“Laboring Under An Illusion:” Rewire Talks to Filmmaker Vicki Elson

Amie Newman

Childbirth educator and documentary filmmaker, Vicki Elson likes to say, aside from the typical hospital birth, there are essentially three kinds of births on television.

Childbirth
educator and documentary filmmaker Vicki Elson likes to say, aside from the
typical hospital birth, there are essentially three kinds of births on
television:

"One type is a
pioneer woman or early Native American just pushing her baby out, no problem.
Another type is an accidental birth on an airplane, in a tree, or during a
hostage situation.  The third type is a planned out-of-hospital birth.
These look pretty flaky on TV, like what they call "extreme birth" with
dolphins or in remote lagoons, although in reality planned home birth with good
midwifery care is as safe as hospital birth." 

After viewing
Elson’s new documentary, "Laboring Under An Illusion: Mass Media Childbirth
vs. The Real Thing"
, you
realize she’s absolutely right. It would be hilarious (and it sometimes is) if
not for the absurd reality that we’re talking about society’s visual
storytelling of the single most connecting link between human beings in the
history of all that is and ever was: birth.  Why are we presenting childbirth in ways that repel, scare
and misrepresent women (and our someday partners) and our birth experiences? By
ceding the representation of childbirth to the "oh, it’s just television" mode
of thinking we surrender some of the wisdom of our own bodies, the knowledge
about birth we can pass onto other women, the wonder of the beauty and the
remembrance of the pain in a way, as well.  Elson is determined to take it back.

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It is a growing
problem. Elson reminds us in the video "two-thirds of pregnant women watch
reality television shows on childbirth but only one-quarter of these women
actually attend childbirth education classes." What kind of "education" about
birth are women getting? First off, babies can be beamed out, as one was from Deanna
Troi
on "Star Trek:
Next Generation."
Or,
cesarean sections are becoming "the norm" as vaginal birth is being presented
as ‘the other’ option on reality television shows about pregnancy and birth
(view her video to learn more). And, finally, should you find yourself
pregnant, on a beach sunbathing? Elson tells me that one of the weirdest
television scenes about birth she’s witnessed was from the old TV show, Baywatch, where one of the characters gives birth
without taking off her one-piece bathing suit.

I spoke with
Vicki Elson about her video documentary: the "panicky fathers" and "mothers screaming
for drugs" on one end of the media-representation spectrum. And the "orgasmic"
and "unassisted" births on the other. Because Elson has been working with women
and their partners for many years, her answers to my questions and her
perspective seem wonderfully balanced, rooted in a crystal clear concern for
what is best for women, preparing women to have the healthiest birth experience
they are able.

You’ve been
educating pregnant women for 25 years! What made you originally decide to get
into this line of work and what was the impetus for making this documentary?

VE: When I had my
first baby, I was young and clueless and I considered myself a wimp.  It was the hardest work I ever did, but
it was a life-changing joy. 
Afterward I felt like I could do anything – which was great, because
what I had to do next was raise a baby. 
I think it really set the stage for my daughter’s entire life – and
mine.  There were certain elements
that contributed to having such a positive experience – my care providers,
childbirth classes, and support team especially.  I wanted to share that with other families, and all these
years later, teaching classes and watching new parents get born is still fun!

The impetus
for the film was this:
I
was doing a workshop for nurse-midwives at a local hospital when a particularly
ghastly and unrealistic (and Emmy-winning) episode of "E.R." came out.  The midwives said their phones were
ringing off the hooks because moms were scared that they could die like the
lady on TV.  Meanwhile, Murphy Brown
was America’s liberated TV mom who could anchor the news and stand up to Dan
Quayle.  But in labor, she was
wilted and powerless, except when she was strangling men by their neckties.  I wanted my kids and their friends to
grow up with realistic, nourishing imagery about the power of their bodies to
do normal things like have babies. 
I was working with midwives Rahima Baldwin Dancy and Catherine Stone on
a workshop called "Empowering Women in the Childbearing Year," and we started
collecting clips to show childbirth educators what they were up against from
the culture.  It’s still a struggle
to compete with compelling but unrealistic imagery that sticks in people’s
minds.  I expanded on that project
to write my master’s thesis 10 years ago, and when the kids grew up I finally
got around to updating the project and putting it on DVD so it’s more useful
and accessible. 

What’s the
film like?

