Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Thu, 22 May 2025
*Content warning: birth trauma, medical trauma, medical neglect, racism, death of an infant, infant loss, death, maternal loss, mature and stressful themes.*Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Center for Black Maternal Health & Reproductive Justice:https://blackmaternalhealth.tufts.edu/Center for Black Maternal Health & Reproductive Justice Instagram:https://www.instagram.com/cbmhrj_tufts/Center for Black Maternal Health & Reproductive Justice Facebook:https://www.facebook.com/CBMHRJTufts/Center for Black Maternal Health & Reproductive Justice LinkedIn:https://www.linkedin.com/company/cbmhrjtufts/Sources: Addressing Transportation Barriers to Improve Healthcare Access in Arizonahttps://repository.arizona.edu/handle/10150/674794 Advancing Health Equity and Value-Based Care: A Mobile Approachhttps://info.primarycare.hms.harvard.edu/perspectives/articles/mobile-clinics-in-the-us-health-system#:~:text=Mobileclinicsareaproven,thecriticalweeksafterbirth American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Birth Centers in Massachusettshttps://baystatebirth.org/birth-centers A Brief History of Midwifery in Americahttps://www.ohsu.edu/womens-health/brief-history-midwifery-america Clinical outcomes improve when patient’s and surgeon’s ethnicity match, study showshttps://www.uclahealth.org/news/article/clinical-outcomes-patients-surgeons-concordanceThe Controversial Birth of American Gynecologyhttps://researchblog.duke.edu/2023/10/27/the-controversial-birth-of-american-gynecology/ 'Father Of Gynecology,' Who Experimented On Slaves, No Longer On Pedestal In NYChttps://www.npr.org/sections/thetwo-way/2018/04/17/603163394/-father-of-gynecology-who-experimented-on-slaves-no-longer-on-pedestal-in-nyc Governor Healey Signs Maternal Health Bill, Expanding Access to Midwifery, Birth Centers and Doulas in Massachusettshttps://www.mass.gov/news/governor-healey-signs-maternal-health-bill-expanding-access-to-midwifery-birth-centers-and-doulas-in-massachusetts#:~:text=GovernorHealeySignsMaternalHealthBillCExpanding,ExecutiveOfficeofHealthandHumanServices Governor Murphy Signs Bill Establishing Maternal and Infant Health Innovation Centerhttps://www.nj.gov/governor/news/news/562023/approved/20230717a.shtml Helping Mothers and Children Thrive: Rethinking CMS’s Transforming Maternal Health (TMaH) Modelhttps://www.milbank.org/quarterly/opinions/helping-mothers-and-children-thrive-rethinking-cmss-transforming-maternal-health-tmah-model/#:~:text=TheTransformingMaternalHealth(TMaH)Model&text=TheTMaHModelfocuseson,midwiferyservicesanddoulacare The Historical Significance of Doulas and Midwiveshttps://nmaahc.si.edu/explore/stories/historical-significance-doulas-and-midwivesInfant Health and Mortality and Black/African Americanhttps://minorityhealth.hhs.gov/infant-health-and-mortality-and-blackafrican-americans#:~:text=In2022%2Ctheinfantmortality,Figure2 Legislature Passes Comprehensive Maternal Health Billhttps://malegislature.gov/PressRoom/Detail?pressReleaseId=136Life Story: Anarcha, Betsy, and Lucyhttps://wams.nyhistory.org/a-nation-divided/antebellum/anarcha-betsy-lucy/Management of Postpartum Hemorrhage in Low- and Middle-Income Countries: Emergency Need for Updated Approach Due to Specific Circumstances, Resources, and Availabilitieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC11643001/#:~:text=EtiologyandRiskFactorsof,insufficienttreatment%E2%80%9D%5B50%5D March of Dimeshttps://www.marchofdimes.org/peristats/about-us Maternity Care Deserthttps://www.marchofdimes.org/peristats/data?top=23 Maternal deaths and mortality rates by state, 2018-2022https://www.cdc.gov/nchs/maternal-mortality/mmr-2018-2022-state-data.pdf Maternal Mortality in the United States After Abortion Banshttps://thegepi.org/maternal-mortality-abortion-bans/#:~:text=In2023%2CTexas'smaternalmortality,suffermaternaldeathin2023 Maternal Mortality in the U.S Declined, though Disparities in the Black Population Persisthttps://policycentermmh.org/maternal-mortality-in-the-u-s-a-declining-trend-with-persistent-racial-disparities-in-the-black-population/Maternal