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0:00:08.6 Jackie Strohm: Welcome to PA Centered, a podcast designed to help listeners be a part of the solution to end sexual harassment, abuse and assault. Each episode, we will take on a topic or current event to help spark conversation and break down barriers to building communities free from sexual violence.

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0:00:32.7 JS: Hi, I'm Jackie Strohm, the prevention and resource coordinator at the Pennsylvania Coalition Against Rape. I'll be your host today as we're joined by certified nurse midwife, Sameerah Shareef, to learn more about her work supporting pregnant people, their babies and their health outcomes. Sameerah has been a women's health nurse serving mid-Michigan families since the mid-1980s. In April 2020, Sameerah became the medical director of Michigan State University Sexual Assault Healthcare Program. Welcome, Sameerah.

0:01:07.8 Sameerah Shareef: Well, thank you so much. I'm very glad to be here.

0:01:12.1 JS: We're so excited to have you. And to get us started, for those of us who don't know, including myself, could you explain what a midwife is? 

0:01:21.9 SS: Yes. Well, there are several different ways to become a midwife. There's different designations, I guess you can say. There is the... What used to be called the direct-entry midwife or the professional midwife. There's the licensed professional midwife. There's the certified nurse midwife. So essentially, a midwife in whatever capacity is a woman, generally, although there are male midwives, that attend women during their childbearing experience, meaning that they will generally see the woman when she is pregnant for prenatal visits and she's there to help the woman, assist the woman when she is giving birth.

0:02:12.8 SS: And she's the professional that is there to make sure that things are going well. And then, she also will see the woman postpartum for her postpartum care as well. So that would be what a midwife is no matter what the category. And the distinctions come with the training. With a nurse midwife, which is what I am, I have a RN degree as well as further training on a graduate level, specifically in midwifery. Direct-entry midwives, licensed midwives, licensed professional midwives, certified professional midwives have advanced training just in midwifery, meaning women's health specifically. The registered nurse, of course, has training... During her professional training, has training in all of the areas of healthcare.

0:03:07.0 JS: Awesome, okay. And so how did you come to be in this work? Was there something that inspired you to pursue nursing and midwifery as a career? 

0:03:18.4 SS: Well, yes. I was always interested in healthcare, in medicine, and just in healthcare in general. And my first degree, I was a medical technologist. So I actually worked for the local Red Cross doing blood banking and those kind of things. So I was drawn to midwifery and I feel called to midwifery after my first pregnancy and birthing experience. It was so unlike what I had prepared myself for. I had did the natural childbirth classes. I had worked with the childbirth educator and felt really prepared. But when I got to the hospital, I... It just... I wish I could find the right words to describe what happened.

0:04:10.0 SS: It just was not what I had expected. I felt disempowered. I felt like things were... I was made to feel like I had to choose what they were telling me to choose. I did not have a lot of choices. And that was almost 46 years ago because my oldest child is 46. So that was back when they were still taking women to delivery rooms, the old-fashioned traditional delivery rooms where your legs were put in stirrups and buckled in. And your arms... Your hands were strapped in wrist restrains, and it was a forcep delivery.

0:04:52.0 SS: I just felt like, this can't... Something is just not right about this. This is not the way that birth is supposed to go. And I remember being in the recovery room and saying to my son as he was laying in a little plastic bin... A bassinet... Wow. He was just so peaceful and everything. And I just remember looking at him saying, "There's gotta be a better way." So I began to really read and study everything that I could get my hands on about childbirth, particularly natural... What was called then, natural childbirth, preparation for natural childbirth, midwives, all of the things that seemed to have been missing from the experience that I had.

0:05:40.1 SS: And also learning how to be an advocate for women during their childbirth experiences. So I spent a lot of years as a childbirth educator and as a... What's called a doula. I spent a lot of years doing that and really feeling called to become a midwife in order to help women have the kind of birth experience that they wanted, where they felt empowered and they felt like they had the decision-making power.

0:06:13.3 SS: And I just... My thing is, I just really loved working with women and families. I love doing women's healthcare. I absolutely love babies. I love brand new people. That's the way I put it. And it's always... To me, it's like a promise... Spiritually, it's like God's promise that the world is gonna go on. Things, are... And the potential that lies in every human being as they come into the world. And it's a honor. I just feel... I feel honored to be in that space quite... Yeah. That's probably a good way to put it.

