April 27, 2023 • 23 mins
Joining the podcast is Dr. Dawnette Lewis, MD MPH for the Center of Maternal Health at Northwell. As a maternal healthcare leader at one of New York’s largest hospital systems, she’ll be discussing the risk black women face during and after childbirth and the solutions Northwell Health provides for black mothers. Throughout the conversation mothers of color will hear about the support systems Northwell Health has in place to combat the black maternal health crisis and ensure black mothers have an equitable health care experience.
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Episode Transcript
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(00:01):
Meternal. I'm a black woman,and so we all. I have my
own birth story, and so Iconsider myself someone who is very fortunate to
have you come through. And Ijust want to know that the work that
I'm doing is meaningful and has purpose. And I am committed to the health
(00:21):
of our birthing moms in our hospital, and so is Northwell Health. Welcome
to Meternal. I am Kenny Gibson, and I'm here with a very special
guest in our studio today, doctorDownette Lewis, MD, MPH, director
of the Center from Maternal Health atNorthwall. Welcome to Meternal. Oh,
thank you so much for having me, and I'm excited to be here to
(00:43):
discuss maternal health. Yes, we'rehappy to have you and hear about all
the things that Northwall is doing inthis space. So I want to hear
a little bit how you got involvedinitially in the maternal healthcare space. Well,
I am a maternal fetal medicine physicianin my day job, and so
every day we take care of patientswho have either high risk pregnancies or their
complications with the fetus. So basicallyfrom my entire career after residency, it's
(01:08):
been focused on maternal health. Wow, and you've been doing this for over
twenty years. Yes, that's veryimpressive. It's fun. I mean,
I enjoy what I do. Sodid you always know you were going to
be in this space? Like,how did you figure out that this was
the area that you wanted to workin? You know, I'm not sure.
So I grew up. I wasborn in Jamaica in the West Indies,
(01:29):
and I always wanted to be aphysician, and somehow it was always
upstructure schanganecology. I don't know howI arrived at that, but you know,
that's where you know, I enterthe field. And I always knew
I wanted to take care of womenand being women's health and it was what
was most interesting to me when Iwas in medical school. That's great.
And then how did you end upat Northwall? I was having this conversation.
(01:53):
So I did my residency in Milwaukee, Wisconsin, and then after that
I did a fellowship in maternal fetalmetals and at Thomas Jefferson University. And
when my parents moved here from Jamaica, we settled in the Bronx and so
New York was basically my home.And so after I was finishing fellowship,
I sat up, you know,my parents are older, maybe I should
move back home, so like it'dbe close to them. And Northwell was
(02:15):
hiring, and so I interviewed thereand in two thousand and three started working
at Northwall. I actually came acrossto quote from your CEO, Michael Dowling,
the risk black women face during andafter pregnancy and childbirth are shameful illustration
of the disparities that continue to diminishthe well being of our nation. How
does it make you feel to hearsomething like that. It's concerning because I'm
(02:39):
a black woman, and so it'salso hurts to know that when you enter
the hospital or any healthcare space,that you're not treated the same as anyone
else. And then what's your positioningon the black maternal health crisis as a
whole, and why do you feelit's important for Northwall to provide solutions to
black mothers to bad this crisis?Well, Northwell Health, it's an excellent
(03:02):
health system, and I would saykudos to our CEO for recognizing that this
is an issue. It's a crisisin this country. And I think north
Wall itself, because of the infrastructurethat's it provides. It's situated perfectly to
handle this crisis for sure. Andone major solution that north Wall has come
(03:23):
to the forefront with is the centerfrom Eternal Health, which you're leading,
And can you share a little bitof how the center is serving families of
color in the community. Sure.So our center, it's it's a virtual
center, and it's it's comprised ofdifferent entities within Northwell Health. So we
have an antipartum work group which isled by doctor Salaslopez in Communitian Population Health.
(03:47):
We have a paripartum work group whichis our obgy and service line,
and we also have a postpartum groupwhich is led by doctor Zena Brown through
Health Solutions at Northwell Health. Andso because of all the assets within Northwell,
we're able to provide care for patientsacross the continuum of their pregnancy.
That's wonderful. So it sounds likeif me as a black mom, right,
(04:09):
if I choose Northwell as my hospitalprovider, I'm going to have a
really good, thorough experience from youmy pre pregnancy to postpartum. It sounds
like you have it all under controlthere. Well, we're trying to get
it under control, and you know, one of the things that's helping us
as data. And so we havea pernatal data center that has information from
(04:30):
seven of our ten birthing hospitals,and so that helps to guide some of
our initiatives. And from the pernatalData Center, we know that their disparities
even in our own healthcare system,and so that helps us to direct some
of our initiatives and some of ourprograms. So, for instance, we
know that preclamsia can cause complications andpregnancy and for non Hispanic Black patients that
(04:53):
rate is much higher compared to whitepatients. So one of the initiatives that
we're doing through the center educating patientsabout lodos aspiring. So we know that
take in lodos aspirin can decrease therisk of preterm preclamsia. And we've developed
a patient facing information card and itsays if you have any of these risk
(05:14):
factors, please talk to your practitioneror your provider about preclamsia and the use
of lodos aspirin in pregnancy. Ohwow, that's great to know. And
I see that you lead the NewYork State Birth Equity Improvement Project. Can
you share a little bit more aboutwhat that initiative is. Sure, So
New York State recognize the disparities andoutcomes for our black birthing patients. So
(05:35):
in New York State, black womenare three times more likely to die in
childbirth compared to white women, andin New York City that's eight times.
