Jaime Lewis: Perhaps you've heard of birth doulas, but what exactly do they do, and how can they help with pregnancy, labor, and delivery? Today, we'll get answers to those questions and more with Rashana Keller, a Registered Nurse and Clinical Educator with PRISMA Health. This is Flourish. The podcast from PRISMA Health.

I'm your host, Jamie Lewis. Hello, Rashana. It's so good to be with you.

Rashana Keller, MSN, RN: Hello. Good afternoon. I am so excited to be here. Thank you for having me.

Host: Yes, of course. Okay. I want to start by getting some context for our discussion. How does the US and how does South Carolina specifically, stack up when it comes to birth outcomes?

Rashana Keller, MSN, RN: Yeah. It's not all that great. So there is some data that shows that, you know, racial and ethnic minorities across South Carolina and the US experience higher rates of illness and death from conditions like diabetes, obesity, asthma, heart disease, when that population is compared to their white counterparts.

But also the CDC data also shows that life expectancy for Black Americans is six years lower than that of white Americans. And then when you add birth outcomes into that, a lot of those chronic illnesses drive how what a patient's birth outcome would be like, that ideal birth outcome that we want to see. So we still have some work to do in in our nation and in South Carolina when it comes to, to birth outcomes. South Carolina rates are steadily increasing, gradual increases, but we're increasing and go in the wrong direction. And same for the US. So there's still a lot of work to do around birth outcomes for our populations.

Host: Well, you've been doing this quite a while. You've been in labor and delivery, and research and clinical education. In your experience, what are some common pregnancy and birth complications you've seen?

Rashana Keller, MSN, RN: Yeah, so moms and babies can actually experience pregnancy or birth complications. So in terms of moms, moms might have diagnoses such as gestational diabetes, hypertension, and maybe they were diagnosed with hypertension outside of pregnancy and now, they're at greater risk for developing conditions in pregnancy like preeclampsia or preterm labor, depression, all of those things kind of go hand in hand with the baby because that mom is growing baby in her uterus for, those nine months or so.

And those things can also contribute to things like low birth weight, preterm delivery, something called IUGR, which is intrauterine growth restriction. So all of those conditions might also show up in baby.

Host: Well, you already hinted at this, but who is at risk most for these complications?

Rashana Keller, MSN, RN: Yes. Anyone can be at risk, but, moms with pre existing conditions have a greater chance of developing those conditions that we've already talked about. So for example, like a hypertensive mom, might be at an increased risk for developing preeclampsia during her pregnancy. That preeclampsia or elevated blood pressures can now determine how a baby might grow in utero.

So those things might pass on to the baby and affect growth and development for that fetus while growing in utero still.

Host: Yeah, and you and you said earlier that Black women are more at risk for those kinds of pre existing conditions. So why are they more likely to die during childbirth or suffer complications after giving birth?

Rashana Keller, MSN, RN: That's right. Really good question. Black women, just to kind of give you some data on that, Black women are 3 to 4 times, yes, more likely to die from pregnancy related events. But, a lot of, there are a couple of different factors that drive that. But one of the things that we continue to see gaps, in healthcare is racial disparities.

So Black women can sometimes be seen as undervalued or maybe those things that they are mentioning, kind of get dismissed or pushed by the wayside and many patients describe it as, I don't feel like my provider heard what I was saying. I don't, feel like they took what I was saying seriously, so a lot of the times those things may get dismissed.

Host: And you know, we don't think, I think a lot of us don't think of being Americans as having a high complication rate or, that folks die from preexisting conditions when they are in the hospital doing labor and delivery. I think it's not something that a lot of people recognize is real and, and a present danger for Americans and as a mother myself, I remember being really anxious to set the stage for a textbook labor and delivery. What can be done to ensure a healthy birth?

Rashana Keller, MSN, RN: There's some responsibility on the patient, and the provider. So as the patient, doing things like talking to healthcare providers, if something doesn't feel right, if there is something that's concerning to you, and then knowing when you should reach out for help and seek immediate care, if you are experiencing any of those urgent maternal warning signs that we speak of like severe headache, extreme swelling of the hands or the face, issues breathing, heavy vaginal bleeding, discharge, sometimes just feeling overwhelmed with stress and anxiety, depression. Those are things that are not really talked about in this space. So those are things that can also drive those urgent maternal warning signs and when you should reach out.

But in terms of the provider, health care providers can ask questions to better understand their patients and things that might be affecting their lives. There are social determinants of health in Black women that might not be present for other patients who these health care providers are caring for, like not being able to access care, not having a way to their prenatal visits. So all of those things are factors that can affect how a patient shows up in the birthing space and whether or not they can birth safely. One of the other things that I will mention that health care providers can do, is just taking some time to reflect and which can be very triggering and hard to do, but just addressing those implicit biases that you might hold.

Those are things that are very, very important because sometimes a lot, well, a lot of the times that unintentional bias is, it's unintentional. So implicit bias or unconscious bias can very well be unintentional and we don't even realize that we do it in our daily practice. But those are things that drive a healthy birth for a patient.

Host: I mentioned at the top of the episode, doulas. So how can using a doula help, can it help improve birth outcomes for maternal and for infant health?

Rashana Keller, MSN, RN: Absolutely. So yes, doulas, doulas can help to enhance the birth experience. I think there's a lot of miscommunication about what doulas actually do, and what their role is in the labor and delivery space. So they are not there as a healthcare provider. They're not there to dismiss or not work well with your healthcare provider or any of the nursing team that's available for, or that's caring for the patient, while a patient might be in labor.

They are there to enhance the birth experience and there are studies out there that support that doulas can help improve the patient experience. They can even help to improve patient outcomes and birth outcomes. So doulas are advocates. They are trained clinical professionals who provide, and I like to use it as the PIE acronym.

So the doulas that are out there provide physical, informational and emotional support. So that's that PIE acronym that we were talking about, but they provide a lot of information to patients and they can act as an advocate to the patient and, and then even show the patient how to advocate for themselves.

Host: For some listeners, they may have already had a child and experienced complications during pregnancy or birth. So for those people, what can they do to prevent that from happening again?

Rashana Keller, MSN, RN: Right. So things that you can control as a patient or as an individual is, how you show up every day. So what kind of lifestyle are you living? So adopting those healthy lifestyle patterns that we talk about, like diet and exercise, taking care of yourself and knowing when you should talk to your provider, but also connecting with your community resources that you have, like a doula who can provide those extra resources to you. I think for doulas, there is a lot of push and information on or surrounding the labor and delivery space, but nobody talks about the postpartum period and how difficult and how hard that might be to navigate. So in the hospital, yes, doulas may very well. There are labor and birth doulas who are with patients in the hospital.

But there are also postpartum doulas, which think every patient might be able to benefit from because when you go home, you don't have that support. So they are there to, some of them make meals for families. They show families and moms how to breastfeed and how to navigate not having any sleep and just being tired all the time and trying to figure out best times to feed baby.

So as a new mom, you're, you're probably feeding your baby at least eight to 12 times a day. So, that's a lot for, and then trying to figure out how to navigate being a new parent and still having your day to day tasks that you do at home. So postpartum doula services, uh, is one that I don't think gets a lot of credit.

Host: I'm so glad you mentioned that. And Rashana, this has been so helpful and informative. I really appreciate you shedding light on the best ways to plan for a healthy pregnancy and a birth. So thank you for joining me.

Rashana Keller, MSN, RN: Absolutely. Thank you for having me.

Jaime Lewis: Thank you for listening to Flourish, the podcast from PRISMA Health. I'm Jamie Lewis. For more information and to hear all of our podcasts, go to prismahealth.org/flourish.