Maternal Wealth Podcast - Own Your Birth
The Maternal Wealth Podcast creates a collective space for sharing all birth-related stories. I want to acknowledge birth's uniqueness, honor its variations, and remind us of the power we hold in giving birth.
As a Labor and Delivery Nurse, I see the impact of our stories. Let's share those stories with those who come after us to prepare them for what's to come. For those who came before us, allowing them to reminisce and heal as we realize we were not alone in our experiences.
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Maternal Wealth Podcast - Own Your Birth
Championing Maternal Safety with Cheniqua Morales BSN, RNC-MNN, C-EFM, C-ONQS
Discover the remarkable journey of Cheniqua Morales, a passionate labor and delivery nurse, as she shares her inspiring story from a curious young girl to a leading voice in maternal health. Cheniqua's early experiences as a birthing assistant and doula at the Brooklyn Birthing Center laid the foundation for her profound appreciation of both natural and medically assisted childbirth. Her journey through nursing school, while personally navigating the challenges of pregnancy, led to a successful career at Lenox Hill Hospital, where she embraced roles in postpartum and high-risk antepartum care. Cheniqua's dedication to leadership and patient empowerment paints a vivid picture of growth and resilience.
Gain valuable insights into the critical balance between natural birthing experiences and essential medical interventions. This episode shines a light on the power of effective teamwork among healthcare professionals and the impact of trust and transparent communication with patients. With alarming statistics on maternal mortality and morbidity, we explore the necessity of advocacy and proactive patient engagement. Through personal anecdotes and professional experience, Cheniqua underscores the importance of being an informed and assertive participant in your healthcare journey, with a special focus on the invaluable support provided by doulas.
We also take a closer look at innovative safety practices aimed at reducing postpartum hemorrhage and enhancing maternal care outcomes. Cheniqua highlights the role of realistic medical drills and strong team communication in improving patient safety and reducing severe hemorrhages. Her advocacy for birth equity is deeply personal, driven by her experiences as a mother and her commitment to nurturing a supportive community. Join us in this heartfelt conversation and become part of the Maternal Wealth community, committed to championing better birth experiences and maternal health outcomes for all.
Discover more about Cheniqua Morales, BSN, RNC-MNN, C-EFM, C-ONQS and her position as a Perinatal Patient Safety Nurse through the links below.
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https://uppbeat.io/t/cruen/city-streets
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https://uppbeat.io/t/abbynoise/dance-with-me
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Welcome to the Maternal Wealth Podcast, your space for all things maternal health, pregnancy, birth and beyond. I am Stephanie Theriault, a labor and delivery nurse and a mother to three beautiful boys. Each week, we dive into inspiring stories and expert insights to remind us of your power in giving birth and motherhood. We're here to explore the joys, the challenges and the complexities of maternal health, Because every mother's journey is unique and every story deserves to be told. This podcast is for entertainment purposes only. It is not intended to replace professional medical advice, diagnosis or treatment. Always consult with your healthcare provider for medical guidance tailored to your specific needs. Are you ready? Let's get into it.
Stephanie Theriault:Today is an exciting day. I have a dear friend of mine, Cheniqua Morales, who is here with us today. Good morning, Good morning. Thank you for having me. You're welcome. It's so nice to see you. I know it's been way too long. So Shaniqua and I used to work together out in New York City at a hospital called Lenox Hill. She's also a labor and delivery nurse, and that's how we came to meet. Way too long. So Shaniqua and I used to work together out in New York City at a hospital called Lenox Hill. She's also a labor and delivery nurse, and that's how we came to meet. I'm excited today because she's doing some amazing things in her practice and beyond, and I'm excited for you to learn too. Shaniqua, can you tell us a little about who you are and what got you into nursing?
Cheniqua Morales :Morales so. Firstly, I'm very excited to be here. Thank you for having me. I love your work, I love everything that you're doing and I want to say that like publicly, even though I keep telling you that, yeah, so who I am, so I am. I am a very passionate, passionate person. When I kind of lock into something, I run with it. And I started.
Cheniqua Morales :I became a nurse in 2012, but started in the birthing world way before that. Actually, when I was six, I knew I loved babies and I was fascinated by the body. My entire life I've just been so fascinated at, like, what the body can do and how we can grow a whole human. That's just like to me to this day. It's just like whoa. It's amazing. I had decided very early on that. I only wanted to go into, like whoa. It's amazing. I had decided very early on that. I only wanted to go into medicine. Well, not medicine, but I wanted to be an OB. I started along that track and at some point I shifted because my niece was actually delivered by a midwife and I learned about midwives and I thought that was really cool and I can deliver babies and do school in half time. I didn't have to do a residency program. So I journeyed into nursing and in 2008, like you said, we worked in New York City together, and New York is pretty much the only place I've worked. I started at the Brooklyn Birthing Center in 2008 as a birthing assistant and then became a doula, and that was one of the most incredible experiences. I couldn't have asked for a better start. I feel like everybody should start in birthing center because you get to see what the body is able to do on its own, and I loved it because I got to see this very organic process. But also, as I've journeyed in my career, I have an appreciation for medicine as well, and so just having that balance has been like the blessing of my entire career. And so I was there for a couple of years and then I went to nursing school and I ended up getting pregnant in the middle of nursing school and I was like so scared. But you know, I was like, okay, this is what I do. And that's when I pivoted also to working at Lenox Hill and I started at Lenox Hill as a nursing assistant. So I was doing a lot. I was working as a birthing assistant, a nursing assistant, and I was in school and I was growing a whole human myself, which was the most amazing time of my life. I never felt more beautiful, oh my gosh, yeah, yeah, when I was growing my daughter she's amazing, which she's 13 now. Time flies, it does, it does. I'm stepping into, like this space and I just look at her. I'm like, oh, but she still likes me. That's a good thing. Yes, day by day, day by day. Everybody's trying to kill my vibe on that one and I'm like, nope, she still likes me and I like her as well, but yeah.
