February 7, 2025 • 22 mins
In this episode of CocoaPods, Dr. Bola Sogade hosts Dr. Julia Interrante from the University of Minnesota to discuss the alarming rise in maternal mortality in the U.S., particularly in rural communities. They examine the consequences of inadequate maternal healthcare access, the role of data in shaping policy, and how technology, such as telemedicine, can support rural healthcare providers. Dr. Interrante highlights the ongoing closure of birth centers and hospitals offering obstetric services, emphasizing that funding and policy changes are essential to prevent further losses. The conversation underscores the need for a systemic shift in healthcare financing and advocacy efforts to ensure safe childbirth for all women, regardless of location or socioeconomic status.Dr. Julia Interrante is a mentee of Dr.Katy Backes Kozhimannil,a Distinguished McKnight University Professor and Co-Director of the University of Minnesota Rural Health Research Center.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Julia Interrante (00:00):
I think, without any interventions, if we
keep going the way that we havebeen going, we're going to
continue to see more moms dyingbefore, during and after
childbirth.
Dr Bola Sogade (00:21):
Hello and welcome to CocoaPods, a podcast
of the Birth Center for NaturalDeliveries Foundation.
My name is Dr Bola Sogade.
I'm a women's health specialist.
On this podcast, we talk aboutall the issues relating to
women's health and identify theproblems and talk about ways in
(00:42):
which we can mitigate theproblems.
Today, I'm very fortunate tohave with me Dr Julia Interrante
, phd, mph from the Universityof Minnesota.
Now, delving back into ourdiscussions from the last
episode, there's probably awoman dying right now, as we're
talking, in a rural community inthe United States, either
(01:05):
because she's driving interrible winter weather to a
hospital to deliver her baby, orshe's just like, forget it, I'm
just going to try to have thisbaby at home.
Or she just had a seizure frompreeclampsia.
Now it's eclampsia.
What do you see as thelong-term consequences number
(01:28):
one of these trends if no realintervention?
Because there's a lot of talkEverybody wants to talk about a
pregnant woman and her baby.
So if there are nointerventions made to improve
access to care, what do we seeas long-term consequences?
And then, how can data fromstudies, like from what people
(01:50):
like you guys have done, informfuture healthcare planning and
resource allocation for maternalhealth?
And now, in this age of AI andtechnology.
And now, in this age of AI andtechnology, what role does
technology such as telemedicineor remote monitoring?
What role could this play inimproving access to obstetric
(02:16):
care in underserved areas?
I know that, even despite this,somebody has to lay hands on a
pregnant woman and help herdeliver a baby, so there's a
limited.
I mean, we don't have robotsthat will deliver babies yet, so
there's a limit to what AI andtechnology can do.
So can you wrap up what thelong-term consequences of a lack
(02:37):
of intervention and thelong-term solutions could be to
this problem?
Dr Julia Interrante (02:43):
Yeah, I think without any interventions,
if we keep going the way thatwe have been going, we're going
to continue to see more momsdying before, during and after
childbirth.
I think we'll continue to seerural areas lose access to more
and more services and more ruralcommunities lose services that
have been like hanging on by athread, basically, which is
(03:08):
terrible.
There are solutions that weknow exist, and part of that is
putting our money where ourmouth is right, like we show as
a society what we value by howmuch we pay for it and if we're
not willing to pay to make surethat services are maintained or
brought back in ruralcommunities where they are
needed, and also, again, we maynot be able to get back services
(03:32):
that have been lost in everyrural community, but to be able
to provide some kind ofconnections of care.
There has been a lot of work onregional partnerships, having
like a spoken hub model whereyou maybe there is a local area
for the lowest risk patients,but there are good connections
and relationships with access to, like, more urban centers with
(03:54):
higher acuity services forhigher risk patients.
That's really important too.
How can the data help withfuture healthcare planning and
resources?
Like I said, we do a lot of ourresearch to try to highlight
where these challenges are, tomake sure that that information
gets into policymakers' handsand that, when they are
(04:15):
developing policy, that our datais there to help inform the way
policies are developed, to makesure that some communities
aren't being left out or therearen't unintended consequences
of policies, which we do seehappen, even with
well-intentioned policies.
Again, I think, ensuring thatthere is a diversity of views,
(04:38):
not just like racial diversitybut also clinical diversity.
