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If we really want to see a better world, we need to take care of our mothers and reduce maternal mortality here in America. The rise of maternal mortality rates are a pressing issue that demands attention and action, as they highlight the inequality in healthcare as well as the lack of evidenced based care being delivered across our country.
Dr. Ginger Garner sits down with Dr. Rebeca Segraves for this episode of the podcast, Living Well, to shed light on this issue. In this heartfelt discussion, Ginger and Rebeca highlight the disparities in maternal mortality rates among different racial and ethnic groups in the United States.
Dr. Garner and Dr. Segraves cover a range of topics regarding how we can reduce maternal mortality, but there are a few key points to highlight.
First, maternal suicide is on the rise and becoming the most common reason for postpartum maternal deaths.
Second, the Hispanic population has experienced the highest rate of maternal mortality compared to other ethnic groups, despite having a strong sense of community and social support.
Third, but not last, our protocol is only 1 visit at 6 weeks postpartum for mothers. Most of the maternal deaths occur within the first 6 weeks after giving birth – there is no way this is adequate to prevent death OR enable new mothers to thrive!
The answer is actually kind of simple. We need to include postpartum care for every mother that includes much more than one 6 week visit. Plus, we need to highlight and take care of those of us who are most vulnerable.
Each person’s care plan should be tailored to include individualized education, interventions and pelvic healthcare to what they specifically need. We need to evaluate all of their systems, including neurological, cardiovascular, musculoskeletal, and psychosocial to ensure they are properly supported and cared for.
Did you know that postpartum care often involves abdominal surgeries, which occur in about 33% of cases? Meaning 1 of 3 people giving birth are receiving a surgical intervention at some point in the birth process, which far exceeds the 10-15% recommended by the World Health Organization. And most are not given referrals for pelvic health PT or OT after these surgeries!
If we want a healthier and happier world, it’s time we empower people giving birth. We can do that in so many ways, but taking care of them during one of the most amazing and challenging times in their lives is critical.
Let’s do everything we can to prevent these unnecessary maternal deaths, so mothers and children get the connection they need for happy and healthy lives!
Dr. Rebeca Segraves, PT, DPT, WCS is a Board-Certified Women’s Health Clinical Specialist. She has extensive experience treating perinatal and pelvic health conditions in acute care, home health, and outpatient settings including long-term hospitalizations for high-risk pregnancy and following perinatal loss.
She has worked with inpatient general surgery, oncology, and obstetrics and gynecology teams to maximize early recovery after delivery, pelvic surgery, and obstetrics critical care diagnoses. She has tailored Enhanced Recovery After Surgery® rehabilitation protocols for abdominal and pelvic surgeries including colon resection, cholecystectomy, hysterectomy, prolapse repair, endometriosis surgery, cesarean section, birth-related injuries, and cancer-related abdominal and pelvic surgeries.
She is the founder of Enhanced Recovery After DeliveryTM, an obstetrics clinical pathway that maximizes mental and physical function during pregnancy and immediately postpartum with hospital and in-home occupational and physical therapy. Her vision is that every person will have access to a qualified rehabilitation therapist before and immediately after birth and any pelvic surgery regardless of their location or ability to pay.
Dr. Ginger Garner Hello everyone, and welcome back. I am here with a guest that I have been waiting to interview for some time, Dr. Rebeca Segraves. She is a physical therapist extraordinaire, and I just want to welcome her to the show today.
Dr. Rebeca Segraves So much. Thank you so much for having me.
Dr. Ginger Garner Yeah, absolutely. Thanks for taking the time out of your schedule to be here. You’re doing amazing things. And that’s what we want to talk about today. But before we jump into that, I want to give you a little bit more information about Dr. Segraves. She is a board certified women’s health clinical specialist. She has extensive experience in treating perinatal and pelvic health conditions, in an interesting setting, which is why we’re here today. Acute care, something that we don’t hear about a lot. And for those of you who are like, what’s acute care? We’re going to talk about that.
But also in home health and where you would think you would usually get this type of care. And that’s in outpatient, like freestanding clinics and outpatient hospitals. clinics, but then she has experience in long-term hospitalizations for high-risk pregnancy and care following perinatal loss, which is something that we don’t talk about enough.