Mortality Is on the Rise: 8 Things To Knowhttps://www.yalemedicine.org/news/maternal-mortality-on-the-rise Maternal Mortality: How the U.S. Compares to Other Rich Countrieshttps://www.usnews.com/news/best-countries/articles/2024-06-04/how-the-u-s-compares-to-other-rich-countries-in-maternal-mortalityMaternal Mortality Rates in the United States, 2021https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm#:~:text=In2021%2C1%2C205womendied,20.1in2019(Table) Medical Exploitation of Black Womenhttps://eji.org/news/history-racial-injustice-medical-exploitation-of-black-women/National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery National Counsel of State Boards of Nursinghttps://www.ncsbn.org/North American Registry of Midwives (NARM)https://narm.org/ Outcome of subsequent pregnancies in women with complete uterine rupture: A population-based case–control studyhttps://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.14338#:~:text=outcomesarerare.-,1INTRODUCTION,experienceacompleteuterinerupture.&text=Completeuterineruptureisdefined,completeruptureofthemyometrium Pregnancy-Related Deaths: Data From Maternal Mortality Review Committees in 36 U.S. States, 2017–2019https://www.cdc.gov/maternal-mortality/php/data-research/mmrc-2017-2019.html Preterm Birthhttps://www.cdc.gov/maternal-infant-health/preterm-birth/index.html#:~:text=Pretermbirthrates&text=In2022%2Cpretermbirthamong,orHispanicwomen(10.1%25) Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Themhttps://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/The Racist History of Abortion and Midwifery Banshttps://www.aclu.org/news/racial-justice/the-racist-history-of-abortion-and-midwifery-bans Reducing Disparities in Severe Maternal Morbidity and Mortalityhttps://pmc.ncbi.nlm.nih.gov/articles/PMC5915910/#:~:text=Severemorbidityposesanenormous,ofseverematernalmorbidityevents State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef The State of Telehealth Before and After the COVID-19 Pandemichttps://pmc.ncbi.nlm.nih.gov/articles/PMC9035352/ Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ U.S. maternal death rate increasing at an alarming ratehttps://news.northwestern.edu/stories/2024/03/u-s-maternal-death-rate-increasing-at-an-alarming-rate/Which states have the highest maternal mortality rates?https://usafacts.org/articles/which-states-have-the-highest-maternal-mortality-rates/ Why Equitable Access to Vaginal Birth Requires Abolition of Race-Based Medicinehttps://journalofethics.ama-assn.org/article/why-equitable-access-vaginal-birth-requires-abolition-race-based-medicine/2022-03 Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag’s original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara 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Chapter 1: What are the key issues in Black maternal health?
Wondery Plus subscribers can listen to Something Was Wrong early and ad-free right now. Join Wondery Plus in the Wondery app or on Apple Podcasts. Something Was Wrong is intended for mature audiences. This season contains discussions of medical negligence, birth trauma, and infant loss, which may be upsetting for some listeners.
For a full content warning, sources, and resources, please visit the episode notes. Opinions shared by the guests of the show are their own and do not necessarily represent the views of myself, Broken Cycle Media, and Wondery. The podcast and any linked materials should not be misconstrued as a substitution for legal or medical advice.
Origins birth and wellness owners and midwives Caitlin Wages and Gina Thompson have not responded to our requests for comment. Additionally, midwives Jennifer Crawford and Elizabeth Fuel have also not returned our request for comment. This season is dedicated with love to Malik.
Hi friends, this is Amy B. Chesler. As season 23 has progressed, and especially over the last couple weeks, many additional brave survivors have reached out to us to share their experiences. With that comes a lot of new evidence, and because we need to follow up on and fact-check every lead before airing the season finale, we need some extra time.