And so the states decided to formthis Birth Equity Improvement Project to improve the
intrapartum and postpartum experience for our blackbirthing patients. And so it comprises of
(05:56):
all birthing hospitals in New York Statesand the ten birthing hospitals that Nord Shore
is participating in the Birth Equity ImprovementProject and the state New York State has
developed something called a PREM, whichstands for a Patient Reported Experience Measure,
And so patients in the postparting period, they're ask if they want to enroll
in the study and to complete thePREM, and then the state provides us
(06:20):
with information once patients complete that tosee how we can improve the delivery of
care to our patients into partiment inthe postparting period. That's great and I
love this three sixty degree approach thatNorthwell takes to improving outcomes from mothers and
babies. Can you tell us aboutyour role and how you oversee all the
(06:40):
aspects of the health systems and maternalhealthcare system sure, so I help to
direct all the efforts through the centerfrom maternal health, but it's using,
like I said, all the assetsin the healthcare system. So with Committee
and Population Health their task with educatingall the patients that are served in the
North wal health system. And we'vedeveloped educational campaigns, public service announcements that
(07:05):
talk about chronic hypertension, preclams here, required pregnancy loss and so we're using
that those educational tools to educate patientsabout these complications and pregnancy and that if
you have any of those issues totalk to your obgyn provider, and if
you don't have an obgyn provider,we can help you find one to discuss
(07:30):
those issues before you become pregnant orearly in your pregnancy. And when you
go back to some of those likehigh risk things that can happen during pregnancy.
You know what support systems is Northwallhave in place to support someone who
might be having high risk between prenatalappointments or the postpartum period at home.
Sure, So North Wall has aMom's Navigation program, and I think you've
(07:54):
heard this many times because a lotof things come out of COVID, and
so during the pandemic, the hospitalwas filled with patients who had COVID,
and so after patients delivered, theywere discharged early from the hospital. So
typically after a vaginal delivery, youwould be in the hospital for one to
two days, and after cesarian deliveryyou'd be in the hospital for three to
(08:16):
four days. So with COVID,patients who were discharged much earlier. So
after a vaginal delivery, you couldbe home within hours of delivery, and
then with a cesarian delivery, youcould be home in one to two days
after your delivery. So the HealthSolutions, which is led by doctor ZENA.
Brown, they got a grant andthey had this Mom's Navigation program,
(08:37):
and so patients who are considered highrisk, who had predistational diabetes, chronic
hypertension, any behavioral health issues,they used this program. And the program
in the background, they have nurseswho were able to receive calls from the
patients and what they found was thatpatients who used the navigation program, they
(08:58):
were able to decrease their readmission ratesoverall by about forty eight percent, and
specifically for our black birthing patients,who were able to decrease the readmission rate
by sixty nine percent. So thisprogram was only in the postpartum period and
was just a three of our tenbirthing hospitals, and so what we hope
to do is to expand that programto all ten of our birthing hospitals,
(09:22):
not just in the postpartum period,but also in the antipartm period, so
that when patients and roll for prenatalcare, there's a system that looks at
the electronic medical record and they'll sayit to a practitioner, Hey, you
know your patient, is that anincrease risk for preclamsia? Speak to her
about Lodo's aspirin because we know startingthat early in pregnancy will decrease the risk
(09:46):
of preterm preclamsia. Yeah. Youalso have another program called MOMS, which
is Maternal Outcomes Measures. Can youtell us a little bit about that collective
Sure that's also in conjunction with thenavigation program that if patients are identified as
having any risk during the pregnancy,that we then refer them to any special
(10:07):
to care that they might need.If they might need help with a cardiologists,
if they have any problems with cardiovascularhealth, if they need a hematologist,
if they have issues with any blooddisorders. And sometimes we have patients
who have cancer and pregnancy, andwe have a cancer and pregnancy program,
so the patients are referred to thoseto that program. So when you're,
(10:28):
you know, dealing with moms anddiverse families, right, Like, I
guess what some advice that you wouldgive to mothers of color if they're in
search for a hospital, Like whatshould be on the checklists when you're making
that selection so that you feel confidentas a family you're in the right place.