She’s worked with inpatient general surgery, oncology, obstetrics, and gynecology teams to maximize early recovery after delivery. Also, though, not just after delivery, but also pelvic surgery and critical care diagnoses. She has tailored enhanced recovery after surgery rehab protocols for abdominal and pelvic surgeries, including, and there’s quite a list, I’ll just include some of those, hysterectomy, prolapse repair, colon resection, endometriosis surgery, that’s a big one, c-section, birth-related injuries, and cancer-related abdominal and pelvic surgeries.
She’s the founder of Enhanced Recovery After Delivery, which is a clinical pathway that maximizes mental and physical function during pregnancy and immediately postpartum. Her vision is that every person will have access to a qualified rehabilitation therapist before and immediately after birth and any pelvic surgery, regardless of their location or ability to pay.
Welcome, Rebeca.
Dr. Rebeca Segraves Thank you so much, Ginger. This is great, it’s wonderful.
Dr. Ginger Garner. That last piece is huge for me. It has been a big passion of mine. And I just want to say first, you’re kind of living my dream come true. It’s the stuff you’re doing that is the stuff we have needed for so long. And I’m going to pause for a minute because it makes me like, I get emotional about it. Because as being a mom for nearly 20 years, that’s another reason to be emotional in itself. I got this far as a mom of 20 years.
It’s not just me, it’s telling everyone’s story. Everyone who has come through this journey has experienced some awful discrepancies in care that you’re really trying to shore up. So you’re creating what we’ve all wanted to see happen, what I wanted to see happen when I first became a mom, when I first realized that I had to go through three practices. Which meant I had to and I guess, I quiet quit two practices or fired them, whatever phrase we want to use, because they weren’t practicing in an evidence-based way. What they were going to force me to do to deliver my children was nowhere near what the evidence base was saying. It was 20 years old, at least.
And it was shocking to live through that and also have to advocate in a system where it’s like, why are you not going to that hospital? Everybody goes to that hospital. Their guidelines are out of date and they’re not going to give me the care that I need. So I just want to say that first, thank you for taking on this huge need in our society, culturally and in so many different ways. So I just want to thank you for that and then say, all right, now I need to hear your story. What set your soul on fire for this vision?
Dr. Rebeca Segraves Yeah, I think it was probably not 20 years ago, but 12 or 13, where about three months before I started PT school, I watched my mother have a massive stroke and it took about 36 hours for her team to get on board with ordering an MRI, with listening to me. And thankfully I had videos at that time and I cannot think of, I knew it was like a flip phone, it had to have been that she used, but I had like just the upgrade from that to where I had these videos of her walking the day before and like begging her team to watch them. So that they could move way faster on what I thought was a code stroke, and then come to find out later it wasn’t. They actually had never alerted a code-stroke on my mom.
And it was knowing I was a personal trainer. Knowing that about 24 hours before that we were in a factory mill physical therapy clinic where the physical therapist had a white coat. And I felt that sense of white coat syndrome to where I knew my mom should not have been on machine after machine after machine without her vital signs being assessed, but I couldn’t speak up. And so 24 hours later we’re in the emergency room and I can’t get anyone to watch these videos of her completely functional but not being able to raise her arm.
And so watching her go through that I think right before PT school and struggling. I should have never probably graduated PT school. I was always on the cusp of failing like my second exam or second practical or whatever it was just to get through. And after going through that and then doing a residency specifically in women’s health physical therapy and just seeing discrepancies between how we treated individuals after knee replacement and hip replacement and elective spine surgery versus someone who comes in to give birth and have a major open abdominal surgery, cesarean section, and then be sent home without her vital signs being assessed. I knew something was wrong.
So when I think of the fire that’s been burning for a while, I have to be honest with listeners. This has been really a personal journey for me, and I’m not a mom. But I am a daughter who’s watched her mom be neglected. And I don’t want to see moms who are the cornerstone of our society. The World Health Organization considers maternal and infant health reflective of the health of an entire population. And so I think that’s really my backstory.
I was a personal trainer. I took vital signs with my clients before we got into high intensity interval training, but during exercise, continuous exercise, whatever it was, and I watched it not happen in healthcare, and I was confused, and then I was angry, and then I was resilient.
