Jennie Joseph - a midwife with vision and plan to make it real
Jennie Joseph, CPM is a midwife who’s re-envisioning a model of care for American mothers that’s practical, compassionate and proving successful regardless of whether women are insured or not, can pay or can’t or are socially high risk. To Jennie, those things don’t matter. What matters are the mothers and the babies. That’s why Jennie is one of our dear friends and why we featured her in our film, "No Woman No Cry". Jennie is the midwife (and director of The Birth Place, a community based maternity center located in Florida), who appears as the voice of American reason in our film and the whistle blower who let viewers in on America’s dirty little secret. It’s also why, in honor of National Midwifery week, we wanted to ask Jennie a few questions and shine a spotlight on her vision.
What is your vision for improving maternity care here in the US?
I have a very specific focus and that is access to care for American women who don’t have the usual support. Most of the women who come to me aren’t able to find anyone who will provide prenatal care in a timely fashion, if at all. That sounds weird coming from the American perspective because most Americans think you just choose a healthcare provider or a clinic and off you go. But for many people, finding prenatal care is nothing like that at all.
So what is America’s dirty little secret?
It’s that maternity care isn’t accessible at all for a wide margin of people. We say, well there’s public insurance and public support, but in reality, there’s not. The women that suffer the most are low income, uninsured or underinsured. They may have Medicare or Medicaid, but for some little quirk, they don’t have a policy that covers pregnancy or they need a different type of Medicaid or they have an HMO. Most physicians won’t take straight Medicaid, let alone HMOs.
There are many horrible bureaucratic hoops for people to jump through and most people don’t know how to do the jumping. They’re told, “Call this 800 number,” but no one ever answers. Or they’re told to wait for a phone call, but if they miss it, they have to start from scratch. They’re told to fax something, but never told if it was received. They’re told to go to the health department, but they just hand them paperwork and put them right back at the beginning of the bureaucratic line. It’s endless. These women are pregnant, but no one will care for them unless they’re insured.
What happens when they come to you?
I have patients come to me at all stages of pregnancy, but many present in their third trimester. Not because they don’t care about their baby, though that’s usually the charge leveled against them. It’s that they couldn’t get into the system that’s found them guilty. It’s too difficult. Some patients just need the prenatal or post partum care piece because they know the hospital has to deliver them. We’ll give them whatever care they need. We start their care immediately and help them with the paperwork later.
I bet that approach catches them by surprise.
You won’t believe the impact. These women feel a huge peace coming over them. They cry with relief that they’re being seen and taken care of. They get to hear their baby’s heart beat for the first time and they’re overwhelmed that somebody cares about them. We match them up with peer doulas and educators and we spend a lot of time providing one-on-one, patient centered, culturally competent care and our staff knows them and greets them by name every time they came in.
And what’s the outcome for their births and babies?
We started noticing the most amazing things so we started a study in 2007 to track the outcomes of 100 women. We discovered that the socially or obstetrically high-risk patients you’d expect to have preterm labor and babies with poor outcomes actually responded to our model of care with amazing outcomes. The women in our study all went to full term. The average birth weight was 7.5 pounds. Not one African American or Hispanic baby had a low birth weight. We had amazing results with breastfeeding. That’s when we realized we were on to something. We were moving the dial. And the thing that was different was, we allowed women to start prenatal care immediately without jumping through hoops. We focused on relationships and a patient centered, humanistic care model, not a more advanced obstetrical model, and they responded beautifully.
How do we recreate this model in other parts of the country?
It’s easy and you don’t need any more facilities, money or staff to create it. You work with existing agencies, clinics and healthcare settings. You train their existing staff to be more effective and to connect the patient directly with the service she needs. You don’t expect her to do it herself. Instead of saying, “Call WIC to get food,” we make the call for her or tell her to go see Miss Suzie at WIC in this office. We make sure Miss Suzie knows who she is, is expecting her and takes care of her when she gets there. Then we follow up to make sure it happened. It’s about collaborating, reaching out to existing relationships and taking care of everything for the patient. We forge the relationships in the communities and agencies and make them work. And then, of course, we get that prenatal care started right away whether that’s at the health department or a private physician’s office. Mother and prenatal care first, paperwork and insurance later.
How do interested physicians and clinics receive this training?
We have the curriculum and model all ready to go. They can contact us and we’ll provide the training. We’ve created a way for any healthcare setting to be a one-stop-shop where all the maternity care and relationships are available in one location. All the mother has to do is show up and she’ll be taken care of. This isn’t really recreating the wheel here. It’s about providing compassionate, practical, human care. That’s how you get great outcomes.
What can you do?
- To learn more about Jennie Joseph’s approach to patient centered care (AKA The JJ Way), contact her non-profit organization, Commonsense Childbirth
- To help support the non-profit and provide funding for all mothers and babies, make donations here.
- To learn more about Jennie’s clinic, log on to The Birth Place.
Watch Christy Turlington Burns shares the story of Jennie Joseph, a midwife whose dedication to providing quality care is changing the lives of pregnant women in her community for the Daily Beast.
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