177 Nicole’s VBAC + Racial Bias in Birth

The VBAC Link

We can’t wait for you to hear Nicole’s incredible VBAC story! She is a successful, driven mama of two and owner of The Polished Playhouse. You will feel her resiliency over and over during this episode. Nicole shares with us her firsthand experiences with racial bias during her first birth and along her journey to VBAC. You will also be inspired by how Nicole overcame challenge after challenge giving birth at the height of the COVID-19 pandemic.

We talk about the reality of racial bias in the birth world, why you shouldn’t trust the VBAC calculator and a way that anyone can advocate for change. Have the courage to set yourself up to feel safe with your birth team and get that supportive birth experience you deserve!

Additional links

Nicole’s Instagram: @polishedplayhouse

Black Maternal Health Momnibus Act of 2020

The VBAC Link on Apple Podcasts

How to VBAC: The Ultimate Prep Course for Parents

Full transcript

Note: All transcripts are edited to correct grammar, false starts, and filler words.

Julie: All right. Good morning Women of Strength. We are so excited to be here with you today as we always are. I think every guest that we have brings this different kind of excitement with them. Today we have Nicole with us who is amazing in 360°, just all-around. We were just chitchatting with her before we started the episode today and she is an incredible, incredible, incredible woman. I cannot wait to share all of those interesting details and information about her with you. But before we do that, Meagan is going to read a Review of the Week for us.

Review of the Week

Meagan: Okay, so this is from holmclaugh90. It says “I listen every day. After a traumatic Cesarean with my first baby five years ago and multiple miscarriages in between, this is a breath of fresh air as I await my chance to have a VBAC this October with my second! Love every story I hear on this podcast and it makes me feel so much stronger in knowing I can do this!”

That was put in last July, so that means last October she would have had her baby. So holmclaugh90, if you are still listening, shoot us a message. We would love to know how things ended up.

Julie: Absolutely. Oh my gosh, thank you so much for the review. You know we always love them. They are near and dear to our hearts.

Nicole’s story

Julie: We are so excited today to have Nicole with us. Nicole is really exciting. I just pulled up her bio. We have a form that we have our guests fill out before they come on our show so that we know a little bit about them. The more I read about Nicole, the more I am just like, “Oh my gosh. I need to know more about this. I need to know more about this. I need to know more about this.”

The first one that caught my attention was she is a social media content creator. She has a really awesome Instagram page called Polished Playhouse. It’s all one word, @polishedplayhouse. You can see the link to that in our bio. We are going to drop it there for you, so you can give her a follow. But she-- oh my gosh. There are so many amazing things.

She creates curated boxes for children ages three to five years old with books and all sorts of educational things in them for your toddlers. I am sitting here, I am like, “Okay. I need to order these boxes. I need to sign up for the subscription box when it comes out,” because there are some really amazing things. I think that what really stuck out to me the most is she is including things with diverse backgrounds and diverse cultures. So her books have black children in them as main characters.

She is a black woman living in Maryland. I’m excited to talk to her because I want to talk about black birth in America and how bias influences how people of color are treated in the birth space. We can talk about numbers all day how black women are two to three times more likely to have a Cesarean and three to four times more likely to die in childbirth just due to race. Guys, this is straight across the board. It is not influenced by socioeconomic status, education levels, income, any part of the country, there is this bias against people that exist in the birth room and I’m really excited that we are going to talk about that today.

One of the things that Nicole said is that having a black provider to support her in a VBAC was very important for her because of that bias that exists. And so I’m excited that we are going to be able to hear about it from somebody who has lived through it, who is living through it, and who has come out on the other side having a hopefully-- I am making some assumptions now. Hopefully, having a very supportive experience for her VBAC. And so I am just going to sit here and geek out over her on her Instagram page while she is sharing her story.

But she is incredible and I just can’t wait to hear from her. And so instead of keep talking about it, I am just going to go ahead and turn the time over to her so that you can hear amazing Nicole’s VBAC story.

Nicole: All right. Thank you so much for this generous and kind introduction. I was a member of y’all’s Facebook group and then also listened to the podcast all the time, so it is a huge honor to be on your show today.

Julie: Aw, thanks.

Nicole: As you mentioned, I am Nicole. I have two sons now. I have one who is four years old and then I have the second one who is seven months. I had my first son in 2016 and then had the second one in 2020. For my first son, I started care with a gynecologist that I had seen since college in the DC area. We had a pretty good relationship, so when I got pregnant, I just decided I would continue on with her.

