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May 25, 2022

All Black Everything


Is a diverse healthcare workforce enough to eradicate racism in medicine?

The short is: no.

 Using race to remedy racism is not enough. 

And let's talk about why with four Black providers in reproductive health: an OBGYN, a nurse midwife, a traditional midwife, and a midwifery student.

Tune in to hear the benefits of adding more Black folks to the healthcare workforce, as well as how this diversity-based approach is an incomplete strategy to remedy health inequity, including:

  • The ways racism is embedded into healthcare education, training, tools and systems
  • How harm can be reproduced in medical settings regardless of the race of the provider 
  • How Black folks can have poor experiences with Black providers
  • Alternative and additional strategies to ensure better health experiences and outcomes for Black pregnant and birthing people

About Our Guests

Camille A. Clare, MD, MPH, CPE, FACOG is a board-certified obstetrician and gynecologist and was recently appointed as Chair and Professor at the Department of Obstetrics and Gynecology of  SUNY-Downstate Health Sciences University College of Medicine and School of Public Health. Full interview on Patreon (running time 00:57:15)

Efe Osaren has been a doula since 2014 and is currently completing her midwifery education. She has served over 200 families and is crowdfunding  to help pay for her license and board exam. Efe is also a reproductive justice advocate and is the Founder of Doula Chronicles. Full interview on Patreon (running time 01:16:10)

Nubia Earth Martin is a Community Birth Worker, Traditional Midwife, and Founder/President of Birth from The Earth Inc., a non-profit organization steeped in education and empowerment, providing a variety of health and wellness services. Full interview on Patreon (running time 01:10:23)

Melissa Thomas* is a Black nurse midwife working in a major metropolitan area who has attended over 350 births in her career spanning over a decade in primarily hospital settings. She came on the podcast anonymously and her name has been changed to protect her identity. Full interview on Patreon (running time 01:03:47)

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Credits

Creator, Host and HBIC: Taja Lindley

Audio Engineering by Lilah Larson

Music by Emma Alabaster who also served as the Pre-Production Associate Producer

Additional Music Production by Chip Belton

Vocals by Patience Sings

Mixing and Mastering by Chip Belton

Lyrics by Taja Lindley and Emma Alabaster

Logo and Graphic Design Templates by Homegirl HQ

This podcast is produced by Colored Girls Hustle 

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Transcript

Producer’s Note: The Black Women's Dept. of Labor is produced as a podcast. Transcripts are generated using a combination of transcription software and human transcribers, and may contain typos. Please confirm accuracy before quoting by contacting us.

[00:00:00] Patience Sings: My labor's the foundation. Life at the intersections. I am my own creation. I do not dream of work.

[00:00:20] Nubia Martin: It sounds like an easy fix. Oh, let's have a all Black everything. 

[00:00:23] Efe Osaren: Am I going to perform a better cesearean because I'm Black? 

[00:00:29] Dr. Camille Clare: There's only 4% of Black physicians in the whole country, 2% are Black women physicians. 

[00:00:39] Patience Sings: Black women the foundation. Life at the intersections. Source of divine creations. Now listen now converse.

[00:00:40] Nubia Martin: There is an intentional suppression of Black midwives.

[00:00:53] Melissa: We have this calculator, but it's a racist tool.

[00:00:56] Dr. Camille Clare: It's not that a Black individual is racist, but they're operating in a white supremacist system.

[00:01:25] Patience Sings: Using our labor for more than wages. Our bliss, our rage, they're both contagious. Beyond the grind, we move through time. Joy is the compass we live in our purpose. Telling our own stories, birthing new possibilities.

[00:01:30] Taja Lindley: You are listening to the Black Women's Dept. of Labor, a podcast and project by yours truly, Taja Lindley, where we examine the intersections of race, gender, and the double entendre of labor to work and to give birth. 

[00:01:43] Taja Lindley: In the last couple of episodes, you heard two incredible birth stories. 

[00:01:47] Taja Lindley: In today's episode we're talking about the other laborers, namely the healthcare workforce that provides care for pregnancy and birth. 

[00:01:55] Taja Lindley: You'll remember that when LeConte and Olivia shared their journeys to motherhood, Black health care providers were an important part of their stories. 

[00:02:02] Taja Lindley: And I get it. I too prioritize finding a Black provider for my health care needs. Many folks in my family and my friends have done the same. In fact, I come from a family of Black health care providers. 

[00:02:13] Taja Lindley: But is diversifying the healthcare workforce with more representation from Black folks enough to reduce or eliminate racism in healthcare? 

[00:02:22] Taja Lindley: My answer is no. That is not enough. 

[00:02:24] Taja Lindley: And today we're going to talk about why and what else we can do to address structural and interpersonal racism in medicine as well as improve birth outcomes for all pregnant and parenting people. 

[00:02:34] Taja Lindley: Spoiler alert. This is a "yes and" conversation. So while I don't think it's enough to simply add Black people to the healthcare workforce, that is not to say it's not useful at all. 

[00:02:45] Taja Lindley: I got to chat with a doctor, two midwives and a midwifery student, all Black women, about the possibilities and limitations of an all Black healthcare workforce, or at least a Black provider for every Black patient that wants one. 

[00:02:57] Taja Lindley: Everyone I talked to shares a commitment to birth justice, and they also have thoughts, experiences, and opinions that differ from one another. All of this is to say: everyone featured in today's episode represents their own voice. Not their employer, not the organizations they're part of, not the other folks on the podcast, and not even me. 

[00:03:16] Taja Lindley: And if you want to hear the full length interviews with each of today's guests, head on over to Patreon.com/TajaLindley. 

[00:03:24] Taja Lindley: Now let's get to it. 

[00:03:30] Taja Lindley: Before we talk about the limitations of increasing the number of Black folks in the healthcare workforce, let's talk about the benefits. 

[00:03:37] Taja Lindley: Meet Dr. Camille, Clare. A board certified obstetrician and gynecologist from the Bronx currently working at SUNY Downstate as the recently appointed Chair and Professor at the Department of Obstetrics and Gynecology. 

[00:03:50] Taja Lindley: As a Black woman physician, Dr. Clare is very familiar with the under-representation of Black folks in her field. 

[00:03:56] Dr. Camille Clare: There's only you know, 4% of Black physicians in the whole country, 2% are Black women physicians. 

[00:04:03] Taja Lindley: And she too looks for Black healthcare providers for her care. 

[00:04:07] Dr. Camille Clare: I personally have all my providers, every single physician that I have is a Black woman actually, and my dentist as well.

[00:04:17] Taja Lindley: In addition to her personal preferences. Dr. Clare is aware of the impact of having Black physicians in the exam room. 

[00:04:24] Dr. Camille Clare: We know that the racial concordance, for example, between a healthcare provider and the patient has meant improved communication, patients are more likely to talk to us better. We write longer notes, we write more extensive notes. We spend a little bit more time with our patients. 

[00:04:41] Dr. Camille Clare: Uh, we speak to patients about more than just, you know, their own individual reasons for their appointment. How's their family? What else is going on? That personal connection, that unsaid understanding, lived experience, which is not always the case, cause there's also classism as well in in medicine.