VE: It’s 100 birth
scenes — TV and movie comedies, dramas, real births — plus narration. Birth
films tend to be very romantic or absolutely terrifying.  I wanted to
juxtapose real and fake births and let people make up their own minds, and I
wanted to make it funny, because the subject can be so intense.  And I
have to say that it is pretty entertaining.  It can be really fun to
examine cultural hopes and fears in a new way, and a lot of the clips are
hilarious.   

Do the
pregnant women in your classes (and/or partners) ever come in to class with
visions about childbirth that they got from the media, that are just so bizarre
or unrealistic that is noteworthy for you?

VE: I wish I had
some hilarious anecdote to tell you – but really what’s striking is that women
who are otherwise smart and capable come to class feeling very scared of a
normal physiological process.  It’s
getting worse over time, too, as people are exposed to more and more media, and
more people are watching birth "reality" shows than coming to childbirth
classes.  The reality shows often
take footage of a nice normal birth and then re-contextualize it with a
terrifying voiceover: "The most DANGEROUS journey of the baby’s life…the
four-inch trip…DOWN…the birth…canal."

What are the
usual stories in TV and movie birth scenes?

VE: The mom is
married, white, heterosexual, upper middle class, slender, and about 30. Labor
starts and she needs to be rushed to the hospital – this started with Lucille
Ball.  She hits a traffic jam or a flood or some other drama on the way.
The doctor is rude or maybe incompetent. She was planning a natural birth but
then she dramatically requests drugs. 

What about
fathers and partners?

VE: They’re
panicking and driving badly or getting waylaid on the way to the hospital. Or,
they’re being beaten up or sworn at by the mom.  But I think the same
thing works for moms and for their partners, whether their partners are male or
female: counteract the unrealistic imagery with realistic imagery and solid
information.  Birth does have some
risks, it is painful, it is messy and noisy and joyful and sweaty.  But it’s not the embarrassment or the
catastrophe it looks like on TV – it’s just the hard work that we mammals
do.  Partners can make a world of
difference with nothing more fancy than love and backrubs and words of
encouragement.

There is a film "Being
Dad" that’s been getting good reviews. 
I think it’s important for moms to know what it’s like for dads as well
as vice versa, and this film may help. 
I am also a big fan of women’s groups and men’s groups.  My partner and I have been in our
respective groups for many years, and there is a lot to be said for the candor
and intimacy of gender-specific socializing.  Such groups are also a great safety net when one member or
another hits a rough patch in life.           

One line
really struck me in the video. When a woman says, "Some of my friends feel sorry for me that
I had a c-section. I had a healthy baby and that’s what matters.

How do we present more realistic experiences of women who have c-sections, while simultaneously addressing how important it is not to
treat c-sections as just "another way to give birth" – that it is
major surgery?

VE: I tried to make
the film inclusive of all mothers. 
It is important to acknowledge that cesarean birth is indeed a birth: it
is every bit as meaningful, and it can be every bit as joyful as birth the
old-fashioned way.  There are two
other things we should acknowledge simultaneously, though.  One is that outcomes don’t improve
significantly when the cesarean rate is over 5 or 10 percent, and now it’s 32 percent in the
U.S.  Therefore the majority of
cesareans are medically unnecessary, with attendant risks and costs. The other
thing to keep in mind is that cesarean birth can be harder to recover from
physically and emotionally, and moms will need extra support.  A woman healing from a cesarean may
need to work on acceptance, and people should be absolutely respectful.  She may experience conflicting feelings
from losing her ideal birth and gaining a healthy baby.  She may also wish to investigate
whether her surgery was medically necessary, or to educate other mothers about
making informed decisions, but such activism must come from her.

In the video,
one woman asks:

"Are these my only choices? An unnecessary cesarean or an orgasm in a hot
tub?"
I think, for women who are set on having a natural childbirth,
sometimes the pressure to think they have to have the most wondrous, orgasmic
birth is another level of perfectionism for women. Do you think more realistic
images of birth in the mainstream media can help women on this end of the
spectrum as well?

VE: Absolutely.
Imagery can be overly romanticized OR overly medicalized. From the beginning,
childbirth education has run the risk of giving the impression that there’s a "right"
way to give birth.  I love the
orgasmic birth films because it’s great to know that birth is not necessarily a
medical event that’s all about pain – birth is, in fact, part of the continuum
of a couple’s love life.  (Hey, if
I’d known orgasmic birth was a possibility, I might have had more kids!) But
just because a few women have such pleasure doesn’t mean the rest of us should
compare ourselves to them.  No two
women give birth alike, and even the same woman will have different experiences
with each baby. Yes, the media should be more realistic, AND women need to take
responsibility for filtering what they take in.  Each of us needs to own and honor our own unique experience.  And our friends and care providers
should support that.