I had a pretty healthy pregnancy. There weren’t any issues that came up. I was doing prenatal swim classes. I did a lot of walking. I was able to manage my diet pretty well. I didn’t have any challenges. The doctor that I was going to was very cautious, so at the time, I had a number of different tests that she was running on me. She never told me why. Just a lot of different things that I wish I would have asked about that I didn’t being a first-time mom. I didn’t know what to ask. But one of the things that I did ask her-- because she was a very popular doctor in this area. So sometimes, my husband and I would go to appointments and it would be standing room only. There was usually space for all the pregnant people to sit, but if you had a partner with you, they would likely have to stand.

One of the things that I asked her is, “If you’re not able to deliver my baby, then what happens?” And she just brushed it off and she was like, “Oh, well that never happens.” Looking back, there was no way physically that she could have delivered all of the babies. So that just what is something that was lingering for me. If she wasn’t able to be there, what would support look like?

So the night that I went into labor, I went walking. I was bouncing on a ball and I started having contractions. I went and sat in the bathtub. I didn’t wake my husband up. Usually, if I was having Braxton Hicks contractions, I would go sit in the bathtub and they would go away. These did not go away so I started to feel like, “Well, maybe this is it.”

I woke him up and he freaked out. He was like, “Oh my gosh. The contractions are too close. We have to go.” We lived about 40 minutes away from the hospital and I chose the hospital simply because it was where my doctor delivered. I didn’t know to do any research into the Cesarean rate or anything like that.

So the hospital was about 40 minutes away. We got into the car. My mom was staying with us at that time as well. At this time, it is clear I am in full-on labor. We roll the windows down. My husband is barreling down the highway trying to get me to the hospital. We get there. As soon as I get into triage, I come off the elevator. I get there. My water breaks. I get back and one of the nurses asks one of the other nurses to check me. They check and she quickly starts calling for them to send me back.

Then, one of the other nurses said, “Well, how far along is she?” I saw her mouth to the other one to say, “Seven.” Once I got to the hospital, my water broke immediately. I was at 7 centimeters. They took me back. My husband had left our car in the middle of the hospital driveway, so he had to go back and move the car. When he went to move the car, I saw my doctor for the first and only time throughout my entire stay at the hospital. She came in and she said, “You know, I know you’re at 7 centimeters, but that was the easy part. I really suggest you get an epidural so that you can calm down so that you won’t be in pain.”

Leading up to that point, I had really wanted a natural birth, but I was obviously in a lot of pain. But she also really pushed the epidural in a way, looking back, in a way where I wish I would have pushed back. My husband was down moving the car so I’m in there by myself and I’m just like, “Okay. I want this epidural.” So I get the epidural. It took over an hour for them to get it. They poked me several times. They just couldn’t get it right. So once they finally got it in, I took a really brief nap, and then they woke me up and told me it was time to push.

So I pushed, and pushed, and pushed. The nurses were somewhat supportive. Now that I have had a new experience, I really know what a really supportive team looks like, but I ended up trying to push my son out for about two hours. He never went into distress. I was exhausted, but he was fine the entire time. So as I am pushing, I am starting to feel really discouraged. I don’t feel like I’m making any progress.

My sister was there and they kept telling me, “Well, we can see his hair, so I think he is close. We can see his hair. We can see his hair.” A doctor comes in that I had never, never, ever met before. I had never seen him before and he walks into the room. He put his hand down. He looks at me and he says, “You are not going to get this baby out. We need to have a C-section.”

He didn’t say anything else. He didn’t introduce himself. My husband said, “Well, I need to talk to you outside.”

Julie: Oh my gosh.

Nicole: Yes. The only reason I can remember what he even looks like is because my sister has a picture of him.

Julie: Wow.

Nicole: He didn’t tell us his name. Nothing. He was like, “There is no way you will push this baby out. You need to have a C-section.” So at this point, I am just hysterically crying. My husband goes out and talks to him. He told my husband that my son was just too big. There was no way he was going to get out, if it was a risk of him being paralyzed, just all of these things.

So I cried, and cried, and cried, and then agreed to the C-section. I went back. First, I had to go back alone and I just remember shaking so bad. I couldn’t tell if I was shaking because of the medicine, or if it was because I was afraid, or what. Finally, my husband came back. They let my husband come in and then I had a C-section. He was 9 pounds, so he was a big boy. He was a big boy, but we didn’t get any information aside from the fact that “He is too big. You won’t be able to push him out. You have to have a C-section.”

