Episode 6: Global Maternal Health

Cara Lunsford (00:00.583)
Okay, technology, technology is never really a close friend of mine. Always kind of a problem. And you know, okay, I'm gonna, I'm gonna admittedly be very woo woo right now. Okay, you're gonna, you're gonna get, we're gonna get close and personal Pandora. I am super woo woo. And I believe in Mercury in retrograde.

Pandora Hardtman (00:28.344)
Bring on the midwitchery, okay? I always ask, who do you want? Do you want my herbs and acupuncture or do you want my pitocin? I can drum circle you or I could put on my political outfit. I could do it.

Cara Lunsford (00:36.583)
We, we, we...

I know we'll do it all. We'll do it all. But it is Mercury in retrograde right now. And I will tell you, everything has broken over the last two weeks. Everything. Everything. It's nuts. It's nuts. I know and people don't believe it, but I'm like, that's real.

Pandora Hardtman (00:52.632)
Mm -hmm.

Pandora Hardtman (01:01.336)
They are the non -believers who actually are gonna be the problem later, but that's a whole nother conversation that we can have on the next day.

Cara Lunsford (01:06.919)
Right? Right? We have that on another day. That's when I'm going to bring you back in for the midwitchery. Today, we're talking about midwifery. We're talking about maternal health, Pandora Hartman. But, but, but you know, yes, it is all a part of it and I am here for it.

Pandora Hardtman (01:18.68)
It's all a part of -

Pandora Hardtman (01:27.64)
Yeah, there's so much to be said. Well, welcome to like, there we go. Click. I feel like I've known you forever. Like sometimes some people just get it.

Cara Lunsford (01:35.111)
Mic drop. Yes, mic drop. We were like, yep, yep. This is, I, so when Leslie referred you as a possible guest was like, okay, there's some awesome people that you should be interviewing. And you, you came up, you were like the one.

Pandora Hardtman (02:00.536)
Happy to hear. Totally different styles, totally different approaches, but again, she still understands me. It's a good thing.

Cara Lunsford (02:02.951)
I -

Cara Lunsford (02:08.231)
Yeah, yeah, I mean, Leslie's amazing. And she was, you know, so not to get totally off topic, but the reason why I even I know about Jopiago in the first place, why I can pronounce it.

which is its own thing. And there's a whole YouTube just like even on how to pronounce Jipaygo.

Pandora Hardtman (02:32.376)
I love that one. I think it's funny every time I watch it. It's great.

Cara Lunsford (02:35.943)
It's fantastic. So anyone who's listening to this right now, like just just look up like how to pronounce Jopi go on YouTube and there's a fantastic skit. Amy Schumer in that.

Pandora Hardtman (02:48.92)
Yes, yeah, it's so funny that you mentioned that because I was just talking to some colleagues about I think it's so funny and it's still the same problem at country level, right? So using that skit and using like they're in country like comedians or actors or actresses to like bring it into the forefront with their people.

Cara Lunsford (03:10.087)
It's amazing. I was like, this is magic. This is magic. This is the best thing because for a long time, I used to be the CEO and founder of Holly Blue, which was a social networking site for nurses and nursing students. And then my company got acquired by Relias, ie nurse .com. And so now I'm over here with my team over here doing this stuff, but I did, just so you know.

Leslie Mancuso's very first Instagram Live. I did it. It was me.

Pandora Hardtman (03:49.304)
Very nice.

Cara Lunsford (03:52.391)
She had never been on an Instagram live. So she had all the people like helping her and how she positioned and joined and the whole thing and she did it. And we had a great interview and this was years ago, but it was so fun. And then she offered to be my, well, I asked and then she accepted to be my CEO mentor because I just thought so highly of her and was like, you're so amazing. So I've just really enjoyed this relationship with Jopago and...

And now we have this incredible opportunity to talk about maternal health and especially like not even just like within the United States, but abroad in other countries. And I had a midwife, I had a home birth. So I, you know, I'm all down for that. I'm granola, super crunchy, granola.

Pandora Hardtman (04:47.224)
Bring it on. And it's so interesting, like the timing of it. I didn't think of it, because it was more the calendar shuffle, you know, to get everything organized. But it was amazing that this is coming on the end, you know, with the Black Maternal Health Week, you know, in the US. So it's kind of like, when you talk about things just sort of drop into place, because there's been so many different sort of activities surrounding that space.

Cara Lunsford (05:12.615)
Yes.

