November 30, 2023 • 41 mins
This week we sit down with March Of Dimes CEO, Dr. Elizabeth Cherot, to discuss the March of Dimes Report Card for New York. This conversation discusses why preterm birth rates are higher in communities of color. In addition to the health and socioeconomic determinants mothers of color are most vulnerable to and what March of Dimes is doing to improve health outcomes in communities of color.
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Episode Transcript
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(00:00):
So it's a real huge accessibility.It's about getting information and education to people
where they are. Yeah, youcan do it on a timely basis when
they want it, and it isabsolutely and it can drive you to your
did you schedule your appointment? Youcan actually then get a text message that
says did you I mean, wecould tie it in there. But again,
(00:21):
just to get accessible information. It'slike when you're in the hospital and
you're about to leave and put upthat education and people click, you know,
the nurses say, oh, watchand some people watch it and others
don't. Yeah, right now you'rehome, it's like, ooh, I'd
like more of that information here itis? Is it subscription based once they
get the box, once you getthe box, Actually we want to hand
out a box for free. That'spart of the whole thing. And then
(00:44):
yeah, and then you think aboutfor the future, what could you build
on it and get here's where thepop up food places, here's where right,
I mean you start thinking about whatyou can really drive through this and
so but we need a pilot programto start it, right. Yeah,
that's a lot, it's a lot. I'd love you to think about partners
for me. Yeah, and we'regoing after you know, United Health,
(01:07):
and I'm going after CVS Right,it's interesting. So I sent CVS health
information about maternal because you know,they do a lot of stuff in the
maternal health space. They actually weresponsors of the DULA expel and they're sponsors
of us A doula work. AndI actually know one of the founder their
(01:27):
chief equity officers. Okay, I'vemet personally and I think she's phenomenal.
Yeah. So, but I andwe already have a huge project of them,
so I don't expect them to divein sure. But but whatever about
a health insurance partner or is that'swhere we're going or is that in it?
Well? I have another question too, Is that a conflict for CVS
health because they are technically at nono, because they their foundation pulls out
(01:51):
separately, got it? So,and most places pull out a foundation for
those particular reasons. So you needa national partner. That's it. Okay,
we're really thinking if we, like, I've got Connecticut super interested,
which is like, okay, greatyour outcomes, No outcomes are great,
but I really need Alabama. Butlet's we know we could make the difference
bigger, right, the opportunities bigger. But honestly, I would love to
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see three states, whether it wasConnecticut in North Carolina and Alabama would be
ideal. And if we have threedifferent sponsors, great, But I'd love
to think about I'd love just youropinion on it. Yea lady of connections.
I appreciate think about it and presentedin a way that goes through all
the details of it. I justthink you're you know, please don't spread
(02:34):
it around. No, of courseI'm not worry but we're friends now,
Yeah, I could think about whatwe could talk about or like, just
think about what it would when youread through it. Then I'll send it
off to you. Yes, andI also want to make sure that I
connect you to Anthem Health, whichis now what do they call it?
Elevants? Yes, yeah, we'reconnected. Oh you are. They were
sponsors of this report card. Ohperfect, and people don't even know it.
(02:57):
I did not know that. Yeah, they were sponsors of the Maternity
Care Desert Report and which was theone that we launched in August. So
they're big partners with us, andI'm hoping they'll be really interested. Part
of it is we have to runout that grant before they'll jump onto the
next one. And I want thisone, okay now, because I have
I have all the other. I'vegot just all the other connected. Right,
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I've got the people, the CEOof Eddie's, i have PBS state,
I've got certain states super interested.Okay, So that's kind of where
we're at. So I'll think ofa list of folks who I would love
that. Yeah, I can helpit, and see if I'm crazy.
No, I think it sounds fascinating. It is really cool on what it
could do, and think about theeducational materity you could send to people.
(03:39):
So I so, how is thisreport different from the report that you and
I discussed back in November? Sogosh last So every year we put out
a Maternity Care Desert Report, whichtalks about where the maternity care desert are
and then this is like your annualreport card. Think about your kid going
(04:01):
to school and get that annual reportend of the year. And that's what
this is. And we focused originallywhen this came out, really narrowed in
on preterm birth, which we stillreport on, but now we dive in
not just state wise, we gointo cities, right, and we have
those top lists, but really getinto kind of why, and it's now
(04:24):
more of a state of report card, or I should say it national report
card on maternal and infant health.Right, you look at it, So
I saw New York at a Cplus. Yes, I was kind of
sad about that. Well, it'sslightly better than the year before, which
overall tells you just in general thatwe are flat right. We haven't seen
(04:46):
an improvement for pre term birth,and overall the country's getting a deep plus.
You know, somebody who prides herselfon her grades, it's really hard
to tell people what their grades arewhen it's this bad. We have cities
failing. So I'm not trying tobe that optimistic go out in New York.
But at least it's not a failure. Yes, we don't have anybody
getting an A this year. Rightin the States, we have fourteen states
(05:06):
that pre term birth got worse,and we have thirty two states that actually
we saw a slight improvement. Right, but the southeast across the country,
when you look at it, you'llsee the swath of red. We do
a really nice job of visualization,and so when you look at the states,
you know see you know, thesoutheast is where it's the worst.
Yeah, I see. Still,like you know, black women are still
(05:29):
leading the charge. Unfortunately in termsof the disparity. I see thirteen point
seven compared to seven point nine,nine point zero. What do those numbers
mean? Yeah, So you know, health disparities exist and continue to exist,
and we're not we're not We're goingin the wrong direction. And when
you start looking at moms and babiesare intertwined. Right, So when we
(05:49):
talked about you and I talked youknow, the last two times we continue
to talk about that. You know, these outcomes are worse for black and
brown mom. We know that ifyou especially when you look at infant mortality
too, that black babies are twotimes more likely not to make their first
birthday. One in ten babies ispremature. And we know that it's one
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and a half times more likely forblack moms for brown right, so Native
American, Alaskan and Hispanic So weknow that that is where we need to
start to really solve for sure.And if we could do that, think
about what we could do for thewhole country. Yeah, I see the
US rate, it's five point four, right, and then here in New
York the infant mortality rate is fourpoint two, So it's not neck and
(06:36):
neck, but it's kind of yeah, yeah, I mean they're listen.
It's not terribly off the mark andthe sense of what we're reporting, but
it you know, in the sensethat it would be great if it was,
you know, so much improved.But the whole country is really going
in the wrong direction. And clearlyI see moms and babies is the window
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in to the health of our country. And I think I get this question.
People ask like, so what doyou mean by that? And when
I say that, you start tolook at are we focusing on the right
things and are we really putting momsand babies at the center of our healthcare
system? No, and that's whywe're failing, and we're not serving them
where they are and getting solutions tothem and specifically to black and brown women.
(07:25):
That's clear in this data. Sowhy do you think in twenty twenty
three, like we're still moving inthe wrong direction as opposed to all the
adecuracy work that happens, all thethings that we're all trying to do collectively
to make sure that this conversation becomesmore mainstream, Like why do you think
we're still kind of tracking backwards alittle bit. So I continue to amplify,
right, that's my job when we'retalking about just being the voice that
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continues. That's what the Martial Timescontinues to do. That's why we put
this report card out, so youhave a benchmark. You have to do
that. So that's the first ofthe why we do this work. The
other is this data is so importantto start thinking about how can we get
to solutions. It's complex, It'syou know, if there was just an
access issue, it's more it's arace issue. It's a lot of social
(08:13):
determinants that we need to focus in. That vulnerability index, which we report
on as well, gives you insightinto every state. When you start looking
at I think about California and NewHampshire where it's green, yeah, right,
and then that swath of red inthe southeast. What are we doing
differently? Is it our review committees? Are we diving into that data and
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using it? Are we doing addressingthings the same? And we know we
don't in every state, So whenyou start looking at things that we can
do, that's where I think thisdata is so healthful sure, or should
be. That's how one should usea lot of this data as thinking about
where And we've got some great programsthat we're doing that is about education,
but we've got some really neat programswe're doing and doing differently because I think
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we're going to have to do healthcaredifferently for our moms and for our babies
differently. And it's a very detailedreport. I mean all the statistics that
are in here. I see someof the leading causes of infant deaths,
which I want to talk a littlebit about that because I'm not sure we've
gotten into that. Yeah, episodes, So what are some of the leading
causes of infant death? So thisdata toxic. So I should also tell
(09:16):
you that CDC just released twenty twodata, so we're a little behind in
the sense of just timing lise ofreporting. But what you start to look
at is preach and birth is oneof the leading causes. Birth to facts
is as well. And so whenyou start looking at preterm birth again,
that can be caused by having apreterm birth before multiples our risk factors so
(09:37):
are hypertension, diabetes, smoking,chronic conditions can lead to that. So
we started really diving into chronic conditionsin a maturnity care desert report in August,
and this really starts to do thesame that we know that if you
have a well, we know alot of things, but we know that
if you have chronic condition as wellas living in maternity care desert, you
(09:58):
even increase your worth of preacher andbirth even more. Then you add race
and it starts to give you goosebumps. Yeah, because it's all I mean
that preterm birth rate skyrockets. Andso again looking back at this, so
that infant mortality data for twenty twentytwo, that data out of the CDC
started looking at maternal complications as ahigher rate as well as bacterial sepsis,
(10:20):
and that took pause. I'm notgonna like when I first saw that,
I said, what, I'm nota pediatrician, So my first reaction was
did we change something within neonatal intensivecarrion its? Did we do something differently?