So having obstetricians andmidwives and family physicians
and nurses, who are highlyinvolved in a lot of providing
maternity care, have a voice andsay, and the communities who
are impacted, so people who aregiving birth being able to have
a say in what's happening intheir communities.
(04:59):
You also asked about the role oftechnology.
You also asked about the roleof technology and I do think
that there is an important rolehere for telemedicine.
It is not a fix-all right.
You talked about thattouchpoint being important and
it's true.
(05:20):
One of the things that we talkabout a lot in rural maternity
care is especially havingprovider-to-provider telehealth
so that rural clinicians havethat connection to another
hospital with potentially moreresources, who see a higher
volume of patients that maybesee more complications more
often and have more clinicalskill in those areas, have that
support back to the localcommunity so that when there is
(05:43):
a challenge that arises thatmight be able to be taken care
of in the local rural community,that those clinicians can reach
out to their partners throughprovider-to-provider telehealth
and get that support and thenagain have those relationships
set up if they do need totransfer a patient who needs
higher level of care.
So again, I think there's a rolefor it and also, again bringing
(06:05):
back the financing part of it,that when that telemedicine is
set up that there's some kind ofpay equity, because again, the
financing of maternity care isreally challenging where if a
rural hospital transfers theirpatients to an urban hospital
for childbirth to make sure thatthat rural hospital has been
doing all of the prenatal carewho will probably be involved in
(06:25):
the postpartum care is stillreimbursed adequately for the
services that they have providedand the role that they have
played, so that all thechildbirth reimbursement doesn't
only go to the urban hospitalwhere the actual delivery takes
place.
If that is the case, if thatmakes sense.
Dr Bola Sogade (06:42):
Yeah, it makes sense.
Yeah, and you did, you know?
Started my next topic, which isabout advocacy and awareness.
You know, how can healthcareproviders, policymakers and the
public work together to raiseawareness about the importance
of maintaining obstetricservices in these rural areas?
(07:02):
What are the most pressing gapsin the current research on
maternal healthcare access andhow can they be addressed?
And the third part of myquestion is what advice would
you give to healthcare providersor advocates looking to
influence policy changes in thisarea?
Dr Julia Interrante (07:24):
Yes, thank you for those questions, let's
see.
So how can healthcare providers, policymakers and the public
work together to raise awareness?
We have been trying to do thatin our work.
As I mentioned, when we doresearch, we're an academic
institution, so often part ofour research goes through the
peer review processes andpublished in peer review
(07:46):
journals, but a lot of those arebehind paywalls and so that can
create a big barrier forcommunity members and even
policymakers and providers foraccessing a lot of the findings
from that we publish as policybriefs or publicly facing
documents that are written andpresented in a way that is less
(08:09):
jargony and complex and juststraightforward.
I'm not always perfect at that,but we do really try to make
things accessible and absorbableand done through like
visualizations rather thancomplicated statsy tables and
things that are not easilyabsorbed.
Also, working with the media wedo work with the media a lot
(08:31):
and they do play an importantrole telling individual patient
stories and individualhealthcare provider stories and
making those connections withpolicymakers, and we even have a
few states have done this now,and it's a policy that has
passed in Minnesota that when ahospital plans to close a
(08:52):
service line and specifically anobstetric unit, that they have
to report that to the departmentof health and they have to have
a policy community conversation.
And setting where communitymembers can come in and discuss
their concerns and having peopleshow up to those is really
(09:12):
important and having peoplestand up and discuss how
important having maternity carein their community is and what
their challenges are when theycan't access that service.
In terms of some of the gaps incurrent research, there's a lot
of challenges with what data iseven available and again, this
(09:33):
is something that I am acutelytied to because I'm a
quantitative researcher.
That's something that there aresometimes questions that are
asked of us by policymakers thatwe can't answer because there's
no data that exists to be ableto analyze it no data that
exists to be able to analyze it.
So things like at the beginningof our discussion I talked
about how it's actually reallycomplicated to figure out which
(09:54):
hospitals are and aren'tproviding obstetric care.
That's even more challengingwhen you're trying to figure out
which freestanding birthcenters exist in which
communities which, like thenumber of midwives that practice
in rural and urban communities,like the number of midwives
that practice in rural and urbancommunities and different types
of midwives too.
A lot of that stuff isn't justnationally publicly available,
(10:17):
so it can get really challengingto even point out what the
issues are.
So again, a lot of the data.