Dr. Ginger Garner I love the way you encapsulate that whole journey, that whole emotional. Everything that you shared is so heavy and so profound, but then you encapsulate it right in the end, you know, being angry to moving into resilience and action. And that kind of leads me into the next question that I had for you, which is if we take our stories, your story, and we get a little go to shift to the nerdy side of things for a second, which we love to do in PT and and on this podcast, I want to talk about your latest paper, which is a clinical commentary that was just published in, I believe, the January-March issue this year, 2023, of the Journal of Women’s and Pelvic Health Physical Therapy. And the title of it is, Initiating Occupational and Physical Therapy in the Hospital After Birth: Access, Reimbursement, and Outcomes. There’s a lot in there.
But when we talk about the vast majority of women going on to give birth at some point in their life, and then the first line, I think, one of the first lines in your paper says 98.4% of births are going to take place in the hospital.
This impacts nearly everyone on some level. because you have a family member that is going into the hospital to give birth. So all of us are touched by this, by the lack of standards of care that we currently have. So give us a little nutshell, however you want to kind of summarize that clinical commentary, which was done with several other colleagues, as well to acknowledge that. Yeah, give us the kind of the cliff notes of it and what the take home is and where the paper was born out of.
Dr. Rebeca Segraves Right. We had five authors on that paper and they’re all acute care therapists. And I am just thrilled that we were all able to represent different areas of the country. And so we had authors from Colorado, from Indiana, from Texas, kind of just kind of give an overview of when you get down to it, it’s really social determinants of health.
We’re talking about physiology, we’re talking about body systems that are impacted, and we are addressing it in terms of the most vulnerable in our society. And if you think about that, you know, we’re all physically active in the kind of the PT world and in general, you know, we understand the the value of physical activity for our clients and I’m a big hiker, big mountain biker and so I always think of when I’m going out on the trail with someone who’s not familiar with the terrain or familiar with the altitude, especially in Colorado, we always hike to the level of those who are least vulnerable, right? And so, or most vulnerable who are not as fit.
We don’t just kind of like power through and get to the top and just leave them behind. And so in healthcare and what we did with this paper, this commentary, we really spoke to the most vulnerable, the least fit. And so those individuals who may have multiple children at home, multiple levels of their home or apartment that they would have to negotiate versus someone who’s on a one level, one story home. Those individuals who don’t have a huge community and support system who may have a baby in the NICU, and while they were being transported by wheelchair after a cesarean section to go down to see their baby, now they’re home.
And so when they’re back at the hospital at the front door, they have to make sure they can get down to the NICU and cover that distance within the first week after delivery. And so this commentary really speaks to the less fit of this population, to the people that we should actually be wrapping services around, wrapping care around, so that we are really not leaving them behind. And so it says a lot in terms of what we as therapists should be monitoring, assessing, fighting to get on the maternal care team for. But it also speaks to those individuals who, if we do leave them behind, it gives the most recent data on how amazingly high the maternal mortality rate has climbed in a very short amount of time.
An incredibly short amount of time. Within the past three years, we’ve seen a population that we could probably all agree by their characteristics has a lot of social and community support, Hispanic population, and they’ve actually had the highest rate of maternal mortality when compared to every other racial and ethnic group in the United States. They’ve had the most change in a short amount of time. Since the data was collected in 2019, 2020 was the biggest shift, and then 2021, their numbers rose incredibly.
And so the commentary was really built on physiology, how pregnancy and the immediate postpartum period affects the neuro system, the cardiovascular system, the musculoskeletal system, and all of those body systems that we’re familiar with, but then how we can now tailor those interventions to the individuals who need our services the most.
Dr. Ginger Garner So paint a portrait for me, if you will, for the listener of what that would look like, what would those services look like? And I think that was one of my questions that I had on the, on the big list of things like, what would you want to see happen for that postpartum care? I mean, we could talk about abdominal surgeries too, because sometimes postpartum care is an abdominal surgery about 33% of the time, which is far above the 10% that the world health organization recommends.
So, give me a snapshot. You’re a mom, you know, going into the hospital for birth. What should happen? What would you like to see happen?
Dr. Rebeca Segraves Right. So you’re a mom going into the hospital after birth and say you experience blood loss that you weren’t expecting to experience. Like you lost considerable amount of blood that was completely beyond your control, completely beyond your health team’s control. So that may leave you feeling a little weak. Right. And so depending on whatever your situation is, you may find that you’re going home, and you’re not able to rest as long as you were when you were in the hospital setting. And so as a health care team, what I would hope is done for you is that your vital signs are assessed as soon as you’re getting in and out of bed and you’re walking around and when you’re doing one of the most demanding activities at home, which is standing in a hot shower.