We've discussed internally. Is this becauseof severe prematurity that twenty two to
twenty three week pregnancy often called amicro pre meiat because they're so small and
(10:46):
so delicate. Are we seeing moreresuscitation there? I think we'll see some
of that data come out. Theother data that came out was about syphilis,
which was there's an eleven time elevenfoldincrease of syphlis in this country untreated
and shockingly so when that can betreated with antibiotics. Sure, so people
(11:07):
getting tested and not getting treated ornot even getting tested. So that data
kind of came out together, whichI thought was sort of fascinating coming out.
At the same time, I actuallybrought it up to a hospital system
we were partnering with and they said, we need to look at our syphalist
date. I said, yes,you do, because I think it's shocking
to people that in this day andage it's something like antibiotics that's so easily
(11:28):
right, or you start thinking aboutyou know, I took a step back
and just said, you know,again, in this country, we have
sanitation, we have vaccines, wehave we should have access to antibiotics,
so to be able to solve forall of this, but it becomes a
bigger issue of about, like Isaid, access to care and about really
looking at some of the disparities.Yeah, and then some of the other
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factors that you have related here tomaternal vulnerabilities, so general healthcare. We
talked a little bit about about thatphysical environment. Yeah, so you're talking
everything from housing to air quality,so pollution, which you know in my
day, you know, I've beendoing this for we never talked about and
I think about it. I thinkit's so much more especially as right,
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I think the last time I washere was when we had the fires over
the summer, and so something thata lot of people don't look at that
that affect moms big time. Sosome of those same issues that we haven't
in that vulnerability index, we haven'treally talked about. And I think our
visualization of this on this report isso much better than it has ever been.
(12:35):
But again, when you start todive into the data, you start
to think there's there's so many layersof solutions that we'll have to do.
Yeah, some of the other thingsI was reading here too, like reproductive
health care. We talked a littlebit about that, and how like maybe
st I's like, yeah, intothe fold mental health and substance abuse,
physical health, and then some ofthe socioeconomic things that we discussed. So
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a lot of layers, a lotof layers. I mean you start thinking
about transportation and housing and you startgoing, oh, my gosh, we're
so far beyond diabetes because then thinkabout, Okay, I'm a diabetic who
needs to have better nutrition. Ineed access to it. I need to
get to that supermarket or market,right, and then the cost of you
just start. You can see howit starts to build. And now I've
(13:20):
got to pay for lancets to pokemy finger and test strips to be able
to check my budget. And thenI got to get to that appointment to
review all this. It's a lot. It's a lot. It's a lot,
and we're seeing more and more ofthose high risk diagnoses that need that
then becomes all of those layers thatneed to be there to support those moms.
There were some positive things, yes, I want to get to right.
(13:43):
So there has been the Medicaid extensionright that received the nice green check,
the Medicaid expansion you got it,paid family leave duel, a reimbursement
policy which is huge. Yes.Yeah, so let's talk a little bit
about that. Yeah, these arethe exciting things. I mean, not
every state has to be and tellmedicine coverage too. Those are things that
we know can make a difference.So we know that you don't recover after
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six weeks of having a baby,eight weeks of having a c section,
that you need more care, sure, and if babies have access, why
are we not supporting moms? Sothe fact that moms can go get mental
health services, follow up for theirhypertension, diabetes, and beyond within that
next year is vitally important. Sothrilled that the mom. But that's an
important for every state to have.Yeah, and every state does or realize
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that that's where fifty percent of complicationscan happen for moms and that's in that
postpartum period. If we I meanI kind of stepped back and couldn't believe
it when I first realized, Like, why didn't we think of this long
ago? Ye? Right, ifyou're taking baby and mom isn't getting supported,
what are we doing? Right?So again now you look at it
and think of the obvious. Butthe same with coverage during work, I
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mean, well the paid family.I was surprised. I thought that was
already like a thing. Yeah,I think all of us all this was
a thing, right. And youthink of women's liberation, right like I
think of the Women's lib movement andthink, wasn't that No, I mean,
we were not and every state isdifferent, and so how are we
supporting our moms at work? Howare we supporting I mean, and then
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it continues with you know, ifyou have God forbid, you have a
miscarriage or a you know, aloss, you know that we're not supporting
right where moms need to be.So I love that we're passing those as
well as doula. We know duelsmake a difference reducing and we talk a
lot about duelas in the intrapartum space, but really in that an apartment postpartum,
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avoiding preterm birth. I mean,there we go right, one of
the solutions. So getting that coverageis vital. Yeah, and also you
know, figuring out the supply anddemand is a big issue, right if
I want one, where do Iget one? How do I know their
qualifications? And then also thinking abouthow do I use them for both and
(16:00):
apartum, interpartum and then postpartum,because we know that they can be such
advocates in all three of those spaces. So and then you know, we
have so many dulas at the Marchof Dimes, I'm like blown away,
but how many people work right atthe March of Dimes doula and I keep
saying like, this is your sidegig and no, it's their passion,
but imagine if it was your fulltime job. Sure you need that reimbursement.
(16:23):
And so so I've had a lotof conversations with just our employees about
why they do it, but moreimportantly like what And of course I'm like,
please don't leave march of diyings,right, but also how do we
make sure they're really supported and thesupport financial and then how how do we
give them the skills to build?Right? We know a business can be
(16:45):
hard to run, so how doyou figure all of that out? And
so we have a huge project rightnow that we're doing indulas for doulas with
dulas across our markets, and alot of this year has been about planning
that and as a partnership with CBSFoundation that we've been over the moon excited
about that actually was probably one ofthe first projects I helped get over the
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finish line and was super excited tosee us do in different markets. So
that and again really looking at retentionintegration in the system as well as as
really the financial support and then thinkingabout it as a burnout situation, right
is making sure that because just aswe do this is like, oh goodness,
you know, there's a lot toabsorb. And again, these are
(17:30):
through some of the conversations with duelsthat I got gotten to know just within
the March of Dimes and thinking abouthow to and now we have partners that
we're really doing this with. Butreally excited to see this come to fruition
and I think also evaluating a programas we go through it, and really
excited so that we can really bringdata to the forefront as we as this
happens is going to you know,it's over the next three years, so
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there's more to come. We'll hopefullybe talking about it over some future conversation,
But really excited to see that.And again and something we were reporting
on here and about Midwiffrey as I'ma huge proponent or supporter of Midwiffrey and
nurse practitioners in the women's healthcare spaceto be able to support moms and babies.
I love that because I feel likethat is a solve that you know,
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closes the equity gap on so manydifferent levels, especially in the black
community. Right, so I lovethat you're coming up with a solve there
and you're really paying close attention towhat can be accomplished in that space.
And again, I think we alsohave to be careful that it's that's not
the only solution, but it's abig one, a big one. It's
a big one, and if wecan really start and thoughtfully think through it,
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we may have to pivot as theproject goes on, right, Yeah,
but thrilled to see states like myown in New Jersey with reimbursement and
others and other governors looking at ittoo, state by state. It's been
kind of excited for our Office ofGovernment Affairs to really have a priority.
That is our big priority for thenext year. As well as the Midwiffrey
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aspect as well. Yeah, whichhas been a challenge across the country which
I kind of struggle and I don'tyou know, I watch obg n's right,
not right, We're watching them burnout and we're watching people, you
know, in medicine not go intothis specialty. There's kind of the obvious
solution hitting people, right. Yeah, this is the midwives and nurse practitioners
and we've gotten duelas but we've gotto be more supportive across all that that
(19:22):
entire spectrum. Sure, so Isee another green check here for the Maternal
Mortality Review Committee, Right, So, state and federal funding that has gone
to this committee which has helped recognizeas an essential to understanding and addressing the
causes of maternal deaths. So I'mglad to see that. Yes, that
is on the agenda. Yeah,so that has to be so not every
(19:44):
state has them, not every state, right, So it's super important because
it gets to root causes because whenyou do have a maternal death, and
as tragic as they can they are, they also need to be dissected and
looked at through a committee that canthen say here's our recommendation. And they're
volunteers. I actually know of onewho's on and it's fascinating to listen to
(20:08):
from an outsider to it. Butalso know that that is mandatory in my
mind that we support that. Wehave to. We can't ignore these,
right, they can't just be We'vegot to really get into the causes and
the root and think about so whenyou look at eclampsya versus sepsis, right,
(20:30):
which what caused death or their morbidityand how do we then really get
to solutions unless we can dig intothe data behind it or what happened,
and in each case, so veryexcited to see that in you know,
New York and other states, butthere are other states that don't believe in
it. I'll leave those states out. You can see me like, oh
(20:52):
my god. And there's that aspectof the prioritization and the elevation of maternal
and how this is part of it. It's exactly part of it, and
so I get excited about it.It's awful to think about, but it's
also like a necessitary necessity. Yeah. One thing that I saw that I
was shocked and it did get alittle red X was the Fetal and Infant
(21:15):
Mortality Review, which I was likeblown away because you know, just identifying
what some of those causes of deathare, I'm like, that's what we
need to kind of solve all andthat, right, So let me explain
that somebody who has had to fillout, you know, death certificates.
