April 5, 2021

#106: Black Moms Matter

#106: Black Moms Matter

In Episode 106, Quinn & Brian ask: Why is it so dangerous to have Black babies in America?

Our guest is Congresswoman Lauren Underwood,  the millenial Black nurse and former senior adviser to President Obama. Her “Momnibus Act” is a suite of 12 bills designed to improve Black maternal health outcomes in America, where Black women are dying in or after childbirth at 3x-4x rates of white women.

In this incredible conversation, Rep. Underwood goes deep to help us understand the complexities of the problem, the crushing personal inspiration for her work, and what we can all do to help.

Have feedback or questions? Tweet us, or send a message to questions@importantnotimportant.com

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Transcript

Quinn:

Welcome to Important, Not Important. My name is Quinn Emmett.

Brian:

And my name is Brian Colbert Kennedy.

Quinn:

Mm-hmm (affirmative). And this is science for people who give a shit.

Brian:

Yeah, it is. We give you the tools, but you need to fight for a better future for everyone. The context straight from the smartest people on Earth, and the action steps you can take to support them.

Quinn:

Mm-hmm (affirmative). Our guests are congresswomen, scientists, doctors, nurses, who are also congresswomen.

Brian:

Yeah.

Quinn:

Journalists, engineers, business leaders, CEOs, investors, astronauts, you name it. We even had a reverend, Brian.

Brian:

Who haven't we had?

Quinn:

Mm-hmm (affirmative).

Brian:

Oh, this is your friendly reminder that you can send questions, thoughts, and feedback to us on Twitter @importantnotimp, or email us at questions@importantnotimportant.com. You can also join tens of thousands of other smart people and subscribe to our free weekly newsletter at importantnotimportant.com.

Quinn:

That's right. In this week's conversation, Brian, we are asking why is it so dangerous to have Black babies in America. I should say to carry and deliver Black babies in America specifically. I mean, Black babies in America don't do great as it is because of this whole system we've designed, but specifically today we're talking about pregnancy, delivery, and everything that comes after it.

Brian:

That's right. And our guest is Congresswoman Lauren Underwood from the great state of Illinois. She's the mind and heart behind the Momnibus Act that is making its way through Congress.

Quinn:

That's right. Were you excited, Brian?

Brian:

I'm very excited. Very excited.

Quinn:

When you discovered who today's guest was?

Brian:

Yes, yes, yes, yes, yes. Very close to where I grew up. Love it. Couldn't love it more.

Quinn:

Yeah, folks. Today we're going to get into all the many reasons why this system does not work for Black women in this country. And as always, specifically how you can help fix it, because this thing is so, so, so fixable. Congresswoman Underwood has 12 bills within this act to get it done.

Brian:

Yes.

Quinn:

So, we're going to get into those today. Should we go do it?

Brian:

Let's go do it.

Quinn:

Great. Our guest today is Congresswoman Lauren Underwood, and together we're asking why is it so dangerous to have Black babies in America. Congresswoman, welcome.

Rep. Lauren Underwood:

Thank you. I'm so delighted to be with you today.

Quinn:

Oh, my gosh. You have infinite energy compared to us. That's-

Brian:

Yeah, this is the best. Can you be our cohost?

Rep. Lauren Underwood:

Sure.

Quinn:

Brian, yeah maybe we'll have an audition for your role later.

Brian:

Yeah. Perfect. She's nailed it already. Seriously, thank you so much for being here, Lauren. If we could just give a quick, brief little intro to our listeners of just of you are and what you do?

Rep. Lauren Underwood:

Sure. I'm Lauren Underwood. I have the great honor of being a Congresswoman for Northern Illinois. It's the 14th Congressional District. I'm a nurse. I do a lot in the health policy space, and I love science.

Brian:

Yes.

Quinn:

That sounds amazing. This is the part where I promised Brian you guys could talk about Chicago for a minute. So Brian, go ahead.

Rep. Lauren Underwood:

Oh, yeah.

Brian:

Only for a second. I didn't grow up in the city, but I spent most of my youth in the west suburbs. Most of my time was in Westmont. I think Westmont is in your district.

Rep. Lauren Underwood:

Not quite. I'm in Naperville.

Brian:

Naperville. Okay. So, we're close.

Rep. Lauren Underwood:

And so, we have Naperville, Aurora, Geneva, Batavia, St. Charles. We have Six Flags and [crosstalk 00:03:35].

Brian:

Yeah.

Quinn:

Oh, that's big. That's big.

Rep. Lauren Underwood:

Mm-hmm (affirmative). It's big.

Brian:

We were just talking about Busch Gardens before the show started.

Rep. Lauren Underwood:

Well, see, that's not as good.

Brian:

No. Absolutely not.

Rep. Lauren Underwood:

We're a big fan of Great America here.

Quinn:

Hold on.

Rep. Lauren Underwood:

It's one of our largest employers. Here, we need our attractions, amusement, our tourism, our travel to come back after the pandemic.

Quinn:

100%. 100%.

Brian:

I love it.

Quinn:

Are you a rollercoaster person? We can take this offline if necessary.

Rep. Lauren Underwood:

No.

Quinn:

Okay.

Rep. Lauren Underwood:

But I am a snack person. I will stand in line with you for the rollercoaster, but I will cheer you on and then I will make fun endlessly of that snapshot of fear.

Brian:

Ah, so good. So good.

Quinn:

But when you're in line, is it big soft pretzel or is it Dippin' Dots? What's your game?

Rep. Lauren Underwood:

Not the pretzel. My first job, I worked at a neighborhood pool in the concession stand. And so, all we sold were the pretzels and the hotdogs, and I had my fair share for life of both.

Quinn:

Yeah, yeah, yeah.

Rep. Lauren Underwood:

So, I will pass on that pretzel with the rock salt.

Brian:

Sure, sure.

Quinn:

No, I get it. It seems like a great idea at the time and then it's just so much. I like the-

Brian:

You know what's good at a theme park is a churro.