Are you
promoting home birth or natural birth?

VE: I tried to make
a film that doesn’t propagandize any particular way of giving birth, because
everybody’s different and there can always be surprises no matter what kind of
birth you’ve planned.  The film has a wide variety of births: real,
imaginary, fast, slow, simple, complicated, natural, surgical, orgasmic…

We see
virtually no images of childbirth doulas in mass media. Do you show your
childbirth students images of doulas at work with their clients?

VE: I can think of
only one or two doulas (non-medical labor support providers) who appear in my
film, but I agree that it’s an extremely important topic that should be
emphasized wherever possible.  I’m
a doula myself and I loved having doulas at my children’s births.  Doulas help moms and partners and
siblings through labor, and often provide more continuity than doctors,
midwives, or nurses can offer.  The
reassuring presence of a doula – even one who doesn’t speak the same language!
– has been shown to shorten labor, decrease intervention rates, and improve
maternal-infant bonding.  There is
a related profession called post-partum doula.  These fabulous people cook and clean and massage and support
breastfeeding in the early weeks.    

It seems
obvious why the mass media portrays birth in the way it does – it’s
traditionally, like most cultural institutions in this country, been a
male-dominated institution, on the whole. So, how do we go about changing these portrayals?

VE: I think that
it’s not just a problem of patriarchy – it’s a problem of profit. 
Hollywood is under the impression that what sells is danger, speed,
indignity.  To remedy this, we have to start with media literacy – making
ourselves less vulnerable to media imagery.  If we have to wait for
Hollywood, we might wait a long time.  I’m giving it a try, though – I’m
starting up an Authentic Birth Clearinghouse (www.authenticbirthclearinghouse.com
will launch soon).  It will offer assistance to mass media writers,
producers, actors, and directors.  There will be guidelines, connections
with expert advisors, links to websites that offer realistic birth imagery, and
workshops in Los Angeles, New York, and elsewhere. 

Who is this
documentary for?

VE: It’s great for
childbirth classes, high school health classes, and college courses in media
studies, medical anthropology, or women’s studies.  It’s a good film to
screen as a fundraiser for childbirth or media literacy organizations. 
It’s a good resource for libraries.  And it’s an offbeat gift (or
activity) for baby showers! 

 

You can view the feel good trailer below but one word of warning to all: have a box of tissues nearby because birth, when it’s shown in all its glory, is a beauty to behold:

For more information on the video or to order a copy, visit Birth-Media.com

Commentary Politics

On Immigration, Major Political Parties Can’t Seem to Agree on What’s ‘Un-American’

Tina Vasquez

As far as immigration is concerned, neither the Democrats nor Republicans are without their faults, though positions taken at the conventions were clearly more extreme in one case than the other.

Read more of our coverage of the Democratic National Convention here.

Immigration has been one of the country’s most contentious political topics and, not surprisingly, is now a primary focus of this election. But no matter how you feel about the subject, this is a nation of immigrants in search of “el sueño Americano,” as Karla Ortiz reminded us on the first night of the Democratic National Convention (DNC). Ortiz, the 11-year-old daughter of two undocumented parents, appeared in a Hillary Clinton campaign ad earlier this year expressing fear that her parents would be deported. Standing next to her mother on the DNC stage, the young girl told the crowd that she is an American who wants to become a lawyer to help families like hers.

It was a powerful way to kick-start the week, suggesting to viewers Democrats were taking a radically different approach to immigration than the Republican National Convention (RNC). While the RNC made undocumented immigrants the scapegoats for a variety of social ills, from U.S. unemployment to terrorism, the DNC chose to highlight the contributions of immigrants: the U.S. citizen daughter of undocumented parents, the undocumented college graduate, the children of immigrants who went into politics. Yet, even the stories shared at the DNC were too tidy and palatable, focusing on “acceptable” immigrant narratives. There were no mixed-status families discussing their deported parents, for example.

As far as immigration is concerned, neither the Democrats nor Republicans are without their faults, though positions taken at the conventions were clearly more extreme in one case than the other. By the end of two weeks, viewers may not have known whether to blame immigrants for taking their jobs or to befriend their hardworking immigrant neighbors. For the undocumented immigrants watching the conventions, the message, however, was clear: Both parties have a lot of work to do when it comes to humanizing their communities.  

