Something Was Wrong
S23 E14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
Thu, 15 May 2025
*Content warning: pregnancy and birth trauma, medical trauma and negligence. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Moms Advocating For MomsS23 survivors Markeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://www.momsadvocatingformoms.org/take-actionhttps://linktr.ee/momsadvocatingformoms Please sign the survivors petitions below to improve midwifery education and regulation in Texashttps://www.change.org/p/improve-midwifery-education-and-regulation-in-texas?recruiter=1336781649&recruited_by_id=74bf3b50-fd98-11ee-9e3f-a55a14340b5a&utm_source=share_petition&utm_campaign=share_for_starters_page&utm_medium=copylink Malik's Law https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB4553 M.A.M.A. has helped file a Texas bill called Malik's Law, which is intended to implement requirements for midwives in Texas to report birth outcomes in hopes of improving transparency and data collection in the midwifery field in partnership with Senator Claudia Ordaz. Markeda’s Instagram:https://www.instagram.com/markedasimone/Moms Advocating for Moms Alliance:https://www.instagram.com/momsadvocatingformomsalliance/Dr. Shannon Clark’s websitehttps://www.babiesafter35.com/Dr. Shannon Clark on TikTokhttps://www.tiktok.com/@babies_after_35Dr. Shannon Clark on Instagramhttps://www.instagram.com/babiesafter35/*Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ ACOG's Texas Levels of Maternal Care Verification Program: Quality Through Partnershiphttps://www.acog.org/news/news-articles/2018/09/texas-lomc-verification-program-quality-through-partnership A Comprehensive Case Report Emphasizing the Role of Caesarean Section, Antibiotic Prophylaxis, and Post-operative Care in Meconium-Stained Fetal Distress Syndromehttps://pmc.ncbi.nlm.nih.gov/articles/PMC11370710/#:~:text=Meconium%2Dstainedamnioticfluid(MSAF)oftenleadstomore,andneonatalmortality%5B3%5D The Difference Between Health Equity and Equalityhttps://www.hopkinsacg.org/health-equity-equality-and-disparities/ EMTALA – Transfer Policyhttps://hcahealthcare.com/util/forms/ethics/policies/legal/emtala-facility-sample-policies/generic-emtala-transfer-policy-a.pdf How cuts at the National Institutes of Health could impact Americans' healthhttps://www.cbsnews.com/news/nih-layoffs-budget-cuts-medical-research-60-minutes/ Individualized, supportive care key to positive childbirth experience, says WHOhttps://www.who.int/news/item/15-02-2018-individualized-supportive-care-key-to-positive-childbirth-experience-says-who Is a HIPAA Violation Grounds for Termination?https://www.hipaajournal.com/hipaa-violation-grounds-for-termination/#:~:text=AHIPAAviolationcanbe,sanctionspolicyoftheemployer March of Dimeshttps://www.marchofdimes.org/peristats/about-us Maternal Safety Series: Joint Commission Case Review Requirementshttps://www.greeley.com/insights/maternal-safety-series-joint-commission-case-review-requirements Meconiumhttps://my.clevelandclinic.org/health/body/24102-meconium Meconium Aspiration Syndromehttps://my.clevelandclinic.org/health/diseases/24620-meconium-aspiration-syndrome Meconium Aspiration Syndrome, Hypoxic-Ischemic Encephalopathy and Therapeutic Hypothermia-A Recipe for Severe Pulmonary Hypertension?https://pubmed.ncbi.nlm.nih.gov/38929252/#:~:text=Infantsbornthroughmeconium%2Dstained,ofthenewborn(PPHN) Medical Auditing Frequently Asked Questionshttps://www.aapc.com/resources/medical-auditing-frequently-asked-questions?srsltid=AfmBOooNLHrxkJi3hp2CO-3OkVj1heZAqWFVu7B-M8njnrJs8R78BBoM Midwifery continuity of care: A scoping review of where, how, by whom and for whom?https://pmc.ncbi.nlm.nih.gov/articles/PMC10021789/#:~:text=Midwife%2Dledcontinuitymodelsin,plausiblehypothesesrequirefurtherinvestigation National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery 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://pubmed.ncbi.nlm.nih.gov/35233771/ Physiology, Pregnancyhttps://www.ncbi.nlm.nih.gov/books/NBK559304/ Pregnant women are less and less able to access maternity carehttps://www.nbcnews.com/health/health-news/pregnant-women-cant-find-doctors-growing-maternity-care-deserts-rcna169609 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 Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Texas