Pandora Hardtman (05:13.208)
It's pretty, I mean, just last evening, case in point, they had, it's going to continue tonight. I should forward it to you. There's a hearing, there's an Ibongi ancestral hearing that is taking, it's giving me chills, right? Lucy, Betty and Anarka and Sims is on trial.

Pandora Hardtman (05:37.848)
Sims is on trial for what he did with the whole obstetrics piece. It's been a dramatized reading with, I mean, they have done it so beautifully. Music, song, spoken word. It's got like the AI generation graphics in it. I will fall for it too.

Cara Lunsford (05:57.959)
Gosh. Okay. So for anyone who's okay. So for anyone who is listening, well, first of all, I'm going to back us up because we just like jump right in. We're like, let me talk about what's going on in maternal health. But we have to, I have to like intro you Pandora Hartman. Tell us who you are.

Tell us who you are.

Pandora Hardtman (06:22.04)
Who am I? Well, I think that's one of the most difficult questions sometimes. I just kind of look at myself as global citizen, nurse midwife for this time and for all times. And it's just what I am. You know, it's a part of my being. And I think this, this sort of a profession, it's either in your blood and in your soul or it's not.

Cara Lunsford (06:44.775)
Agreed, agreed. How long have you been working in the area where you're working right now? Like historically, like how long have you been a midwife? What areas have you worked in geographically?

Pandora Hardtman (06:59.544)
Well, historically as a midwife, when you realize you're rapidly approaching your third decade doing this, you're like, oh my goodness, I've still got so much to learn. And as much as it changes, it stays the same. Yeah, hard to believe. So my story is interesting because even the way now we're talking about the mass migration of nurses and midwives coming into this country. Well, yep, I was one of those pulled from that last migration to come in.

So as a result of that and other stuff, I've had the privilege of working all across this country, East Coast, West Coast, North, and the South is still in my blood, sitting here in the South, but also outside of America as well with the work in Africa, lived and worked in Southeast Asia as well, Bangladesh, getting midway free up and running as well, kind of all Caribbean.

as well all over because women are women everywhere. And it's interesting enough because as it goes, coming to America, I never intended to global health. A lot of the, I find nurses now they're asking about global health and how did you get there? Well, I still say by accident because it was really me always choosing to work in socioeconomically underserved immigrant, poor populations, we're English and.

American culture was not the same that actually got me into global health. We used to have a map and we would just put a pin on the map and we would have women from everywhere. People often find it crazy when I talk about the US as a place. Baltimore actually where I became one of the experts on female genital mutilation, female genital cutting, depending like here in the good old US of A. Because of you.

Cara Lunsford (08:52.935)
Okay, wait, hold on, tell me more about that. Tell me more about that.

Pandora Hardtman (08:55.032)
Yeah. Oh, yes. It's huge. It's as we look at America as a melting pot, right? We saw a melting pot and a microcosm. We bring culture with us. Culture is not stagnant. Culture is ever evolving people, customs, tradition. So if you think about that coming in with first generation immigrants, primary immigrants, your kids, your kids go home for the summer, don't they? You send your kids to...

the parents, the aunties. So like there was a whole nother piece to this as well that deals with even like we call it vacation cutting. You know, so literally raising the awareness among nurses, midwives, advanced practice providers here that this is still very much an issue for the United States as well. And, you know, looking at different pockets of folks and stuff. So yeah, ongoing, ongoing issue. And...

It can be even more detrimental to the women here, I think, in the US when it's not recognized or not dealt with. Because we're like, we're in America, so these things don't happen. Yes, these things, they do happen. Yes, these things, they are here. So all of these experiences led me into global health, kind of that exposure where even today, a part of my life, I still work clinically as well. And still in another hospital, in another undeserved area where,

My brain gets mixed up because it's Haitian Creole in one room and it's Spanish in the next. And then it's English and probably a dose of Hamam on the side, you know, and that being the north. Southeast Asian language as well. Yeah, so it's amazing.

Cara Lunsford (10:32.487)
What's hamang? Tell me what's hamang.

Cara Lunsford (10:41.703)
Look how cultured you are. You're amazing. You're amazing. So I always make the assumption when I'm doing these interviews that the people listening, some of them just, I try to bring it down to the lowest common denominator, to the person who's like, I don't know what female genital mutilation is. I don't know what that is. What is that, Pandora?

Pandora Hardtman (11:10.136)
Well, there's no...

I will, I will. Okay.

Cara Lunsford (11:16.871)
You don't have to be, you can be descriptive. It's okay. Most of us are nurses and if you're not, you can tune out.

Pandora Hardtman (11:23.768)
I like, hey, there we go. We have put in the rightful disclaimer, you know.