0:06:51.6 JS: I really love that. It's so hopeful for the future.

0:06:57.7 SS: Yeah, healing... I definitely feel called to be a healer... Definitely called to be a healer. And for me, it was a matter of figuring out how that needed to play out in my life. So yeah.

0:07:15.2 JS: Great. So at what point then did you go to nursing school and become an actual midwife? 

0:07:23.2 SS: Yes, I actually... I decided to become a midwife after meeting midwives, in particular, Kitty Ernst was someone that I met even before I became a nurse or a midwife. And again, this was part of that calling. And after being in conversation with them, knowing that this was what I wanted to do. And at the time, Kitty Ernst was talking about a program that they were gonna be starting at Frontier... It used to be called Frontier School of Midwifery and Family Nursing. It's now Frontier Nursing University.

0:08:00.5 SS: But they were gonna be starting this innovative program based on the concept of distance learning and where you wouldn't have to leave your... You wouldn't have to move from your home state or wherever you were living to come to Kentucky for class. It would be done in a distance mode. So that was really exciting. So I knew that nurse midwifery was what I wanted to do. So while I was working for the Red Cross, that was when I went back to... I decided to go back to nursing school to pursue midwifery. And I liked the idea of doing nursing as a basis for me becoming a midwife because it gave me more training and information in the other aspects of healthcare, so to speak.

0:08:46.0 SS: So I went back to nursing school. That would have been in '84... 1984, '85. I'm dating myself a little bit. And yeah, so I finished nursing school December of 1985 and took my boards and passed those the first time around in 1986... Early 1986. Then, I always say this, it seems like the big events of my life. There's big stories that go behind it. I was getting ready to do the midwifery... Not midwifery, my apologies. The nursing boards, what's called the NCLEX. Back in '86, they only gave them... You could only sit the boards twice a year, February and I wanna say August or something like that.

0:09:31.4 SS: I just remember that February of 1986, I had to travel from East Lansing where I lived to Grand Rapids 'cause there were only two places in the state where you could sit. That was Grand Rapids and Detroit at that time. So I'm driving to Grand Rapids and there was like the ice storm of the century. And I had left East Lansing at about 4:30 in the morning to meet some classmates for breakfast at 8:00 AM, gave myself plenty of time. The board started at 8:00 AM. I'm sorry. We were gonna meet for breakfast at 6:00 AM. And so I am stuck on the freeway.

0:10:08.0 JS: Oh no.

0:10:10.0 SS: Ice everywhere. And back then, literally, it was a seat and a desk, a pencil and Scantron sheet, that's how you did it. And there was no... If you were late, there was... You just had to wait till later in the year.

0:10:26.8 JS: Right.

0:10:27.6 SS: So I literally... Finally, stuff got moving. I pulled into the Amway Grand. It's a big convention kind of place where they did the boards. I pulled into a federal judge's parking space. [chuckle] I didn't know all this till after I came out of the exam. I run in and ironically or I should say, coincidentally, one of my classmates from nursing school, we looked at each other... 'Cause we're running and we're both running. We get in and they literally closed the doors, maybe, maybe five minutes after I got in there.

0:11:06.8 JS: Oh, wow.

0:11:07.8 SS: So yeah, oh yeah. So I just tell people when things are supposed to go your way, no matter what happens, they'll go your way. So I made it there and sat the board exams and stuff. But I remember just thinking to myself, "How am I gonna make this?" So for me, that just kind of reinforced, this is what you're supposed to be doing. So yeah.

0:11:32.1 JS: Very cool.

0:11:33.3 SS: Yeah.

0:11:35.7 JS: So you've been in your current role as the Director of the Michigan State University Sexual Assault Healthcare Program for a little over a year now and officially opened the center in November last year in 2020. So can you share with us more about the program and your role? 

0:11:56.4 SS: Yes, absolutely. I started April of 2020. So kinda right after the... [chuckle]

0:12:07.4 JS: The start of the pandemic. Yeah.

0:12:10.3 SS: The pandemic, yeah. But this was something that a group had been meeting together on campus, the person who's the director of the Center for Survivors, some experts in the field of sexual assault and sexual assault nurse examiners, etcetera, etcetera. That was in place before I got there. So they had been working probably close to two years by the time I came onboard. So when I came onboard in April, there was really no working on campus. The charge... What I was charged to do was to begin working on writing protocols and procedures, putting together this program. Our center is a campus-based, but it's not connected with student health services. It's free standing, meaning that it's not even in a building that is a designated healthcare facility on campus. It's probably one of the few campus... Truly campus-based programs that are not connected with university health services.