So metabolically on your own body system, that is really metabolically challenging to your system to just stand in a hot shower or stand for a period of time when you’ve been resting and you’re at a lower volume of blood flow in your body. And so that’s really one of the first things that I touch on there.
And when I’m teaching therapists and providers this, I often use cases where those moms who did lose a considerable amount of blood, whose blood pressure reduced quite significantly, and experienced what we know in the medical world as orthostatic hypotension, but that just means that you’ve lost the ability of your body and your heart to pump enough blood to your brain quickly enough when you’re changing from lying down in bed to standing up, that’s the kind of thing that we would expect would be tracked automatically, shouldn’t need a doctor’s order to do that.
And so what we’re finding is that that’s often not the case. Blood pressure is checked at rest. And I worked the first hospital that I worked in with before I collaborated with other therapists who were doing this around the country. We were tracking the amount of moms who were falling. We called it the maternal fall rate and the infant drop rate. We had so many incidences where we were able to track how many times mothers were falling and infants were being dropped during the hospital stay after birth.
And so that’s the number one thing is that that’s one of the fundamental things that I teach individuals is in order to really address the issues that we’re seeing between racial disparities in maternal health, especially those that contribute to higher rates of preeclampsia in the black maternal population, higher rates of of issues of postpartum hemorrhage and issues leading later on to heart failure during the later postpartum period, up to 12 months after someone gives birth.
In order to address that, we have to kind of scale back and really start with a communication that’s not being done when someone is in the hospital giving birth. And that is a communication or a conversation around their home environment, around children that they may have to take care of at home, and around their support system.
And so if I’m a mom going into the hospital, giving birth, I would hope that a conversation about my individual perspective or characteristics or whatever I’m going to have to, that I might find as a challenge, I’m hoping that that conversation starts early enough so that interventions are tailored to me.
Dr. Ginger Garner Yeah, absolutely. And I think you mentioned one phrase that the listener may not have heard before. I mean, if you’re in health care, you should know about it. But that phrase is social determinants of health. That’s asking you if you have support, if you have transportation, if you feel safe, if you have access to the healthy and nutritious food, clean water, those things that we can often take for granted just by assuming someone’s in our presence for services, they must have access to that when oftentimes it’s not true.
So checking for those things is a basic thing that, you know, you want to have happen really for anyone. But because we’re talking about the high risk of maternal death, which has increased when many other countries in the world have seen their maternal mortality decrease, We have seen ours do nothing but steadily increase since the 1960s, which should be shocking to everyone hearing that statistic. Let’s talk a little bit about that, I think, because right now, when you go home in the US, you get one six-week follow-up visit. I know we both have feelings about that. So tell me what your thoughts are. And because I know it’s associated with a lot of things that can happen that increase those numbers and increase maternal mortality.
Dr. Rebeca Segraves Absolutely. So in terms of now one of the highest contributors to maternal mortality. As of 2022, we’re seeing that suicide has risen in the maternal population from pregnancy through the first few months after delivery. And so when I think of maternal mortality and I think of the emphasis that I’ve even had on in my own practice with cardiovascular health in this population. I often think back to what I said before, having a conversation with someone specific to their unique environment and challenges and support is probably one of the most impactful things we can do within 24 to 48 hours after delivery while they’re in a system where they’re surrounded by more resources by default.
We know that in a hospital, which is why I moved my practice more to hospital-based care was because I had a bigger team there than I did as a solo provider, right? Or even as a part of an outpatient pelvic health team where we were seeing patients who were privileged enough to be referred. I saw more women of color in the hospital after birth than I’ve ever seen in my practice of five years up until that point. And so I needed to really shift my thinking of addressing people when they’re surrounded and when they’re at least should be from a medical standpoint, being kept the most comfortable, being kept the most safe, and then really getting into the nitty gritty of what they might encounter when they’re now alone.