[00:04:59] Dr. Camille Clare: So we're not always coming from the same place, exact place as our patients, we, we have privilege that we recognize, but I think a lot of that lived experience is unsaid. And so that gives our patients a set of comfort, I would like to think, trust and comfort that we're able to establish, in a short period of time uh, much less than, you know, maybe going two or three appointments. Maybe in the first appointment, we're able to at least lay a groundwork of comfort that patients are able to, to talk to us about a lot of different things.

[00:05:28] Dr. Camille Clare: There was just a recent study about women physicians who happen to be primary care providers. So it was just looking at gender identity. So not just race and gender identity, but in this study, women primary care providers were- had better outcomes. Their patients did better. They were less likely to be admitted to the hospital. Um, they had less emergency department visits. The patients did better. So from an outcome perspective, everyone thinks about data, right? Data is important in, in, in medicine and science. The patients did better. 

[00:05:59] Dr. Camille Clare: For Black uh, patients - and this was a study that was done in Black male patients and Black male physicians. Again, better communication. Um, notes were longer notes. They had more time spent with the patient because of that, again, communication, lived experience. So I think that's extremely important. 

[00:06:19] Dr. Camille Clare: I can tell for myself when I'm spending time with patients, that extra three to five minutes or three to 10 minutes or whatever it is, without my hand on the door to go, that really speaks volumes for the things that patients tell me.

[00:06:34] Dr. Camille Clare: They'll tell me things that maybe they wouldn't have otherwise told me. Because I really took that time. I sat down, I looked them in their eye. I didn't look at the computer. Now for me, that meant me writing my notes for hours later, but it took me time to just sit down with them, look at them face to face.

[00:06:50] Dr. Camille Clare: And that's really been the best part of why I chose this job, because I really wanted to feel connected to my patients more than just, you know, what my notes say, what my standard questions say. 

[00:07:04] Taja Lindley: So, yes: representation in healthcare can impact health outcomes. 

[00:07:09] Taja Lindley: Though it's worth noting here that what Dr. Clare mentions, spending more time with patients, is something that every provider can do with any and every patient they see, regardless if they have shared identities or not. 

[00:07:22] Taja Lindley: However, the dehumanizing that is inherent in racism is ripe for interactions where patients are hurried, dismissed, or ignored. A shared lived experience can indeed be a shortcut to building trust and relationship. 

[00:07:35] Taja Lindley: But before someone is able to see patients and offer services in our current health system, they have to go through some sort of formal training and education process. 

[00:07:44] Taja Lindley: Meet Efe Osaren, a midwifery student who has been publicly documenting her journey since 2018. She was inspired to become a midwife after witnessing the poor care her doula clients received. 

[00:07:55] Efe Osaren: The birth that did it for me was at Brookdale. It was a transfer from a birth center birth. 

[00:08:00] Efe Osaren: When we get to the hospital, they want her to sign these paperworks. Basically so they can do a C-section if necessary.

[00:08:07] Efe Osaren: And she didn't want to do a C-section. She didn't even want to think about doing a C-section so she didn't want to sign the paperwork. She didn't want to do an epidural. So she wouldn't sign the paperwork and they wouldn't do anything without her signing paperwork.

[00:08:17] Efe Osaren: They sent in other Black providers. I mean, there was one point, there was a, a nurse who just like threw a stack of papers on top of her belly and was like you either sign this or get out and walked out the room. We were all crying and angry and trying to really figure out what we're gonna do. While also the staff is trying to figure out how to get rid of me saying like, oh, well you're not needed. 

[00:08:38] Efe Osaren: I was just so frustrated with the care and the lack of control, the lack of power I had at that time. I may have attended maybe 70 births. I felt pretty senior ish doula, that I knew what I was doing, knew what I was talking about. And I couldn't do anything. I couldn't stop what was happening. And so that's when I realized that I need to become the healthcare provider in the room.

[00:08:59] Taja Lindley: Becoming the healthcare provider in the room is easier said than done as Efe quickly realized during her midwifery studies. 

[00:09:07] Efe Osaren: So traditionally a preceptor is just someone who is more senior in that path that you chose and that you become their apprentice. According to NARM - the North American Registry of Midwives - which doesn't cover all of North America by the way- a preceptor, according to them, is a licensed midwife or certified professional midwife or a certified nurse midwife or a certified midwife, who is registered with NARM to become a preceptor to teach you.

[00:09:37] Efe Osaren: And so they have a lot of authority over what you do, of how you move, what you learn, how far you go, if you even get licensed. They can, can really control that.

[00:09:50] Efe Osaren: It can also lead to a lot of abuse. 

[00:09:52] Efe Osaren: Like they can really control what happens to you. And because NARM doesn't have an accountability program, the midwives move with a lot of reign over your life, over how you perform as a student.

[00:10:05] Efe Osaren: Talking to other students, I've have heard students who have been working with preceptors for three, four years and at the end, the preceptor didn't want to sign off on anything or would tear up their paperwork or make it go missing. And they would have to start over from scratch. 

[00:10:20] Efe Osaren: And NARM's response would be, well, you should have had a contract or why didn't you make copies of it?

[00:10:25] Efe Osaren: Or if you knew this preceptor was abusive, you should have left them. You know, it's a lot of victim blaming. 

[00:10:31] Efe Osaren: Becoming a midwife, it's almost like a hazing process for you to finish.

[00:10:36] Taja Lindley: The hazing process that Efe is referring to isn't just the interactions with fellow students and preceptors. It's also built into the paperwork process for becoming a midwife. 

[00:10:46] Efe Osaren: The application is just paper you print out and they come with all of these really complex strategic rules on, you can have this and you can't have that. You can have this, you can't have that, and it has to do this. And it's so complicated and so very, very dated that we have to get handwritten signatures, notarized signatures, and mailing forms and mailing money orders. And there's just so much room for error. There's just so much room for manipulation.

[00:11:12] Efe Osaren: I found out that a lot of, you know, the white students would pay their preceptors to sign off on things for them. Like we Black students, we can't move that way. And you know, there's, there's white students who are graduating, who they didn't actually do the work, but I'm doing double the work.

[00:11:27] Efe Osaren: There's just so much room for error and being audited by NARM. And then having to redo what they don't approve of, or maybe the signature doesn't look like the other signature or this doesn't look well. And especially if you've had years of signatures. You get up to 10 years to complete your application. All of those things can factor in. 

[00:11:46] Taja Lindley: These preceptor signatures would become a big point of contention and frustration in Efe's journey to complete her midwifery education. 

[00:11:54] Taja Lindley: But before she experiences that, Efe was already dealing with the challenges of being the only black person in her midwifery program. 

[00:12:01] Efe Osaren: One of the things the alumni of the school were warning me about was the racism in midwifery. 

[00:12:07] Efe Osaren: And when I got there, I was the only Black person. And it showed up in everything. It showed up when we were teaching. It showed up when I was at a birth. It showed up when we were in the dorms or in the bedrooms. It showed up when we went grocery shopping. It showed up all the time. I was constantly receiving microaggressions. I've never received so many microaggressions in my life.

