Caitlin Whyte (Host): In this compelling episode of In Their Words, Dr. Sharee Livingston unveils the transformative impact of the Diversifying Doulas Initiative, a groundbreaking program from Patients R Waiting, supported in part by the UPMC Pinnacle Foundation. By addressing critical racial disparities and maternal healthcare, this initiative is revolutionizing support for black and Latinx birthing persons in Lancaster county. Through strategic recruitment, certification, and compassionate matching of women of color as doulas, the program directly combat systemic healthcare inequities. Witness how this innovative approach empowers women, reduces health outcome disparities, and demonstrates UPMC's commitment to equitable culturally-responsive maternity care.

Dr. Sharee Livingston: I'm Dr. Sharee Livingston. I'm the OB-GYN department chair here at UPMC Lititz. I've been here at UPMC Lititz since 2006 and have enjoyed every moment. I am a Black maternal health advocate. I have a strong desire to see everyone birth beautifully, specifically marginalized birthing people. During the COVID crisis, maternal health care gaps widened. And because I care tremendously about safe birth, I co-founded the Diversifying Doula initiative. The mission of the Diversifying Doula Initiative is to decrease maternal morbidity and mortality in birthing people of color through doula care.

And so, we have several areas of focus. We train black and brown doulas. And to date, we have trained 52 doulas. We provide fully subsidized doula services to birthing people of color and, to date, we have provided 313 birthing people with fully subsidized doula care. We performed qualitative and quantitative research to determine how well we were doing and if what we were doing is effective. And our mixed method research has proven that we are making strides. Our C-section rates are lower than national average, our preterm birth rates are lower than national average, and postpartum depression rates are significantly lower than national average. So, we're pretty proud of the work that we're doing.

We have created community doula education classes where every week patients or people who aren't pregnant or interested in becoming pregnant, recently pregnant, currently pregnant can join us for a two-hour session where they learn everything about childbirth and birth education, lactation, postpartum health and well-being, and knowing and understanding their rights and autonomy. So, that's a very exciting program that we have, because we're directly facing the community. And so, I want to give a big shout out to UPMC Pinnacle Foundation because they were the first to support us through major sponsorship. And so, DDI is forever grateful to UPMC Pinnacle Foundation for that support.

Host: When asked what drew her to this field, Dr. Livingston shares a poignant childhood memory.

Dr. Sharee Livingston: I was born and raised in the inner city of Harrisburg, and I sort of recall, there are stains my memory, but through narratives and family storytelling, I'm sure the picture has become more clear, but I was sitting at the kitchen table with my maternal great grandmother. And she passed away in front of me from a diabetic coma.

And I remember through the very microscopic memory of that moment. And obviously, with the storytelling, I remember feeling like I will always be committed to helping people, because she and I were so helpless in that moment. And fortunately, I was super good at math and science, and so I took those three things: the love of math, the love of science, and the strong desire to not be in that moment that I was in with my maternal great grandmother, where I couldn't help. I took those three things and I took those three things and fused it into a fierce desire to become a physician.

When I was only nine years old, I volunteered at the Community General Osteopathic Hospital in Harrisburg, Pennsylvania, and I would walk around from room to room passing out water. It was the simplest of acts, but the most gratifying because back then, people enjoyed young candy stripers coming in and out of their room, talking, smiling, delivering water, and those moments meant a lot. I valued seeing smiles on people's faces when they were tended to. So, all of this was just pouring gasoline on my dreams of becoming a physician. Maybe at the time I wasn't using words like that, but I knew the act. I knew the act of helping people in this very bold and audacious profession. And so, it was that that created the bedrock for my desire to go into health care, and just Worked very steadfastly. I studied biology at St. Joe's and then went to medical school, and just really had a good time developing myself. I always knew I wanted to go into women's health care. I grew up in a very matriarchal family. Anybody that's heard me talk knows I love to brag about the women in my family. They're very strong. And so, I just learned to love women very early. And that also helped to focus my desire on women's health care. And being an OB-GYN is pretty amazing because you get to care for two patients. You get to care for women, girls, and people throughout their reproductive life cycle, whether they choose to reproduce or not. And having that impact during such an important time frame is really amazing. It's nothing short of amazing.