Cheniqua Morales :So I eventually graduated from nursing school, transitioned into nursing at Lenox Hill, which was an incredible place to work. We had an incredible team there and I was there for about 10 or 11 years. I worked postpartum, I worked high-risk postpartum and then I went into labor and delivery and worked labor high risk antepartum and made my way. I pretty much worked all of the units there and it was amazing. At that point I wanted to grow more and I wanted to do more with my career. I've always been like a very natural, like I've had very natural leadership abilities and I just love empowering people and like showing people like, hey, we're doing this for a cause, right. And I just love empowering people and showing people like, hey, we're doing this for a cause, right. And so I wanted to figure out what my role was in leadership, because at that point I decided I didn't want to be a midwife anymore, but I did want to do something. And so, very long story short, tried a few different hats on. They were not a good fit, but I learned a lot. I did management for a little while. I did quality for a bit, and the quality piece really came in during 2020, because that was a very that was a terrible year for more reasons than just COVID. It was a terrible year for people of color, and especially women of color and men of color, and it was scary. It was scary, I was burnt out, I was tired, I felt like I couldn't really find my pace and then, everywhere I looked, people that looked like me were dying, whether it was women in the hospital from a childbirth, something that was preventable, a preventable complication or whether it was George Floyd and you know just that whole thing. And I just knew I needed to do something. I've always been an advocate for justice and I was like, how do I tie my profession into this justice piece? And that's when I started really looking into quality and thinking about just kind of like what do I need to do to make things safer for women and birthing people of color? And just like going down that route. And so got into quality because I figured if we're going to make things better, I have to know how to use these tools, these measurement tools that our hospitals and healthcare organizations are using. And so got my certification there and really started kind of going down that road. That was amazing because I was able. I hated quality before Stephanie. You couldn't tell me nothing about quality, and you know this.
Cheniqua Morales :In the hospital, quality for a long time was like Foley catheters and CAUTIs and all these things that we never had on labor. Like none of it applied to us. I didn't care. So when they finally found metrics that mattered to me, I was like, yay, I can do this. Now I really just got to a place where I I developed my skills.
Cheniqua Morales :I was really intentional.
Cheniqua Morales :I've always been very intentional about mastering my craft and like developing my skills and, you know, starting to address different issues in the hospitals, in the healthcare spaces, finding allies and friends that like were doing this work, and got very, very, very involved with AWAN, our professional organization, association of Women's Health, obstetrics and Neonatal Nursing, and so got very involved there and it's just been an incredible journey.
Cheniqua Morales :And, to make a longer story even longer, I have now found an incredible opportunity with New York Presbyterian really take all of these skills over the past 10, 11 years and all of this passion and all of this energy that I have and really put it into something meaningful with one of the most incredible teams I have ever worked with as a patient safety nurse. And that is where I have landed. I do feel like this job was absolutely created for me. It is everything that I want it to be. I get to be my kind of crazy and also impact positive outcomes, and so it's just been a true blessing Like the journey has been hard, but I have an incredible sister circle. I have people like you who I can lean into and watch the work that you're doing and feel encouraged. You know when we get tired, and so it's been an amazing, amazing journey, and that is how we got here.
Cheniqua Morales :I don't even know if I answered your question, but here we are.
Stephanie Theriault:You did, but I want to ask you perinatal patient safety nurse for our listeners aren't patients safe in the hospital? What's going on, ooh girl?
Cheniqua Morales :Yes and no. I think what's happening in a lot of these institutions across the country, across our state, our city, our country. A lot of us are aware of the maternal mortality statistics and how the US has the worst outcomes for birthing people of all the developed countries, which is awful, because you know we're supposed to be this thriving country that just has everything you know winning, and that's not where we're winning. And so, no, the hospitals are not a safe place if people are not intentional about making it a safe place and it's not an individual. Sometimes it can be, very rarely it is. So one of the things in my role that I do is we review cases and we go through things and we look to see, you know, what went wrong and why. Right, and it's very easy to blame people and individuals. It's very easy to say, oh, you didn't do this or you didn't do that, but we don't take a minute most times as a healthcare system to look at the overall grand scheme of things and accept the fact that it is a very complex system, that is layered, and if I am not set up for success as a nurse with the tools, the education, the resources, the understanding, the culture of safety and collaboration and non-blaming and non-bullying. If I'm not set up with that, it's very likely that mistakes will happen and there are statistics that show not just in OB but across the board, medical errors are the biggest cause of death. And that's just national, very public news. It's easy to make a mistake, it's easy to feel overwhelmed, it's easy to get scared, it's easy to misconstrue or misunderstand what the care plan is if there's not really good communication or effective communication. So it's so layered that it's not safe most times, unless we have leaders and organizations that are intentionally putting processes into place that will create a culture of safety. And I love that about where I work because that is exactly what our leadership is intentional about really creating a culture of safety.
Cheniqua Morales :Then you have patients that come in their families. They know, they're very aware of statistics. It's not like we are hiding anything. We have them coming in and they know the stats. I've had patients during COVID and they were women of color and they were just like I don't want to die. I know the statistics in New York. I know the statistics in the five boroughs. You know our statistics are for every one white woman that dies, you have eight black women in the five boroughs that die right. So they're aware. Patients are a lot more intentional about their knowledge.
Cheniqua Morales :For the most part, google at one point was a big thing, but now we have AI. We used to laugh, we used to say, oh, dr, google, bop, bop, bop. But now AI is pretty accurate. You put anything in there and it will give you a very accurate synopsis of whatever you ask. And so we have to meet our patients where they are. We're not here to tell them what to do, but we are here to guide them and help them understand the importance of decisions that need to be made based on their care.
