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The statistics on the disparities women of color face in pregnancy, birth, and postpartum highlight some of our current healthcare system problems. I encourage you to listen to this episode, even if that may not apply to you. This episode features registered nurse Layo George of Wolomi. We discuss the challenges women of color face, owning your pregnancy, advocating for yourself, and the importance of building community.

Thank you to Layo George of Wolomi for sharing their expertise for this episode. Layo George is a registered nurse and an entrepreneur who focuses on population health in response to the nationwide maternal health crisis facing black women. Layo founded Wolomi, which provides resources and guidance to improve Black women’s experiences and outcomes during their perinatal periods.

You can learn more about Layo George by visiting the Wolomi website or connecting on Instagram.

Article/Transcript and Resources

Vanessa: Today on the podcast. I have Layo George, a registered nurse and an entrepreneur who focuses on population health in response to the nationwide maternal health crisis facing black women. Layo founded Wolomi, which provides resources and guidance to improve black women’s experiences and outcomes during their perinatal periods. Layo, you have a very extensive resume and bio. I don’t want to cut anything out, but if you can explain a little bit about your background story, that will help set the stage for our conversation today. Can you share a bit of how you went from being a nurse to getting your master’s in health administration from Georgetown, to what you’re working on today?

Layo: Thank you so much, Vanessa, for having me on the podcast today. I’m excited to be here and share a little bit about what Wolomi is doing and what we’re all about. A bit of background for me is my mom was a midwife. When I was growing up, I always saw that birth was a community thing and it was a happy environment when birth happens. She delivered some of my friends that I grew up with. I went to nursing school because I decided that I wanted to be part of something happy. In my head, happiness happens in labor and delivery. When I had the chance to go to work as a delivery and delivery nurse, I did because I thought people are happy when they go home because they are having a baby.

Then I started to see the different things that happen. It turns out that working in a labor and delivery unit is not necessarily a happy thing, and things happen at times that are not so good. Before I started practicing as a nurse where I did my clinicals, this is something they call clinicals. Before you graduate, you go and learn something practical. Some people call it practicum. When I did my practicum, I saw the things there, especially in the labor and delivery unit, were very different. Then, when I graduated and went to work as a labor and delivery nurse, I went out of state from where I was living. I saw that it was different.

I saw that a lot of times when I even think about it, it was very therapeutic in the way of that birthing unit that I was working on. You were entitled to massage therapy before you leave the unit after you have a baby. Those are things that I’ve never heard of. That was my first time hearing breastfeeding is very important. The whole idea of a baby-friendly, the whole idea of making sure that the nurses teach you breastfeeding as primary, instead of formula. Where I was trained, formula was a thing. I started to see the differences that there are different options to have in babies. I also started to see the differences between which population was being served, primarily where I was training and when I started as a nurse.

I decided, okay, I’m going to get my master’s in healthcare administration because I felt like healthcare needed to change in the way that it delivers care. That’s what motivated me to get my master’s. That whole idea of maternal health and stuck with me and the differences that I saw. As a woman of color, a black woman, how do I produce an environment where birthing is safe for women of color? At that time, I, myself, was pregnant. I remember before I got pregnant, I was telling my husband, I want to go back to where I used to work, where everything was really nice. It was almost like a spa center. I started to think, while I was in grad school, why is healthcare this way? Why isn’t it that I could model a different kind of care for people that everyone can enjoy and have good outcomes? So that’s my background. I did a lot of research in grad school. When I graduated, one of my professors told me, I think you should pursue entrepreneurship. Here I am, that is how Wolomi was created.

Vanessa: I love that you pulled from all these different backgrounds of being a nurse, grad school, your own experience, and growing up with your mom being a midwife. It’s refreshing to get somebody from an outside perspective. I feel like so much of U.S. healthcare is a big machine. You have huge hospitals that are laying out policies. In a lot of ways, we’ve fallen into, this is how you give birth. There are such differences in care from one place to the next.

Disparities in Health Care

Vanessa: I did want to talk a little bit about the disparities in care. According to the CDC black, American Indian, and Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women – and this disparity increases with age. In women older than 30 was four to five times as high as it was for white women. To put this into perspective, approximately 700 women die annually in the U.S. from pregnancy-related complications. A report published last year found that approximately three in five deaths were preventable, which is insane.

