INSPIRE 310: INFANT MORTALITY IN KANSAS

- Coming up on "Inspire" a difficult but important topic to discuss, the high infant mortality rates in Black communities, and a discussion on the racial disparity surrounding infant mortality rates in Kansas.

Stay with us.

(upbeat music) - [Narrator] "Inspire" is sponsored by Kansas Furniture Mart using furniture to inspire conversation.

And by the Blanche Bryden Foundation - [Announcer] The Friends of KTWU, honored to support programs and services that enrich the lives of our viewers.

And the Raymond C. and Marguerite Gibson Foundation.

(upbeat music) - Hello and welcome to "Inspire."

I'm pleased to be here with my co-host Betty Lou Pardue and Leslie Fleuranges.

- Thank you.

- We're gonna be talking about a difficult topic today.

A topic that's so hard for all of us to discuss.

- The United States is a highly developed country but why is it that we have some of the highest mortality rates compared to our peer countries?

And why do Black communities end up with higher rates of infant deaths?

- Lots of factors to discuss in this disparity including social and economic factors, racism, stress access to healthcare and insurance.

And how does a family cope when the unspeakable happens and they lose their beautiful infant?

Here to discuss is Dr. Jamesina Dickson, obstetrician and UN gynecologist.

And Tara James-Wallace, licensed social worker and therapist from the YWCA Board of Directors.

So ladies, thank you for joining us today.

You know, when I moved here to Topeka I learned for the first time that Topeka actually has some of the highest rates of infant mortality.

I had no idea, not having children myself, it never occurred to me that that was even an issue in this country.

This is the 21st century, why is this happening?

- Well, that's a very complex question and it's gonna take a while to answer that.

First of all, in Topeka, Starkville is a high risk center.

So we get referrals from a around Kansas.

So from the small rural areas they will come to Stormville for delivery.

We get transfers from high-risk patients that have very complex histories.

And so I think that number kind of obscure what exactly the infant mortality rates truly is in Topeka, we have some patients that are kind of unhealthy to begin with.

And that also contributes to the infant mortality and morbidity mortality during pregnancy.

We have patients that are poorly controlled diabetics, hypertensive, all of that can contributes to that and to really do them any justice help to prevent that, we need just we need better care for those patients so that that very first visit, we need to thoroughly go over their medical history and talk to them about how they how to manage their care during the pregnancy have a safe outcome.

If they're diabetic they're gonna be a little bit more stringent in checking their sugars more frequently.

They're going to eat healthier, they're gonna exercise they're gonna, we have other doctors in the community that help manage their care.

So we, we try our best to tackle things in that first visit, try to get a very comprehensive visit and to see where we need to improve and to make the best outcome for that patient.

- Okay and Tara, there's wast the why that you can help individuals, how so?

- Actually helping individuals get access to all of the things that Jamesina mentioned would be beneficial.

You have individuals who don't have access transportation to get to all of those services.

You don't have a car you don't have anybody that can take you to those appointments.

You don't have money to get a bus pass.

You don't, you can't take an Uber.

Things of that nature.

There are a lot of cost-prohibitive factors that influence that.

If you live in a food desert if you live many places that don't have resources that allow you to get the treatment, the prenatal treatment, you don't know where to get those resources.

There are very many things that are collectively contributing to the high infant mortality rate in Topeka.

- We talked about this on a previous show about some of the women who were pre-diabetic and didn't know and talked about food deserts and other things like that.

And again, all of those things contribute to the high infant mortality rates.

- Absolutely.

- Talk more about that because I would like to hone in on those factors.

- The current recommendations we have is that that patients should be screened pretty early for diabetes.

So typically in the pregnancy, we are screened at 28 weeks for gestational diabetes.

But if your weight or your BMI exceeds a certain level or you have certain risk factors such as family history, you need to be screened at that very first visit.

So we try to tackle them early, try to diagnose those patients early so we can make modifications in their diet, start them with insulin or oral medications early in pregnancy to help with that.

- I think about television, right?

We all watch these horrific scenes of women having these terrible labor pains and then they get this beautiful baby nine times outta 10.

But nobody ever talks about the fact that when you get pregnant, it is not a definite that that baby is going to come out healthy or that it's going to have a long life.

What can we do to help people understand that it's not just as easy as getting pregnant and having a baby?

- I think that prenatal care needs to start pre conceptually.

I think that's the first thing that we need to do.

I see very few patients that come in, I'm interested in trying for pregnancy, I just wanna make sure I'm healthy enough to have a baby.

And I think that's where it needs to start.

I mean, you can make a lot of intervention early.

You can look at their histories, screening for diabetes at that time by doing some simple blood tests.

They're hypertensive, let's get them on medication that is safe to take during pregnancy.

If you're significantly overweight, getting them on start on a healthy diet.