They're not easy, especially you're involvedin the case. The second part of
(21:37):
is even the education on them.Do you know what education I got on
them? Zero? Wow? Soand then there was somebody, all of
a sudden, a social worker standinggoing okay, here we go, we're
gonna I'm thinking I'm the one responsiblefor filling this out, right, and
so thinking about that in my ownexperience, how you need to fill those
(21:57):
out and how important they are becausethey're data just as a birth certificate does.
Right, that's where we pull alot of data from yea. So
so really thinking about and again myown experience is a long time ago.
But what needs to be done hereis so that we can again it's being
really transparent and very truthful through thisdata collection. Sure, And what I
(22:22):
will say though is to end onor pivot to a high note. We
have the Perinatal Quality Collaborative, whichis state and federally funded right to help
improve and identify care issues amongst maternaland infant healthcare. So I was happy
to see that got a nice greencheck. You got it, Listen.
I think New York has done well, needs to continue to do well,
(22:45):
and needs to do what they aredoing well, continue to do and then
continue to amplify and step up.Sure, I think that's where we're headed.
So what was interesting is like NewYork was not doing great, but
I saw and ram up Poe NewYork that they had received an a with
the greatest number of live births hadat a pre term birth grade. A
(23:08):
lot of other places received an Fthe majority of the country, and then
I saw Ramapo. Yeah, whenwe started looking at cities, I was
like, wow, yeah, sowhat are they doing differently? Right?
I don't know, but it's agood question, and it's what So when
you start to look at this isyeah, is there something they are doing
differently? Are they doing home visits? Great example, you know places that
(23:29):
are doing home visits after imagine havingsomebody actually come to your home and check
on you after your deliver I haveno idea what they're doing, but wouldn't
it right, Yeah, we knowthose make differences. So I am super
curious as we have just you know, put this report out, is starting
to do that deep dive of placesand what they're doing. So yeah,
so that was very interesting to me. I saw Seattle, Washington has a
(23:49):
good blueprint in place as well,so that was that was also very interesting.
You know, most of the countryin the red, which was not
good to see, but but Isee like kind of where things could be
maybe turning the corner, if youknow, people take a look at this
data and they take it seriously andthey can kind of, you know,
understand what's happening. Yeah, right, Okay, nobody gets right. There
(24:12):
are cities that are doing it well, there's cities that clearly aren't. But
there are states that are doing itwell. So what are they doing?
How can we take We know thatCalifornia is not Tennessee, which is not
New York, but are there programs? Are there the review committees? Are
there things that we can take fromdifferent states to then you know skill,
(24:34):
Sure, but we know that it'snot the same in every place. And
so when you and you start lookingat that vulnerability index, it's the same
kind of thing. You can reallyuse some of the stata to say,
oh this is similar, this isdifferent. But that's where I start to
think hopeful. Right, the Californiaseeing you know, quality committee is fantastic,
(24:57):
and we've taken programs from there andand elevated them. Same for and
I mentioned Tennessee because we've done thesame and sure, so are there ones
that we can really start to launchand program and try them out in other
places? Yeah? Yeah, that'swhere I start to get I guess that's
where I get the hopeful part.Yeah, yeah. I mean there's a
lot of positive things. I mean, this report is not all you know,
(25:18):
no, and specifically for New York. I mean you start to look
at inadequate prenatal care. I meanyou listen, it's sort of you go
back and look at other places,go oh my goodness. There are bits
and pieces of this. There's anoverall theme that we are flat, we're
not focused on the right. Wehaven't as a country focused and here as
a as a nation. I thinkyou can pull apart different states to say
(25:41):
there's been successes and different pieces ofit. Sure, but I and again,
I think and the contribution of riskin each of these places is slightly
different. You know, when youlook across the southeast and I start thinking
about you know, OBC or diabetesand things. But we see that other
places to Sure, so so therehave been Like I said, I think
(26:03):
that we can start to think abouthow to be more intentional with this data.
Yeah, so I saw to yourpoint. I saw hypertension was one
of the preterm birth factors. Wetalked a little bit about diabetes previous pre
term births, which was ranked youknow, pretty high in the scale,
and then carrying multiples twins, andyeah, so when average twins deliver it
(26:25):
thirty six weeks, so four weeksearlier, right, and triplets. Don't
quote me because I want to tripletssince whatever in two thousand and yeah,
two thousand, So they're on averageI think thirty two weeks. So for
every child, every multiple, it'sfour weeks earlier, right, And so
and that that's been known data that'sout there and you can imagine two percentas
(26:45):
right, they need all that bloodflow and growth. And yeah, so
you can see the just from astamp, you know, global standpoint.
Why and we don't We used tohave tremendous amount of triplets and twins.
We've had less and less so becauseof just advances in the reproductive you know
IVF kind of infertilities world from thatstandpoint. But yeah, that in smoking
(27:07):
is another big smoke, like peopleare smoking. Oh so yeah, I
mean, so you're no judge,I'm not judging. I judge. I'm
gonna say I'm a judger so onthis one, because this isn't something that
we haven't been talking I mean,we've been talking about this for so long.
Smoking, right, we yea,smoking is terrible and yeah, smoking
contributes an amazing way in pregnancy.So and we needed to quit way ahead
(27:32):
of time, sure, and sonot just when you get the positive pregnancy
tests. So so to me,this is one of those that's so right.
You can change that, right,you can absolutely change that. But
yeah, people still smoking, andpeople smoke not just or what I like
my family always used to call funnycigarettes. Right, So about marijuana,
and people think it's safe when itis not in pregnancy. So and you'll
(27:56):
get pushed back from patients all thetime saying disagree. And that's so interesting
as a clinician, Right, you'retelling someone that it's not safe, yes,
right, and they're like their justificationfor yes. And a lot of
it is about you know, peopleusing marijuana differently, right, and it
is so much more potent today thanit used to be, and you can
(28:18):
really pull out the THHC. Right. I mean, there's lots of discussion
on this, and American College ofOban has done a really nice job of
puting a statement out there saying likewe you know, we know that this
has growth restriction issues. Sure,this has future implications for children, we
know, so growth restriction alone shouldI would think make people stop but does
not often. Let's take get alittle step further. So what about an
edible or something, So it's thesame thing, And actually edibles are higher
(28:41):
potency, so you're getting more inyour circulation by eating it, Yes,
smoking and just you know, ruiningthe filter of oxygenation, which is your
lungs. Right, I, especiallyin State, have have always said please
eat it before you smoke it,but really need to seasoned. And I
say that just in general, right, right, in the sense of saving
(29:03):
your lungs, But really the potencyis so much stronger in your bloodstream and
so much higher going to your baby, filtering across right across the placenta and
right to baby's brain, right,I was gonna say brain development besides yeah,
no, mom's lungs. And thenreally, and I'm was just trying
to make sure I clarified about whyI was Probably it's probably you know,
(29:25):
I'd much rather see people eating itthan smoking it, but not when you're
pregnant. I want to see anyany of it. And yeah, so
then it's at a much higher levelgoing across the placenta and into baby's bloodstream
and into every organ. And thenyeah, it really looks at gross restriction
and really we haven't right the studiesout about what else long term with the
(29:45):
potency we have today is a problem, I mean and right, and then
also doing the drug test and findingout somebody, right, people are not
wanting to have anything to do withthat. Then you know, we we
have to really know that this isnow right, it's so much more of
it elbow then it used to be. The potency is so much higher than
it was in the sixties right whenit was you know, much different,
(30:06):
and the accessibility of it has nowmade it much we see it much more,
right, Yeah, which is crazy. Stop smoking and stop eating edibles
while you're pregnant. I'll go onthe record and say that I love that
thing. Yeah, no, Imean and listen. And then if you
go to the number one drug isalcohol, people still drink. Wow,
And so that right, so weknow about you know how fetal alcohol can't
(30:29):
write, so we know that crossesinto the baby's bloodstream. And so again
you're talking about you can have awhole really large birth defect because of alcohol,
and we don't know how much istoo much. So people say,
oh, you can just have alittle drink. No, we just say
none at all, because we don'tknow what ones forget about their tolerance.
I'm talking about what baby's tolerance is. So again and something that we could
(30:52):
prevent birth defects way ahead of time. And again it's asking people to stop
before they conceive or if they andit's like one in five I think are
are binge drinking. That's crazy.So there's crazy statistics about alcohol, which
again stepping back, we've known thisfor a really long time. You see
in the bathrooms in almost every restaurant, right, stop drinking if you're pregnant.