[00:12:30] Efe Osaren: And it was very difficult for me to focus on learning while also fighting the students, fighting my preceptors.

[00:12:37] Taja Lindley: All of this fighting took its toll and Efe took a break from her midwifery education. In 2021, she returned to her midwifery education, this time committed to completing the process as a PEP student. Which means Efe was no longer completing her education with an accredited school and is now responsible for learning on her own. 

[00:12:56] Efe Osaren: Yeah, so pandemic hits and I'm in New York, you know, we're not making money as birth workers as we used to, but also just so much has changed physically, mentally. A lot of people left. 

[00:13:11] Efe Osaren: So I moved back to Texas. When I came back to midwifery, as a PEP student, I have to now find my own preceptor. 

[00:13:22] Efe Osaren: I reached out to a midwife in Texas and it was a Black midwife. She has own birth center and I just figured I'm at the end already with like 80% of the work done. 

[00:13:35] Efe Osaren: So I reached out to her. I was like, hey, I'm thinking about finishing. I don't have a lot to do. I maybe need about three to four months on call. I don't have a lot of money, but I would drive back and forth from my parents' house. It was about maybe less than a two hour drive. It just felt like the most ideal thing to do.

[00:13:54] Efe Osaren: And I get there and you know, it's fine. It's a birth center, nothing too problematic on the, you know, very naive eyes. And like my second or third week there, I had a couple of sit downs with her. I was like, hey, I'm really far removed from the observed phase. Like I am a primary student. I need to be doing primary things. But she'd be like, yeah, yeah, you good. You'll get all your numbers. I would never sabotage anything. You'll be fine. Just come to the births.

[00:14:23] Efe Osaren: That's what she would say: just come to the birth, you'll be fine, I'll sign off on anything, just come to the birth. And I was like, okay, that's not what I'm supposed to be doing, but okay. 

[00:14:29] Efe Osaren: And maybe about 15 births in I'm just like, I'm not getting any signatures. So I sat down after one day of the shift, I was like, hey, you have to sign these things for the births I've attended.

[00:14:42] Efe Osaren: So she's signing off on things. And then she gets to the births attended, she was like, well, who was this? And who was that? And I'm naming them off, I'm naming the task I did. And she was like, well, I didn't see you do that, so I'm not going to sign off on it. And I'm sitting there like trying to breathe.

[00:15:00] Efe Osaren: And so, she's signing off things and then she's like, you know what? I don't think you're ready to be a licensed midwife. And so she takes her pen and she crosses out her signatures that she had already signed on my form. Mind you, the paperwork that we sign for NARM is very important. Marks can't be all over the place.

[00:15:19] Efe Osaren: It has to be in chronological order. It has to be pretty much perfect. And so she crosses it out and I'm just like, I do not have the stamina to go reach out to all the previous midwives who signed on this paperwork to re-sign because she did this. And she just keeps crossing out and she's just like, you know, I think I need to sit on this and she takes a photo of it.

[00:15:39] Efe Osaren: And then we leave. And end the day. And nothing was really said. And there was other birth assistants who were watching and they were like in the kitchen watching. They were just like, oh shit, because they've been students before they know what this is like. They know when a preceptor decides to take away signatures, the trauma that you would have to go through going forward.

[00:16:01] Efe Osaren: And I remember being just like ain't no way I left New York City for this shit. Ain't no way that I packed up my entire life to be in a Black owned birth center with a Black midwife and for her to- no dialogue, no conversation, just straight up power pulling. And when we left, I'm sitting in my car and I scream like a shriekish scream and I'm fuming, and I'm just like, I can't, I can't do this.

[00:16:29] Efe Osaren: I wanted those 15 signatures, you know, I really was like, I deserve to get, and I remember saying this to her, like I deserve to get my labor. I deserve to get compensation for my labor. And that compensation is in those signatures. 

[00:16:42] Efe Osaren: Her response being that like, that's why I didn't sign it because you think you deserved this. 

[00:16:47] Efe Osaren: And so I get Jenny Joseph on the phone -

[00:16:50] Taja Lindley: Jennie Joseph is a British trained midwife and the Founder and Executive Director of Commonsense Childbirth Inc. She is the creator of the JJ Way, a patient centered model of care. And in 2022, she was recognized as one of 12 Women of the Year by TIME's magazine. 

[00:17:06] Taja Lindley: Basically, she's a well-respected and widely known Black midwife. 

[00:17:10] Efe Osaren: -and I tell her I was like, hey, I need a mediation phone call with my preceptor. This is what's happening. One, I need a witness to the behavior that I was receiving. And that two, I needed to figure out how am I going to get these signatures. 

[00:17:25] Efe Osaren: And the call, it lasted about an hour long. Jenny barely even got in a word in, and she's just going on and on and on about how I think I deserve things that I didn't work for. And that this is her birth center. This is her business. She gets to choose what happens there.

[00:17:41] Efe Osaren: At the end of the call, she goes, I actually want you to bring that paperwork back to the birth center so I can cross off on all the signatures that I gave you because I don't think you deserve them not anymore.

[00:17:53] Efe Osaren: And we get off the call, you know, obviously I'm distraught and Jenny calls me. And she was like, so you're aware that that wasn't about midwifery, right? And I was like, yes. Yeah. And she was like, so now what are you going to do? And I was like I, I don't know. I'm I, I basically balling, snots coming out my mouth and she was like. You're going to find another preceptor and you're going to finish.

[00:18:18] Efe Osaren: I never did go back to the birth center to give her that paperwork for her to cross out signatures because I posted it in a NARM Facebook group, and all the responses, even one of the quote, unquote advocacy partners or whatever at NARM commented and was just like, it's not, it's not legal or whatever. You cannot retract signatures that if the preceptor didn't want to sign, she shouldn't have signed in the first place. And they put in that protocol maybe just a few years ago, because a lot of midwives were doing that and it was just straight up abuse.

[00:18:52] Efe Osaren: And so I remember taking like a deep breath, was like okay. At least I don't have to start all over again. 

[00:18:58] Efe Osaren: That was one of the moments where I were just like this whole hire Black preceptor, work with a Black owned birth center. Like all this shit is for the birds. What we really need to file down to is that within a racial analysis, there's still a class analysis. There's still a power struggle. There is still white supremacy in, up and through everything at all times, and being a Black provider does not mean that you were safe with that Black provider.

[00:19:26] Taja Lindley: Efe's story reminds me of the phrase: not all skin folk are kinfolk. Just because someone is Black don't mean they'll have your back. And she experienced that firsthand with a Black preceptor.

[00:19:37] Taja Lindley: Efe's story also highlights the ways Black students may feel discouraged and experience challenges that can prevent them from completing their education, or has them finishing with a lot of trauma and stress.

[00:19:49] Nubia Martin: We also have to break down these barriers of the hazing and weathering that happens during the education process where Black student midwives or prospective or aspiring Black student midwives are not able to complete their education process or are not able to get certified or licensed because of all of these barriers.

[00:20:08] Nubia Martin: It sounds like an easy fix. Oh, let's have a all Black everything. Right. But not if the person is coming with their own baggage. Right. Not if they're coming with their own trauma from midwifery school and not if they can't even finish the education process in a way that they're whole and centered and healed and are able to then provide that care for somebody else.