0:13:28.2 SS: Really, really focused on trauma-informed care for survivors of sexual assault. All of our nurses are trained... All of the nurses... I can say there are eight of us that work now. We've got our core group together, are committed to being the first step to survivors of sexual assault, the first steps to them moving forward in their journey towards healing. And the way that it's designed... The way that our physical space is designed, it's designed for privacy. We take care of one patient at a time. The decor, the lighting, everything is trauma-informed, the way that it's designed. We're located within the Center for Survivors. Those are the outer offices, and we're like on the inner space. Secured, only certain people have access, electronically swiped secured. We have soundproofing so that even when somebody is there, nobody can hear what you're saying. It's not like people walking down the hall can hear what you're saying. So focused on trauma-informed care, privacy, confidentiality. Patients that come to us can decide to report or not report.

0:14:56.5 SS: The way that we are designed, the way that we are set up, the nurses that are working there, we are not mandatory reporters. Whereas, other healthcare professionals on the campus, if a patient comes in and mentions anything about sexual assault, they have to identify that they're a mandatory reporter, etcetera, etcetera. So we wanted to make this the kind of program where privacy and confidentiality are of the utmost importance so that survivors can come and feel secure in knowing if they don't want anybody to know, the only person that's gonna know is the nurse and the medical advocate that you come in contact with for your care. And that you can decide what you want. Do you want a sexual assault nurse exam or do you just want maybe prophylaxis medications for sexually transmitted infections? Do you just need to talk? Do you need help to feel secure and safe? So the patient dictates what they want and how much involvement or no involvement in terms of law enforcement or university. So very, very focused on the patient, that is our primary concern that we are taking care of patients.

0:16:12.9 JS: Yeah. Providing all of those options is so important.

0:16:17.0 SS: Yes. Mm-hmm. Mm-hmm. Yeah.

0:16:20.5 JS: And what has it been like... What has it been like opening up this center, this program during COVID? 

0:16:30.8 SS: Oh, wow. Yeah. Well, one of the things that I found very interesting is that... Because we were supposed to open... Before the pandemic opened... When they hired me to start in April, we were supposed to open like May or June. So one of the things that was a lesson that I learned from all this is that you have to know... The best way I can put it is that you have to know people that know people. And I'll give you an example. Personal protection equipment that... Everything was shut down, and I was saying, "We cannot open without personal... " The nurses are not... We're not seeing patients without our ability to protect the patient and the ability to protect ourselves as healthcare professionals from potential infection from patients. So just simple things like masks, face shields, gloves and stuff, all of a sudden everything was on lockdown. And they had hired another nurse by this time and so the two of us were like placing orders and stuff like that. All it required was for us... For the director of the Center for Survivors to make a call to someone, and all of a sudden, all of the stash that they understandably were... What's the word I'm looking for? They were keeping on quarantine...

0:18:02.3 JS: Yeah.

0:18:03.1 SS: All of a sudden we had access to that. So that was one of the lessons is always know where all the players are, so to speak. Also learned how important it is to have a team of people that are working together no matter what the circumstances are. And being committed to the work that needs to be done and figuring out... Being able to work together and figure out how to do the work in the best possible way for the patients, of course, number one, and for staff and the security of both, so to speak. That was a big lesson. [chuckle]

0:18:39.0 JS: Yeah. That's awesome that you were able to overcome and still be able to open up, even if it wasn't exactly when you were... Had it planned, but opening up...

0:18:51.4 SS: Yeah, it was November.

0:18:52.0 JS: In November. Yeah.

0:18:52.6 SS: Yeah. We opened in November. So it took a while, but everything... Everything was kind of slow downed or even at a standstill.

0:19:04.0 JS: Sure.

0:19:05.4 SS: So we did not have the full contingency of students on campus, and of course, that was a blessing. We haven't had many patients because of that. But what it also allowed us to do is to have time to iron out things in the program, in the implementation of the program because they just announced that we're gonna have a full contingency of students on campus. The sports schedule is gonna go full force and they're gonna try to make up the lack of last year's sports schedule. So it allowed us to iron out some things. Yeah. Yeah.

