Cheryl Martin (Host): Crouse Health has a new initiative to reduce maternal and infant mortality in our region and improve maternal health experiences at Crouse. It's called Standing in the GAP, and our partner in this effort is Doula for a Queen. Its founder SeQuoia Kemp, a nurse and childbirth educator, is here to tell us about this exciting program along with her research assistant, Roma Agarwal, a pre-med student at Syracuse University. This is the Crouse HealthCast, a podcast from Crouse Health. I'm Cheryl Martin.

Roma, let me begin with you. What is a doula?

Roma Agarwal: A doula is a trained professional who provides not only emotional, but also physical and informational support to the birthing person before, during, and even after childbirth. So, unlike a midwife or a doctor, a doula doesn't deliver the baby, but they serve as a constant and reassuring presence, and they help the birthing people feel empowered, heard, and supported throughout the experience. So, they are very important in the birthing process.

Host: So SeQuoia, you founded Doula for a Queen. How did you begin your journey as a doula?

SeQuoia Kemp, BSN: So, I would like to say being a doula really chose me. When I was about 13 years old, I actually had one of my first surgeries at Crouse Hospital. And so, I was in recovery and out of school. And the person who was babysitting me at the time, she was pregnant. I would go to her appointments with her and spend a lot of time with her asking questions about her pregnancy and how it was. And so, at the age of 13, she was giving birth at Crouse Hospital. And I asked my mom if I could go. And there I was, I'm 13 years old with a camera recorder. And I was there and I witnessed my first birth.

And so, really from that moment, I knew that I wanted to be involved in this work. So after a while, a few years later, when I graduated high school, during I think my freshman year of college, I learned about this term doula and did a research project on how the doula care was helping to reduce the cesarean rates in the United States.

And so, from there, the education, the research, and then going on to become a trained doula at the age of 17, it really helped shape the work that I was doing and wanting to make an impact within maternal health.

Host: Well, that dovetails nicely into the Standing in the GAP Program. So, what will this program provide for patients and families at Crouse?

SeQuoia Kemp, BSN: The most important part of Standing in the GAP is to use patient experiences to drive change through, whether it's policy, you know, we say customer service, but patient care, to ensure that even if a client has a vaginal birth or a C-section that is uncomplicated, sometimes the experience, maybe it's a comment that a nurse makes, maybe they had an induction that they really didn't fully understand, we want to use that data, those experiences to say, "Hey, although we might be the top hospital as far as outcomes go, there are people who are leaving the hospital feeling traumatized and wanting to know how it could have been better."

And so, the first portion of the Standing in the GAP Program is going to be collecting data from the nursing staff, from the OB-G residents, from anyone who interfaces with doulas and patients, to figure out how can we make our experiences better? How can doulas, nurses, and doctors and midwives work together to understand that we have the same goal, which is good patient care, minimizing obstetric violence as well as birth trauma, which a lot of our clients unfortunately experience, especially those that we serve in the Black and brown community.

And then, the other portion is to also have some networking events, community engagement events. We don't want the first time that a nurse or a doula ever interface to occur at the hospital. We want to be able to work together.

Host: You have a lot of experience working in the community. So, how great is the need for such a program for the historically marginalized communities served by Crouse across 14 counties in the state?

SeQuoia Kemp, BSN: Absolutely. One of the things that we've noticed is that our doula collective-- I have partnered with Sankofa Doula Collective-- and we service families as far as Watertown. We have some folks who have been in Utica. And we realize that, one, when people have other children, they have to leave their children and come to the Crouse Hospital, and they might not have that mother, that sister, that loved one there, because they might be tending to their kids. So, making sure that the staffing know that the doula is not someone who just is there for the birth, that we've built relationships beforehand. We really know our clients really well. And so, that helps to bridge the gaps that we're seeing in patient care, right?