Cara Lunsford (11:28.519)
That's right. This may be a little descriptive and it might be upsetting. I think that it's perfectly responsible of us to say, if this is something that you think might be triggering for you, you might want to skip forward. But go ahead. I mean, I do think it's important for awareness to talk about what these things are.

Pandora Hardtman (11:57.304)
I definitely think it's definitely important for awareness knowing we think about not just the condition itself, but when we begin to think about things like trafficking, you know, that are still happening here lots in America. But with the FGM or FGC, female genital mutilation, female genital cutting, it's basically, if you look at your vaginal area, and there are pieces of it that are removed, that are removed with different, from glass to scalpel, and sometimes depending.

from just the partial clitoris being removed, you know, the clitoris nicked, or then we can take away pieces of clitoris and labia majora, or we can say clitoris and labia minora and labia majora, and kind of sewing it back together to varying degrees. So it depends, not all FGM looks the same, there's varying degrees of it. It's held, it's done a lot. There's millions of women who are purported to have had this done.

a lot of times sub -Saharan Africa gets the bad reputation for doing this as well, but there's also a significant population of, I think it's two to three million in India as well who are at potential risk of this. So it's a multi -layered.

Cara Lunsford (13:11.975)
Yeah. What is the cultural? So what is the cultural signal? So if you were to ask somebody who is either had this done or even if you were to interview somebody who does it, what would be, what would their justification be? What would they say is the reason why they do this?

Pandora Hardtman (13:34.616)
This is so interesting because this can be culture. Culture is usually voiced, I think, as a number one culture tradition. Some people do try and implicate religion in this, although it's not a tenet of the Islamic religion at all. But usually those are the ones who those are the people who are blamed.

How it really interesting when you ask this question, because in my pre -Japago days, I actually worked extensively with the country of Nigeria on this particular issue, where we actually had to put this into fully the curriculum for nursing and midway free students and also the examination and the structures of this. So we taught what was called de -infibulation as well, the ability to deconstruct what had been done with the women with the scar tissue and reconstruct.

Because this is what's also associated a lot with like obstructed labor, prolonged labor, very painful periods, bleeding, you know, disrupted.

Cara Lunsford (14:40.647)
Yeah.

Pandora Hardtman (14:41.624)
disrupted lives. But talking to the women, because I have done this on both sides, as a part of that Nigeria experience, you can imagine me now, we've got the content, we've got the curriculum, and then I had to sort of scale. So I was all around the different portions of the country. And there was this one day, like sitting in the room, I've got, you know, your core educators. And in the sort of debriefing roundup, there were two actually male educators, principals of the institutes, and I will never forget them.

because they both admitted that their daughters were scheduled for that procedure this, that week, that very same week that we were there. And then the nurses and midwives in the room started talking about it and fully 75 % of them themselves had had the procedure done. This was more Northern, this was Northern Nigeria. And it was a really, really telling, telling kind of experience where just having gone through that,

together and seeing stuff and practicing on the models and whatnot. One of the principals said he was changing his mind about having his daughter, his daughter, his daughter, his daughter cut. It's challenging because then you speak to women who have had it done and who are really like, this is what we're doing. And this is because, because you realize that it's a part as well of social acceptance.

You know, you don't want to be considered to be a loose or immoral woman with all your stuff hanging out. And I can remember as a young midwife, years and years and years ago, first time.

Cara Lunsford (16:21.511)
So that's the belief that if you are not cut, that can be part of it.

Pandora Hardtman (16:27.864)
That can be part of the belief. It's all part of it. Yeah, there's so many pieces of it. But, you know, if you are the only woman in that particular setting who hasn't had this done, you're the outlier. You know, so imagine what it means to be the outlier when it could be a matter of your very survival or being ostracized and things like that. So it's deep. And then on the flip side, you know, I can I can speak to friends in Europe.

friends in Europe, educated women, you know, master's degrees, whatever, who chose to have this done.

Cara Lunsford (17:04.647)
Wow, and what age is this typically done? This is done as a... Oh, they chose.

Pandora Hardtman (17:06.936)
As adult women, I'm a mother Europe. Well, it's usually done. Right, that's what I'm saying. They chose. That's what makes it different where a lot of times this is done in girlhood or just as part of sort of puberty rights. But I'm thinking of some of the Europe, those living in Europe who chose to have it done.

Cara Lunsford (17:28.039)
in a more clinical setting, not.

Pandora Hardtman (17:29.464)
in a more, you got it, in a more clinical social setting due to acceptance, belief, marriageability, all of these other things. So I say all this to say there's a full gamut and like there's, I think that's so much of what we do in midwifery and maternal health. There's no one way to look at it. And so I think as providers.

