Maternal Health, with Vanessa Guzman

Join us as Ebehitale Imobhio interviews the brilliant Vanessa Guzman, founder of SmartRise Health. Learn about maternal health care, barriers to postpartum care, and the experiences of LGBTQ+ people as they navigate parenthood and motherhood. 

Award-winning healthcare leader and author Vanessa Guzman MS, ME founded SmartRise Health to help healthcare organizations assess complex operational problems and devise strategic, quality improvement, and training initiatives to optimize outcomes and satisfaction among employees, partners, and patients.
Vanessa graduated from Columbia University’s Fu Foundation School of Engineering and Applied Science with a BS and MS in Biomedical Engineering, specializing in Diagnostic Imaging. She is also certified in Quality Engineering and Quality Management and Organizational Excellence by the American Society for Quality. For her outstanding contributions, she has been awarded the 2018 Becker’s Hospital Review “Rising Stars Under 40” and 2017 Modern Healthcare’s “Up and Comers” Awards. 

Resources: 

• SmartRise Health

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Transcript

Ebehitale Imobhio  0:13 
Hi, good afternoon. My name is Ebehitale Imobhio. I am the Assistant Director of Equity, Diversity, Inclusion and community engagements for the School of Public Health and Health Professions. I'm here today with Vanessa Guzman, can you please introduce yourself?

Vanessa Guzman  0:28 
Yeah, sure. Thanks again for having me as I need this Vanessa Guzman, and the CEO for two organizations. One is called SmartRise Health, which is a health equity value based care quality consulting firm, and Ella Es Health, which stands for she is in Spanish. And that is a organization solely focused on the health of women. So super excited to be here with you today.

Ebehitale Imobhio  0:52  
We're glad to have you with us today. So we have some questions I would like to go over with you today. And I'm just gonna get right into it. So can you discuss the importance of equitable access to contraceptive methods and family planning resources for marginalized community, specifically for bipoc, and LGBTQ communities?

Vanessa Guzman  1:14 
Yeah, for sure. And it's important to recognize that maternal health starts way before a person becomes pregnant. And the importance and inequities that exist among women, or, or just in general, people of color and the LGBTQ community are, are significant, primarily because of insurance coverages, financial barriers, cultural nuances that are different in our communities than it is for other populations, as well as education, right in our ability to know, to ask questions, and and know that we have the agency to make decisions on our own, and that their options are out there. So the origin of a lot of that is already systematically challenging. Not to mention that our workforce in health care predominantly does not include our communities, which causes even more significant barriers when we're talking about maternal health and, and having appropriate health care pathways to support our different communities.

Ebehitale Imobhio  2:19 
So what role if any, does comprehensive sexuality education play in this process?

Vanessa Guzman  2:25  
It plays a crucial process because it allows persons to understand and identify with who they really are, and their true feelings and giving names to things and outcomes that historically had been stigmatized. It also gives persons the agencies to understand what options they have, especially as they perhaps are considering understanding what you know, family support looks like in the future or family planning looks like in the future. So the earlier we start and identifying some of those gaps, that earlier, we are in a position of providing health and education to our communities around what exists around so sexual education, but also sexual pleasure, which oftentimes, are stigmatized and are taboo and not talked about. And you wind up with very unhappy communities, about their own bodies and their own health.

Ebehitale Imobhio  3:23 
So you want to kind of talk of sexual pleasure. So why is that important for you, in this space of not just comprehensive education, but also in maternal health overall?

Vanessa Guzman  3:36 
I think it's considered a part of a woman's house pathway, right. And we're talking the general definition of a woman because oftentimes, what we find is that persons comes to the, you know, practice or their OB GYN, and they don't necessarily report having pain upon intercourse, right, or having heavy bleeding, or having, you know, even you know, other symptoms that interfere with their sexual pleasure that are related to that. And they often don't bring it up because they feel embarrassed, or they feel that they that's not that doesn't warrant a doctor's visit, right. And humans have the tendency of hiding or diminishing the value of their own well being including pleasure overall, but especially sexual pleasure, given again, that is often such a personal topic, and often requiring the trust of having equals provider to have a discussion. Usually we can talk about our, you know, with our best friends or girlfriends, we can have those conversations, but often they're not brought up to the doctor where we're honestly that's where they can get the best help, especially if it's tied to their pathology or something that inherently can be corrected or address directly in their bodies.

