Reimagining Birth, Restoring Trust

JOEL BERVELL: My guest on this episode of The Dose is Elaine Welteroth. The well-documented maternal health crisis is a fact in this country, but changing its course, even ending it, seems elusive. Elaine Welteroth decided to step in and make some changes. She’s the mother of two children and the founder of the birthFUND, filling a critical gap in the maternal health crisis in this country. Elaine was a judge on Project Runway, a host on The Talk, former editor-in-chief at Teen Vogue, and she’s the author of a memoir, More Than Enough: Claiming Space for Who You Are No Matter What They Say. It was her personal experience becoming a mother that prompted Elaine to create and continue to evolve the birthFUND to meet the needs of mothers. The birthFUND supports midwifery care for at-home births, at birthing centers, or hospitals where certified nurse-midwives can be integrated with the birthing team. And that’s what we’re going to talk about today.

Elaine, thank you so much for joining me for this conversation.

ELAINE WELTEROTH: Thank you for having me.

JOEL BERVELL: Let’s start with your own story of becoming a mother. Can you share a little bit about what that was like?

ELAINE WELTEROTH: Yeah, I mean it wasn’t until I became pregnant and I found how large those gaps are in our system firsthand that I realized, “Oh, there’s a lot of work to do.” Not just around solving for these massive health gaps that are underserving women and birthing people, but really the storytelling crisis around it, because A, most people don’t know that America is the deadliest country to give birth in all of the industrialized world. And rarely, if ever, are we talking about solutions.

And when I was navigating my pregnancy and having a very hard time finding proper quality care, even as someone with the privilege that I have and the access that I have and the network that I have, I realized that, “Wow, we’re really doing a disservice to women in this country.” And I think it’s by design. And I think when I put my journalist hat on to kind of make sense of what was happening to me and also happening to so many women across this country, particularly women who have a lot less privilege, women that don’t speak the language, people who don’t have access to health insurance, people who live in maternal health deserts. If I’m experiencing this much friction and this level of negligence and this level of just this lack of care and realizing how low the standards of care are, just imagine what the rest of the country is experiencing.

And as I dug in, I learned that midwifery care, which is the most ancient form of birth care, could prevent so many maternal deaths in this country and across the world.

And so as a mom, going back to your question, I was so grateful to discover midwifery care in my third trimester, after dating eight different doctors who, in different ways, just I felt underserved me and weren’t the right fit and really kind of compounded the fear that I had about birth and becoming a mom, especially as a Black mother in this broken system.

And because of my community, which I have to give a shout-out to my community online because I was very open and transparent about the challenges I was having, not finding the right kind of care, and they directed me to midwives. And I met the midwives at Kindred Space LA, which is one of the only Black-owned birth centers in all of Southern California. And the care was night and day. It was so different. It was holistic. It was patient-centered. They gave me time. It wasn’t a rushed 15-minute conversation. We talked for I think two hours the first time we were together. They came to my home. There was this personal connection that really informed their ability to care for me. And I didn’t even know that that was something in America you could aspire to have, right?

JOEL BERVELL: Yeah. Yeah.

ELAINE WELTEROTH: And it should not be a luxury. And so many women, especially women of color, are seeking out midwifery care because of their fear of the hospital systems. And it was transformative for me. I ended up having a home birth where I gave birth to a 9-pound big old baby, unmedicated, in my house. And it was hands down the most empowering of my entire life. It acquainted me with my power in a way that nothing else has in my life. And I thought if there is anything I can do to leverage my platform, my relationships, to help families have access to this kind of culturally competent, holistic form of care that can save lives, then I’ve done something with my life. This is the reason that God made me a storyteller. This is the reason that God gave me the exposure that I have so that I could leverage it for this purpose.