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“No Business Being in This Country”

For context, Republican presidential nominee Donald Trump and his running mate Mike Pence are the decidedly anti-immigrant ticket. From the beginning, Trump’s campaign has been overrun by anti-immigrant rhetoric, from calling Mexicans “rapists” and “killers” to calling for a ban on Muslim immigration. And as of July 24, Trump’s proposed ban now includes people from countries “compromised by terrorism” who will not be allowed to enter the United States, including anyone from France.

So, it should come as no surprise that the first night of the RNC, which had the theme of “Make America Safe Again,” preyed on American fears of the “other.” In this case: undocumented immigrants who, as Julianne Hing wrote for the Nation, “aren’t just drug dealers and rapists anymorenow they’re murderers, too.”

Night one of the RNC featured not one but three speakers whose children were killed by undocumented immigrants. “They’re just three brave representatives of many thousands who have suffered so gravely,” Trump said at the convention. “Of all my travels in this country, nothing has affected me more, nothing even close I have to tell you, than the time I have spent with the mothers and fathers who have lost their children to violence spilling across our borders, which we can solve. We have to solve it.”

Billed as “immigration reform advocates,” grieving parents like Mary Ann Mendoza called her son’s killer, who had resided in the United States for 20 years before the drunk driving accident that ended her police officer son’s life, an “illegal immigrant” who “had no business being in this country.”

It seemed exploitative and felt all too common. Drunk driving deaths are tragically common and have nothing to do with immigration, but it is easier to demonize undocumented immigrants than it is to address the nation’s broken immigration system and the conditions that are separating people from their countries of originconditions to which the United States has contributed. Trump has spent months intentionally and disingenuously pushing narratives that undocumented immigrants are hurting and exploiting the United States, rather than attempting to get to the root of these issues. This was hammered home by Mendoza, who finished her speech saying that we have a system that cares more about “illegals” than Americans, and that a vote for Hillary “puts all of our children’s lives at risk.”

There was also Maricopa County Sheriff Joe Arpaio, a notorious racist whose department made a practice of racially profiling Latinos and was recently found to be in civil contempt of court for “repeatedly and knowingly” disobeying orders to cease policing tactics against Latinos, NPR reported.

Like Mendoza, Arpaio told the RNC crowd that the immigration system “puts the needs of other nations ahead of ours” and that “we are more concerned with the rights of ‘illegal aliens’ and criminals than we are with protecting our own country.” The sheriff asserted that he was at the RNC because he was distinctly qualified to discuss the “dangers of illegal immigration,” as someone who has lived on both sides of the border.

“We have terrorists coming in over our border, infiltrating our communities, and causing massive destruction and mayhem,” Arpaio said. “We have criminals penetrating our weak border security systems and committing serious crimes.”

Broadly, the takeaway from the RNC and the GOP nominee himself is that undocumented immigrants are terrorists who are taking American jobs and lives. “Trump leaned on a tragic story of a young woman’s murder to prop up a generalized depiction of immigrants as menacing, homicidal animals ‘roaming freely to threaten peaceful citizens,’” Hing wrote for the Nation.

When accepting the nomination, Trump highlighted the story of Sarah Root of Nebraska, a 21-year-old who was killed in a drunk-driving accident by a 19-year-old undocumented immigrant.

“To this administration, [the Root family’s] amazing daughter was just one more American life that wasn’t worth protecting,” Trump said. “One more child to sacrifice on the altar of open borders.”

It should be noted that the information related to immigration that Trump provided in his RNC speech, which included the assertion that the federal government enables crime by not deporting more undocumented immigrants (despite deporting more undocumented immigrants than ever before in recent years), came from groups founded by John Tanton, a well-known nativist whom the Southern Poverty Law center referred to as “the racist architect of the modern anti-immigrant movement.”

“The Border Crossed Us”

From the get-go, it seemed the DNC set out to counter the dangerous, anti-immigrant rhetoric pushed at the RNC. Over and over again, Democrats like Congressional Hispanic Caucus Chair Rep. Linda Sánchez (D-CA) hit back hard against Trump, citing him by name and quoting him directly.

“Donald Trump believes that Mexican immigrants are murderers and rapists. But what about my parents, Donald?” Sánchez asked the crowd, standing next to her sister, Rep. Loretta Sánchez (D-CA). “They are the only parents in our nation’s 265-year history to send not one but two daughters to the United States Congress!”