Rep. Lauren Underwood:

Delicious.

Quinn:

Sure, churros are good.

Brian:

It's probably my favorite thing.

Quinn:

On a hot day, the paper cone, the triangle cone with the ice and you can pump the pump into it.

Brian:

Sure, sure, sure.

Rep. Lauren Underwood:

Yeah. The lemon ice, oh.

Brian:

Ah. So good.

Quinn:

Ah, it's so good.

Brian:

This is starting off so well.

Quinn:

Okay. There you go, Brian. There's your minute.

Brian:

Awesome. Yeah, fine. Westmont's not in your district. That's fine. Naperville is wonderful. I went to the Riverwalk all the time as a young boy. It was the best.

Rep. Lauren Underwood:

Yes. Snap.

Brian:

Awesome. All right. So, thank you for that. As a reminder to everyone here, our goal is we'll provide some context or our question today, and then we'll dig into action-oriented questions, and what everybody out there listening can do to help support what we're talking about here today, if that sounds good.

Rep. Lauren Underwood:

Sounds great.

Quinn:

Rock and roll. Congresswoman, we do like to start with one important question to set the tone for this mess. Instead of saying tell us your life story, as exciting as I'm sure that is, we like to ask why are you vital to the survival of the species?

Rep. Lauren Underwood:

Oh.

Quinn:

I encourage you to be bold.

Rep. Lauren Underwood:

Okay. Well, I would just say that I bring a voice that Congress has never heard. It is very important to have representation in the Congress in order to solve persistent problems like we've seen with maternal mortality. It took a millennial Black woman to come to Congress to bring folks together in a bipartisan basis to save moms' lives. We've made unprecedented progress, but we still have a ways to go.

Rep. Lauren Underwood:

And so, I think that I am essential, not just for my sunny disposition and willingness to fight for democracy, but also to speak up for people who have just been used as political punching bags for too long. Had our rights eroded. People like to make characterizations of us, like caricatures of young Black people. Like what? No. We deserve to be at these tables, too.

Quinn:

Awesome. I love that. You're right.

Brian:

Yes. That's pretty damn vital.

Quinn:

It shouldn't have taken someone like you coming to Congress, but we are thankful for you nonetheless. All right. Just some quick context today. Come on, coffee. Come on. For all of our listeners out there. According to the World Health Organization, maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Does that line up?

Rep. Lauren Underwood:

So, we actually don't use the WHO definition.

Quinn:

Perfect. Great.

Rep. Lauren Underwood:

Because, theirs cuts off-

Quinn:

I was going to say, that's early.

Rep. Lauren Underwood:

... six weeks postpartum.

Quinn:

Mm-hmm (affirmative).

Rep. Lauren Underwood:

And some states use a 60 day postpartum definition, which is also not good. What we embrace is the full year postpartum.

Quinn:

Okay.

Rep. Lauren Underwood:

Because we see deaths for severe illness from pregnancy related causes up to that full year postpartum. Over a quarter of pregnancy related complications and deaths occur a full year postpartum, and that is our opportunity to save lives.

Brian:

Wow.

Rep. Lauren Underwood:

And so, what we are trying to do, I co-found and co-chair the Black Maternal Health Caucus, and we are working to pass policy solutions to save lives from that prenatal, labor and delivery, to the immediate postpartum, to the extended postpartum period.

Quinn:

Okay. That's actually super helpful. I appreciate it for you explaining that to me. I'll just take another step down in my self confidence.

Rep. Lauren Underwood:

Nope. We love the WHO.

Quinn:

We do.

Rep. Lauren Underwood:

But we can be better on that definition here in America.

Quinn:

Okay. I like it. Again, keep correcting me.

Brian:

Please. I love it.

Quinn:

Despite being the richest country in the history of the world, America has the highest maternal mortality rate among developed countries. Is that correct?

Rep. Lauren Underwood:

Correct.

Quinn:

And that is the going up, I believe?

Rep. Lauren Underwood:

The only rate that's rising.

Quinn:

Oh, perfect. We're doing great.

Brian:

Wow.

Quinn:

I want to make sure I get this one correct. Black women are dying at three times the rates of White women. Is that correct?

Rep. Lauren Underwood:

Three to four times. Yeah.

Quinn:

Three to four times. Okay. And we're going to-

Rep. Lauren Underwood:

It's a decimal, so we just say it's a range. Three to four times.

Brian:

Yeah.

Quinn:

Perfect. It's not great. We're going to get into the why today, which is the inputs for these complex problems like this pre-birth and after. And the infuriating part of all of these deaths is that they are preventable.

Rep. Lauren Underwood:

That's right. And Quinn, can I give you one more fact?

Quinn:

By all means.

Brian:

Yes.

Quinn:

This is your show.

Rep. Lauren Underwood:

For every death, there are 70, seven zero, near misses. So, we talk a lot about mortality, death rates, but the other problem is severe morbidity. And as a result, particularly among Black people, we all know somebody because we're talking about this universe of people who have been touched by severe morbidity or mortality just trying to have babies.

Quinn:

And that's important and I do want to dig into that as well. Which is, like you were saying, it's easy to focus on the deaths, and we should be, but there's so much else around that. That's what I want to get into today is why is it so dangerous to have Black babies in America, to carry Black babies in America. Congresswoman, again, keep correcting me. You've got two degrees in nursing and another in public health?

Rep. Lauren Underwood:

That's right.

Quinn:

You worked for a gentleman named Barack Obama.

Brian:

I've heard of him.

Quinn:

At the Department of Health and Human Services. You taught at Georgetown. Now you're a congresswoman. The bona fides to be doing what you're doing are extensive. It's exhausting, frankly, for those of us who have a podcast. But look, in all seriousness, my first goal, I want to get down to the fundamental pieces here, the first principles of this problem. This is probably going to seem a little bit like small potatoes, but I want to paint the picture, especially for folks out there who haven't been through a pregnancy or a birth or a miscarriage or a death. What the health care process is supposed to look like from the blood test to confirm pregnancy, through post-delivery, OB-GYN checkups for the mother. Could you just briefly describe what, I guess for lack of a better term, what that standard of care is supposed to look like, so that later we can talk about what's missing or broken?

