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Brian Lehrer: Brian Lehrer on WNYC amid all the news about the Delta variant and the January six committee and other big headline grabbers. You might have missed something really important that happened in New Jersey on Thursday, Governor Murphy signed into law a bill designed to address one of the most shameful things about the state. According to The New York Times, New Jersey is one of the most dangerous states in the country for women to give birth in, especially for Black women who are seven times more likely to die from pregnancy-related complications in the state than white women.

Overall, for every 100,000 births in New Jersey, 26 women lose their own lives, that's from CDC data cited by The Times, and again, it's one of the worst rates of any state in the country. Now, the new law creates a visiting nurse program available to every new mom in the state. We'll talk about that new program now, why it's needed, and what it can accomplish with the sponsor of the bill, state Senator, Teresa Ruiz of Newark, and Nastassia Davis, who is a registered nurse.

She's a professor of nursing at Montclair State. A nurse and international board-certified lactation consultant, and founder and executive director of the Perinatal Health Equity Foundation. Miss Davis and Senator Ruiz, thanks for coming on. Welcome to WNYC.

Senator Ruiz: Morning, and thank you for having us.

Miss Davis: Good morning. Thank you.

Brian: Senator, can you tell us why your bill was needed and what you hope it might accomplish now that Governor Murphy has signed it into law.

Senator Ruiz: Clearly, you opened up the story with some brazen statistics that face New Jersey and faces country as a whole, while the tenets and the impetus of the bill wasn't structured around all these statistics, because it was a real personal bill that I drafted based on my own experience, in while we were discussing this with different groups, and getting exposed to dorm connects, which is where the bill was modeled after to some degree, after participating in a conference down in North Carolina, I realized quickly that having that touch point with a nurse in the household in the first few days of giving birth, the extraordinary outcomes in preventing negative impacts will be phenomenal.

For me, it was having a special lactation nurse specialists come visit me. I was having a lot of apprehension, and uncertainty in my newness as a mother, whether I was feeding my daughter or not. She came over, she stripped my daughter down, put her on a specific scale, and then asked me to nurse her and then later again and looked at me and said, "You just fed her three ounces." I get emotional because it's an extraordinary thing, to have someone just quell that uneasiness that you have when you come home from the hospital.

I remember that moment clearly, as she looked at me, and she said, "What you're doing is right," and the opportunities that we had to exchange with each other, whether via the phone after that visit, or text messages, assured me that what I was doing for my daughter was right and if I had any questions, I had access to a resource. I was fortunate enough to breastfeed her for four years of her life.

Brian: For people who don't know the context, three ounces for a newborn is really, really good. Professor Davis--

?Senator Ruiz: Yes, really good. It is really good so I said no pun intended at the press conferences that I will tell you this, I had so much apprehension as new mothers know and look, I support everything, a fed is best when it comes to it, but when you're new nursing mom, and you don't know and you're very concerned about it, the last thing you want is a mother that has anxiety, because that will prevent you from producing the most optimal amounts of milk during that timeframe.

Brian: Professor Davis, could you tell us about some of the postpartum home visitation programs that you've been involved with and what role you think things like those could play under the new law?

Miss Davis: Sure, so I have not personally be involved with any home visitation programs, but I will say that our university did receive a grant from the Rita Hillman Foundation to expand on the nurse family partnership model, which is a very well-known model which is designed to give in home nurse visitation for first time parents. That's one of the gaps for me is that it is specific to new parents. If you'd have a second child, you don't be see that supports.

I think that's where this program will help to fill in some of those gaps because it's not specific to any population or whether you've had children before or not, everyone will have access to that service, which I think is amazing.

Brian: Listeners--

Senator Ruiz: Thank you. Brian, can I just chime in on that one too, and I think that's what was important?

Brian: Yes.

Senator Ruiz: I was fortunate enough to have that visit from the nurse, because it was covered from my insurance. Shortly after, when I started exploring, I fell in love with the program that she is talking about, which is New Jersey's Nurses Association Program, but we only cover 10% of mothers in that program. I wanted to be sure that when we drafted policy that it was going to be inclusive. This is not solely specific to women, it's for anyone who's bringing a newborn into their household, so that they have that touch point from a medical professional to see.