[00:20:28] Taja Lindley: That's Nubia Earth Martin, a community birth worker and traditional midwife based in Yonkers, New York. She is also the Founder and President of Birth From The Earth Inc. - a non-profit providing a variety of health and wellness services. 

[00:20:42] Nubia Martin: What I learned during my education was that there is an intentional suppression of Black midwives.

[00:20:48] Nubia Martin: And that is in the process of getting into these institutions, in completing a midwifery education, in being able to pass these board exams. So there's so many different gatekeeping efforts that many people simply decide, okay, this is, this is just too much. I'm not gonna, you know, continue on.

[00:21:08] Taja Lindley: I imagine that other students, including aspiring nurses and doctors have experienced similar and parallel challenges and frustrations in their educational journey. 

[00:21:18] Taja Lindley: And even though Nubia holds a Master's Degree in Midwifery, she understands the limitations of a midwifery degree.

[00:21:23] Nubia Martin: I know this is going to be an unpopular opinion, but I believe the degrees, the certificates, all of that - I equate them to a "massa's pass." It's like I got this paper. So with this paper, I can now do XYZ, but it really also imposes some type of limitations because with that license or with that degree, or with that diploma comes a certain way in which they want you to practice your profession.

[00:21:54] Taja Lindley: You'll hear more from Nubia in a moment. Right now, I want to introduce you to Melissa, a nurse midwife in a public hospital in a major metropolitan area who has been practicing nurse midwifery for over a decade and chose to come on the podcast anonymously so she can speak freely. 

[00:22:09] Taja Lindley: She too is invested in Black providers for her personal health care. 

[00:22:13] Melissa: When I was looking for a provider I really wanted, um a physician, just a dermatologist that was Black and it's very hard to find, or those people are super booked. 

[00:22:24] Taja Lindley: When she and I chatted, she reflected on the early days of her career and shared how it can be challenging as a newer midwife to provide the full scope of your training, especially in a hospital setting. 

[00:22:34] Melissa: When you work in a hospital setting, it's very interdisciplinary, obviously. You're working with physicians, you're working with um, social work, you're working with nurses, which is all great.

[00:22:47] Melissa: Um, but primarily your clinical work can sometimes be overseen by physicians and depending where you work, you know, your work can be limited in what you can and cannot do as a midwife. 

[00:23:00] Melissa: In my first setting, which was a private setting, working very closely with physicians, it was a teaching hospital, or is a teaching hospital, residents who are in training in OB GYN. There was always a struggle, especially as a newer midwife to get your experience because it was also like working with residents who also needed to get their experience.

[00:23:23] Melissa: I kind of felt like residents are just there to get their experience and move on. And it was hard to watch sometimes. Especially kind of having this image in my head of what midwifery was supposed to be like which when people think about it, it's supposed to be this like holy grail of peace and tranquility and your birth is going to be beautiful.

[00:23:44] Melissa: And then you work in a hospital and sometimes it's beautiful, and sometimes it's traumatic even as a midwife in terms of intervention in birth, not allowing women to move around, kind of making decisions for women that may not fit them um, or that you can clearly see, they're like not with it, but they feel like they have to go along, um, or they don't even know what their rights are that they can challenge.

[00:24:10] Melissa: A lot of times that became a challenge for me, and that still is a challenge, working under physicians and they were really, you know, into your work and what you do and kind of dictating your practice.

[00:24:26] Melissa: And I think too, probably the idea too, that midwives are there. You know, we kind of get swept up in the whole teaching thing. Like you guys are here to work for us and, you know, they don't understand what midwifery is about and what our philosophy really is grounded in and so it becomes a struggle.

[00:24:47] Taja Lindley: This is important because I've come across many a policy recommendation that says “let's center, a midwifery model of care for birthing people.”

[00:24:55] Taja Lindley: So if we get a bunch of Black folks to become midwives, what will be the impact if they are then working in hospital settings, where many people give birth, and are not able to provide the care they are trained to give because many hospitals settings, in practice, center a physician led birthing model. 

[00:25:10] Taja Lindley: The issue then is more systemic than simply adding more Black folks into the healthcare workforce. And adding Black folks to the workforce is not enough when the trained professionals who can provide quality care for pregnant and birthing people are not legally allowed to provide their skills and training to their neighborhoods and their communities. 

[00:25:27] Taja Lindley: Nubia shares a poignant example of this that is currently unfolding in New York state. 

[00:25:32] Nubia Martin: New York is interesting. I know we think about New York as being this really liberal, you know, place.

[00:25:37] Nubia Martin: But when you think about the politics behind midwifery, depending on the letters behind your name and the paper, you know, behind your name, that kind of informs the way in which you can legally practice here in this state. So right now, CPM, Certified Professional Midwives, who primarily operate and serve in out-of-hospital settings, are not legal to practice in New York.

[00:26:01] Nubia Martin: Which I think really drives up our high mortality and morbidity rate disparities for Black women specifically in New York. So in the U.S., we're three to four times more likely to die, but here in New York, we're eight to 12 times more likely to die. And that's simply because we don't have enough Black midwives who are culturally competent, who are not going to be imposing systemic racism and implicit biases, who are willing to work in out-of-hospital settings, and who have cultural competency and sensitivity to understand the unique needs of people from the African diaspora.

[00:26:39] Nubia Martin: So when you have a law that says that a group of qualified midwives can't legally practice here, and they primarily serve in out-of-hospital settings, that means you're not going to have enough home birth midwives to provide for people wanting to birth in out-of-hospital settings. And you're especially not going to have enough Black midwives. 

[00:26:58] Taja Lindley: Let us also consider how policy and practices are enacted and enforced regardless of the race of the healthcare provider. A good example of this was the VBAC calculator. VBAC stands for vaginal birth after cesarean. So this is talking about folks who had a previous birth via C-section and want to deliver their next baby vaginally. 

[00:27:24] Melissa: One of the things that I was really frustrated with is the VBAC calculator. 

[00:27:30] Melissa: We used to use this calculator. You punch in these numbers, how old the patient is. What's their BMI or weight? What's their race? Uh, if they've had a normal delivery before. What was the reason for their C-section?

[00:27:47] Melissa: So if it's something benign like, oh, the baby was breached, then your score would be higher than someone who was in labor and maybe didn't dilate more, for instance. So the calculator takes all these criteria and comes up with a percentage of your success rate. 

[00:28:02] Melissa: But that success rate includes a race category. It's like, what does race have to do with my ability to push a baby out? I mean, Black women push babies out all the time. But once you put in African American into the calculator, your score is lower than if you leave it blank because blank is defaulting to being white. And so you have tons of women who are excluded.

[00:28:28] Melissa: Why not just give people a try? I mean, unless you have absolute contraindications, which I understand, I'm not like naive, but I mean, race has nothing to do with it. If I'm Black, so what? I want to try to have a baby naturally. If I come in in spontaneous labor, if I'm dilated, why not give me a chance? But walking in like that and they do that calculator, you're not even seeing the person, you're seeing a number on a page and that alone disqualifies you.