And I feel like that would be, to me, in my mind, one of the biggest things that we can do or interventions that we can change to address the maternal mortality rate is having that conversation, then letting our patients guide us in terms of our interventions. And so a lot of therapists, they wanna know, what do you do in the room? What are the things that you do, the skills, the techniques, the log roll, the abdominal binder, the breathing, and all of that is important.
But I have to mention that one of my colleagues, who’s the founder of Operation Mist, she is Dr. Katherine Sylvester, and she speaks a lot about the social determinants of maternal health. She says something that I’ll never forget, and it’s changed my thinking on this completely. She said, what’s the point of teaching someone a log roll who doesn’t have a mattress at home? So you have someone who just had maybe an unplanned cesarean section. She’s a single mom. And your first thought is you read in the chart, you walk into the room, and you want to teach her how to protect her incision.
But then you don’t go down the path of actually establishing what is the environment she’s going to return to that would actually put her at most risk? Is it the cesarean section that she had, her body habitus, the position she is in bed, or is it where she’s gonna spend most of her time? And if we’re not asking those questions, I don’t think we’re making a dent on the maternal health crisis in this country.
Dr. Ginger Garner Because that’s exactly what it is. I was able to speak in South Africa on that several years ago at World Congress on a Rapid Five research platform where I gathered together a group of us to look at global maternal mortality. And I was already pretty angry about the statistics that were already out there, which is what was the impetus for bringing the team together.
But we received such a warm response, like overwhelming, like flood of questions after of how can we change it? What can we do? We don’t have any care at all. And one thing that you mentioned, hit home for me, which is a thing that lots of women and people with abdominal surgeries in general aren’t getting, and that’s for someone to come in and even work with them on how to care for their incision after. We haven’t historically even seen that, right?
So there’s so much work to be done, especially within that first six-week postpartum period, where that’s where I believe most of the risk is. They’re at very high risk for hospital readmission. Talk to me about that a little bit, within that six-week time frame, and what do you see as being necessary for change so that we can truly tackle the it’s global mortality, you know, maternal mortality problem, but we seriously have a problem with it in the US due to a lack of standards of care. Talk to me about that first six weeks in the postpartum. What are moms most at risk for coming back and being readmitted for having trouble with?
(25:21) Dr. Rebeca Segraves Right. So the three main causes of death, especially in the first six weeks. So that’s 42 days, right, postpartum. And we’re looking at an increased risk of infection. Hemorrhage is one of the biggest risk factors during the delivery stay through the first week. And then it extends and it starts to kind of really start to cross over with infection, with cardiovascular complications. And then the third one is really kind of that global cardiovascular impairment, what we really term as preeclampsia, what we term as cardiac arrest, cardiac failure, that can occur during the first three weeks as well.
So infection, complications from postpartum hemorrhage, and then the big cardiovascular umbrella, right, that moms fall into. And so if we just address risk factors to that within 42 days after delivery, then there would be little sense to wait until six weeks to see someone. For the one third of the population that has a cesarean delivery that gets a two week visit. What I was seeing when I first started practicing in this field was that two week visit was done via telehealth and some practices haven’t really let go of that.
So just imagine that, cueing a mom to take her blood pressure so that you can know the reading, and then cueing a mom to position her camera so that you can observe her incision. You tell me how beneficial that would be for someone of darker skin complexion who may not show up, especially on camera, let alone in person, that she has a raging infection underneath her melanated skin.
And so when I just think about the big three, the hemorrhage that’s happening, day of delivery during the first week, because a woman can still be bleeding abnormally and losing hemoglobin, or hemoglobin can be dropping. And then there’s now signs of heart failure and cardiac issues that may show up as what we call exertional hypotension. So we know orthostatic hypotension. We know that when someone changes position from lying down, to sitting, and then to standing, those are stasis, those are stationary positions.
But we hardly talk about the mom whose blood pressure is dropping when she’s walking and being active because we’re only monitoring vital signs when she’s usually at rest. And in some cases, our OB care team wants those vital signs charted every 15 minutes. And so the sense in terms of doing an evaluation that doesn’t cross over into reality is really, I think, what I will teach individuals and physicians and therapists to address first, is to do evaluations that really cross over into the functional activity that individuals would do at home.
So for someone who’s lost a significant amount of blood, which is one of the three main contributors of maternal mortality within the first six weeks, I would say our practice needs to expand into active vital signs assessment, not just assessing vital signs at rest. And that activity needs to mirror what that mom will perform at home. So if it’s a single mom, or if it’s a mom who has several steps that she needs to negotiate in her home, then we should be doing that assessment during the hospital stay.