So, there's certain things that we can do.

There's list goes on and on, they have history of depression, make sure they're in right mind before they get pregnant because the depression needs to be treated.

People that have uncontrolled depression pregnancy are at high risk for delivering early.

They have high risk of delivering small babies and small babies have their own complications as well.

They don't feed well and if they don't have pass certain parameters or time of delivery they automatically go to NICU.

So we need to intervene from day one before they get pregnant.

- And would you say that's, especially in the African American community and definitely because of socioeconomics, because I know a lot of people who have higher socioeconomics go through those plans ahead of time to make sure that they have the healthiest outcomes when it comes to having a baby.

- You may, I think you're correct with that statement.

And I think one issue you brought out was about transportation.

A lot of patients on Medicaid don't know that Medicaid will pay for your transportation to your doctor's office if you give them a head three day notice.

So that in itself really helps.

- Okay, you mentioned earlier that you yourself were two pounds a little over.

What did your mother, 'cause that was a time back and I know we've made improvements.

- Right.

- But what did she tell you about those times?

- You know, not much.

She didn't really tell much.

She just told me about that experience that how I was born prematurely and but in how I stayed in NICU for over a month.

But otherwise she didn't really, she didn't she didn't talk much about her prenatal care at that time.

- But that's so expensive and not, again not everybody can do that.

Can the Y help theirs at all?

- So there are individuals who have access to information and they can connect you to resources in the community that can get you connected to doulas.

There are individuals, absolutely.

And that's one thing that I stress with a lot of the individuals that I see.

The families, there are individuals that provide resources or support in the form of a doula or birthing coach, things of that nature.

Because those individuals can go with you to those appointments and ask the questions that you may not be aware of.

Especially a lot of that testing and stuff that you may not be aware of.

There are individuals who don't necessarily know who their birth family is.

They may not be connected to their birth family.

They may not be aware of certain things that their body are showing them during the pregnancy that the doula may have knowledge of and say, hey, I noticed this about you when you are in your first or second trimester, let's talk about this.

This is what I recognize it as.

So we're gonna do some research and we're gonna talk to your doctor the next time you go for your appointment.

Those kinds of things.

That's education and that's critical especially before, during, and after that individual's need to be connected to the why has a community health worker in the building and that individual is resources, support, education, knowledge.

And that is critically important to families especially.

I want to learn more about doulas 'cause this is fascinating to me, even though my eggs are like pretty much dehydrated by now.

But anyhow, we're going to take a short break but we'll be back to continue our discussion.

Please stay with us.

(upbeat music) - We're back with Dr. Dickson and Tara James-Wallace.

And on our last discussion we were talking about doulas.

So for those who are just joining us, we explain what that is and that there's an organization here in town that can help.

- Absolutely, Topeka Doula is an amazing organization that provides services and support to individuals.

And it's not just related to pregnancy.

They go with the individuals before, during, and after.

They will walk with them through their appointments.

They will provide support in any kind of way that that family needs.

And that's what I think is so great about what they do because they walk in to say, how can I help you?

How can I support you?

What is it that you need?

If they just need someone to go to their home and just sit and talk company and it's nurturing to the parent because while you're in the process of getting birth to bring forth this life, you need someone to nurture you.

And that's exactly what they do.

And it's a beautiful experience.

From my experience with the organization the individual that went through the process their experience was like night and day and it was amazing.

Absolutely amazing.

- Are there a number of doulas in town?

- There's a very small number of doulas in town but I think for me, my experience with doulas I think they think of things that I don't think of.

And they really help those first time moms when they come to their visits, they follow them through labor and delivery.

So I think they're crucial but sometimes forgotten part of OB care.

- So, you were talking about the fact of postpartum depression also having an impact on infant mortality.

- [Jamesina] Absolutely.

- Can you say more about that?

And does a doula help?

Can a doula help with that also?

- I'm sure they can do an extent.

I think postpartum depressions a lot of times is addressed at their postpartum visit.

But in our, and usually that first postpartum visit is usually six weeks after they deliver.

And so from baby till six weeks a lot has gone on and probably gone wrong.

It's very stressful during that time.

They're trying to nurse their breast milk production is not the greatest.

Their husband's going back to work their family is heading back out of town.

So they're sometimes at home by themselves.

And so, it's very stressful.

They're not sleeping well.

And so all of that impacts on infant care.

If they're too tired or depressed they're not gonna take the time out to nurse.

They're not gonna pump, they're gonna throw a nipple in their mouth or a formula.

So yes, it definitely impacts, and I think right now we're trying to make certain changes with that with screening for depression, not only before pregnancy we also be screening depression during pregnancy.

So like get like every trimester, so beginning pregnancy, middle and end of the pregnancy, we should be screening for depression and treating it as needed.