Rep. Lauren Underwood:

Sure. So typically, a birthing person finds out that they're pregnant sometime in what we call the first trimester. Then they typically select a provider. Oftentimes, that birthing person lives in a community where they have a choice of providers. That is something that particularly people who are planning pregnancies look forward to, is picking a provider that they connect with and that they're excited about, picking a hospital or other delivery center that they feel comfortable in. That is something that people affirmatively look forward to when they have that choice.

Rep. Lauren Underwood:

And then, there's a variety of tests that get done to make sure that the fetus is healthy. And some great coaching that happens between that provider, the birthing person, and their support system, family, partner, whomever. Typically, there are opportunities for more intense coaching, think like Lamaze class, that happens as that due date comes closer. And then, this is, again, a term, healthy pregnancy.

Quinn:

Of course.

Rep. Lauren Underwood:

As that due date approaches, typically there is a little bit of anxiety and anticipation, and something called Braxton Hicks contractions, which are not labor. You're not in active labor, but sometimes people think they're in active labor.

Quinn:

Sure feels like it.

Brian:

Wow. Yeah.

Rep. Lauren Underwood:

Yes. So, you make some extra visits to that provider because you think you're about to have the baby, and then they send you home. But eventually, labor starts. And typically in the United States, you either are at a hospital or birthing center or at home. But if you're at the birthing center or at home, you have a provider there with you. And after 12, 20 hours, whatever ... Let's just be normal. Let's normalize. Right?

Brian:

Yeah.

Quinn:

Yes.

Rep. Lauren Underwood:

Which takes, sometimes, a very long time particularly for a first delivery. Then at the end of it, in an ideal world, you have an affirmative, supportive birthing team, provider team, that is caring for the birthing person during that delivery. You have the baby. The baby is healthy. You go through all the APGAR, all these things right when the baby gets born to make sure everything's all set. Mom and baby have some skin-to-skin time. You do your footprints and your handprints, and you take your pictures. And then, typically in the United States, within 48 hours you're sent home. You're sent home, and you're like, "Figure it out."

Quinn:

Good luck.

Rep. Lauren Underwood:

[crosstalk 00:14:04] this human alive.

Quinn:

Sure. Right. Right. Right.

Brian:

Man, that sounds scary.

Quinn:

Suddenly, you have a new roommate. They're very small.

Rep. Lauren Underwood:

Yeah. They have a lot of needs. Yeah.

Quinn:

And then, over those next few months, can you talk a little bit about, again briefly, what the typical, like you said, healthy pregnancy, healthy delivery for mom and baby, what those checkups look like for the mother?

Rep. Lauren Underwood:

Typically, postpartum you mean.

Quinn:

Mm-hmm (affirmative). Yes.

Rep. Lauren Underwood:

Okay. Typically, after the delivery, there's one visit.

Quinn:

Okay.

Rep. Lauren Underwood:

For the mom. And many visits for the baby.

Brian:

Oh, okay.

Rep. Lauren Underwood:

Sometimes there's more if there is a Caesarian, and if there's some kind of issue with the healing. But typically, it's just that one.

Quinn:

Sure.

Brian:

Oh.

Quinn:

And again, in a healthy, everybody's fine, no postpartum depression sort of situation?

Rep. Lauren Underwood:

Well, I would not say that that is the ideal for there to just be one, because in an ideal scenario, that family has some support beyond their obstetrician, their midwife, someone who's going to be in that primary care setting. So maybe they'd get a home visit, maybe they're getting a doula, lactation consultant.

Quinn:

Lactation.

Rep. Lauren Underwood:

Right. Something like that, where that provider in the office is not the only person in that supportive network.

Brian:

So, it's not ideal but the standard.

Rep. Lauren Underwood:

Correct.

Brian:

Okay.

Quinn:

Okay. Perfect. Thank you for doing that. I really appreciate it. I have somehow made three children, but it's obviously much more verifiable coming from you than from me.

Rep. Lauren Underwood:

But that's consistent with your experience. Yeah.

Quinn:

It is. Without too much inside baseball, we had a lot of trouble making our kids. We never actually figured out why. We were very lucky to do a lot of IVF. We had a bunch of miscarriages, and a bunch of them not work. And then on sort of a last shot, we were able to make our first child. One of those, they put the embryo in. They were like, "See you never," because science wasn't working in our favor, and then it did.

Rep. Lauren Underwood:

And it's incredible.

Quinn:

Yeah. And then science helped us make the second one. And then, of course, the third one was an accident during breastfeeding. Because, why not?

Rep. Lauren Underwood:

Oh, wow.

Quinn:

Yeah. I mean, why not?

Rep. Lauren Underwood:

That's so nice.

Quinn:

It was very difficult at times. Obviously, especially for my wife, sitting on the bed and eventually getting to the point where you're scrolling through egg donors and things like that. But again, we were very privileged to be able to follow the course that we did to do what we did. So, ours was about 100 more checkups than that over the course of all of it, including one very long hospital stay. Which I think is one of things, in a very good hospital in Los Angeles, not everybody gets that standard of care by any stretch. So, we were very lucky to have that. So, thank you for painting that picture. I really appreciate it.

Quinn:

Obviously, pregnancy and delivery is super complicated. We've been doing this thing for a few hundred thousand years and it's still hard, but we should be handling it much better. So again, I want to focus on these inputs, Congresswoman. I want to talk about the environmental factors here. We talk about here about how clean air, clean and affordable water, healthy and affordable food, reliable and affordable shelter, these are all human rights. Without them, it's pretty difficult to pursue life and liberty and happiness. But in America, I think the latest statistic was something like 68% of Black people live within 30 miles of a coal plant.

Rep. Lauren Underwood:

Mm-hmm (affirmative).