Cheniqua Morales :And, like I said, I started in a birthing center, so it was a very organic, hands-off, very natural process. But there were women at the birthing center that needed a C-section or needed an epidural, and they did get transferred out and that was okay. They weren't made to feel terrible because they needed this. So I think striking that balance is really important. So, quite honestly, I think when it comes to safety is twofold.
Cheniqua Morales :It starts with the clinical teams. I don't care who you are in the clinical team, whether you're the provider, you're the doctor, you're the midwife, you're the nurse, you're the nursing assistant, you're the clerk. You are all part of this clinical team, right, and making sure that we all as a clinical team can get along, can be respectful, can effectively communicate and, most importantly, respect each other's expertise. We're all trained very differently. Doctors are trained differently from NPs. Nps or midwives are trained differently from doctors and PAs. Nurses have holistic model. Doctors practice from the medical model. We have to understand that we're all looking at this patient from different angles and every angle is so important. So I can't disregard your angle as the OB, because you're seeing it from your perspective and now I'm bringing mine to the table and we can provide a more holistic care. So that's the first part of safety is making sure the team has the tools to operate effectively, efficiently and safely. The second part is making sure that we hear our patients, but we're also honest with them. We build trust with them so that when we make recommendations as providers and nurses and clinicians, they will trust and follow the recommendations that we're making.
Cheniqua Morales :I've been in places where people are like oh you know, I think I was on one seminar years ago and the person was like yeah, my doctor told me that I was at risk for high blood pressure and all of these other things, and she was upset about it. But the fact was she had a high BMI. She was at risk, right. So, even as a patient, we have to be accepting of what is true. I'm all about a low risk.
Cheniqua Morales :All natural birth in a birthing center or even home births, I'm all about it. I all natural birth in a birthing center or even home births, I'm all about it. I think our populations, at least here in New York and in the five boroughs is where I can speak to. We're older, we're sicker and pregnancy just exacerbates whatever underlying issues you have. So we'll take ownership as the patient side of our health, our mental health, which is huge, especially after COVID and our physical health, you know, and whatever that looks like, whether you decide to do it in a holistic way or in a best chance also to grow this incredible human and keep ourselves safe as women and birthing people. So I think the safety piece is twofold it's not just it's, yes, the hospitals, but also us as individuals. And so having these forums to have these kinds of conversations honest, organic, truthful, transparent conversations is really important.
Stephanie Theriault:When you talk about safety, it's not just maternal mortality. Does it include other things like safety for the baby, outcome complications? What else does it include?
Cheniqua Morales :Maternal mortality. I mean, when we look at it on a grand scale of things, I think we are at about 1,200 deaths a year approximately. I got to check the stats, but it's approximately 1,200 deaths a year across the country.
Stephanie Theriault:That's insane. It is.
Cheniqua Morales :It's a lot, but my thing is more like I'm very much about taking a proactive approach. And before somebody dies they get really sick, which speaks to that maternal morbidity piece. So if we can really and maternal morbidity affects for every I feel like, oh, I don't have these stats, I have to get them for you, but for every one and please I hope I'm saying this correctly for every one person that dies of child pregnancy related complications, 70 women or birthing people become severely ill from these complications. What does that mean? That means they are so sick that it changes the entire course of their life. They can't function the way they were functioning before. They might have had a stroke. They now need home care like this wasn't the. They're alive, but their standard of living or their way of life is completely altered because of the complications that took place during the pregnancy or delivery and or postpartum period, and that, to me, is that's just as awful. Like you come in, you're excited about having this baby and then you know there's a story about a woman who ended up having an entire stroke and she had this baby and she has, but she was in the ICU, for you'll hear these stories. She was in the ICU for weeks, never really bonded with her baby. Her whole right side is paralyzed, she's in PT and I can't imagine looking at this child and feeling like this was not the experience. I feel robbed of the experience that I wanted and now, like you can't pick up your kid, or you can't like play baseball with or play run with your kid, whatever it is you want to do with children, whatever it is you had in your mind, you can't do because you're sick and you were fine before. So to me, the morbidity. I am more passionate about the morbidity piece because right before mortality comes morbidity. So if we can improve the morbidity or reduce the morbidity piece because right before mortality comes morbidity, so if we can improve the morbidity or reduce the morbidity, then we can send patients home healthier, safer and able to have this incredible experience that they wanted to have.
Cheniqua Morales :My role also does include the babies as well. It includes the neonates. Some of what I do with that I'm not NICU, I'm not, that's not my jam. Shout out to all the NICU nurses I will pass that kid to you in a heartbeat. But it does include making sure that in those first couple of hours of life, and even like those first couple of days in the well baby nursery, like the processes and the standards are safe. And so, yes, part of my job is reviewing neonatal occurrences or incidents that happened to see where we went wrong, or to see where the system went wrong or what barriers. What does my team need? What supplies do they need? What you know, what workflow do they need? And just listening to them to find out what that is to make it a safer place for healthy babies and healthy moms.
Stephanie Theriault:In the media and you have mentioned that women of color are dying from preventable causes. Can you speak to? What are these preventable causes, so that women who are going into the hospital can be aware of what these causes are to keep?
Cheniqua Morales :themselves safe, absolutely. In New York City we have what's called MMRCs and they are Maternity Mortality Review Committees. Right, we have them for the state, we have them for New York City. This group gets together and really looks at what went wrong. They review all of the cases of maternal mortality, look over what went wrong and it was, I think, 10 or 12 most common causes of maternal mortality. Some of them include postpartum hemorrhage. Some of them include hypertensive crisis and complications. Some of them are cardiac related. It can be. It varies but when we're talking about preventability, we're talking about Particularly in the hospital, us being ready, practicing for these emergencies.