If it’s infection, we need to include those individuals who have melanated skin and really teach from grad school on the differences in what wounds look like between skin type to skin type. And then with cardiovascular conditions, we have to know that systemic stressors play a role. So we can’t have conversations without addressing people’s social determinants of health, their own background. you know, what they’re bringing to the hospital and what they’re taking home with them.
So I think if that changed, we wouldn’t have these conversations on whether or not physical or occupational therapy is an unnecessary intervention. We would have these individuals on the team years ago with the assistive devices that moms needed to walk with. Two-thirds of the population do not give birth by cesarean section. So those might include individuals who have had a pubic symphysis injury where it is incredibly difficult, where they can’t walk at all. And so having a walker to go home with is crucial in their recovery.
But oftentimes, we are backloading care with this population, we’re not front loading care with this population. And for those of the listeners who don’t know what that means, in almost every area of health, whether it’s someone who suffered a stroke, whether it’s someone who suffered a knee replacement, an OT and PT are automatically on the team to front load care, front load rehabilitation. There’s no question that that person after a knee replacement will benefit sometimes same day from an OT or PT evaluation. But when it comes to maternal care, we are backloading interventions until they demonstrate a need for services. Meaning they’ve already been impaired, they’re already having difficulty walking, they may be having shortness of breath going up and down stairs, and then we determine that an OT and PT is necessary. That’s too late. Six weeks is too late.
(31:30) Dr. Ginger Garner It’s far too late. And it is unfortunately what I see every day in patient care, you know, in my practice and have for this is year 27 of this. And so I have all these stories, you know, flooding my mind of the frustration and the flat out anger that I have felt for the lack of standards of care, that if someone comes in and not to mention, we also have the whole mental health, they’re taking care of a brand new person that needs their care 24/7. And then they’re saddled with multiple injuries and things that happen just as a natural consequence of giving birth, whether no matter what mode, you know, that, that you gave birth in.
So I often will front load the conversation with moms who come in that this is not your fault. You didn’t do anything wrong. It is the system’s fault that has let you down, that didn’t provide the care that you need from day one. A six-week visit is ridiculous. One six-week visit is frankly insane when if you were getting an ACL reconstruction done, you know, if you’re getting a surgery on your knee or a rotator cuff repair or you name it, back surgery. There’s a protocol for that, and you’re getting therapy.
And let’s just pick hip arthroscopy, which is a very popular surgery that’s happening right now, or hip preservation surgery as it goes. There’s a four-month protocol for that. It’s still not enough, but it’s four months. Anywhere from one to three times a week, four months for a hip surgery.
And yet you can have multiple injuries that have happened as a result of giving birth and you’re sent home with absolutely nothing other than a one six-week checkup, which Rebeca, you well know, but the listener may, this may be the first time they realize, gosh, there’s a protocol for knees and shoulders and hips and spines and hands and everything else, but there’s nothing for the marathon of giving birth, which is a total travesty.
And frankly, because I’ve been angry enough about it long enough, it is just an awful disservice. It’s nothing but lip service to valuing mothers, to valuing families, to taking care of our people, you know, here in the United States. It’s not doing anywhere near the justice of care and the health care justice, social justice of what we should be doing. So words can’t describe, I guess, the level of frustration that I feel for all moms who come in, because there’s two issues at hand. One is their emotional, their physical, their spiritual health, and what has happened inside the system.
The very system where they should be finding sanctuary is where sometimes they are being harmed, and they are being let down, and they are being left alone. And we don’t have to go very far to see the stories in the media of moms who are being sent home, particularly moms of color, that are being sent home not cared for, and they’re preventable deaths that are happening. So on the one hand, there’s that. So there’s the physical health and the mental health, and we are letting moms down on both cases.
So I think, which you know all this, but I just had to vent for a second because I want moms to come away from listening to this interview knowing that I have a right to care. I have a right to more than a flimsy six, one six week visit. I have a right to have my vital signs monitored, not just at rest, but now I’m going to get up and set up, sit on the edge of the bed. I have a right to have my vitals monitored again.