Postpartum, same thing right now for us our breastfeeding clinic does a pretty good job of helping us to screen for depression.

The breastfeeding clinic is a free service for everybody who delivers at the hospital.

So they come in day one, day two, day four, day five whatever they think is necessary to make sure they're doing right for their baby, make sure the baby's growing make sure their milk reduction is greatest but they also address depression.

So whenever a patient is seeing a breastfeeding clinic, they have their blood pressure checked to make sure their blood pressure is doing great and they also are screened for depression.

And then whoever nurse sees that patient, sends a message to the doctor, say, "Hey, this is what we saw today."

And so we look at things like that and then we get back to the patient and to follow up.

- In the incredibly sad event that there is a mortality, there's a loss.

How do those of us who interact with that family on whatever level, how, what's the best way for us to approach and give support, comfort?

- I would say ask the family what they need.

Because usually it's a difficult time and if you've never experienced it it's hard to say the right words.

So just be there, just be in that space.

Usually people are uncomfortable and so you go in and you try to overdo things and you do too much and you do the wrong thing.

And usually that makes the situation worse.

Just your presence alone is enough to be a support to that family.

Just be there in that space.

Don't try to do things, remove things that I don't want them to have this in the house.

It's a reminder of the loss.

You're overcompensating for their grief and their loss and maybe they haven't had time to process it in the moment.

Just be there.

- And what services are available for the family?

- Any services, there are any number of grief counselors.

My mentor, Felicia Glass is a great grief counselor and is awesome at giving supports and resources.

And she has any number of individuals that she would refer to.

As I said, I think that the best support that you can give individuals is just to be there, simply just to be there because you don't know how individuals are processing that loss.

- Right?

- Everybody doesn't process grief the same way.

Everybody doesn't process loss the same way.

- Yeah.

- I literally just had this conversation with somebody yesterday.

I process grief and loss completely different than anybody I've ever seen.

So I would tell people, just see what people need.

And if they say, "I don't know," be comfortable with that.

Be comfortable with saying, "Okay, I'm just gonna be here for you in this space."

They tell you I don't want you in this space.

Be okay with that as well.

And just say, okay, I'm gonna check on you every day just to let you know that I'm still here and I'm still a resource for you.

And just be okay with that.

- And what do we do?

You know, is there any signs or signals that this child is at risk of leaving us?

Which is there anything we can look for, we can identify?

- Feeding, how well the baby's feeding, how well the baby's growing.

If you have a lot of wet diapers during the day you know the baby is eating well and doing what's supposed to.

So that's the one thing that you can look into, see how well the baby's growing.

- What can we do on a societal level to stop the rates of high infant mortality.

There's gotta be something that we could do in the here and now to stop this from being a situation.

- Something that Jamesina mentioned that I think is amazing and I think would be just perfect, is that follow up appointment where everybody is checking everything.

And for the individuals that can't get to the doctor's office for those, the breastfeeding clinic, that type of follow up, go to the house.

If those individuals had a baby, you know they had a baby and they're not coming in.

Mobile clinics, bring that clinic to the community where individuals are not able to access the resource for the breastfeeding, because my practice, I have an office, but I bring my practice to the community because I know that these individuals cannot get to my office.

I know they can't get to the resource.

So the resource comes to them.

- That's wonderful.

- And that is number one, 96% of the infant mortality losses in the state of Kansas were preventable.

- Yes.

- Wow.

- We can do something.

We need to stop researching and doing reports on.

We're moving the baseline.

That's what we are doing.

Every time we do a study we're just moving the baseline of when these happen.

That's all we're doing.

Stop, we're gonna have reports stacked from here to the moon pretty soon because all people are doing is wasting money on reports and research.

This has been happening since my youngest set of siblings was born.

They're in their 40s now.

- Wow.

- My mother experienced a similar situation when they were born.

We need to stop doing the research and use that money to do exactly what she said.

- Okay.

- The breastfeeding clinics, all of those take all of that stuff and put it in the community where those things are happening where those resources can be used by the individuals that need them the most.

You know where it is you've already researched it a million times.

- Yeah.

- Bring that into the community where it's needed.

- Well, Dr. Dickson.

- [Jamesina] Yes.

- Tara James-Wallace thank you so much for being with us today.

This is such an important topic and we appreciate you taking out the time to let us know and we're gonna try and have some of those resources listed during the show as well.

So thank you so much.

- Thank you.

- Thank you.

(upbeat music) - Hello, I'm Carol Bragdon with the Shawnee County "Master Gardeners" and today we're going to talk about growing herbs.

The first thing we should say is, what is an herb?

It is a plant that is useful.

Herbs can be used for many different things but we think of them as things that provide us with an additional use other than just our enjoyment in the garden.

Culinary herbs are those that are used to enhance the flavor, fragrance and healthiness of foods.

There are several types of herbs that you may want to grow.