Each speech from a Latino touched on immigration, glossing over the fact that immigration is not just a Latino issue. While the sentiments were positiveillustrating a community that is thriving, and providing a much-needed break from the RNC’s anti-immigrant rhetoricat the core of every speech were messages of assimilation and respectability politics.

Even in gutsier speeches from people like actress Eva Longoria, there was the need to assert that her family is American and that her father is a veteran. The actress said, “My family never crossed a border. The border crossed us.”

Whether intentional or not, the DNC divided immigrants into those who are acceptable, respectable, and worthy of citizenship, and those—invisible at the convention—who are not. “Border crossers” who do not identify as American, who do not learn English, who do not aspire to go to college or become an entrepreneur because basic survival is overwhelming enough, what about them? Do they deserve to be in detention? Do their families deserve to be ripped apart by deportation?

At the convention, Rep. Luis Gutiérrez (D-IL), a champion of immigration reform, said something seemingly innocuous that snapped into focus the problem with the Democrats’ immigration narrative.

“In her heart, Hillary Clinton’s dream for America is one where immigrants are allowed to come out of the shadows, get right with the law, pay their taxes, and not feel fear that their families are going to be ripped apart,” Gutiérrez said.

The Democratic Party is participating in an all-too-convenient erasure of the progress undocumented people have made through sheer force of will. Immigration has become a leading topic not because there are more people crossing the border (there aren’t) or because nativist Donald Trump decided to run for president, but because a segment of the population has been denied basic rights and has been fighting tooth and nail to save themselves, their families, and their communities.

Immigrants have been coming out of the shadows and as a result, are largely responsible for the few forms of relief undocumented communities now have, like Deferred Action for Childhood Arrivals, which allows certain undocumented immigrants who meet specific qualifications to receive a renewable two-year work permit and exemption from deportation. And “getting right with the law” is a joke at this point. The problem isn’t that immigrants are failing to adhere to immigration laws; the problem is immigration laws that are notoriously complicated and convoluted, and the system, which is so backlogged with cases that a judge sometimes has just seven minutes to determine an immigrant’s fate.

Becoming a U.S. citizen is also really expensive. There is a cap on how many people can immigrate from any given country in a year, and as Janell Ross explained at the Washington Post:

There are some countries, including Mexico, from where a worker with no special skills or a relative in the United States can apply and wait 23 years, according to the U.S. government’s own data. That’s right: There are people receiving visas right now in Mexico to immigrate to the United States who applied in 1993.

But getting back to Gutierrez’s quote: Undocumented immigrants do pay taxes, though their ability to contribute to our economy should not be the one point on which Democrats hang their hats in order to attract voters. And actually, undocumented people pay a lot of taxes—some $11.6 billion in state and local taxes last year, according to the Institute on Taxation and Economic Policy—while rarely benefiting from a majority of federal assistance programs since the administration of President Bill Clinton ended “welfare as we know it” in 1996.

If Democrats were being honest at their convention, we would have heard about their failure to end family detention, and they would have addressed that they too have a history of criminalizing undocumented immigrants.

The 1996 Antiterrorism and Effective Death Penalty Act and the 1996 Illegal Immigration Reform and Immigrant Responsibility Act, enacted under former President Clinton, have had the combined effect of dramatically increasing the number of immigrants in detention and expanding mandatory or indefinite detention of noncitizens ordered to be removed to countries that will not accept them, as the American Civil Liberties Union notes on its site. Clinton also passed the North American Free Trade Agreement, which economically devastated Mexican farmers, leading to their mass migration to the United States in search of work.

In 1990, then-Sen. Joe Biden introduced the Violence Against Women Act, which passed in 1994 and specifically excluded undocumented women for the first 19 of the law’s 22 years, and even now is only helpful if the victim of intimate partner abuse is a child, parent, or current/former spouse of a U.S. citizen or a permanent resident.

In addition, President Obama is called by immigrant rights advocates “deporter in chief,” having put into place a “deportation machine” that has sent more than two million migrants back to their country of origin, more than any president in history. New arrivals to the United States, such as the Central American asylum seekers coming to our border escaping gender-based violence, are treated with the same level of prioritization for removal as threats to our national security. The country’s approach to this humanitarian crisis has been raiding homes in the middle of the night and placing migrants in detention centers, which despite being rife with allegations of human rights abuses, are making private prison corporations millions in revenue.

How Are We Defining “Un-American”?