[00:28:55] Melissa: Um, and so there was a big push to kind of get rid of this stupid calculator and give people a chance. You're obviously still gonna assess them. You're going to talk to them about risk and benefits. I mean, some people still use it um, just as a guide, you know. 

[00:29:09] Melissa: But it still would make someone, if you tell them, well, you know, we have this calculator, we put these stats in, not telling the patient what is part of these stats, which is what I do. I'm like, just by the way, it's saying that you have a 50% chance, but it's a racist tool.

[00:29:26] Taja Lindley: Dr. Claire is also familiar with the limitations of the VBAC calculator. 

[00:29:31] Dr. Camille Clare: So I did a presentation not long ago regarding that they've removed race and ethnicity from the calculator. However, when we think about where it has come from, they were thinking about pelvic architecture, pelvic bones. And what we've learned is that the individuals that looked at skeletons, maybe in the twenties and the thirties, was based on a racist system.

[00:29:58] Dr. Camille Clare: They thought that there was some difference between Black skeletons and white skeletons. There aren't any difference between Black skeletons and white skeletons. You know, we learn anatomy. When the person's open, if you're looking only at their bones, you have no idea, are they Black or are they white? 

[00:30:16] Dr. Camille Clare: There was a study recently up to 2016 or so medical students and residents still believe that there are Black individuals and white individuals have differences in how they experience pain. That's the other day. So where does that come from? That comes from an educational system, that again was based on earlier physicians, earlier doctors that had those notions. And they're still, unfortunately, we're taught that in the medical system. So until we really are educated ourselves, we have to do a lot of self-education.

[00:30:57] Dr. Camille Clare: We don't learn that in medical school. We don't learn about Dr. Samuel Cartwright, who there was a term called drapetomania. It was a condition where if you were an enslaved person and you wanted to be free, that was a, that was a mental disorder. You were thought to have a mental disorder, if you wanted to escape from slavery. And that was written in, in our textbooks, written in textbooks and papers and manuscripts, which are still apparent and involve. 

[00:31:24] Dr. Camille Clare: So if you're learning in those systems without that background, without learning you know, these things, which I've come to learn later in my life. I didn't learn this as a medical student.

[00:31:33] Dr. Camille Clare: I didn't learn it as a resident. And so, because we're not taught as a medical student and a resident, we hold onto these ideas, which can impact our care even as a Black physician, even as a Black woman physician. And so until we learn to dismantle that from other disciplines outside of medicine - medical anthropology, sociology, education you know, any other specialty, any other branch of profession that can help us really understand, epidemiology - that can help us understand you know, the systems in which we were learning a lot of the information that was not correct.

[00:32:11] Taja Lindley: I appreciate what Dr. Claire shared here about bone structure, race and racism. It reminds me of this moment during my conversation with Melissa. 

[00:32:18] Melissa: I had a patient who, on her ultrasound, she was of African descent. And it was her first baby and it was, she was like 40 years old, you know, worked hard to get this baby. On her ultrasound they, they look at the nasal bone of the baby, if it's present or not. And for hers, they put absent nasal bone, which if it's a true absence of a nasal bone, it could be an indication of some kind of genetic disorder, like down syndrome or something like that.

[00:32:49] Melissa: I think part of me being a midwife or just a person really in tune with my insides, my spirituality, my intuition, I knew there was nothing wrong with this baby. But I felt like at some point I had heard that sometimes with people of African descent, you know, because we have quote unquote flat noses or flatter noses, in an ultrasound it may appear like there is no bone, but there is a bone it's just our nose is a little bit flatter.

[00:33:18] Melissa: So I told her that, you know, we have to remember that ultrasound stats and parameters, just like every other parameter in the world, or at least in the United States is based off of the white race. So if it's not matching you know, the European features, if it's not matching that, it may come off as an abnormality, but not necessarily true.

[00:33:41] Melissa: But again, we have to have parameters, right. But the problem is the parameters are based off of a certain group of people.

[00:33:47] Melissa: So she's walking around thinking there's something wrong with her baby. And I'm like, it's probably fine.

[00:33:53] Melissa: And then later on, as the baby grew, it was like, yes, the baby has a nasal bone.

[00:33:58] Melissa: And the baby was born and the baby had a nose, but it was just like, you know, who wants to like have their whole pregnancy jaded with these feelings? 

[00:34:08] Taja Lindley: To be clear, there is nothing wrong with having a child or being pregnant with a child who has down syndrome. What's important to note here is that the patient was surprised, concerned, and feeling unprepared for that potential possibility. And her worry was initiated by an ultrasound reading that centered phenotypes often associated with white people. 

[00:34:27] Taja Lindley: Melissa brought up another great point about how racism gets baked into medicine, specifically how industries of health share conclusions without context about why and how Black folks may be more at risk for certain health conditions. 

[00:34:40] Melissa: I had an example of, so a patient handout that I used to give out to my GYN patients when they had bacterial vaginosis, just normal information about what is bacterial vaginosis, which is, you know, a normal vaginal infection that can occur in a woman if her bacterial flora is off a little bit. 

[00:35:01] Melissa: And then one day I was like, let me actually read what this says. Sometimes we like hand out things from these authorities and you think, oh, it's done in good faith. Right. So I read it and they put down, it was more of a Q and A type of handout. And it was like: who's at risk for BV [bacterial vaginosis]? 

[00:35:22] Melissa: And it had, you know, women with multiple sex partners, douching, some other things. And then the last thing was Black women. And I was like, what? And that like put me off so much. And I was just like Black women, just, just bullet pointed there. And I was like, okay, every woman is at risk for bacterial vaginosis.

[00:35:49] Melissa: And we already know the stigma with women and their bodies in general, but now you're putting race on top of it to a specific group of women that has historically had labels and stereotypes put on their sexuality. 

[00:36:06] Melissa: And BV as benign as it is, you know, some people think it's an STD, you know, and we know how people are stigmatized when they're thought to have an STD of some kind, and this should be nothing that would make any person feel bad about themselves. And they listed this and this is like a reputable organization.

[00:36:26] Melissa: So I wrote to them, pointed it out to like the editor and stuff and talk to them how racist this was, et cetera. Girl, they didn't even blink.

[00:36:36] Melissa: Had the nerve to send me a letter back quoting some outdated studies and some studies that were done in Africa with like small groups of women who had like a higher incidence of BV. I'm like one we're not in Africa. 

[00:36:48] Melissa: And it's unfortunate. So of course I stopped giving out that handout um, because they never did change it. They kind of reworded it a little bit, but it still had Black women in there.

[00:36:57] Taja Lindley: Nubia mentioned something similar in our conversation, how there is a desire to talk about race but the conversation stops at who is at risk and does not dig further into why that is the case. 

[00:37:08] Nubia Martin: I remember when I was in midwifery school and the running joke was: if we had a test and it said, which group of people is more at risk for anything- heart disease, diabetes, you name it, right? Anything bad. That you can automatically check off African-American or Black. And that was going to be the correct answer. 

[00:37:25] Nubia Martin: And I started thinking about that and I said, well, why is that? And they were like, oh, well, you know, because Blacks are more at risk for this. And I said, well, hold on a second. That makes no sense. I know that there's nothing in our cellular DNA that predisposes us to these things. So why would we be more at risk for that? And when you dig further, it's not because there's something inherently wrong with us. It's because of the way in which Black and brown is treated in this country.