0:19:49.9 JS: That's great though. So I know that you've worked lots of different places in your career, and I wanna... Not shift gears, but I wanna focus in on talking about health outcomes for patients.

0:20:06.0 SS: Okay. Sure, absolutely.

0:20:06.7 JS: And we know that those health outcomes are different based on race or class or other social conditions. And so could you tell us a little bit about what your experience has been working cross-culturally with patients? 

0:20:22.3 SS: Yes. One of the blessings of being able to work cross-culturally is actually learning how many things are common in terms of women's healthcare and in particular with pregnancy. Moms want the same thing across the board. They want a healthy pregnancy, they want to birth in a way that's safe and affirming for them, and they want their children or their babies to be cared for. So that's been universal. No matter where you come from, no matter what language you speak, spiritual, discipline, whatever. I really find that the way that birth works is that it changes how a woman interacts in the world. That's another thing that's cross-cultural. It changes how she sees the world and sees herself in the world, especially with the first child. If you... This is your first baby. You go from being a woman and a woman that's pregnant, and then you give birth and now you're a woman that's gone through pregnancy and birth, but now, you're a mother. So yeah. Yeah. It's... Wow... It's such a... That's why I'm stumbling for words. It's such a beautiful thing that every human being that has ever existed has come through the birth process. That's... To me, that's mind-blowing right there.

0:22:04.6 SS: The issues with the discrepancies that come when you're caring for women from different cultural backgrounds, racial and ethnic backgrounds, really has a lot to do with the systems that are in place in terms of how we give care and the way that we're taught to give care. They've done studies that have shown healthcare providers' attitudes about people of color in general and then if you're talking about birth, women of color giving birth, particularly for Black women, we tend to not be believed. "Oh, your pain can't be that bad. You're not really feeling... " It's like, for lack of a better way of saying it, the ultimate gaslighting. "Oh, you're not in labor." And I remember working as a staff nurse... 'Cause all of the nursing that I've ever done has been maternal-child. I remember having coworkers that I had to say, "What are you saying?" "Well, she can't... She can't be in that much pain." "Okay, so she's not in pain, but the other White woman that you're caring for is in pain and now you're getting the doctor's order for pain relief." So this was way back in the day when we didn't do epidurals.

0:23:17.9 SS: So just things that the way that healthcare providers treat women of color when they're getting care, whether it's women's healthcare or if it's pregnancy related, birth, the hospital experience, those kind of things, the disparities in terms of how we are viewed is consistent with a system that views us in that way even outside of the birth experience. When we talk about women from other cultures, if you're not a English-speaking person giving birth in America, how people can look at you and how you are treated, again, this is what I've observed. Okay, can you call an interpreter or can you... Just simple things like that. And speaking to people in such a way, I always say, if somebody speaks little English or what we might call broken English or something like that, that doesn't render them mentally incompetent. It means that they're learned in another language and you only know one. [chuckle]

0:24:24.9 JS: Exactly.

0:24:25.6 SS: So find a way to communicate. Even back in the day before, now we can do video interpreters and stuff like that. We had... The Red Cross had a language bank of people who did interpreting. So when I worked as a staff nurse, if we had someone come in... If the people that came in with her were limited in terms of their speaking and understanding of English, we called on the telephone. But people, healthcare providers, still have this prejudice that because this woman is non-English-speaking, somehow we can't believe what she says. First of all, you don't know what she's saying, but somehow, she doesn't deserve the level of attention and care that a White woman would if she was in the same kind of situation. I've seen in income... Areas that have been designated as low-income people, again, think because people come from areas where they are economically disadvantaged, that somehow they are not deserving of the same level of respect and care, or that they don't have the capacity to truly understand what's going on, the patronizing that goes on in terms of how you talk to people.

0:25:42.9 SS: It happened to me when my oldest... When my son was in a car in an accident. I won't go into all that. But anyway, I got to the hospital and the nurse... Now, this is before they figured out that I was a healthcare professional. The nurse comes in and she says, "You know, we're gonna wash this off of your baby's head, your son's head, 'cause there are some little-bitty germs that could be in there." And so I just let her play it out.

0:26:15.4 JS: Wow.