So afterward-- when I tell the story, I talk a lot about the parts where I was separated from my husband because I think that’s where I felt the least supported because I didn’t have him there.

Julie: Yeah. He was your voice.

Nicole: Yes. They separated me from my husband. I went into a separate room and they were checking me, doing all of these things afterward, and they let my husband go with the doctor and the baby, and then a nurse came in. I heard her talking to the doctor that delivered my son and she said, “But she is allergic to this,” and I heard him say, “It’s fine.” The nurse said it again, “No, but she is allergic to this,” and he said, again, in this very direct tone to her, “She’s fine.” What happened was, they gave me something that I was allergic to. After I had my son, I broke out in hives all over my body.

Julie: Oh my gosh.

Nicole: I was literally digging into my skin. People say, “Oh, well after you have the epidural, you itch.” I’m just like, “No. I’ve never had a baby, but I can’t imagine you are supposed to itch like this.” So they just kept giving me allergy medicine after the fact, and then they put an allergy bracelet on me. This was after I had already had a C-section, after I heard the nurse tell the doctor twice that I was allergic, they put an allergy bracelet on me. And then after that, I see pictures of myself and I am so tired. It’s because I am literally just pumped full of allergy medicine because I had this horrible reaction.

So after that, we had a decent stay in the hospital, didn’t really have any complications from the C-section, but one thing that always stood out to me even now is until I went to my follow-up appointment, I never saw my doctor again. I never heard from her again. Her shift ended while I was having my son and I literally never saw or heard from her again until I went to the appointment. Ahead of the appointment, she sent a review from her office, so she wanted me to review her. And so I think it was out of four stars. I was very generous and gave her three just because I felt like she abandoned me.

Julie: Yeah.

Nicole: The entire appointment, my first six-week check-up after my C-section, all we talked about was why I gave her three stars instead of four.

Julie: No. No, really?

Nicole: She never asked. Yes. Yes. She never asked how I was doing. She never asked anything about the baby. She was just so hurt and upset that I gave her three stars instead of four.

Julie: Wow.

Nicole: So needless to say, I didn’t go back.

Julie: You should have gone back and changed the review to one star. That’s what I would have done.

Nicole: I know. Yes.

Julie: Oh my gosh.

Nicole: So I was good because I had a really positive healing experience. I didn’t have any complications. I really was just like, “Oh, well I am one of the lucky ones. This is okay,” but not until much later did I start to think about the emotional impact of having the birth that I wanted to be changed in really such an insensitive way.

So when we started thinking about having a second baby, I knew that obviously, I was not going back to her. I had started researching about VBAC, started listening to y’all’s podcast, joined the Facebook group, and really started looking for a provider. I learned a lot about black maternal health which I didn’t know before. I learned a lot about biases and a lot of it of just not being listened to, not being heard from black women mirrored my experience.

Julie: Yeah, absolutely.

Nicole: I really wanted to have a black provider. I found out that I was pregnant in late October 2019. We lived in DC when I had my first son. We had moved to Maryland right outside of DC and I found a practice, all midwives. There were only four. It was a small practice. Two of them were black and then two were white, but they were really, really experienced and from everything I read, it was a really pro-VBAC practice.

I went there for care. I had a completely different experience just from the very beginning. With my first doctor, I always felt like I was very sick. With them, I never feel like I was sick. They were just so positive. They kept reassuring me, “You can do this. We think you can do it. We know you can do it.” Never did any type of VBAC calculator, anything like that. They were just really positive.

So I was going there. I went there all the way through March, so up until I was about 20 weeks, I went there. I had such a positive experience, always left really happy. March 11th of last year, I went for my 20-week scan. This was right when COVID was just starting. It was just starting to be talks of, “This is a thing. This might change everything for us.” So I went at the 20-week. It was one of the appointments where they were just starting to limit people who could go into offices. So I went to the 20-week scan, everything was great. The next day is when we got an email from work, from my job, that we were going 100% remote. That’s when my son‘s daycare closed. It all happened in that same week.

And then I was home on my very first day of remote work and I got an email from the midwives that said, “We are so sorry, but after 20 years, we just cannot continue the practice. It’s just not financially viable for us, so we will be closing.”

Julie: Oh my gosh. This is so much all at once. Oh my gosh.

