The LamazeLIVE! 2018 event is just about two weeks away. I am excited to attend and experience this "new to Lamaze" conference concept. As educators and other professionals get ready to travel from all around the world to San Antonio, TX, USA for this event, I had the opportunity to interview Nina Martin who is the LamazeLive! 2018 closing keynote speaker and a renowned journalist.

Nina Martin is a reporter at the nonprofit news organization ProPublica, where she covers sex and gender issues, with a special interest in maternal health. Her Lost Mothers project, examining maternal mortality and life-threatening complications in the U.S. (in partnership with National Public Radio), has received a George Polk Award. Just yesterday, March 7th, Nina and her co-authors won the prestigious Goldsmith Prize for Investigative Reporting. The Goldsmith Prize recognizes journalism that encourages good government and public policy by disclosing excessive secrecy, impropriety, and mismanagement, or instances of particularly commendable government performance. Before joining ProPublica in 2013, she worked at numerous news organizations, including San Francisco magazine, Health magazine, the Washington Post, the International Herald Tribune and BabyCenter, where she was founding editor of the print edition. She lives and works in Berkeley CA.

Sharon Muza: The topics you are covering/writing about are big and serious and to be blunt, frankly depressing. (Poor outcomes for parents and babies is never NOT depressing!) How do you write about these topics in such a way that people will want to keep reading but you continue to accurately reflect the situation? Do you ever get discouraged when researching and writing about parents and babies dying?

Nina Martin: This has definitely been the hardest reporting I've ever done, in terms of the emotional effect it's had on me and my colleagues and the people I write about. Every story is indescribably sad in its own way, but that's not the only reason the stories have been so challenging - there's also the desire to get the story right, to honor the women who died and the loved ones who survived them, while also telling sometimes difficult truths. Reporters always do their best to get every fact right, but this reporting feels different - we are also being called to bear witness to an injustice that the larger system either doesn't see or doesn't want to acknowledge. Reporters also understand, based on many years of reporting, that telling a mother's story will not erase her loved ones' pain or right the wrongs that have been done to her and her family. If anything, our reporting may expose things that a woman's survivors didn't know about, which can open new wounds.

We've also taken the approach that when we write about women, we try not to treat them as just an anecdote. We get to know them as well as we can, then we tell as much of their stories as we are able. It's hard and sad. But it gives women a face and a voice. It moves people who read or listen to their stories, and it honors them.

SM: What has been the reception for your articles and the topics you are covering. Have professional organizations reached out to you with feedback? Have you heard from consumers? Do other people invite you to share their story? Who is excited about your work? Who wishes you would move on?

NM: The response has been far greater than anything we could have imagined. We had our first inkling about the impact in February 2017. That month, we formally launched our project with a call-out for women's stories that we published on ProPublica and NPR. We published the call-out on a Friday and by the weekend, we received more than 2,000 stories, the vast majority from women who had nearly died. Neither ProPublica nor NPR had ever seen anything like it. A year later, we have collected more than 5,000 stories.

We published our first big piece, 'The Last Person You'd Expect to Die in Childbirth,' just before Mother's Day. I hoped that people would be moved by the story of Lauren Bloomstein, a NICU nurse who died from HELLP syndrome at the hospital where she worked. But I was also expecting a lot of pushback from medical professionals who would argue that Lauren was an anomaly. Yet the opposite was true. We heard from hundreds of women who had nearly died, from family members whose loved ones had died, and from doctors, nurses, and midwives who acknowledged that the factors that led to Lauren's death were not rare at all. The medical professionals recognized the systemic problems because they experienced them every day.

We did hear criticism from people who wondered why our first piece had focused on a middle-class white woman when black mothers are three to four times more likely to die from pregnancy or childbirth complications. The answer was: because the racial disparities story was much harder to report. Over the next few months, we published a series of pieces that fleshed out the larger story we wanted to tell. One looked at the 120+ 'Lost Mothers' who had died in 2016 - young and old, black and white, rich and poor. Another focused on the case of Shalon Irving, a black researcher at the Centers for Disease Control who died three weeks postpartum, in January 2017. We looked at why hospitals fail black women and why severe maternal complications have been rising at an even faster rate than maternal deaths. By the end of the year, we were able to paint a much fuller picture of the complicated risks facing mothers in the U.S. - and the big picture has really caused a lot of people (researchers, lawmakers, medical professionals) to say: 'This is unacceptable. This must change - and WE must change it.'

SM: Do you think we are standing at a precipice? Is there enough momentum to really effect change that results in improved outcomes or are we just spinning our wheels? Can this ship be turned around here in the USA?

NM: Yes and no. On the one hand, medical professionals and maternal health advocates seem to be activated in a way that they haven't been before. We're seeing lawmakers and policymakers push for the creation of maternal mortality review committees in states like Pennsylvania, Indiana, and Kansas that have been content to ignore maternal deaths until now. Groups like Black Mamas Matter Alliance and Moms Rising have come together to press for meaningful changes to address racial disparities, and researchers have felt a call to action. All of that is extremely positive.