[00:37:50] Nubia Martin: And I said, well, the way you're teaching this is not accurate because you're making it seem like if somebody comes into my office, when I'm practicing and they're Black, I have to tell them that them alone being Black is a risk factor. What do they do with that? I can't change my Black skin. 

[00:38:06] Nubia Martin: Now if you tell me, yes eating, you know, fast food is a risk factor for developing, you know, high cholesterol. Okay. That's something I can change. If you tell me that smoking is a risk factor for preterm labor, that's something I can change. What can I do with Black as a risk factor? And that's not the actual reason behind it.

[00:38:25] Taja Lindley: This is like the VBAC calculator taking race into account, but making race, not racism, the risk factor for having poor health outcomes. From where I sit, I imagine that these Black healthcare providers ask these kinds of questions of the information that is presented to them because they are Black and know that what is being presented to them in these brochures and in their education is not the whole story. 

[00:38:48] Taja Lindley: But had they, or any other medical provider taken this information at face value they could have easily perpetuated and supported these practices and beliefs, even as a Black provider. 

[00:38:59] Dr. Camille Clare: It's not that a Black individual is racist, but they're operating in a white supremacist system. So they're themselves are not racist per se, but are really operating as Black individuals in a white supremacist understanding.

[00:39:16] Dr. Camille Clare: As we think about the VBAC calculator in particular, I never used that calculator. Not once did I ever, like, I think, I didn't even know it was a thing. I'm like, I've never used this calculator. So it's just so interesting that in the environments that I worked, I took care of people and offered a lot of vaginal birth after cesarean without even knowing this calculator. So it's just so ironic that, even us doing the same line of work, obstetrics and gynecology, everyone can come at it at very different angles.

[00:39:49] Dr. Camille Clare: And so I think not that I'm not going to advocate for being comfortable in whoever takes care of you the best. It may not be the self-identity that you hold. But I think acknowledging that we have work to do as Black women physicians, as Black individuals who are providing medical care, midwifery care, whatever healthcare, professional uh, services, we still have work to do in, in unpacking, dismantling, liberating ourselves from these racist white supremacist thoughts.

[00:40:19] Taja Lindley: And although I'm sure folks who say "let's increase the Black healthcare workforce" are aware that racism does not start and end in the exam room, I would be remiss in this episode if I did not mention the ways in which inequitable health outcomes are impacted by racism in the world at large. 

[00:40:35] Dr. Camille Clare: Before we named racism, we really learned that the patient is beyond just the clinical or medical experience that they were undergoing. So their environment where they live, their family, the other people that interfaced with the patient or the client as they interfaced with the healthcare system, we learned about that very early, who the person lived with, who made up their support system.

[00:41:02] Dr. Camille Clare: I perhaps chose my line of work of medicine because I was called to serve in this way. So how can I get the patients what they need?

[00:41:12] Dr. Camille Clare: So, for example, I've taken care of patients that may be challenged by transportation issues,

[00:41:18] Dr. Camille Clare: So the patients being able to make sure they have uh vouchers, for example, to get to their appointments. Can their appointments fit into a time where they're able to get there because they have either other children or they have other appointments to navigate, or they have their own work responsibilities?

[00:41:37] Dr. Camille Clare: Does their appointment fit into when they can come in to see us? You know, we're not really a hundred percent flexible, many times. Our hours are eight to four, nine to five. If you're working beyond that six, you know, can you get into later hours? Are there weekend hours that it can accommodate patients?

[00:41:55] Dr. Camille Clare: Some of my patients were challenged by housing insecurity. So being able to get them what they need within the shelter system if they're currently living in the shelter system. 

[00:42:05] Dr. Camille Clare: Some of my patients um, may have had food insecurity. So we always had uh, sandwiches snacks, juice available in the clinics in case their appointments were much longer than anticipated. That they have something to eat. They have something to eat for breakfast, they have lunch, they have a snack. 

[00:42:22] Dr. Camille Clare: Is there childcare available? Does my patient have to pick up her child at a certain time? So they have to, you know, get out of the clinic visit earlier than anticipated because they have a certain time to pick up their child three o'clock or two o'clock.

[00:42:34] Taja Lindley: But let's say you're listening to this and you're still gung ho about increasing the number of Black folks in the healthcare workforce. You may be thinking: I get it Taja. This policy solution may not fix all of the racism in healthcare, but it's a good start. 

[00:42:48] Taja Lindley: I'd like you to consider not only what it takes for someone to become a healthcare provider, but what is required to retain their presence in the workforce. Efe shared some interesting things to consider namely the toll of this work on the bodies and lifespan of midwives. 

[00:43:02] Efe Osaren: Your body deteriorates from the lack of sleep and how can we perform well, if you are exhausted in the mind, in the spirit, in the soul. Even just during this pandemic, we lost two Black midwives before their elder years. 

[00:43:17] Efe Osaren: And I remember when the midwife in Houston passed, Afua Hassan, and I go to like, look up some interviews or whatever. And I find out that she's the age of my mother. And I remember just being like, my mother is not at her elder years. 

[00:43:30] Efe Osaren: How can a career that everyone loves so much, take us away from this Earth before it's our time? Or give us chronic health issues? Or make you resentful, make you bitter?

[00:43:41] Efe Osaren: And I've met other midwives who retired at 40, 45 who are just like, I'm not trying to go out like that so I'm going to stop right now. And I'm 32, you know, I'm coming into the game a little late, but I'm just like, I can't do this for 20, 30 years. 

[00:43:56] Efe Osaren: And no one training us, no one talking to us about the longevity of midwifery, at the longevity of our lives, the lifestyle of on families, on your children, on your health. Our entire basis is to really deplete yourself for the clients you have. 

[00:44:17] Taja Lindley: Having a Black provider for every Black patient that wants one will not automatically equate to better health outcomes. 

[00:44:24] Efe Osaren: When I hear things like: hire a Black provider. I think about all the Black providers my clients had, the Black providers that I've had and how I wasn't listened to. They didn't hear me. Or if they did hear me, sometimes there'd be this side conversation with a Black provider like, I really think you deserve this type of care, but we can't provide this type of care for you because these are the limitations that exist inside a medical industrial complex. 

[00:44:48] Efe Osaren: There's always like this centering of this really violent white person who created the entire framework for our profession that we've been using for centuries.

[00:44:57] Efe Osaren: And to, to hear that a Black provider will be better when the system is the same. When they have to work with the same limitations of their, as their counterparts often with less resources, often while exhausted, often while experiencing abuse of themselves from their own counterparts, their peers and their management. 

[00:45:17] Efe Osaren: It doesn't make any sense to me.

[00:45:19] Efe Osaren: Am I going to perform a better cesearean because I'm Black? Am I going to give you better care of trial of labor because I'm a Black provider? And when the rules are the same, I have to induce you at this certain time. I have to transfer you at this certain time. I have to give you this medication at this certain time.