(31:14):
I mean you see these people aren'tdoing it. It's crazy because the
numbers are so startling. So I'mreading here that nineteen eight hundred and sixty
eight babies died before their first birthday. I think you started the episode with
something similar, right, statistically,that's it's unreal. Yes, so we
had three hundred and five thousand.I think that was the number. Mak
make sure I say it right becausemy team will grill me for not saying
(31:37):
the right number. We're born premature, so if you think about the report
card, it's ten percent. Soliterally, my husband on Saturday night is
I was telling him the report cardnumber that ten percent. He said,
that means one in ten babies isborn premature in this country. Yes,
that's exactly what That's exactly what itmeans. And I think he just I
(32:00):
mean stopped in his tracks and wewere onto a fundraiser for the March of
Dimes. But I said, yeah, that's that's really it. That that's
that you need to stop there andyou realize. So, yeah, we
we have a lot to do andwe're doing a ton of research in this
area. There's a lot to come. We're making big strides when it comes
to biomarkers for preclampsia or we're doinggreat science, but we've got to get
(32:22):
something that translates into mom's and babieshands. Yeah, well you're doing a
lot. You have the mobile unitsthat are going to be browling out,
so let's talk a little bit aboutthat. Yeah, we're excited. You
know, this is something Martial Timehas been doing for a little bit of
time. But now I think we'rereally looked at as the you know,
as as because only what is ittwo percent of all mobile units are doing
(32:45):
maternal care on their mobile units.So you think about mobile units, I
think about mammograms or maybe getting blooddraws or you know, even blood donation,
right. But but actually what we'vebeen doing is going using it as
bringing providers to the patient. Sowe're in places like Washington, d C.
We're up which, believe it ornot, as Maturity Care Desert,
(33:07):
and then we're in Apple Ahia sowe're in the middle of Ohio. And
then we've got we're launching in Arizonaand with New York Presbyterian. So really
excited to see it take off asreally one of our solutions and bringing a
lot of partners together because we're notproviders, right. I always remind people
we're not providers, despite me beingone, that we're trying to bring solutions
(33:30):
to the patients so that we canthat access issue. We are really trying
to make it so simple. Yeh, we know it's not simple, but
that's really what we're trying to do. So and I can, you know,
really excited that we're expected to bedelivering care five days a week.
Wow, Yeah, that's just great. Yeah, and really thinking about how
(33:53):
that care is delivered and what isdelivered and looking at it from the angle
of it's just there's so much todo for one touch point for a patient
and thinking about all the services wecan wrap around. Yeah. Yeah,
so it gets exciting to that isvery exciting. So anything else you know,
coming going into twenty twenty four thatwe can look forward to our do
a little work is big. Oh. I should also say that the New
(34:15):
York Presbyterian they're really doing a needsassessment of what borough to go into,
Queens or Brooklyn and what's where youknow they and I think in twenty eighteen
we had was among the five NewYork City boroughs. Brooklyn had the highest
total number of births so and burstand Medicaid. So there are lots of
(34:37):
data that again that's old data,right, really trying to figure out the
needs assessment to figure out where thisbush is. Sure, So before I
say that, so twenty twenty four, listen, I'm super excited to think
about new partnerships we're building. Ilove our National Service partners I don't you
know, and where we're going thereand education and driving that trying to really
refocus a little bit on the basicsthat education is super important to keep updated.
(35:02):
I love our doula work. We'vebeen talking about a low dose aspirin
campaign, so I guess I'll sayit publicly of really trying to get education
about who needs low dose aspirin andwho doesn't need, so women who are
at risk for preeclampsia, and there'sa huge criteria. The American COLLEJUVIGN has
(35:23):
it nicely listed, so does thePerinatal Task Force as a society of MFM.
And you know, lots of peoplehave said aspirin isn't safe in pregnancy.
This is low dose. You're talkingabout that eighty one milligrams, starting
it, you know, after thethirteenth week of pregnancy and reducing pre eclampsia.
So that imagine you know, foryour listeners, anyone who's delivered premature,
(35:46):
if I could have gotten one moreweek, if you just think about
one more week. Yeah, sonow we hope no week right, get
full right, no preclampsia, butreally thinking about extend, right, extending
that justtational age and that's what asproncan do. And so we've seen that
it can really reduce the onset ofthe preclamsia, so growth restriction as well
(36:07):
for babies and that pre term birth. So if we can do that,
it can move the needle. Andwhen you talk to some providers that are
like everybody should take it all thetime, forget about screening, and we're
really trying to use evidence bace medicine, but also really want to do the
campaign where we get to moms sothey ask should I be on lodos asprin
(36:31):
And one of the things that Ifind amazing is that black women are on
it the least and they need itthe most. Well, I think because
we don't know about it. Yeah, this is the first time I've ever
heard of it. Oh now nowwe need to ken you have a whole
other session. Yes, because itcould. We are so excited about it
and what partnerships we can bring tothe table, which we are building and
(36:54):
galvanizing right now and thinking about reallylaunching this on as a national basis,
just like we did the Born TooSoon campaign when we talked about please don't
have your baby before thirty nine weeks. You're electively doing that. That's wrong
because babies have a higher chance ofbeing in the neonatal intensive carrying it because
a lung immaturity, another immaturity.But and we stuck to you know,
(37:15):
we really hate help champion that.And when I think about what the Marsha
of Dianas has done and in mycareer that was huge to get that information
out to patients who then ask mebefore I could even say to them,
Nope, not till thirty nine weeks. So we need partnerships like the hospitals,
like outpatient, all of these toreally implement this to yes, because
it makes a huge difference and shouldbe offered just like preen nellow vitamins.
(37:37):
Right, we know full gacidtroduces spineand befit us. Yeah, it's not
so easy because it is a differentdose. It's not right full dose asperin,
it's low dose aspirin. Also,women going to the pharmacy and the
pharmacists saying nope, can't take aspirinin pregnancy, Well you can take low
dose. So really thinking, andwe want it beyond thirteen weeks so not
(37:59):
you know, not in the firsttrimester, and it's the bleeding risk is
incredibly low. Yeah, so allthe pros and conspt what I want every
mom to ask about lotos aspron andI think if we did that, we
would make an amazing thread. Yeah. Yeah, so I get really excited
about coming back, yes, tohave that conversation as we launch it,
(38:20):
but also thinking about implementation science abouthow do you implement to the communities about
lotos aspron. Everyone needs to getinvolved and so that families and you know
so and so is pregnant, Okay, she and loados aspron would be a
great question, Yeah, to ask, right, and do you know about
it? So the fact you don'tmakes me I think we have a lot
more work to do. I alsothink there's also a huge connection in the
(38:43):
black community around cardiac health, yes, right, and aspirin, and that
you could be the connective tissue rightto having those conversations. No, that's
a really good one. We Yeah, so you think about pretty clamsy and
that woman over her lifetime having youknow, risk factors for cardiovascular disease,
for arrhythmias or needing heart surgery lateron in life after having preeclampsia. Aspirin
(39:06):
seems so you know, like,of course, yeah, been on ASPERN
or I should be on aspirin.Whereas in pregnancy, I think it just
isn't a positioned properly. Yeah,and I think from the provider's standpoint,
we've known about this for some time. I just spoke to somebody the other
day who said, you know,I was on that. I had no
idea why and so and the riskscan be race age, I mean not
(39:30):
just having had preclampsia before hypertension.You start going down this list, it's
almost everybody. Yea. So it'spretty and it's again incredibly safe. We
think has lots of evidence behind it. Excited that we'll will be partnering and
more to come on that as welaunch into twenty twenty four. So that
and also really looking to kind ofpresent data before our lotus aspirin and after,
(39:54):
and then a lot of our duelawork as we said, and then
really working on getting our educational materialin Spanish. So I'll throw that down
on the gauntlet that that's what,you know, I really want to make
sure forty two percent of our birthsare you know, I mean we need
to have Spanish materials and we havewe have a lot. I just want
(40:16):
us to be top notch. Yeah, yeah, and then we'll have a
whole nother report card, yes,going into twenty twenty four. So we're
already thinking about it and what it'ssuper excited about our visualization of our data
this year really took a turn andsuper exciting to see how it laid out.