When writing about the Democratic Party, community organizer Rosa Clemente, the 2008 Green Party vice president candidate, said that she is afraid of Trump, “but not enough to be distracted from what we must do, which is to break the two-party system for good.”

This is an election like we’ve never seen before, and it would be disingenuous to imply that the party advocating for the demise of the undocumented population is on equal footing with the party advocating for the rights of certain immigrants whose narratives it finds acceptable. But this is a country where Republicans loudly—and with no consequence—espouse racist, xenophobic, and nativist beliefs while Democrats publicly voice support of migrants while quietly standing by policies that criminalize undocumented communities and lead to record numbers of deportations.

During two weeks of conventions, both sides declared theirs was the party that encapsulated what America was supposed to be, adhering to morals and values handed down from our forefathers. But ours is a country comprised of stolen land and built by slave labor where today, undocumented immigrants, the population most affected by unjust immigration laws and violent anti-immigrant rhetoric, don’t have the right to vote. It is becoming increasingly hard to tell if that is indeed “un-American” or deeply American.

Culture & Conversation Maternity and Birthing

On ‘Commonsense Childbirth’: A Q&A With Midwife Jennie Joseph

Elizabeth Dawes Gay

Joseph founded a nonprofit, Commonsense Childbirth, in 1998 to inspire change in maternity care to better serve people of color. As a licensed midwife, Joseph seeks to transform how care is provided in a clinical setting.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

Jennie Joseph’s philosophy is simple: Treat patients like the people they are. The British native has found this goes a long way when it comes to her midwifery practice and the health of Black mothers and babies.

In the United States, Black women are disproportionately affected by poor maternal and infant health outcomes. Black women are more likely to experience maternal and infant death, pregnancy-related illness, premature birth, low birth weight, and stillbirth. Beyond the data, personal accounts of Black women’s birthing experiences detail discrimination, mistreatment, and violation of basic human rights. Media like the new film, The American Dream, share the maternity experiences of Black women in their own voices.

A new generation of activists, advocates, and concerned medical professionals have mobilized across the country to improve Black maternal and infant health, including through the birth justice and reproductive justice movements.

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Joseph founded a nonprofit, Commonsense Childbirth, in 1998 to inspire change in maternity care to better serve people of color. As a licensed midwife, Joseph seeks to transform how care is provided in a clinical setting.

At her clinics, which are located in central Florida, a welcoming smile and a conversation mark the start of each patient visit. Having a dialogue with patients about their unique needs, desires, and circumstances is a practice Joseph said has contributed to her patients having “chunky,” healthy, full-term babies. Dialogue and care that centers the patient costs nothing, Joseph told Rewire in an interview earlier this summer.

Joseph also offers training to midwives, doulas, community health workers, and other professionals in culturally competent, patient-centered care through her Commonsense Childbirth School of Midwifery, which launched in 2009. And in 2015, Joseph launched the National Perinatal Task Force, a network of perinatal health-care and service providers who are committed to working in underserved communities in order to transform maternal health outcomes in the United States.

Rewire spoke with Joseph about her tireless work to improve maternal and perinatal health in the Black community.

Rewire: What motivates and drives you each day?

Jennie Joseph: I moved to the United States in 1989 [from the United Kingdom], and each year it becomes more and more apparent that to address the issues I care deeply about, I have to put action behind all the talk.

I’m particularly concerned about maternal and infant morbidity and mortality that plague communities of color and specifically African Americans. Most people don’t know that three to four times as many Black women die during pregnancy and childbirth in the United States than their white counterparts.

When I arrived in the United States, I had to start a home birth practice to be able to practice at all, and it was during that time that I realized very few people of color were accessing care that way. I learned about the disparities in maternal health around the same time, and I felt compelled to do something about it.

My motivation is based on the fact that what we do [at my clinic] works so well it’s almost unconscionable not to continue doing it. I feel driven and personally responsible because I’ve figured out that there are some very simple things that anyone can do to make an impact. It’s such a win-win. Everybody wins: patients, staff, communities, health-care agencies.

There are only a few of us attacking this aggressively, with few resources and without support. I’ve experienced so much frustration, anger, and resignation about the situation because I feel like this is not something that people in the field don’t know about. I know there have been some efforts, but with little results. There are simple and cost-effective things that can be done. Even small interventions can make such a tremendous a difference, and I don’t understand why we can’t have more support and more interest in moving the needle in a more effective way.

I give up sometimes. I get so frustrated. Emotions vie for time and energy, but those very same emotions force me to keep going. I feel a constant drive to be in action and to be practical in achieving and getting results.