[00:45:40] Efe Osaren: It doesn't change because they're Black. It might give you a little bit more comfort mentally. But the results are often the same. 

[00:45:47] Efe Osaren: Because I'll even get folks who will reach out to me as like, oh, well, you're a Black doula, you're a Black student. I would like you to be my healthcare provider or my doula or whatever, and it's just, do we bond? Do we have similar backgrounds? Do you think that I can help you do so-and-so? Or do we have a cultural connection? You know, there's so much missing for how I can show up for you, how someone else could show up better for you.

[00:46:14] Taja Lindley: And understanding the limitations of diversifying the healthcare workforce means understanding how power operates in the U.S. healthcare system. 

[00:46:22] Melissa: On a micro level, it is lovely to walk into a room and see that your provider is a person of color, but recognizing at least being a provider, knowing the machine is a big machine and we are literally pawns in the game. Because all that is working above us does not look like us. And so we have to answer to people and those people answer to people, even if they are persons of color, it could be the CEO of the hospital is Black, but that CEO is answering to another CEO that's most likely not Black.

[00:46:56] Melissa: On a micro level, like I said, I definitely think it is helpful for us to have providers and providers of all kinds nurses, ancillary staff, that look like our patients and reflect the neighborhoods in which we work and the communities that we serve should definitely match. Because I think there is a level of comfort um, and understanding that comes with that.

[00:47:22] Melissa: You know, a Black person or a person of color is not a monolith. Even if you have physicians or midwives that are the same color as their patients, they may not necessarily understand racism and how it works. I mean, they may have experienced it, but maybe not have seen it that way or they are experiencing it differently. 

[00:47:43] Taja Lindley: So if diversity in the healthcare workforce is not enough, what else can we do? 

[00:47:47] Taja Lindley: Dr. Clare shared her thoughts about anti-racism education and commitments among her colleagues and professional organizations.

[00:47:54] Dr. Camille Clare: As we learn more, we know more. And it, and that's, that's natural in medicine. We do continuing medical education all the time. We keep up with medicine all the time. In a same way we need to keep up with these concepts to unlearn, unpack what we learned incorrectly before.

[00:48:11] Dr. Camille Clare: We can recognize that everyone is on different parts of the continuum, right.

[00:48:17] Dr. Camille Clare: But we have to, as an organization, say that well, even though you're individually on a different part of the path, we are committed to this anti-racist work. This is what we're going to do. And we want to one, have you identify where you are on that continuum. Either you're in the fear zone, learning zone, growth zone and get you from one part to another.

[00:48:41] Dr. Camille Clare: I've had those individual battles, like, what is this? You know, I'm not racist. I'm not this. I have Black friends or whatever, and that's not a thing you're either racist or you're anti-racist. So there's no, I'm not a racist. You have to actively be anti-racist. You have to do many different things to get where you are on the journey and that we just have to demand and require. 

[00:49:05] Taja Lindley: Nubia shared the hopes and challenges of bringing a midwifery led birth center to the Bronx. 

[00:49:10] Nubia Martin: The two options that we have, can't just be hospital and home birth. There has to be a middle ground, but we really believe in a midwifery led and operated birth center. Because what happens when you have a birth center that is still run by a physician, is all those policies we were talking about, that kind of still need to be followed.

[00:49:30] Nubia Martin: So the catch 22 is if you have a birth center that is operated and run by a physician, you can pretty much almost open it overnight. Right? So that's what happened with the Brooklyn Birthing Center and then their new location, which was the Jazz you know Birth Center that's currently in Manhattan because they're both being, you know, run by the same physician. They were able to open up seamlessly. 

[00:49:54] Nubia Martin: The red tape to open up a birth center that is led and operated by midwives is almost the equivalent to trying to open up an ICU - an intensive care unit. Which makes no sense because we wouldn't be caring for anybody high risk there, but you know, again, it's the politics and follow the money, right?

[00:50:13] Nubia Martin: So a lot of hospitals believe, oh, well, if we have birth centers, you know, all around, it's going to take away from our business. I'm like - it's not about taking away from your business. 98% of people are still birthing in hospitals. That's not going to do an about face overnight. Less than 2% of people birth in home birth or in out of hospital settings. However, if again, if we're not only following the money, but we're talking about evidence-based research, 85% of pregnancies are considered healthy and low-risk. Probably even more because they consider 35 and over advanced maternal age and quote unquote high risk. But let's go with their 85%. Evidence-based research shows that the safest place for that 85% to give birth is in out-of-hospital settings. Yet 98% of people are still birthing in hospitals and the math just doesn't, you know, it doesn't make sense.

[00:51:03] Nubia Martin: We believe in a midwifery led birth center. We are still fighting for that right now, but the politics behind it is we have to wait for certain amendments to be passed. 

[00:51:15] Taja Lindley: And Efe shared some radical pivots away from the healthcare as we know it into something new. 

[00:51:20] Efe Osaren: So this is where birth justice come in. This is where a lot, the bulk of my politics come from working and shadowing at Ancient Song Doula Services with Chanel Porchia Albert. 

[00:51:31] Efe Osaren: We talk about all of the spectrums, right? We talk about housing. We talk about food insecurity. We talk about being in a police state. We talk about healthcare. We talk about education. And, Dr. Joia Crear Perry has written about this often. And Dr. Monica McLemore often talks about weathering and how their body is picking up these stressors on a daily basis, your entire life. And then often these stressors from your person who birthed you and that stressor creating your egg and so forth and how it becomes generational stress.

[00:52:09] Efe Osaren: If we know that weathering of the body creates these really chronic health conditions or even health conditions that don't show up until you're in labor, I feel that those things should be in the focus before we even get to pregnancy care, before we even get to the labor.

[00:52:24] Efe Osaren: Does this person have secure housing? Does this person feel safe in their housing? Is this person getting the nutrition that they need? Do they have access to it? Are they able to get to their jobs if they wanted to? Or are they working in a job that they want to work to? Do they have the transportation for that? Or are they being surveillanced everyday? Do they have bright lights staring into their projects all day long? 

[00:52:45] Efe Osaren: And then we get to how we manage labor. 

[00:52:49] Efe Osaren: I had this hashtag, birth communes, not birth centers.

[00:52:52] Efe Osaren: Because I really think having a space that centers, all of these insecurities in someone's life. To factor in, you know, even as that person as a child who was living in a similar lifestyle throughout, and then when they are ready to birth and pregnant, we're not having to teach basic reproductive health. We're not having to teach them consent.

[00:53:13] Efe Osaren: They're not fighting for a good provider. All of this has already provided for them in the work of their ancestors before them. And so that is what I, I'm not sure how I'm going to make this happen, what it's going to look like. But I would like to see these communes all over.

[00:53:29] Efe Osaren: I don't want a birth center. The way it exist now it's just complicit in what we have. Like, okay, it's better than the hospital, or it's better than what we have, but it's not thriving. Do you leave that place feeling like I'm inspired to now raise this child to the best of my ability and I have all the postpartum healthcare that I want? No, we don't.

[00:53:49] Efe Osaren: The message with, international midwifery this year was about how, I can't remember the exact number, but basically we need millions of midwives by a certain year for us to have better health care in this world. How are we going to get to millions of midwives if we can't even get the ones we have now to finish?