The stories that we heard from women who participated in the visitation program, one was second pregnancy, nurse visited the house, she was unaware, you're so involved in taking care of the child that you lose sight of your own personal health. Her blood pressure was at a tipping point where she was developing postpartum preeclampsia and that was identified during that visit, and addressed, otherwise, she wouldn't have been able to join us at the press conference.

It is going to be an amazing touch point where that medical professional can identify several things, whether it's an issue with breastfeeding, whether it's high blood pressure that can lead to other things, whether it's something with the infant that doesn't look right, whether its strains on postpartum mental health. The volume of what can happen in that visit will be limitless because it will be a personal touch point with that individual to really just gain some sense of comfort and for the medical professional to provide resources and links of family to avenues, where they can get extra help.

Brian: Listeners, you can help us report this story. We welcome your stories or your questions for a state Senator, Teresa Ruiz, and nurse and lactation consultant at Montclair State Professor, Nastassia Davis, about the very basic thing we shouldn't even have to be talking about really surviving pregnancy and childbirth and in this case, surviving pregnancy and childbirth in New Jersey, which has one of the worst rates in the country and a shameful seven to one Black mom to white mom disparity and maternal mortality rates.

Now Senator Ruiz's new visitation law is in effect, it was signed by Governor Murphy on Thursday 646-435-7280, 646-435-7280. With your story or your questions, or you can tweet @BrianLehrer. Could you each talk about why you think New Jersey has one of the worst new mother death rates in the country 26 deaths per 100,000 births and why there is such a profound and outrageous disparity in the new mother death rates by race? Seven Black women die from pregnancy-related causes for everyone, white woman, Professor Davis, would you take that first?

Miss Davis: Sure. I think the information has been out there for quite some time and I established the Perinatal Health Equity Foundation in 2018, based on a need that I was seeing before it had garnered this public attention in New Jersey. I am in a number of different mommy support groups. Through out those groups, I was constantly hearing moms giving condolences for another family member that had passed away during birth or a child that had passed away and these are Black mother groups.

I really started looking at what was going on in our state and it wasn't really having that public attention at that time. We know now that a lot of this is going to racism, implicit bias, structural barriers and policies. I think for New Jersey, we have a lot of the information on the statistics and some of the clauses related so your top choices are cardiomyopathy, which is related to preeclampsia. We have very high preeclampsia rates, and postpartum hemorrhage.

We are one of the states who has not adopted a full like California has the postpartum hemorrhage protocols, where every hospital in the state is operating on the same basic policy and how to manage a hemorrhage. We know that these deaths occur pretty much equally in pregnancy, postpartum and birth. While I think the program is great for covering the postpartum piece of it, we don't have a great system in place to look at the pregnancy and the birth points. We do have a Maternal Mortality Review Committee. I think as a state, that information that we're collecting needs to be released publicly so that we know what is happening with our families as what's really contributing to these statistics that we have. We know most of these deaths are preventable. My hope is that as we begin to implement this program, that we include some of that implicit bias and anti-racism training for those nurses that are going to be going out to the home because otherwise, we perpetuate the same issue that's happening currently in the hospital that Black women aren't being heard. They're not being listened to.

That's very important to me with that piece. Then also looking at the follow-up points of where we were granted [unintelligible 00:10:45] to do a similar home visitation program, where we're focusing specifically on preeclampsia and making that cardiology connection because we know that that is happening after delivery. We're really excited about that and hope to share those results out soon. I think it's a multi-fold issue of really looking at a system that is not built to support Black women at this time.

Brian: Senator Ruiz, do you want to add to that?

Senator Ruiz: Yes, I absolutely agree with everything and was taking notes on the postpartum hemorrhaging protocol. It's something I will follow up with research. On the implicit bias, I also sponsored a bill that was signed into law and that really identifies with how we're training the next generation of medical professionals to deal with women in general and then to deal with women of color. The numbers are clear, there is facts, it's not something that someone's deducing, or happens in one instance, is that, even when in fact, we are advocating for ourselves inside of an emergency room, somehow that voice is not being translated or heard.

