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6. Maternal Health and Race with Dr. Fatu Forna
120 Plays1 year ago
In our new episode of Our Womanity podcast with Dr. Rachel Pope, we're privileged to host Dr. Fatu Forna, Co-Founder of The Mama-Pikin Foundation, dedicated to enhancing maternal health in the US, Sierra Leone and around the world. Dr. Forna, a leading expert in obstetrics, gynecology, and epidemiology, has spearheaded groundbreaking initiatives globally. Her Cocoon Pregnancy Care Model, aimed at improving perinatal outcomes, has garnered widespread acclaim. Beyond her professional achievements, Dr. Forna is a passionate advocate for adolescent reproductive health, authoring essential resources and pioneering educational programs. She has served as Lead for Reproductive and Maternal Health for the World Health Organization in Sierra Leone, as a Medical Epidemiologist at the Centers for Disease Control and Prevention, and as Chief of Women's Services and Physician Program Director for Perinatal Safety and Quality for Kaiser Permanente in Georgia (KPGA).
Beyond her professional endeavors, Dr. Forna is a passionate advocate for the reproductive health of young women. She is the author of "From Your Doctor to You," a crucial resource empowering teenage girls with essential knowledge about their bodies, sexuality, and contraception. Additionally, Dr. Forna has pioneered educational initiatives like the “From your doctor to you: Puberty Party and Manhood/Womanhood Party” curriculum, aimed at fostering healthy conversations around puberty and sexuality.
Dr. Forna's impact extends beyond borders, as she continues to inspire change through her engaging speaking engagements and media appearances. Her commitment to improving the health of women and children has earned her recognition, including features on CNN International.
Join us as she shares her insights on maternal health, race, and the pursuit of equitable healthcare.
Featured in this episode:
- Dr. Fatu Forna TikTok
- Cocoon Pregnancy Care Model
- Why Maternal Death is Increasing in the US
- Health Providers Recognizing the Problem
- Advice for Black Women About to Give Birth
Submit your questions on anything and everything women's health-related and we will answer them in one of our episodes.
Subscribe to our newsletter here to stay updated and not miss out on new episodes.
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Transcript
Introduction to Dr. Fatu Forna
00:00:01
Speaker
Welcome everybody to Arwell Manatee. I am pleased to be here with Dr. Fatu Forna. Dr. Forna is quite an accomplished woman. She's an OBGYN and she got her medical degree from Duke University and did her residency at Emory University School of Medicine.
00:00:18
Speaker
She's a fellow of ACOG, and she served as the lead for reproductive and maternal health for the World Health Organization in Sierra Leone, and also as the director of the Perinatal Safety and Quality and Chief of Women's Services for Kaiser Permanente in Georgia. She does so much work. I can't even list it all. We'll put her website here for you to read more. But she and I actually met fortuitously in Sierra Leone. I was talking to my colleague about obstetric fistulas, and she said,
00:00:47
Speaker
This allows you, you must be my people. I also have to mention that Dr.
The Dancing Doctors on TikTok
00:00:54
Speaker
Forna is part of the Dancing Doctors. You'll have to check them out on TikTok. They're so good. She and her husband are quite the duo. But today I'm welcoming her to speak about her work with maternal mortality because we have an issue in our country.
Addressing Maternal Mortality Disparities
00:01:08
Speaker
We also have, you know, there are lots of issues elsewhere, but especially in Sierra Leone where she does a lot of her work. I just want to hear
00:01:16
Speaker
what you've been up to, what you are doing and about your passions. Thank you. Nice to talk to you again. I know how we met was just crazy and so much fun. Yeah. So tell us what you are doing in Georgia. Maybe we could start locally. Okay. So like you said, I am a OBGYN and epidemiologist and I've found a way to kind of, you know, marry those two careers. You know, I was born in Sierra Leone and I moved to the US as a teenager and
00:01:45
Speaker
At that time, Sierra Leone had one of the highest maternal mortality in the world. I just knew growing up, I was surrounded by stories of women dying, childbirth, women in my family, women all over. I grew up wanting to be the type of doctor that would help keep women from dying. I didn't know it was called an OBGYN or maybe an epidemiologist. I just follow that career and I think
00:02:13
Speaker
You know, that's where I am now. I live in Atlanta and work both in Atlanta and in Sierra Leone and travel back and forth and kind of do both working to make a pregnancy safer for women here in the US and around the world, specifically in Sierra Leone and in some other countries too.
00:02:32
Speaker
Yeah it's so crazy maybe not all of our listeners are aware but the maternal mortality ratio has been worsening getting it's increasing here in the US over the last few years and I would love to hear your thoughts on that and what we can be doing about it.