Cheniqua Morales :This year I focused heavily on postpartum hemorrhage, because that's one of the biggest common causes of maternal morbidity and mortality, and so really readying our teams to recognize what does this crisis look like, how do we respond to it, how do we communicate in the middle of the crisis? Communicate in the middle of the crisis. So if I'm speaking to patients, I want them to know like, yes, come in with your ideas, your birth plan, what you ideally want, but please know that, as organic and natural as birthing is, it's also just as life-threatening. And that's just because that's just what it is and I can speak for myself as a nurse, right, like if I'm going to go in and have this conversation. I remember one night I had a patient and she was having really high blood pressures, like severely high. Anything over a systolic blood pressure over 160 is we're freaking out a little bit because you're at high risk for stroke, right, you're at high risk for seizures, you're at high risk for all things. And I remember she wasn't my patient. My patient was sharing a room with her and the nurse came out of the room. I was like she wants to go, she wants to leave, you know, against medical advice and her pressures are so high and blah, blah, and we get righteously indignant, but we have to be mindful of how we're bringing that to the patient. And so I went in the room. I wasn't really going to do much, but I went in the room and just ended up just having.
Cheniqua Morales :I sat down with her. I was like, hey, my name is Shaniqua. Like what's going on? Um, I'm a nurse on the floor, you know what's happening. And she ended up talking to me. She's like I just need to get home. You know, like I don't want to take these meds. I'm not into meds and, as people of color, we don't trust the medical system. There's plenty of reasons why we don't. We don't trust the justice system and we don't trust the medical system. And so I said you know, we just had a little bit of a conversation she don't want to take meds. She's like, I'm just stressed out, that's why it's so high and I just took a minute to tell her listen.
Cheniqua Morales :I don't know why this happens to us more than other people, I said. But what I do know is you're not stressed out, it's not resolving the way that we would have hoped. And so she had, I think, three or four kids at home and she was like I just need to get home to my babies. I was like, well, if you go home and you have a stroke and you die, you won't see your babies ever. And I wasn't saying it in a way of scaring her. She didn't take that from me. I was telling her these are the risks.
Cheniqua Morales :Sis, I need you to understand that we want to help you, but we have to stabilize you first. As I kept listening to her and her concerns, I explained the medications and what they did, because she had questions about them, and so I explained it and I just told her hey, this is what this medicine would do and this is what this medicine will do, and maybe you don't need to be on it forever, but for now, just to keep you in a safe, health, you know, therapeutic place. We really recommend that you do, and I think I spent all of like I don't know 10, maybe 15 minutes which you know at the bedside not all nurses. We don't always take the time to talk to our patients, which is not good, but I knew she needed to be heard and the real reason why she wanted to leave AMA was not for any of those reasons that she gave me. It got down to I would just want my baby.
Cheniqua Morales :My baby was diagnosed. She was basically a readmission into the hospital. She delivered a week before her baby was diagnosed with sickle cell. She just wanted to be her baby. I said we could do that. We can absolutely do that. I said you need to have somebody here with your baby, but your baby can come and be with you. And she just looked at me and like you could just feel this release of her, like somebody heard me, somebody is listening to me, you know, and we were able to get to the core of the problem and or her concern.
Cheniqua Morales :And we got her baby there and she ended up getting the meds. A couple of days later I came back to work and someone in the nurses was like yo, whatever you said to her really stuck with her because her partner came the next day, because at that point I was on night shift and her partner comes the next day and the nurse says to me she was like, yeah, her partner said no, don't take the meds, it's not good for you, for you, and she was like no, no, no, I want to, I want to take it, so I don't have a seizure. She was able to and he was like, oh, okay, so you know, we have to be willing, as clinicians, to have these very transparent conversations with people and there's a difference between accountability and blaming or judging, and if a person, especially a person of color, feels judged, they're not. No one that feels judged is going to want to do anything you say to do right. So, as people coming into, as families coming into the hospitals, I would ask that you definitely understand the risks of any comorbidities, complications that you're having during your pregnancy.
Cheniqua Morales :If you have them and ask questions, have someone there that can ask the questions for you. Get real inquisitive, but do understand that these are real conditions and I am in a space where I am preparing my teams to be able to have those very therapeutic, effective conversations with their patients, because I think that's really, really important. Even when you're finding your providers, if they don't resonate with your soul and I know a lot of us, we have to go by the providers within our insurance network and that kind of stuff but like, find someone you can trust and that you feel peace with or that feels peace in your spirit with when you're thinking of your providers, right, or your midwives, your OBs, whoever it is that is going to be delivering and handling your care. Those are some of the things that I would say and just ask a lot of questions.
Cheniqua Morales :Yeah, that's really what I would say Do your homework, do your research on your own personal health and then come in with questions and be ready to be a part of your care is what I would say.
Stephanie Theriault:When you mentioned finding somebody that resonates with your soul and who listens to you, what would you recommend for our listeners? Someone's in the hospital, they're in labor and the specific provider is just not being respectful, not listening. How do you go about finding somebody else in that situation?
Cheniqua Morales :I think you can ask. I think the most you can do is you can ask your nurse. You can ask your nurse and say, hey, listen, this is how I feel. If you're not comfortable enough, or the partner or the family member is not comfortable enough, verbalizing that with the provider. I think it's a question you can ask your nurse to ask like what do I do here? I don't feel safe with this provider, I don't feel heard with this provider, like what do we do? But at that point I think, as the nurse, I would escalate it. Most hospitals have different chain of commands. We do, at least in our hospital, we'll do a huddle. Well, we have tools where we can say listen, this is a concern of the patient. There are different hospitals. If they have, like a patient experience team, while you're in the hospital, ask for them Really getting a good idea of what the resources are and finding out how exactly that would work. I've seen it happen in different places that I've worked with anesthesiologists or nurses or providers.