[00:54:09] Efe Osaren: If you are learning midwifery outside of the system, I would like to see more things like Jenny Joseph's Common Sense of Childbirth School that she opened up. Um, I would like to see schools like that, where we have the JJ Way Framework being the foundation and learning in that capacity while also the students having full, you know, we need funding. Like we shouldn't, I should not be crowdfunding. 

[00:54:45] Taja Lindley: Before we go, I want to make this very clear. This episode is not about discouraging people from entering the medical professions, nor is this episode about dissuading people from actively seeking out healthcare providers who share their identities. 

[00:54:58] Taja Lindley: The purpose of this episode's conversation is to think beyond diversity. And to consider how harm can reproduce in medical settings, regardless of the race of the practitioner. And to imagine the additional or alternative strategies that are necessary to ensure a better health outcomes and experiences for birthing people. 

[00:55:16] Taja Lindley: It's not enough to recruit more Black people into medicine without addressing the systemic harms and structural challenges that prevent Black folks from entering or completing their education, and that prevent Black folks from staying in the profession. And let us not forget what today's guests shared with us: that providers in training of all races can be indoctrinated to believe in ideas and use tools and methods that are racist. 

[00:55:40] Taja Lindley: Capitalism in general and the United States in particular, loves to use diverse representation to pander to our sensibilities and desires to be included, to see ourselves represented. So we are more comfortable with oppression rather than addressing and eliminating oppression itself. 

[00:55:55] Taja Lindley: And we cannot simply add more Black people to a for-profit healthcare system when the system itself will find ways to continue to cause harm with and without the presence of Black staff.

[00:56:05] Taja Lindley: At some point, we've got to transform the policies, practices, and leadership of said systems. Or create new ways to support people's health outside of the current structures that exist. 

[00:56:15] Taja Lindley: I give thanks for your time, attention and listenership. 

[00:56:19] Taja Lindley: If you are enjoying your experience, tell a friend and leave us a review wherever you get your podcasts or on our website.

[00:56:26] Taja Lindley: If you'd like to share your story or perspective with us, write us a message or leave us a voicemail at BlackWomensLabor.com. 

[00:56:32] Taja Lindley: Find us on Instagram @BlackWomensLabor and sign up for our newsletter to receive project updates in your inbox. 

[00:56:39] Taja Lindley: And support this work y'all at Patreon.com/TajaLindley where you will be able to access exclusive content and full length interviews with each of our guests, including everyone you heard from today. Trust me, there is so much more relevant insight and wisdom that each guest shared that simply could not fit into this episode. 

[00:56:57] Taja Lindley: You can also support this podcast by dropping some coins in our PayPal or purchasing the podcast music on ColoredGirlsHustle.Bandcamp.com. 

[00:57:05] Taja Lindley: This podcast is created and hosted by yours truly, Taja Lindley, also known as the HBIC. 

[00:57:12] Taja Lindley: Audio engineering by Lilah Larson. 

[00:57:14] Taja Lindley: Music by Emma Alabaster, who also served as the Pre-Production Associate Producer. 

[00:57:19] Taja Lindley: Additional music production by Chip Belton. 

[00:57:21] Taja Lindley: Vocals by Patience Sings. 

[00:57:24] Taja Lindley: Mixing and mastering by Chip Belton. 

[00:57:26] Taja Lindley: Lyrics by Taja Lindley and Emma Alabaster. 

[00:57:29] Taja Lindley: Logo and graphic design templates by Homegirl HQ. 

[00:57:35] Patience Sings: Telling our own stories. Birthing new possibilities.

[00:57:37] Taja Lindley: This podcast is produced by Colored Girls Hustle.

Nubia Earth Martin Profile Photo

Nubia Earth Martin

Community Birth Worker, Traditional Midwife, Founder/President

Nubia Earth Martin is a Community Birth Worker, Traditional Midwife, and Founder/President of Birth from The Earth Inc., a non-profit organization steeped in education and empowerment, providing a variety of health and wellness services.

Nubia holds a Masters Degree in Midwifery, and a Bachelor's Degree in Sociology. She is a Childbirth Educator, provides Birth and Postpartum support, and offers Lactation consulting. Nubia Martin sits on the Board for Chocolate Milk Cafe National, The Black Coalition for Safe Motherhood, and the Hudson Valley Birth Network.

Nubia is dedicated to improving birth outcomes for women of color, and toppling maternal mortality and morbidity rate disparities. The legacy and lineage of the Grand Midwives runs deep through Nubia Martin. She sees Midwifery, not as a profession, but as a way of life and a rite of passage.

Listen to her full length one-on-one interview on Patreon.com/TajaLindley
Interview length: 01:10:23

Efe Osaren Profile Photo

Efe Osaren

Doula, Midwifery Student, Reproductive and Birth Justice Advocate

Efe has been a doula since 2014. She has completed her training and certification as a full spectrum Doula with DONA, The Doula Project, and Ancient Song Doula Services and direct entry midwifery apprenticeship with Maternindad La Luz, Borderlands Birth Education and Advocacy Project, and Dyekora Sumda Midwifery. She has served over 200 families in Houston, NYC, and El Paso.

An avid reproductive and birth justice advocate, Efe is the Founder of Doula Chronicles, a reproductive education platform for communities of color, that focuses on holistic uterine health and reproductive justice education. She is also a co-founder of Homecoming, a collective of BIPOC Queer+Trans birthworkers and healers. In the future, she aims to return home to West Africa to provide midwifery support.

Currently, she is completing her Midwifery education and is now back in NYC taking doula clients to pay for her license and board exam. She is crowdfunding and you can send resources to:
- Website (https://www.doulachronicles.com/midwifery-fund)
- Paypal (https://www.paypal.com/paypalme/Sassye)
- Cash App ($EfeO)

She likes solo traveling, handbuilding pottery, and hot yoga without the Bikram.

Listen to her full length one-on-one interview on Patreon.com/TajaLindley
Interview length: 01:16:10

Melissa Thomas*

Nurse Midwife

Melissa Thomas is a Black nurse midwife working in a major metropolitan area who has attended over 350 births in her career spanning over a decade in primarily hospital settings. She came on the podcast anonymously and her name has been changed to protect her identity.

Listen to her full length one-on-one interview on Patreon.com/TajaLindley
Interview length: 01:03:48

Camille Clare Profile Photo

Camille Clare

Obstetrician and gynecologist

Camille A. Clare, MD, MPH, CPE, FACOG is a board-certified obstetrician and gynecologist. She received her medical degree from the Albert Einstein College of Medicine, Bronx, New York, and completed her obstetrics and gynecology residency at the State University of New York at Buffalo. She obtained a Master of Public Health in Health Policy and Management at New York Medical College. She is a Certified Physician Executive as conferred by the Certifying Commission on Medical Management. Dr. Clare was recently appointed as Chair and Professor at the Department of Obstetrics and Gynecology of SUNY-Downstate Health Sciences University College of Medicine and School of Public Health, a role that she began as of January 2021.

Listen to her full length one-on-one interview on Patreon.com/TajaLindley
Interview length: 00:57:15