Nicole: Yes. It was the day that the world shut down and I’m sitting here like, “Well, this is the new normal. I work from home. My son is here,” and they sent an email and they said, “This is it.” They would be doing births through May and my due date was July. I could stay on with them until May or I could switch then. I was just completely devastated because I had grown so fond of all of the midwives. I had met with all of them.

I knew there was another practice in the same area, so I just thought, “People have positive births with midwives, so I’ll just switch to that one.” I continued to get care from them up until around the time that they closed, but I had been researching where I would go. So they closed. I went to my last appointment with them and at that time, I started really looking into also getting a doula. The hospital where I would be delivering had, in maybe April or May when COVID was really bad, they said, “No additional support people,” so, at that time, I couldn’t have a doula. I would only be able to have virtual support. I was bummed about that.

So I’m looking into the possibility of not being able to have a doula or having a virtual doula and then also finding someone completely new to deliver my baby. I went to one appointment at the new practice. This was, again, the only appointment that I had during my entire pregnancy where my husband was not allowed to come with me. I went to this practice. I went in and immediately it was, I don’t know. The energy of the place just did not feel right to me. I went in. I was sitting. I was waiting and then the midwife came in and she said, “I need to do this calculator on you.” And I had heard about the calculator. I heard a lot about the limitations, a lot of the biases that are built into the calculator.

Julie: Yes.

Nicole: Again, this is someone who did not introduce herself to me. She didn’t ask me anything about my--

Julie: All she wanted was a number.

Nicole: She wanted the calculator. She did the calculator and the calculator said that I had a 30% chance of a successful vaginal birth. She was like, “You know, I mean, I can let you try, but just look at this. Your chances are not good. I’m telling you now.” She said it in a very matter-of-fact way. “Well, I mean, what have you been doing with yourself?” And at this-- I was so sick during my first trimester.

Julie: Wait a minute. She said, “What have you been doing with yourself?”

Nicole: Yes. She said that because--

Julie: Oh my gosh.

Nicole: Because I had a big baby before that there was a chance that I would have another big baby and she linked big baby essentially to me eating too much. So, I know.

Julie: Oh my gosh.

Nicole: Yes. At this point I was--

Julie: And this is a midwife.

Nicole: Yep. This was May, so--

Julie: Was it a white midwife?

Nicole: Yes. This was May.

Julie: I think this is where bias is coming into play as well for sure.

Nicole: Yeah. Yep. Mhmm.

Julie: Sorry, I’m going to let you keep telling your story. Sorry.

Nicole: That’s all right. She made a lot of assumptions. At that point, I had literally gained nine pounds because I was so sick during my first trimester. I didn’t gain a lot of weight at all. And even with my son who was 9 pounds, I gained 27 pounds for my entire pregnancy. And then for my entire pregnancy with my son, I gained 27 pounds and he ended up still being a 9-pound baby.

Julie: That’s still a perfectly average weight gain.

Nicole: And so she asked me, “Well, what have you been doing with yourself?” I am like, “I have been walking. I’ve been eating hardly. I haven’t gained a lot of weight.” She said, “Well, I am telling you now. You will have to get a weight scan close to your due date and at that point, we will decide whether or not we can try for the VBAC.” She said, “But based on this calculator, I don’t think you have a good chance.”

I said, “Well, I have heard that the calculator is inaccurate.” She said, “Well, we have been having some conversations at the hospital about it, but we still think it is the best tool.” I said, “Okay.” I left there. I literally held myself together just to get to the car and I was so frustrated. I called my husband. I am like, “This is not it. I am not doing this with them, so we have to find someone else.” This was right in the middle of the worst of COVID, so a lot of places were not seeing people in person. They were doing a lot of telehealth visits, especially for someone as far along as me.

So I don’t know what to do. With the first practice where I was, I had to go to an OB/GYN to get essentially cleared for the VBAC, and the one that I went to, I really liked her. I decided that I would transfer to them. I am like, “Okay. I will just move on from midwives and I will transfer to this OB/GYN.” She was also a black woman. I started the process of transferring to that practice. I looked online at the reviews and the reviews were either a one-star or a five-star. So then I looked further and the practice actually was about 30 doctors and you didn’t get to decide. It was whoever was on call, so that reminded me a lot of my first birth where it was just this doctor that I had never met that I didn’t have a relationship with, so I quickly got over going there. I got over that and I had no idea like, “What am I going to do?”