Occupations Code, Chapter 203. Midwives https://statutes.capitol.texas.gov/Docs/OC/htm/OC.203.htmTypes of Health Care Quality Measureshttps://www.ahrq.gov/talkingquality/measures/types.html#:~:text=Outcomemeasuresmayseemto,informationabouthealthcarequality The US has the highest rate of maternal deaths among high-income nations. Norway has zerohttps://amp.cnn.com/cnn/2024/06/04/health/maternal-deaths-high-income-nations U.S. maternal deaths doubled during COVID-19 pandemic, among other findings in new studyhttps://www.brown.edu/news/2025-04-28/maternal-mortality#:~:text=Maternalmortalityratesdeclinedagainin2022,dieeachyearintheUnitedStates What is ‘physiological birth’? A scoping review of the perspectives of women and care providershttps://www.sciencedirect.com/science/article/pii/S0266613824000482 World Health Organization, Maternal mortalityhttps://www.who.int/news-room/fact-sheets/detail/maternal-mortality 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 StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Chapter 1: Who are the guests and what is their background?
Hi, yeah, I am Dr. Shannon Clark. I am a double board certified OBGYN and maternal fetal medicine specialist. That means after medical school, I did four years of OBGYN residency training. Then I decided to do more training to be a maternal fetal medicine specialist. So that is also known as perinatology or a high-risk pregnancy specialist.
Chapter 2: What challenges do medical professionals face during long shifts?
All my patients are pregnant with either maternal fetal complications or both. I've been a faculty in maternal fetal medicine and OBGYN since 2007. And now I'm a professor at a large academic institution. institution. That's my day to day. And I'm actually right now, I'm post call. So I've been up since about four o'clock yesterday morning.
Oh, my goodness. Do you get used to that?
Yeah, I mean, I've been doing it forever. I'm older now and I can tell you the recovery is not as smooth as it once was. We do the 24 plus hour shifts and that's just the lifestyle at this point.
Comes with the territory, I suppose. Since we're on that topic, is 24 hours for you the longest you feel confident in working a shift? What is that cutoff point for you personally?
Honestly, I don't think I have a cutoff point because I think that as physicians, especially those of us that are in a surgical specialty like OBGYN and as a high risk pregnancy specialist, we can be on at the drop of a hat. And while we're on call, we may have a chance to rest if things are kind of quiet. I can go from sleeping 30 minutes to being in the OR with someone hemorrhaging.
I can't say that I've ever really felt that I couldn't function appropriately after being on call or being up because we just turn it on. It's the skill set we develop over years of doing this.
I asked about the hours and like the cutoff of stamina, so to speak, because in some of these interviews that I've done, especially with ex-employees at the birth centers, they mentioned that midwives would sometimes be working 48-hour shifts per
48 hours is a lot. I've done 48 hours as a resident back in the day. Not so much now, but I will say it's not only just the lack of sleep, it's being out of your home or being away from your family or being in that high intensity environment for that period of time. Even if you're able to step away and go to your office or go to the call room and take a nap.
you're in a hospital setting or a birth center setting. So I can imagine having someone cover for that period of time in a birth center or in a hospital will take a toll. The most I will do now is probably about 36 hours. And that's very, very rare. But it's not always that I'm clinically active, taking care of patients on labor delivery.
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Chapter 3: What are the risks and realities of birth center care versus hospital care?
I want to say that I am not anti-midwifery model of care, as long as it still applies to the patient. They may walk in at point A, being low risk, where the midwifery model of care completely applies. But pregnancy is a dynamic state. You have a lot of physiological changes, anatomical changes. A whole new being is being grown inside of someone's body. And we have to respect that.