In the meantime, today's special episode features a conversation between the Broken Cycle Media team and Dr. Ndidiya Maka Amuta Onukaga, founder and director of the Center for Black Maternal Health and Reproductive Justice.
This season, it was extremely important to have an honest conversation about the state of maternal health in America, especially for Black birthing people and other marginalized communities. We deeply appreciate Dr. Amuta Onukaga for sharing her time and expertise with us.
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Chapter 2: What personal experiences shaped Dr. Amutah-Onukagha's work?
Please don't forget to show your support for her and her organization by visiting the episode notes and finding out more about what they're doing to improve maternal and neonatal health in America.
Good afternoon, everybody. My name is Dr. Mutana Kaga. I am the founder and director of the Center for Black Maternal Health and Reproductive Justice, as well as the founder and director of the Mother Lab, which is a large research lab dedicated to training the next generation of maternal health scholar activists. I have 35 students in that lab.
I'm also a dean here in the School of Medicine and I have a consulting company. Thanks for having me.
Thank you so much for your time and expertise today. Can you share with us what led you to this work?
A lot of my professional journey was shaped by personal tragedies. So I lost a friend of mine in childhood. She died from complications after giving birth. She had lupus and the pregnancy exacerbated her lupus. The hospital she delivered in was not equipped to handle a high-risk pregnancy.
I think experiencing that as a young person, I was 16, she was 15, and then experiencing the death of a colleague and friend in my adulthood, Dr. Shalon Irving, who was also a preventable case, had been seen eight times after delivery, should have been readmitted and prioritized, was not. and also died from complications after her delivery.
These types of events solidified my professional expertise and passion in Black maternal health. I also have training in this area. My doctorate is in maternal child health. I'm a woman with lived experience. I have children of my own, and I can firsthand see how the healthcare system does not prioritize and frankly fails to listen to Black women in the pregnancy and birthing process.
So that is both the personal and professional overview of how I came to do this work, addressing these systemic inequities and really questioning why do we see the disproportionate maternal mortality and morbidity around Black women.
I've been coupling that with the research aspect of it, so both quantitative and qualitative research, really trying to document how pervasive the impact of racism, environmental stressors, and unequal access to care is on Black women's bodies and birth outcomes. And then a lot of my work also includes authoring studies and being a principal investigator of research studies
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Chapter 3: What are the statistics on maternal mortality rates for Black women?
All of those things cumulatively are why we're seeing the higher rates that we're seeing in Texas and other parts of the country.
Also, the systems that are training and educating doctors are rooted in so many ways around the centering of white person's experiences.
You touch on something that I just want to illuminate, which is the field of obstetrics and gynecology, how clinicians are trained. I think if you ask the average first or second year medical student, do you think people of color, Black people have thicker layers of skin, have higher pain thresholds, all these types of questions, they'll tell you yes, which we know is not accurate.
But when they're being trained in racist ideologies, up until recently, the person that was considered the godfather of obstetrics and gynecology was an inhumane, racist criminal who essentially perfected his surgical techniques on the bodies of Black enslaved women without anesthesia, without consent. There were up to 12 women that he did these things to.
We only know three of their names, Lucy, Betsy, and Anarka. J. Ramsey perfected these techniques, how to repair fistula, how to perfect the C-section, how to create a speculum. All these techniques and procedures were perfected on the bodies of Black enslaved women with no pain medicine, no consent. This is the history of obstetrician gynecology in this country.
So clinicians who are trained in these racist ideologies will perpetuate them, particularly for clinicians who may not come from diverse communities, may not have a lot of overlap and interaction with people of color, may not be comfortable in those spaces, may have preconceived notions, may have racist and biased stereotypes, gender stereotypes.
These things all exacerbate the ability to deliver information. quality and timely care to birthing people of color. You know, it's very problematic that these things exist. And frankly, if you talk to most OBGYNs today, they'll tell you that's the history, but all of us are not doing it now. Up until pretty recently, people thought J. Ram Sims was a There's an algorithm called the VBAC.