The annual herbs are those that you put in your garden or pot each year because they are not hardy.

In Kansas, we have cold winter so some herbs that may be likely to survive in some areas, will not survive here.

So when you grow your basil for that wonderful pesto you need to replant it each year.

The same with cilantro.

Some will reseed themselves like parsley and dill but they do not come back as original plants.

The other types of herbs that are available are the perennial herbs and those are the ones that will come back fairly reliably in the next spring growing season.

One that comes back readily for us are chives and mint, oregano.

So those things you can plant once and reap for many years.

Growing herbs, there's a few things that will help you grow your herbs.

One is to plant them in a sunny location.

It's best to have about six to eight hours a day.

You want a nice, fairly neutral soil pH of about 6.5 to seven.

It's important to have good drainage for herbs.

They do not like wet feet.

You want good drainage because plants in the herb families do not like their wet feets.

Many of them have an origin from the Mediterranean and think of that rocky, sandy soil.

We do want some organic materials mixed in with it.

So if you're starting your garden, till it up a bit, add a little nice organic and then you are ready to plant your herbs.

It's important to use fresh water when you are taking care of your herbs because rain barrel or stored water can become contaminated.

And herbs tend to be things that we use for edible use and we do not want to eat anything that could be potentially contaminated.

There are very few things and insects that bother herbs.

Those essential oils that they contain chase away most of the bugs.

We think of caterpillars in our dill and that's something we really like, that turn into swallow tail butterflies.

So we want those caterpillars.

So you plant a few pieces of dill for you and a few pieces of dill for the caterpillars.

(upbeat music) - Ladies, what an impactful discussion that we have with Dr. Dickson and Tara James-Wallace about infant mortality.

And there's so many things that I just did not know especially about Shawnee County and what you mentioned about the high infant mortality rates.

What did you gather from today's conversation?

- Well, I mean for me, I mean, I was shocked that there are so many resources here that people just don't know about.

- Right.

- So that there, there are ways that people can have their healthcare checked there are ways that you can get it paid for.

There are doulas that can come out and help you.

I mean, that was a lot of great information for me and I'm hoping for our audience as well.

- I do too, because I just think of the maybe the young woman who finds herself pregnant doesn't wanna tell her family, maybe doesn't have a family, she doesn't know what to do, where to go, how to deal with it.

She's alone and she's terrifically scared.

- And if I can jump on that for one second, I also was amazed at, it's important to start even before you get pregnant, to make sure that your health is in good shape.

And to know your background, right?

Your family background in terms of, do people have arthritis?

Do they have diabetes?

Do they have heart disease, whatever.

I mean, all of that is important.

Everybody thinks you just get pregnant and you have a baby, everything is great.

Boom!

And that isn't so.

- Well, and then the sadness of it too, when the mortality does happen.

I mean that's just an incredibly sad, oppressive time.

- When she said it was 96% preventable.

- Yeah.

- That hit me.

I'm like, oh my goodness.

Like what aren't we doing to communicate that message?

Like we need to be more proactive.

- Right.

- In making sure that these young ladies get the information that they need, that we get them like to clinics so they can go and get their checkups, that they get the transportation to get to the clinics.

That we get them healthy food.

I mean, all these things need to be put in place and of course at the beginning of all resources.

- Right.

- Right.

- Because if you don't have money or at least resources to get these things.

- Right.

- Then that's where it all starts.

- Right, she said, "Stop doing all of these studies."

- Right.

- Let's get the money.

Get the money.

- Yeah, exactly.

- Make these services available to everyone and let people know about these services.

I mean, that's the key thing.

I mean, there was a recent article in the New York Times about infant mortality that California just did.

California has a great situation.

The rest of the country doesn't necessarily have it.

Why don't you use that money to help the people in California?

Why don't we help the people all over the country that need these services to have healthy babies?

Our population is important.

- Yes.

- And we need to have the best population that we can, the best lives that children can have.

- Strong, healthy babies.

- Strong, healthy babies.

- Absolutely.

- Strong, healthy adults.

- Absolutely.

- Thank you so much.

I wish we did have more time but that is all we have for today.

If you'd like to watch this program again or any KTWU program you can do that online at watch.ktwu.org.

- And if you are so inspired to learn more about our guests, find out what's coming up on future shows and get access to additional content, be sure to visit our website at www.ktwu.org/inspire.

- Inspiring women, inspiring education designed to change disparities in our communities.

Inspiring you on KTWU, thank you for watching.

(upbeat music) - [Narrator] "Inspire" is sponsored by Kansas Furniture Mart, using furniture to inspire conversation.

And by the Blanche Bryden Foundation.

- [Announcer] The Friends of KTWU, honored to support programs and services that enrich the lives of our viewers.

And the Raymond C. and Marguerite Gibson Foundation.