Quinn:

So, there was a report last year that said air pollution is probably responsible for about, this is globally, 500,000 infant deaths in 2019. A lot of those were in low-income countries. Folks that are still using wood fires at home and coal fires at home. But we also know that, especially in the US, particulate matter from highways and airports can basically act like tobacco smoke, whether you smoke or not, inside the body. Cause birth defects. Early labor. So, I want to talk about what those detrimental environmental effects to Black moms and babies mean for your work and where you're coming from, as far as what the whole Momnibus is trying to effect, if we could just focus on those for just a moment.

Rep. Lauren Underwood:

Yeah. We might've seen the same study. Because when it came out last summer, it essentially said that air pollution and extreme heat had detrimental issues that impacts on both maternal and infant health. We knew that we needed it in the Momnibus. And so, quickly got to work in crafting the Protecting Moms and Babies Against Climate Change Act that I have introduced with Senator Ed Markey from Massachusetts.

Rep. Lauren Underwood:

And so, what this legislation does is everything from real, practical, concrete interventions like if you need an air conditioner, we can set up a program to get you an air conditioner, to also doing the work to continue to study the impacts of climate change and this extreme heat and air pollution on these maternal health outcomes, recognizing that. And also, offering some real specific community supports. For example, we know from the environmental justice movement that there or often clusters, like cancer clusters for example. Or in our maternal context, a lot of people who are experiencing pregnancy complications or deaths happening in a geographic area.

Rep. Lauren Underwood:

However, the health care system that serves that community may not be in that neighborhood, may not be in that community. And so, the providers have often missed it. So if you think about a health system, a hospital for example, even an academic health system in our major metropolitan areas are not always doing the data analysis by zip code, by census block to determine if there are predictable trends. They're not plotting that data. They are oftentimes receiving patients case by case, and treating that person based on the information that presents right in front of them. And so, if it's not captured in some vital signs, if it's not captured by the birthing person saying, "You know, I sometimes have a hard time breathing at night." Right?

Quinn:

Yeah. Sure.

Brian:

Right.

Rep. Lauren Underwood:

If they're not making those complaints, the health care system may not know that they're living in the shadow of a chronic pollutant. So if we are able to support the community-based people who know all about the legacy of the environmental health impacts of whatever contaminants or neighborhood issue that's going on, then we can help create those linkages with the care providers to get these families and birthing people the resources that they need. That's basically the thesis behind the bill.

Quinn:

I mean it makes a lot of sense.

Brian:

Yeah.

Quinn:

It comes back to, I guess, the Silicon Valley guy essentially said if you can't measure it, you can't change it, or whatever it might be.

Rep. Lauren Underwood:

That's right.

Quinn:

What did M.C. Hammer say a couple weeks ago? If you're going to measure, you have to include the measurer.

Brian:

Oh, yeah. Measure the measurer.

Quinn:

But if we're not looking for these things and people don't know to proactively put them into the system by talking to their providers about it, whether it's primary health and asthma, or it's an OB-GYN, or whoever it might be, or a cardiopulmonary person, then we're just not going to register that stuff on the whole and it's not going to become part of it. That's super helpful. Thank you for explaining that.

Brian:

Yeah. And actually, let's talk about insurance. That's a good little segue there. Obviously, health insurance is kind of a nightmare here. Despite Obamacare, it's still mostly tied to corporate work and it's very exclusive and very expensive. Of everything that we've discussed above about the perfect ideal standard situation, what does a lack of health insurance do to impede a standard of care for Black moms?

Rep. Lauren Underwood:

Right. In our country, if you are a low-income ... So, one thing that we didn't cover in our statistics-

Quinn:

Please.

Rep. Lauren Underwood:

... was that this disparity persists regardless of income and education. So in America, Black women are three to four times more likely to die regardless of how much you make, how many degrees you have, whether you have prenatal care, whether you had health insurance. You can control for all of it. You could be Beyonce and Serena Williams, or you can be the girl around the corner in the hood, and you have the same very high likelihood of severe morbidity or mortality. I use these words 'we' a lot, because I put myself in with the ladies across the country.

Brian:

Oh, yeah.

Quinn:

Sure.

Rep. Lauren Underwood:

Okay. So at the lower income levels, in our country, if you are pregnant you are eligible for Medicaid. If we're going to just streamline all of this, low-income birthing people are eligible for Medicaid. If you are in a state that did not expand Medicaid under the ACA, prior to the American Rescue Plan, which we'll get to in a second, your coverage cut off 60 days postpartum.

Quinn:

Okay.

Rep. Lauren Underwood:

Where the baby's coverage continues on, the mom's coverage cut off. Now, I told you that in that extended postpartum period, a quarter of the maternal deaths, infection, mental health, substance use, we have all kinds of reasons moms will die in this country. And so, we were missing a great opportunity to save their lives because they didn't have health care coverage. If you don't have health care coverage, you're not seeing your provider both for preventive visits like, "Oh, this is just our check-in," during the standard of care conversation that we had, but also if something goes wrong and you know you don't have health coverage, that cost conversation comes in and you're like, "Well, I'm just going to stay home and try. Let's see if I can make it." Because if you report it, folks know what medical bills mean. We are adults, and remember what that pre-ACA time was like. Medical bankruptcies were a thing and a lot of people are not volunteering for that kind of debt.

Quinn:

Sure.

Rep. Lauren Underwood:

Okay. So the American Rescue Plan, I should say Medicaid is so important to this conversation because the Medicaid program pays for 66% of deliveries for African Americans in this country. Two-thirds of all births are paid for by Medicaid.

Quinn:

I was just going to ask you, because you differentiated between states that have taken on the ACA support. I think there's like 16 states that haven't yet. Does that number you just gave, is that different for those states that haven't picked it up yet or that have?

Rep. Lauren Underwood:

So, that 66% is paying for the delivery.

Quinn:

Okay.

Rep. Lauren Underwood:

It's paying for the birth.