Cheniqua Morales :I've seen it happen and more often than not hospitals want to give you a good experience for ratings right they want you to have this great patient experience and they'll send you a letter, you know, in the mail after you deliver. And I think voicing your concerns is important and having a place to go and say, hey, this was my experience or this is my experience and I don't like it, but don't be afraid to speak up. I think a lot of times people are afraid to speak up because it's like, well, if I say something, they're going to do something like that retaliation. And if you feel that way, again we have to be brave. It's not an easy thing and I don't think anyone who is laboring and about to birth a baby needs to be put in that predicament. So I would say absolutely. Have someone who can advocate for you a family member, a partner. Ask a provider before you even get to the hospital During your visits. Have very intentional questions in your prenatal visits with your provider, go on the tours, look up reviews, if you can, about the hospital before you. There's so much you can do before you get there. Because when you get there, I mean, it's just kind of like a roller coaster ride, like everything happens really quickly at that point and it's very intense and scary. So the fear also compounds how we all respond. So I think doing your due diligence before you get there is really important. If you get there and it is not at all what you thought and you are truly concerned, have your nurse escalate it to patient experience or a supervisor or someone that is higher up. And if you still don't feel heard, there are different surveys that you can take that are anonymous. I know we're doing a PREM survey which talks about your experience. Did you feel like you were affected by racism? Did you feel that you were heard? We do that survey at our institution. There are places to voice your experience and your concerns and ultimately write a letter. Like we have to put things in writing. I think nobody's going to like that.
Cheniqua Morales :I'm saying this, but I remember being in a hospital that I worked at and we literally had one anesthesiologist on the floor one. So if a patient was having a cesarean right, the OR was running and the patient was in the back getting a cesarean section and you had a patient laboring on the floor. That patient on the floor, who requested an epidural for pain, now has to wait until that one anesthesiologist comes out of the OR. Yeah, I hated that. I was like this is stupid, like why are we doing this? And you know, as a nurse, we know all the things that are wrong and we take it to management and sometimes we're not heard. So what I started doing was I said, hey, you're going to get a letter in the mail. Tell them, shaniqua was amazing, your nursing care, your provider, is incredible. Tell them about that anesthesia. Because they would tell me, especially on postpartum, like I had to wait all this time and eventually, enough.
Cheniqua Morales :People wrote letters and I started getting all this recognition, like, oh, shaniqua, you know you're being recognized. I was like, oh, they're really writing these letters. They also like put it in a letter about anesthesia, how long they had to wait. And after maybe a couple of years, we ended up finally getting two anesthesiologists on the floor. Okay, yeah, so we had one to work the OR and one to work the floor, and that came from the patient voice, and I don't think patients realize they have so much power in writing a letter or voicing their concerns instead of trying to fight a system in a way that's ineffective. So I think we need to be more effective in how we strategize, and so that's what I would say Advocate for yourself.
Cheniqua Morales :If you're not happy, say something. And if even then, escalate it even more. Write a letter, write an email. People listen, they respond to those things because ultimately the goal is a good experience. Now, if it just didn't go the way you wanted it to go, that's. You know, I've had patients where they just were so intentional about wanting this like vaginal birthing experience, but it just didn't happen right, like that way. And my goal as a bedside nurse was always I want you to have your best chance. I want you to know you left that labor, that hospital, that delivery, knowing you did everything you could to deliver this baby in the way that you wanted to, right. But sometimes life just doesn't work that way. And my thing was, if you know you did everything you could, at least you have that. You still missed the experience, but at least you'll have that and all of my patients they always appreciated that.
Stephanie Theriault:They always should have appreciated that I agree with what you're saying, that they just want that chance. Yeah, absolutely.
Cheniqua Morales :Absolutely.
Stephanie Theriault:One other thing I wanted to mention about advocacy. A lot of times, with the role of a doula, that we think of just physical support, but with a doula they also advocate. So if I'm the patient and I'm scared and no one's listening to me, my partner's scared, or if I have my family with me, everyone's in the moment, in the emotion, and then a doula is separate. They can also be a good advocate for you. Would you agree?
Cheniqua Morales :I would absolutely agree. I'm going to say this because I was a doula and I did work in that space, especially with the birthing center. We are all part of this birthing team. I think what happens is I have had the most incredible doulas since I've become a labor nurse Incredible.
Cheniqua Morales :I remember one doula truly advocated that her client didn't want an epidural and she didn't want to be rushed. There was no clinical concern for the baby, the patient just wanted to deliver her way and let her body do her thing. She did need some Pitocin and some medicine to help her along, but she didn't want an epidural. And I remember I was covering this lady for 30 minutes, maybe an hour, it was a short break and I walked into the room just say hey, what's going on? And I walk in and like the room is calm, she knows she's there, she's on her Pitocin, she's on her Pitocin. You could tell she's really focused on getting through these contractions unmedicated. And her doula walks in and I just said, oh my God, this is so beautiful. I woke in and I talked to the doula. I said do you guys need anything? They were like no, we're good. I said okay, and they had music, the aromatherapy going. It was beautiful and I just walked in I was like there's nothing for me to do here. I'm going to let her keep doing what she's doing because she's doing great with her client.
Cheniqua Morales :With that particular patient, the doctor did want to suction her quickly, we all knew it, and that dealer was like no, is there a medical indication? So, keeping it very to your point, having that person that's grounded and not emotionally attached, is huge. And that patient had a beautiful delivery. And then she even came back and she had mugs. She remembered me just from the one time I went in the room to check on her. She came back with gifts. Like I'm a nurse, what's your surprise? These little tumblers. It was beautiful and I was just like holy cow, like you really don't know how you affect people in those small moments, right, and that to me was the most incredible experience of a doula because she was there to support physically. She was there to advocate. She was not giving medical advice, she wasn't creating barriers, she was just advocating in her space and it was beautiful.