We have to do that 360 degree viewpoint of everything that we're faced with, from family planning choices to all of it. There's not just one way to look at it.

Cara Lunsford (18:05.991)
Not that this is the same thing, but I chose not to circumcise my son. I felt that it was a form of genital mutilation. He wasn't old enough to choose it for himself. It's a piece of his body, but it's my own personal, that was my own personal choice. But we did talk as a family and my son has two dads, he has two moms. So he has a kind of an interesting family dynamic already.

And I was like, Oh God, do we want him to be any more different? You know? But so we had that, we had that conversation of like, is he going to be upset that he doesn't fit in or, you know, now he has this different family and he, is he going to get made fun of by his friends who are circumcised and why do you look like that? And why, you know, and I had to think to myself like, well, what would I say to him?

when he's old enough to ask me about it, if he ever asked me about it, and he's 12 now and he's never asked me, it's never been an issue. He's never said, why don't I look like daddy or why don't I look like Paul? He's never said that. But if he did, I would say to him, it's your body. And I just didn't feel like I had the right to make that decision for you.

And yes, it might be more painful as an adult for you to do that if that's something that you feel you need to do in order to fit in in some way. But then at least I'll know that you made that decision. That was your choice. That was your body. You took something off of your body. You were a perfectly healthy baby. There was no reason for me to make any changes to you. So.

That was my thing, no judgment here against anybody who has chosen otherwise. Because I think to what you're saying, the gamut, we get a lot of societal pressure to fit in. That sense of belonging is strong. And so I think sometimes we villainize and we wanna be like, oh.

Cara Lunsford (20:22.759)
terrible people who have done these terrible things and but it's never that cut and dry is it it's never that black or white.

Pandora Hardtman (20:34.392)
it is never that black and white. And when it's the difference, you know, in some of the settings in which we operate with you eating or not eating, you know, being married and provided for or not, you know, the world looks very different from differing viewpoints. And, you know, if we just look at people in life, someone is always going to be different, right? Someone is always going to be different because the world is just not homogenous.

So it's about like the embracing and the acceptance and the...

being okay with whatever it is, you know, whatever it looks like knowing that you sort of did your best.

Cara Lunsford (21:17.991)
Yeah, yeah. I don't know why this makes me feel so emotional. This whole topic makes me feel so emotional. And I think it's because I like to talk about things that are not, they're not black or white. They're not, they're not so, you know, clean. It's like you have to, you have to dig in and you have to be willing to be a little uncomfortable.

And you have to wrestle around with it a little bit and go, you know what, how do I feel about this? And it's these topics that I feel like this is what it's all about. These are the meaningful conversations that we have to be having so we can educate people, so we can create compassion and empathy and enlightenment and education. I mean, that's really the only way through, right? In my opinion.

Pandora Hardtman (22:14.04)
and grace.

Cara Lunsford (22:15.399)
And grace, grace, absolutely grace.

Pandora Hardtman (22:17.816)
You know, really giving each other grace for that. And for me, you know, that is actually the heart of midwifery. You know, the heart of nurse midwifery is being able to go a little deeper.

you know, the actual physiology of the mechanisms that an obstetrician might be taught and that a midwife might be taught. We're going to learn the same thing about how to resolve a shoulder dystocia, you know, when the baby kind of the baby's shoulders get stuck after the head comes out. It's the same thing, but it's kind of that approach. You know, I have a wonderful T -shirt that talks about midwifery, both modern and ancient.

you know, combining and like pulling those two together and pulling together also the philosophy, you know, the philosophical underpinnings of what it means to be in the community, in the family as being a huge part.

Cara Lunsford (23:17.415)
What do these statistics look like? Because I know, I personally chose to have a home birth. I had someone straight up say to me, home delivery is for pizza. Literally said home delivery. And I was like.

Oh, that's an opinion. Um, and, but it was, it was my choice. And I had wonderful midwives. I had a midwife who was actually rather new in training. And then I had Marina Alzagari who had delivered thousands of babies, you know, or caught, caught, not delivered, caught, you know, all these babies. And it was the most.

Pandora Hardtman (23:54.072)
Yeah, I know her.

Cara Lunsford (24:03.495)
for me, the most magical experience, but I was healthy and I had been seen by an OB for my entire pregnancy. I was checked in at a hospital, but I registered at a hospital, but that was as a backup in case I needed to go. I felt like I had checked my boxes and was like, okay, if things are not going well, I trust that the people that are here with me are going to notice those things.

and they're gonna know that I need to be, you know, I need an elevated level of care. But I didn't. I mean, I had a really wonderful birth and my son was healthy and birthed him in a tub and it was a wonderful, wonderful, wonderful experience. But I...