More importantly to me as thinking abouttwenty twenty four's data and what more
we need to be adding so andbringing in sponsors. So right, well,
(40:38):
I'm sure there's some great partners thatare out there who are listening to
this episode. I mean, weappreciate your partnership. This has been so
great, like just building up thisplatform and the content that we've been able
to push out and the credibility thatyou all have you know, brought to
the platform. So we appreciate youfor that. We look forward to continuing
to work together and all such afun time for me. And it's always
(41:00):
impressive come in this space and seeyou and see what you do and all
the patients you're reaching. It's soimportant, so amplifying, right, we
need to continue to do what wedo. Yeah, thank you for sure,
well, thank you, no,thank you. Partnership happening because of
you, so we appreciate that.But you're listening to me eternal on iHeartRadio
(41:20):
here with the lovely doctor Elizabeth Chiroll, CEO of March of Dimes, and
you'll be back sooner than later fromsome more you know, conversations input insight
on all the things that March ofDimes is doing to be effective in the
community and help people have a betterquality of life. Great thanks
So it's a real huge accessibility.It's about getting information and education to people
where they are. Yeah, youcan do it on a timely basis when
they want it, and it isabsolutely and it can drive you to your
did you schedule your appointment? Youcan actually then get a text message that
says did you I mean, wecould tie it in there. But again,
(00:21):
just to get accessible information. It'slike when you're in the hospital and
you're about to leave and put upthat education and people click, you know,
the nurses say, oh, watchand some people watch it and others
don't. Yeah, right now you'rehome, it's like, ooh, I'd
like more of that information here itis? Is it subscription based once they
get the box, once you getthe box, Actually we want to hand
out a box for free. That'spart of the whole thing. And then
(00:44):
yeah, and then you think aboutfor the future, what could you build
on it and get here's where thepop up food places, here's where right,
I mean you start thinking about whatyou can really drive through this and
so but we need a pilot programto start it, right. Yeah,
that's a lot, it's a lot. I'd love you to think about partners
for me. Yeah, and we'regoing after you know, United Health,
(01:07):
and I'm going after CVS Right,it's interesting. So I sent CVS health
information about maternal because you know,they do a lot of stuff in the
maternal health space. They actually weresponsors of the DULA expel and they're sponsors
of us A doula work. AndI actually know one of the founder their
(01:27):
chief equity officers. Okay, I'vemet personally and I think she's phenomenal.
Yeah. So, but I andwe already have a huge project of them,
so I don't expect them to divein sure. But but whatever about
a health insurance partner or is that'swhere we're going or is that in it?
Well? I have another question too, Is that a conflict for CVS
health because they are technically at nono, because they their foundation pulls out
(01:51):
separately, got it? So,and most places pull out a foundation for
those particular reasons. So you needa national partner. That's it. Okay,
we're really thinking if we, like, I've got Connecticut super interested,
which is like, okay, greatyour outcomes, No outcomes are great,
but I really need Alabama. Butlet's we know we could make the difference
bigger, right, the opportunities bigger. But honestly, I would love to
(02:14):
see three states, whether it wasConnecticut in North Carolina and Alabama would be
ideal. And if we have threedifferent sponsors, great, But I'd love
to think about I'd love just youropinion on it. Yea lady of connections.
I appreciate think about it and presentedin a way that goes through all
the details of it. I justthink you're you know, please don't spread
(02:34):
it around. No, of courseI'm not worry but we're friends now,
Yeah, I could think about whatwe could talk about or like, just
think about what it would when youread through it. Then I'll send it
off to you. Yes, andI also want to make sure that I
connect you to Anthem Health, whichis now what do they call it?
Elevants? Yes, yeah, we'reconnected. Oh you are. They were
sponsors of this report card. Ohperfect, and people don't even know it.
(02:57):
I did not know that. Yeah, they were sponsors of the Maternity
Care Desert Report and which was theone that we launched in August. So
they're big partners with us, andI'm hoping they'll be really interested. Part
of it is we have to runout that grant before they'll jump onto the
next one. And I want thisone, okay now, because I have
I have all the other. I'vegot just all the other connected. Right,
(03:19):
I've got the people, the CEOof Eddie's, i have PBS state,
I've got certain states super interested.Okay, So that's kind of where
we're at. So I'll think ofa list of folks who I would love
that. Yeah, I can helpit, and see if I'm crazy.
No, I think it sounds fascinating. It is really cool on what it
could do, and think about theeducational materity you could send to people.
(03:39):
So I so, how is thisreport different from the report that you and
I discussed back in November? Sogosh last So every year we put out
a Maternity Care Desert Report, whichtalks about where the maternity care desert are
and then this is like your annualreport card. Think about your kid going
(04:01):
to school and get that annual reportend of the year. And that's what
this is. And we focused originallywhen this came out, really narrowed in
on preterm birth, which we stillreport on, but now we dive in
not just state wise, we gointo cities, right, and we have
those top lists, but really getinto kind of why, and it's now
(04:24):
more of a state of report card, or I should say it national report
card on maternal and infant health.Right, you look at it, So
I saw New York at a Cplus. Yes, I was kind of
sad about that. Well, it'sslightly better than the year before, which
overall tells you just in general thatwe are flat right. We haven't seen
(04:46):
an improvement for pre term birth,and overall the country's getting a deep plus.
You know, somebody who prides herselfon her grades, it's really hard
to tell people what their grades arewhen it's this bad. We have cities
failing. So I'm not trying tobe that optimistic go out in New York.
But at least it's not a failure. Yes, we don't have anybody
getting an A this year. Rightin the States, we have fourteen states
(05:06):
that pre term birth got worse,and we have thirty two states that actually
we saw a slight improvement. Right, but the southeast across the country,
when you look at it, you'llsee the swath of red. We do
a really nice job of visualization,and so when you look at the states,
you know see you know, thesoutheast is where it's the worst.
Yeah, I see. Still,like you know, black women are still
(05:29):
leading the charge. Unfortunately in termsof the disparity. I see thirteen point
seven compared to seven point nine,nine point zero. What do those numbers
mean? Yeah, So you know, health disparities exist and continue to exist,
and we're not we're not We're goingin the wrong direction. And when
you start looking at moms and babiesare intertwined. Right, So when we
(05:49):
talked about you and I talked youknow, the last two times we continue
to talk about that. You know, these outcomes are worse for black and
brown mom. We know that ifyou especially when you look at infant mortality
too, that black babies are twotimes more likely not to make their first
birthday. One in ten babies ispremature. And we know that it's one
(06:14):
and a half times more likely forblack moms for brown right, so Native
American, Alaskan and Hispanic So weknow that that is where we need to
start to really solve for sure.And if we could do that, think
about what we could do for thewhole country. Yeah, I see the
US rate, it's five point four, right, and then here in New
York the infant mortality rate is fourpoint two, So it's not neck and
(06:36):
neck, but it's kind of yeah, yeah, I mean they're listen.
It's not terribly off the mark andthe sense of what we're reporting, but
it you know, in the sensethat it would be great if it was,
you know, so much improved.But the whole country is really going
in the wrong direction. And clearlyI see moms and babies is the window
(06:59):
in to the health of our country. And I think I get this question.
People ask like, so what doyou mean by that? And when
I say that, you start tolook at are we focusing on the right
things and are we really putting momsand babies at the center of our healthcare
system? No, and that's whywe're failing, and we're not serving them
where they are and getting solutions tothem and specifically to black and brown women.
(07:25):
That's clear in this data. Sowhy do you think in twenty twenty
three, like we're still moving inthe wrong direction as opposed to all the
adecuracy work that happens, all thethings that we're all trying to do collectively
to make sure that this conversation becomesmore mainstream, Like why do you think
we're still kind of tracking backwards alittle bit. So I continue to amplify,
right, that's my job when we'retalking about just being the voice that
(07:48):
continues. That's what the Martial Timescontinues to do. That's why we put
this report card out, so youhave a benchmark. You have to do
that. So that's the first ofthe why we do this work. The
other is this data is so importantto start thinking about how can we get
to solutions. It's complex, It'syou know, if there was just an
access issue, it's more it's arace issue. It's a lot of social
(08:13):
determinants that we need to focus in. That vulnerability index, which we report
on as well, gives you insightinto every state. When you start looking
at I think about California and NewHampshire where it's green, yeah, right,
and then that swath of red inthe southeast. What are we doing
differently? Is it our review committees? Are we diving into that data and
(08:35):
using it? Are we doing addressingthings the same? And we know we
don't in every state, So whenyou start looking at things that we can
do, that's where I think thisdata is so healthful sure, or should
be. That's how one should usea lot of this data as thinking about
where And we've got some great programsthat we're doing that is about education,
but we've got some really neat programswe're doing and doing differently because I think
(08:56):
we're going to have to do healthcaredifferently for our moms and for our babies
differently. And it's a very detailedreport. I mean all the statistics that
are in here. I see someof the leading causes of infant deaths,
which I want to talk a littlebit about that because I'm not sure we've
gotten into that. Yeah, episodes, So what are some of the leading
causes of infant death? So thisdata toxic. So I should also tell
(09:16):
you that CDC just released twenty twodata, so we're a little behind in
the sense of just timing lise ofreporting. But what you start to look
at is preach and birth is oneof the leading causes. Birth to facts
is as well. And so whenyou start looking at preterm birth again,
that can be caused by having apreterm birth before multiples our risk factors so
(09:37):
are hypertension, diabetes, smoking,chronic conditions can lead to that. So
we started really diving into chronic conditionsin a maturnity care desert report in August,
and this really starts to do thesame that we know that if you
have a well, we know alot of things, but we know that
if you have chronic condition as wellas living in maternity care desert, you
(09:58):
even increase your worth of preacher andbirth even more. Then you add race
and it starts to give you goosebumps. Yeah, because it's all I mean
that preterm birth rate skyrockets. Andso again looking back at this, so
that infant mortality data for twenty twentytwo, that data out of the CDC
started looking at maternal complications as ahigher rate as well as bacterial sepsis,
(10:20):
and that took pause. I'm notgonna like when I first saw that,
I said, what, I'm nota pediatrician, So my first reaction was
did we change something within neonatal intensivecarrion its? Did we do something differently?