Again I mentioned the challengesof maternity care financing.
A lot of that data is notpublicly available and not
available to the level where wecan see, like, how much each
hospital is spending onmaternity services specifically,
let alone like on which typesof maternity services that
(10:42):
they're providing.
And so without being able todig into the weeds on the
financing of it, it can bechallenging to say did this
policy actually solve thisproblem or did it not, and why
did it not, if that makes sense.
Dr Bola Sogade (10:56):
It does, it does .
Yeah yeah, I'm glad youmentioned even the fact that if
service line is closing,specifically maternity service
line, that hospital needs tonotify the health department,
because, as I'm speaking to you,we're broadcasting from Forsyth
, georgia.
We do have a rural hospitalhere close to obstetric services
(11:17):
.
About 40, maybe 45 years ago,we opened a freestanding
birthing center providing carefor the women.
So it's important to know, youknow for the community to know
that this service is notavailable in this hospital and
they need to know theiralternatives.
You published paper Changes inHospital-Based Obstetric
(11:38):
Services in Rural US Countiesbetween 2014 and 2018, in which
you underscored the systemicchallenges in maternal health
(12:00):
care access and theirimplications for you know
maternal and infant outcomes.
So you know, and I know we'vetalked about this and this even
preceded your 2010 paper.
So you guys have been, like yousaid, looking at this for a
long time.
So, if we're just going tosummarize that paper I believe
(12:21):
you did this with Dr how wouldyou summarize that paper?
Dr Julia Interrante (12:26):
Yeah.
So again, this one was somewhatsimilar to our more recent
publication, but we were reallylooking at our like unit of
analysis, which again it's avery jargony turn, but we were
looking at counties, whereas ournewest one was looking at
actual hospitals.
So we were looking at countiesand we were looking at were
these counties rural or urban?
(12:47):
And if they were rural, didthey border another county that
was urban or were they not?
So again, these are likethinking about more isolated,
further driving distance if youneed to get to an urban center.
So that's where we were reallyjust documenting what did it
look like in counties formaternity care services?
(13:07):
And that's where we were seeing, again, the loss of obstetric
services was much higher inthose that were the most remote
and rural.
And again, our newest paper wasjust documenting again that
those challenges have continued.
Those losses have continued.
Despite some of the policiesthat have been implemented and
despite the awareness that hasbeen raised, it hasn't been
enough yet to curb this trendthat have been implemented and
(13:28):
despite the awareness that hasbeen raised, it hasn't been
enough yet to curb this trendthat we're seeing.
Dr Bola Sogade (13:34):
So we have been talking to Dr Julia Interante
with the University of Minnesota.
You know you said that some ofthe data actually about
freestanding birthing centersand how midwives practice can be
obtained from the AmericanAssociation of Birth Centers and
the Commission of Accreditationof Birth Centers.
(13:55):
So all accredited birth centersare under this umbrella and
these organizations collect dataand we actually submit data to
them.
You know they give us acriteria of data to submit and
we submit data to them.
So that's a good place to getsome data on these free birthing
(14:17):
centers.
But as we close, Dr Ntaranti,this problem is a big problem.
I'm happy that you are doingthe research, at least
quantifying some things that wecan look at in the past and look
to the future for but it'sstill a big problem.
Women do live in rural areas ofAmerica.
(14:38):
A lot of families are in ruralareas of America.
They are living their liveshaving babies and doing the
things people do in urbanAmerica as much as possible.
You know what can be done.
You know, when you reflect onsome of the insights from Dr
Cozy Manuel's paper and yourpaper and your studies, what are
(15:04):
the lessons learned from thisresearch and how can healthcare
providers implement the researchfindings to improve care
delivery and what can we as acountry do to help this
vulnerable group, you know,which is pregnant women and
(15:28):
their newborn infants?
What can we as a country do?
Because, like you said, thisproblem has been around for a
long time and it's still youhappening, and this is America.
I'm not talking about a thirdworld country, I'm talking about
the United States of America,where women are still dying,
compared to other developedcountries, at an alarming rate,
(15:51):
from pregnancy and childbirth.
What are the lessons learnedfrom research and what can we do
to somewhat improve thisproblem?
And what can we?
Dr Julia Interrante (16:02):
do to somewhat improve this problem?
Yeah, maybe I can even start byanswering this question by
talking about my own experiences, if that's okay.
So I know we have talked in ouremails before this.
