JOEL BERVELL: My guest on this episode of The Dose is Dr. Kaytura Felix, a nationally recognized maternal health expert, physician, and health justice scholar dedicated to advancing equitable care for Black families. She’s a distinguished scholar at the Johns Hopkins Bloomberg School of Public Health.
Dr. Felix leads the Black Birthing Futures Project, a national research initiative examining the experiences and impact of Black community midwives and community-based models of care across the United States. The project highlights how culture-grounded care, community support, midwifery, improve outcomes and can meaningfully change the conversations around Black maternal health.
This month, Dr. Felix launches her podcast, Deep Care, a narrative series taking listeners around the country to hear powerful stories of relationship-centered maternity care and how midwives and community-based support can have transformative impacts and improve outcomes for Black families.
In other words, it’s all about keeping the joy and restoring the dignity everyone should experience with the birth of a child. I’d be happy to have this critical conversation anytime, but especially now as we head into Black Maternal Health Week.
Dr. Felix, thank you so much for joining me on The Dose.
KAYTURA FELIX: It’s so good to be here with you, Joel. Thank you so very much, Dr. Bervell.
JOEL BERVELL: Absolutely. Well, first I want to take a minute and say your approach is so aligned with what this podcast aspires to do. You’re focused on solutions, not citing and repeating statistics about the maternal health crisis in the United States.
As I’ve said before on this show, this is an entrenched problem, including facts like Black women are three times as likely to experience a pregnancy-related death, and we’re familiar with that. And the work is exactly where you are, surfacing and integrating solutions. So truly, thank you for that.
But I’d like to first hear about your research, the origins of your project, and your goals. Were you motivated by particular gaps in research or data and where did you go to find the data that you wanted?
KAYTURA FELIX: Absolutely. This is such a critically important question, the origin of this project.
So I started this research with a very simple question. I too was hearing about the statistics. I was disturbed about the statistics, but I knew the story had to be more than the statistics. I knew that the communities, the people involved, the people who loved Black women and Black birthing people, had to be solving the problems.
So, I started with the question, what is the Black community doing about the Black maternal health crisis? I turned to experts, people in the field, people I knew and people who had written about it. And I spoke with about 70 people and they told me in no uncertain terms, look to Black community midwives. And of course, a number of other points came up, but this issue around community midwives really surfaced and it really struck me.
I was curious. And so the first thing I did, I went to observe a midwife. In the course of doing this research, I’d met a couple of them. And so I asked one of them, “Can I shadow you?” And I spent two weeks shadowing a midwife. I went on two separate postpartum visits, and what I saw just blew me away, in the sense that the kind of care, the kind of engagement, the kind of focus, it was care that I didn’t have, care that I had never seen before.
So, for example, the first visit was to a postpartum mother, 10 days, and the entire visit happened on the bed because the midwife was very committed to having the mother rest because that’s a very important part of postpartum care: rest.
So the midwife didn’t say you should rest and then ask the client to come to her office or ask the client to come to the living room. She went into the bedroom and the entire visit happened there. The baby was weighed, the conversations, and deep conversations. What is the family doing? How is the family adjusting to this new baby? And the focus of the conversation was all about support, support for the mom, support for the baby. So that was important for me to see.
But the second question was like, is this midwife unique? Am I looking at a unicorn here or is this a real phenomenon? And so I designed a study. It’s a qualitative study. So we’re going deep having storytelling and it’s a multistate study, a multicity, multicase study. And we went deep, talking about the data. So we wanted to look at these midwives. So the question was, what is a community midwife? What are they doing? What is the experience they’re having and what impact are they having on the people they serve?
We went to five cities and we collected rich data. There were three sources of data we had. We had interview data where you talk to people and you try to understand what’s going on, what experiences people are having. So that’s one, interview data. We had observation data, and we had survey data.
So the interview data, we interviewed the midwives, but we didn’t stop there. We didn’t just say, “Oh, tell me about your practice. How is it going?” We interviewed people around the midwives. What I call, we did a 360 around these midwives. Because if people are saying that community midwifery is a solution to the Black maternal health crisis, well, I felt very responsible. I better understand what this community midwifery is all about. So it’s interviewing them, interviewing the people around them. We interviewed their clients. We interviewed their clients’ families. We interviewed their collaborating providers. These are people who are working with these midwives to provide care.
We also interviewed community stakeholders. They make it possible for these midwives to provide care. And then I observed them. When I started this project, I didn’t think being a physician would be important, but it is. So I put on my clinical lens and said, “Let me look at this care and let me see what’s happening.” And then we also surveyed their clients. So these are the sources of data we drew on around this research.