And really, I launched it around my birthday in December 2023 with just a IG [Instagram] fundraiser where I was like, “For my birthday, all I want is just your support in helping raise money for another family in my community to have access to this kind of lifesaving birth care.” And in 16 hours, we raised enough to cover the cost of not one, but two families. And that was kind of my impetus to start birthFUND. I knew I could scale this model of leveraging people’s care in real time and bring corporations into this work and institutions like the Gates Foundation and Pivotal, which I’ve been lucky enough to secure funding from. And so in the last year and some change, we’ve raised over $3 million to support covering the cost of midwifery care for families across the country. And we have over 138 birthFUND babies who’ve been born through our funds so far.

JOEL BERVELL: Wow. That’s incredible.

ELAINE WELTEROTH: And we’re not slowing down anytime soon.

JOEL BERVELL: That’s absolutely amazing. And thank you for being vulnerable and sharing that story. And one of the things that you said too about talking about the breakdown in the system, I was thinking a lot about that and the fact that it defies socioeconomic factors too, in the sense that . . .

ELAINE WELTEROTH: Absolutely.

JOEL BERVELL: . . . socioeconomics are not protective when it comes to birth in the United States. There’s a significant amount of data out there about what doesn’t go right for mothers who are pregnant and delivering babies. The crisis is big, it’s entrenched, it’s well-studied, and yet it still persists. I know you mentioned leveraging your platform, but even from there, how did you decide what to try and fix first?

ELAINE WELTEROTH: Well, the reason why I decided to focus on solutions and specifically midwifery care is because I think that Black women in particular, but mothers at large, are being fear-mongered. There is so much fear around childbirth and becoming a mother, and I think that is all by design. We give up our power when we are in fear. And we are more likely to hand over our agency and our authority to an institution, a system, a doctor, who may not always understand exactly how to care for us and may not be as interested in making certain decisions that are in our best interest. And that’s systemic, right? We know that systemic racism is real. We know bias is real. We know it’s well-documented. And so without knowing other options, without knowing how to advocate for yourself, a lot of us just end up in this conveyor belt where we just go straight through the system. And 50 percent of mothers, even if you come out with a baby, 50 percent of mothers describe their births as traumatic.

I found it so bewildering and so humbling and so overwhelming to try to navigate this system without any direction, without the tools and the education that I really needed. And I’ve only ever seen birth through this medicalized lens where women are rushed into the hospital, the epidural comes, they relax, and then you just see this baby come out. And yet when you talk to people about their birth experiences, you hear about C-sections at alarming rates. And not to say that some medical intervention is not lifesaving and necessary, but what we know is in this country, the national C-section rate is 32 percent. That is astronomical. And it is absolutely unnecessary for that many mothers to have C-sections. So I really wanted to focus on a singular solution that is data-backed that we know we can move the needle on.

JOEL BERVELL: I’m curious, do you see a pipeline for training more midwives who can provide culturally competent care at scale?

ELAINE WELTEROTH: Yes. And we’re actually focused on developing a midwifery scholarship program to help solve the pipeline problem because there is this rapidly increasing demand for midwives, again, especially postpandemic. And especially as more people are learning about the maternal mortality crisis and the disparities that Black women especially are experiencing, there’s a lot of fear around going into the hospital to have a baby. And so there’s a lot more demand for out-of-hospital births, birth center births, all led by midwives. But currently there are so many systemic barriers to becoming a midwife, and so one piece of that that we are tackling and developing a program for is a midwifery scholarship program to support midwives in training.

JOEL BERVELL: Absolutely. I want to jump to the history piece of it too. Midwifery has such deep, historical roots, and yet your model with the birthFUND feels both traditional and cutting edge at the same time, bringing birth back into the community while also leveraging online platforms. How does the history of midwifery inform this moment and why do you see home plus the internet as the right equation for today?

ELAINE WELTEROTH: What a great question. I love the framing of that. Thank you for that question. I think that more and more, we are realizing that the health of our communities is in our own hands. And our mantra at birthFUND is “It’s on us to save us.” And that sense of community and that sense of intimacy and customized care that really centers the individual, that takes a preventative approach, is all baked into the legacy of midwifery care. And by the way, midwifery is the most ancient form of birth care. It’s how all of our ancestors got here. It’s Black midwives have birthed this country.