I came to that conclusion for myself because I had watched the business of being born.

while I was pregnant. And it opened my eyes to birth, A, in the United States, how things are done differently in different parts of the world, how the outcomes are different in different parts of the world. So many people listening to this right now maybe have not ever watched this documentary, but maybe you can speak a little bit to...

Pandora Hardtman (25:07.21)
Mmm.

Cara Lunsford (25:35.559)
the differences between different countries and these outcomes, these maternal mortality rates.

Pandora Hardtman (25:43.928)
It's such a complex addressing of the question in itself. You started asking about sort of numbers statesides. Well, it's interesting because there are far fewer women choosing to have birth. So that's why pizza's are for delivery. Because not even delivery, birth, right? So just the very words I think that we use shift the entire onus of what's happening with that woman within the context of that family.

So most midwives within America deliver in a hospital setting. And that is by choice. And you know, when I, as a midwife of color, I say, I'm going where the women who need me most are. Because the well -fed, well -educated, well, they may have more choice. So bring on my Medicare, Medicaid. Those are the women where you can make the biggest difference in the less than quote unquote.

Cara Lunsford (26:20.071)
Yes.

Pandora Hardtman (26:43.48)
Ideal circumstances and where when you look at midwifery care you will still see significant differences in terms of the preterm birth rates in terms of the intervention well birth trauma even in terms of birth trauma There is less of that so that's one piece because a lot of people still think of midwifery as just the home stuff And if we look at what's happening in the media, perhaps it's a home birth birth center type stories that I get a lot more the coverage and I

I'm really like on a mission to draw people's attention to the fact that, okay, let's look at Kaiser. Kaiser is like all over America. The fact that midwives are a staple of a Kaiser, which ultimately is a health management organization that's there for funding. And it's decades, decades and decades of hundreds of Kaiser midwives, right? So what does that tell you? So there's that piece.

So if we look at global maternal mortality, it's like 542 per thousand is sort of like the rough average. We're looking at trying to bring like the numbers down to 70. There was a steep decline in overall maternal mortality, but now it's getting to that last mile as they're calling it and a lot of countries are still struggling. So America is interesting. So if we do like the comparison contrast,

people are probably hearing a lot of stories of the media, because it's caught attention, about how the maternal mortality is one of the worst in the developed world. What's interesting, and this is where I'll put on my nerd midwife hat, her, and say, we also got to look at the statistics. Because while the statistics quote, like, two to three times the rate of maternal mortality and subsequent long -term morbidity in women of color.

If we go to the UK, right, UK, a lot of there's an idealism of UK midwifery. And I could say this because I got both passports. So I've delved into both. So caveat on that. Were they one of the lowest in the world with like a 6 .5 case? But however, when you dig deeply into their data, you can look just in March last year, there was another parliamentary report. You can look at the 2019 Embrace report. Don't believe me, y 'all. Look it up then for yourself.

Cara Lunsford (28:46.567)
I love it.

Pandora Hardtman (29:03.384)
But when you dig into that, even though they look like a 6 .5, the maternal mortality and morbidity for women of color is that still same two to three times higher. So in some ways actually on par what is happening in, with what is happening in America. So it's real, so you really have to play and really dig deeper into the data. You know, it's funny, my daughter and I were talking and she was like, I called it the oppression Olympic.

Because now that this has gotten traction, every state is like, I'm the worst. No, I'm the worst. No, I'm the worst. And I can say this, having been in three states, and they really made me go back to the data this weekend to say, OK, what is USA Facts and CDC saying? Mississippi is the worst, then Alabama, then Georgia. So the southern states not doing so hot. But really, so that as we're looking into these issues,

nationally and globally, not just co -opting the narrative of horror, because I think what happens is people become so overwhelmed that they're not able to deal with the issues. And acknowledging too that a lot of the morbidity and mortality occurs after the woman has actually given birth in that first year. So for all our activists out there, get politically involved. The expansion of postpartum Medicaid.

in America to cover that full year, that spectrum to cover sort of our blood pressure, cardiac issues. These are what come up all the time when we look at more tunnel mortality reviews. Interesting comparing that to global. It's kind of the same issues when we look at issues with high blood pressure, issues with hemorrhage, bleeding. The issues, the whys behind are the same. You know, issues with rural access to care. I'm sitting here doing...