I gave birth to my first childin Georgia and I had a midwife,
which was wonderful.
There were no birth centersthat took insurance in the time
(16:24):
where I was, and so I ended upgiving birth in a hospital, and
that hospital is now closed.
It doesn't exist anymore.
I moved to Minnesota shortlyafter and where I gave birth to
my second and third child at afreestanding birth center with
midwives.
It was the most wonderfulexperience I could have ever
imagined.
(16:44):
I was able to have the birththat I had dreamed of having for
both of those, and that birthcenter is also now closed.
They just announced that theyclosed just in December 2024.
So every place now that I havegiven birth no longer exists,
which is heartbreaking.
And again, to know that this ishappening to rural communities
(17:04):
and in some urban communitiesall over the country is just
unacceptable.
So we know that offeringobstetric care is a financial
challenge for hospitals and forbirth centers, and a lot of the
revenues don't cover the costthat is required in our system
to maintain those services.
There's dedicated space that'sneeded, equipment and trained
(17:27):
staff that are available tosupport labor and delivery
whenever pregnant patients needthat care.
So again, I think paying forthose services that we need is
essential and treating health asa human right is also essential
.
We talk about, again, thehealth of people before they
give birth, during and after,and paying for all of that to
(17:51):
maintain those services isreally necessary.
So some of the actions that wecan take again are funding
standby capacity to cover thefixed costs of providing
maternity services, standbycapacity to cover the fixed
costs of providing maternityservices.
Making sure that Medicaid isfully resourced and reimburses
at a rate that is financiallyreasonable and like covers the
(18:11):
cost of actually providing thatcare.
And, again, paying more for allservices and not leaving out
things like the postpartumperiod and interpregnancy
periods.
And, again, really tying inquality and safety that is
available to all patients,regardless of where they live,
(18:31):
the color of their skin, whattheir income is.
All those other factors that weknow have deep systemic issues
and result in inadequate andinequitable outcomes in maternal
and infant health.
Dr Bola Sogade (18:47):
Wow, I like the way you tie the fact about your
deliveries, because this is athing Anytime.
There's a personal experiencelike that, people listen, people
are like, wow, you know this isa professor, you know she's
done all this study and you knowthis is her story.
You know people relate a lotlike that and you know I'm on
(19:08):
several forums and on severalboards about this birth center
and I see the problem and a lotof birth centers, especially for
the accredited ones likeourselves.
You know we go through arigorous process of
accreditation.
We want a safe delivery too.
Accredited ones like ourselves,you know we go through a
rigorous process ofaccreditation.
We want a safe delivery too.
(19:29):
You know the compensation forthe facilities is less than the
hospital.
So a lot of us do it out of thefact that we do see a need, we
see a better way of doing thesethings and we want to help women
actualize and realize theirdreams of how they want to have
their babies.
So I feel so fortunate, soblessed to actually have had you
, in particular, as a guest onthis podcast, because this is
(19:51):
going to resonate to a lot ofwomen, because it's a problem.
We want it solved, we don'twant to give a life for a life.
We want to make sure that womendeliver safely in the United
States of America, like in otherdeveloped countries.
(20:11):
We want women to have thatoption, regardless of, indeed,
the color of their skin, theirability to pay.
It should be a human rightsissue.
So I'm just so grateful to youfor coming to this CocoaPod
podcast, and we always ask ourguests to say one fun fact about
themselves.
You have a lot of degrees.
(20:33):
I'm curious to hear what is thefun fact about you.
You have a BA, you have a PhD,you have a mom times three.
That's the biggest thing Ithink you know.
We just want to really thankyou for coming and, you know, is
there a fun fact about you thatyou want to share with us?
Dr Julia Interrante (20:55):
Yeah, I can share.
It's silly, but I live inMinnesota where, like, it's cold
and people go ice skating.
I grew up in New Mexico whereit's a desert and there's no
outdoors ice skating there, butmy kids have all been ice
skating since they could stand.
My husband is Canadian, so heplays hockey and has skated his
(21:18):
whole life.
I finally, this year, took myfirst skating lesson, so I'm
learning how to ski.
That's my totally not relatedfun fact that.
Dr Bola Sogade (21:28):
I'm very proud of.
Dr Interrante, I just want tothank you very much and I want
you to please extend ourappreciation to Dr.
Kozhimannil because she madethe introductions.
We're very grateful for thework that you guys are doing.