JOEL BERVELL: Yeah, this is something I think about a lot. And I always approach it first from the historical perspective and then connecting it to today. And so, one of the stories I often tell on my social media platforms is about grand midwives of the South who were crucial to the legacy of specifically Black health care providers in the South. And they specifically were delivering poor and rural women’s babies in the South way before doctors or hospitals became the norm. And these women that were healers in their communities, they were connected to the legacy of slavery specifically. But in the 20th century then, grand midwives started to be squeezed out by doctors, hospitals, and federal law as well. And as you mentioned, midwifery became kind of associated with poverty, with being rural, with being uneducated, even though, as you’re mentioning, there were some benefits to it as well.

And so I think when we think about midwifery, we can see it as this gap that was being filled in the past that was then taken away, that has then increased a lot of lack of access. But I’m an internist, which means I’m mostly in the hospital. And our goal is always to get people out of the hospital because being in the hospital, you’re in an unfamiliar environment, and there’s a risk for infection as always. And so when you’re home, research shows there’s lower intervention rates, that there’s reduced infection risk because you’re not in a hospital environment, that things like oxytocin flow a little bit better because you’re in a more familiar private environment where your stress hormones like adrenaline are lower, but then the hormones that you need, like oxytocin, which helps strengthen contractions, actually helps then and helps with bonding after birth.

So there’s a lot of research that shows the benefit of both. The power in ob/gyn so is recognizing when someone has a high-risk pregnancy, what do we do in those cases. And making sure that through it all, we have the testing, that we’re getting the right supplements and vitamins, that if you have a high-risk pregnancy, you have someone that can be there for you.

ELAINE WELTEROTH: I love that. I wanted to say just for people who aren’t familiar with midwifery care, that you are only a candidate for midwifery care if you have a low-risk pregnancy. And that is something that is determined at the very first appointment. You can’t just opt into a home birth because you feel like it. Midwives are thorough and skilled and they are trained to discern who is a good candidate for midwifery care and out-of-hospital care and who isn’t. And let’s make sure that people know if they are low risk and if they are looking for a different kind of birth experience, that they have access to that kind of out-of-hospital care. So I am not anti-doctor, I am not anti-medicine. I think that we just need to know what our options are, and we need access to that information and we need access to those different pathways of care.

JOEL BERVELL: And like you said, I think our system of health care, both in medical school and way beyond, have unfortunately failed us when it comes to “reproductive health,” in terms of understanding it, even from a layman’s perspective. The things I was learning in medical school, I kept asking myself, “Why did I never learn this before?” This doesn’t need to be some high-level MD-level type of information. Everyone should have this information, both male and female.

ELAINE WELTEROTH: Yeah. I am so glad that you brought that point up because that is something that we pride ourselves on at birthFUND, is making sure that this movement that we are mainstreaming is reaching everybody where they’re at, including men. And I think it makes no sense that men are not being spoken to directly, pulled into this work, their voices aren’t being heard when it comes to maternal health care. It doesn’t make sense to me because next to the mothers who are losing their lives or directly impacted by birth trauma, fathers and partners are directly impacted because they are the ones left to raise the babies on their own without their partners, or they are the ones there to support their partner who are often dealing with debilitating trauma after birth. And so I want to lift up 4Kira4Moms.

JOEL BERVELL: Ah yes. Charles Johnson.

ELAINE WELTEROTH: Which was founded by Charles Johnson, who’s our founding advisor. And he sadly lost his wife in a avoidable, preventable medical malpractice case. And he has turned his pain into a purposeful mission to make sure that fathers know their role, that partners know their role in supporting and advocating for the birthing person in their lives.

And by the way, he says this so well, this is not a Black woman’s problem. This is an all-of-us problem. And I think it’s so important that we don’t frame this conversation as just a Black maternal mortality crisis that we’re fighting against. This is a maternal health crisis that impacts all of us.

