Women’s History Month Feature
PaSH Magazine is celebrating Women’s History Month with a Q&A style mini-series highlighting women from many different industries making an impact in the world, their communities and for themselves. In this Q&A we will spend time with Dr. Kaytura Felix.
Meet Dr. Kaytura Felix
Dr. Kaytura Felix is a spiritual activist and health justice scholar whose work focuses on advancing community-driven solutions to systemic inequities. She has trained in medicine, health services research, community-based participatory research, and generative leadership coaching.
Dr. Felix is a Distinguished Scholar in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. Her research highlights community-rooted responses to systemic challenges such as racism and inequity in health systems. Through her teaching, she supports leaders in developing the skills needed to navigate and address complex social issues including racism, climate change, and poverty. As a leadership coach, she works with individuals and organizations navigating profound social and institutional change, helping them build more compassionate, equitable systems.
Dr. Felix leads the Black Birthing Futures (BBF) project, an in-depth national study examining the experiences and impacts of Black community midwives across the United States. The project centers community-led solutions and helps shift narratives around Black birthing toward care that is person-centered, community-rooted, and life-affirming.
Prior to joining Johns Hopkins, Dr. Felix spent more than twenty years advancing health equity through leadership roles at federal agencies and national foundations, including the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, and the Robert Wood Johnson Foundation, where she focused on improving health outcomes for historically marginalized and under-resourced communities across the United States.
Outside of her professional work, Dr. Felix enjoys spending time with her sister circle and taking long walks with her family in Trenton, New Jersey, where she lives.
How does chronic stress, especially stress shaped by racism or structural inequity, affect pregnancy outcomes and long-term maternal health?
Here’s the thing. People, and I mean all people, experience stressors from daily living. That can be from day-to-day activities, work, family, etc. And then for Black people, there are additional stressors that come from racism and systemic and racial biases. There are daily microaggressions that Black people experience at work, school, and other settings. And then there are evergreen macro aggressions that include neighborhood segregation, environmental pollution in Black neighborhoods, and pay gaps, to name a few. That type of stress compounds the stress of daily life and forces the body into a state of high alert. And that’s even before pregnancy. Then there’s pregnancy. Pregnancy places a huge demand on the body. And appropriately so. Another human is about to be born. But the body cannot effectively support itself and provide resources to the growing baby when under sustained high levels of stress. It is already overloaded and may become overwhelmed. It starts to break down. The birthing person’s hormonal and immune systems are shot. More systems fail and disorders— which can be harmful and fatal to the birthing person and baby—develop.
From a biological standpoint, why does feeling emotionally safe with a provider matter during pregnancy and birth?
This goes back to stress. Biologically, stress — whether physical, emotional, or social — changes the body’s chemistry. It overburdens the body’s systems with excessive inflammation. Over time, that stress reduces the body’s ability to adapt and respond to changes.
As human beings, we can co-regulate one another; that is, we can calm or settle each other. And the same holds true in reverse. Our central nervous systems are connected. Providers are uniquely positioned to use that ability for healing. Through making clients feel heard when they voice their concerns. By noticing and skillfully addressing symptoms. Providers can help ease the life stress and anxiety clients experience in medical settings. Through co-regulation, they can change the body’s chemistry and, therefore, what the pregnant person’s organs and blood vessels are exposed to. This effect could also extend to the placenta, the organ shared by the pregnant person and the baby.
That’s why choosing a provider you feel safe with really matters. Clients in our study reported that their midwives’ care and attention helped them offload their feelings of stress during the visit. They felt good, felt ‘loved’ by their midwives. This is significant because it means that, for the 1-2 hours they were with their midwives, their body chemistry was programmed for healing. Whereas stress takes us away from healing, emotional safety takes us towards it. Whether the provider is a midwife, a community birth worker, or an OB, establishing emotional safety is essential.
What does relationship-centered prenatal care look like when it is done well, especially for Black mothers?
In our work with Black mothers and birthing people in the Black Birthing Futures study, we saw that relationship-centered care is attentive, responsive, and truly competent. It not only supports healthy pregnancies, but it also offers an experience of being seen, protected, and valued in a system that too often does the opposite.
First, the provider is attentive to the client. One of the midwives I interviewed spoke of a time when she had a new client who was very anxious about her pregnancy. The midwife scheduled the client’s last appointment of the day so the client could have time to express all her concerns and questions. That client reported that throughout the meeting her midwife “never looked at her watch.” The midwives’ attentiveness was a common theme in our study. That level of attention is powerful; it is not a nice-to-have; it’s essential and potentially life-changing. We learned that in the midwifery model of care, pregnancy is not just about the birth of the baby, but also about the pregnant person’s rebirth as a mother/parent.