0:26:16.5 SS: And when she got done, I started talking to her in medical language and her eyes got like big as saucers. I don't know what she went on and did. She figured out where I worked or whatever and she came back in. The doctor came back in and all of a sudden I was Mrs. Shareef. This is what... I said, "I understand clearly what happened." Well, and the nurse is like, "I didn't mean any harm but... " "No, you meant what you said when you said it in the way that you said it." And this is stuff that continues because here we are eons later, I'm still a healthcare professional, and this is still the way that I know from personal experience as well as being in the profession, how women can be treated in the healthcare business. Well, it is a healthcare business, but in the healthcare... By healthcare professionals. Yeah.

0:27:06.5 JS: Yeah, absolutely. We know that racism and systemic discrimination and prejudice, it runs deep and really...

0:27:17.5 SS: Yes, it really does.

0:27:18.2 JS: And I think what you're saying about how it can really impact long-term health outcomes for folks.

0:27:26.3 SS: Absolutely. And the whole concept that's been studied now and the information that's coming out about adverse childhood events or just adverse events that happen in a person's life and how that impacts their health. There are some healthcare providers that, again, if you've had... If one of your adverse childhood events was being brought up in a area economically disadvantaged, etcetera, etcetera, that does not mean that that person deserves less in terms of what they receive from healthcare providers and from the healthcare system.

0:28:03.4 SS: It should not... Being poor should not be, for lack of a better way of saying, a death sentence for you. Just because you're poor should not mean that you are not entitled to healthcare. But in this country, the viewpoint is that healthcare is... It's something that you should earn. You get educated, you get a good job with benefits, or you become a millionaire and you can pay cash for all of the healthcare that you could possibly need. And we can't... That can't be how we take care of people. I have a family member now that just got diagnosed with lung cancer. And had she... If she had not had the kind of insurance that she has or even the insurance that she has, the amount of monies that are going to be needed is ridiculous.

0:29:06.1 SS: Healthcare should be a right and not a privilege. I guess that's the best way of looking at it and looking at racism in terms of how it impacts healthcare. That's just... As I said earlier, healthcare provider's attitudes, people's attitudes about poor people, and especially Black poor people or Latinx poor people, it's so interwoven and it's so... My best solution is that it has to be a part of how we are trained as healthcare professionals, that healthcare is healthcare no matter who the person is that's coming for healthcare. And we have to learn how to disconnect our implicit biases. First of all, to recognize them, work on them, and disconnect them from the process of giving care to people. Now, that's a big statement. [chuckle] That's a big statement but that's what has to happen. I firmly believe that that's what has to happen. Yeah.

0:30:15.8 JS: Absolutely. It has to start with training before you even walk into a hospital or a place where you're providing care. We have to examine our own biases, like you said.

0:30:29.5 SS: Yes, absolutely, absolutely. And I believe that healthcare is... I believe healthcare is a right. The issue that some people have, they have a belief system that everybody deserves to be born but then that doesn't translate into everybody deserves to be cared for once they're born. The belief is we just need to get the child here, and then we don't have any more responsibility. I believe as a healthcare provider, anyone that comes to me deserves my care.

0:31:10.3 SS: And people used to ask me, when I first started out in practice. I've worked for a number of different practices. People used to ask me," Well, do you take Medicaid," which is Michigan public health insurance. It's like I don't look at the face sheet. I don't care what kind of insurance you have. I might be a bit concerned if you're coming to me for women's GYN care and you want contraception or something like that. And the only reason I might be concerned is that some insurances cover this and some insurances don't. I really leave that to the pharmacist. That this is what you've decided, let's see if your insurance will cover it, and if not, what can we do.

0:31:54.8 SS: But before I go in and see a patient, I don't look and see what your healthcare coverage is. I just... The way that I practice is that's not my business in terms of caring for you. You are here for a normal yearly GYN exam as a woman or you're here for pregnancy or postpartum so that's what I'm supposed to be doing. We have people in practices, that's what they do. They're billers. [chuckle] That's their business. And I have worked for practices that only took certain insurances. That was just their policy at the time. And unfortunately, it is a business. Healthcare... See, I'm dating myself again, back when healthcare was just healthcare. Now, it's the healthcare business, so yeah, yeah.

0:32:47.2 JS: Yeah. I think it's so important though what you're emphasizing is that we treat people like humans that deserve dignity and respect, and regardless of their circumstances, we wanna make sure we're providing care for them.

0:33:02.0 SS: Absolutely. Absolutely.