JOEL BERVELL: I think those sources of data are so important, especially that you’re doing this wraparound model looking at everyone, not just one individual. And the systems that birthing parents encounter are very familiar to most of us. We’ve talked on this podcast before about how for many parents, those systems at times can make the prenatal and birthing process pretty joyless and actually can cause additional stress and compromise of safety and wellness during the most vulnerable time.
I’m curious what your research found about that. And was it because of a focus on technical care over interpersonal care?
KAYTURA FELIX: Yeah. I think this issue of joy is really important. Joy, it may seem frivolous, but it’s not. It is fundamental because with joy comes safety, with safety comes less stress, feeling of less stress, less pressure on your sympathetic system, more opportunities to have a safe birth.
And clearly there was technical care. So I saw blood pressure being measured. I saw fundal exams, fetal scopes, all of that. The technical piece was there. I was familiar with the technical piece. I was trained in that model. What was unfamiliar to me was the joy, was the laughter, was the conversation. Was the client saying, “I feel seen. I feel safe. I feel this person has my back.”
And it’s really important because safety, emotional safety, is always important. When women experience stress, when they experience mistreatment, these are not just small things. They are huge things that affect our central nervous systems, that affect the parasympathetic system, and the systems that can support what is called vaginal birth, physiological birth, and less complications around pregnancy.
The other thing I also observed was the whole consent process. At every step of the way, these midwives are asking clients for consent: “Can I touch you? Can I listen to the baby?” So you have joy and technical care. And I think those things have to go together. The technical skills have to go with the care skills.
JOEL BERVELL: Mm-hmm. We’ve talked about joy. We’ve talked about wraparound care. When you went into these communities, what were the other solutions you heard about and saw? And was that totally outside of the conventional systems of prenatal care or alongside it?
KAYTURA FELIX: So when I went into the communities, I saw a system of care. It’s nascent, it’s fledgling, but there’s a system of care. These midwives, the midwives I worked with and spoke to, they weren’t operating on their own. They were operating in collaboration with other providers, with doulas. We know doulas play an important role.
They were collaborating with birth assistants. They were collaborating with physicians, obstetricians, and maternal–fetal medicine doctors and pediatricians. So there was a constellation of providers who were caring for the client. So that’s what I saw, and I thought that was very striking.
The other thing I saw were other services: education, not just for the pregnant person, but for their family. So that’s another, community education. So for example, in Los Angeles, we had not just the midwives providing care, but there were also peer support groups, group visits where . . . I mean, and I sat in on a group visit, which was just amazing.
I felt so honored being in that space. There’s a midwife there facilitating, doing a little thing, but these families are talking among each other. Somebody came out and said, “Hey, anybody can tell me about a glider? Where can I get a glider?” And five people are like, “Yeah, you can do this, that, and the other.” So you have this community support, this peer support, people helping each other.
And the other piece that I think is really important is that is what I saw was a whole lot of wraparound care around these families. So one of the things I saw, frankly, which made me really happy was that the family is the sun and all the providers are orbiting them, meaning the providers are all working together to support the pregnant person and to support the pregnant family.
JOEL BERVELL: I think that’s such an important distinction to make, and I entirely agree. I feel like so often in the hospital, the physician is the center as opposed to family members being the center, especially when there’s this power imbalance when it comes to knowledge of the medical system at least.
Could you walk me through how midwives collaborate with that conventional health care system, especially ob/gyns and hospitals? I’m curious how that works in practice, especially when it comes to things like insurance coverage, as well as challenges around integration, respect, or even stigma.
KAYTURA FELIX: Yeah. I’ll start with the best-case scenario, and then we’ll go from there.
So the midwives that I worked with, all of them collaborate with physicians, ob/gyn. They value what physicians, ob/gyn, maternal–fetal medicine bring to the conversation. And at the same time, they know and respect their own expertise. They pay attention not only to the medical criteria, but to the state criteria. So those criteria vary state by state.
So for clients who have uncomplicated pregnancies, they generally care for the clients, except if the client also wants to be seen by obstetrician, and some clients do. And the midwives I work with are very open to that. For complicated pregnancies, the obstetrician and the midwife would see the client concurrently. And so midwives also refer clients. I mean, so if a midwife has a client and the client has been uncomplicated, and then you see complications.
And because these midwives have very close relationships, these visits are hour-long visits, 45-minute-long visits. You can cover a lot and you can observe and you see people over time. So they make referrals to obstetricians, but some of the midwives that I worked with also consult with the obstetrician and pick up the telephone and say, “Dr. X, I’m seeing this like, what do you make out of that?” And so the obstetrician partners with the midwife as a consultant or as a collaborator, two very distinct kinds of approaches.
Now, that works really well. So you have that kind of interaction and that kind of either consultation or collaboration. And when that works well, it works beautifully. Now let me tell you the time. Now that kind of collaboration is not the norm. Unfortunately, it should be the norm. It’s not the norm.