Quinn:

Right.

Rep. Lauren Underwood:

And so, that's how we know that those people are qualifying for Medicaid.

Quinn:

Okay.

Rep. Lauren Underwood:

A third of African Americans having babies in this country have private health care for the delivery. Two-thirds have Medicaid. Okay? And yet, the deaths are equally dispersed whether you have private insurance or Medicaid. They're still as equally likely to die. So, we've been working on what we call a postpartum Medicaid expansion for a number of years in the Congress. This is the solution that everybody agrees, everybody from the private insurance companies to the progressive groups, the March of Dimes, the providers, the nurses and the docs, the OB-GYNs. ACOG has been such a great partner for us, then there's midwives. Everybody agrees, let's do this Medicaid expansion. It passed the House unanimously in the last Congress, unanimously, to extend this Medicaid. Yes, for full postpartum.

Quinn:

Nothing passes.

Rep. Lauren Underwood:

Nothing passes unanimously in the House these days. And then, it went over to the Senate and Mitch killed it.

Quinn:

Sure.

Rep. Lauren Underwood:

So, we brought it back this year. With the change in political leadership in the Senate and with the change in leadership at the White House, President Biden has been a great partner for us on maternal health issues. And Vice President Harris actually introduced the Momnibus with me last Congress.

Quinn:

Awesome.

Rep. Lauren Underwood:

She goes hard for these issues.

Quinn:

Yeah.

Rep. Lauren Underwood:

They were willing to put this postpartum Medicaid expansion in the American Rescue Plan, the recent COVID relief bill. So, this is now the law.

Brian:

Bam.

Rep. Lauren Underwood:

That they have an opportunity to expand their postpartum Medicaid coverage to a full year. It's a great incentive, even for those conservative Southern states that have been holding out forever.

Quinn:

Sure.

Rep. Lauren Underwood:

The politics around Medicaid expansion have changed. So now, we are giving them a financial incentive to do it, and political coverage to do it, and there's a great multicultural coalition of support to get this done. So, that is one area that we feel real good has been addressed. However, we still have this issue where even if you have private coverage you're still as likely to die.

Quinn:

You're still going to ... yeah.

Brian:

Right.

Rep. Lauren Underwood:

So, we still need solutions like the Momnibus, these comprehensive things. Why? Because, well, people need, as you said, social determinants of health. Housing, transportation, nutrition. We have a pandemic, which has just been devastating for maternal health.

Quinn:

Sure.

Rep. Lauren Underwood:

And then, we have a workforce where I emphasize choice during my standard of care conversation.

Quinn:

Absolutely.

Brian:

Right.

Rep. Lauren Underwood:

So many pregnant people don't have a choice among providers, and it's a problem.

Quinn:

Right. No, that makes sense. And that's what I love about the Momnibus, is that it is this comprehensive suite of ways to attack this thing. That is one of the things we come back to. We're really focused on these action steps, as we put them, whether it's climate change or clean energy or COVID or whatever it is. There's a really great quote, there's a science writer I feel like you would love if you haven't read, Ed Yong for The Atlantic.

Rep. Lauren Underwood:

Hm-mm (negative).

Quinn:

Oh, my God. He's amazing. He wrote a book called We Are A Multitude ... I can't remember. Great science writer. Anyways, he wrote some incredible stuff the past year for The Atlantic, but he had this quote about COVID. It applies to this, to COVID, to climate change, whatever it is. Which is essentially, to paraphrase was, COVID was a flood that exposed all the cracks that we already had in our society. Those were there. I've thought about it as like, look, this was like a pop quiz to show are you ready. What were the choices you've made up to this point? Because, you're about to find out how they went. And it turns out, not great for so many folks. Of course, some folks are fine as usual in America. But for a lot of folks, it isn't. And that's why I really appreciate that the Momnibus approaches all these different things. Because when people say, "What are you going to do about climate change," it's like, "Everything. You have to all of the things."

Brian:

Yeah, right. All the things.

Quinn:

It's not just get rid of these fossil fuel plants that are poisoning the air and causing asthma for pregnant moms or children. It's not just water and housing and transportation to get to these doctors of which you have no choice.

Rep. Lauren Underwood:

Right.

Quinn:

It's not just insurance. It's all of these different things. And so, I think that's what is so fantastic about it. So for the next bit of that, and we just had a really fantastic conversation. I think you spent some time at Johns Hopkins. Is that right?

Rep. Lauren Underwood:

Mm-hmm (affirmative).

Quinn:

Just a little dip.

Rep. Lauren Underwood:

I love Hopkins. They've been great partners of this work.

Quinn:

So, we had an awesome conversation about why, one of those conversations I wish didn't have to exist, but why young Black men die within the first year of heart transplants way more than average. And with a gentleman named Dr. Errol Bush, who's the head of lung cancer surgery at Johns Hopkins, and a young resident, Dr. [Hasena Maredia 00:30:19], who was working on this for like five years. One of the things we covered is that only 5% of doctors in America are Black, and only 10% of nurses are Black.

Quinn:

You spoke a little bit about, like you said, you can factor in all the wealth you want, but Beyonce and Serena Williams so bravely shared this incredibly traumatic birth stories. Clearly showing, again, celebrity means nothing when it comes to relying on a system that in your most vulnerable, dangerous moments, only accounts for skin color. I would love if you could talk a little bit about what role implicit bias plays in Black maternal mortality, because clearly, it affects not just this area, but like I said, the heart transplants and so many other across the board.

Rep. Lauren Underwood:

Yeah. So, let's just be clear about one thing to start.

Quinn:

Please.

Rep. Lauren Underwood:

There is nothing wrong with the women/birthing people. Okay?

Brian:

Right.

Rep. Lauren Underwood:

It's not some genetic issue. It's not like, "Oh, they just can't carry their baby." No. This is about a racist health care system. Now, when we talk about bias, there's two kinds of bias. There's implicit bias, which is like, "I'm a health care provider going about my day. I don't quite realize that I assume that Black people have a different pain tolerance than White people."