We've discussed internally. Is this becauseof severe prematurity that twenty two to
twenty three week pregnancy often called amicro pre meiat because they're so small and
(10:46):
so delicate. Are we seeing moreresuscitation there? I think we'll see some
of that data come out. Theother data that came out was about syphilis,
which was there's an eleven time elevenfoldincrease of syphlis in this country untreated
and shockingly so when that can betreated with antibiotics. Sure, so people
(11:07):
getting tested and not getting treated ornot even getting tested. So that data
kind of came out together, whichI thought was sort of fascinating coming out.
At the same time, I actuallybrought it up to a hospital system
we were partnering with and they said, we need to look at our syphalist
date. I said, yes,you do, because I think it's shocking
to people that in this day andage it's something like antibiotics that's so easily
(11:28):
right, or you start thinking aboutyou know, I took a step back
and just said, you know,again, in this country, we have
sanitation, we have vaccines, wehave we should have access to antibiotics,
so to be able to solve forall of this, but it becomes a
bigger issue of about, like Isaid, access to care and about really
looking at some of the disparities.Yeah, and then some of the other
(11:50):
factors that you have related here tomaternal vulnerabilities, so general healthcare. We
talked a little bit about about thatphysical environment. Yeah, so you're talking
everything from housing to air quality,so pollution, which you know in my
day, you know, I've beendoing this for we never talked about and
I think about it. I thinkit's so much more especially as right,
(12:13):
I think the last time I washere was when we had the fires over
the summer, and so something thata lot of people don't look at that
that affect moms big time. Sosome of those same issues that we haven't
in that vulnerability index, we haven'treally talked about. And I think our
visualization of this on this report isso much better than it has ever been.
(12:35):
But again, when you start todive into the data, you start
to think there's there's so many layersof solutions that we'll have to do.
Yeah, some of the other thingsI was reading here too, like reproductive
health care. We talked a littlebit about that, and how like maybe
st I's like, yeah, intothe fold mental health and substance abuse,
physical health, and then some ofthe socioeconomic things that we discussed. So
(12:58):
a lot of layers, a lotof layers. I mean you start thinking
about transportation and housing and you startgoing, oh, my gosh, we're
so far beyond diabetes because then thinkabout, Okay, I'm a diabetic who
needs to have better nutrition. Ineed access to it. I need to
get to that supermarket or market,right, and then the cost of you
just start. You can see howit starts to build. And now I've
(13:20):
got to pay for lancets to pokemy finger and test strips to be able
to check my budget. And thenI got to get to that appointment to
review all this. It's a lot. It's a lot. It's a lot,
and we're seeing more and more ofthose high risk diagnoses that need that
then becomes all of those layers thatneed to be there to support those moms.
There were some positive things, yes, I want to get to right.
(13:43):
So there has been the Medicaid extensionright that received the nice green check,
the Medicaid expansion you got it,paid family leave duel, a reimbursement
policy which is huge. Yes.Yeah, so let's talk a little bit
about that. Yeah, these arethe exciting things. I mean, not
every state has to be and tellmedicine coverage too. Those are things that
we know can make a difference.So we know that you don't recover after
(14:07):
six weeks of having a baby,eight weeks of having a c section,
that you need more care, sure, and if babies have access, why
are we not supporting moms? Sothe fact that moms can go get mental
health services, follow up for theirhypertension, diabetes, and beyond within that
next year is vitally important. Sothrilled that the mom. But that's an
important for every state to have.Yeah, and every state does or realize
(14:31):
that that's where fifty percent of complicationscan happen for moms and that's in that
postpartum period. If we I meanI kind of stepped back and couldn't believe
it when I first realized, Like, why didn't we think of this long
ago? Ye? Right, ifyou're taking baby and mom isn't getting supported,
what are we doing? Right?So again now you look at it
and think of the obvious. Butthe same with coverage during work, I
(14:54):
mean, well the paid family.I was surprised. I thought that was
already like a thing. Yeah,I think all of us all this was
a thing, right. And youthink of women's liberation, right like I
think of the Women's lib movement andthink, wasn't that No, I mean,
we were not and every state isdifferent, and so how are we
supporting our moms at work? Howare we supporting I mean, and then
(15:16):
it continues with you know, ifyou have God forbid, you have a
miscarriage or a you know, aloss, you know that we're not supporting
right where moms need to be.So I love that we're passing those as
well as doula. We know duelsmake a difference reducing and we talk a
lot about duelas in the intrapartum space, but really in that an apartment postpartum,
(15:39):
avoiding preterm birth. I mean,there we go right, one of
the solutions. So getting that coverageis vital. Yeah, and also you
know, figuring out the supply anddemand is a big issue, right if
I want one, where do Iget one? How do I know their
qualifications? And then also thinking abouthow do I use them for both and
(16:00):
apartum, interpartum and then postpartum,because we know that they can be such
advocates in all three of those spaces. So and then you know, we
have so many dulas at the Marchof Dimes, I'm like blown away,
but how many people work right atthe March of Dimes doula and I keep
saying like, this is your sidegig and no, it's their passion,
but imagine if it was your fulltime job. Sure you need that reimbursement.
(16:23):
And so so I've had a lotof conversations with just our employees about
why they do it, but moreimportantly like what And of course I'm like,
please don't leave march of diyings,right, but also how do we
make sure they're really supported and thesupport financial and then how how do we
give them the skills to build?Right? We know a business can be
(16:45):
hard to run, so how doyou figure all of that out? And
so we have a huge project rightnow that we're doing indulas for doulas with
dulas across our markets, and alot of this year has been about planning
that and as a partnership with CBSFoundation that we've been over the moon excited
about that actually was probably one ofthe first projects I helped get over the
(17:07):
finish line and was super excited tosee us do in different markets. So
that and again really looking at retentionintegration in the system as well as as
really the financial support and then thinkingabout it as a burnout situation, right
is making sure that because just aswe do this is like, oh goodness,
you know, there's a lot toabsorb. And again, these are
(17:30):
through some of the conversations with duelsthat I got gotten to know just within
the March of Dimes and thinking abouthow to and now we have partners that
we're really doing this with. Butreally excited to see this come to fruition
and I think also evaluating a programas we go through it, and really
excited so that we can really bringdata to the forefront as we as this
happens is going to you know,it's over the next three years, so
(17:53):
there's more to come. We'll hopefullybe talking about it over some future conversation,
But really excited to see that.And again and something we were reporting
on here and about Midwiffrey as I'ma huge proponent or supporter of Midwiffrey and
nurse practitioners in the women's healthcare spaceto be able to support moms and babies.
I love that because I feel likethat is a solve that you know,
(18:14):
closes the equity gap on so manydifferent levels, especially in the black
community. Right, so I lovethat you're coming up with a solve there
and you're really paying close attention towhat can be accomplished in that space.
And again, I think we alsohave to be careful that it's that's not
the only solution, but it's abig one, a big one. It's
a big one, and if wecan really start and thoughtfully think through it,
(18:36):
we may have to pivot as theproject goes on, right, Yeah,
but thrilled to see states like myown in New Jersey with reimbursement and
others and other governors looking at ittoo, state by state. It's been
kind of excited for our Office ofGovernment Affairs to really have a priority.
That is our big priority for thenext year. As well as the Midwiffrey
(18:56):
aspect as well. Yeah, whichhas been a challenge across the country which
I kind of struggle and I don'tyou know, I watch obg n's right,
not right, We're watching them burnout and we're watching people, you
know, in medicine not go intothis specialty. There's kind of the obvious
solution hitting people, right. Yeah, this is the midwives and nurse practitioners
and we've gotten duelas but we've gotto be more supportive across all that that
(19:22):
entire spectrum. Sure, so Isee another green check here for the Maternal
Mortality Review Committee, Right, So, state and federal funding that has gone
to this committee which has helped recognizeas an essential to understanding and addressing the
causes of maternal deaths. So I'mglad to see that. Yes, that
is on the agenda. Yeah,so that has to be so not every
(19:44):
state has them, not every state, right, So it's super important because
it gets to root causes because whenyou do have a maternal death, and
as tragic as they can they are, they also need to be dissected and
looked at through a committee that canthen say here's our recommendation. And they're
volunteers. I actually know of onewho's on and it's fascinating to listen to
(20:08):
from an outsider to it. Butalso know that that is mandatory in my
mind that we support that. Wehave to. We can't ignore these,
right, they can't just be We'vegot to really get into the causes and
the root and think about so whenyou look at eclampsya versus sepsis, right,
(20:30):
which what caused death or their morbidityand how do we then really get
to solutions unless we can dig intothe data behind it or what happened,
and in each case, so veryexcited to see that in you know,
New York and other states, butthere are other states that don't believe in
it. I'll leave those states out. You can see me like, oh
(20:52):
my god. And there's that aspectof the prioritization and the elevation of maternal
and how this is part of it. It's exactly part of it, and
so I get excited about it.It's awful to think about, but it's
also like a necessitary necessity. Yeah. One thing that I saw that I
was shocked and it did get alittle red X was the Fetal and Infant
(21:15):
Mortality Review, which I was likeblown away because you know, just identifying
what some of those causes of deathare, I'm like, that's what we
need to kind of solve all andthat, right, So let me explain
that somebody who has had to fillout, you know, death certificates.