It's a good question because I thinka lot of times what we hear
(10:48):
as that patients feel like they're notheard. And I think that it's important
to get become educated prior to becomingpregnant or if you have questions, make
sure that you have someone who's therewho's an advocate for you, and come
as a family to get your questionsanswered. And what I was delivering patients
(11:11):
patients always wanted to know am Igoing to be safe in the hospital,
And so when they come, wecan talk to them about the initiatives at
Northwell Health is doing across the healthcaresystem so that they know that they're in
good hands and they'll be well takencare of when they come to the health
system to deliver their babies. That'sright. And they can visit beforehand,
right, so they make their selectionand they can get all the information they
(11:33):
need prior to sure if someone wantsto have what's called their preconception consultation to
considering a pregnancy, or even ifthey're not considering a pregnancy and they want
to know, how can I behealthy in the future if I want to
plan a pregnancy, they can alwayshave a consultation with a maternal fetal medicine
specialists in the healthcare system. That'sgreat, And about how many families do
(11:58):
you think that you're serving now?With the Center Well North Wall the ten
birthing hospitals that we have, wedeliver about thirty thousand babies a year,
which is about fifteen percent of thebirths in New York State and one percent
of the births in the nation.So we have the potential to serve all
of those patients in the healthcare system, which makes you one of New York's
(12:20):
largest hospital systems. Yes, yeah, yes, yes. So going back
to north Wall's commitment to decrease therisk that have unfairly affected black moms and
babies, what is your commitment asa physician and an advocate for maternal health.
So I think one of the thingsthat we haven't touched on is systemic
racism and institutional racism, and Ithink that has a lot to do with
(12:45):
the treatment of black patients when theycome into the hospital. And I know
the New York Times had recently publishedan article from the National Bureau of Economic
Research and the study was coming outof California where they looked at birth data
for California, and they looked atmaternal and income infant outcomes based on income
and race. And what they foundis that if you're wealthy, you tend
(13:11):
to have better outcomes and if you'reat the lower income earning group. But
they found for black patients that womenwho are the highest income earners who are
black had the same outcomes as patientswho were in the lower income bracket who
are white. And so their conclusionis that a lot of the policies that
(13:31):
have to deal with, you know, decreasing that disparity should not just focus
on socioeconomic status, because an educatedblack woman has definitely a worse outcome when
compared to someone who's white who hasa high school less than a high school
education, and we're having education asprotective, that's not the case for black
(13:54):
women. So it's important for usto make sure that all of our team
members they have implicit biased training sothat you can recognize I think we all
have our own biases and with thattraining, well, we hope is that
that will impact the delivery of carefor our black birthing patients. That's great.
I was going to ask you ifthere was a program in place for
(14:15):
implicit biased training. We just hadMarch of Dimes on a couple episodes ago
when they've equipped over like I thinkit's thirty thousand providers with implicit bias training.
So I am happy to hear thatnorth Wall is a aligned with that
because it's just so important that peopleunderstand the biases that are there, and
like how as a provider every usthere's no one size fits all to any
(14:37):
demographic. So north Wall has acenter for equity of Care and so they're
charged with implicit biased training across thehealthcare system, and they're you know,
going to moving towards efforts to trainall their employees because there's over by now
probably ninety thousand employees in the healthcaresystem, or I should say team members,
and so the plan is to fullytrain all those team members. But
(15:01):
one of the things we know isthat it cannot be a one time training.
So it has to be something that'ssustained. So whether that's half you
know, twice a year or quarterly, that's something that hasn't been decided or
planned out. But we know thatit can't be just once that it has
to be something that's sustained. That'sgreat. So what advice would you give
(15:24):
to black mothers who are listening tothis podcast for the first time. They're
in a search for a hospital,they're in a search for equitable healthcare,
Like what should they be asking interms of questions to make sure that they're
getting the information and resources they need. You know, I think education is
key, and I go back towhat the patients used to ask me.
They want to know, am Igoing to be safe in the hospital?
(15:46):
Am I going to be taken careof? And it's also a challenge for
some health systems to get the accurateinformation for their outcomes in terms of race,
ethnicity, language, gender. Soit's important to ask those questions about
what's my if I'm a first timemom and I'm going to have a baby,
(16:07):
what's my risk of having a caesariandelivery, Because we know having a
cesarian delivery increases the rate of severematernal morbidity. So there's an increased risk
of having a blood transfusion, there'san increased risk of an I see you
admission, there's an increased risk ofpotentially losing your uterus, and so I
think it's important to ask those questions. Yeah, I'm just thinking about some
(16:30):
like the postpartum care, right that'sneeded that goes into you know, after
you have the baby. Are thereany specific programs that you have in place
that address that specifically? We do, and you know, part of that
program is the Mom's Navigation Program,and we're trying to expand that to all
ten of our birthing hospitals. We'realso partnering with DULA groups to provide some
(16:53):
of that care, and New YorkState is in the process of expanding dedcaid
for one year postpartum. So thehealth system, I think can do everything,
and so part of our goal isto partner with community based organizations that
can provide some of that care inthe postpartum period. And we have formed
(17:15):
a relationship with Adula organization and theyprovide health care in the postpartum period up
to three months. And so we'replanning to continue that expansion and planning to
continue establishing relationships with other community basedorganizations. That's so encouraging to hear because
it would be great to see dula'shave more of a participation when it comes
(17:38):
to mainstream healthcare. Yes, yeah, And how do you see them fitting
into the fold? Because I knowsome people don't really understand what ADULA does
or like how ADULA it can bea part of that journey. So what
is that like for you in termsof your insight there? Sure? Well,
I mean a DULA is not amedical profession. They're professional there there
(17:59):
as a support person for the personwho's in labor. So they're just there
to help them to provide any supportthat the patient would need. And certainly
we encourage patients to talk to usabout what their birth preferences are, what
their wishes are when they're in laborand delivery, and hopefully we'll be able
to fulfill their wishes. I thinka lot of the conversations about labor and
(18:26):
delivery needs to start early in pregnancy, so during the antipartum period, when
patients are going to their provider fortheir healthcare visits, that there should be
a lot of conversations about what shouldI expect when I come to the hospital,
When I come to the triage area, you know what happens when I
come When I go into the laborand delivery room, you know what happens.