Dr Julia Interrante (21:46):
I'm not as eloquent as Dr Kozhimannil is
she's a great mentor to me.
Dr Bola Sogade (21:50):
And I just want to thank you very much for the
time spent here.
I know you have a busy schedule, but I am very grateful and
thank you so much for coming toCocoaPods podcast.
Dr Julia Interrante (22:01):
Thank you so much for coming to CocoaPods
podcast.
Thank you so much for having me.
I think, without any interventions, if we
keep going the way that we havebeen going, we're going to
continue to see more moms dyingbefore, during and after
childbirth.
Dr Bola Sogade (00:21):
Hello and welcome to CocoaPods, a podcast
of the Birth Center for NaturalDeliveries Foundation.
My name is Dr Bola Sogade.
I'm a women's health specialist.
On this podcast, we talk aboutall the issues relating to
women's health and identify theproblems and talk about ways in
(00:42):
which we can mitigate theproblems.
Today, I'm very fortunate tohave with me Dr Julia Interrante
, phd, mph from the Universityof Minnesota.
Now, delving back into ourdiscussions from the last
episode, there's probably awoman dying right now, as we're
talking, in a rural community inthe United States, either
(01:05):
because she's driving interrible winter weather to a
hospital to deliver her baby, orshe's just like, forget it, I'm
just going to try to have thisbaby at home.
Or she just had a seizure frompreeclampsia.
Now it's eclampsia.
What do you see as thelong-term consequences number
(01:28):
one of these trends if no realintervention?
Because there's a lot of talkEverybody wants to talk about a
pregnant woman and her baby.
So if there are nointerventions made to improve
access to care, what do we seeas long-term consequences?
And then, how can data fromstudies, like from what people
(01:50):
like you guys have done, informfuture healthcare planning and
resource allocation for maternalhealth?
And now, in this age of AI andtechnology.
And now, in this age of AI andtechnology, what role does
technology such as telemedicineor remote monitoring?
What role could this play inimproving access to obstetric
(02:16):
care in underserved areas?
I know that, even despite this,somebody has to lay hands on a
pregnant woman and help herdeliver a baby, so there's a
limited.
I mean, we don't have robotsthat will deliver babies yet, so
there's a limit to what AI andtechnology can do.
So can you wrap up what thelong-term consequences of a lack
(02:37):
of intervention and thelong-term solutions could be to
this problem?
Dr Julia Interrante (02:43):
Yeah, I think without any interventions,
if we keep going the way thatwe have been going, we're going
to continue to see more momsdying before, during and after
childbirth.
I think we'll continue to seerural areas lose access to more
and more services and more ruralcommunities lose services that
have been like hanging on by athread, basically, which is
(03:08):
terrible.
There are solutions that weknow exist, and part of that is
putting our money where ourmouth is right, like we show as
a society what we value by howmuch we pay for it and if we're
not willing to pay to make surethat services are maintained or
brought back in ruralcommunities where they are
needed, and also, again, we maynot be able to get back services
(03:32):
that have been lost in everyrural community, but to be able
to provide some kind ofconnections of care.
There has been a lot of work onregional partnerships, having
like a spoken hub model whereyou maybe there is a local area
for the lowest risk patients,but there are good connections
and relationships with access to, like, more urban centers with
(03:54):
higher acuity services forhigher risk patients.
That's really important too.
How can the data help withfuture healthcare planning and
resources?
Like I said, we do a lot of ourresearch to try to highlight
where these challenges are, tomake sure that that information
gets into policymakers' handsand that, when they are
(04:15):
developing policy, that our datais there to help inform the way
policies are developed, to makesure that some communities
aren't being left out or therearen't unintended consequences
of policies, which we do seehappen, even with
well-intentioned policies.
Again, I think, ensuring thatthere is a diversity of views,
(04:38):
not just like racial diversitybut also clinical diversity.
So having obstetricians andmidwives and family physicians
and nurses, who are highlyinvolved in a lot of providing
maternity care, have a voice andsay, and the communities who
are impacted, so people who aregiving birth being able to have
a say in what's happening intheir communities.
(04:59):
You also asked about the role oftechnology.
You also asked about the roleof technology and I do think
that there is an important rolehere for telemedicine.
It is not a fix-all right.
You talked about thattouchpoint being important and
it's true.