They're not easy, especially you're involvedin the case. The second part of
(21:37):
is even the education on them.Do you know what education I got on
them? Zero? Wow? Soand then there was somebody, all of
a sudden, a social worker standinggoing okay, here we go, we're
gonna I'm thinking I'm the one responsiblefor filling this out, right, and
so thinking about that in my ownexperience, how you need to fill those
(21:57):
out and how important they are becausethey're data just as a birth certificate does.
Right, that's where we pull alot of data from yea. So
so really thinking about and again myown experience is a long time ago.
But what needs to be done hereis so that we can again it's being
really transparent and very truthful through thisdata collection. Sure, And what I
(22:22):
will say though is to end onor pivot to a high note. We
have the Perinatal Quality Collaborative, whichis state and federally funded right to help
improve and identify care issues amongst maternaland infant healthcare. So I was happy
to see that got a nice greencheck. You got it, Listen.
I think New York has done well, needs to continue to do well,
(22:45):
and needs to do what they aredoing well, continue to do and then
continue to amplify and step up.Sure, I think that's where we're headed.
So what was interesting is like NewYork was not doing great, but
I saw and ram up Poe NewYork that they had received an a with
the greatest number of live births hadat a pre term birth grade. A
(23:08):
lot of other places received an Fthe majority of the country, and then
I saw Ramapo. Yeah, whenwe started looking at cities, I was
like, wow, yeah, sowhat are they doing differently? Right?
I don't know, but it's agood question, and it's what So when
you start to look at this isyeah, is there something they are doing
differently? Are they doing home visits? Great example, you know places that
(23:29):
are doing home visits after imagine havingsomebody actually come to your home and check
on you after your deliver I haveno idea what they're doing, but wouldn't
it right, Yeah, we knowthose make differences. So I am super
curious as we have just you know, put this report out, is starting
to do that deep dive of placesand what they're doing. So yeah,
so that was very interesting to me. I saw Seattle, Washington has a
(23:49):
good blueprint in place as well,so that was that was also very interesting.
You know, most of the countryin the red, which was not
good to see, but but Isee like kind of where things could be
maybe turning the corner, if youknow, people take a look at this
data and they take it seriously andthey can kind of, you know,
understand what's happening. Yeah, right, Okay, nobody gets right. There
(24:12):
are cities that are doing it well, there's cities that clearly aren't. But
there are states that are doing itwell. So what are they doing?
How can we take We know thatCalifornia is not Tennessee, which is not
New York, but are there programs? Are there the review committees? Are
there things that we can take fromdifferent states to then you know skill,
(24:34):
Sure, but we know that it'snot the same in every place. And
so when you and you start lookingat that vulnerability index, it's the same
kind of thing. You can reallyuse some of the stata to say,
oh this is similar, this isdifferent. But that's where I start to
think hopeful. Right, the Californiaseeing you know, quality committee is fantastic,
(24:57):
and we've taken programs from there andand elevated them. Same for and
I mentioned Tennessee because we've done thesame and sure, so are there ones
that we can really start to launchand program and try them out in other
places? Yeah? Yeah, that'swhere I start to get I guess that's
where I get the hopeful part.Yeah, yeah. I mean there's a
lot of positive things. I mean, this report is not all you know,
(25:18):
no, and specifically for New York. I mean you start to look
at inadequate prenatal care. I meanyou listen, it's sort of you go
back and look at other places,go oh my goodness. There are bits
and pieces of this. There's anoverall theme that we are flat, we're
not focused on the right. Wehaven't as a country focused and here as
a as a nation. I thinkyou can pull apart different states to say
(25:41):
there's been successes and different pieces ofit. Sure, but I and again,
I think and the contribution of riskin each of these places is slightly
different. You know, when youlook across the southeast and I start thinking
about you know, OBC or diabetesand things. But we see that other
places to Sure, so so therehave been Like I said, I think
(26:03):
that we can start to think abouthow to be more intentional with this data.
Yeah, so I saw to yourpoint. I saw hypertension was one
of the preterm birth factors. Wetalked a little bit about diabetes previous pre
term births, which was ranked youknow, pretty high in the scale,
and then carrying multiples twins, andyeah, so when average twins deliver it
(26:25):
thirty six weeks, so four weeksearlier, right, and triplets. Don't
quote me because I want to tripletssince whatever in two thousand and yeah,
two thousand, So they're on averageI think thirty two weeks. So for
every child, every multiple, it'sfour weeks earlier, right, And so
and that that's been known data that'sout there and you can imagine two percentas
(26:45):
right, they need all that bloodflow and growth. And yeah, so
you can see the just from astamp, you know, global standpoint.
Why and we don't We used tohave tremendous amount of triplets and twins.
We've had less and less so becauseof just advances in the reproductive you know
IVF kind of infertilities world from thatstandpoint. But yeah, that in smoking
(27:07):
is another big smoke, like peopleare smoking. Oh so yeah, I
mean, so you're no judge,I'm not judging. I judge. I'm
gonna say I'm a judger so onthis one, because this isn't something that
we haven't been talking I mean,we've been talking about this for so long.
Smoking, right, we yea,smoking is terrible and yeah, smoking
contributes an amazing way in pregnancy.So and we needed to quit way ahead
(27:32):
of time, sure, and sonot just when you get the positive pregnancy
tests. So so to me,this is one of those that's so right.
You can change that, right,you can absolutely change that. But
yeah, people still smoking, andpeople smoke not just or what I like
my family always used to call funnycigarettes. Right, So about marijuana,
and people think it's safe when itis not in pregnancy. So and you'll
(27:56):
get pushed back from patients all thetime saying disagree. And that's so interesting
as a clinician, Right, you'retelling someone that it's not safe, yes,
right, and they're like their justificationfor yes. And a lot of
it is about you know, peopleusing marijuana differently, right, and it
is so much more potent today thanit used to be, and you can
(28:18):
really pull out the THHC. Right. I mean, there's lots of discussion
on this, and American College ofOban has done a really nice job of
puting a statement out there saying likewe you know, we know that this
has growth restriction issues. Sure,this has future implications for children, we
know, so growth restriction alone shouldI would think make people stop but does
not often. Let's take get alittle step further. So what about an
edible or something, So it's thesame thing, And actually edibles are higher
(28:41):
potency, so you're getting more inyour circulation by eating it, Yes,
smoking and just you know, ruiningthe filter of oxygenation, which is your
lungs. Right, I, especiallyin State, have have always said please
eat it before you smoke it,but really need to seasoned. And I
say that just in general, right, right, in the sense of saving
(29:03):
your lungs, But really the potencyis so much stronger in your bloodstream and
so much higher going to your baby, filtering across right across the placenta and
right to baby's brain, right,I was gonna say brain development besides yeah,
no, mom's lungs. And thenreally, and I'm was just trying
to make sure I clarified about whyI was Probably it's probably you know,
(29:25):
I'd much rather see people eating itthan smoking it, but not when you're
pregnant. I want to see anyany of it. And yeah, so
then it's at a much higher levelgoing across the placenta and into baby's bloodstream
and into every organ. And thenyeah, it really looks at gross restriction
and really we haven't right the studiesout about what else long term with the
(29:45):
potency we have today is a problem, I mean and right, and then
also doing the drug test and findingout somebody, right, people are not
wanting to have anything to do withthat. Then you know, we we
have to really know that this isnow right, it's so much more of
it elbow then it used to be. The potency is so much higher than
it was in the sixties right whenit was you know, much different,
(30:06):
and the accessibility of it has nowmade it much we see it much more,
right, Yeah, which is crazy. Stop smoking and stop eating edibles
while you're pregnant. I'll go onthe record and say that I love that
thing. Yeah, no, Imean and listen. And then if you
go to the number one drug isalcohol, people still drink. Wow,
And so that right, so weknow about you know how fetal alcohol can't
(30:29):
write, so we know that crossesinto the baby's bloodstream. And so again
you're talking about you can have awhole really large birth defect because of alcohol,
and we don't know how much istoo much. So people say,
oh, you can just have alittle drink. No, we just say
none at all, because we don'tknow what ones forget about their tolerance.
I'm talking about what baby's tolerance is. So again and something that we could
(30:52):
prevent birth defects way ahead of time. And again it's asking people to stop
before they conceive or if they andit's like one in five I think are
are binge drinking. That's crazy.So there's crazy statistics about alcohol, which
again stepping back, we've known thisfor a really long time. You see
in the bathrooms in almost every restaurant, right, stop drinking if you're pregnant.