(18:49):
Do I need to have an IV? Can I walk around? Will
I be able to breastfeed after Ideliver? Can my partner cut the cord
or if they want to delay chordclamping? To ask you know, all
those questions to see if their wishesare going to be fulfilled. And you
know, sometimes we know that laborand what happens in labor delivery, complications
(19:11):
can arise. And to have thoseconversations with the patients in the antipartan pyode
to know that, sure, wewant everything to happen and to be low
risk, but sometimes it's out ofour hands, and so patients have to
know also that things could become complicatedin labor and delivery, and our what
(19:33):
we hope and what we want todo is that when those complications arise,
that we're able to let the patientknow what's happening, like their support person
know what's happening, and so thatthey are constantly in the know and part
of what's going on in labor anddelivery, even when it becomes complicated.
That's great. And where is thecenter located? And how can folks connect
(19:55):
with you all? Well, thecenter it's a virtual center, but the
way to connect with the center oris through our Mom's Navigation program. Perfect.
And I love that it's virtual becausewe talk a lot of times about
maternal health deserts right on this program, and I think that that's a big
solve to women who may not haveaccess or who they have to travel right
(20:15):
so far to feel like they canhave an adequate healthcare experience. So I
love that you've taken that virtual modelwhen it comes to creating a solution in
this space because it's so important,you know, absolutely, and we always
say because of COVID, So wewouldn't have been using Tally Health the way
we're using it now if it wasn'tfor COVID, and so there are multiple
ways that we can reach a patientand speak to them and provide them with
(20:40):
the care that they need. Weappreciate that, and I love the work
that you're doing in this space,and I love that Northwell is really like
leading the charge because we want aplace to be able to send our moms
right So when we're having these conversationsaround the Black maternal health crisis, we
wanted to be more than just aconversation in a way to drive down a
lot of the statistical data that's outthere is having solutions like this in place.
(21:03):
So we thank you for your work. Sure, thank you. And
one of the things I should mentionI mentioned this niliperous term singleton vertex delivery,
meaning the first time pregnant person,the first time they're going into hospital
delivering. North Wall has a planand they're trying to decrease that cesarion deliver
that first time caesarian delivery rate.And because we have this Perinatal Data Center,
(21:26):
we have statistics on all the physiciansthat deliver in the hospital, and
so there is an effort across thehealthcare system to decrease that first time cesarian
delivery rate, and so each practitionerhas a scorecard where they get that they
get quarterly and that tells them whattheir niliperous term Singleton Vertex delivery cesarian rate
(21:48):
is and if it's over forty percent, then the leadership for the obg I
in service line they talk to thosepractitioners about ways in which they can decrease
that cesarian delivery rate. So that'sagain one of those initiatives that's going across
the entire healthcare system to decrease thatrate and to promote a safe vaginal delivery.
(22:08):
Wow, that's great, and that'svery impressive, very impressive. So
I want to thank you again forjoining us on maternal Is there anything else
that you like to share with ouraudience about your personal commitment to this space
of black maternal health or anything thatNorth Well it plans on contributing to this
space. Well, certainly, Imean, I'm a black woman and so
(22:32):
we all. I have my ownbirth story, and so I consider myself
someone who's very fortunate to have youcome through. And I just want to
know that the work that I'm doingis meaningful and has purpose, and I
am committed to the health of ourbirthing mombs in our hospital, and so
is Northwell Health. That's great andwe love those stories, you know,
(22:52):
on this platform. That's what thisplatform was built on, as stories of
motherhood and how we can take thosestories and turn a negative into a positive.