Second, the provider is responsive to what the client is saying and what’s happening in the client’s life. I observed a midwife caring for a 7-day postpartum mother. A couple of days after a home birth, the baby was assessed at the hospital. But the mother could not remember the outcome of that visit. The mother talked about having postpartum fog. The midwife responded by calling the pediatrician to clarify what had happened in the hospital and plan for future care. The mom, midwife, and pediatrician developed a care plan that included a home visit by the midwife instead of having the client “fight traffic to get to” the hospital.
Third, the provider is competent. They have the skills to deliver the necessary care and know when to refer the client to a higher level of care, as well as the courage and humility to consult with other experts and transfer clients to other providers. These are not just technical skills but moral skills that take clients to health and healing.
What structural changes are most urgent if we want to meaningfully reduce maternal health disparities?
From our research with Black pregnant people, community midwives, and other community providers, here is what we learned about the structural changes needed to reduce maternal health disparities. We share these changes in our upcoming podcast, Deep Care, which drops April 13 on all major platforms.
The first and foremost structural change is institutionalizing the midwifery model of care as standard medical care. I spoke recently with an expert who has worked on maternal health for 20 years. They lamented that “we in the U.S. have a blindness about midwifery care…we ignore what midwifery does and what it can do to improve maternal health.” Today, this care exists on the fringes of the health system. It needs to be in the center. This shift would include increasing the number of midwives operating within the maternal health system. Midwives are experts in uncomplicated pregnancies, and most pregnancies start off that way. They are trained to support and work with the birthing process and to minimize interventions that would trigger adverse events or complications.
It’s important to note that when we refer to the midwifery model of care, we are not limiting ourselves to midwives; we also include doulas and other perinatal workers who help fully implement the model. That translates to investments not only in expanding the number of midwives but also in doulas, community health workers, and other perinatal workers. Doulas, for example, have an important educational and advocacy role in improving birth experiences in hospitals. Women, across the board, have difficult experiences.
This shift to the midwifery model of care is both a structural and cultural change, right. Families would need to be educated about the value of midwifery care and see it as relevant and safe. We found in our study that many clients, even when they had the financial resources to work with a midwife, had to overcome family resistance to access care from a midwife. Family members mistakenly believed that midwifery care was either outdated or unsafe. We inherited this kind of attitude towards midwives because in the late 1800s and early 1900s, medical obstetricians successfully convinced the American public that midwifery was unsafe, that hospital birth was better than a home birth, and that doctors provided better care than midwives.
Something significant happened then with long-ranging consequences. Before then, pregnancy was a time when women provided care to other women. After that, men became the primary providers of pregnancy care. I, too, was a victim of that kind of thinking. I never considered a midwife when I had my baby, even though I had family members who were midwives. That shows how effective that misinformation can be. Cultural change is needed so that families can appreciate what midwifery care provides.
Another structural change is to make community-based maternal health investments, such as more community birth centers in Black, rural, and low-income communities, and more midwives trained to provide care in the home or birth centers.
A third structural change is ensuring adequate payment and reimbursement for midwives, doulas, and other birth workers. This would involve changes to how the government and private insurance pay for midwifery care. A somewhat related structural change involves ensuring that rules are in place that encourage midwives and obstetricians to work together for the good of patients. Rules that encourage information exchange and support between these providers, and the transfer of patients between community and hospital when necessary.
And lastly, and just as important, is providing paid family leave, for sure. An ideal coverage would be at least six months postpartum for the birthing person and their partner. Today, more than half of Black women on maternity leave do so without pay. That also means that they are more likely to work up to the day before or on the day of delivery. Stress not only taxes the pregnancy but also the process of childbirth.
What are practical ways women can advocate for themselves when something feels off, but they are being dismissed?
When we are dismissed in any type of setting, we need to recognize that it undermines our dignity. But having community support, that is, friends and family there as your witness or advocate, helps protect your dignity and empowers you to express your autonomy. Based on my own experience as a pregnant person and mother and the findings from our study, I encourage pregnant people to bring along to their medical encounters someone who loves and cares for them. The medical system is very complex, and it requires a lot of support to navigate it effectively. Family members, friends, partners, doulas, or midwives can be very helpful in advocating for the pregnant person and protecting them from harm.
In our study, some clients who saw both midwives and obstetricians valued the midwives’ assistance in understanding their medical experience or preparing for it. Clients used several strategies when they realized something was off. Fortunately, many did not dismiss their own concerns. Some took notes during the appointment and discussed their observations and concerns with others, including their midwives. Some asked clarifying questions of their providers and pressed until they understood what was going on. This takes a lot of courage because the medical visit is not set up to educate or help clients understand. Most doctor visits last about 15 minutes, and the doctor is often seen as the expert on pregnancy. The clients are expected to be passive. And others left providers who dismissed them or with whom they were uncomfortable. This too can take a leap of faith.