People might wonder, "Well, why is the doula answering the question? We need to hear from the patient." But we spend time developing their birth plan. We spend time understanding their triggers, understanding what is it their most important needs beyond just having a successful birth. That's one of the ways that we can capitalize on how we can replicate this care in these other counties and ensure that the doulas who don't live in Syracuse, when they come to the hospital with their clients, they can benefit from the change in policy, the change in morale, and the unity that we're trying to have at the location.

Host: Talk about how you will work with nurses and providers specifically at Crouse to improve health equity.

SeQuoia Kemp, BSN: So, one of the first things is understanding the history of obstetric violence and how it impacts Black women specifically. we're going to have some continual learning where we're going to come into the hospital and have many presentations, just understanding why Black women are fearful of hospitals, what is the history, teaching them about Marion Sims, teaching them about the history of Black women's bodies being used as experimentation. So while you as a nurse might just be like, "Oh, this is just coming into work. We're here to serve clients," we want to make sure that people know the history so that that history can be a foundation as to why the care might have to look different from people from different ethnic backgrounds, if that makes sense.

And then, also speaking with the medical students as well as the residents to understand that there might even be gaps in their learning, right? When you're a doctor, a lot of times they don't get to see normal physiological labor and birth. So, teaching them some techniques on how they can support their clients, especially those who might not want to use medicine who might want to do more movement. It's really important for us and providers to understand that we are just like conduits of the space. And so, many times, doctors and residents, they want to control or manage, but we have to teach ourselves, work with the client, talk with the client. So, that even if you have to make a recommendation that veers away from their birth plan, they fully understand that their best interest is at heart, and being able to communicate that in a way that makes people feel a part of the decision-making process. So, some of those workshops will include role playing, will include some of the things that we've seen as doulas in hopes that they will just learn a little different perspective that will impact their care, long after they even finish their residency at Crouse Hospital.

Host: So when you're talking about the Standing in the GAP Program, SeQuoia, what would be your first main sentences when you talk about the overall goal at the end of the program, what you hope will be accomplished?

SeQuoia Kemp, BSN: What I hope will be accomplished is that people realize that this project is not just about outcomes, it is about experiences. It is about making sure that doulas feel welcomed. For me, you know, I'll speak personally, I came up with this idea because I have left births from Crouse hospital having panic attacks, carrying secondary trauma is what we call it in the birth world, because I'm like, "Hey, this could have went differently. You know, my patient wasn't spoken to the way that they should have." So, we want people to walk away saying, "No matter what the outcome was, we worked together, we were cared for." People feel prideful and say, "Yes, take me to Crouse for my next pregnancy. I trust the care team up there are going to listen to my needs and are going to support me and support the people that come with me to support my birthing experience."

So, the goal really is to make sure we're on the same page to face any biases that we know that they exist, right? Some people might have issues with doulas and how we provide care. We might have different perspectives on how the hospital provides care. But none of that should ever interfere with the person's experience and while they're at the hospital. And so, that's the ultimate goal is that we really check our biases. We realize that really it's not about us as individuals, it's about us as a community, as a collective. Because after that person leaves that hospital, there are so much work to be had to make sure they stay healthy and thrive. And so, that's really what the goal is. If we can stand in the gap while we're at Crouse Hospital, imagine what beautiful outcomes we can see beyond and in our community.

Host: You've already shared some of the steps that you've taken to achieve this goal. Any others you want to mention?

SeQuoia Kemp, BSN: One of the other aspects we want to focus on is capturing these experiences through photography. Storytelling is so important. And when we talk about Black maternal health and equity work, a lot of time it's focusing on the statistics. But I was telling people that there are people that connect to those statistics. So, we do have a portion that we're hoping to reunite some of the nursing staff, doctors to reunite with some of our clients and to show that impact, right? Because a lot of times, our clients will say, "Do you remember who that nurse was, that she took really good care of me or she helped me really remain calm?" And they say we never get to actually thank them. We never really get to connect with them outside of that. And many of the nurses say the same thing. You know, you see these beautiful babies being born and you just never know what's up with them, how are they doing. So, the photo series is something that we're really excited about because I think we all could kind of put our defenses down and really focus on those success stories when the doula and the care team really worked well together to support a client.