And it’s not the norm because our system does not encourage it. The system we have makes it such that obstetricians can choose whether or not to work with midwives. Many midwives that I spoke to have difficulty finding that kind of collaboration. I’ve heard that some of them have to have a fiduciary relationship, they have to pay to have that kind of relationship, and sometimes it’s expensive.
Other times, some obstetricians who have that kind of relationship with midwives are marginalized in the obstetric community. I think you also mentioned stigma. That’s a big piece, Dr. Bervell. That’s a huge piece. Midwives and not just midwives, midwives and their clients face a lot of stigma. A lot of the stigma, we inherited it, frankly. It’s from just like miseducation, misinformation, disinformation — a legacy of disinformation. I mean, you’ve talked on your podcast about that legacy of disinformation. And so people training in medicine think that midwives are not trained, and that is far from it.
And if it’s one message that I want to convey and to convey in no uncertain terms, community midwives, those are trained and they have an expertise and they have a body of knowledge that is distinct and complementary to allopathic medicine. And they experience stigma from nurses, from physicians.
One of the things I learned is that the physicians who train with midwives, so those who train with midwives have deep respect for them, deep respect for them, because they know what these people can do. They know the toolkit they have.
So I think we have opportunity in this country to do a couple of things: one, to increase the number of midwives, two, to strengthen the relationship between obstetrics and midwifery, community birth and hospital birth, and three, to really strengthen community birth, to really bring more resources such as insurance coverage for midwives, to bring more resources into the community.
I think we have a tremendous opportunity to do that and clients, families want that, but I would also say families need that kind of holistic care.
JOEL BERVELL: So many important things of what you said. I think it’s so important, as you’re mentioning, that this is complementary and that we recognize that there’s distinct value that midwifery can bring that adds onto the value of, like you said, traditional allopathic medicine.
And I want to home in on one thing that you mentioned at the end there as well, which was about cost and money. And so the idea that for ob/gyns, that most likely could be covered by insurance, but working with a midwife is probably not covered. I’m curious if you can talk a little bit more about the cost that’s there.
KAYTURA FELIX: Yeah. The cost. Yeah. We met with clients and they talked about the cost. They loved the care. They raved about the care. And when we asked them, what was hard about this? Many of them talked about the cost, and it’s expensive. All the people we talked to, but two, had to pay out of pocket, and the two were on Medicaid.
So I mean, in some places, Medicaid does support that kind of care. And these people we talked to, most of the clients we talked to had insurance. They had insurance, but their insurance would not cover midwifery. They paid between $4,000 and $8,000, and that’s a lot of money. And when insurance covers it doesn’t cover it, it’s partial coverage. So that’s something that’s also very, very unfortunate.
We had some clients whose cost was subsidized by some birth funds, so we were really excited about that. Some community groups were coming together to really subsidize the cost of midwifery, and that was really important.
The work we did in Philadelphia, we were enthusiastic that midwifery, like the community saw it necessary to support these families. So there are definitely financial costs. The other cost I want to mention is the cost of the bias. People, clients experience a lot of bias. We talked a little about that, but not just from the medical establishment. We know that there’s bias in the medical establishment against midwifery and against people who choose community birth. Either when they transfer to care, they talked about withholding of care.
So somebody who’s having a community birth and in the course of having the community birth needs a higher level of care. So you call in a consultant, you call in somebody, you transfer people from one hospital to the next because this is a community hospital, we have done everything, we need a higher level of care. That is something that is common in medicine. Step up.
When the community tries to step up to that, they’re treated not only with ridicule, but also withholding of care. What I’m saying is in that space, there are people doing good work, and when they want and need to transfer to hospital systems, they should be welcomed and they should be encouraged.
And the last piece around cost is around families being afraid of community birth for their relatives. And that is also a cost that people doing community birth also pay within their families because of miseducation. So the Deep Care podcast is really primarily aimed at people giving birth, Black birthing people and the people who love them, but also for all people to really understand what midwifery care is and what community midwifery care is and what is possible within the community that can really turn around the Black maternal health crisis.
JOEL BERVELL: And this is a perfect transition to one of the stories that you tell actually in your podcast. In it, you introduce the Deep Care model through the story of a mother in Florida, expecting her third child, someone who you described as a walkout. Can you explain to listeners what you mean by walkouts and introduce us to Brittany and her story?
KAYTURA FELIX: Yeah. So Brittany, I’ll introduce you to Brittany and then I’ll talk about what we call Deep Care.
So Brittany is, at that time she was probably in her mid to late 30s. She’s a nurse. She’s had two children. They were both traumatic births, meaning C-sections and not just C-section, C-sections with pain, C-sections with not listening to her, just really painful experiences people have in hospitals. I mean, her doctor not listening to her, she wanted to switch doctors and her doctor not allowing her to switch providers.