Cheniqua Morales :On the other hand, I've had doulas that literally have shamed the partner or the husband in the room. They want to be the center of it. They want to be the reason that the mom is going to win and have this vaginal delivery, and it creates a very, very hostile environment in the room. And there was one provider that I worked with that I absolutely loved her God, her heart, amazing woman, amazing doctor. And there was a doula that came in and the doula was just talking and making everything about her and I'm trying to center on the patient. This is not your experience, this is not my experience, this is her experience. We have the blessing and the honor of being a part of this, but it's not about us, right. Blessing and the honor of being a part of this, but it is not about us Right.
Cheniqua Morales :It got to the point where I watched the father disengage with the doula. He was over it. Yeah, the ma, the mother, is laboring. I'm very confused about what to do, because how can you labor and just do this thing? It's like working out while also trying to make huge life decisions. That's crazy. Like how do you do that? You can't do that. And at some point, even the OB was really upset because she made a recommendation and the doula was like, no, that's not your role as a doula and that I'm very good with working a room and kind of building trust, and patient ended up coming. She's like what should I do? I said, listen, I think you should do A, b and C. We've been here for a while. This is the situation. And she was like okay, at that point I knew I had the trust of the patient and the husband more than the doula did. Turns out this doula was also stealing instruments from different hospitals. Yeah, she's crazy she's crazy.
Cheniqua Morales :Yeah, sounds like it. Yeah, she's nuts, and that patient went on to have a very beautiful delivery. So, just like you have I don't want to say bad, but just like you have like challenging doctors, you have amazing doctors. Just like you have challenging midwives, you have amazing midwives. And for nurses at the end of the day we're all human You'll have incredible doulas, and then you'll have doulas that you just refuse to work with, that are truly overstepping. And I say this because I was a doula. I took a lot. So I think when the birthing team meaning the family, the patient, the doula, the nurse, the provider when they're all working in their very specific expertise, so beautiful, it's sort of like coordinating, like an orchestra, right, yeah, it could just be so beautiful for that patient and so empowering, because this is just the birthing part. She's still got to raise this kid. Yeah, you could just get one win in the beginning.
Cheniqua Morales :I feel like that could probably help you through the rest of it, but I think that's the importance of having a very just, intentional birthing team. It can be beautiful as long as ego and pride and control are not in the mix or in the recipe. That causes a lot of contention and you don't need that when you're laboring Like you just don't need that energy.
Stephanie Theriault:I want to talk a little bit about your other role as a patient safety coach for obese.
Cheniqua Morales :My role is very cool because I get to work with all of the leadership teams, meaning nursing, nursing, leadership, anesthesia, do any events that were reported to me by the staff? I get to look into it and investigate it and come up with a plan to make it safer or to resolve the problem. I am like the rich auntie on the unit. I don't have to be management, I don't have to write anybody up, I don't have to man anybody nothing. I go to their parents. I'll be like listen, this is what the data is showing, this is what we're seeing and this is my recommendation on what we need to do. I'm very intentional with my role because I get to pull in all these teams and one of the things that I do is I'm big on what's called interdisciplinary learning. So that means I pull in an anesthesiologist, I pull in a doula, I pull in a midwife, I pull in an obstetrician, anyone that's on this clinical team. We all go into a room and we do what's called simulation drills. So we get to practice.
Cheniqua Morales :I made some very cool blood practicing with a girl. It was like, oh my God, amazing, amazing. Anybody who wants to see this blood? You can go to my LinkedIn or my IG to see this blood. It's amazing, it's disgusting. It looks so gross. I was like mixing it and I'm like ew, this is disgusting, it was amazing.
Cheniqua Morales :Got your hands in it and everything I did, but I had gloves on because I can. Okay, okay, no, but it was great, right, and the recipe I use is just so fun and I like to make these learning environments fun, so I basically set up opportunities or rooms and courses and classes where I create a scenario and I say, okay, this is the scenario, what would you do? And we just all practice together. I meet all this blood and we were talking about weighing it and what could happen and whether the repercussions if we get to this point of blood loss and when I tell you we have reduced our severe hemorrhages from January to now by almost 10%, oh, wow, yes, by bringing all of the teams in and saying we're going to practice, we're going to do a drill, this is what we do, this is how we do it, this is what your team does and this is how we're going to effectively communicate. It has improved our outcomes tremendously and this year we have sent so many people home safe and healthy and it is just a big, big, big win. So when I'm working with the teams, I'm working on a system level, in the sense of, hey, let's go have some fun and learn and let's talk about why we're doing a lot of what we're doing and they get on board and then they go and they do it at the bedside and they understand the expectations of each other, and so that's the beauty of my role as a safety nurse. We do drills on postpartum hemorrhage. We're going to be doing some drills on hypertension. We're going to be doing some different drills with babies. I'm going to be, working with the NICU team, do some drills to prepare with the babies. So it's fun, and so I come up with all of these ideas and sessions and things based on the metrics that I'm seeing. Am I seeing too much of one thing? Am I seeing a risk that could happen but hasn't happened yet? Remember, we talked about preventability, right, and so I'm looking at the workflows. How do we make this workflow better? So it's very cool.
Cheniqua Morales :I'm like the kind of the coordinator of all the teams and bringing them all together and putting like magic in the room and they love it. They really love it. You have a few that are not so excited, but you always will yeah, you always will. They're just not happy. Yeah, it sucks for you. We're still going to do this right, but I'm very, very proud of my team and the work that we're doing, the work that they're doing, my leadership team for just allowing me to be my kind of crazy. I'll come up with an idea and they'll be like, okay, go do it, but building relationships with them is the biggest piece. I don't tell them what to do directly meaning the staff. I let their respective leaders do that but I do come in and really focus on the clinical practice piece how do we get better as a team? And that has really been fun, and it's just been awesome to see our metrics, like our numbers get better and sending patients home safer and healthier it's amazing.