All of these strategies depend on the pregnant person having a support network. I’ve come to realize that our current health care systems see pregnancy as an individual event, and maybe some family involvement. But I’ve learned pregnancy is most powerful if it’s conceived as a communal event. Pregnant people benefit from a lot of support, not just from their families but also from their wider community network. It takes community support to express autonomy.
How does distrust or dismissal in medical settings affect hormones, inflammation, or stress responses in pregnant patients?
Both distrust and dismissal are harmful. They’re not just emotionally harmful; they are biologically harmful because they induce a stress response in the pregnant patient receiving that treatment. And that kind of stress is not good. The body is under a lot of pressure trying to regulate itself. So to then be dismissed or ignored by a provider meant to calm these stressors, only heightens the body’s responses to them. More stress signals are released into the body, which leads to a greater load on the body’s immune and hormonal systems, resulting in excessive inflammation throughout the body. And then breakdowns happen because the body loses its capacity to adapt, increasing the risk of pregnancy-related disorders and complications.
Dismissal also just creates more work for the patient. If the patient is trying to express concerns over a symptom and their provider is not engaging with them as needed, the responsibility falls on the patient to search for another provider with solutions. That’s more time spent. More energy wasted. And more stress. And so you can begin to see the downward spiral.
Where is a good starting point for Black new mothers looking for the best care?
I started my research wanting to know what the Black community was doing about the Black Maternal Health Crisis in 2023. Here’s what I learned about how Black pregnant people were accessing the best care. Birthing people who were dissatisfied with the level of care they received from their provider did one of two things.
One, they turned to their family and friends, their immediate network, to identify providers. What we’re seeing here is that they are doing the wise thing of consulting with family and friends, people who care about them, whom they trust, and who have had positive experiences of care. I think that it’s critically important to work with providers who are both caring and competent.A provider must be both. To me, competence without care is poor quality care. Here’s why: it is extremely difficult to trust a provider who does not care for you. I’m a physician, but it’s only recently, through observing these Black community midwives serving Black clients, that I’ve come to understand how critically important it is for one’s provider to really careabout them. Because if someone does not care about you, they will have no curiosity about you, and they will ignore what you say or what’s important to you. Worst of all, they will miss important aspects of you and your care. They will not go the extra mile to respond to your needs if it’s not easy or convenient. Likewise, the client will be difficult to trust, will be vigilant toward them, or will hide from them. And that is also harmful.
Two, they turned to the internet and social media. You can look up providers, look up reviews on that provider, and join e-groups that distribute information on the service you’re looking for. In our research, clients used social media to find resources and educate their friends and family. We live in a world where there is an abundance of information on social media, from recognized experts to lay people. And of course, when using it, discernment is needed. And discussing what you’re learning with trusted friends and family and getting information from diverse sources is an important quality check.
What would a healthcare system designed around protecting mothers, rather than managing crises, actually look like?
It would look like Deep Care, a term my team and I coined to describe an approach to care that midwives advance. Their approach prioritizes the pregnant person’s dignity & autonomy, the safety of both the birthing person & the baby, and the person’s lived experience & spirituality. They provide not only clinical services but also advocacy and education services that help their clients navigate the medical system. They are attentive and responsive to their clients, and their care centers the pregnant person’s family, providing both pregnancy education for the family and integrating family members into care processes. It would look like the U.S explicitly adopting the midwifery model of care as the foundation for pregnancy care. This would include several significant shifts, as the midwifery model of care encompasses more than just midwives.
First, the system would expand the footprint of midwives—many more in the community and in hospitals—to support healthy, uncomplicated births.
Second, the system would include more birth workers, such as doulas, community health workers, and lactation consultants, who would support families with education and advocacy around pregnancy and birth.
Third, the system would support birth centers in every community, so that maternity care deserts are a thing of the past.
Fourth, the system would demand and reward collaborative care between midwives and OBs wherever clients receive care, whether delivered at home, in a birth center, or in a hospital. Fifth, the system would ensure that birth work performed by midwives, doulas, obstetricians, etc., is a valuable and sustainable endeavor by providing living wages to all birth workers, regardless of whether this care is funded by the government (e.g., Medicaid or private insurance). This is very important because our country’s future depends on the quality of the birth experience. We don’t yet realize how important this is because the quality of the birth experience is almost universally poor in the US. Poor quality birth experience. Poor future. Sixth, given the importance of birth to society, the system (including the economic system) would provide more support for pregnant families by offering longer-term paid family leave for birth and additionalsupport through a group care model.
Thank you for reading the fifth installment of the Women’s History Month Features. Come back each day to read a new inspiring story, centering women.
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