So I appreciate you coming on heretoday and sharing your insight and sharing
your journey and how you got intothis space. So we thank you when
we appreciate you for that. Thankyou so much for having me. Yes
for sure, So you're listening toMeternal on iHeartRadio again in studio with doctor
(23:18):
Donnette Lewis, md, MPH,director of the Center for Maternal Health at
Northwall. Thanks for joining us today. I'm Eternal. You're listening to Meternal
on iHeartRadio. Throughout this conversation,mothers of color will hear about the support
system's Northwell Health has in place tocombat the black maternal health crisis and ensure
black mothers have an equitable healthcare experience. Visit Meternal dot info for additional resources
(23:45):
and information for mothers of color andto learn more about the Center of Maternal
Health at Northwall
Meternal. I'm a black woman,and so we all. I have my
own birth story, and so Iconsider myself someone who is very fortunate to
have you come through. And Ijust want to know that the work that
I'm doing is meaningful and has purpose. And I am committed to the health
(00:21):
of our birthing moms in our hospital, and so is Northwell Health. Welcome
to Meternal. I am Kenny Gibson, and I'm here with a very special
guest in our studio today, doctorDownette Lewis, MD, MPH, director
of the Center from Maternal Health atNorthwall. Welcome to Meternal. Oh,
thank you so much for having me, and I'm excited to be here to
(00:43):
discuss maternal health. Yes, we'rehappy to have you and hear about all
the things that Northwall is doing inthis space. So I want to hear
a little bit how you got involvedinitially in the maternal healthcare space. Well,
I am a maternal fetal medicine physicianin my day job, and so
every day we take care of patientswho have either high risk pregnancies or their
complications with the fetus. So basicallyfrom my entire career after residency, it's
(01:08):
been focused on maternal health. Wow, and you've been doing this for over
twenty years. Yes, that's veryimpressive. It's fun. I mean,
I enjoy what I do. Sodid you always know you were going to
be in this space? Like,how did you figure out that this was
the area that you wanted to workin? You know, I'm not sure.
So I grew up. I wasborn in Jamaica in the West Indies,
(01:29):
and I always wanted to be aphysician, and somehow it was always
upstructure schanganecology. I don't know howI arrived at that, but you know,
that's where you know, I enterthe field. And I always knew
I wanted to take care of womenand being women's health and it was what
was most interesting to me when Iwas in medical school. That's great.
And then how did you end upat Northwall? I was having this conversation.
(01:53):
So I did my residency in Milwaukee, Wisconsin, and then after that
I did a fellowship in maternal fetalmetals and at Thomas Jefferson University. And
when my parents moved here from Jamaica, we settled in the Bronx and so
New York was basically my home.And so after I was finishing fellowship,
I sat up, you know,my parents are older, maybe I should
move back home, so like it'dbe close to them. And Northwell was
(02:15):
hiring, and so I interviewed thereand in two thousand and three started working
at Northwall. I actually came acrossto quote from your CEO, Michael Dowling,
the risk black women face during andafter pregnancy and childbirth are shameful illustration
of the disparities that continue to diminishthe well being of our nation. How
does it make you feel to hearsomething like that. It's concerning because I'm
(02:39):
a black woman, and so it'salso hurts to know that when you enter
the hospital or any healthcare space,that you're not treated the same as anyone
else. And then what's your positioningon the black maternal health crisis as a
whole, and why do you feelit's important for Northwall to provide solutions to
black mothers to bad this crisis?Well, Northwell Health, it's an excellent
(03:02):
health system, and I would saykudos to our CEO for recognizing that this
is an issue. It's a crisisin this country. And I think north
Wall itself, because of the infrastructurethat's it provides. It's situated perfectly to
handle this crisis for sure. Andone major solution that north Wall has come
(03:23):
to the forefront with is the centerfrom Eternal Health, which you're leading,
And can you share a little bitof how the center is serving families of
color in the community. Sure.So our center, it's it's a virtual
center, and it's it's comprised ofdifferent entities within Northwell Health. So we
have an antipartum work group which isled by doctor Salaslopez in Communitian Population Health.
(03:47):
We have a paripartum work group whichis our obgy and service line,
and we also have a postpartum groupwhich is led by doctor Zena Brown through
Health Solutions at Northwell Health. Andso because of all the assets within Northwell,
we're able to provide care for patientsacross the continuum of their pregnancy.
That's wonderful. So it sounds likeif me as a black mom, right,
(04:09):
if I choose Northwell as my hospitalprovider, I'm going to have a
really good, thorough experience from youmy pre pregnancy to postpartum. It sounds
like you have it all under controlthere. Well, we're trying to get
it under control, and you know, one of the things that's helping us
as data. And so we havea pernatal data center that has information from
(04:30):
seven of our ten birthing hospitals,and so that helps to guide some of
our initiatives. And from the pernatalData Center, we know that their disparities
even in our own healthcare system,and so that helps us to direct some
of our initiatives and some of ourprograms. So, for instance, we
know that preclamsia can cause complications andpregnancy and for non Hispanic Black patients that
(04:53):
rate is much higher compared to whitepatients. So one of the initiatives that
we're doing through the center educating patientsabout lodos aspiring. So we know that
take in lodos aspirin can decrease therisk of preterm preclamsia. And we've developed
a patient facing information card and itsays if you have any of these risk
(05:14):
factors, please talk to your practitioneror your provider about preclamsia and the use
of lodos aspirin in pregnancy. Ohwow, that's great to know. And
I see that you lead the NewYork State Birth Equity Improvement Project. Can
you share a little bit more aboutwhat that initiative is. Sure, So
New York State recognize the disparities andoutcomes for our black birthing patients. So
(05:35):
in New York State, black womenare three times more likely to die in
childbirth compared to white women, andin New York City that's eight times.