Layo: I know it’s crazy.

Vanessa: There are some things that the CDC suggests that hospitals and healthcare systems can do. Layo, I know that we’re going to talk a lot about what individuals who are pregnant right now can do as well. The CDC suggests that Hospitals and healthcare systems can do two things. First, implement standardized protocols in quality improvement initiatives, especially among facilities that serve disproportionately affected communities. Secondly, they can identify and address implicit bias in healthcare that would likely improve patient-provider interactions, health communication, and health outcomes. Can you expand a little bit and talk more about the disparities in care?

Layo: Yeah. I just want to start by saying that in general, the U.S., as you mentioned, the outcome is not as good when you compare us to any other developed country. That in and of itself, it’s not good. That affects everybody when you were talking about the fact that there’s a disparity. Even in those numbers, that make it really bad. I want to explain it in a way that your audience, might understand. Sometimes it’s like when you go to the hospital or when there’s an emergency. I just want to say that we get this a lot where people are like, well, why are you focusing on black women or women of color? It’s for those statistics you mentioned. If you’re in an emergency and somebody is bleeding out, that’s the person you’re going to help first. You’re going to try to stop the bleeding, and make sure that everybody’s okay. You’re going to help the people who are in the most need.

That’s why Wolomi is what it is. I just wanted to make sure that I clarify why this is so much needed. Acknowledging that, the U.S. outcome is not what it used to be in general. When we talk about the disparity, why is it that it is the way it is? A lot of times black women and women of color feel ignored when they raise concerns? Research has shown that even when a woman of color gives any information, they’re often given information too late. It is this idea that the system, in general, feels they know better. The whole idea of governing of the black woman’s or the woman of color’s, body, or her parenting. Often the system feels like they know better than that woman and that she does not know what’s good for her.

That is where the implicit bias comes from. I don’t think there are a lot of providers or nurses or doctors, midwives, all of those people who serve people at the point of delivery or going into healthcare thinking, I’m just going to discriminate today. They’re not that many people who do that. A lot of the providers and nurses going to healthcare are trying to help people. It’s just systemic, the way that education is done. The systemic idea that makes it feel like we know better than a certain group of people. Those groups of people cannot necessarily say, I’m feeling this way or that way. Then the healthcare system response is often, well, you just, you can wait, or you don’t know what you’re talking about.

So things get bad, and things get worse before anybody pays attention. By that time, it’s too late. That’s when death occurs. We have the same issue with infant mortality. The baby’s dead by the time somebody intervenes. There are different layers to it. We’ve talked about the idea of women of color not feeling like they have the authority over their bodies and that the system knows better for them. For example, I was shocked that I’ve heard stories of when, for example, a black woman says, oh, I don’t want to get a vaccine for my child, the system, the hospital, sometimes calls social work on them. But, that often does not happen when white women say, I’m going to delay vaccines.

Did the system in those circumstances feel like, that white woman knows what’s best for her and her family? When the situation is reversed, and it’s a black woman, it’s kind of like, no, she does not know what’s best for her and her family. In fact, she’s going to be a problem with the system. So that’s how historically the healthcare system is related to black and brown women. So that’s a problem that we have to fix. We have to see black and brown women as women who have authority over themselves and over their families. So that’s one of them.

Then, there’s the whole idea of understanding the culture. I don’t know if you’ve heard of the word code-switching. Often black women and women of color go into a healthcare system that’s not set up for them. Recently, the healthcare system is understanding that. There’s a lot of emphasis on, for example, the COVID vaccine, making sure that black and brown people are participating. When you do research, you do a lot of data on bodies that are not black and brown, then the outcomes that you’re going to get might not be as effective for black and brown bodies. Not that there’s a whole lot of differences, but sometimes there is. There is that understanding of the cultural differences in how we’re not just doing a one size fits all in the way we communicate the knowledge that we know. In fact, in healthcare, we should be able to communicate things in a way that everybody can understand. The way you would communicate the same information or instruction when you go home from a hospital to a Hispanic mom should be probably different from the way that you communicated to a black mom. Even when you talk about income levels, you know, the challenges that one mom may face, who is receiving Medicaid might be different from somebody who has private insurance. So we have to consider all of those things to get the kind of results that are equal, you know?

