Work right now feels an awful like a Pat Benatar song. It’s an anthem, a love story, a refusal to let the heart break lessen our resolve, a fierce defiance and gentle, pulsing, persistent moving forward, and a little bit of a headache from time to time. We are busy writing grants, seeking friends, and funds, and friends with funds…to make the dreams and visions we see so clearly manifest in the actual real world. As I’ve engaged neighborhood agencies to bring them into our vision and to find out how we can contribute to their work it has been a unique pleasure to connect with others who want what we want, who share our passion for healthy mothers and babies, who believe that money, transportation, and official job descriptions should not be a barriers to care for local families.
And they, like us, believe it enough to meet people where they are at. Literally, we drive to them if they can’t get to us. Clinically, we respect their family culture and values and their right to accept or decline care options. Emotionally, we care for women who bring a lifetime of understanding about the ways their bodies and healthcare and feelings collide. Financially, we provide care. It isn’t always paid for in part or whole, but what we don’t get in cash, we get in goodness and the promotion of a family’s health, and probably a referral down the road that will pay–it all seems to work out.
As we pursue our community-based work we have exciting new programs and services on the horizon. Really Exciting. And so, we have to explain to those we want to bring in who we are, what we believe in, and what we can do. The goals seem easy at first—we want to affect outcomes. Low birth weight babies, preterm babies, gestational diabetes, easier access to and increased quantities of prenatal care and better birth outcomes (lower cesarean, induction, and intervention rates). Our methods are wrapped around the idea of slow paced, individualized care. It all makes sense. It should work. But while we would like to believe we have the power to change birth outcomes by ramping up the quality of care and options, the research is stark and rather horrifying. A person, any person, will live 17 years less if they happen to live in our zip code instead of the affluent one we can see, barely more than a stone’s throw, across the lake. Birth outcomes are much more a reflection of complex community deficits than just perinatal care. Minimal access to resources, food deserts, missing cohesiveness in communities, unequal education, no access to the internet (we have kids filling out college applications on their phones, to name just one of the disparities that comes from lack of internet access), poverty, the stress that comes from living an impoverished life, the side effects of the stress that comes from worrying about the effects of the impoverished life, and on and on it goes.
I am stunned by the work our community agencies are doing to address the variety of disparities. When someone from one of these huge organizations asked me today which agency I work for and how many people are there I just laughed. “We are a small group of passionate people, each of us hope to be an agent of change, each of us dedicated to these goals, but emm…there are sort of 4 or 5 of us in a tiny little building.” I suppose one day we will look back and think it was romantic. Because it kind of is. Our dedication and relative size allow us to say out loud that care changes when the cost-benefit ratio gets more attention than the health of the mother, the access she has to care, and the balance in her provider’s life. We get to embrace the idea that abundance breeds abundance in our work with our colleagues, students, mentors, and the physicians who collaborate with us. We get to make mistakes and repair the ruptures with kind hearts and tenderness for each other. We get to have a learning environment where everyone present is seen as someone of value, with valuable insight to share. We get to provide care that combines good science, best practice, the skills we have, and the data we have not just from research but from the individual in front of us. We get to laugh with each other and listen, really listen to the stories women share. We get to show that women who had no prenatal care at all because of previous trauma within the system become savvy consumers of health care for their families after we walk through it with them during their pregnancy. We get to say in public forums what happens when the language of the provider changes from “I own this, the responsibility is mine” to “Welcome. Let’s share this together. Thank you for allowing me to participate in your care.” That’s crazy-beautiful, musical, romantic care. It’s not everything, but it is our something we can do. So we are doing it. And if I have anything to say about it, I hope we never look back at it as an artifact of the early days.