But the reality is that we live in a country with perhaps the most fragmented medical system in the industrialized world. Millions of women don't have access to insurance except for the few months when they're pregnant and the 60 days afterward. Millions of women live in rural areas that don't have any ob/gyns, midwives or hospitals providing obstetric services. Millions of new mothers don't have maternity leave, child care, transportation or other kinds of support that are vital to staying healthy in the postpartum period. Without systemic change, the U.S. will continue to lag other developed countries in maternal and infant health outcomes. But in order for those things to change, medical professionals - doctors, nurses, midwives, childbirth educators - have to step up and make it happen.

SM: Childbirth educators are working with groups of expectant families (most often first-timers) every single day. How can educators use your material in their classrooms? What should/could they be sharing from your work so that parents are better able to navigate the journey?

NM: When I was pregnant, the last thing I wanted to read about was a woman who had died giving birth! So if I were a childbirth educator, I'm not sure I would share the stories of Lauren Bloomstein or Shalon Irving with my clients or patients. Instead, I might focus on the much more likely scenario - that 1 to 2 percent of American mothers suffer serious, often life-threatening complications of pregnancy and childbirth. My message would be: the best way to protect yourself and your loved ones is to be educated. For ideas about how to advocate for yourself, here's a very useful piece we wrote that draws on the experiences of mothers who nearly died.

Black women must be given more information about the specific risks they face. Racial discrimination and chronic stress take a huge physical toll that can make pregnancy and childbirth more dangerous, even for black women in their 20s and 30s.

They have a much higher prevalence of dangerous conditions such as chronic hypertension, preeclampsia, and peripartum cardiomyopathy. They are more likely to have c-sections and more likely to suffer serious complications even when they have vaginal births. They are more likely to have uterine fibroids, which can have enormous consequences for pregnancy and childbirth. And they are much less likely to be listened to and to have their complaints taken seriously. Look at what happened to Serena Williams. And childbirth educators need to work especially hard to inform and empower black moms.

SM: What are the barriers to change and how can outcomes be improved, especially for black families and people of color?

This is such a complicated issue. When something unfortunate happens to a new mom or her baby, a lot of medical professionals have a tendency to blame the women themselves - they're often overweight, they have chronic conditions that make pregnancy and birth more complicated and risky, they may not make it to all their prenatal and postpartum appointments. But the reality is that the maternal health system is riddled with systemic problems that endanger ALL women and are potentially most dangerous for low-income women of color. More than 60 percent of maternal deaths and upwards of 40 percent of cases of severe maternal morbidity are preventable. The problem isn't women; the problem is a system that doesn't know how to care for women and that often prioritizes the health and safety of fetuses and babies over that of their mothers.

The first thing medical professionals need to do is to acknowledge that bad things - maternal deaths and near-deaths, as well as less serious complications - happen much more frequently than they may realize or want to admit. Second, they need to understand how implicit racial and class bias is built into the maternal care system - it affects the way doctors and nurses treat their patients and how patients react to their caregivers. Implicit bias can create a really toxic feedback loop that can have long-term consequences for mothers.

Medical providers who treat black patients should also educate themselves about the specific health issues and risks facing black mothers. Black women need attentive care throughout pregnancy and - critically - in the postpartum period. But they often receive less attentive care than white women.

The most urgent problem that needs fixing is the way we deliver postpartum care. Many new mothers in this country don't see a doctor for their own care until six weeks after they give birth - and if they don't have maternity leave or childcare or transportation, they are likely to skip their postpartum visit altogether. That's dangerous.

SM: Can you share programs or actions that are 'doing it right' and their results demonstrate that?

NM: By focusing on systemic improvements, the California Maternal Quality Care Collaborative has managed to bring down maternal deaths and the rate of severe postpartum hemorrhages at hospitals throughout the state. Hospitals that have adopted safety bundles developed by the ACOG-led Alliance for Innovation on Maternal Health have also seen significant drops in severe morbidity from preeclampsia and hemorrhage. AWHONN has led programs to reduce postpartum hemorrhages and improve education for moms about post-birth complications. All of these initiatives are saving lives.

Meanwhile, many medical professionals are working on initiatives to understand post-birth risks and improve postpartum care. Those efforts are harder to put in place - but vital to protecting moms and babies.

SM: What direction are you hoping to take your series? What can we expect in the future from you?

NM: I'm fascinated - and horrified - by the deficiencies in postpartum care, and I hope to explore these in greater depth. We also need to start holding local systems - hospitals, lawmakers - to greater account.

SM: Your 'Lost Mothers' series has made a big splash and gotten lots of coverage. Are you surprised at the reactions?

NM: Surprised - and gratified. One of the most important things I never saw coming was the way that our project has empowered mothers to speak out. It's been a sort of maternal #MeToo moment.

Published: March 08, 2018

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