Stephanie Theriault:That's really nice to hear, because that's what the American woman need. When we think about birth and we're talking about hemorrhage, it's not just about dying from postpartum hemorrhage. If you have a hemorrhage, it still affects your outcome. Postpartum right, we'll give you the medicines to help you, but then you don't feel great when you're in postpartum. It can affect your recovery. It can affect your breastfeeding. So there's different aspects to having a postpartum hemorrhage that aren't as grave as dying but that will affect your outcome and then, subsequently, your postpartum journey.
Cheniqua Morales :At 110%, and that's the part where I'm like I pray every day. I want to make that better. I want people to go home with the picture in their mind that, like, everything doesn't happen the way we want it to, but it doesn't have to happen Again. I, I'm working out of that. 73% preventability, you know? Um, that's a big number. That's a huge number.
Cheniqua Morales :I think you know, when you come into these spaces, even after, I think, make sure that you ask any questions that come to your mind. And I specifically want to give this to as women of color, we go a long way when it comes to holding out, being strong, not asking questions, not wanting to be a bother. Right, that's not it. That's not it. We have to ask questions, we're not bothering anyone, and so we really got to get out of that mindset of thinking we need to do all things and I can, I'm fine, I'm good, I'm just tired Making excuses, of writing things off that just don't feel right in your body. It's easy to do that after you have a baby too, and it's easy for people around you to do that, and I think that's the biggest thing. When you know something is you know your body best. And when you know something is not right in your body, you have to say something, you have to call, you have to be very clear. Make sure you're following up on your visits. If you start having intrusive thoughts or things that are just not, you ask for help. It's okay. Like we need each other, and I think we need to be in circles that uplift each other, that empower each other, but that also give us a space to say, hey, something's not right, I need help and we can lean into each other. You know and I think that's one of my biggest takeaways especially when you go home, the hospital is two or three days right, seven days if you're complicated, maybe you know a little longer. Right, if there are serious complications. But the biggest part of where these maternal deaths are happening and these complications are happening are in the postpartum period, when you go home.
Cheniqua Morales :Anything can be a barrier. We know there's something called social determinants of health, right, like where you live, where you work, how much money you get if you get time off from work, all of those things work, how much money you get if you get time off from work, all of those things. But we can't let those things be the things that determine our decisions when it comes to life-threatening issues. However way you need to get to your doctor or an urgent care or an ED, get there if you need to. However way you need to lean into different resources or people, do it. However many times you need to call your doctor and keep saying, hey, this is what's happening.
Cheniqua Morales :Do it because staying quiet doesn't help, making yourself small doesn't help and making excuses like, oh you know, I have my kids. Yeah, we know. That's exactly why. That's probably the reason why you should follow up on anything in your body that just feels really off past, regular fatigue or things like that, because that's where it's happening. It's happening in that postpartum period, from the time you leave the hospital up until one year, of having your baby out and not trying to handle it yourself or being embarrassed for any reason at all. Really let go of that shame and like just seek out the help that you know that you need is my biggest takeaway as I mentioned earlier, I love a good birth story.
Cheniqua Morales :I would love to hear okay, all right, I would love to hear your birth story, okay, my birth story. So my daughter was disrespectful and I got married and then I ended up getting pregnant, like quite literally in the middle of nursing school, and I was so mad. I was like I wanted to be a nurse so I can get my coins, I can get into nursing. I had plans, okay, and here she comes. And what was even more disrespectful was I was due in September, which was supposed to be my last semester in nursing school. It was also the rotation that I waited the entire time. It was my OB rotation, my labor and delivery rotation, and at that time it was labor and delivery for six weeks and then peds for six weeks. She's due at the beginning of September. I was like you couldn't be due at another time, like August, like this is when you want to be due. This is disrespectful.
Cheniqua Morales :So I was actually a patient at the birthing center because I love the midwives, that I trust them like fully and completely, and I went into labor. You know, I got to the birthing center and they were amazing. I was not calm enough. I think I was very anxious. Obviously, I was scared. I was like nervous. My sister was with me, my husband at the time. So we're not, you know, we're not together anymore, but he was great because my daughter is beautiful. But she, I was there at the birthing center and it was amazing. It was great, but I was. I was there at the birthing center and it was amazing, it was great, but I was. I was really uncomfortable and I kind of stopped at four centimeters Now me having been at other deliveries I was like, listen, we got a 24 hour window here.
Cheniqua Morales :We don't have any goals. Ultimately, yes, I want her to come out the bottom, but we are not struggling here. Okay, couldn't tell me we were gonna struggle at all. And so, um, at that point I had I had, I was at four centimeters and I just wasn't making change and they were like we're gonna send you, we're gonna transfer you to the hospital. I'm like it's fine, like I did not want a c-section. But I was like, listen, it is what it is. I get to that as I'm in the ambulance, my water breaks and the problem is, you know all these things in your head, so you're like you can anticipate what's going to happen. My water breaks and I was like, oh no, this is going to get worse. So I just I just kind of went like this, just tried to keep it together, cause I am a G, you will not catch me crying in public. I'm from New York, from the city, we do not, um. So I end up getting to the hospital and I remember looking up and seeing the.
Cheniqua Morales :Now I was a night student. We did our clinicals at night, so we had our own squad right and we had the day students and they were corny and I didn't like them, but it used to be a thing too that was like anyway, um, but I remember seeing the day students doing their rotation. Now one I'm in labor. I'm on the opposite side of this equation. This was disrespectful, so I'm upset about that. Then I'm upset that they get to be here for clinicals and I'm here to actually have a baby. I remember I was so mad. I was so mad with so many emotions, and then I'm I'm contracting, all at the same time all at the same time, all the things all the things.