(05:20):
One of the things that we talkabout a lot in rural maternity
care is especially havingprovider-to-provider telehealth
so that rural clinicians havethat connection to another
hospital with potentially moreresources, who see a higher
volume of patients that maybesee more complications more
often and have more clinicalskill in those areas, have that
support back to the localcommunity so that when there is
(05:43):
a challenge that arises thatmight be able to be taken care
of in the local rural community,that those clinicians can reach
out to their partners throughprovider-to-provider telehealth
and get that support and thenagain have those relationships
set up if they do need totransfer a patient who needs
higher level of care.
So again, I think there's a rolefor it and also, again bringing
(06:05):
back the financing part of it,that when that telemedicine is
set up that there's some kind ofpay equity, because again, the
financing of maternity care isreally challenging where if a
rural hospital transfers theirpatients to an urban hospital
for childbirth to make sure thatthat rural hospital has been
doing all of the prenatal carewho will probably be involved in
(06:25):
the postpartum care is stillreimbursed adequately for the
services that they have providedand the role that they have
played, so that all thechildbirth reimbursement doesn't
only go to the urban hospitalwhere the actual delivery takes
place.
If that is the case, if thatmakes sense.
Dr Bola Sogade (06:42):
Yeah, it makes sense.
Yeah, and you did, you know?
Started my next topic, which isabout advocacy and awareness.
You know, how can healthcareproviders, policymakers and the
public work together to raiseawareness about the importance
of maintaining obstetricservices in these rural areas?
(07:02):
What are the most pressing gapsin the current research on
maternal healthcare access andhow can they be addressed?
And the third part of myquestion is what advice would
you give to healthcare providersor advocates looking to
influence policy changes in thisarea?
Dr Julia Interrante (07:24):
Yes, thank you for those questions, let's
see.
So how can healthcare providers, policymakers and the public
work together to raise awareness?
We have been trying to do thatin our work.
As I mentioned, when we doresearch, we're an academic
institution, so often part ofour research goes through the
peer review processes andpublished in peer review
(07:46):
journals, but a lot of those arebehind paywalls and so that can
create a big barrier forcommunity members and even
policymakers and providers foraccessing a lot of the findings
from that we publish as policybriefs or publicly facing
documents that are written andpresented in a way that is less
(08:09):
jargony and complex and juststraightforward.
I'm not always perfect at that,but we do really try to make
things accessible and absorbableand done through like
visualizations rather thancomplicated statsy tables and
things that are not easilyabsorbed.
Also, working with the media wedo work with the media a lot
(08:31):
and they do play an importantrole telling individual patient
stories and individualhealthcare provider stories and
making those connections withpolicymakers, and we even have a
few states have done this now,and it's a policy that has
passed in Minnesota that when ahospital plans to close a
(08:52):
service line and specifically anobstetric unit, that they have
to report that to the departmentof health and they have to have
a policy community conversation.
And setting where communitymembers can come in and discuss
their concerns and having peopleshow up to those is really
(09:12):
important and having peoplestand up and discuss how
important having maternity carein their community is and what
their challenges are when theycan't access that service.
In terms of some of the gaps incurrent research, there's a lot
of challenges with what data iseven available and again, this
(09:33):
is something that I am acutelytied to because I'm a
quantitative researcher.
That's something that there aresometimes questions that are
asked of us by policymakers thatwe can't answer because there's
no data that exists to be ableto analyze it no data that
exists to be able to analyze it.
So things like at the beginningof our discussion I talked
about how it's actually reallycomplicated to figure out which
(09:54):
hospitals are and aren'tproviding obstetric care.
That's even more challengingwhen you're trying to figure out
which freestanding birthcenters exist in which
communities which, like thenumber of midwives that practice
in rural and urban communities,like the number of midwives
that practice in rural and urbancommunities and different types
of midwives too.
A lot of that stuff isn't justnationally publicly available,
(10:17):
so it can get really challengingto even point out what the
issues are.
So again, a lot of the data.
Again I mentioned the challengesof maternity care financing.
A lot of that data is notpublicly available and not
available to the level where wecan see, like, how much each
hospital is spending onmaternity services specifically,
let alone like on which typesof maternity services that
(10:42):
they're providing.
And so without being able todig into the weeds on the
financing of it, it can bechallenging to say did this
policy actually solve thisproblem or did it not, and why
did it not, if that makes sense.
Dr Bola Sogade (10:56):
It does, it does .