So my husband has a really good friend that was a doula. She is taking a break right now. He called her and she told us about the hospital where I ended up delivering in DC. She said, “If you want to have a VBAC in this area, that’s where you have your very best chance.” So the midwife practice in DC, they are very, very popular. They have all of these rules you have to follow. There’s a specific diet and they have different groups that meet, so I just was convinced it was too late.

I was about 32 weeks at this point. That was so late. It’s the middle of COVID. There’s no way they will let me join. They wouldn’t let me make an appointment with midwives, but they did let me make an appointment with the OBs. So I went and I saw the first OB. I was very nervous. I am 32 weeks at this point. This is my last shot. So she came in and she was asking me about the birth and she is like, “Yeah, I see that the first baby was really big.” And I just was like, “Oh my gosh. Here we go again.” She is like, “Well, that really shouldn’t hinder you.” So I just was like, “Oh my goodness. I think I found my people.”

Julie: What a relief to hear.

Nicole: Yes, I think I found my people.

Julie: Yes.

Nicole: So she was really great and that was a white provider. She was really great. She was like, “Well, I don’t think that will be a hindrance. We deliver 12, 10, 11-pound babies here all the time.” She obviously gave me the risks for the uterine scar tearing, all of those things, but just in a very informative way, but still very supportive and saying, “We think you can do this.” So because they made my initial appointment with the OB’s, I just was convinced, “Okay. This is it. I have to go to the OB‘s.”

I went to another appointment. I met another one of the OB’s. She was also great and then about 35, I think it was 35 weeks, that hospital, in particular, said, “We will allow doula support again.” I was seeing a prenatal massage therapist and she had been watching the hospitals, like, updates for me really closely. She texted me in the middle of the night, “You can have doulas again at the hospital, so make sure you find one.”

At this point, I needed a doula within a week’s notice. So I went on Instagram, was reading, scrolling, looking for a doula. I found one doula, a woman of color that I reached out to. I sent her an email and I am like, “I know it’s completely late. I am delivering here. I’m having a VBAC. Please, will you take me?” She said, “Well, you know, I really don’t come to that part of Maryland. I really don’t come to your area, but can I think about it? And then I’ll let you know.”

We had a quick chat and later, she told me she just was making sure, feeling me out. We had a quick chat and then we signed the contract. She was my doula at about 36 weeks. I met her in person only one time and she suggested to me, she said, “I know you have had these two appointments with the OB’s and feel comfortable, but I really think you should switch to the midwives.” I am like, “I am 36 weeks. There’s no way they will let me do this.”

So when I went to an appointment at about 36 weeks or 37 weeks, I asked one of the OB’s, I said, “Do you think they would let me switch to the midwives?” She said, “I don’t know. We really don’t do transfers this late, but I will ask.” So she sent an email to the midwives and she said, “We have a mom here who really wants to be seen by a midwife. She is a VBAC. She seems like a good candidate. Please, will you do this for her? She really wants it.”

For some reason, they said, “Yes.” I went to an appointment at 38 weeks. I went to my last appointment with them and my very first appointment with the midwife. I was 38 weeks. I think it was a Tuesday and I met a black midwife that I had heard about. Everybody talked about how amazing she was and she was just this fierce advocate for black birthing people and she is just amazing. And so my first and only appointment with the midwives was with her and it was just so great. I am like, “Yeah, they did the calculator on me.” She’s like, “Oh no. We don’t use that calculator.” She talked so badly about it.

Julie: Yeah. That’s what I like to hear.

Nicole: Yes. She was like, “We don’t do that. Blah blah blah.” So I told my husband, I’m like, “Oh, I really hope we just get the luck of the draw.” It was, I think, six or eight midwives and I’m like, “This is it. This is it. I really, really want her. I think I will have a great experience with her.” So I went home. I was praying, “I want this midwife to deliver my baby.”

I started having contractions the very next day after I met her and I am like, “I don’t think this is it.” So I actually went and I did some shopping. I went to FedEx and mailed some packages and my contractions started really picking up. I texted my doula and she was like, “Well if they get a little closer, let me know. But I think this might be it, so you should go home. Take a nap. Lay down.”

I laid down for a little bit and the contractions just kept picking up, kept picking up and I knew like, “This is it.” So my husband called the doula. She said, “I won’t make it to your house. Just hurry and go to the hospital.” On the way to the hospital, I had to roll the windows down and get air. We were playing meditation on the Bluetooth in the car. We get to the hospital. I say all the time that literally every good person that was available in DC was there at that moment in time from the guy who just literally let us leave our car in the middle of the street and asked if I need a wheelchair if I needed anything.