Rewire: In your opinion, what are some barriers to progress on maternal health and how can they be overcome?

JJ: The solutions that have been generated are the same, year in and year out, but are not really solutions. [Health-care professionals and the industry] keep pushing money into a broken system, without recognizing where there are gaps and barriers, and we keep doing the same thing.

One solution that has not worked is the approach of hiring practitioners without a thought to whether the practitioner is really a match for the community that they are looking to serve. Additionally, there is the fact that the practitioner alone is not going to be able make much difference. There has to be a concerted effort to have the entire health-care team be willing to support the work. If the front desk and access points are not in tune with why we need to address this issue in a specific way, what happens typically is that people do not necessarily feel welcomed or supported or respected.

The world’s best practitioner could be sitting down the hall, but never actually see the patient because the patient leaves before they get assistance or before they even get to make an appointment. People get tired of being looked down upon, shamed, ignored, or perhaps not treated well. And people know which hospitals and practitioners provide competent care and which practices are culturally safe.

I would like to convince people to try something different, for real. One of those things is an open-door triage at all OB-GYN facilities, similar to an emergency room, so that all patients seeking maternity care are seen for a first visit no matter what.

Another thing would be for practitioners to provide patient-centered care for all patients regardless of their ability to pay.  You don’t have to have cultural competency training, you just have to listen and believe what the patients are telling you—period.

Practitioners also have a role in dismantling the institutionalized racism that is causing such harm. You don’t have to speak a specific language to be kind. You just have to think a little bit and put yourself in that person’s shoes. You have to understand she might be in fear for her baby’s health or her own health. You can smile. You can touch respectfully. You can make eye contact. You can find a real translator. You can do things if you choose to. Or you can stay in place in a system you know is broken, doing business as usual, and continue to feel bad doing the work you once loved.

Rewire: You emphasize patient-centered care. Why aren’t other providers doing the same, and how can they be convinced to provide this type of care?

JJ: I think that is the crux of the matter: the convincing part. One, it’s a shame that I have to go around convincing anyone about the benefits of patient-centered care. And two, the typical response from medical staff is “Yeah, but the cost. It’s expensive. The bureaucracy, the system …” There is no disagreement that this should be the gold standard of care but providers say their setup doesn’t allow for it or that it really wouldn’t work. Keep in mind that patient-centered care also means equitable care—the kind of care we all want for ourselves and our families.

One of the things we do at my practice (and that providers have the most resistance to) is that we see everyone for that initial visit. We’ve created a triage entry point to medical care but also to social support, financial triage, actual emotional support, and recognition and understanding for the patient that yes, you have a problem, but we are here to work with you to solve it.

All of those things get to happen because we offer the first visit, regardless of their ability to pay. In the absence of that opportunity, the barrier to quality care itself is so detrimental: It’s literally a matter of life and death.

Rewire: How do you cover the cost of the first visit if someone cannot pay?

JJ: If we have a grant, we use those funds to help us pay our overhead. If we don’t, we wait until we have the women on Medicaid and try to do back-billing on those visits. If the patient doesn’t have Medicaid, we use the funds we earn from delivering babies of mothers who do have insurance and can pay the full price.

Rewire: You’ve talked about ensuring that expecting mothers have accessible, patient-centered maternity care. How exactly are you working to achieve that?

JJ: I want to empower community-based perinatal health workers (such as nurse practitioners) who are interested in providing care to communities in need, and encourage them to become entrepreneurial. As long as people have the credentials or license to provide prenatal, post-partum, and women’s health care and are interested in independent practice, then my vision is that they build a private practice for themselves. Based on the concept that to get real change in maternal health outcomes in the United States, women need access to specific kinds of health care—not just any old health care, but the kind that is humane, patient-centered, woman-centered, family-centered, and culturally-safe, and where providers believe that the patients matter. That kind of care will transform outcomes instantly.

I coined the phrase “Easy Access Clinics” to describe retail women’s health clinics like a CVS MinuteClinic that serve as a first entry point to care in a community, rather than in a big health-care system. At the Orlando Easy Access Clinic, women receive their first appointment regardless of their ability to pay. People find out about us via word of mouth; they know what we do before they get here.

We are at the point where even the local government agencies send patients to us. They know that even while someone’s Medicaid application is in pending status, we will still see them and start their care, as well as help them access their Medicaid benefits as part of our commitment to their overall well-being.