Cara Lunsford (30:52.615)
So in some situations, would you say, so, I mean, I still think access to care is like even in the United States, like access to care and then systemic racism also.

Pandora Hardtman (31:01.208)
Yes.

Pandora Hardtman (31:09.976)
The isms are definitely a huge part of it here. Definitely. Isms, and I think isms are everywhere that impact this. You know, and looking at the healthcare deserts, even sitting here in the outskirts of Atlanta, a major metropolitan city, we still have these same sort of issues. So when we look globally, some of the issues access to care are fundamental doing with ratio of health workers.

it's looking at access to the actual facilities, how far are you traveling? So same, same, but it might be the different with having to take a boat and get in the river versus, you know, it's a two hour drive, but that access to care and then the same quality healthcare once you actually arrive. Getting through the ERs, getting through triage. If I switch into America, what's happening with your insurance and your co -pays and all that before you get seen or.

Cara Lunsford (31:59.495)
So.

Pandora Hardtman (32:09.624)
you know, entered into continued care. So there's a lot of parallel, I think, when you look at nationally and some of the international parallels, which are also compounded by poverty. You know, if we look at poverty and the overarching social determinants of health as truly being problematic to everything that's happening in maternal health, there's, you know, including the full spectrum of reproductive health services, not just...

in the delivery suite.

Cara Lunsford (32:40.519)
Yeah. I know that some people have said to me when I've talked about home births and even natural, I don't even know if that's even the correct term, but like, birthing but without a lot of intervention, like a lot of like medications or epidurals or things like that. And I know that some people have said,

Pandora Hardtman (33:00.28)
Mm -hmm.

Cara Lunsford (33:09.895)
Well, you know, you just don't, you don't know how many people used to die in childbirth before there were a lot of interventions. And I'll be honest, I don't know the answer to that question. So people will say that back to me. They're like, well, you just, you don't know how many people used to die in just natural childbirth. Like, you know, if some woman was squatting next to a tree birthing a baby, how many of those women didn't have successful births or died in childbirth? And...

Maybe you can answer a little bit of that because I'm sure that there's like indigenous tribal, I don't even know if I'm using the correct terms. So please correct me if I'm not using the right terms. But of a more indigenous culture where they are still having just home births and they're not going to local clinics or hospitals to have their babies. What do those statistics look like?

Pandora Hardtman (34:07.736)
So this is an interesting comment that you make because there's something that's also called the wheel of intervention. So once you get on the wheel of intervention, it's harder to get off and you increase your risk for other kinds of complications. So if we rewind the historical, yes, they may have died, but related to what? Nutrition, what was going on with their pelvises and their overall bleeding.

If this is baby number 10, even if it's not baby number 10, if it's like pregnancy number seven, you still may have a few more issues than your average woman. So there was that. And then we just look at like what we call wash, water, sanitation and hygiene. The ability to actually have cleanliness. Notice I didn't say sterility. Cleanliness as a part. And we know that that was implicated. There was actually a portion through history.

where midwives a lot of times were being blamed for a lot of those early deaths. But when they actually did some deeper dives and looked at it, it was the new physicians, new I say new because midwives always were obstetrics was a new profession who would like go from the cadaver to the birthing suite. So they like they documented like the increased rates of sepsis in some of the lying in hospitals, particularly, yeah, I see your eyes because of that. So yes, Moore died.

but there was a whole lot more going on. Also, if you look historically at what's happening with women actually lying on their backs, it's more physiologically, it don't make no sense. Come on, gravity is your friend, squat the baby up, pelvis, you know, open.

Cara Lunsford (35:48.711)
That was my worst contraction, by the way. I laid on my back one time, one time during my labor, and I was like, no more of that.

Pandora Hardtman (35:53.464)
Uh...

Pandora Hardtman (35:57.816)
You see, you found it. And you see if women left to their own devices, even when women do what's physiologically feels more normal, but when women were prevented from it, there's a lot of sociological ties that look at maternal health and midwifery also with gender and economics. And we could have a whole nother conversation about that too, like how the two and the history of women went parallel to what was going on.

And with the rise of hospital -based birth, you know, when we look at things like the great migration of the South, in the South it happened as the post -Reconstruction people coming into the cities to do that, the ability to pay for stuff, also being equated with...

Cara Lunsford (36:24.743)
Yes.

Cara Lunsford (36:42.951)
a different stature. It's a different stature. Like having, I'm sure, like having a home birth was like, oh, you're poor. You can't afford to come to a hospital and have a proper, a proper birth, a civilized birth, a, you know, you're, you know, you're gonna, you can't afford those things. And so, of course,

Pandora Hardtman (36:44.376)
You got it. So all of these things.

