*Content warning: death of an infant, infant loss, death, birth trauma, medical trauma, medical neglect, racism, mature and stressful themes. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Birth Centers Offer Potential to Transform Maternity Care Through Community-Led Approaches that Focus on Families of Colorhttps://ccf.georgetown.edu/2024/08/19/birth-centers-offer-potential-to-transform-maternity-care-through-community-led-approaches-that-focus-on-families-of-color/ CDC, Maternal Mortality Rates in the United States, 2023https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/maternal-mortality-rates-2023CDC, Working Together to Reduce Black Maternal Mortalityhttps://www.cdc.gov/womens-health/features/maternal-mortality.html Center for Black Maternal Health and Reproductive Justice: https://blackmaternalhealth.tufts.edu/Comparative Analysis of Therapeutic Showers and Bathtubs for Pain Management and Labor Outcomes—A Retrospective Cohort Studyhttps://pmc.ncbi.nlm.nih.gov/articles/Fetal Heart Monitoringhttps://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/fetal-heart-monitoring Fundal Heighthttps://my.clevelandclinic.org/health/diagnostics/22294-fundal-height Health Equity Among Black Women in the United Stateshttps://pmc.ncbi.nlm.nih.gov/articles/PMC8020496/ Insights into the U.S. Maternal Mortality Crisis: An International Comparisonhttps://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison March of Dimeshttps://www.marchofdimes.org/peristats/about-us March of Dimes, Data: Heath Insurance/Incomehttps://www.marchofdimes.org/peristats/data?reg=99&top=11&stop=653&lev=1&slev=4&obj=1&sreg=48https://www.marchofdimes.org/peristats/data?reg=99&top=11&stop=154&lev=1&slev=4&obj=1&sreg=48Midwifery Education Accreditation Council (MEAC)https://www.meacschools.org/ Monitoring Baby’s Heart Rate During Laborhttps://familydoctor.org/monitoring-babys-heart-rate-labor/ Mucus Plughttps://my.clevelandclinic.org/health/symptoms/21606-mucus-plugNasal Cannulahttps://my.clevelandclinic.org/health/treatments/25187-nasal-cannula National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery CDC, National Vital Statistics Reportshttps://www.cdc.gov/nchs/data/nvsr/nvsr73/nvsr73-05.pdf North American Registry of Midwives (NARM)https://narm.org/ State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Water breaking: Understand this sign of laborhttps://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/water-breaking/art-20044142Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications*SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag’s original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Chapter 1: What critical issues are addressed in this episode?
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Something Was Wrong is intended for mature audiences. This season contains discussions of medical negligence, birth trauma, and infant loss, which may be upsetting for some listeners. For a full content warning, sources, and resources, please visit the episode notes.
Opinions shared by the guests of the show are their own and do not necessarily represent the views of myself, Broken Cycle Media, and Wondery. The podcast and any linked materials should not be misconstrued as a substitution for legal or medical advice. At the time of this episode's release, midwives Jennifer Crawford, Gina Thompson, and Caitlin Wages have not responded to our request for comment.
This season is dedicated with love to Malik. Every year in the United States, hundreds of women die during or after pregnancy, and many more face serious long-term health complications. According to the Centers for Disease Control and Prevention, over 80% of these deaths are preventable. Tragically, Black women are three times more likely to die from pregnancy-related causes than white women.
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Chapter 2: Why is maternal mortality a significant concern in the U.S.?
This disparity is driven by a variety of factors, including inequities in healthcare quality, underlying chronic health conditions, and social determinants of health that limit access to care, particularly for racial and ethnic minorities. the U.S. continues to have the highest maternal death rates among high-income nations.
Within the U.S., Black women are disproportionately affected, often receiving lower-quality care than white women, with significant disparities in care processes, outcomes, and overall patient experiences. These inequities are deeply rooted in discrimination and clinician bias.
In 2023, the CDC reported the maternal mortality rate for Black women was 50.3 deaths per 100,000 live births, far higher than the rates of white women at 14.5, Hispanic at 12.4, and Asian women at 10.7. While the rates for white, Hispanic, and Asian women decreased from 2022, the rate for Black women rose slightly from 49.5 per 100,000. Race also plays a component in infant loss.