00:02:49
Speaker
I know that race is part of the problem, racism and discrimination and some structural issues, so just love to get your thoughts on it. Like I said, when I left Sierra Leone, I always thought of, you know, I'm coming from a country that has high maternal mortality, you know, into the place like the US that has one of the best healthcare systems in the world, or so I thought.
00:03:12
Speaker
Throughout my career, I have now learned that the US is the only industrialized country where the maternal mortality rate is rising. In fact, nearly every other country in the world, the maternal mortality rate is declining, included in Sierra Leone.
00:03:27
Speaker
Here in the US, it's going up and not only is it rising, there's a big discrepancy. There's a higher rate of death, especially for black women who have two or three, sometimes even four times higher mortality than white women. That's a challenge to be in a place where we know we can do a lot better. We have all the resources.
Cocoon Pregnancy Care Model
00:03:50
Speaker
You see other countries around the world that are really doing well and trying and making the effort.
00:03:56
Speaker
whether it's improving their quality of care, people to help take care of pregnant women, their maternity workforce, more OBGYNs, more midwives. We are one of the countries that have really one of the lowest numbers of our maternity workforce compared to some of these other countries. It's really mind-boggling because I think we can do a lot more.
00:04:19
Speaker
Yeah. I saw on your website that you developed a cocoon pregnancy care model. Can you tell us about that? I'm curious about that. So a cocoon, if you think of a cocoon, it's putting something in the middle of a protected layer. All right. So I think of
00:04:35
Speaker
pregnant women, you have this mother baby diet, you know, pregnancy, it's a normal condition, but it can be a very, very vulnerable time for women. We say pregnancy is not a disability, but it can be disabling, right? So it's a time when women need extra TLC and care and protection. And so the cocoon pregnancy care is putting this mother baby diet in the center of layers of
00:05:00
Speaker
healthcare workers taking care of them, services, everything you need to keep a pregnant woman and her baby safe, whether it's easy access to care, getting that care without bias, making sure that care is evidence-based, making sure you have the OBGYN and the midwife and the maternal child health nurse and the nutritionist and the specialist,
00:05:25
Speaker
making sure you get appropriate time of work that you need. You get support, whether that's with a doula or some kind of support. You get mental health care. You get all of those little things that come together because, you know, when you think of maternal mortality, it's multi-factorial.
00:05:43
Speaker
Many things cause it, so you have to do many things to try to prevent it. The way that cocoon pregnancy care came about, I worked in Sierra Leone for a few years after I had been in the US working at the Centers for Disease Control at Kaiser Permanente.
00:05:58
Speaker
I had the opportunity to go work for the World Health Organization in Sierra Leone. They were starting their country's first maternal death surveillance and response system. You're a perfect person to be a biologist and native to Sierra Leone, but working in the space in the US. I saw the job posting, actually at that time I was chief of OBGYN at Kaiser and I saw the job posting.
00:06:25
Speaker
I'm leaving. This is my job and everyone thought I was crazy, but it was my life's work. Yeah, exactly. Basically, I went to Sierra Leone and the World Health Organization at that time, I went to lead their reproductive and maternal health department. They were supporting the Ministry of Health with this maternal death surveillance and response system. What they did was every single maternal death in the country, they investigated it. From the mother's home,
00:06:52
Speaker
to where she got care in a clinic, all the way to the hospital, transportation, money, all of the barriers, everything that caused that woman to die, investigated it, and then came up with a plan to learn from it to prevent more women from dying.
00:07:10
Speaker
Basically Sierra Leone had gone through a process where in the past 10 years or so in the past decade they had halved their maternal mortality. So I noticed all of those things that were happening is it was where I got the idea from Pregnancy Care was realizing that all of these things needed to come together.
00:07:29
Speaker
Yeah, so when the US was going through a period where we were now paying attention to maternal mortality, especially in black women, I came back, I got recalled to my job at Kaiser Permanente to help put together this perinatal patient safety program.
00:07:44
Speaker
I worked together with our team. We had this huge team of midwives and nurses and other OBGYNs. We came together and put together these layers of service, all of the things needed around the mother. That's how we came up with Kukun Pregnancy Care. What we did to try to transform and improve the health for women to improve our outcomes. We were able to improve outcomes.
00:08:11
Speaker
remote blood pressure monitoring, you know, making sure women had licensed clinical social workers, all of those things. And we published that information last year in the New England Journal of Medicine Catalyst. And we're hoping to spread cocoon pregnancy care here in the US around the world to say
00:08:29
Speaker
Pregnant women, indeed, we need all of these. We need all of these layers of support to have good pregnancy outcomes. It's so interesting because it's like the same work, the same sort of digging and investigation that you were doing in Sierra Leone, then you can apply here to the US.
00:08:46
Speaker
Of course, the culture is different, the landscape is different in terms of what some of the factors might be, but that sort of investigative work that you're doing to try to catch these situations where women are losing their lives and try to prevent them from happening again, you know, it just translates.