And guess what? For anybody who says like, “This doesn’t have anything to do with me.” “Do you have a mama? Did you come through a woman? Yes, you did.” All of us should be engaged in this work. And it is also, people want to politicize everything, but birth is something . . . Listen, this issue around maternal health is bipartisan. It should appeal to both sides of the aisle. We should all be able to agree that mothers deserve to survive birth and to thrive through birth so that they can take care of the children that they’re bringing into this country. And so I am glad that you brought up the point about the role of fathers because the role of fathers, the role of allies, it needs to be magnified in this conversation. I think far too often it starts and ends in these mommy circles. And the reality is women are powerful. We can do a lot all by ourselves, but giving birth safely in this country, in this broken system, is not something we can do by ourselves.

And certainly for any allies who look at the work that I’m doing and they go, “Oh, that’s so great that you’re doing that,” and if they participate and they think that they’re doing it for my community, it’s like I always tell them, “You are not doing this as a service to my community. You are doing this as a service to yours.” This is about all of us. This is about saving all of our moms. And this is true of any system that we try to fix. When you fix a system that disproportionately impacts people of color, you are benefiting everybody, right?

JOEL BERVELL: Yes. Yep.

ELAINE WELTEROTH: So I think it does a disservice to all of us when we hyper-focus on the people of color that are disproportionately impacted because we’re disproportionately impacted by every crisis in this country, right?

JOEL BERVELL: Mm-hmm.

ELAINE WELTEROTH: But when we talk about it and frame it as Black problems, then it’s left on Black people to fix. Or when we frame it as a woman’s problem, then it’s left on women to fix, when the reality is this is an all-of-us problem that will take all of us to fix.

JOEL BERVELL: Absolutely. I’m so glad you talked about 4Kira4Moms because Charles, he’s a good friend, and the work he’s doing is incredible. So against that backdrop of everything happening, the birthFUND, started with 10 families, is now on track to support over 130 families right now next year. How are you measuring impact and outcomes on the ground?

ELAINE WELTEROTH: Yeah. So we to date have over 138 babies born through birthFUND. And we are a year in some change into this work. And when I think about impact, we go to the ground floor and we’re talking directly to these families. And we’re hearing from them that not only are they coming through midwifery care, having babies that are alive and their lives are intact, but they’ve had much higher satisfaction rates. And I will say a lot of our mothers have had former traumatic birth experiences in hospital settings, and that is why they’re seeking midwifery care for their next birth experiences. And they’re validating all of the research that we’ve seen that says midwifery care produces higher satisfaction, fewer interventions, healthier postpartum periods, lower incidences of postpartum depression. These are all things that we see in our populations.

And part of the difference I think we should highlight between what you can expect from an ob/gyn and what you can expect from a midwife has a lot to do with just the amount of touchpoints and the amount of time that you’re spending in those different touchpoints.

So postpartum, which by the way, most maternal deaths are happening in the postpartum period. And a lot of people don’t know that there’s so much that can happen after you give birth to a healthy baby where things can go tragically in the wrong direction. And midwifery care doesn’t leave you to your own devices. They see you the day after you give birth, then they see you a few days after that, then the following week.

And I can tell you from personal experience that midwifery care saved my life after I gave birth. Twelve days after, I thought I was in the clear. I had this beautiful transformative, dare I say, spiritual experience having my child at home. And I just felt so . . . I experienced that euphoria that you hear about. And 12 days later, I woke up and I felt this weird sensation in my leg. This was the first time I learned what they mean when they say mother’s intuition. It was the first time I had access to that. I immediately thought, “Do I have a blood clot?” And I Googled the sensations. And sure enough, it said it sounds like DVT, which is by the way, what Serena Williams had when she almost left her life during childbirth.

And I texted my midwife at five in the morning and I told her what I was feeling. I told her when I looked up on Google and she said, “Get out of bed right now and go to the emergency room right now.” And I was like, “No. I thought I avoided the hospital system. That’s why I got you. That’s why I got you.” She’s like, “No, baby girl. You need to go to the hospital right now. That absolutely sounds like a blood clot.” She validated me. She listened to me. She was available to me. And she gave me real-time advice that saved my life because I listened to her because we have a trusting relationship. And I went right to the ER. I found out that day that I had two blood clots.

JOEL BERVELL: Wow.