And so the states decided to formthis Birth Equity Improvement Project to improve the
intrapartum and postpartum experience for our blackbirthing patients. And so it comprises of
(05:56):
all birthing hospitals in New York Statesand the ten birthing hospitals that Nord Shore
is participating in the Birth Equity ImprovementProject and the state New York State has
developed something called a PREM, whichstands for a Patient Reported Experience Measure,
And so patients in the postparting period, they're ask if they want to enroll
in the study and to complete thePREM, and then the state provides us
(06:20):
with information once patients complete that tosee how we can improve the delivery of
care to our patients into partiment inthe postparting period. That's great and I
love this three sixty degree approach thatNorthwell takes to improving outcomes from mothers and
babies. Can you tell us aboutyour role and how you oversee all the
(06:40):
aspects of the health systems and maternalhealthcare system sure, so I help to
direct all the efforts through the centerfrom maternal health, but it's using,
like I said, all the assetsin the healthcare system. So with Committee
and Population Health their task with educatingall the patients that are served in the
North wal health system. And we'vedeveloped educational campaigns, public service announcements that
(07:05):
talk about chronic hypertension, preclams here, required pregnancy loss and so we're using
that those educational tools to educate patientsabout these complications and pregnancy and that if
you have any of those issues totalk to your obgyn provider, and if
you don't have an obgyn provider,we can help you find one to discuss
(07:30):
those issues before you become pregnant orearly in your pregnancy. And when you
go back to some of those likehigh risk things that can happen during pregnancy.
You know what support systems is Northwallhave in place to support someone who
might be having high risk between prenatalappointments or the postpartum period at home.
Sure, So North Wall has aMom's Navigation program, and I think you've
(07:54):
heard this many times because a lotof things come out of COVID, and
so during the pandemic, the hospitalwas filled with patients who had COVID,
and so after patients delivered, theywere discharged early from the hospital. So
typically after a vaginal delivery, youwould be in the hospital for one to
two days, and after cesarian deliveryyou'd be in the hospital for three to
(08:16):
four days. So with COVID,patients who were discharged much earlier. So
after a vaginal delivery, you couldbe home within hours of delivery, and
then with a cesarian delivery, youcould be home in one to two days
after your delivery. So the HealthSolutions, which is led by doctor ZENA.
Brown, they got a grant andthey had this Mom's Navigation program,
(08:37):
and so patients who are considered highrisk, who had predistational diabetes, chronic
hypertension, any behavioral health issues,they used this program. And the program
in the background, they have nurseswho were able to receive calls from the
patients and what they found was thatpatients who used the navigation program, they
(08:58):
were able to decrease their readmission ratesoverall by about forty eight percent, and
specifically for our black birthing patients,who were able to decrease the readmission rate
by sixty nine percent. So thisprogram was only in the postpartum period and
was just a three of our tenbirthing hospitals, and so what we hope
to do is to expand that programto all ten of our birthing hospitals,
(09:22):
not just in the postpartum period,but also in the antipartm period, so
that when patients and roll for prenatalcare, there's a system that looks at
the electronic medical record and they'll sayit to a practitioner, Hey, you
know your patient, is that anincrease risk for preclamsia? Speak to her
about Lodo's aspirin because we know startingthat early in pregnancy will decrease the risk
(09:46):
of preterm preclamsia. Yeah. Youalso have another program called MOMS, which
is Maternal Outcomes Measures. Can youtell us a little bit about that collective
Sure that's also in conjunction with thenavigation program that if patients are identified as
having any risk during the pregnancy,that we then refer them to any special
(10:07):
to care that they might need.If they might need help with a cardiologists,
if they have any problems with cardiovascularhealth, if they need a hematologist,
if they have issues with any blooddisorders. And sometimes we have patients
who have cancer and pregnancy, andwe have a cancer and pregnancy program,
so the patients are referred to thoseto that program. So when you're,
(10:28):
you know, dealing with moms anddiverse families, right, Like, I
guess what some advice that you wouldgive to mothers of color if they're in
search for a hospital, Like whatshould be on the checklists when you're making
that selection so that you feel confidentas a family you're in the right place.