Yeah yeah, I'm glad youmentioned even the fact that if
service line is closing,specifically maternity service
line, that hospital needs tonotify the health department,
because, as I'm speaking to you,we're broadcasting from Forsyth
, georgia.
We do have a rural hospitalhere close to obstetric services
(11:17):
.
About 40, maybe 45 years ago,we opened a freestanding
birthing center providing carefor the women.
So it's important to know, youknow for the community to know
that this service is notavailable in this hospital and
they need to know theiralternatives.
You published paper Changes inHospital-Based Obstetric
(11:38):
Services in Rural US Countiesbetween 2014 and 2018, in which
you underscored the systemicchallenges in maternal health
(12:00):
care access and theirimplications for you know
maternal and infant outcomes.
So you know, and I know we'vetalked about this and this even
preceded your 2010 paper.
So you guys have been, like yousaid, looking at this for a
long time.
So, if we're just going tosummarize that paper I believe
(12:21):
you did this with Dr how wouldyou summarize that paper?
Dr Julia Interrante (12:26):
Yeah.
So again, this one was somewhatsimilar to our more recent
publication, but we were reallylooking at our like unit of
analysis, which again it's avery jargony turn, but we were
looking at counties, whereas ournewest one was looking at
actual hospitals.
So we were looking at countiesand we were looking at were
these counties rural or urban?
(12:47):
And if they were rural, didthey border another county that
was urban or were they not?
So again, these are likethinking about more isolated,
further driving distance if youneed to get to an urban center.
So that's where we were reallyjust documenting what did it
look like in counties formaternity care services?
(13:07):
And that's where we were seeing, again, the loss of obstetric
services was much higher inthose that were the most remote
and rural.
And again, our newest paper wasjust documenting again that
those challenges have continued.
Those losses have continued.
Despite some of the policiesthat have been implemented and
despite the awareness that hasbeen raised, it hasn't been
enough yet to curb this trendthat have been implemented and
(13:28):
despite the awareness that hasbeen raised, it hasn't been
enough yet to curb this trendthat we're seeing.
Dr Bola Sogade (13:34):
So we have been talking to Dr Julia Interante
with the University of Minnesota.
You know you said that some ofthe data actually about
freestanding birthing centersand how midwives practice can be
obtained from the AmericanAssociation of Birth Centers and
the Commission of Accreditationof Birth Centers.
(13:55):
So all accredited birth centersare under this umbrella and
these organizations collect dataand we actually submit data to
them.
You know they give us acriteria of data to submit and
we submit data to them.
So that's a good place to getsome data on these free birthing
(14:17):
centers.
But as we close, Dr Ntaranti,this problem is a big problem.
I'm happy that you are doingthe research, at least
quantifying some things that wecan look at in the past and look
to the future for but it'sstill a big problem.
Women do live in rural areas ofAmerica.
(14:38):
A lot of families are in ruralareas of America.
They are living their liveshaving babies and doing the
things people do in urbanAmerica as much as possible.
You know what can be done.
You know, when you reflect onsome of the insights from Dr
Cozy Manuel's paper and yourpaper and your studies, what are
(15:04):
the lessons learned from thisresearch and how can healthcare
providers implement the researchfindings to improve care
delivery and what can we as acountry do to help this
vulnerable group, you know,which is pregnant women and
(15:28):
their newborn infants?
What can we as a country do?
Because, like you said, thisproblem has been around for a
long time and it's still youhappening, and this is America.
I'm not talking about a thirdworld country, I'm talking about
the United States of America,where women are still dying,
compared to other developedcountries, at an alarming rate,
(15:51):
from pregnancy and childbirth.
What are the lessons learnedfrom research and what can we do
to somewhat improve thisproblem?
And what can we?
Dr Julia Interrante (16:02):
do to somewhat improve this problem?
Yeah, maybe I can even start byanswering this question by
talking about my own experiences, if that's okay.
So I know we have talked in ouremails before this.
I gave birth to my first childin Georgia and I had a midwife,
which was wonderful.
There were no birth centersthat took insurance in the time
(16:24):
where I was, and so I ended upgiving birth in a hospital, and
that hospital is now closed.
It doesn't exist anymore.
I moved to Minnesota shortlyafter and where I gave birth to
my second and third child at afreestanding birth center with
midwives.
It was the most wonderfulexperience I could have ever
imagined.