ELAINE WELTEROTH: One in my thigh, one in my calf, and they were traveling. And so I had to get medical intervention, and I’m so grateful that I had access to that medical intervention, but I know that if I did not have a midwife to text, I would never have gotten out of that bed and gone to that ER. And too many women second-guessed those instincts and are second-guessed, by the way, and not listened to. And so anyway, that’s just a personal anecdote that speaks to this much larger macro trend of, unfortunately, women losing their lives unnecessarily to preventable deaths where there could have been intervention if someone was paying attention, if someone showed up and was just there for you. So I just wanted to share that tangible example of the difference in the care models because I do think people don’t really know much about midwifery care in a practical sense.

JOEL BERVELL: Absolutely. Well, thank you for showcasing how important that is to have those individuals, especially like you said, so much can go wrong there. That midwife truly saved your life in that moment.

As the birthFUND evolves and you gain insights from the families that you’re serving, what do you anticipate as the next iteration of this project in your work?

ELAINE WELTEROTH: Well, I had hoped when I started birthFUND that we wouldn’t need birthFUND forever, right?

JOEL BERVELL: Yeah. Right. Right.

ELAINE WELTEROTH: Like in a perfect world and society, the government would be stepping in and taking this on. And unfortunately, since the inception of birthFUND, we’ve been moving in kind of the wrong direction as it relates to maternal health and the protections and safety guards that were originally put in place that were already underserving so many people. They’re disappearing. With the rollback of Medicaid, Medicare, thousands, millions of people are going to lose their health care, and we need organizations like birthFUND now more than ever.

JOEL BERVELL: Absolutely.

ELAINE WELTEROTH: The most innovative, forward-thinking measures we can take are local, grassroots, rapid response, immediate funding opportunities for families in our communities. And that is what we are set up to do. And we are here to do that in coalition with other organizations who are on the front lines fighting for legislative change. We know that that needs to happen. We also know it’s unlikely that a lot will get done in our favor around this issue in the next few years. And so in the meantime and in between time, this is why we have organizations like birthFUND.

And I just implore anyone who this resonates with, to just remember that you can be part of the change. You can save lives. You don’t have to be a bajillionaire to be a philanthropist. Part of what we’re doing is reframing philanthropy for a new generation, because by the way, I never considered myself a philanthropist before this. I’ve never run a nonprofit before. I come from the world of fashion and media. I’m a journalist, I’m an author, but I hope that I am emblematic of just somebody who gave a damn and used my anger and my frustration with what’s broken to motivate myself to be a part of the change. And that’s why for people who do care about mothers, if you care to keep a mother alive, join us.

We really say “It’s up to us to save us.” So I hope, if anything, that’s what people walk away from this episode feeling.

JOEL BERVELL: Well, I’m walking away with chills right now.

ELAINE WELTEROTH: Oh.

JOEL BERVELL: Elaine, truly, thank you for sharing not just your personal journey, but I think the vision and urgency behind the birthFUND. What hopefully listeners heard today is that while the maternal health crisis can be daunting, solutions do exist. Many of them rooted in practices, as you mentioned, that have always been a part of our history, but are now being brought forward in new ways by collaborating, working with so many different partners that seem unlikely. And thank you for just showing how solutions rooted in history and innovation can change outcomes for families today and help us move closer to equity in maternal care. I truly appreciate you being on my podcast.

ELAINE WELTEROTH: Thank you, Joel. You are an inspiration. Your voice in this space matters so much. And it’s an honor to be on your show. So thank you, thank you, thank you for shining a spotlight on the work that we do at birthFUND.

JOEL BERVELL: This episode of The Dose was produced by Jody Becker, Mickey Kapper, and Naomi Leibowitz. Special thanks to Barry Scholl for editing, Jen Wilson and Rose Wong for art and design, and Paul Frame for web support. Our theme music is “Arizona Moon” by Blue Dot Sessions. If you want to check us out online, visit thedose.show. There, you’ll be able to learn more about today’s episode and explore other resources. That’s it for The Dose. I’m Joel Bervell, and thank you for listening.