It's a good question because I thinka lot of times what we hear
(10:48):
as that patients feel like they're notheard. And I think that it's important
to get become educated prior to becomingpregnant or if you have questions, make
sure that you have someone who's therewho's an advocate for you, and come
as a family to get your questionsanswered. And what I was delivering patients
(11:11):
patients always wanted to know am Igoing to be safe in the hospital,
And so when they come, wecan talk to them about the initiatives at
Northwell Health is doing across the healthcaresystem so that they know that they're in
good hands and they'll be well takencare of when they come to the health
system to deliver their babies. That'sright. And they can visit beforehand,
right, so they make their selectionand they can get all the information they
(11:33):
need prior to sure if someone wantsto have what's called their preconception consultation to
considering a pregnancy, or even ifthey're not considering a pregnancy and they want
to know, how can I behealthy in the future if I want to
plan a pregnancy, they can alwayshave a consultation with a maternal fetal medicine
specialists in the healthcare system. That'sgreat, And about how many families do
(11:58):
you think that you're serving now?With the Center Well North Wall the ten
birthing hospitals that we have, wedeliver about thirty thousand babies a year,
which is about fifteen percent of thebirths in New York State and one percent
of the births in the nation.So we have the potential to serve all
of those patients in the healthcare system, which makes you one of New York's
(12:20):
largest hospital systems. Yes, yeah, yes, yes. So going back
to north Wall's commitment to decrease therisk that have unfairly affected black moms and
babies, what is your commitment asa physician and an advocate for maternal health.
So I think one of the thingsthat we haven't touched on is systemic
racism and institutional racism, and Ithink that has a lot to do with
(12:45):
the treatment of black patients when theycome into the hospital. And I know
the New York Times had recently publishedan article from the National Bureau of Economic
Research and the study was coming outof California where they looked at birth data
for California, and they looked atmaternal and income infant outcomes based on income
and race. And what they foundis that if you're wealthy, you tend
(13:11):
to have better outcomes and if you'reat the lower income earning group. But
they found for black patients that womenwho are the highest income earners who are
black had the same outcomes as patientswho were in the lower income bracket who
are white. And so their conclusionis that a lot of the policies that
(13:31):
have to deal with, you know, decreasing that disparity should not just focus
on socioeconomic status, because an educatedblack woman has definitely a worse outcome when
compared to someone who's white who hasa high school less than a high school
education, and we're having education asprotective, that's not the case for black
(13:54):
women. So it's important for usto make sure that all of our team
members they have implicit biased training sothat you can recognize I think we all
have our own biases and with thattraining, well, we hope is that
that will impact the delivery of carefor our black birthing patients. That's great.
I was going to ask you ifthere was a program in place for
(14:15):
implicit biased training. We just hadMarch of Dimes on a couple episodes ago
when they've equipped over like I thinkit's thirty thousand providers with implicit bias training.
So I am happy to hear thatnorth Wall is a aligned with that
because it's just so important that peopleunderstand the biases that are there, and
like how as a provider every usthere's no one size fits all to any
(14:37):
demographic. So north Wall has acenter for equity of Care and so they're
charged with implicit biased training across thehealthcare system, and they're you know,
going to moving towards efforts to trainall their employees because there's over by now
probably ninety thousand employees in the healthcaresystem, or I should say team members,
and so the plan is to fullytrain all those team members. But
(15:01):
one of the things we know isthat it cannot be a one time training.
So it has to be something that'ssustained. So whether that's half you
know, twice a year or quarterly, that's something that hasn't been decided or
planned out. But we know thatit can't be just once that it has
to be something that's sustained. That'sgreat. So what advice would you give
(15:24):
to black mothers who are listening tothis podcast for the first time. They're
in a search for a hospital,they're in a search for equitable healthcare,
Like what should they be asking interms of questions to make sure that they're
getting the information and resources they need. You know, I think education is
key, and I go back towhat the patients used to ask me.
They want to know, am Igoing to be safe in the hospital?
(15:46):
Am I going to be taken careof? And it's also a challenge for
some health systems to get the accurateinformation for their outcomes in terms of race,
ethnicity, language, gender. Soit's important to ask those questions about
what's my if I'm a first timemom and I'm going to have a baby,
(16:07):
what's my risk of having a caesariandelivery, Because we know having a
cesarian delivery increases the rate of severematernal morbidity. So there's an increased risk
of having a blood transfusion, there'san increased risk of an I see you
admission, there's an increased risk ofpotentially losing your uterus, and so I
think it's important to ask those questions. Yeah, I'm just thinking about some
(16:30):
like the postpartum care, right that'sneeded that goes into you know, after
you have the baby. Are thereany specific programs that you have in place
that address that specifically? We do, and you know, part of that
program is the Mom's Navigation Program,and we're trying to expand that to all
ten of our birthing hospitals. We'realso partnering with DULA groups to provide some
(16:53):
of that care, and New YorkState is in the process of expanding dedcaid
for one year postpartum. So thehealth system, I think can do everything,
and so part of our goal isto partner with community based organizations that
can provide some of that care inthe postpartum period. And we have formed
(17:15):
a relationship with Adula organization and theyprovide health care in the postpartum period up
to three months. And so we'replanning to continue that expansion and planning to
continue establishing relationships with other community basedorganizations. That's so encouraging to hear because
it would be great to see dula'shave more of a participation when it comes
(17:38):
to mainstream healthcare. Yes, yeah, And how do you see them fitting
into the fold? Because I knowsome people don't really understand what ADULA does
or like how ADULA it can bea part of that journey. So what
is that like for you in termsof your insight there? Sure? Well,
I mean a DULA is not amedical profession. They're professional there there
(17:59):
as a support person for the personwho's in labor. So they're just there
to help them to provide any supportthat the patient would need. And certainly
we encourage patients to talk to usabout what their birth preferences are, what
their wishes are when they're in laborand delivery, and hopefully we'll be able
to fulfill their wishes. I thinka lot of the conversations about labor and
(18:26):
delivery needs to start early in pregnancy, so during the antipartum period, when
patients are going to their provider fortheir healthcare visits, that there should be
a lot of conversations about what shouldI expect when I come to the hospital,
When I come to the triage area, you know what happens when I
come When I go into the laborand delivery room, you know what happens.