And I say this all the time. A lot of things have to go absolutely perfectly for there to be no complications. And there's a lot of room for error just innately by being pregnant. We can't dismiss those, as Kristen said, red flags. And red flags develop, not in every pregnancy, but in a lot of them.
I feel like the stories that I heard on this season, they were being forced into that box where they were low risk. And even though red flags kept popping up, they weren't willing to acknowledge that they're starting to move out of that low risk box. As physicians, we get criticized all the time for dismissing patients.
It also happens in a free model of care, just as it has happened with us OBGYNs who deliver in a hospital setting. We have to understand and respect pregnancy for what it is. There is a lot of room for things to go wrong. We have to listen to red flags when they pop up.
We have to appropriately evaluate them and do what we need to do to manage them in order to ensure the best outcome for both the patient and the fetus in neonate. If we keep trying to dismiss them so that they stay in that low risk box, that's going to do a huge disservice to the patient and their care.
One topic that kept coming up this season in many of the survivors' stories was meconium. I'm curious, Dr. Clark, what your opinion on this matter is. When is meconium serious? At what point when meconium enters the situation does a person need to be transferred and is that considered high risk?
I am an OBGYN and high-risk pregnancy specialist. I do all high-risk pregnancies. So I am in a different setting dealing with a different acuity of care at baseline with my patients. But shit happens, right? There's a saying that says meconium happens. But we can't dismiss meconium and just say, oh, well, it happens because there are a lot of consequences to meconium.
It's associated with abnormal fetal heart rate tracings, meconium aspiration syndrome, increased admission to the NICU for the neonate, need for neonatal ventilation. In really bad scenarios, it can even lead to hypoxic ischemic encephalopathy of the neonate. It can cause an increased risk of cesarean delivery for the patient, infection, fever.
The consequences of meconium aspiration syndrome or having HIE are so significant and profound that we can't dismiss it When we start seeing meconium, the first thing we need to do is once a patient in labor starts showing signs of meconium passage during the course of their labor, we need to let the neonatal resuscitation team know, hey, patient in room 321 has meconium.
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Chapter 4: How does meconium impact labor and when is it considered high risk?
This has been proven. to improve patient care and outcomes. The fact that it's that standard that birth centers are required to do that is a disservice to the community because they deserve to know what these stats are. Another thing to consider is if there is a complication in the birth center and they go to the hospital, that stat falls on the hospital.
If there's a death or patient ends up in hysterectomy or X, Y, and Z, that's going to be on my stats. It's easy to not have to report it if it's not following on your stats. A lot of patients don't even realize that when they're looking at where they're going to give birth. And I'm not trying to throw birth centers under the bus.
I do think there is a role for them, but they should be required to do reporting just like we are because patients deserve to know all of those stats and they should be able to see the receipts. Changing medical records, that was another issue throughout. You can go back and change a medical record, but in our hospital system, if you change something, It's going to be known. Epic logs every edit.
If somebody's requesting medical records, they're going to see that. There's an audit trail. One of the things about some of these systems, and I don't know if it was true in this situation, but when you do certain types of record keeping, they will charge for the number of users you have.
So I don't know if it was at play in this situation that it was a way to cut costs, but depending on how many different usernames you're issuing, that is a cost. And I can tell you in a hospital setting, if you were to chart under somebody else's username or you were to go into a chart that you did not actually care for, that is grounds for dismissal, termination of your job.
I've heard of people getting fired because they went into somebody's chart or they did X, Y, and Z that was not their documentation. It happens.
And that's certainly one of the elements that drew me to work on this season. I tend to gravitate towards stories where areas of the law, there's these significant gaps because it really perplexes me how they still exist in so many situations.
And what I continually see in all settings, in all seasons that we have worked on is that when there is a lack of oversight and accountability, this is where abuse flourishes. And this is where abusers flourish. And as much as it might not be the majority, unfortunately, those, quote, bad apples are in these sorts of parameters can really thrive.