My doula was literally standing right there as soon as we got there. We went up and at this point, I am in full-on labor. I am trying to practice my breathing, doing everything. I get checked in. As I am getting checked in, they say, “Can you call the midwife who is on call?” And then one of the nurses said to the other one, “Which one is it?” and she said the name of the midwife that I had met literally just hours before, this black midwife that I told my husband, I am like, “That’s her. She is going to deliver the baby.” And she was on call. At this point, I am bawling because I just cannot believe that all of this has worked out in this way.

So she comes back. She checks me and I was 9 centimeters. They had to give me a COVID test. They gave me the COVID test. I didn’t even get the results.

Julie: Yeah, I was going to say.

Nicole: They took me right back. My husband went down to move the car and I’m like, “Oh no. This is déjà vu. This is what happened last time.” But I had a doula with me and she was there and she was advocating for me. I honestly didn’t even need any advocacy anyway because they were just so great. So I’m like, “I don’t know what’s happening. I think I have to push.” I remember the nurse said, “Well, push,” just so casually.

So I was sitting there and I’m like, “Okay. Maybe I will try to push or just try to breathe into it.” My doula talked me through some breathing. I was on my back. They called the midwife. They said, “You have to come in here. We think this baby is coming.” My husband got back right just in time. I am literally still fully clothed.

At one point, I was on all fours and I heard the midwife say, “Okay, his heart rate is dropping.” And I said, “Oh no.” They all slapped me back into reality and they were like, “No. You turn over and you push this baby out.” So I turned over. I did three massive pushes and he came flying out with his perfectly round head, which was the first thing I noticed about him, and a head full of hair.

I just could not believe it. My doula was able to get a really great video of it and I said, “Did I do it?” And they all said, “Yes, yes, yes. You did it! You did it!” It was just such an amazing experience the way everything worked out, just the support from all of the nurses. It was such a healing, liberating, amazing, amazing experience. At no point did I ever feel like I would need a second Cesarean. They didn’t even mention it. Everyone was just committed to helping me have the VBAC that I really wanted.

I was able to do skin-to-skin with him right away, which I wasn’t able to do the first time. I had such a different healing experience. It was just a really, really great experience for us.

Julie: That’s amazing. If everybody would feel so supported in their labor-- you went through a lot of negativity until you found your people. Like you said, “These are my people.” And to feel so supported during your labor and to know the midwife that was going to be delivering your baby, that had to be such a weight off of your shoulders. That alone probably shifted your entire feeling going into the hospital.

Nicole: Yeah. It was such a great experience and the midwife, after I had been with her, she had to leave really quickly because somebody else was having a baby, but when she came back in, I just kept thanking her over and over. She was telling me, “No. You did it. You did it.” And I just kept thanking her over and over because I just felt so grateful that she was there and that she listened to me. I am just forever grateful to her.

The VBAC calculator

Julie: That’s amazing. There are so many things I want to talk about. Holy cow. We just don’t have time to talk about it. First of all, the VBAC calculator is awful.

Nicole: Yes.

Julie: Let’s just talk for two minutes about the VBAC calculator and then I want to get into some current legislation to improve maternal health outcomes for everybody, but specifically with a specific focus on reducing the mortality rates for black people and minority populations.

The VBAC calculator, we actually created a bit.ly for it. So if you go to bit.ly/vbaccalc, it will bring up the VBAC calculator. Put in all of your information and calculate it and you will get a percentage, right? First of all, if you’re preparing for a VBAC, this calculator is not evidence-based. ACOG discourages even using it and if you have a predicted success chance of less than 50%, it doesn’t really mean anything.

My first client ever as a doula, my very first client was a VBAC. She was an islander and her VBAC success calculator told her she had a 4% chance. Like, a four. F-O-U-R. She pushed her baby out in 20 minutes, guys. She totally nailed it, right? And so don’t let that number discourage you, but what I want you to do is go in there, put your in your information, and calculate your number.

And then, change your ethnicity. Change it from white to black and calculate it. Just change only that one thing and when you input black as your race, it drops your chances by 20%, roughly.

Nicole: Yep. Exactly.

Julie: It’s always right around 20% just because you are black.

Nicole: I did that. Yep. I did that and I had about a 30% chance when I was black. I didn’t change anything else, my weight, my height, anything, and when I took out black, it went up to a low 50%. Yep. It went up a little bit over 20%. Exactly.