Others are already replicating this model across the country and we are doing research as we go along. We have created a system that becomes sustainable because of the trust and loyalty of the patients and their willingness to support us in supporting them.

Photo Credit: Filmmaker Paolo Patruno

Joseph speaking with a family at her central Florida clinic. (Credit: Filmmaker Paolo Patruno)

RewireWhat are your thoughts on the decision in Florida not to expand Medicaid at this time?

JJ: I consider health care a human right. That’s what I know. That’s how I was trained. That’s what I lived all the years I was in Europe. And to be here and see this wanton disregard for health and humanity breaks my heart.

Not expanding Medicaid has such deep repercussions on patients and providers. We hold on by a very thin thread. We can’t get our claims paid. We have all kinds of hoops and confusion. There is a lack of interest and accountability from insurance payers, and we are struggling so badly. I also have a Change.org petition right now to ask for Medicaid coverage for pregnant women.

Health care is a human right: It can’t be anything else.

Rewire: You launched the National Perinatal Task Force in 2015. What do you hope to accomplish through that effort?

JJ: The main goal of the National Perinatal Task Force is to connect perinatal service providers, lift each other up, and establish community recognition of sites committed to a certain standard of care.

The facilities of task force members are identified as Perinatal Safe Spots. A Perinatal Safe Spot could be an educational or social site, a moms’ group, a breastfeeding circle, a local doula practice, or a community center. It could be anywhere, but it has got to be in a community with what I call a “materno-toxic” area—an area where you know without any doubt that mothers are in jeopardy. It is an area where social determinants of health are affecting mom’s and baby’s chances of being strong and whole and hearty. Therein, we need to put a safe spot right in the heart of that materno-toxic area so she has a better chance for survival.

The task force is a group of maternity service providers and concerned community members willing to be a safe spot for that area. Members also recognize each other across the nation; we support each other and learn from each others’ best practices.

People who are working in their communities to improve maternal and infant health come forward all the time as they are feeling alone, quietly doing the best they can for their community, with little or nothing. Don’t be discouraged. You can get a lot done with pure willpower and determination.

RewireDo you have funding to run the National Perinatal Task Force?

JJ: Not yet. We have got the task force up and running as best we can under my nonprofit Commonsense Childbirth. I have not asked for funding or donations because I wanted to see if I could get the task force off the ground first.

There are 30 Perinatal Safe Spots across the United States that are listed on the website currently. The current goal is to house and support the supporters, recognize those people working on the ground, and share information with the public. The next step will be to strengthen the task force and bring funding for stability and growth.

RewireYou’re featured in the new film The American Dream. How did that happen and what are you planning to do next?

JJ: The Italian filmmaker Paolo Patruno got on a plane on his own dime and brought his cameras to Florida. We were planning to talk about Black midwifery. Once we started filming, women were sharing so authentically that we said this is about women’s voices being heard. I would love to tease that dialogue forward and I am planning to go to four or five cities where I can show the film and host a town hall, gathering to capture what the community has to say about maternal health. I want to hear their voices. So far, the film has been screened publicly in Oakland and Kansas City, and the full documentary is already available on YouTube.

RewireThe Black Mamas Matter Toolkit was published this past June by the Center for Reproductive Rights to support human-rights based policy advocacy on maternal health. What about the toolkit or other resources do you find helpful for thinking about solutions to poor maternal health in the Black community?

JJ: The toolkit is the most succinct and comprehensive thing I’ve seen since I’ve been doing this work. It felt like, “At last!”

One of the most exciting things for me is that the toolkit seems to have covered every angle of this problem. It tells the truth about what’s happening for Black women and actually all women everywhere as far as maternity care is concerned.

There is a need for us to recognize how the system has taken agency and power away from women and placed it in the hands of large health systems where institutionalized racism is causing much harm. The toolkit, for the first time in my opinion, really addresses all of these ills and posits some very clear thoughts and solutions around them. I think it is going to go a long way to begin the change we need to see in maternal and child health in the United States.

RewireWhat do you count as one of your success stories?

JJ: One of my earlier patients was a single mom who had a lot going on and became pregnant by accident. She was very connected to us when she came to clinic. She became so empowered and wanted a home birth. But she was anemic at the end of her pregnancy and we recommended a hospital birth. She was empowered through the birth, breastfed her baby, and started a journey toward nursing. She is now about to get her master’s degree in nursing, and she wants to come back to work with me. She’s determined to come back and serve and give back. She’s not the only one. It happens over and over again.

This interview has been edited for length and clarity.