Quinn:

Sure.

Brian:

Right.

Rep. Lauren Underwood:

That's implicit bias. Then there's explicit bias, AKA racism.

Quinn:

Sure.

Rep. Lauren Underwood:

Both are at play here. Both. They both dangerous. They are both deadly. And you cannot solve this problem if you only tackle one. There's a lot that's been made about implicit bias. Why? Because people are more comfortable with it. They are uncomfortable-

Quinn:

Of course. "I didn't know."

Brian:

Right. Right.

Rep. Lauren Underwood:

Yes. They're uncomfortable actually examining what could be explicitly furthering inequality in this country leading to death. Not just an adverse health outcome, not just like, "Oh, we have a delayed recovery," but death. Unnecessary, unwarranted death.

Quinn:

Sure.

Rep. Lauren Underwood:

Okay. So in our bill, we have support for training. Now, I know somebody out here is rolling their eyes like, "Lauren, now you know there is no one hour webinar or one CE credit that is going to solve this problem." And I agree.

Quinn:

Sure.

Rep. Lauren Underwood:

I agree. But there is an opportunity to start that conversation, and then there's also incentives for people to begin examining within their institutions their outcomes in order to tease out what's implicit and what's explicit, and to be able to begin to work through this. There's also support within our legislation to reach providers while they're training, because there's a lot of bias in the training. For example, in my nursing education, we were taught some version of, "Oh, there's just something about Black people where they're more likely to die." That's a very general statement. That is really open to interpretation, and it's not actually about the Black people. It's more about the system. We have to be very clear, very clear about that. And so, we have funding to support that.

Rep. Lauren Underwood:

And then to the choice piece that I spoke about earlier, we have a society that is very physician oriented when it comes to health care, especially labor and delivery. The data show that there are other health care providers who have the same or better quality outcome for healthy, normal pregnancies. Not the complicated outliers here, but you can have a choice.

Rep. Lauren Underwood:

And so, we want every birthing person in this country, no matter if they're urban or rural, whatever race, whatever language that they speak, to have their choice of providers for obstetrician/gynecologists, midwives, nurse midwives, lactation consultants, doulas, and make sure that there's both the people in the communities, that they are racial and ethnically diverse, that they speak different languages. But also, that there's the payment available by either their insurance company or Medicaid so that there is true choice in this environment. So that if you say, "You know what? I don't have it in my spirit today to educate somebody on the nuances of what it means to be a Black woman in America," which, "There, girlfriend. I hear you. I don't always have it in my spirit either."

Quinn:

Sure.

Rep. Lauren Underwood:

But you can find a provider where you walk in the door and they're like, "Okay. You're welcome here." [crosstalk 00:34:59].

Quinn:

Sure. Sure. I mean, look, I mean I feel like everybody is going to the doctor in a vulnerable place.

Rep. Lauren Underwood:

Yes.

Quinn:

Whether it's your annual checkup if you're lucky enough to have those, or whatever it might be. But there is, and again, just speaking from the guy who is sitting in the chair in the corner of the room where we went through some stuff, absolutely, but there is nothing quite as vulnerable as going in and being like, "My body is changing. I fit nothing. I feel terrible. I'm angry. I hate that guy." All of the usual stuff. That's still borderline standard stuff. It's, and again, I can't even imagine and even more so for my wife or all the many women, but try the moment where the doctor comes in and says there's no heartbeat. Start with that. If you don't have someone who can speak to you and who gets you, and like you said, some of these people don't have time to try to understand you with our standard doctor visits taking five minutes, it's just incredibly unfair.

Quinn:

And like you were saying, there's a difference between implicit and explicit bias. We try to be very transparent about that here, especially as two White guys. I think I saw a stat, and please correct me if I'm wrong, is it that women and Black women in Illinois are six times as likely to die?

Rep. Lauren Underwood:

That's right. That's right.

Quinn:

So in any given system, if something is twice as bad for a cohort of people, you would say, "Boy, that's broken."

Brian:

Pretty broken.

Quinn:

When something is three to four times or six times as bad, the answer is the system is designed that way and it's designed by people who look like us, like all of the other systems. They're the ones who put those fossil fuel plants there. And so, that's why I want to focus on this comprehensive plan to take about the system and rebuild it, because this is the way it was designed. It's not broken for anybody. Can we talk a little bit about, again trying to clarify for everybody, the OB-GYN and midwives and lactation consultant side of it. Can you explain a little bit about what role midwives can serve during pregnancy and birth? They're not covered by insurance, is that correct, in the US?

Rep. Lauren Underwood:

There's two different kinds of midwives in this country. There's nurse midwives, which are registered nurses. They've completed a four year Bachelor's degree. They are licensed as a nurse, and then they have additional education in midwifery. They have to pass a certification exam, and they are what's called an advanced practice registered nurse.

Quinn:

Okay.

Rep. Lauren Underwood:

So, sort of like a nurse practitioner, which you might be familiar with, or a nurse anesthetist that does anesthesia that you might be familiar with. We have within the nursing profession specialists that deal with maternal health, women's health, and labor and delivery. So, that's one type of midwife. Oftentimes, in states that allow advanced practice nurses to practice at any level, there will be some type of reimbursement offered for the nurse midwives. So, they'll be within your network, there are just maybe fewer of them, and they may not have any openings because they're very popular. Wherever they are, they usually have very full caseloads.

Rep. Lauren Underwood:

Okay. Then there's lay midwives or just midwives. Those are people who may not have, may not, but they may have a different certification, but they're not required to be licensed necessarily in the same way that you would find a nurse midwife. They often are trained through an apprentice program. That's like the best analogy I can offer.

Quinn:

Okay.

Rep. Lauren Underwood:

They train under someone. They're very, very skilled and have their own practice in their communities. Those folks are the ones that may not be covered in all insurance plans. They may be more difficult to find if you're relying on your insurance provider to give you all of your options. If you live in some regions of the country, they are very clinical. Think about maybe the rural South, where there are health systems that haven't been as welcoming to some individuals. Then there have been generations of midwives that have been trained to care for families in that community. Right?