And so it's concerning because, again, these are life and death situations. When we looked at the data in certain states and areas of the U.S., it's certainly concerning. From your perspective, what are the elements causing this maternal health care crisis, if you agree that that's what's occurring?
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Chapter 5: What is Malik's Law and how does it aim to improve midwifery accountability?
And providers have to recognize both their implicit and explicit biases. And if we're not willing to do that, it's never gonna be fixed. It starts with the individual provider and then it balloons out from there. So we have to acknowledge that racism in obstetrical care has a huge impact on pregnancy outcomes and birth outcomes and neonatal outcomes. We have tons of stats to back that up.
We need to fix it. Those are probably the top three things that I think really need to be addressed first.
Thank you so much.
Markita, I remember in the early days, us sitting in coffee shops and talking about how there is a need for more awareness around what is happening in out-of-hospital settings to recognize patterns, to recognize faults and gaps in care, and also a need to bridge out-of-hospital and in-hospital care. That's how Mama was born.
Mama was born to assess some of those disparities, to protect mothers and their babies, and to help provide them with information to make informed decisions for themselves. We're really big on education beforehand. The more knowledge you have will improve. better serve you throughout your pregnancy, labor and delivery, and even beforehand in helping you determine what provider is best for you.
The nuances and types of midwives in the US is often confusing for the consumer. And so really making sure that we Give foundational education on that and what that means for you and how that could potentially affect your care. Questions you should be asking your out-of-hospital providers.
What you should be looking for when you're looking at a birth center and what you should know if you're going to be choosing a home birth. Because this affects everybody. This doesn't just affect us. We're just the survivors. You never know if that's going to be you. low risk pregnancies are known to become unpredictable and become high risk.
And so preparing mothers for that, I think is paramount. Doing what we can to make sure that out of hospital options are held to a high level of professionalism is super important. Especially if we are considering out of hospital deliveries and out of hospital care, to be a bridge to the obstetrical deserts that we face here in Texas.
There really needs to be catch up in making sure that these providers are held to very high and similar standards that we hold our doctors, our nurses, and our hospitals to. and ensuring that there is collaboration.
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Chapter 6: Why is data reporting and transparency important for maternal care outcomes?
Like Kristen said, we originally thought that this was just a origins thing and these unfortunate events happened to us. And then realizing that this was definitely happening all over and it has been for a while. Many people are unaware that you can become a midwife without being a nurse or without even having medical background or knowledge.
So we just really want to advocate for mothers, for babies. And then as far as moving forward with creating bills and the legal aspect of everything, we talked about it and it rolled into place and happened very quickly. We are so, so excited about the bill that was introduced yesterday. this past month. And for the future of Mama, we are hoping to host support groups.
We are looking to host events, provide more resources, more education, more tools for moms, and just provide a safe place for moms and their babies. Even when it comes to mental health, postpartum is a very real thing. Grief, losing your child, losing the idea of what your birth was supposed to be like. So we're hoping to also help with the mental aspect as well.
Mama's definitely growing and we are excited about providing these resources to moms.
I love that you brought that up, Markita, because that's really what we're focusing on this year 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. I know that freshly postpartum, I've never felt more isolated in my life. Unless you have adequate childcare and
and you have a good support system, and you are more than financially stable, you don't have access to important mental health resources. You don't have access to a community that can help you recover and heal through your postpartum period. And birth trauma happens everywhere. It happens in hospitals. It happens in out-of-hospital settings.
It happens even if you don't have a life-threatening issue that happens during your pregnancy, labor, and delivery. And all of those moments are important. Birth trauma, I wholeheartedly believe, affects the mother you're going to be and the person you grow into after.
So we're making a huge effort to collaborate with professionals from all different walks of this healthcare system to help us come up with some awesome solutions that would help us be able to reach people who previously did not have access to resources that could really help them recover and take the best foot forward in their postpartum and motherhood journey.