Global Perspectives on Maternal Support
00:09:05
Speaker
It's fascinating because at the end of the day, you realize that it doesn't matter where you are in the world. Pregnant women need the same care. They need the same protection. They need the same services. They need paid time of work, which has 14 weeks of mandatory time of work.
00:09:26
Speaker
Wow, it's really more advanced than the United States. Again, the only industrialized country where we don't have paid time of work. So it's all of those little things that I think we can learn from the rest of the world and try to make things better for pregnant women and their kids.
00:09:43
Speaker
Yeah, that's wonderful. So if you are speaking to a woman who is getting ready to birth, what would you want her to know? And maybe we should say, especially if she's a woman of color and we're worried that there are more risks for her because of the issues that we have in the U.S.
00:10:02
Speaker
Hi, friends. I'm here to remind you to subscribe and like to the podcast. I love doing this. I love bringing people on, but I need to know if you're actually listening to me. I get no feedback out here, so I know things are going out. And then suddenly I'll talk to someone and they say, oh yeah, I love your podcast. It's awesome. I'm like, oh, I didn't even know you were listening. So if you want to stay in the know, you want to get notified when new episodes come back, please, please, please subscribe and like. I love the We Can Do Hard Things podcast, so I'm going to show you as an example.
00:10:32
Speaker
go into your podcast and you just go to the upper right corner you press the plus sign and it turns to a check mark and then you're subscribing and then of course you can like it um five stars of course right if you can please and um if you spotify if you use zencaster whatever i use it's fine just please subscribe and like thank you what would you feel like is the most important thing to tell her
00:10:54
Speaker
Yes, so that's something I face all the time. I take care of patients, black women, who walk into my exam room and look at me and say, Dr. Fauna, I'm not going to die at this pregnancy. And it just breaks your heart. And you understand it because you see story after story of this happening. And I think
00:11:15
Speaker
What's important is for you to look that woman in their eye and say, no, that's not going to happen, not on my watch. I am going to do everything in my power and I'm going to help you and guide you and coach you and give you the resources to make sure that you have a safe pregnancy. And that starts with trying to get that trust and trying to
00:11:38
Speaker
help that woman understand that we're on the same team and we're working together and at the end of the day we want a healthy mom and a healthy baby and that we're going to plan out a strategy these are the things we're going to do you know of course safety and good outcome starts from even before you get pregnant so you kind of
00:11:56
Speaker
As OBGYNs, we see women when they're not pregnant, and that's where we go into how do you optimize your health to get pregnant. But once you're pregnant, you kind of talk through what are the biggest causes of death? What are the biggest things that cause illness? What are the support systems that you need? What can I do to decrease my stress?
00:12:20
Speaker
all of those little things that you need. What's my plan for postpartum care? How do I, as a pregnant woman, build a cocoon around myself? I'm going to reach out to my network, whether get my doctors, all my doctors, my midwife, all my mental health care, give us all of the things I need. But also at home, what's my support person? Who's going to be the person that's with me at appointments? Who's going to advocate for me? Who's my advocate?
00:12:49
Speaker
who, what's my plan? We learn from people in different countries around the world, postpartum. What are you going to do postpartum? Who's going to help you? What are you going to do about work? All of those things that we need to take about. I think our society does it, especially in the US, we don't do a good job providing that support for mothers. Unfortunately, you have to build that cocoon around yourself, but it can't be done.
00:13:18
Speaker
Yeah, it's true and resources hopefully are continuing to be developed and roll out and and hopefully, you know, with people like you in the work that you're doing, more people can become aware of what those resources need to be. What would you tell the healthcare providers, the physicians, the midwives, the people who are working in obstetrics? You know, what would it be when you're speaking to them?
00:13:43
Speaker
Yeah, that's an important one. I think as health care workers here in the US caring for pregnant women, we first of all have to understand and recognize that there's a problem. We need to take that time to learn about the problem. What's the problem? You know, what are some of the factors so that we
00:14:02
Speaker
understand where our patients are coming from. So when patients are scared, when patients are seeking alternate care, when they're maybe not following your advice and going online and doing all these things, it's because they're scared and it's because they don't trust. And so given that we have to go the extra mile to help strengthen that trust, we have to go the extra mile to make sure we're listening to patients.
00:14:29
Speaker
I mean it's very easy for us to see patient after patient and to forget that you have to take time and listen. Give that extra care to mothers because they need it and that extra care and that extra time listening and going that extra mile that could mean the difference between life or death.
00:14:46
Speaker
Yeah, that's serious. And it kind of brings up a point that I've talked about with a couple other people on this podcast of, you know, part of our system of the way, at least I can speak as a physician of how many patients you're kind of expected to see and how short amount of time that you get with people.