Quinn:

Sure.

Rep. Lauren Underwood:

They'll be very clinical in one geographic area.

Quinn:

Sure.

Brian:

Right.

Rep. Lauren Underwood:

Okay. That's generally the difference. And then there's lactation consultants, who are licensed, who are often employed by health systems. And sometimes you will find them as independent providers that have their own practice, but generally they'll be connected-

Quinn:

I remember the office right in the hospital. They were like, "Go talk to that lady."

Rep. Lauren Underwood:

That's right.

Brian:

Oh, wow.

Rep. Lauren Underwood:

That's at your academic medical centers or your larger health care systems will have them on staff. And then, there's doulas. Doulas are the birthing person's advocate. They are your delivery ... assistant is the wrong word. They are your support person.

Brian:

Right.

Rep. Lauren Underwood:

Both as a physical support person, an emotional support person, that anchor. Then they do the follow-up care also.

Quinn:

Okay.

Rep. Lauren Underwood:

We have been working very aggressive to make sure that doula services are covered by private insurance and Medicaid, and that is still something that's in process. That's why the Momnibus is so important. We are providing a pathway for not only there to be more of these providers, and we're diversifying those provider workforces, but then also making sure that there is coverage for their services in these different health plans.

Quinn:

It's a lot.

Rep. Lauren Underwood:

It's a lot, but it's also like this is a problem that has been around my entire lifetime. I'm 34. It's also a problem that has a solution. It's not some pie in the sky solution. This is an evidence-based solution.

Quinn:

Right.

Rep. Lauren Underwood:

And so, am I a Democrat? Yes. Am I a millennial? Yes. Do I have some progressive point of views? Yes. But is this some radical progressive solution to maternal health-

Quinn:

It's the one thing we do.

Rep. Lauren Underwood:

No. This is so commonsense, and some of the policies in the Momnibus are bipartisan. Our veterans bill is bipartisan because-

Brian:

It just seems so clear.

Rep. Lauren Underwood:

... hello, single payer health care system, the VA. We have an opportunity to save moms' lives. Our mental health bill is bipartisan. In Illinois, the number one cause of maternal death, overdose and suicide. Number one. Number one cause. And remember, Illinois is six times more likely to die. That's a problem. And then, and newly in the Senate we have a Republican lead for our Tech to Save Moms bill, which is trying to have equity in telehealth and access to some of the digital tools that have come onto the market. So, excited.

Quinn:

Two, well I guess one quick thing. You talked about the overdose that happens afterwards. I mean, postpartum depression at the least is nothing to mess with.

Rep. Lauren Underwood:

That's right.

Quinn:

It is something super substantial.

Rep. Lauren Underwood:

Period.

Quinn:

If you could just take just a moment, and then I would love to hear, besides all of those reasons, besides it being this incredibly just and right thing to do, what's really driving you personally on this. But could you talk for just a moment about what it means to have this other thing that we're totally talking on, which is any sort of paid leave for childcare after birth. What does it mean for people, especially working hourly and part-time jobs, what would it mean for them to be able have paid leave after childbirth, to accomplish any of these things, to be healthier?

Rep. Lauren Underwood:

Okay. On the maternal mental health piece. Everyone I think now, at least of our generation, is very comfortable with the idea of postpartum depression. Folks are more comfortable talking about it, asking about, checking in on friends that might be new moms, make sure everything's okay. But what happens when it goes beyond depression? When there is anxiety, when there is a substance use disorder, where there is suicide ideation, do you know where to go in your community? Do you know if there's an expert that is very clearly skilled on maternal health risks in this space?

Quinn:

Right.

Rep. Lauren Underwood:

Many communities don't have those level of specialists. And I'm not saying you're looking for a maternal health psychiatrist. No. I'm just saying someone who's had experience here.

Quinn:

Sure.

Rep. Lauren Underwood:

Yes, that's what we're trying to fix, because this is the resource that we need everywhere. And the same way that we got all these Narcan grants going out so that we can save somebody that overdoses-

Quinn:

Yeah. Someone who gets it.

Rep. Lauren Underwood:

... everywhere, we need this kind of support.

Quinn:

Sure.

Rep. Lauren Underwood:

Everywhere. Okay. Now on paid leave. Paid leave is critical. We don't call it paid parental leave anymore. We call it paid family leave because this is something that impacts everyone. And it shouldn't matter whether you're an out LGBTQ American that wants to adopt to be able to access that paid leave, or whether you're someone who's dealing with elder care or whatever. Paid leave is so important. And many, many, many workers, I would say the majority of workers in this country do not have access to comprehensive paid leave which includes paid time off and job protection. Both are critical.

Rep. Lauren Underwood:

Now, there are documented issues with pregnant people being discriminated against in terms of being offered employment, being offered advancement. We are working to address that in the Congress. We have a Pregnant Workers Fairness Act bill that we are going to be advancing next month. But then also, we do need to have paid leave. Economic security is important for everyone.

Brian:

All true.

Rep. Lauren Underwood:

Period. Paid leave is an economic issue. It allows for complete participation in the workforce. Let's talk about our COVID economy and how we still have 10 million people unemployed that were employed last year at the beginning of this pandemic. We are not going to have a full and robust economy unless we have full participation from the labor market which includes, hello, birthing people and women. And if you have children or if you have a family, you need to have these kinds of protections, again, that offer the paid time and the job protection.

Quinn:

Yeah. Absolutely.

Rep. Lauren Underwood:

Okay. We have a bill called the Family Act, if you want to learn more.

Quinn:

Okay.

Rep. Lauren Underwood:

Please be in touch with your legislators about that in addition to the Momnibus.

Quinn:

I love it. We're going to finish with the action steps in a sec. Besides all of this, what is driving you on all of this personally?