Ebehitale Imobhio  4:53 
What role do you think peer relationships plays in like conversations around like health as well, especially relating to sexual and reproductive health? We just spoke about how a lot of women are more comfortable talking with their girlfriends or their friends, we lean into conversations about sex. But how can we kind of empower peer groups to be more educated or more candid or just smart, and open and empowering to their friends?

Vanessa Guzman  5:22 
Yeah, I think it takes trusting relationships, right, and meaningful relationships to have those discussions. And if you'd have those relationships, then it's about taking the opportunity to have those conversations. I'll give you an example, of my own personal story during in 2020, right at the start of COVID, my husband and I were eager to have children, we saw a bunch of pregnant people we're like, "Oh, we get pregnant too." And unfortunately, we actually have three miscarriages, back to back in that year alone. And, you know, whenever I would go to the doctor, it wasn't, it didn't sound like it was something that was so uncommon, right? Actually, the opposite. The doctor said about anywhere from 30 to 50%, of woman had miscarriages at any point, I didn't know that information. So I thought something was wrong, or I was broken. Because the one thing that I could do as a woman is like to have kids, that was the mentality, right? Although we all know that's, that's incorrect. But then I learned it, the more I spoke about it was networks of friends and colleagues, they're like, "Oh, yeah, I've been through that." And they themselves became the resource to me emotionally, but also connected me with other resources that we have perhaps have worked for them, or whatever the outcome was, for them. Ultimately, even up to today, you know, I had a have a baby girl, and, and I'm pregnant now, actually, as we speak with twins. And we still don't know why those miscarriages actually happened. You know, we were ready to embark in the journey of in vitro fertilization, because we, you know, we didn't think we had any other options. And we thought there was something inherently wrong with us. But ultimately, I got pregnant, I still don't know the reason. Because again, there isn't enough research to demonstrate some of these nuances that does occur in our bodies and readiness in our bodies. But generally, peer groups are so important, because you rely on them for, for all those reasons for resource as emotional support, to have a discussion on what best are, how helpful can those individuals be to you? And how can they support you? Because when you're in that situation, you honestly feel lost. And you feel like it's only happening to you, but you'll be surprised how it happens to so many of us.

Ebehitale Imobhio  7:30 
Thank you for sharing your story and congrats on your pregnancy. So going back to the topic of the decision of becoming pregnant, how did social determinants of health and racial disparities affect a person's decision to become pregnant?

Vanessa Guzman  7:46 
Yeah, no, that's, I love that question. Because it's, there's something to learn. I think, for all of us there, it's a first of all, is options. And starting early, right, when you generally, most people, you know, go to the doctor, for especially women, they go for yeast infections, and contraceptive pills, like early on, right, as adolescents or as we move into our 20s and whatnot. It's generally not about what the future family planning. So a lot of the preventive care that's necessary, and the education that goes into that part of your age range gets lost, right, in the opportunity of having those discussions and options, early on. One of the biggest challenges that I see, in addition to the the preventive care is insurance coverage, right. So what winds up happening with a lot of our communities is that we you know, we have Medicaid or some form of low income, insurance coverage. And that may not necessarily include some of the education and wraparound services, right, that exists in addition to going to the doctor to help support and educate everyone on what options exist, right, and many more exists than what we think what we see, statistically, is that, especially non white populations, generally instead of oral contraceptives, we generally take the shot instead. And the reason why we see those numbers is because generally, there is stigma around our partners or our families or our culture around taking the pill, right, to prevent pregnancy. So that's one one thing. The other piece is that there are a number of contraceptives that are not well known other than the pill. So being able to not only understand access, and be comfortable taking those other approaches or novel approaches, still still is a barrier in our communities, unfortunately.

Ebehitale Imobhio  9:43 
So now pivot into the LGBTQ community. What are some of those specific challenges faced by members of this community in access and family planning or fertility services? And how can some of these challenges be addressed?