0:33:04.5 JS: Yeah. So...

0:33:07.4 SS: The differences that we've implemented as human beings, the things that make us different, and the things that we pay attention to, and the things that we use to be biased against one another, so to speak, the thing is, we all get here the same way. If there was a real hierarchy, if you will, in terms of human beings, wouldn't there be a distinction in how we get here? Wouldn't it be... I don't know. This is where my imagination kind of goes crazy. But we all get here the same way. We all get born. I always tell my patients. There's only two ways out. You're either gonna push your baby out or we're gonna help your baby out in another way. There's nothing... There's nothing to say that the rich people, they get to be birthed in a different physiologic way. Now, we know in terms of where people give birth, there can be a big difference.

0:34:10.2 JS: Sure.

0:34:11.3 SS: But the process in terms of how we get here is absolutely the same for everybody.

0:34:17.2 JS: Yeah, I love that. [chuckle]

0:34:21.4 SS: It's so... It's really... It's mind-blowing when you think... If you really think about all of the stuff that we use to categorize one another... And again, the implicit bias that we bring to how we interact with one another or care for one another... Until we decide to dismantle that, just thinking about the fact that we all come here the same way. That it's the same process, and there's only two ways that the process happens. So yeah.

0:34:58.5 JS: So my last question, as we're wrapping this up, in your work, you've provided support to survivors who may be pregnant. So do you have any advice to share with advocates and nurses and midwives when working with pregnant people who may also be survivors of sexual violence? 

0:35:18.2 SS: Of sexual assault. Yes. We do know that through research that women who have experienced sexual violence at some point in their life prior to the pregnancy, it can have a significant impact on the pregnancy and especially on the birthing process. I would say that having a... When a woman self-discloses that, that that's a part of her history, the way in which we care for her must be even more trauma-informed because if we're really asked about it, everybody's had some kind of trauma. So all healthcare should have a baseline of trauma-informed care, so to speak.

0:36:05.8 SS: So in working with women who have self-disclosed this, and you know this is a part of their history, give them the space to talk about this especially if they haven't processed it. And also, know what the resources are in your community. Is this something that she needs to unpack further during the process of the pregnancy? Know the impact that it can have on the birthing process itself... Midwives, we tend to just be like... We're chilled out the birth take... The birth goes how this woman's birth needs to go.

0:36:41.4 SS: We tend to have more patience with the physiologic process of birth. Women who are survivors of sexual assault, when they are giving birth oftentimes need even more patience and even more time to complete this... I call it doing the work... Completing this work that she has to do. So I think we really have to pay attention to that and make that part of the care that we are giving her. And remember that for most women in America, in particular, we don't see birth until we go through our first birth.

0:37:18.1 SS: And understand that there has to be a level of instruction and teaching when women are pregnant to be unafraid of the birth process because this is something that we've never seen, something that we've never done, and avail the women that we're caring for information and the educated process of knowing what's going on with her body, what kind of changes happen with pregnancy and what kind of changes happen after this baby comes out. I mean, 'cause we literally go from being non-pregnant to pregnant and you know.

0:37:52.9 JS: Yeah.

0:37:53.6 SS: Depending on how soon the sperm meets the egg, I have had women say over the years, it's like, "Yeah, I was fine, then one day all of a sudden I was throwing up. I didn't know what was going on, then I realized maybe I'm pregnant." So to help her by providing education and instruction and modeling how to care for yourself, how the pregnancy goes, what are the warning signs that... Why do you need... When are the... What's happening that you need to call me, those kind of things to give her, empower her with education in terms of what's happening in her body and what she can expect and building up her confidence and the ability to do it.

0:38:34.9 SS: I still say to women... Women come in, they're afraid, whatever, and we're talking. And I say to them, "Understand that women didn't just start doing birth 50 years ago or a hundred years ago or a thousand years ago." As I said earlier, I say to women, "Literally, every human being that comes in on the planet comes through the process that your body is doing right now and knowing will do to get through to your birth and the postpartum time." So giving them information to help them understand that, "Your body is designed to do this and all of the sisters before you that did this. Their spirit and their energy is coming through to help you do this as well." So yeah. We have... As caregivers, we have an immense amount of influence, if you will, to help women feel empowered and to help women be able to do this. Yeah.

0:39:32.1 JS: I love that so much, remembering that bodies are meant to do this.

