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Childbirth Experience Sparks Maternal Health Career, Advocacy

Five Questions with RN Tiffany Vassell on overcoming bias and achieving equity.

While in labor with her first child, Tiffany Vassell faced intense pressure from the delivery team to undergo a Caesarian section, a well-documented trend in busy urban hospitals. Trusting her own instincts about her body and the baby she was birthing, she adamantly resisted. Within two hours, she had an uncomplicated vaginal birth.

Though she was thankful for the outcome due to her self-advocacy, Vassell was bothered that in order to be heard, she was backed into the role, in her words, of “that stereotypical angry Black woman.” The experience catalyzed both a new career as a labor and delivery nurse and a passion advocating for Black maternal health. She is committed to helping ensure other women don’t face what she did during what should be one of the greatest moments of life.

Vassell is a registered nurse specializing in labor and delivery in Cambridge, Massachusetts. She is one of the newest members of the Community Coalition for Equity in Research, part of Harvard Catalyst’s continuing effort to engage community members with research and researchers. Last spring, she participated in the new Collaborative Catalyst initiative aimed at building trusting relationships between researchers and community members with shared interests and was invited to speak at the eighth annual Black Maternal Health Conference at Tufts University to share her perspective as a labor and delivery nurse, consumer of midwifery services and Black maternal health advocate.

How did your experience birthing your two children influence your work and advocacy today?

I’m a mom of two little people whose births have influenced who I am and the type of nurse I am. I actually became a nurse when I was 31 because of my birth experience with my daughter. I felt alone during the process. I felt that I was not being listened to, that I was being forced into having a C-section. I resisted the pressure and had her vaginally a couple hours later, but I had to be really aggressive, in some ways, portraying the stereotypical “angry Black woman.” Why did I have to be the angry Black woman during one of the greatest moments of my life?

With my second child, I tried to have him at home, but it didn’t work out that way. When I got to the hospital, I immediately felt the disdain of “Oh, she tried to home birth and see, it didn’t work.” I could feel the micro aggression. But the attitude changed the moment I said: “I’ve been a labor and delivery nurse for almost nine years. This is what happened at home, this is my labor process, and this is what we’re going to do.” Then they understood that I knew what I was looking for because I was an insider. I can’t say that another Black woman in the same situation would get the same treatment.

I wrote a book because of my experience. It’s called “Preparation for Hospital Birth” and was published in 2022 with my co-author Althea Robertson, a midwife and former labor and delivery nurse. We explain what to expect during the birthing process — why you should have a healthcare proxy; what is a doula; who can be in the room with you; what you can decline, and what you should accept.

I think people generally understand the process that their body has to go through during birth, but most people don’t understand that when they walk through the hospital doors, there’s also a process there. You’re having your baby and it’s your moment, but they also need the room for the next person in labor.

Having that knowledge and being aware of your options prior to walking through the door is so empowering. You can have a little more control over the flow, because a lot of times going with the flow means you end up in the operating room getting a C-section.

Maternal health is an area where disparities in care are particularly glaring. How do we begin to break down these inequities?

It’s so bad, right? And we know what the problem is. We know there is racism. We know there is bias. But these issues are not being addressed. I feel like some places are slapping a Band-Aid on the issues by hiring more doulas or midwives, but the main issue is not being addressed. We have to address racism head on.

“Bias is something that we have to continually address. It doesn’t go away overnight, and it takes a lot of work on oneself.”

Massachusetts, although not the worst in terms of maternal health, could be doing so much better. We have hospitals and birth centers closing. Instead of offering more, we’re offering less, and it’s putting people’s lives in danger. We need more freestanding birth centers, like the Neighborhood Birth Center we’re creating in Roxbury. Home births are very expensive, and not covered by insurance. Birth centers are covered.

We need to keep talking about it. We can’t depend solely on hospitals and their policies. We need to force our lawmakers to make a difference as well. We need our lawmakers to back us. People like Senator Liz Miranda are doing this, with her omnibus maternal health bill. The out-of-hospital birth bill would allow midwives to practice within their full scope. It’s a multi-tiered issue that’s going to require many folks to address.

How does bias negatively affect maternal healthcare and what can be done?

Everyone has bias. Some people say: “No, that’s not me. I don’t feel that way.” But bias is universal and inescapable. The question is: What are we biased against and how do we handle it when we recognize it? How do we take a step back, and without punishing ourselves, work to remediate it? Maybe we need to talk to somebody, maybe we need to take a class. We can’t just shove it under a rug because it will always rear its ugly head.

It starts with saying something and stepping up. If you see someone do something that seems off, and they aren’t able to recognize their own bias, ask to have a one-on-one conversation about it. If the person is still pushing back, maybe it’s something that needs to be elevated. Maybe it requires a conversation with a manager or someone else who can address  it as needed. It’s also good to document things as they arise, which can be as simple as writing down what happened, when you reported it, and whether it was addressed or not.

Bias is something that we have to continually address. It doesn’t go away overnight, and it takes a lot of work on oneself.

Part of your role with the Community Coalition for Equity in Research is working directly with scientists to advise them how to make their studies more equitable and diverse. What has that experience been like for you?

It’s been a fabulous experience so far. I’ve learned so much from other Coalition members as well as the researchers we have connected with.

We convene once a month and have looked at a variety of research projects in many different areas. Each member serves as either a reviewer or observer, and it tends to alternate. As a reviewer, you give feedback to the researcher about how they can make their project more equitable, how it could help the community, how they could extract more data, that sort of thing. As an observer, you’re kind of watching and listening throughout, and you can offer input toward the end of the review.

I’ve enjoyed both roles. When you’re a reviewer, you tend to do a deeper dive because you really want to give these researchers high-quality feedback that they can run with it.  Hopefully they can adjust their design if necessary to get the information they’re seeking.

“I’m in awe of the hard work that everyone is doing in their lives, communities, and jobs, and in bringing that wealth of expertise to the Coalition to help researchers.”

One of my favorite examples where I served as a reviewer was a study proposed by Kei Ouchi, MD, MPH, an emergency physician at Brigham and Women’s Hospital, which focused on end-of-life care planning for patients coming to the Emergency Department (ED). [Read our Q&A with Kei Ouchi.] Based on our advice in the study review, Dr. Ouchi is really taking the project a step further to find out what we can do to help these people before they come into the ED. He was very open to our suggestions about partnering with community-based organizations to address the issue of planning for end-of-life care in a very proactive way.

Has anything stood out about your work with the Coalition?

I am so surprised by the depth and experience of the other coalition members. Every time we get together, I find myself saying: “Wow, I didn’t think of it that way, but it totally makes sense now that you’re saying that.” I’m in awe of the hard work that everyone is doing in their lives, communities, and jobs, and in bringing that wealth of expertise to the Coalition to help researchers.

For example, I’ve learned so much from Madeline [Stump], a Coalition member who is a trans advocate. To hear her point of view makes me stop and really think about how to be more inclusive of trans and LGBTQ+ folks. Having her voice there is eye-opening. It pushes me to want to be that person who ensures inclusivity.

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