So it essentially calculated the likelihood of someone being able to labor vaginally after having a prior C-section. And it subtracts from your likelihood of success if the person is a person of color. So this is not something that has any medical accuracy.
It's literally putting in someone's race into an algorithm and then telling the patient, I think you're going to need another C-section, even though the person may not actually need that.
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Chapter 4: How does systemic racism affect maternal health outcomes?
make sure that we have providers that come from these communities and backgrounds as well. I think that's a very, very important part of the conversation. So if we have universal healthcare, who is providing the healthcare? What do they look like? What's their background? What's their ideology around labor and delivery and birth?
And how do they prioritize patients of color, people from underserved backgrounds, et cetera? It's both. Yes, universal healthcare is a card to play in this conversation and also diversifying the healthcare workforce is huge to me.
Absolutely. I'm curious if you could shed any light into how Medicaid and insurance policies are influencing the maternal health outcomes for Black birthing persons.
Medicaid plays a huge role. The type of insurance you have really dictates the quality of care you're going to be able to get, how long it takes to get into the care. Can you see a specialist? Do you get the bells and whistles? Do you get a nutritionist? Do you get a lactation consultant coming to your house? Do you get sent home from the hospital with a remote blood pressure monitoring kit?
If you have good private insurance, these are the things that you should have. Even if you have pretty decent public insurance, these are some of the things you should have. Medicaid has a huge role to play because they cover so many births. And there is a current model on the street. CMS just released something called TEMA, Transforming Maternal Health.
It's a 10-year project that is funding 15 states to reimagine, redevelop, revamp their maternal health, clinical care, and Medicaid policies. It's an incredible initiative and commitment. It's just starting now. So we don't have a lot of data, but I am excited to see this type of commitment. I really hope that we're able to see it through for the 10-year duration as it was slated to be.
I hope that we're able to actually launch it and get it off the ground and that it actually has the resources and personnel to be meaningful because that's how it was conceptualized.
Something that has been highlighted for me when speaking with other doctors, specifically in Texas, who are working in these maternity deserts is the reason why a lot of birth centers are being created and why they can be really positive for the community, given how many maternity deserts there are. Do you guys study that within your work?
And could you share a little bit more with us about how that impacts maternal health care?
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Chapter 5: What role does Medicaid play in maternal health?
We have epidemiologists or statisticians who can analyze disease trends and look at current data and say, OK, here are the places of intervention. And here's where we can subsequently support birthing people in the inter-pregnancy period. So if a person had a previous SMM event and we're looking at the data, we can say, OK, here's where the points of opportunity are to kind of interrupt that.
We also have a focus on policy, a focus on education and training, being very intentional about building a culturally responsive workforce. We work with students, practitioners, doulas, midwives, focusing on racial bias, cultural competency, and a very clear focus on patient-centered care. And then our community engaged research unit, which is our face of the center.
focuses on building and maintaining partnerships with our community stakeholders, OBGYNs, public health leaders, doulas, other academics, community health workers, policymakers, to really co-create solutions that are going to reduce maternal health inequities. So the center is a small but mighty think tank.
We're very intentional about our ability to hold space for communities because ultimately that's where the answers lie. And we are researchers and scholars who have a passion for this, but we would not be, frankly, able to move our mission forward if we did not co-create it with other community partners who are able to assist us in this work. This is why the center is so unique.
Half of my lab is 19 years old because that's the next generation of scholars. They're 19 today and then tomorrow they're in medical school and then after that they're in law school and they're on the floor for L&D as a training as a nurse and they're on the ground doing public health programming. If you're not investing in the next generation, then what are we doing?
Clinicians only focus on individual level treatment. Public health people, we focus on population level prevention, but we need each other. Clinicians don't have the training, a lot of them, to run large academic studies. And we as researchers don't have access to a patient population. We're not bedside. So herein lies the solution and the challenge.
It's really just about breaking down our silos, checking your ego at the door, and working collaboratively to save lives.
how and where can listeners support the center?