Amazing. I'm just in awe of you three and the things that you are working on. We have linked in the episode notes this season, the website and their Instagram and more information. And the same will be true for this episode. So please check out, support, contact your legislators. Also, Markita is a real estate agent in the DFW area. And I'm just going to plug that. We want to support her.
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Chapter 7: What factors contribute to the maternal healthcare crisis in the US?
I'm incredibly grateful because what has been silenced and what has been pushed behind closed doors is now open into the light and people can make their own choices and they can make their own judgments on what happened. And maybe this sparks conversation to make changes.
the wide reach of the people that you are going to help, you'll actually never know how broad that is, which is what is so beautiful and wonderful about sharing in this forum.
I just wanted to commend you all for sharing your stories because I'm in the medical complex, if you will, and I'm a highly skilled physician. I've dedicated my life to this work.
And what I found since being on social media, and I'm sure you will understand when I say this, people are very willing to share their experiences with OBGYNs, whether it be either during their pregnancy care or postpartum. labor and delivery care or postpartum care when it's not what it should be. They're generally very open about it.
But the same is not necessarily true for those who have chosen to do an out-of-hospital birth in a different setting. I do think there is a hesitation to talk about when things don't go right in those settings.
And I think for some people, there's a level of guilt about it, or they don't want the criticism saying, well, you should have given birth in a hospital, which I don't think is ever an appropriate thing to say to anybody, no matter what choices they made.
Coming forward and talking about this on such a public forum is very commendable because you guys will give other people a voice and maybe prompted them to share their stories as well. Things can happen in any setting, but it's expected at hospital birth settings that things should be right. And they fit in that perfect Instagram square and they have the beautiful pictures and all that.
And things don't always go right. We just don't see it. And you guys are bringing it to light. So I hope you know that as difficult as it may have been for you to do this, you are going to change somebody's life and you are going to change somebody's outcome by helping them better make informed choices.
Could not agree more. Thank you so much, Dr. Clark. I mean, it brings tears to my eyes just to hear you say that. This started with if we could just help one person, it would be enough. And I think we've done more than that. There seems to be this unequal scale for how we judge hospitals as opposed to how we judge out-of-hospital settings.
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Chapter 8: What solutions can address health equity and improve maternal outcomes?
We have to make sure the patient is a part of their care and the decisions being made. Just sitting someone down and explaining you had this postpartum hemorrhage because of X, Y, and Z, and this happened and not sending them home where they just don't have answers. That goes a long way. Yes, it takes time, but we have to do it.
When I hear about patients choosing an out-of-hospital birth because of things that happened to them in the hospital, to me, that's not the answer, but I understand why they do it. Knowing that some of these patients go to birth centers like the one talked about on this podcast and that they're not placed in better hands, that's even more alarming to me.
And I know it just doesn't happen in Dallas. It happens all across this country.
It seems like statistically from what we've gathered that there can also be really positive results of having midwifery care in hospitals. Do you have any insight there?
Yes. Since 2000 was when my first year of residency, I've always worked alongside midwives on a labor and delivery unit. Where I work, it's a little bit of a different model. Maternal fetal medicine specialist staff labor and delivery 24-7. But we also have midwives there to take care of patients. But they're on the floor with us. And if they need us, they let us know. If they don't, they don't.
But we're there. It's still a hospital setting. But if something goes wrong, they have what they need. I love that model. I wish we had midwifery care on all labor delivery units. I wish we had doula services available on labor delivery units. So that's another place to focus on is what can we do on labor delivery units to get the best of both worlds?
Yeah, it seems like to me, people a lot of times are trying to avoid intervention, and that's one of the motivators for out-of-hospital births. But those interventions are really essential when things go wrong. Kristen, I see you want to add.
Something I often see when people are talking about the benefits of out-of-hospital birth versus hospital birth are that physiological birth cannot be achieved in hospital settings and OBGYNs are not trained in physiological birth. I was just wondering if Dr. Shannon Clark could speak to that a little bit.
The first thing is what exactly is physiological birth? What's the definition? Because there is no one definition. It's pretty much going to be according to whoever's talking about it. If you think about it, maternal physiology is what the body does during the course of birth.
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