Vanessa Guzman  9:59 
I think there isn't enough research or found practitioners or doctors in general who have the care team preparation or education or even inclusive language, to connect with our LGBTQ community in a way that feels inclusive and feels like they're getting the same same treatment, as you know, heterosexual or cisgender groups. Believe it or not, you know, the LGBTQ community have similar options than others, including everything from IUI, IVF, adoption, surrogacy, that are not other non traditional methods. The challenges with those, that is a very expensive and long process for almost all of them. So their options are a bit more limited by financial barriers. And I think where, where we see the opportunities is in providing some of the options that are more accessible to the communities early on in the process, and know what type of readiness steps they can take to prepare themselves will pathway decide taking later on in life. So education and financial, tend to be specifically on the topic of family planning, that are the largest barriers. In general, the LGBT community is faced with sharing information, private information about themselves, their identity and sexual orientation as well, right to perform other preventive care services, often not shared with the provider because of fear of discrimination or retaliation and the use of that information. So we, you know, my team often works with providers, offices, health plans, and health systems to help, you know, integrate inclusive language, and creating an environment that's everyone friendly, so that folks know, when they walk into a practice, that they're open, that we can trust the team that together they will build the best plan that serves best with their lifestyle and their family plans.

Ebehitale Imobhio  12:06 
So earlier, you spoke about people's use of contraception and how culture affects it. So are there any cultural or community specific approaches to family planning, that are particularly effective for marginalized populations?

Vanessa Guzman  12:24 
It's less of a model or more of an approach of how we, how we engage with the populations and the communities. So for instance, is having discussions during preventive care visits or annual examination, where the provider ask specific questions to the patient on what their future plans are, and then having a discussion what makes the most sense for their lifestyle? You know, one of the barriers I've talked about earlier was insurance coverage. And for instance, one common resource that's usually present during maternity, but even postpartum is a doula. So many insurances now cover doula programs, nutritionist. Right, all that are so critical for engaging in healthy behavior during and throughout your pregnancy, but also postpartum not only for the baby's health, but also for, for the person who's carrying the pregnancy. In those that's so important, is not only understanding what their benefits are from an insurance perspective, but what's the best way of making use of those resources. So when we're talking about contraceptives, access to services or any other I think the approach around building effective communication between the patient and the provider, having services that are not provider driven, right, sometimes there's things that are easier, you know, discussed with like a social worker or another, another caregiver of the practice than the doctors having those options also, to build that trusting relationship with the practice and a woman's or persons overall health is as important.

Ebehitale Imobhio  14:04 
And now we're going to be discussing the specific challenges marginalized people face during their pregnancies. So how has your work been impacted by the high rates of maternal mortality in the US, especially among bipoc pregnant people?

Vanessa Guzman  14:21 
Yeah, that's such an important topic. The, we see that black populations have, you know, upwards of three times mortality rates compared to to white and it's disappointing to know that you're born into a specific race or ethnicity and that, to some extent, defines the opportunity to live a healthy lifestyle, and even make it make it after pregnancy. Right. It's kind of scary as a woman of color to think that I may be at higher risk of delivering these babies to someone else who has maybe has the same resources that I do, right. But what's important for me to call out is that it's not our fault. It's not our race that's at fault.  It is the services and opportunities and resources given to us, that puts us at risk. It's not on us, right? There's nothing different or broken with our bodies. I just want to start premise with that. But I think the services that we provide include, making sure that we help folks who are interested in becoming pregnant, are pregnant, or even after they have their babies navigate different health system resources, such as doula programs, social workers. We have coaches on site who provide them with like lifestyle support, because it's not just taking care of the baby, when the baby is here it's learning how to take care of herself as a woman. That's probably one of the most difficult things that we encounter. And it's challenging, in all ways, why because, again, lack of information early on. But even as you transition into parenthood, finding the right caregiver, especially for working mothers, is even more challenging because of financial barriers. You know, on average, in the US, we see that parents spent about a third of their income easily in it, especially if you're working in some sort of sitter, or nanny or daycare, and that is expensive, right. So it's discouraging, especially for persons who are looking to continue in the workforce on their careers, and balancing that it becomes almost a choice between do I have kids, or do I keep in career? And generally you can balance, and harmonize all of it but, we don't have necessarily, especially communities of color, have a lower threshold of being able to access some of those services and conveniences that other groups have.

Ebehitale Imobhio  16:30 
Can you talk about the disparities in access and prenatal care for marginalized pregnant parents?