Pandora Hardtman (37:07.288)
you were seeing how it all relates. So some of these same things, and while there's traditional indigenous village -based birth that still goes on, the overall push globally, because maternal mortality was so staggeringly high, was to bring all births into facilities, you know, under licensed providers. That has not taken hold 100%, but there was definitely that.

push, but and so it's not all dealing with those sequelae facilities that may be overburdened, you know, by numbers and things of that sort. So we're doing a lot looking at quality of care issues and not just being in the facility, but then is the facility resource? Do we have sufficient drugs for hemorrhage or like even IV fluids or if needed? Because again, you don't have to have IV fluids, but if you are in a let's just say a super, super

Cara Lunsford (37:44.519)
Mm -hmm.

Pandora Hardtman (38:06.392)
hot place in sub -Saharan Africa, kind of in that existing pre -existing state of almost dehydration, your birth isn't gonna go as smoothly. You know, if you've been eat glassed at the table, so you're not nor... So again, there's a lot of graze and factor. So it's not cut and dry to say, oh, you was just crazy, because we can do more now. I could actually also talk about the psychology behind this. The psychology of models that accept that this is,

childbirth. Again, this is just something I got to do. I got to get through.

And the quintessential American picture where, whoa, ah, ah, she's screaming and having a hullabaloo of a time. Well, culturally, I've seen it where you must be serious and correct and stoic. And so that crying out and acting out is actually shameful. And that if this is something that women do. So if I flip the script and say, well, you may have less pain.

with the epidurals, things like that, that are more and more increasingly coming. Well, you're gonna work hard during labor, because labor is work. Labor, let's look up the word, or you're gonna work hard to keep the baby out. Now, interestingly enough, there's other stuff that we look at the connection. The connection to the wee ones when we have interfered medically back on that wheel of intervention with the cascade of natural hormones and bonding. Hello.

and breastfeeding and all of that stuff. So we can't look at every time you do something, you lose something. And so I think as we look at this whole maternal health stuff, we have to keep remembering it's a doing and it's a losing of something. And as a nurse midwife, I have to admit I'm becoming increasingly concerned with a generation of labor and delivering nurses who have no idea how to support a woman who is choosing.

Pandora Hardtman (40:06.2)
and unmedicated birth.

Cara Lunsford (40:09.415)
Yeah. Well, and I think there's fear, right? Yeah.

Pandora Hardtman (40:10.104)
because everyone's had the stuff in their computers, you know, with the computerized charting systems and the ability to just sit and be and bear with someone. I'm fearing it's becoming an illusion art. Oh my goodness, hearing those words, I feel like I'm sounding like an old timer. But like, this is real. It's real in what I'm seeing and like really the, and then the discomfort, because as a society, we numb our pain.

Cara Lunsford (40:20.743)
Hold space.

Pandora Hardtman (40:38.52)
But pain is also there to show us something, whether you stub your toe.

So it's all like maternal health again, not multi. So are women numbing it away? Are there issues that we are not dealing with in the whole reproductive realm of care? You know, when we look at things like gender -based violence and sexual assault and all, you know, the numbing that we could talk all day. There's so many nuances to this maternal.

Cara Lunsford (41:07.751)
Oh my gosh. I was like, oh my gosh, this is my person. I've met my person. Yeah, because if I had not gone into nursing, I swear I would have gone into sociology or something. The study of people, why they do what they do, the decisions that they make, cultures and how we evolve and all of that is...

absolutely fascinating to me. And I just think that what I'm just taking from you, and I hope all the listeners who are listening to this are taking from this, is that it's like, you know, get curious about things, ask questions, be open, you know, learn people's stories and...

You know, also be, be okay being uncomfortable. That's a trend that I feel like comes up a lot in my podcast episodes where I'm like, it's okay to be a little uncomfortable. Like just sit with it, roll with it. And.

Pandora Hardtman (42:22.808)
Pain with a purpose, right? Pain with a purpose.

Cara Lunsford (42:26.055)
Yeah, because whether you're transitioning because you're helping someone to bring a baby into the world, bring a life into the world, or you're helping someone to transition out, because there's a lot of overlap there.

Pandora Hardtman (42:46.52)
Yes, ma 'am, you'd be surprised at how many midwives retire out of maternal health care and go into palliative care. It's a thing. It's a thing. It's the same sort of skill set. And, you know, that art of being present, which was so much a part of nursing orientation, of midwifery orientation, the art of being present to just sit at a bedside, whether it's maternal health or med surge. And with the increasing amounts of tasks,

Cara Lunsford (42:52.967)
Yeah, I could see it for sure.