According to the CDC, in 2022, the United States reported a total of 20,577 infant deaths, marking a 3% increase from 2021. The highest mortality rate was observed among infants of Black non-Hispanic women, at 10.90 per 1,000 live births.
This was followed by infants of American Indian and Alaska Native women at 9.06%, Native Hawaiian or other Pacific Islander women at 8.5%, Hispanic women 4.89%, White women 4.52%, and Asian women 3.51%. Systemic racism in healthcare also plays a role in where patients and clients seek care, such as freestanding birth centers.
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Chapter 3: How do systemic inequities affect maternal healthcare?
These are facilities that offer an alternative to hospital births that are gaining popularity for their potential to reduce adverse birth outcomes and aid maternity deserts. However, less than 5% are led by people of color, despite their effectiveness, especially in minority communities.
Examples like Roots Community Birth Center in Minneapolis, which serves a predominantly black and indigenous population, show positive outcomes such as lower cesarean rates and higher breastfeeding rates. Challenges such as limited funding persist, especially for community-based organizations in minority populations.
Efforts to establish birth centers in areas like New Mexico's Navajo Nation have struggled due to insufficient financial support. To add, between 2021 and 2023, an average of 63.7 of birthing mothers in Texas who are Hispanic were Medicaid users, and an average of 61.2 of birthing mothers in Texas who are Black were covered by Medicaid.
And as data from the March of Dimes illustrates, 48.8% of Texas births are covered by Medicaid. This limits options for those receiving pregnancy or labor care via Medicaid-approved facilities, as only a portion of licensed birthing centers are covered by Medicaid.
These efforts highlight the need for greater support to improve maternal health outcomes and address disparities in minority communities through accessible, relationship-centered care. I'm Tiffany Reese, and this is Something Was Wrong.
you don't know anybody until you
Please note, this episode discusses the death of an infant and may be distressing for some. Please take extra care when listening.
Hey, my name is Markita. I am a registered nurse here in Dallas. I am a firm believer in all things wellness, all things health, something that I always advocate for. I'm also a firm believer in holistic medicine and health care. I do believe Western medicine has a place, seeing as I am a registered nurse and I do work in an emergency room. But I definitely also believe in holistic care.
So that is one of the primary reasons that I did choose to have a natural birth. That is what brought me to midwifery. Most people were like, really? What made you choose that? I definitely got those looks and questions, but I still stuck with it because I do believe that our bodies can do it naturally.
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Chapter 4: What led Markita to choose midwifery for her birth experience?
But there are cases where when it cannot, then it's a beautiful thing that we're in the 21st century and we have the technology and the interventions to step in and help in those instances. I believe my body will do what it's supposed to do. That's what I had hoped for whenever I first was researching birthing centers and midwives.
That's why I chose midwifery over the route of choosing an OBGYN doctor. Another reason why I thought that having a midwife and having my birth at a birthing center would be different is because of the alarming statistics in hospital, what happens with black mother and babies. The fact that regardless of where you choose your prenatal care and where you choose to give birth for us women,
Unfortunately, we have to be not only the patient, but we also have to be advocates for ourselves. Unless you have someone that can truly advocate for you in the health care system, oftentimes we get looked over. Things go untreated, unseen, and we're ignored.
We have to make sure that we advocate for ourselves as much as we can and just continue to make ourselves be heard, especially if it is a health scare or something that is concerning. That is what led me to Origins Birth Center in Dallas, Texas. How did you find them? It was online. There weren't a lot of nurses that were gung ho about holistic stuff.
I've come across a few that kind of had my same perspective, but I looked up some birthing centers here in the Dallas area and was searching, you know, looking through reviews and I would go to their website and see what they had to offer. How did your partner feel about you selecting Origins and taking this route? He trusted my choosing. I typically do research and I look people up.
I went and did a tour at Origins and I felt good about it. I actually came to Origins in the middle of my pregnancy. I was 20 weeks pregnant whenever I got to Origins. I was at the Dallas facility.
Who was at your first initial appointment and what do you recall about that experience?
Honestly, I do not remember who it was because I didn't have the same person each time. You would have a different midwife whenever you went to your appointments because whenever you go into labor, the midwives were on call. So you wouldn't get your particular midwife that you would have chosen.