Host: When questioned about pivotal insights into the systemic challenges facing black and brown women in maternal health care, Dr. Livingston offered a deeply illuminating perspective.

Dr. Sharee Livingston: Yeah, I unfortunately witnessed maternal death firsthand. And, you know, if you practice obstetrics long enough unfortunately you'll see things that we didn't sign up for. You know, We get the joy of helping to bring birth into the world, but sometimes things don't go in that direction. And when I saw that maternal loss, I did my own research because we didn't talk about it a lot in medical school. We didn't talk about maternal mortality. Even in residency, you just didn't talk about it to the depth that people are talking about it right now. And my research led me to discover that Black women are three to four times more likely to die in childbirth.

And up until, you know, 2018 when we became much more sophisticated at determining maternal mortality or reviewing it or even diagnosing it or discovering it, if you will, with the checkboxes on death certificates, and just the national commitment to follow and track maternal morbidity and mortality. Up until then, we just didn't have great understanding, and now we do have a greater understanding. And so, there are many things that contribute to the health disparity of marginalized birthing people, specifically Black birthing people, having these disparate rates. And it's not because Black people are broken. Black people birth beautifully. The issue lies with systemic and structural racism that contributes to many things, including the social determinants of health and the racial disparities that lead to social determinants of health impacting or negatively impacting people of color, where people work and where they live and lack of transportation, lack of healthy food, lack of access to affordable health care. Inequities that are hundreds of years in the making that will require us to dissect each one out so that we can be solution-focused and not have patients walking into the office like they do, terrified that they may not survive childbirth.

You don't even have to be in medicine these days to know about these statistics. Everybody's talking about them. It's on TV, it's on the radio, it's in the paper, in magazines. And people are ready for solutions. And that's why when I speak publicly about this, I really break it down into five part solutions where we focus on health care providers and what they're doing; patients, patients are part of the solution as well, government, community, and we want to think about what organizations like UPMC are doing. So, those five pathways are pathways to really addressing the solutions regarding healthcare providers, anti-racism training, and dedication to anti-racism training, and anti-bias training. Those things are imperative for health care providers to be able to see their patients as human and provide them with the care that they deserve.

Regarding patients, patients can always play an integral role in contributing to the solutions to the disparate health outcomes, patients walking into pregnancy the healthiest version of themselves, patients learning to advocate for themselves and creating their tribes, gathering their tribes pre-childbirth, but especially once they become pregnant, gather their team that's going to help them walk through pregnancy safely. And patients can also feel comfortable asking their health care providers, "Hey, are you aware of the statistics, especially if it's a birthing person of color?" Or, "Hey, dear doctor, are you aware that the statistics show that I'm three to four times more likely to die in child birth? What are you doing to avert that? How can you and I grab hands and do some asset framing and ensure that I'm going to go through this birth unscathed and have a great experience?" It's wonderful when patients can ask questions like that.

Regarding government, there are solutions that sit on the government and the legislative side. Increasing telehealth, increasing data collection, hospital to hospital, focusing on legislation like the  Momnibus Bill, increasing access to affordable health care extending Medicaid for postpartum people, obviously increasing access to doulas. And really, just getting government centered and focused on safe childbirth.

So, these are some things that I really emphasize when talking about solutions. Organizations like UPMC, we have UPMC Health Equity Now. That's a bold commitment to making sure that the people who are delivering in our hospital system are doing so safely. Our mission at UPMC Health Equity Now is to ensure that all birthing people, but specifically racially and ethically diverse birthing people who are delivering in our hospitals do so in the safest manner. And we focus on people, we focus on processes, and we focus on policy when implementing that safe care for birthing people of color in our UPMC hospitals.

And then fifth, regarding community. Organizations like the one I co-founded, the Diversifying Doula Initiative, there are orgs out here doing the work. We don't have to be duplicative or reproduce the work. People are doing the work and kudos to organizations like UPMC Pinnacle Foundation for Supporting community organizations that are boots on the ground and doing the work. So, yeah, I really like to highlight those five pathways to a solution and focus on getting things done and getting birth done safely here in our Commonwealth, but also in our nation.