Vanessa Guzman  17:01 
Sure. So we're talking about everything from cancer screening to diabetes related screening, to prenatal care, including nutrition, and vitamins and supplements are crucial and so important throughout the pregnancy. Also behavioral health and mental resources because it is one of the most challenging times in a person's life is to be come pregnant, but also be pregnant. You know, hormonal imbalances, as well as family support are also as crucial throughout the pregnancy. So when we're talking about access to prenatal care, and preventive care, we're talking from everything from screenings to monitor both the mother and the baby, but also screenings to determine a the risks involved in any other sort of health complications for the woman, including upon delivery, risk related to the pregnancy itself in the in the in the and the fetus, and also risks related to mental health related or unrelated to the pregnancy, that are impacted by social economic factors, like we discussed anything from financial, violence, or housing, that are often a key influencers, in determining a successful and healthy pregnancy.

Ebehitale Imobhio  18:26  
How does systemic racism impact the quality of prenatal care for people of color?

Vanessa Guzman  18:32 
It's an important question. It's also a loaded question, because when we're talking about systemic racism, we're talking about years upon years of misinformation, misuse of resources and research that have disproportionately or negatively impacted different communities in the US. So dismantling that those decades of that experience involve creating and regaining that trust, again, across the communities that we serve as number one. Number two, it means for systems to make the right investments in health care, whether it is health systems, providers, communities, payers, and health plans to dismantle existing systems and rebuild them in a way that are serving across different populations and why that's why so many organizations these days are collecting data on race ethnicity. So that combined with identifying what disparities exist and what gaps exist among different populations, they're in a position of comparing it with the literature and what the research shows are the highest risk factors for these groups, and almost getting ahead of it right, or creating initiatives to address some of those gaps. For instance, when we're talking about on the preventive care side, right, pap smears, right, cancer screenings, and we're we want to identify which populations are not getting screened, so that we can engage them and tailor our communication to those groups a little bit differently, so that we can get ahead of that. Or when it comes to prenatal care and postpartum care, we want to make sure that we're still engaging those mothers to come back and, and get the right screenings in place so that any risk factors are identified early on, and can be addressed through either pharmacotherapy therapy, mental health, or any form of social support, and has the experience even postpartum.

Ebehitale Imobhio  20:38 
So now, how do disparities in postpartum care, access and quality affect bipoc women's post birth experiences and health outcomes.

Vanessa Guzman  20:51 
Well, it's actually kind of related to the question around systemic racism, right. So with postpartum care, we're looking for things like depression, diabetes, hypertension, we often think that those are factors that are often found during pregnancy, but they're even more predominant, postpartum. And so many resources go should go toward the babies. And the attention goes toward the baby that we often forget that there's a human who just birthed, and went through this existential experience to deliver these babies. So we're talking about health care systems really addressing unconscious bias that when women report pain, or report feeling down, it's a big deal. It's a big deal across everyone, I just want to we're not the other, that there's access to different options around the pharmacotherapy and medications, and therapy options being shared with the woman, that their screening is done at very specific intervals during postpartum care, including during their postpartum visits, to identify if it is normal mood that's down, which is explainable given the hormonal changes that women experience after birth, or is there something to be addressed? Is there something bigger? And you know, is there a way that appropriate care and resources can be shared, in addition to those that are clinically relevant, like does a woman and the baby have sufficient food? Are they in safe housing? Do they have the financial resources to access the care around their communities that they need to live a healthy lifestyle. So those are all the factors that we look for during postpartum failure is both the clinical as well as social factors that we know impact the overall wellbeing for for the family.

Ebehitale Imobhio  22:48 
In thinking about how we can care for mothers and parents after birth, how does the intersection of race, gender identity, and socioeconomic status impact the availability and quality of postpartum mental health resources?

Vanessa Guzman  23:03 
Where inputs the most is really in the coordination of care. Meaning, when you're caring for especially when you're in early stages, caring for a child, that's where your focus is. It's important that we substantiate our engagement with the community with mothers and their families to increase you know, check ins, how are you doing today? How are you feeling and tracking some of those resources, instead of just waiting for a visit, right to where we often that's where we download all the different issues, right. And again, so much focus goes to the well child visits, but the postpartum visits are essential. So that's number one, increase tailored communications and check ins number two, is making sure that there's still access potentially to everything from lactation, doula services, those things that are hardest and most relevant to a birthing person early on in the process is going to be crucial. And number three is around what we generally don't talk about, is this aspect of it that I call like, of mothering or parenting right around what are the important factors of raising a healthy family and really working with the hearts of the of the of the infants that that just came to this earth? Right. So those are really important conversations often not had at a doctor's office, and that's where our models of care are helpful, because we talk about more of the lifestyle. What do we think is best for the family? What are what are the options available for the family? Versus the biometrics, which is what a doctor's office generally does and the focus on that, versus the holistic way of like, let's move with the hearts of these babies right in the family, and making sure that whatever the family looks like, whether it's non traditional or traditional, that they remain inclusive and accepting, and that the family feels like they belong to that community, that's probably the most important priority for us.

