Institute for Innovations in Medicaid — Webinar 11/13/2020

I use Dr., and she, and her pronouns. You have my consent to post my words on social media. First, I am deeply honored to be participating in this webinar and thank the organizers for inviting me. Three quick points:

· Pregnancy is not a disease state to be managed, it is a normal physiological condition that needs to be attended to and witnessed. Birthing is a reverent event that deserves respect and humility. Shepherding new humans to this plane is a process that has for centuries ensured the propagation of our species. This is a radically different way of understanding birth than the risk categorization that dominates obstetrics. So, when I talk about and think about birthing people, this distinction needs to be made.

· Next, regardless of age, income, education, insurance and marital status, Black women carry the greatest burden for poor reproductive outcomes across the spectrum. Pregnancy is the condition and there are many outcomes of pregnancy: abortion, birth, miscarriage, surrogacy, stillbirth. Using a lifecourse perspective we can understand the continuity that is required in care provision for those who carry the greatest burden.

· Humans have been birthing since the dawn of time. The midwifery model of care is shown to have superior outcomes around the globe and is the primary model of care in many places. Yet, here in the United States our uptake and scale of the model is hampered by a lack of courage, political will, available workforce, and rampant disrespect for birthing people and the constellation of individuals who surround them.

HOW: Dr. McLemore, recognizing your extensive research and expertise on workforce development, what role can Medicaid agencies, health plans, and providers play in supporting the development of midwifery workforce that supports equitable birth outcomes?

· Midwifery agnosticism

· Wrap Around Services (i.e., Aspiring Black Midwives — Asmara Gebre)

· Racial concordance & Teaching History

· Loan repayment, Cancel student debt — tell story of your path

· Current Workforce vs. Future Workforce (doulas and carceral system work)

We need to acknowledge we have different roles and common goals!

HOW: Dr. McLemore, you have great expertise as a researcher in meaningfully bringing community voices into research. Based on your experiences, I’d love to hear your advice for how state agencies and health plans can intentionally bring communities of color to the table as full partners in their endeavors, to co-develop initiatives and approaches that meet community needs and expectations. What are some best practices?

· Living wage paid community advisors from the BEGINNING of any project, planning, grant submission etc.

· Support and lift up the work of community-based doulas and birthworkers already doing the work;

· Show up — community baby showers, events in community — change the table

· Have a goal that a percentage of the people you serve will be your future workforce — Homeless Prenatal Program, PTBi