(16:44):
I was able to have the birththat I had dreamed of having for
both of those, and that birthcenter is also now closed.
They just announced that theyclosed just in December 2024.
So every place now that I havegiven birth no longer exists,
which is heartbreaking.
And again, to know that this ishappening to rural communities
(17:04):
and in some urban communitiesall over the country is just
unacceptable.
So we know that offeringobstetric care is a financial
challenge for hospitals and forbirth centers, and a lot of the
revenues don't cover the costthat is required in our system
to maintain those services.
There's dedicated space that'sneeded, equipment and trained
(17:27):
staff that are available tosupport labor and delivery
whenever pregnant patients needthat care.
So again, I think paying forthose services that we need is
essential and treating health asa human right is also essential
.
We talk about, again, thehealth of people before they
give birth, during and after,and paying for all of that to
(17:51):
maintain those services isreally necessary.
So some of the actions that wecan take again are funding
standby capacity to cover thefixed costs of providing
maternity services, standbycapacity to cover the fixed
costs of providing maternityservices.
Making sure that Medicaid isfully resourced and reimburses
at a rate that is financiallyreasonable and like covers the
(18:11):
cost of actually providing thatcare.
And, again, paying more for allservices and not leaving out
things like the postpartumperiod and interpregnancy
periods.
And, again, really tying inquality and safety that is
available to all patients,regardless of where they live,
(18:31):
the color of their skin, whattheir income is.
All those other factors that weknow have deep systemic issues
and result in inadequate andinequitable outcomes in maternal
and infant health.
Dr Bola Sogade (18:47):
Wow, I like the way you tie the fact about your
deliveries, because this is athing Anytime.
There's a personal experiencelike that, people listen, people
are like, wow, you know this isa professor, you know she's
done all this study and you knowthis is her story.
You know people relate a lotlike that and you know I'm on
(19:08):
several forums and on severalboards about this birth center
and I see the problem and a lotof birth centers, especially for
the accredited ones likeourselves.
You know we go through arigorous process of
accreditation.
We want a safe delivery too.
Accredited ones like ourselves,you know we go through a
rigorous process ofaccreditation.
We want a safe delivery too.
(19:29):
You know the compensation forthe facilities is less than the
hospital.
So a lot of us do it out of thefact that we do see a need, we
see a better way of doing thesethings and we want to help women
actualize and realize theirdreams of how they want to have
their babies.
So I feel so fortunate, soblessed to actually have had you
, in particular, as a guest onthis podcast, because this is
(19:51):
going to resonate to a lot ofwomen, because it's a problem.
We want it solved, we don'twant to give a life for a life.
We want to make sure that womendeliver safely in the United
States of America, like in otherdeveloped countries.
(20:11):
We want women to have thatoption, regardless of, indeed,
the color of their skin, theirability to pay.
It should be a human rightsissue.
So I'm just so grateful to youfor coming to this CocoaPod
podcast, and we always ask ourguests to say one fun fact about
themselves.
You have a lot of degrees.
(20:33):
I'm curious to hear what is thefun fact about you.
You have a BA, you have a PhD,you have a mom times three.
That's the biggest thing Ithink you know.
We just want to really thankyou for coming and, you know, is
there a fun fact about you thatyou want to share with us?
Dr Julia Interrante (20:55):
Yeah, I can share.
It's silly, but I live inMinnesota where, like, it's cold
and people go ice skating.
I grew up in New Mexico whereit's a desert and there's no
outdoors ice skating there, butmy kids have all been ice
skating since they could stand.
My husband is Canadian, so heplays hockey and has skated his
(21:18):
whole life.
I finally, this year, took myfirst skating lesson, so I'm
learning how to ski.
That's my totally not relatedfun fact that.
Dr Bola Sogade (21:28):
I'm very proud of.
Dr Interrante, I just want tothank you very much and I want
you to please extend ourappreciation to Dr.
Kozhimannil because she madethe introductions.
We're very grateful for thework that you guys are doing.
Dr Julia Interrante (21:46):
I'm not as eloquent as Dr Kozhimannil is
she's a great mentor to me.
Dr Bola Sogade (21:50):
And I just want to thank you very much for the
time spent here.
I know you have a busy schedule, but I am very grateful and
thank you so much for coming toCocoaPods podcast.
Dr Julia Interrante (22:01):
Thank you so much for coming to CocoaPods
podcast.
Thank you so much for having me.
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