And so, that's one of the aspects that I'm really excited about because research is important, data is important. But at the end of the day, we are all human beings working in the system, doing the best that we can, and we really want to see that reflected through the photo series.

Host: Why did you choose to work with Crouse on this program?

SeQuoia Kemp, BSN: I decided to work with Crouse because, just thinking about the full circle moment of my baby doula journey, starting at Crouse in 2007, but also despite all of the challenges that doulas have had in the local area, navigating hospitals, Crouse has consistently been that one hospital that has been welcoming to critique and for feedback and has been the most progressive in supporting doulas at the hospital. And so, we were saying, "Well, we can continue to build upon that relationship. We hope that this could be an example for the other local hospitals to understand what it looks like to actually collaborate and not dictate what doula care can look like on the labor and delivery or postpartum floor."

Host: SeQuoia, talk about the kinds of educational opportunities that will be available for Crouse staff around this program and also the opportunities for Crouse's patients, which you haven't covered.

SeQuoia Kemp, BSN: Education for Crouse staff will look like us doing our-- so, we've been invited to some of the staff meetings once a month to talk about the data that we're going to be collecting. Also, again, doing some of the community work. So, I will be out with Crouse at Juneteenth. We'll be out at different events. Letting people know this is a true partnership and getting feedback from them as well.

And then, with the clients, there is also going to be a questionnaire that we're going to be disseminating amongst people who have given birth at Crouse, whether they have had a doula or not, to understand: what was your perspective? What gaps do you think that the hospital can do to improve? What can doulas do to improve in working relationships? So, my hope is to really expand upon and do some more like a healing circle or healing work, because we know that all births do not end in positive outcomes, right? We have clients who have experienced perinatal loss, have experienced pregnancy loss. And so, figuring out, really just looking at all the aspects and having dialogue to really say, "Hey, this is what we can do on the hospital side to improve this experience, and on the doula side." So, that's really what it's about, dialogue.

One of our first events we had was our Black Doula Day Celebration where we had the celebration at Crouse Hospital to really recognize the impact that doulas are making on the maternal health world, but also specifically Black doulas. So, it's a huge project, has a lot of different moving parts, but I'm hoping that through the interactions, whether it's social, educational or data collection, that people will understand the project as a whole and its overall mission.

Host: Great. Roma, what has it been like for you working on community-wide initiatives in maternal health with SeQuoia for a year? What have you learned? And then, how do you think this will impact you when you achieve your goal of being a physician, specifically an OB-GYN?

Roma Agarwal: Yes. I think that this, honestly, it's completely changed my view in how I view becoming a doctor and truly treating these communities of people that need help the most. And I think it's things that you don't really learn in the traditional premedical environment. These topics are not exactly covered. And even if they are, it's invaluable experience to gain firsthand seeing and viewing these inequities. And seeing them on a case by case, personal level, by every patient that I do come across as a new doula. And I think it's incredibly important for the new generation of pre-medical students and doctors that are beginning to enter the medical field to do this work, working within communities and changing healthcare and changing the view that health professionals have. And I think that this experience will really help me as an OB-GYN, and I will carry it with me throughout the rest of my career. And I could not be more thankful for the opportunities I have been given through working with SeQuoia and making a change in the Syracuse area.

Host: Well, SeQuoia Kemp and Roma Agarwal, your passion is obvious. You've done a great job educating us on the Standing in the GAP Program. Much success and thank you so much.

SeQuoia Kemp, BSN: Thank you so much, and we appreciate the partnership and you all taking the time to learn more about the project.

Host: For updates, you can visit crouse.org/news. Now, if you found this podcast helpful, please share it on your social channels. And check out the entire podcast library for other topics of interest to you. This is Crouse HealthCast, a podcast from Crouse Health. Thanks for listening.