Julie: And my VBAC, just for comparison, so my VBAC calculator was 62% was for my first VBAC and then when I changed it to black, it dropped it down to 48%. Now that I have a way higher BMI when I calculate it now and keep in mind I’ve had three VBACs, it takes me being white to 42.7% and when I’m black, it drops me down to the mid-20’s.

The VBAC calculator is based on a sample size of 7,000 people. They just tried to use all of this data to collect to tell what kind of chances people could have because in healthcare, they love data. They love to see the numbers. They like to know what’s going on. They like to predict things. But what they didn’t consider in that calculator is the bias that comes in the birth room for black women specifically because our black parents are dying at 3 to 4 times higher rates than white women of the same socioeconomic status, education level, income level, and same parts of the country, and Hispanic people are dying at twice the rate.

And so we have this big healthcare disparity, but oh my gosh. It is so hard. I am so grateful for the last year. COVID has totally sucked, but I think there have been a lot of good things that have come about, lots of stirrings, and lots of noise, and riots, and challenges, and things come up where black voices are being amplified and we are hearing them more in our healthcare system. We are hearing them more. I think that’s a really good thing, but if you are just some white doula from Utah like I am, what are we supposed to do? How can we influence the healthcare disparity in our local communities? I have an answer, something you can do if you want. I don’t know, Nicole, have you heard of the Momnibus legislation?

Black Maternal Health Momnibus Act of 2020

Nicole: No. I need to look into that.

Julie: Yeah. So Representative Underwood is a black female representative in Congress and she introduced the Momnibus Act. It’s spelled just like it sounds. It’s M-O-M-N-I-B-U-S. It’s designed to address the overall-- we are one of the greatest nations in the world, but we have one of the highest maternal mortality rates and that’s really sad. But what is even sadder is the disparity of those mortality rates between white people and people of color, and black people are in a separate class. They are even more likely to have Cesareans and more likely to die during childbirth.

And so this act addresses the overall maternal healthcare system in improving and decreasing that overall maternal mortality rate but also decreasing the bias that exists in our healthcare system. I’m just going to go over-- you can just Google “Momnibus Act”. They introduced it in 2020. They’re making some changes to it and they are introducing it again in 2021.

I mean, a lot of some good changes have started to be implemented in 2020 just coming from this, but the bill has 12 key points in it. I am going to try and just go through these super quick.

The first one is, “Make critical investments and social determinants of health that influence maternal health outcomes.” So housing, access to healthcare, transportation, and nutrition. “Provide funding to community-based organizations.” So community healthcare in underserved populations, community-based maternal health care, rather.

They are studying the risks facing pregnant/postpartum veterans, which, I am a veteran. I served in the military for five years, and so I think that’s actually a really cool thing that they put in this bill in addition to everything else. But they want to put effort and money into diversifying the perinatal workforce because Nicole, you said it was really important to you to have a black provider to reduce the risk of bias against you. So this bill has a goal to increase the number of black providers and providers of other color that we have access to in our healthcare system because that’s another part of the problem.

Nicole: Yeah. Mhmm.

Julie: “Data collection processes” so we can better understand the maternal healthcare crisis. “Support moms with maternal mental health” because that’s a big thing as well. “Improve mental healthcare and support for incarcerated moms.” “Invest in digital tools to help monitor maternal health overall.” It has lots of other things. I’m not going to keep going on, but one of the things I really like is that it talks here about educating providers about these biases that exist in their space because I know that a lot of the time, we are not aware of our own inherent biases that exist around us.

Nicole: Yep.

Julie: And I think as white people, it’s easy to kind of brush off, “Oh, well I am not racist. I don’t treat black people any differently than I treat white people,” but then doing that dismisses the idea. Even if that’s true, it closes you off to see what other things you might be doing or what other things exist in our healthcare system that are biases against people of color. And so I think that’s a big thing for me right now is just being more aware. I have had, I know me and Meagan have both had clients-- other nations, Asian clients.

My biggest one I had was a Hispanic client and man, there was such a bias against her. I can’t even tell you the amount of crap we had to deal with in the birth room and this is just here in Utah. And so we have seen and experienced it ourselves, but I think when you say, “This is not a problem because I am not a problem,” really closes you off to help fix the problem.