We've heard stories with women, Serena Williams herself went through this experience, it's not something that's solely unique to the state of New Jersey. What I would like to add is that there are a lot of things that we have to do but New Jersey now I think is peaked at the forefront of setting the model to reverse these drastic negative numbers and to become number one in the state for pioneering and championing women during the time of postpartum.

We've drafted several pieces of legislation that have gotten signed into law. We have an administration that is advocating and vocal in both the Governor and the First Lady, or lending voice to this and really lifting it up from our policy perspective on down to a regulatory perspective. We do have a commission in place, but as Nastassia stated, there is greater work that needs to be done. Women, in general, don't get listened to. You've heard multiple cases where someone will go into an emergency room, and get diagnosed a different way.

We saw this clearly early on with heart, with issues with heart disease, how women were being treated completely different. It gets exacerbated when it's in a maternal space, and it gets super amplified when you're a Black woman in the state of New Jersey, unacceptable and something that we're working towards. We hope that the implicit bias education training begins to compartmentalize that and lend a better viewpoint to the next generation of medical practitioners and the current people who are in those workspaces. We hope that these other pieces of legislation, but we also have to get educated ourselves.

There were so many things that I learned of and if it were not for having a direct connection with my OB-GYN, I could have been in a space where I would have been in trouble. For instance, and I share this story and I'm going to use this platform, Brian, if you'll allow me, I remember calling my OB-GYN and saying that the bottom of my feet were itchy. I don't know why I called and I shared it maybe because I was just so scared. I was a new mom. She said to me, "Come into the office right away, I want to get your blood work drawn," and I couldn't understand why.

That is an indication of having your liver enzymes could be off, which could lead to a stillbirth. I never knew anything about that. How many women will experience an itchy foot or itchy palm and think it's, "I'm swelling, it's hot outside," whatever it is, and not even understanding the severity of what that could have been. Fortunately, it was not although I experienced it later on in my pregnancy so I was going in that direction, that my body was changing in a way that wasn't the best for being the house for my daughter but not understanding those kind of things can lead to really negative outcomes that we need to curtail, it has to happen on both ends.

We have to get better acquainted with what our issues are, and most importantly, our medical professionals need to listen to us and need to understand from every lens who we are when we're sitting on a hospital bed.

Brian: We just have a few minutes left before I know you have to go. Senator, let me get a couple of calls in here. Toni in Watchung, you're on WNYC. Hi, Toni.

Toni: Hi, good morning. I just wanted to know, how is this bill going to affect prenatal care and care during the delivery, is it going to cover doulas? I used to work in New York where we used to have a program that we would have visiting nurse from 20 weeks on every week to come to new mother's house prior to delivery. Is this going to cover any prenatal stuff, during delivery stuff, or just postnatal care?

Brian: Thank you, Toni. Senator.

Senator Ruiz: Currently, the bill doesn't speak to prenatal care. The advisory committee in the Department of Children and Family, I think will have an opportunity to explore that. This really deals with a post of visitation and they're looking for up to three visits after.

Brian: Valeria in Union County, Union City, sorry, which is in Union County, you're on WNYC, hello?

Valeria: Hi. Were you referring to me in Union City?

Brian: Yes, yes, yes, we got you.

Valeria: Oh, hi. Yes, I'm Valeria. First, I wanted to say I'm really happy to hear that this issue of maternal mortality is finally being addressed at least to some degree. It's really shameful that we're at this point in such a developed country. The other thing I wanted to say is that it's strange to me how in other countries, women after giving birth, they're usually kept in the hospital for a much longer period of time than in the United States, that allows for the mother to get that aftercare in the setting where it's most beneficial to her.

I feel like here in the United States, they release you like the day after you've given birth, and it's not healthy, and then you end up having the need in the first place for the visitations. At home, obviously, you can't provide the same care as in the hospital. That's my first point and--

Brian: Yes, I'm going to have to leave it at your first point, for time. We're hitting the end of the senator's availability, we could keep professor--

Senator Ruiz: I can stay on a few more minutes, Brian, if that's okay with you. I'm good.