Ebehitale Imobhio  25:08 
Are there unique postpartum needs for LGBTQ folks specifically related to mental health resources?

Vanessa Guzman  25:17 
Yeah, there generally is the need to address social factors, right. And generally, we find that having peer groups, or specific resources that connect the LGBTQ community, with other families who are, who have chosen the path, or whatever the path of creating or expanding the family is, that's probably one of the most helpful resources is creating community within the community, that that they serve. And oftentimes, doctors practices don't have those type of resources. So we work closely with the resources at Family Health, which is an organization focused on really engaging influencing the care of LGBTQ patients, and members of the community and having those resources available in healthcare organizations. But, the one of the most important factors to consider among this community is the need for, you know, education that's inclusive, non discriminatory, and that upon the process that it takes to engage their children and care that it's the same as with any other group, right? Children are children, and they require the same level of attention. As far as the mothering, the mother or the birthing person, the care has to be tailored, obviously to their, their biology, and prior history, just like we would do for for any other individual.

Ebehitale Imobhio  26:57 
You share examples of initiatives or programs that have successfully improved postpartum care quality equity for bipoc are LGBTQ populations. If there are any buffalo Can you share those too?

Vanessa Guzman  27:14 
Well nothing specifically in Buffalo. Well, we do have programs have been throughout the country. Specifically, there's one success story I want to share, which is really a doula program, where we connected patients to to doulas those that were Medicaid recipients. And we follow them from early pregnancy to three months postpartum. And what we did was we embedded a coach who was able to help them navigate through a coordinated list of questionnaires and assessments to determine Okay, where can there be a risk everything from the medication that they were taking, the type of birth, the birthing center hospital where they deliver, the type of family dynamic or composition. So we did that. And those who had an assigned doula or care advocate reported having more satisfaction, but also healthier outcomes as a result of that engagement, because we were able to help them and remind them of key services. So generally, you just forget, you're trying to deal with the the child right after birth, it's crazy. So having that level of support really helps, but also giving, giving them the options of what's out there for them to really tap into what was super helpful. So that's that's one case study of the impact of doulas and care advocates. And I think that, regardless of location, I think that really applies. The differences that we see in locations like Buffalo versus somewhere else is, is it's the the common disparities that we see across health in general between urban settings and more rural settings. Where with rural settings, we see you know, things like transportation, substance abuse, domestic abuse being more predominant, whereas in urban settings, you see more of the common chronic conditions such as diabetes and hypertension, primarily because of diet and regimens related to that, among other genetics, composition, but I think location is is more relevant to the population  cultural nuances that we see across all different conditions even beyond beyond postpartum or pregnancy care.

Ebehitale Imobhio  29:40 
So you spoke to just now about the effectiveness of a doula program. How do you feel about New York's new Medicaid approved doula program that will be taking effect in January?

Vanessa Guzman  29:56  
I'm excited because generally people who can afford to doula had access to doula now, we're talking about everyone. You know, a lot of Medicaid recipients, this would be totally new for them, especially if they've had kids before, they still have the opportunity to benefit from someone who is giving them the necessary physical and emotional support that perhaps they see their supplemental or they're simply don't get from their network or their families. And that that's exciting. I mean, I use a doula. This is my second time using a doula for pregnancy. And for my pregnancy, with twins, for instance, I need more protein supplements than ever, and I would have, I honestly would have would have not been as accountable. In taking more protein. On my own. Sometimes you just need an accountability partner, someone who tells me what you already know, but make sure you do it, right? And it's not your your your partner or your family. But sometimes doulas even provide onsite support during delivery, so that the birthing persons don't feel stuck with one options of delivery, right, we see that in the US we have such a high rate of C sections, for instance, versus vaginal. And and we tend to diminish that is a major surgery. C section is a major surgery. So unless it's clinically relevant and needed for the overall health of both baby and the mother, we generally don't recommend it. But it's become kind of like such a common thing that it's like, oh, yeah, sure, just got a C section, right, it just schedule is so much more convenient, versus kind of like ignoring the benefits of having vaginal delivery, for instance. So that's where doulas kind of really are in there kind of with you to really infuse their knowledge and helping you make decisions that ultimately you would have made on your own. And they can support you throughout the pregnancy, but also a little bit also postpartum, generally, depending on the coverage. So I am very excited for that, because it's something that studies have shown the effectiveness of patients having the agency to make better decisions when they are accompanied by a doula work here.