Rep. Lauren Underwood:

It's the stories. I mean listen, when I was at Hopkins, I did my Master's in Public Health and Master's in Nursing degree at Johns Hopkins. I was the youngest member or my class there. I had a good girlfriend, Dr. Shalon Irving. When she enrolled in the MPH program, she already had a dual-doctorate in gerontology and sociology. She was brilliant. She was beautiful. And, we were just good friends. Well, fast forward like 10 years, and when I was wrapping up my service in the Obama Administration, she was getting ready to have her first child. She was so excited. It was a beautiful baby girl named Soleil. And then three weeks after she gave birth, we lost her. She died, and it was devastating.

Rep. Lauren Underwood:

Shalon was a Lieutenant Commander in the United States Public Health Service Commission Corps. She had focused her life and her work as an epidemiologist on ending health disparities. She was working at the Centers for Disease Control and Prevention. I will never forget just being devastated at her funeral. The CDC director came and spoke at her funeral and was talking about how we know [inaudible 00:47:10] disparities, and someone who is an expert in this area still dies because of all these issues that we talk about.

Rep. Lauren Underwood:

Now, Shalon's story has been well documented by ProPublica, actually. Had this great article series that NPR I think picked up about her life and death. And now, her mother, Miss Wanda, has started an organization called Dr. Shalon's MAP that folks should look up if they like. But it took something that was a clinical fact and made it really personal to me. And then, it just emphasized how much I was not alone. I feel like all of us know somebody who's been impacted in this way. I knew that if I were elected to Congress this was something I wanted to solve. Because again, this is a problem that has solutions and has just been a policy choice by those in power to skip it.

Rep. Lauren Underwood:

One thing I was always surprised, I learned in my first term in Congress, I always thought that Congress worked on the issues that was important in our country. No. Congress works on the issues that the members raise. We determine the work that we do. And if we are not there to lift up these problems and say we've got to solve these problems, it doesn't happen. You could have the best advocates in the world, and if the person in the seat doesn't want to hear, doesn't care to hear, isn't conditioned to hear about that problem, you're not going to have forward progress. Representation matters. And so, that's why I've been so passionate about this issue. It's about saving lives. Period.

Quinn:

Well, I'm terribly sorry for your loss. You're right. Everybody does know someone in some capacity. It's like pre-ACA. I remember riding on a plane and somebody telling me that the preexisting conditions part was ridiculous. And I was like, "Oh, then you must not know somebody. Because if you know someone with a preexisting condition, there's no way to oppose this thing."

Rep. Lauren Underwood:

That's right.

Quinn:

Well, thank you for sharing that. I really appreciate it. I know you've got to run. Brian, bring us home with the action steps part. Congresswoman, just want to get specific on people can get out there and support what you're doing.

Brian:

The whole reason we do this thing. Yeah. If you could, just in the time you have left, just let everybody know, please just tell me what I can do to support you in any and every way possible.

Rep. Lauren Underwood:

Well, thank you. We're so excited. The Momnibus is up to over 120 cosponsors in the House and the Senate.

Quinn:

Wow.

Rep. Lauren Underwood:

Which is incredible. You can learn more about our legislation. If you Google Black Maternal Health Momnibus, M-O-M-N-I-B-U-S, it'll bring you to our caucus website. There's all kind of fact sheets and information about the legislation. And then, we need folks to reach out to their elected officials. So, everybody listening has one congress member and two senators, and we need all three of those people to be on this bill. And so, the way that it works is the Momnibus has been introduced as a standalone package, all 12 things. We need them to cosponsor that. So, you have to explicitly ask them to cosponsor the Momnibus. And then, ask them to cosponsor each of the 12 individual bills. So, 13 things in total that they need to cosponsor. And all of the H.R. numbers and that kind of relevant information is on the website.

Quinn:

Awesome. Perfect. We will draw that up into a very specific script so people can just mash their fingers against the button and get it done.

Brian:

It's easy as hell.

Rep. Lauren Underwood:

Oh, my gosh. Thank you.

Quinn:

Congresswoman, we know you've got to run. Thank you so much for your time, for everything you're doing. We usually have a little lightning round of ridiculous questions we ask, but you have so many more important things to do.

Brian:

Oh, this isn't the most important thing you're doing today, talking to us on this podcast? Wild.

Quinn:

Yeah, yeah. So weird.

Rep. Lauren Underwood:

No. [crosstalk 00:51:07].

Quinn:

Thank you so much. We really appreciate it. We look forward to talking to you once this has all passed and you've fixed so much.

Brian:

Thank you for kicking butt and being a leader in my home state and very close to my home city. Much appreciated.

Quinn:

It's not about you, Brian.

Rep. Lauren Underwood:

Yes. Thank you. Thank you.

Quinn:

All right. We will talk to you soon. Thank you so much.

Brian:

Thank you.

Rep. Lauren Underwood:

Thank you. Take care.

Brian:

You bet. You, too. Thank you.

Quinn:

Take care. Thanks to our incredible guest today, and thanks to all of you for tuning in. We hope this episode has made your commute, or awesome workout, or dish washing, or fucking dog walking late at night that much more pleasant. As a reminder, please subscribe to our free email newsletter at importantnotimportant.com. It is all the news most vital to our survival as a species.

Brian:

And you can follow us all over the internet. You can find us on Twitter @importantnotimp.

Quinn:

That's so weird.

Brian:

Also on Facebook and Instagram @importantnotimportant, Pinterest and Tumblr, the same thing. So, check us out, follow us, share us, like us. You know the deal. And please subscribe to our show wherever you listen to things like this. And if you're really fucking awesome, rate us on Apple Podcast. Keep the lights on. Thanks.

Quinn:

Please.

Brian:

And you can find the show notes from today right in your little podcast player and at our website, importantnotimportant.com.

Quinn:

Thanks to the very awesome Tim Blane for our jamming music. To all of you for listening, and finally, most importantly, to our moms for making us. Have a great day.

Brian:

Thanks, guys.