Brian: Okay. What about, well, let me actually throw this to Nastassia Davis, as Professor of Nursing at Montclair State, have you looked internationally, and of course, I think it's considered progressive to get women out of the hospital after birth, as soon as possible-

Nastassia: Absolutely.

Brian: -in general, but what do you say, to Valeria's concern?

Miss Davis: We know that the longer people stay in the hospital that infection rates go up. It's not ideal for people to stay in the hospital unless there is a medical situation that warrants them staying. We've had the fortunate growth in birth centers in New Jersey, and the birth center model is you birth, and within a couple of hours, you go home. We know that those birth outcomes work and that process works. What's not working is that there is a system that's setting people up for failure, to begin with.

It's not really the discharge component that's really the issue, it's more the teaching that we're giving people after they go home, because this may happen, we have up to a year for these births to occur. A longer stay in the hospital isn't going to address that issue. We know that A1, for example, has come out with a post-birth warning sign teaching families what to look for when they're at home so that if things begin to change, that they can go seek that help.

This nurse visitation program will provide access to that information, the assessments that are key to checking in to make sure those things are not happening. If they are, help them to get the intervention that they need early before it becomes a complication. Again, if we're looking at this from the lens of preventability, we know that doing assessments and teaching is really key to making sure we don't have bad birth outcomes.

Brian: One more, Shayla in Montclair, you're on WNYC. Hi, Shayla, thanks for calling in.

[silence]

Brian: Shayla, do we have you? Am I saying your name right? Shayla in Montclair?

Shayla: Yes, I'm here.

Brian: Oh, there you are. Hi there?

Shayla: Yes, great. Hi. On my third daughter, I was sent home and after three days, I started having bad cramps, and backaches. I went to see my OB-GYN and the nurse made fun of me because she thought I wasn't clean, and [unintelligible 00:19:45] left some tissues inside and the test results after came back and they told me I had cancer. The doctor wanted to remove my uterus and I went for a second opinion. It was just [unintelligible 00:19:59] doctor did a simple colposcopy and said that I was fine, it was just an error. The worst part was that my sister in Montreal, three years later, had a child and she almost died. She was close to death because of less tissue as well, but I called the hospital and begged for them to give her antibiotics because I knew what was happening to her. It wasn't until now, a few years ago, that I realized there was a problem with, by the way, I'm Black, that there was a problem with Black women not being taken care of properly in hospitals.

Brian: Wow. Senator-

?Senator Ruiz: I'm sorry to hear that.

Brian: -give her a last response and also tell people how they can access this program now that the law has been passed for universal postpartum nurse visits in New Jersey.

Senator Ruiz First, Shayla I'm so happy that you're still with us here in Essex County and the green township of Montclair, and you're hearing from a woman who advocated for herself, or she knew something was wrong, she called the OB-GYN. She went in and even though she was gotten made fun of she kept pursuing because she knew something wasn't right with her body. What happens when someone just pushes that aside, doesn't understand the language, doesn't make the phone call or doesn't have access to healthcare overall? 40% of women don't attend a postpartum visit in this country.

In that space, we are losing individuals consistently on a daily basis to preventable causes. I think Valeria did talk about, or are you ask Nastassia, how are we looking internationally? When I think about this country versus what other countries do for women after we've given birth, there are extraordinary lengths that we still have to go to the fact that we still have to leave our children after three months because that's up to with the time that we have.

Some of us get an opportunity to spend more time with them and you look at neighboring countries who give women a year and then give them education and then give them childcare during that timeframe. When the mother returns back to work after giving birth, she's empowering herself and can make a career change to improve the quality of life, we still have a lot of work to do.

Brian: State Senator, Teresa Ruiz from Newark who sponsored this new universal home visit for afterbirth law that Governor Murphy signed in New Jersey on Thursday, and Nastassia Davis, nursing professor at Montclair State and founder and executive director of Perinatal Health Equity Foundation. Thank you both so much for joining us. I could tell so many listeners were both thrilled and educated by what you all had to say. Thank you very much.

?Senator Ruiz: Thank you.

?Miss Davis: Thank you for having me.

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