One of the things I want listeners to leave with is our goal here at the center is to strengthen our partnerships, deepen our commitments, work in service of maternal health with an urgency and an intention. And if listeners want to get involved in our efforts, we are a self-funded center. So we really rely on financial support to fund our research, to stipend our students, to provide trainings, to
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Chapter 6: How do maternal health care deserts impact access to services?
Another way is to sponsor a MotherLab student. MotherLab is addressing maternal health research and training the next generation of scholar activists. And these scholars are really, really ambitious. They want to go to conferences. They want to publish research. They want to do advocacy work. They want to work with community. All those things are expensive, and what keeps me up at night is
Getting that email that inevitably will say, hey, Dr. Muta, I want to go to this amazing conference. I want to get a training. I want to get a certification. They're students. They're ambitious. They're hungry.
As their mentor, I want to be able to support them because I know that these students are going to get that training through my lab and they're going to go on to do great things and save lives. We are small and scrappy, but we're committed. And I think everybody that works here has some type of personal tie to the work.
Either they're a birthing person or one of their family members had something like everybody has skin in the game, which makes us work harder. There's so much need that if you're a researcher, we need you. If you're a fundraiser, great. If you have marketing, great. You have relationships, awesome. We need everything. I really do want to just implore people to reach out.
We're very, very, very willing, open, appreciative of all the support that we get. I know that our work is so successful because we have such strong relationships and partnerships. So we could always use more. All of our information is on our website, blackmaternalhealth.toughstudy.edu. We're on Instagram, CBMHRJ underscore Tufts. We also have a LinkedIn site.
We have Facebook or email, blackmaternalhealth.tufts.edu. In this current landscape, now more than ever, we do have to be creative in our fundraising efforts and our strategies and our resources.
We will be sure to put all of the links for everything you've just listed in the episode notes. We are so grateful for all the work that you're doing and also all the time and energy that you gave us today.
Oh, you're so welcome. Thank you for this opportunity.
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Chapter 7: What are the benefits of telehealth in maternal care?
Next time on Something Was Wrong.
At some point, I'm on the floor, kneeling, and I feel this distinct, large, and painful movement in my uterus. And just excruciatingly painful. More painful than the contractions. She was like, oh, your baby's just turning around. I'm like, no, a baby can't move that way. And it was all very downhill from there. It turns out that was the pop of my previous scar starting to open.
It came to light that the hygiene practices were pretty abysmal. The fact that we used to have multiple different women's placentas drying in the same dehydrator at the same time. Sometimes you would mix up whose placenta was whose.
i do believe that part of gina's shortcut method that she presented to me on here's how you could become a midwife so quickly that just from the get-go was you can make a lot of money and their birth centers grew and their clientele grew because the seemingly perfect portrayal of births and the herbal baths and the pictures and the videos
underneath that if you looked behind the pretty was just a whole undercurrent not good for anyone we are so so excited about the bill that was introduced and for the future of mama we are hoping to host support groups events provide more resources more education more tools for moms and just provide a safe place for moms and their babies.
As legislative session is soon to come to an end, we are really hoping to focus on community because that is something that we have all felt at some point in time.
Something Was Wrong is a Broken Cycle Media production created and produced by executive producer Tiffany Reese, associate producers Amy B. Chesler and Lily Rowe, with audio editing and music design by Becca High. Thank you to our extended team, Lauren Barkman, our social media marketing manager, and Sarah Stewart, our graphic artist.
Thank you to Marissa, Travis, and our team at WME, Wondery, Jason, and Jennifer, our cybersecurity team, Darkbox Security, and my lawyer, Alan. Thank you endlessly to every survivor who has ever trusted us with their stories. And thank you, each and every listener, for making our show possible with your support and listenership.
Special shout out to Emily Wolfe for covering Gladrag's original song, You Think You, for us this season. For more music by Emily Wolfe, check out the episode notes or your favorite music streaming app. Speaking of episode notes, there every week you'll find episode-specific content, warnings, sources, and resources. Until next time, stay safe, friends.
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