Well, I wrote an op ed in the Lancaster newspaper last Sunday, and I spoke specifically about the new administration coming in and what needs we have. A significant. I think it was upwards of 90 plus percent of the voters voted based on economics. And we know that $320 billion are lost to health disparities. And so, we need to find reasons. If people can't find enough reasons because we see each other as human, or we care about each other, we love each other, then let economics be the driving force to eliminate health disparities. People can just find what matters to them. And if 90 plus percent of Americans voted with their purse, then 90 plus percent of Americans can work to eliminate health disparities for financial reasons.

My number one reason is because it's the right thing to do. My number two reason is people are human and deserve to birth safely. And so if, other folks don't emulate that, then each and every person can lean on their why and say, What is it that matters? If economics matters, then this issue should matter to them, because it is costing us to have such disparate health outcomes. So, I think the answer to the question is fairly easy. Find your why, and if it's logical and it makes sense, then we all strive and work to eliminate health disparities.

Host: Dr. Livingston illuminates the powerful dynamics between mothers and doulas. We're revealing compelling insights into their transformative support relationship.

Dr. Sharee Livingston: Oh my. So, we did a qualitative analysis where we asked patients what they felt or how they felt about having a DDI doula. And many of them, I think it was somewhere around 70%, had never even heard of a doula. So once they had the experience of a doula and a culturally congruent doula, they valued that experience. They felt seen and heard and listened to because their needs were centered. And the patients understand the importance of having an advocate. Doulas are professionally trained birth support people. They provide informational support, educational support and emotional support. And they are masters at it. They understand that they are not medical. They're not interested in practicing medicine. We say that for our midwifery friends and our obstetric friends, but doulas are amazing at staying in their lane, mastering their lane, and really centering the patient's experience. And they listen to them. Studies show that doulas spend 6 to 11 times more time with their clients-- they call them clients-- than we do as obstetricians. And that's the secret sauce. That's the key. When you spend time, you're able to understand and know what the birthing person values, what's important to them, what may make them fearful, what makes them happy and joyous, and you're able to expand upon that knowledge and really bring a safer birth to that person.

DDI reviews our data on a weekly basis. And to date, we have trained 52 black and brown doulas, and we have provided 313 fully subsidized doula services to birthing people of color. When I learned that UPMC Harrisburg received a grant to erect a Birth Circles Doula Program, my heart just filled up because Harrisburg is my home base and I always wanted to increase doula access in that area. And so for the grantees to have come through and really provided this level of financial support for the erection of a doula program. For the birthing people of Harrisburg, and there are plenty, Harrisburg Hospital for a long time has been providing great obstetric care. And now, along with doulas, holding hands with doulas, they can provide even better care to the Harrisburg and surrounding areas.

So, my dream is for every birthing person who wants a doula to have a doula. We have work to do. We can turn this around. The solutions to the maternal health crisis in our country is not difficult to solve. We just have to focus on the right things, and it will not sit squarely on the laps of just doulas to solve the problem. But doulas and midwives are an integral part of the perinatal workforce, and together we are going to make birth safer in our cities. In our commonwealth, in our nation, we'll do it. Yeah, I think that people can support. Patients are waiting, and the Diversifying Doula Initiative.

Many people are asking, especially now post election, what can I do? You know what people can do? Support the organizations that are doing the work. Because in 5, 10, 15, 20 years, I want our organization to have such substance that we are standing in confidence that we have increased and diversified medicine and just really improving care.

Host: And this groundbreaking episode of in their words, Dr. Sharee Livingston has illuminated the critical work of the diversifying doulas initiative. Through powerful storytelling and rigorous insight. She has revealed how this program is transforming maternal healthcare by addressing systemic inequities. Empowering women of color and providing culturally aligned, compassionate support during one of life's most profound journeys. The Diversifying Doulas Initiative stands as a powerful model, a testament to how targeted community-centered interventions can reshape healthcare outcomes and restore dignity to birthing experiences, by training and connecting doulas who truly understand and reflect the communities they serve. This program isn't just changing statistics, it's changing lives