(31:14):
I mean you see these people aren'tdoing it. It's crazy because the
numbers are so startling. So I'mreading here that nineteen eight hundred and sixty
eight babies died before their first birthday. I think you started the episode with
something similar, right, statistically,that's it's unreal. Yes, so we
had three hundred and five thousand.I think that was the number. Mak
make sure I say it right becausemy team will grill me for not saying
(31:37):
the right number. We're born premature, so if you think about the report
card, it's ten percent. Soliterally, my husband on Saturday night is
I was telling him the report cardnumber that ten percent. He said,
that means one in ten babies isborn premature in this country. Yes,
that's exactly what That's exactly what itmeans. And I think he just I
(32:00):
mean stopped in his tracks and wewere onto a fundraiser for the March of
Dimes. But I said, yeah, that's that's really it. That that's
that you need to stop there andyou realize. So, yeah, we
we have a lot to do andwe're doing a ton of research in this
area. There's a lot to come. We're making big strides when it comes
to biomarkers for preclampsia or we're doinggreat science, but we've got to get
(32:22):
something that translates into mom's and babieshands. Yeah, well you're doing a
lot. You have the mobile unitsthat are going to be browling out,
so let's talk a little bit aboutthat. Yeah, we're excited. You
know, this is something Martial Timehas been doing for a little bit of
time. But now I think we'rereally looked at as the you know,
as as because only what is ittwo percent of all mobile units are doing
(32:45):
maternal care on their mobile units.So you think about mobile units, I
think about mammograms or maybe getting blooddraws or you know, even blood donation,
right. But but actually what we'vebeen doing is going using it as
bringing providers to the patient. Sowe're in places like Washington, d C.
We're up which, believe it ornot, as Maturity Care Desert,
(33:07):
and then we're in Apple Ahia sowe're in the middle of Ohio. And
then we've got we're launching in Arizonaand with New York Presbyterian. So really
excited to see it take off asreally one of our solutions and bringing a
lot of partners together because we're notproviders, right. I always remind people
we're not providers, despite me beingone, that we're trying to bring solutions
(33:30):
to the patients so that we canthat access issue. We are really trying
to make it so simple. Yeh, we know it's not simple, but
that's really what we're trying to do. So and I can, you know,
really excited that we're expected to bedelivering care five days a week.
Wow, Yeah, that's just great. Yeah, and really thinking about how
(33:53):
that care is delivered and what isdelivered and looking at it from the angle
of it's just there's so much todo for one touch point for a patient
and thinking about all the services wecan wrap around. Yeah. Yeah,
so it gets exciting to that isvery exciting. So anything else you know,
coming going into twenty twenty four thatwe can look forward to our do
a little work is big. Oh. I should also say that the New
(34:15):
York Presbyterian they're really doing a needsassessment of what borough to go into,
Queens or Brooklyn and what's where youknow they and I think in twenty eighteen
we had was among the five NewYork City boroughs. Brooklyn had the highest
total number of births so and burstand Medicaid. So there are lots of
(34:37):
data that again that's old data,right, really trying to figure out the
needs assessment to figure out where thisbush is. Sure, So before I
say that, so twenty twenty four, listen, I'm super excited to think
about new partnerships we're building. Ilove our National Service partners I don't you
know, and where we're going thereand education and driving that trying to really
refocus a little bit on the basicsthat education is super important to keep updated.
(35:02):
I love our doula work. We'vebeen talking about a low dose aspirin
campaign, so I guess I'll sayit publicly of really trying to get education
about who needs low dose aspirin andwho doesn't need, so women who are
at risk for preeclampsia, and there'sa huge criteria. The American COLLEJUVIGN has
(35:23):
it nicely listed, so does thePerinatal Task Force as a society of MFM.
And you know, lots of peoplehave said aspirin isn't safe in pregnancy.
This is low dose. You're talkingabout that eighty one milligrams, starting
it, you know, after thethirteenth week of pregnancy and reducing pre eclampsia.
So that imagine you know, foryour listeners, anyone who's delivered premature,
(35:46):
if I could have gotten one moreweek, if you just think about
one more week. Yeah, sonow we hope no week right, get
full right, no preclampsia, butreally thinking about extend, right, extending
that justtational age and that's what asproncan do. And so we've seen that
it can really reduce the onset ofthe preclamsia, so growth restriction as well
(36:07):
for babies and that pre term birth. So if we can do that,
it can move the needle. Andwhen you talk to some providers that are
like everybody should take it all thetime, forget about screening, and we're
really trying to use evidence bace medicine, but also really want to do the
campaign where we get to moms sothey ask should I be on lodos asprin
(36:31):
And one of the things that Ifind amazing is that black women are on
it the least and they need itthe most. Well, I think because
we don't know about it. Yeah, this is the first time I've ever
heard of it. Oh now nowwe need to ken you have a whole
other session. Yes, because itcould. We are so excited about it
and what partnerships we can bring tothe table, which we are building and
(36:54):
galvanizing right now and thinking about reallylaunching this on as a national basis,
just like we did the Born TooSoon campaign when we talked about please don't
have your baby before thirty nine weeks. You're electively doing that. That's wrong
because babies have a higher chance ofbeing in the neonatal intensive carrying it because
a lung immaturity, another immaturity.But and we stuck to you know,
(37:15):
we really hate help champion that.And when I think about what the Marsha
of Dianas has done and in mycareer that was huge to get that information
out to patients who then ask mebefore I could even say to them,
Nope, not till thirty nine weeks. So we need partnerships like the hospitals,
like outpatient, all of these toreally implement this to yes, because
it makes a huge difference and shouldbe offered just like preen nellow vitamins.
(37:37):
Right, we know full gacidtroduces spineand befit us. Yeah, it's not
so easy because it is a differentdose. It's not right full dose asperin,
it's low dose aspirin. Also,women going to the pharmacy and the
pharmacists saying nope, can't take aspirinin pregnancy, Well you can take low
dose. So really thinking, andwe want it beyond thirteen weeks so not
(37:59):
you know, not in the firsttrimester, and it's the bleeding risk is
incredibly low. Yeah, so allthe pros and conspt what I want every
mom to ask about lotos aspron andI think if we did that, we
would make an amazing thread. Yeah. Yeah, so I get really excited
about coming back, yes, tohave that conversation as we launch it,
(38:20):
but also thinking about implementation science abouthow do you implement to the communities about
lotos aspron. Everyone needs to getinvolved and so that families and you know
so and so is pregnant, Okay, she and loados aspron would be a
great question, Yeah, to ask, right, and do you know about
it? So the fact you don'tmakes me I think we have a lot
more work to do. I alsothink there's also a huge connection in the
(38:43):
black community around cardiac health, yes, right, and aspirin, and that
you could be the connective tissue rightto having those conversations. No, that's
a really good one. We Yeah, so you think about pretty clamsy and
that woman over her lifetime having youknow, risk factors for cardiovascular disease,
for arrhythmias or needing heart surgery lateron in life after having preeclampsia. Aspirin
(39:06):
seems so you know, like,of course, yeah, been on ASPERN
or I should be on aspirin.Whereas in pregnancy, I think it just
isn't a positioned properly. Yeah,and I think from the provider's standpoint,
we've known about this for some time. I just spoke to somebody the other
day who said, you know,I was on that. I had no
idea why and so and the riskscan be race age, I mean not
(39:30):
just having had preclampsia before hypertension.You start going down this list, it's
almost everybody. Yea. So it'spretty and it's again incredibly safe. We
think has lots of evidence behind it. Excited that we'll will be partnering and
more to come on that as welaunch into twenty twenty four. So that
and also really looking to kind ofpresent data before our lotus aspirin and after,
(39:54):
and then a lot of our duelawork as we said, and then
really working on getting our educational materialin Spanish. So I'll throw that down
on the gauntlet that that's what,you know, I really want to make
sure forty two percent of our birthsare you know, I mean we need
to have Spanish materials and we havewe have a lot. I just want
(40:16):
us to be top notch. Yeah, yeah, and then we'll have a
whole nother report card, yes,going into twenty twenty four. So we're
already thinking about it and what it'ssuper excited about our visualization of our data
this year really took a turn andsuper exciting to see how it laid out.
More importantly to me as thinking abouttwenty twenty four's data and what more
we need to be adding so andbringing in sponsors. So right, well,
(40:38):
I'm sure there's some great partners thatare out there who are listening to
this episode. I mean, weappreciate your partnership. This has been so
great, like just building up thisplatform and the content that we've been able
to push out and the credibility thatyou all have you know, brought to
the platform. So we appreciate youfor that. We look forward to continuing
to work together and all such afun time for me. And it's always
(41:00):
impressive come in this space and seeyou and see what you do and all
the patients you're reaching. It's soimportant, so amplifying, right, we
need to continue to do what wedo. Yeah, thank you for sure,
well, thank you, no,thank you. Partnership happening because of
you, so we appreciate that.But you're listening to me eternal on iHeartRadio
(41:20):
here with the lovely doctor Elizabeth Chiroll, CEO of March of Dimes, and
you'll be back sooner than later fromsome more you know, conversations input insight
on all the things that March ofDimes is doing to be effective in the
community and help people have a betterquality of life. Great thanks
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