So what I want you to do right now if you’re listening and you want to help change this big gap in maternal health care for black women and other women of color is I want you to go look up your local state representatives and senate members and send them an email, or just Google “Momnibus Utah” or “Momnibus” in your state because each state has their own ways of introducing the stuff. I know Utah, maybe not all the states do, but most of the states have their own versions of the Momnibus Act they’re integrating at the state level as well.

Google your state representatives. Google your state Momnibus Act and send a letter to your representative, to your local legislator, and tell them that you support this, that this is important to you, and you want them to vote to move this forward and start implementing this across the country because that is the biggest way to get things to change from the top is letting your state representatives know that this is a big issue for you. When they hear the voice of the people that vote for them, that’s the biggest way to get them to change things.

Even get a community petition started, or something to where you can bring this up to your local leaders in our country, but also focus on your state as well because there is-- gosh, I wish I had the information in front of me. There are ways to reach out and I don’t know. There’s somebody here in Utah that was in charge of introducing a Utah version of the Momnibus Act. Gosh, it is just missing from my brain right now, the information.

But giving feedback to our leaders, giving feedback to our leaders is what’s really, really important and then being aware. Don’t say, “Hey, I am not a problem because I don’t treat black people differently.” You say, “Hey, this is a problem. Let me be more aware of it,” and just observe. Even observing and being more aware of the actual problems and what they look like is going to help you be more cognizant of things you can do to help change them.

And then as birthing people, stand up for yourself. Change providers. Find your voice. I know it’s not as easy as I make it sound. It’s easy for me to say that, right? But getting educated about your options. Knowing like you knew, Nicole, that the VBAC calculator is crap. It is just crap. But you knew that. But somebody that doesn’t know that and doesn’t know that it is biased against black people is going to say, “Oh my gosh. I only have a 30% chance of success. Maybe I just shouldn’t do this at all,” and then they have a repeat Cesarean which increases your chance of maternal death anyways-- a very small amount, but then, I mean, it’s just a huge escalation. So being aware of the racial disparity in our healthcare system, and then observing it, and seeing what it looks like practically in your local area, and then speaking up and emailing your state representatives and your state government leaders about the Momnibus Act are things that you can do right now, today in order to help improve this change, and being aware of it, and stepping up for people.

If you witness people of color, whether you are white, black, Asian, Hispanic, whatever your ethnicity or your background of your color is, speak up if you’re witnessing this. If you’re seeing this happening, speak up and say, “Wait, this is wrong.” I guess it could just be regardless of whether it’s due to race or not, but you should always speak up if you see somebody being mistreated in the birth room. But also, don’t be afraid to file complaints against the hospital or against the provider because that’s another thing that is just going to bring more awareness of what is going on in our local communities.

Sorry. I feel like I’ve been talking for just a really long time. Nicole, what would you add to that?

Nicole: I think everything that you said is important, but I really want black women, women of color to know it’s okay for you to advocate for yourself. It can be very tiring and very exhausting on top of what should be a very happy and positive experience but don’t be afraid to advocate for yourself and don’t be afraid to switch providers. If you go see someone and you get a feeling just in your interaction with them that you will not have a positive experience with them, don’t be afraid to switch.

I switched three times in the middle of a pandemic and it was honestly the best decision that I ever made. I would also suggest if you can, get support from a doula, or a partner, or a trusted family member so you always have someone else there to give voice to what you’re saying, what your needs are, what you are experiencing, but just really advocate for yourself. Don’t be afraid. Don’t think you’re being too much, or you’re asking too many questions, or you are being too aggressive, this is your life. It’s the life of you. It’s the life of your baby. Advocate for yourself and don’t be afraid to do that.

Julie: Absolutely. I think that’s so, so, so important. I love that you switched providers twice. But I’ve had clients, and I know we’ve had several people on our podcast, switch providers until they find the right fit. If somebody is treating you wrong, you have the right to leave providers and go to a different birthing location, even if it’s in the middle of your labor. I know that sounds really hard and scary, but people have done it. It’s been done.

All right, Nicole. Thank you so much for being on our podcast today. I am seriously fangirling over here on your Instagram. I love your subscription boxes. Seriously, we are going to be doing something with that I think. Like, your monthly subscription. I want to get my hands on these diverse books for my kids. I really do. It’s a really important thing for me.

I’m happy that we found you, and that we connected, and that you shared your story, and especially for allowing us to talk more about the healthcare disparity with black people in our country. So thank you. Thank you for spending that time with us today.

Meagan: Yeah. Thank you so much.

Nicole: Thank you. Thank you so much for having me. Thank you.

Closing

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