Ebehitale Imobhio  32:17 
I think a lot of people will really benefit from this program when it goes into the facts. And I'm personally really looking forward to reading about all of the wonderful, long term studies that come.

Vanessa Guzman  32:29  
Yeah, yeah, absolutely. It's, it's a magic, it can be a magical, but it can be a very stressful period in the person's and family's life. So having the additional support is something that's so much, much more needed, of course.

Ebehitale Imobhio  32:46  
So now we're going to be talking about the challenging work of actually being a parent, as I'm sure you're aware.

Vanessa Guzman  32:54 
Yeah.

Ebehitale Imobhio  32:54 
So how do racial and ethnic disparities affects the experience of pregnancy, childbirth, and parenting for bipoc individuals?

Vanessa Guzman  33:06 
The biggest one biggest challenge is the support. Right? So when we talk about, you know, not only family support, because a lot of us just have to work right generationally in in our day and age, there's less of like, the grandpas and the grandmas helping out, right, like we used to see back in the day, that's not often necessarily the case, and especially in the LGBTQ community, maybe you know, their families may look different than traditional families, right. And people of color, we see that, you know, most of the family works. So then where's the support? As I said earlier, you know, you're stuck making really hard decisions around like, Well, should I pay 90% of my salary or 80% of my salary to a nanny or daycare to care for my child, because childcare expenses have doubled just in the last decade in the US. So not to mention other key factors like food and, you know, diapering and all the expenses that are well known. But I feel that and the data shows that financial barriers are probably the the biggest ones from, from a support system perspective, the second barrier or challenges around emotional support. Once you have a child coming into the home, integrating into the family, whatever that family looks like for you, you're integrating another individual with to whom you are providing support, as well as guidance and helping them grow as a little person. And that the that there's there's a need for a higher self for self awareness for the parent, to be able to regulate your emotions, so that your good support system for the child. So all those things are, again, a balancing act between the heavy demands and the sleep deprivation that comes with parenting. So, you know, we try our best, but, you know, having the additional support, whether it's financial, or the care of emotional support from families and caregivers becomes so critical for you to effectively be a parent, especially in modern life.

Ebehitale Imobhio  35:27  
And following up on that, can you discuss the impact of racism and other types of discrimination on maternal mental health and the challenges that mothers or parents of color encountered during their parenting journey?

Vanessa Guzman  35:45 
Yeah, we communities of color still highly stigmatize the use of mental health services or the need for mental health services, throughout pregnancy, postpartum, and as parents. That's just the reality. A part of it is embedded into our cultures and into our ways of being. But the other where there's I said, accountability to health care organizations is that the workforce, does not necessarily look like us, right? So from a trust perspective, it becomes challenging for people to feel the trust and the comfort of sharing their fears, their feelings, their emotions to someone who perhaps they think will not never understand that, or doesn't know where they're coming from. And that, that kind of puts in question, who will, how helpful are you going to be if I connect with you, right, as a therapist, or whatever, social workers, psychiatrists and others. So so there's opportunity for both for a higher self a level, higher self awareness and openness on behalf of our community to know when we need help. And when things just our mood has been consistently down for certain period of time, that it is not normal, to our baseline to recognize that, to know that they can talk to a provider, or a member of the community to voice some of those concerns. But it's also up for the hospitals and providers to really facilitate that connection with the community so that there is trust in engaging with communities of color and the LGBTQ community to support some of those, those both those insecurities and emotional support that we that we need, as individuals.

Ebehitale Imobhio  37:43  
Speaking of the LGBTQ community, in your experience, what challenges do LGBTQ plus parents face and navigating the healthcare system, and societal attitudes when it comes to parenting? And what can be done to support them?