0:39:37.1 SS: Absolutely. The uterus has one purpose, grow babies and get them out. [chuckle] And I always say, you know, it practices every month. "Oh, we're gonna have a baby. We're fluffing up," you know the lining and everything. "Oh, no baby, okay," so then you have a period. And people do exactly what you're doing, which is laughing, when I say that. But that really is what it is. And the ovaries, of course, have the function of... The endocrine function of hormone production and everything. So a lot of times I watch what happens to women's faces as we're talking about this and it's like, "Wow, I never... " And they'll... Sometimes they'll actually say that. "I never thought about it like that." It's like, "Yeah, you're equipped. You can do this."

0:40:15.8 JS: Yeah. Since you and I have talked to prep for this interview, I've shared that with so many other women in my life and it... I don't have children of my own, but the thought of being pregnant can feel really scary 'cause like you said, American women don't see birth until it's happening to you. And so I love the idea, especially for folks who are survivors, to really help them and empower them to understand that this... We're gonna get through this, we're gonna figure out how to do this, and you let me know what you need to feel comfortable as much as possible throughout this process.

0:40:56.6 SS: Yes. And being respectful of... Going back to cultural differences... Being respectful of the things that the woman and her support system feel are important. I've been honored to attend women from... I can't even count the number of countries... But you know, they would have certain traditions. And a lot of times in the hospital setting, this, the nurses or the doctors are like, "Do you know they wanna wrap the baby in this cloth thing." It's like, "Well, that's what we do with them." [laughter] The only difference is the cloth. We can wrap them in the...

0:41:35.6 JS: Sure.

0:41:36.6 SS: Those striped little blanket things that we wrap all babies in or they brought their own cloth. So what's the problem? "Well, we don't know where that cloth has been." Well, it's been with the family. And the baby's been in the mama, and I call it the mama's soup. Been in the mama's soup so whatever, the mama... You know what I'm saying? Just ridiculous things that should not bother people.

0:41:57.8 JS: Right.

0:41:58.3 SS: The baby's born, she wants to put this special cloth on the baby. Put the special cloth on the baby. It's not deep. Just because you don't know this tradition or this cultural tradition doesn't make it any less valuable to the women... To the woman who's asking for it, and it's not... It's not interfering with your professional duties or anything like that. It's amazing to me the stuff that we give people crap about. It's like... And I've been a... I've attended women who've had musicians. They're playing music in the birthing room. That's cool to me. I mean, I've been a musician, a singer all my life, so.

0:42:38.8 SS: I remember one birth we did where after the baby was born and mom was snuggled with the baby and dad got out his guitar and we started singing hymns. And I'm like, "Yeah, I grew up on those hymns. I know those hymns." And he's looking at me, I'm like, "Yeah, I sing alto. Let's sing together." Just things like that is so... Is supportive of the family and what they want. It's not impacting what we feel like we need to do professionally or anything like that, but it's affirming for this woman and her family. And it's so easy to do 'cause I gotta be there anyway. I gotta make sure you're not bleeding heavily after your baby's born. So I can listen to the music or I can sing if it's okay with you. And it feeds me as a person, and certainly as a professional, to have been exposed and learned about all these different things over the years that I've been doing this. It's just been great.

0:43:32.9 JS: I'm sure you have many many...

0:43:34.7 SS: I could do...

0:43:36.1 JS: Stories to share... [chuckle]

0:43:36.2 SS: Yes... I could talk all day. [laughter] So yeah. Cut me off 'cause I'll be talking all day. [laughter]

0:43:43.3 JS: Well, Sameerah, I have enjoyed so much getting to have this conversation with you, and I just wanna say thank you so much for joining us...

0:43:51.3 SS: You are very welcome.

0:43:52.1 JS: To talk today.

0:43:53.0 SS: You're very welcome. It's been my pleasure. It's been my pleasure.

0:43:57.5 JS: Alright. Well, that's all the time we have today, so thanks to everyone who listened to this episode of PA Centered. You can learn more by visiting the links in the episode description.

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0:44:17.2 JS: If you or a loved one needs help, a local sexual assault center is available 24/7. Call 1888-772-7227 for more information or find your local center online at pcar.org. Together, we can end sexual violence. Any views or opinions expressed on PA Centered by staff or their guests are solely their own and do not necessarily reflect the opinions of PCAR or PCAR's funders.