island, then left, and now come back. It was an amazing experience to be a part of it and talk about what I hold most dear in my heart.
ANARIDIS: Tell us a little bit about your background and what brought you to being part of the docuseries.
ANA: Yeah, so I’m Cape Verdean and was born in Cape Verde and then immigrated here as a young child. Grew up in Pawtucket that I love dearly, and then went off to undergrad where I always knew I wanted to be in health care, specifically women’s health. And while there I recognized that my values and what I believed in and what I thought of birth and women’s health didn’t truly align with the medical model of being a doctor, which is what I was aspiring to be. And at that time, I went back to Cape Verde and spent time with my grandmother who was a midwife there, and had been a midwife for over 40 years, both in the community and the hospital as laws changed there and where midwives could practice or not practice.
And then I came and I worked with midwives in the hospital, doing an internship there. I came back here and questioned, “Where are the midwives? Where are they?” And really couldn’t find one to speak to and asked how they got there or what path they chose. And that’s what set me off on this path of midwifery. I really found someone who I could talk to and their values and the way they see birth as normal physiologic birth and not a medicalized version of birth was what inspired me to continue down this path in midwifery.
ANA: And Keesler, what about you? You are the program manager for the Urban Perinatal Education Center in Pawtucket, which I’ve driven by many times. It is a great space. ... How did you come about becoming a doula?
KEESLER: I have supported friends. So the first baby, the first birth that I attended, he is going to be 21 in February. So I’ve been doing it for a while. I was a doula before I knew what a doula was. I’ve always been like a mom’s helper. So that’s what doulas do. So we support moms or birthing people for the majority, but we are also there for the entire family. We make sure their partner is hydrated and sleeping and taking care of themselves so that they can then support their partner through the labor delivery process.
ANA: I was able to watch the first episode of the docuseries, and one of the first people you sort of meet outside of the families is the executive chief of OB-GYN at Women and Infants. And he said something that really stopped me in my tracks. Ana, you mentioned this documentary bringing awareness and it really was an eye-opening experience for me, and I know will be for many women. And he said in 2023, the maternal health crisis is not getting better. It’s getting worse. ... Can you give us a snapshot of what is happening to women in Rhode Island?
ANA: Yeah, so Rhode Island is such a small state that when we talk about mortality, we don’t really have the numbers to back up what is happening across the nation. Our morbidity numbers are higher, and we can talk about what that means as well. But across the United States, Black women specifically are two to three times more likely to die from childbirth. The number exactly from (the) 2021 CDC report is 2.6 (times) higher than what they usually term as the norm, which are white women or white birthing people. And that is a big vast difference, right? And in some states, and in some counties, in some cities, in some towns, it’s even higher than that.
It can be even four times as more likely to die in childbirth because of the rising increases of deserts of OB-GYN or midwifery care in certain parts of the country. And so here in Rhode Island, we don’t have ... I don’t, it’s weird to say as many maternal deaths as other states because of the number of population here, but that’s just one piece of the puzzle. It’s the morbidity as well, which includes preeclampsia, high rates of C-section, postpartum or perinatal mental disorders. All of those things are part of the morbidity as well.
ANARIDIS: Why is this happening? Why are women of color dealing with such a high mortality rate in the United States? You mentioned some of those health factors. Can you dive into those a little bit more?
ANA: That is a very loaded question.
ANARIDIS: It could take a long time to get there, right?
ANA: Yeah, it can take a long time. And please interrupt me and chime in, Keesler, as you see fit. I like to look at it from a more macro-systemic view and then dive into the little pieces because if I knew the answers, then we’d have solutions, right? But it’s a little bit of everything. And the number one thing right now, if we’re talking about Black maternal health is structural racism. Like the United States was built on racism, on enslaved peoples, profiting off of their bodies, profiting off of the Black body, profiting off of the Black woman’s body to create more folks for chattel slavery, to create basically the income for this nation.
And the legacy, or I should say the enduring trauma of slavery, has trickled down to what we see today. One thing that I really like to talk about is Black midwifery or the lack of Black midwifery that exists in the United States right now. And the change from grand midwives in the South and immigrant midwives and Caribbean midwives ... spanning from the 1800s to 1950s and more and even now, there’s a rise in Black midwives coming back into the fold as well. And the changes in community midwives versus what we’re doing mostly now, which is certified nurse midwifery, the biggest group out of all the midwives. And we’re mostly seeing in the hospitals, right? And we’re mostly providing outpatient care in clinics. But the true community midwives who are certified professional midwives or the traditional midwives, the numbers are much lower.
ANARIDIS: Keesler, I’ll fold you into the conversation. This overall infrastructure that’s not serving everyone the same. How does that manifest in the work that you do? How does a pregnant people, a pregnant person rather, meet you?
KEESLER: So I just wanted to first piggyback off of what Ana said. It is about money. It’s always about money, right? So that’s how we got the doula bill passed here in Rhode Island because we presented it to the insurance companies as like a business proposition. They found out they could save money if doulas were in the mix. And there’s less likelihood of cesarean sections and higher chance of birth satisfaction rates, right? With doulas. So all of those things, the data shows that those things happen with dual services. But at the same time, I don’t feel like it was an accident that there are now a higher rate of inductions, right? And so inductions are forcing the body to do something that they’re not ready to do yet. And the higher rate of inductions is a higher chance of C-section, and higher chance of C-section is then a higher chance of morbidity or mortality. Do you know what I mean?
ANARIDIS: Complications.
KEESLER: So I don’t think that was an accident. It all plays into the money part.
ANARIDIS: So this is how you’re seeing this disparity manifest itself, right? And even as a result of advocating for service to be protected for expecting mothers. Any other examples you can share with us on how these disparities manifest in your work and what you do to try to bridge that gap?
KEESLER: So the services that we provide at UPEC or Urban Perinatal Education Center, Ana mentioned that the folks don’t see the provider for like the first 10 weeks or so, like right after they get pregnant. So they can come to us. We have our Easy Access Care model clinic. So what that is a gap filler. So we see them when they first find out they’re pregnant, we can confirm pregnancy, they can listen to the baby’s heartbeat, we can talk about nutrition, talk about how they feel about the pregnancy ‘cause not everybody is excited or happy. Some people are stressed out and some people just need to cry, right? They need somebody to talk to. And then after baby is born, they need to wait another maybe six weeks for mom to see somebody. And so they can come to the Easy Access Model Care Clinic that we have.
We can weigh the baby for them, make sure that breastfeeding’s going well, make sure their mental health is OK. And we can also check their blood pressure and make sure that there is no type of postpartum eclampsia going on. And if there is, we can refer them to their care provider sooner rather than later. So that’s something that we’re doing. We also have free childbirth education classes. We provide those Tuesday night, Friday night, Saturday night, 5 p.m. to 7 p.m., 7 p.m. to 9 p.m. It’s free to the public. Everybody’s welcome. The birthing person can bring whoever they want. We also have the first Rhode Island depository and dispensary of human milk. So that right there is also super exciting.
You can watch all three episodes of the docuseries here.
Generation Rising airs on Fridays at 7:30 p.m.