And it’s important that moms have advocates too, because you just gave birth. You can’t just cover all the bases. Like if we told you, you know, if we told you all the, the rights that you have to healthcare, you could still not remember them and rattle them off when you get to the hospital, right? So it’s important to have an advocate there. But she has, moms have, people giving birth have a right to more than they’re being given now. And frankly, we should all be angry about it until it happens.
Dr. Rebeca Segraves I agree. And I also think that what you’re doing, speaking directly to moms, is the future of healthcare. We all can see it. We all can see that with an app, I can have a car at my home, have the address inserted, and it’s just automatic. We know healthcare will be one of the last industries to kind of make that change. But we all can see this power in automation, this power in control, that I as a user now have all of these services that care more about the experience that I have. So I’m going to subscribe. And it’s not just going to be a one-off.
And so if we take that mindset into, well, how can we put you in control where things are automated? I envision a future, Ginger, and then this is kind of maybe part two, but I envision a future where moms are already informed. Individuals are already informed before they even go into the hospital to have pelvic surgery. And let’s talk about hysterectomy next time.
What individuals who know they’re going to have a particular surgery, well, they already have a checklist of things that should be given. And I’m not talking about a birth plan. I’m actually talking about something that’s queuing them with a little green check mark, to say, did this happen? Did you receive this? Can you request this? And it will be probably in our best interest to be doing that now through educational platforms like this. Your podcast is so uniquely doing that to where you take time to cover medical terminology that might just go over the listener’s head. You take time to go back and explain, this is what that means to healthcare providers, but this is what it means to you. And this is how you can control the experience that you have.
So first and foremost, thank you is not enough for inviting me on your podcast today, because I know through you, the education that is getting to the listeners is what’s going to change healthcare, not me and four other authors on a commentary, but education that they can understand and that they can control.
36:36 Dr. Ginger Garner Thank you for just like, wow, I’m just going to leave some silence there because I think it’s equally as important. I was so excited to see your commentary came out. It was like fist pump, because, and the work that you’re doing. And I saw your talk at CSM. I was sitting there with a bunch of other of us old, old PTs, old pelvic PTs on the second row. And I just wanted to clap the whole time. I was like, oh, this is it. This is it. This is it.
So I want to thank you for the work that you’re doing because this is bringing to the forefront things that should have been done decades and decades and decades ago. And it’s just now a conversation, right? But for people giving birth, you have a right to ask for PT and OT, pelvic PT, pelvic health in the hospital. You have a right to actually push back against when you ask for that, because this is a story I hear weekly. And I wish I could say that I didn’t hear it anymore.
And I would think that more than 25 years into my practice as a PT, I would not still be hearing this, but I do. And it’s this. I think I might need this pelvic therapy thing that, you know, I heard about, like my friend in Chicago, or, you know, had it. And then the OB says, you just gave birth, we don’t refer for pelvic PT, like, why would you need that? Like, full stop. Those are verbatim the words that I hear on a regular basis. And just to have everyone listening know that that is just crap. You do not have to accept that as an answer.
It is a reason that if you could, not everybody can quiet quit or just outright fire their provider, but that is grounds for firing or quiet quitting your provider because they are not providing evidence-based care. The current evidence-based care means that you need to be seen really in the hospital during your care for giving birth. That’s when you need to be seen, but at a minimum, within the first 30 days. Not within six weeks, not, and I have multiple, and I’ll probably get in trouble for saying this, but I don’t care anymore because I’ve been a PT forever and I’m just going to say it anyway.
There are still PTs, uh, not PTs, but OBGYNs and care care providers in the area and beyond that will say, no, you, you can’t go see your PT before you see me. You must see me first. And I say, no, that’s, and I might have meant, I might have, you know, danced around the topic 10 years ago and said, well, you know, but now I’m like, no, that’s not evidence-based care. I’m just going to say it. And if it pisses somebody off, I just can’t care anymore because we have wasted too much time. And if it was, if it was even one death due to neglect. One maternal death is too much, but we’ve had, we carry the record for it in the U.S. So moms out there, listen to your gut. You’re right. If you feel like something’s not right, you’re right. Listen to your body. It is smarter than the smartest healthcare provider out there. Demand that care. There are so many of us out there that will help you find the care that you need. Doesn’t matter if you can pay for it or not. We will help you make it happen. So know that you have resources for that. Don’t hesitate to reach out. That’s why we do what we do, is to fight for you. So with that.