Vanessa Guzman  38:00 
There's some challenges and having frank conversations of making the overall care experience for the LGBTQ community much more inclusive than it is today. And we're talking basics like the check in process, right forms that includes appropriate pronouns, I think that maybe for you and I are like, that's pretty obvious, right? Like, pretty obvious to know that. But it's not that obvious to all the practices and hospitals that support these patients. So what we need is one, process of standardized and consistent across different industry partners in practices that see patients so that everyone feels inclined and in a trusting environment, that they can be themselves and the doctors are working on their behalf for the for the greater good, right? That there if they're being asked questions about their identity or sexual orientation that it's being used in the most effective ways and not in a way that will open the door to discrimination and other, you know, non inclusive behavior. The second piece, I think is, is making sure that we have we we work closely with community organizations that are ready trusting in our community and connecting them with healthcare systems, so that healthcare systems are empowered to do what's best for the LGBT community and also get to learn what type of resources and narratives and forms right and research is most relevant to the community. Like I said before, there's a friendly health resource guides are amazing at setting the standard for effective population health, especially with the LGBTQ community.

Ebehitale Imobhio  39:53 
How can we ensure that parenting resources, support groups, and education are inclusive and accessible for all members of the LGBTQ community?

Vanessa Guzman  40:07 
It's important that it's available at all access points, right, where especially in non clinical settings, like community based organizations. Places where we know that their trust exists, right, and that they're already accessing other resources that are relevant for their overall wellness. You know, examples of that can include anything from, you know, libraries, and food pantries, and, you know, shopping centers, anywhere that we all gravitate towards, right, whatever our lifestyle supports, versus having forms and education available, you know, at a clinic. That's why there's there's such a huge investment these days and in tech companies, especially to have access to like digital health platforms, so that folks can can access all of these resources digitally, regardless of the setting, and without the fear of being discriminated against, or stigmatized in any form for the type of content that they're accessing.

Ebehitale Imobhio  41:13 
So speaking of, promoting materials and cases that we all frequent. What are some other successful strategies for promoting equity and maternal and parental support services, and reducing health disparities for marginalized populations?

Vanessa Guzman  41:29 
We, we talked about digital access. We talked about the need for community based organizations. I think, the access to preventive care, and also in non traditional ways, like whether it's virtual care, or through integration of life coaching and navigation services, I think is very important. But also, there's complex what we call complex care management and complex care in general, which is basically us understanding Well, what else right this person is currently pregnant, or postpartum. What else right, it's understanding the patient in their entire health care journey, and not just that one instance, in time. And I think that's where we we fall short as healthcare is because we often feel birthing persons and woman in particular, we're all about the babies and the milk. And there's so much more than that part in our lives, right. And understanding our trajectory from as early as adolescence, to older women who perhaps are experiencing menopause, and other hormonal imbalances and understanding that is also as important. So I think the biggest gift to people is to making sure that we all have an understanding of what are our pathway options are based on our age, our lifestyle, the way that we live our lives, our stories, and that they complement the needs of healthcare. Because really, it is not made easy for you when you access care, right? It has to be accessible, it has to be so easy and obvious to you, for you to follow the different steps. It was important to us, to really create a setting that is extends well beyond that, that snapshot in time that we talked about today.

Ebehitale Imobhio  43:34 
Finally, for our listeners, what are some lessons that you have learned through your work that you would like for them to leave with?

Vanessa Guzman  43:41 
I want you all to know that your stories matter. And that wherever you're at today, is this a compilation of all your prior versions of yourself, and that we love that version of you today. And that's, that's really the most important part. When you learn to love yourself, and value yourself in that way, you automatically will want to take care of your health. And that's how you prioritize your health because you're that valuable, that you deserve to be your highest self and you're healthy yourself at all times. Third, also know that there are services out there for you. So don't give up and making sure that you gain access to it, that you know your options that you ask the questions and that you see care with a provider that you feel connected with. And if that's not enough, if that's not meeting your needs, really create a network of peers that can be to the resources that you need. But just know that you have the agency to really prioritize your care. And we have amazing systems in place that do exist, believe it or not, that are there. But we still have a long way to go. So while we wait, build a trust with folks that that makes sense for who you are today and who you want to be tomorrow.

Ebehitale Imobhio  45:12 
Thank you so much, Vanessa.

Vanessa Guzman  45:16 
Thank you for having me today and hope that is constant is helpful to everyone.

Transcribed by https://otter.ai