I know towards the end, I was seeing Jennifer more, but I had had an appointment with all of them at least once. I know because it was, I believe, three midwives, three or four.
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Chapter 5: What challenges did Markita face during her labor?
Yep. What sort of typical things were happening when you would go in for your checkups? Some people have sort of described like group doctor appointments. Was that also your experience?
There were two group things that I did. One group was the glucose check. You would come in. There were other women there. And they would do it all at the same time. We had to wait a certain amount of hours and they have to recheck it. And then there was another time. But my appointments that I would typically go in for like my monthly appointment, it was just me.
The midwife would ask the same life questions. How are you feeling about supplements? They would do like a manual fundal height check, check the baby's heart rate with a Doppler. And that's really pretty much it. My pregnancy, I was very healthy. My son was very healthy. There was no issues. I didn't even have morning sickness.
And I didn't really get any swelling or anything to my last month of pregnancy. It was all pretty smooth. I worked all the way up until probably to like 37 weeks, somewhere around there. There weren't really any red flags until I went into labor and went to Origins. I was like an easy patient. Everything was normal. So it wasn't until things went abnormal, they had no clue of what to do.
On Friday, June 30th, I remember the mucus plug. I seen that and I was like, oh, I think it's about to happen.
According to the Cleveland Clinic, the mucus plug is a thick piece of mucus that blocks the opening of the cervix during pregnancy. It forms a seal to prevent bacteria and infection from getting into the uterus and reaching the fetus. You can think of it as a protective barrier between the vagina and the uterus. An increase in pregnancy hormones like progesterone form the mucus plug.
Shortly after that, it was probably around 8 p.m., I started having contractions. Initially, they were pretty far apart and inconsistent. So, you know, it was early labor. And I did text the midwife on call that Friday night, and I told her that I was having contractions, and she gave me some tips, maneuvers to do. And this was, I believe, Danielle that was on call.
And then I had texted her on Saturday that, again because they were getting closer and closer and we thought maybe it's almost time to go in but she told me don't come in until they were four minutes apart lasting at least a minute or something like that so they wanted you to wait till you were like very very close in contractions it was definitely confusing it was a little nerve-wracking
Saturday, I did not sleep all night because every 10 minutes I was waking up, contracting, trying to move around. Then on Sunday, days started to get worse and worse. I would try to sit in the tub to try to help. I would try to move around. But my contractions, they were already lasting like a minute and they were already three to four minutes apart.
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Chapter 6: Why is there a need for better support in maternal healthcare?
According to Mayo Clinic, typically at the beginning of or during labor, membranes will rupture, also known as water breaking. It's not always easy to tell if water has broken. For example, it might be difficult to tell the difference between amniotic fluid and urine. Typically, after water breaks at term, labor soon follows, if it hasn't already begun. Sometimes, however, labor does not start.
The longer it takes for labor to start after your water breaks, the greater the risk of infection.
I hadn't got any rest at all, but I was feeling the excitement of meeting my son. I was excited that it had finally come. So whenever I got there, you know, I was tired, but I was also, you know, like, oh man, we're so close. I had a doula that met me there. She was actually my cousin, amazing doula. And then my mom and my dad was also there.
So my mom was in the room, but my dad was out in the little living room area. They had arrived the day before because I'm the only girl. So they were excited for me. And then my best friend, she's also a registered nurse in the emergency room. She arrived maybe a couple hours after I got there. I have an amazing family, amazing friends. I have amazing people in my life. So I'm really blessed.
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When I got there, they have the ball that you can bounce on. There's the chucks pads that you put on the bed. So they had put that on the ball. And this was right after I got to the facility. I noticed there was like a little bit of yellow fluid there. Yes, I'm a nurse, but no, I've never given birth before. I've seen a baby born once and it was in a car. A mom pulled up to the ER and
pop, there goes baby. I've never experienced birth myself. So I thought that this fluid that was on the Chuck's pad was normal. I noticed that, but I didn't say anything at the time. It was a very small amount that was on the pad there. Throughout the night, I was in and out of the tub because the tub helped provide some relief when the tractions came.
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