Systemic Challenges in Maternal Care
00:15:04
Speaker
So I don't practice obstetrics anymore, but I do see my colleagues and how many patients they have to see in a day and just having that time to be able to hear a concern
00:15:16
Speaker
It's almost like you wanna ask, oh, is there any issues? Are you doing okay? Okay, great. Things do get skipped, but just trying to be there for women and understand what their context is and where they're coming from. And then, of course, doing all the other parts that we do as
00:15:34
Speaker
healthcare providers of screening their blood pressure and checking their blood work, all of that stuff that is part and parcel of it. But if people are given more time with each individual, then they might actually find out some more of these deeper issues and be able to contribute to the cocoon. That's right. That's part of the systemic problems that we have when we talk about our maternity caregivers.
00:16:01
Speaker
not having enough of them and also our model of care.
Midwifery Models and International Practices
00:16:05
Speaker
A lot of other countries that are doing much better have midway free. They do have more midwives built into their system. I don't know what our resistance is. When you look at Sierra Leone, for example, just about five years ago, Sierra Leone had 300 midwives. They now have over 1,500 midwives. Wow.
00:16:28
Speaker
Sierra Leone is a similar size like South Carolina. Well, South Carolina has less than 50 midwives for an entire state. So those are some of the things you need to be thinking about is how do we strengthen our workforce?
00:16:44
Speaker
so that we have enough time to spend with patients so that we have different caregivers so that it's a collaboration. I think the best model of care really is when you have a midwife and an OBGYN taking care of patients so that cocoon they're both working
00:16:59
Speaker
synergistically together. And, you know, there are times when the OBGYN has more time, and there are times when you don't. And there are times when the midwives have more time. In other countries, for example, you know, they have midwives doing home visits, post-partum. She would imagine not leaving the house after just pushing out a baby and trying to recover at home and sometimes to you.
00:17:23
Speaker
It's one of the things that we did at Kaiser Permanente and that's one of the reasons why I love them so much. I had a baby and I had a midwife come see me the next day and I'm an OBGYN and I was flustered and I loved the visit and I needed that extra person looking at me, looking at a baby, helping with breastfeeding, asking how I'm doing, TLC. That's all we need is that extra TLC and that extra eye.
00:17:50
Speaker
They're gonna help you so it can't be done if Kaiser Permanente can do it here in Georgia. They had midwife deliveries. We just have to, I think it's part of the advocacy that all of us have to make fuss about this. Our mothers deserve care.
00:18:07
Speaker
Our mothers deserve to have a midwife go home to visit them like they do in the Netherlands, like they do in the UK. All of those tiny things come together in that puzzle, in that cocoon, that leads to better birth outcomes.
00:18:24
Speaker
Yeah, it's so true. And they deserve to live, right? And to survive. So thrive and thrive. Yes, exactly. No, it's so true. And it is interesting, like the history, and maybe I need to do an episode about that, the history of childbirth in the US, because it's fascinating.
00:18:41
Speaker
to see kind of why we don't have this midwifery model the way the rest of the world does and how things evolved here. But yeah, it doesn't mean that we should stay in those ways if they're not working, which they obviously are not perfect. And we should be getting better and not worse. And so we should be examining the process bigger structures. Yeah.
00:19:01
Speaker
I do a series of TikTok videos called Survive and Thrive, where I take different health topics related to pregnancy and talk about them.
Sharing Insights Through Social Media
00:19:12
Speaker
And then the other thing I do too, I travel a lot around the world. So when I go to a different country, I'll do a video on how pregnant women are cared for in that particular country. Oh, I love that. I have to link that to this book and check it out. That sounds great.
00:19:28
Speaker
So, you know, you go to Switzerland, you go to Guinea, you go to Sierra Leone, learn about how moms are cared for. And those little things can help us to do better. That is amazing. But my undergraduate degree was in anthropology. And so I did a research project in Brazil to look at the childbirth practices there, which was fascinating between the public and the private sector was so interesting.
00:19:50
Speaker
I went to Ghana and got to see some deliveries there. I love that sort of research and that understanding and it makes you then look at your own culture and look at, you know, here in the U.S., why do we do things the way that we do them and what could we be learning from each other?
00:20:05
Speaker
It's fascinating. I think a lot of lower and middle income countries do have higher maternal mortality than the U.S. And they are struggling with resources and struggling to get better.
Conclusion and Gratitude
00:20:16
Speaker
But there are things that they do, that they do, that they do well. And, you know, when it comes to support, that postpartum support for mothers, a lot of countries do it well.
00:20:28
Speaker
Well, thank you so much for your time. I really, really enjoyed talking to you and learning about what you're doing all over the world. And I'm so glad that I bumped into you and Sierra Leon and got to meet you there. And I love following what you continue to do. And like I said, we'll put your link in the show notes so other people can check out what you've been up to. I really appreciate your time. Absolutely. It was a pleasure talking to you.