Cheniqua Morales :And I remember making eye contact with one of the nursing students and she looked at me like like she knew me and I get, I know I gave her this. Look like, don't act like you know me, don't say nothing to me and don't come in my room. No, stay out. Yeah, I was like this is not no Cause. I was jealous of them too, cause I was like why do y'all get to be here as students? I was so mad and so I get into the labor room. I ended up, um, the part for me was I really wanted an epidural and they were just the nurses that I had. The day nurse that I had that received me, had the worst attitude, you know, and I did lose. I did lose it a little bit, you know, while I'm waiting for this epidural. But after I got the epidural and I was fine, I was better. I was like listen, I'm so sorry, you know, if I was like you know extra or whatever, I'm telling the nurse and she's like, yeah, okay, and I said, oh, lightning's Hill, having worked at the birthing center at the time that I was also having this baby, I was like we don't do this, so it made me upset. The other piece, too, was like I would fall asleep during the. You know, you're falling in and out of sleep during labor, had my epidural and all of a sudden the nurses would run in the room and go under my gown and like do things. And I'm like it was startling. It was like who's under my gown? Like what are we doing? I don't even know who you are. It was terrible and I'm like I never like it was awful.
Cheniqua Morales :And then, when I changed the shift, happened my midwife. It's time for me to push. I'm pushing, I'm in stirrups. Now, remember me and my midwives. We're friends because I've worked with them and I'm literally. People think that you know people that are in labor if they're in and out of sleep or in and out of like what looks like consciousness, that they're not listening. No, we're fully aware.
Cheniqua Morales :And so this day I remember my midwife. I'm in stirrups, right, so my legs are up and pushing. My midwife is like. My midwife is like oh, we're going to do skin to skin. And the nurse the night nurse there was like no, we're not, I'm taking this baby to the warmer. And I looked at her one because this midwife was my friend and I'm very protective of my friends. Don't talk to my friends like that, yeah. And number two, like who are you talking to? Like why are you having such an attitude while I'm pushing? Like it was just awful. And literally my midwife was like what are you going to do? Take the baby out of my arms. So she was advocating for me, which I felt so good about. But the nurse was just so gross. She was just awful, yeah.
Cheniqua Morales :So I ended up having a beautiful delivery, pushed this kid out, but, stephanie, I told you she was disrespectful. She came out meconium, everywhere. You're crapping on me already. You just got here, like you've already. I'm already here, okay, patient and not a student nurse, and now you're crapping on me. She wasn't that cute. My kid was not that cute. You know we see babies all the time. This one. I did not post any pictures until she was like a month old. Now she's gorgeous, she's beautiful.
Cheniqua Morales :Yes she is Thank you, but I took that I took. It was a beautiful experience because I did have a vaginal delivery, which, thankfully, I was able to. I trusted my team, like my midwife. I was blessed enough to not have to worry. I knew what they were doing, I knew how they worked. My sister was in the room. It was just a beautiful, it was amazing. It was an amazing birth.
Cheniqua Morales :And then, when I went home, I thought about what happened and I didn't like it, and so I did two things. One, I wrote a letter. That was then. I wrote a letter to, I think, the supervisors. It was printed out, all of my demographics were taken away from it, but it was handed out to every nurse on the unit. Oh really, yeah, they shared my letter Absolutely. They called me back. They said we're so sorry you experienced this. I said listen, I work as a doula and a nursing assistant. I work at Lenox Hill Hospital. We do not do that. That was very it was awful and I'll never forget it, you know. And so, in addition to so, I wrote my letter and I was very pleased.
Cheniqua Morales :Now, six weeks later, I had to go back to my rotation. So I prayed to God. Nobody remembered me. I was like, oh God. And then I took all of that into practice with me and did the things where I would tell the patients, hey, I might have to turn and reposition you or prep them or give them a heads up, ask for permission to touch them, the things I didn't like that happened to me. I was very intentional about not doing those things with my patient but still keeping my patient safe, and I think that was the beauty of the takeaway for me. Last part I did end up in my.
Cheniqua Morales :I went back to school six weeks later to do my PEDS rotation. That same girl that I told you was there and looked at me. She looked at me again. I gave her another look while we're sitting in pre-brief and and I was like, oh no, we're not going to talk about that. And then she just looked away Like I just gave her a look like you will not. We will never discuss this. Well, it's a funny story, but she, my daughter, has been the most incredible blessing of my life and I think she's a lot of the reason why I just keep going and I keep advocating and I keep doing things. One because she's expensive as hell, oh my God, but two, because it's just been such a beautiful journey for me and I pray that I can extend that to patients and now to also nurses, who can then extend it to even more patients and have like a wider ripple effect in this work in a positive way.
Stephanie Theriault:Yeah, I think that's exactly what you're doing.
Cheniqua Morales :Thank you, I received that.
Stephanie Theriault:Thank you so much for taking the time to chat with me it was great.
Cheniqua Morales :Yay, this was so fun and please continue to keep doing what you're doing and anything that I can do to support you or any of the listeners, they can always reach out. I'm on LinkedIn, just under Shaniqua Morales, and then I'm also on Instagram, at the Birth Equity Network on Instagram, and you know, I'd love to just continue the conversations and continue the work with you, stephanie, and anyone who's willing to partner in this work, because it's awesome, exactly, exactly.
Stephanie Theriault:It's people like you are making movements and keeping women safe, so thank you for doing what you do, thank you.
Cheniqua Morales :I totally receive that, because that is the only mission that I have at this point. That is my main goal.
Stephanie Theriault:I hope you enjoyed Shaniqua's story. Here at Maternal Wealth, we're honoring the women who are making change, who are recognizing the risks, who are educating and empowering us to stay safe, to helping the key players recognize the problems so that you can go home with your baby. I can feel the change is coming. We want something better. We want something safer. Remember stay strong, stay empowered, and you got this. Please follow us on our social media platforms, at maternal underscore wealth on instagram and maternal wealth on facebook. Visit our website at wwwmaternalwealthcom to sign up as a maternal wealth provider or search for maternal wealth providers near you. Lastly, check out our birth course, where I discuss how hospital staffing policies and access to medication can affect your birth experience and outcome.