(18:49):
Do I need to have an IV? Can I walk around? Will
I be able to breastfeed after Ideliver? Can my partner cut the cord
or if they want to delay chordclamping? To ask you know, all
those questions to see if their wishesare going to be fulfilled. And you
know, sometimes we know that laborand what happens in labor delivery, complications
(19:11):
can arise. And to have thoseconversations with the patients in the antipartan pyode
to know that, sure, wewant everything to happen and to be low
risk, but sometimes it's out ofour hands, and so patients have to
know also that things could become complicatedin labor and delivery, and our what
(19:33):
we hope and what we want todo is that when those complications arise,
that we're able to let the patientknow what's happening, like their support person
know what's happening, and so thatthey are constantly in the know and part
of what's going on in labor anddelivery, even when it becomes complicated.
That's great. And where is thecenter located? And how can folks connect
(19:55):
with you all? Well, thecenter it's a virtual center, but the
way to connect with the center oris through our Mom's Navigation program. Perfect.
And I love that it's virtual becausewe talk a lot of times about
maternal health deserts right on this program, and I think that that's a big
solve to women who may not haveaccess or who they have to travel right
(20:15):
so far to feel like they canhave an adequate healthcare experience. So I
love that you've taken that virtual modelwhen it comes to creating a solution in
this space because it's so important,you know, absolutely, and we always
say because of COVID, So wewouldn't have been using Tally Health the way
we're using it now if it wasn'tfor COVID, and so there are multiple
ways that we can reach a patientand speak to them and provide them with
(20:40):
the care that they need. Weappreciate that, and I love the work
that you're doing in this space,and I love that Northwell is really like
leading the charge because we want aplace to be able to send our moms
right So when we're having these conversationsaround the Black maternal health crisis, we
wanted to be more than just aconversation in a way to drive down a
lot of the statistical data that's outthere is having solutions like this in place.
(21:03):
So we thank you for your work. Sure, thank you. And
one of the things I should mentionI mentioned this niliperous term singleton vertex delivery,
meaning the first time pregnant person,the first time they're going into hospital
delivering. North Wall has a planand they're trying to decrease that cesarion deliver
that first time caesarian delivery rate.And because we have this Perinatal Data Center,
(21:26):
we have statistics on all the physiciansthat deliver in the hospital, and
so there is an effort across thehealthcare system to decrease that first time cesarian
delivery rate, and so each practitionerhas a scorecard where they get that they
get quarterly and that tells them whattheir niliperous term Singleton Vertex delivery cesarian rate
(21:48):
is and if it's over forty percent, then the leadership for the obg I
in service line they talk to thosepractitioners about ways in which they can decrease
that cesarian delivery rate. So that'sagain one of those initiatives that's going across
the entire healthcare system to decrease thatrate and to promote a safe vaginal delivery.
(22:08):
Wow, that's great, and that'svery impressive, very impressive. So
I want to thank you again forjoining us on maternal Is there anything else
that you like to share with ouraudience about your personal commitment to this space
of black maternal health or anything thatNorth Well it plans on contributing to this
space. Well, certainly, Imean, I'm a black woman and so
(22:32):
we all. I have my ownbirth story, and so I consider myself
someone who's very fortunate to have youcome through. And I just want to
know that the work that I'm doingis meaningful and has purpose, and I
am committed to the health of ourbirthing mombs in our hospital, and so
is Northwell Health. That's great andwe love those stories, you know,
(22:52):
on this platform. That's what thisplatform was built on, as stories of
motherhood and how we can take thosestories and turn a negative into a positive.
So I appreciate you coming on heretoday and sharing your insight and sharing
your journey and how you got intothis space. So we thank you when
we appreciate you for that. Thankyou so much for having me. Yes
for sure, So you're listening toMeternal on iHeartRadio again in studio with doctor
(23:18):
Donnette Lewis, md, MPH,director of the Center for Maternal Health at
Northwall. Thanks for joining us today. I'm Eternal. You're listening to Meternal
on iHeartRadio. Throughout this conversation,mothers of color will hear about the support
system's Northwell Health has in place tocombat the black maternal health crisis and ensure
black mothers have an equitable healthcare experience. Visit Meternal dot info for additional resources
(23:45):
and information for mothers of color andto learn more about the Center of Maternal
Health at Northwall
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