And when she got pregnant for the third time, she was in a C-section group on Facebook. When she got pregnant the third time, she was like, “I’m not going back to a hospital. I just cannot do this.” And so she said that to her group and somebody said to her, “Whoa, yeah, I hear you. I understand you. I’m feeling you. Here, here’s the name of a midwife.”
And so she called the midwife and she met the midwife, and the midwife wanted to know what midwives do. They want to hear your story and they want to hear all the story. And so she says that she was expecting the midwife to be like, “No, we’re not doing this. I can’t do this. I can’t help you.” And the midwife said to her, “Yeah, I’ll work with you.”
And so Brittany, they started a relationship and they worked together and Brittany has this triumphant birth, and she describes what is a triumphant birth. And so Deep Care, what I call Deep Care, is what I saw these midwives doing. It’s the clinical care. It is the clinical care, but it’s the social care, it’s the emotional care, and it’s the spiritual care, which is really important.
Who knew that spirituality was really important? I didn’t know that. And so that is why you have this holistic care where these clients can tell their midwife what’s going on with them and the struggles they’re having.
And the midwives can educate them. The midwives are providing these services that we know are important, but we realize we are educating them so that these midwives see this opportunity as a moment of transformation, not just for the baby. Of course, the baby is being born, but something is happening at the family level. The birthing person is also being rebirthed into a parent.
So that’s what I call Deep Care. It is care that is centered in love. And when I say love, I’m not talking about romance and the mushy stuff. I’m talking about care. I’m talking about attentiveness. These midwives listen, listen to people’s needs, right? So they listen.
They also take responsibility. They go the extra mile to make sure that these clients have their needs, and they’re competent. So that’s in my mind, and I named it Deep Care, not because it was so different from what I had experienced, what I had observed, what I was taught, and what I myself provided. Our team had to signal that something fundamentally different was going on here.
JOEL BERVELL: Absolutely. And as we wrap up this conversation, I have to ask, where do you see this Deep Care model scaling next, and how do we ensure it remains accessible and affordable as it grows?
KAYTURA FELIX: I think that’s a really beautiful question. And there are a number of entities, a number of organizations that are advancing, wanting to advance the midwifery model of care. The piece that I’m really focused on is advancing the midwifery model of care in communities, meaning in people’s homes and in birth centers. I believe it also needs to happen in hospitals and what happens between communities and hospitals.
So for example, we have the Beloved Birth 50 by 50 national goal. I think that is really important. I’m partnering with a number of organizations to advance that goal. And that goal, for your listeners, is that by 2050, in 25 years, 50 percent of births in the U.S. will be supported by midwives, and that’s really important.
Involved in that, we have the Birth Center Equity as an organization who is really holding that goal for all of us to participate in. I’m participating in that goal myself and the Black Birthing Futures.
I want to lift up the National Association of Community of CPMs, the National Association of Certified Professional Midwives as an organization advancing that, really working to have more community midwives in the field. We have a number of birthing schools, midwifery schools coming up in the community. One just opened up in Chicago, on the south side of Chicago, a community midwifery school.
So you have people educating, working on the workforce piece. I think that’s important. You have people working on the credentialing piece. That’s also important. We have the perinatal common-sense childbirth. I mean, so there are so many organizations doing this, and so I think that’s what needs to happen. And I think we need the Momnibus.
And I think there’s a lot to do around workforce and financing. And there are people in that space around narrative change is something that I care a lot about. And the podcast is around that, really getting people’s hearts and minds to shift towards that kind of respectful generative care.
JOEL BERVELL: Absolutely. Dr. Felix, this conversation was such a powerful reminder that better outcomes don’t just come from an intervention, but really, as you mentioned, from deeper connection, trust, and care. And I know as we head into Black Maternal Health Week, this is going to feel especially urgent, but also hopeful, because as you’ve shown, the solutions are already there. We just have to be willing to see them, support them, and scale them.
So thank you so, so, so much for joining me and for the work that you continue to do to reimagine what care can look like. And to everyone listening, make sure to check out Deep Care. It’s a powerful extension of everything that we’ve talked about today. Thank you so much.
KAYTURA FELIX: Thank you so much. First episode is April 13th and the trailer is April 6th.
JOEL BERVELL: This episode of The Dose was produced by Jody Becker, Jesús Alvarado, and Naomi Leibowitz. Special thanks to Barry Scholl for editorial support, Matthew Simonson for recording assistance, Jen Wilson and Rose Wong for art and design, and Paul Frame for web support. Our theme music is “Arizona Moon” by Blue Dot Sessions. If you want to check us out online, visit the dose.show. There, you’ll be able to learn more about today’s episode and explore other resources. That’s it for The Dose. I’m Dr. Joel Bervell, and thank you for listening.