Dr. Rebeca Segraves Amen. Amen. I just about came out of my seat, Ginger.
Dr. Ginger Garner We are going to change this thing. We are going to turn around the maternal health crisis that we have in this country. one step at a time, one paper at a time, one patient at a time, one podcast at a time, one blog at a time. So if you are listening and you are saying, well, what can I do? What can you do? Go love the moms, the mamas, as we say in the South. Go love the mamas in your life. Go advocate for them. Share this podcast with them. Say, hey, you know, the scientific guidelines are that you need pelvic PT or OT immediately, and especially within the first 30 days. Let’s help you get that.
If you are active politically, and I will say this about something being a political issue. Giving birth to the next generation is not a political topic. It is so much more important than political banter, to be lobbed back and forth in a partisan way. No way. Giving birth to the next generation is far more important than it just being petty politics. But it also takes legislation to help women get care. So if you’re active and you want to get involved, here’s something that you can do.
And I know Rebecca and I are both stoked that APTA has adopted the bill that’s currently sitting in Congress, HB 2480, as its platform legislation to try and get pushed through. What in the heck does that mean? It means that the American Physical Therapy Association cares about you too, as moms. It means that if you were a student or a clinician, you need to get on the phone and we will put this in the show notes. You can email if you’re not a phone talker. Millennials out there and beyond that you’re not phone talkers, you’re texters or emails. I know I do the same thing.
Please contact your Congress member and ask them to support this bill. It is in the House, so it would be your representative, not your senator. But just call and ask them. You would not believe how influential it is if they get a hundred calls or emails that says, we want to see moms stop dying just because they’re giving birth in the United States.
So we’ll put that in there of how you can look it up. Quick email. It is two minutes of your time. If you do it, we will get this bill passed. And here’s what the bill says, which is the coolest thing of all.
It mandates care for those who have the least resources to be able to find care. Yeah. So Medicaid, the CHIP program, it will mandate screening. It will be a coordinated effort, and the reason I’m taking a little bit of extra time on this is because I was able to sit and help write the bill as a part of the Academy of Pelvic Health Task Force two years ago, so we’ve been talking about this for a long time.
But it will mandate that providers must screen for and refer for PT and pelvic health services. We’ll just call it that, PT or OT, pelvic health services. It will mandate that the CDC and the NIH get involved for a public health education awareness campaign. Kind of like what we’re doing right now, getting out there and saying, you deserve care and we’re going to get it for you and we’re going to pay for it. The biggest thing. So if you could do that, we’re going to put it in the liner notes. Thanks for listening to that little extra bit of tossing that in there.
Rebecca, what do you have to add on that? Cause I know that we’re totally tracking on this and we could keep talking about it for hours.
Dr. Rebeca Segraves Two minutes. I just want to emphasize two minutes. It takes two minutes to add your voice to this movement, right? Two minutes. And it goes back to what we said before. This is wraparound care for the most vulnerable in our society. So think about them. Think about your hiking partner. You’re not going to forge ahead without them. You’re going to wait until they are in line with you. Two minutes.
Dr. Ginger Garner Yeah, absolutely. Thank you, Rebeca, for the work that you’re doing. Thank you for your passion. Thank you for sharing your story. Your mom’s story is, unfortunately, so many other people’s story and I can’t close the podcast without making sure that all people of color understand that you’re at a higher risk here and it’s not okay.
We can make this better. We have an obligation to make this better. Maternal mortality, your risk of death as a person of color should not be almost four times higher than everyone else. That speaks volumes to the problems we still have in this country culturally and from a health care justice perspective. So I’m just sending, you know, I’m kind of at a loss for that because the stat is just so shocking to me, but I want to see that everyone get postpartum care. Rebeca, you want to see everyone get postpartum care that they need, and we need to continue to talk about this because everyone who also has cancer care and other abdominal surgeries that require, you know, major incisions y’all should also be receiving care. And there are no standards of care for that either. So we’re going to pick on, we’re going to pick that back up on the next podcast for sure.
But from the bottom of my heart, thank you, Rebecca, for the work you’re doing. I really appreciate you.
Dr. Rebeca Segraves Thank you so much, Ginger. Thank you.
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