Cara Lunsford (43:03.175)
Yes.

Pandora Hardtman (43:16.568)
and computerization and like have we gotten somehow away from just that? When I trained in Massachusetts, they called it presencing. Exactly.

Cara Lunsford (43:24.135)
Your intuition, your intuition. Yeah, your gut, your intuition. Like that is like one of your greatest, I think as a nurse and maybe a woman or just, you know, people in general, like being able to tap in to your own intuition. And you can only do that when you're willing to get quiet and present.

Pandora Hardtman (43:46.488)
Quite and uncomfortable. And it's interesting because I'll have these conversations sometimes and then people will talk about the increasing liability. And that's a global phenomenon. There's more and more instances of nurses, midwives being taken to court, even on the continent of Africa as much as here. And then I keep saying, well, let's dig a little deeper because we know that when emergencies things happen, it's that.

It's the relationship with the client and family and your communication that are gonna save you, not what's clicked in X charting system or written in charting systems. Like when they know you, you're able to pick up on those subtle nuances and changes of care. So it's usually a conversation stopper at that point, like back to Bay. And that is actually for me sometimes the beauty of working in lower resource settings.

Because although you may look around you and you may not have all the trappings, right? The ability to be.

Cara Lunsford (44:44.391)
Mm -hmm, true.

Cara Lunsford (44:53.479)
Yeah, yeah, 100%. And so this is just such a beautiful interview, Pandora. I'm so incredibly grateful to you. I feel like I can't wait to share this interview with also my colleagues who are working in maternal health. Relias has a whole suite of options around maternal mortality.

and awareness around maternal mortality. And that's why it's such a big, it's a real interest for Relias. And so I'm just really excited to take this and then do more, do more with you, do more with any of your colleagues. I just so grateful that you spent this hour with me.

Pandora Hardtman (45:49.272)
Well, thank you. I mean, the time is flying by, so it doesn't even feel like an interview. It just feels like we're having a thoughtful conversation about stuff. You know, just kind of thinking it through and talking it, you know, and seeing actually, it's funny you mentioned the Relias, because as, you know, being PRN, you get to see a lot of different things and seeing the Relias name pop up on a lot of the OB facing sort of modules that are mandatory to keep you on your knowledgeable toes.

Cara Lunsford (45:56.711)
That's what it's supposed to feel like.

Pandora Hardtman (46:18.52)
Because the field of knowledge, as much as it's changing, it's staying the same, and we've got to keep that open sponge approach.

Cara Lunsford (46:19.367)
Yeah.

Cara Lunsford (46:29.351)
Yes. And I think that bringing you in, I have no doubt that they would love to have you maybe do a little subject matter expertise to bring in the depth and breadth of knowledge that you have and all your historical knowledge to even help the products that we do have to be even better. So.

Pandora Hardtman (46:52.344)
Yeah, maternal health, reproductive women's health, we are amazing. You know, I think women, we are the products of literally the survival of the fittest, right? You know, in terms of just moving through and just continuing to look at this, no matter whether it's in America or in Africa or in Southeast Asia as a part of that continuum. You know, that continuum of life, that continuum of women, of knowledge.

being that was passed on to one another in many ways before we had books.

Cara Lunsford (47:22.279)
Yep.

Cara Lunsford (47:27.111)
Oh, beautiful, beautiful. Pandora, this will not be the last time I speak to you. I know it for sure.

Pandora Hardtman (47:36.568)
Well, hey, you know how to find me. And I think that's that is the beauty of our global world, right? The global connections, I think, for our community as nurses and midwives, we can find each other all of the time, everywhere. And we really have to like be thoughtful about building those connections and learning, you know, from each other.

Cara Lunsford (47:57.351)
Absolutely. Absolutely. I am sending all my love to you and thank you for all that you do. Thank you for all that you're doing for women everywhere you go. And just a huge shout out to JopiGo and all the work that they do.

Pandora Hardtman (48:03.256)
Right back action.

Pandora Hardtman (48:16.056)
Yeah, well thank you for this and we keep on keeping on.

Cara Lunsford (48:21.799)
Keep on cupin' on. Have a great rest of your day, my friend.

Pandora Hardtman (48:25.56)
You as well and it's never goodbye I always just say to be continued because it's a never -ending circle.

Cara Lunsford (48:34.215)
be continued. Bye sweetheart!

Pandora Hardtman (48:36.664)
Take good care, bye for now.

Cara Lunsford (48:39.175)
Bye for now.