Vanessa: Yeah, absolutely. And it’s in so many ways. Hospitals are not set up to do that. You’ve got limited time for appointments. I think a lot of time, practitioners just get in the groove of repeating the same discharge speech that they’re going to give everyone after they have a baby. Not taking time to understand an individual’s situation or the home life they’re going home to and taking into account specific things that happened to them during their birth. Even thoroughly explaining warning signs that you should keep an eye out for as you’re recovering from birth.

Anxiety and Stress from Disparities in Care

Vanessa: For anyone to hear that 700 women in the U.S. die from pregnancy-related complications every year is scary. But for somebody in the black community, that’s got to be even more terrifying. Right? How much stress and anxiety is that creating? Just knowing that you are three to five times more likely to die? What can somebody in that position who’s worried about that do to alleviate some of that?

Layo: Yeah. That’s an important question because the truth of the matter is that even if you have more money, it does not help. Even if you have more education and just not help. The statistics show that even when you’re looking at women with a college education, they’re still three to five times more likely to die during childbirth or as a result of.

When I was in grad school, I was looking into the data. When I saw that, someone who let’s say has diabetes, obesity is less likely to die from pregnancy complications than I was. I have no underlying conditions, I was like, the stress of that is a feeling of you can’t get away from this. It’s something other than the fact that you have diabetes or it’s the obvious things. Those obvious things, you can’t change. The number one thing that I would tell any mom who’s listening, who is feeling that pressure because we get that little lot Wolomi is very present on social media and especially with COVID now, it’s like, Oh my God I just read this thing. It’s saying I’m going to die, I’m black. The stress is just a lot. What I want, what the number one thing is the stress is not good for your body. It’s not good for the pre-pregnancy process. Even if you’re not pregnant yet, and you’re thinking of planning a pregnancy, the stress is not good in your preconception time. Even during pregnancy, stress is not good because there is research out now that shows that stress adds to negative outcomes during pregnancy. That’s the first thing that I would like moms to know is that whatever you can do to not focus on those negative things is what you should do.

For example, in my case, I remember I was so scared even though I am a nurse and I was so scared of birth. I’m not gonna lie to you. I was so scared. What I did for me was, luckily I was able to hire like I had a therapist, I had my doula. I’m sure you probably talk a lot about the different kinds of people that help during childbirth on your podcast. My doula, one of the first meetings that I had with her, was just telling her, Hey, I have been watching and reading all these bad things, and I am scared. She was just basically like, how about we replace those bad things with good things? One of the things that we started to do is look through positive pictures, positive affirmations of what it is to be black and pregnant. Positive thinking about people who have made it, who had babies, and were successful at it.

That’s one of the things that Wolomi does on the app is just creating that environment where it’s positive. There is a place where you talk about recipes and all of those things, and pictures, just a positive reinforcement of that. Yes, the statistics say X, Y, and Z, but you are special. You can do this. The more that we focus on the positive, the more our body relaxes and does the things that he needs to do and prevents us from having all these other complications.

Owning Your Pregnancy

Then being knowledgeable about all of the things we talked about. We live in a society where you as a pregnant mom, you cannot afford not to be knowledgeable. We often say, we often joke that, well, the providers went to school for these things. Suddenly, we, even though we didn’t go to school it is supposed to keep them accountable and make sure that they know what they’re saying. Unfortunately, it is our job to make sure that we are knowledgeable about the things that we want and the things that we need, and how to navigate the healthcare system to get the outcomes we want. Sometimes that takes a lot of planning. Sometimes it takes money, you know, it takes resources. Let’s just put it that way. It takes time, money, effort, and just doing some research, getting yourself the tools that would help you be successful at pregnancy and even postpartum. For example, I’m telling you that I have my therapist. Yeah. I hired people to just help me navigate that time of my life. We can’t just afford to not put an effort. I wished it was the case that you would just be pregnant, and then life would take care of itself. You go to the doctor, or you get the best doctor, or you get the best healthcare, and things just work out. But we know by data that that’s not the case. So we need to come into the healthcare system, into pregnancy, a little bit more prepared. That’s not to say to be scared of it, but if you have information, if you empower yourself, you can be successful at pregnancy. Wolomi, one of the things we say, pregnancy is a great thing. What I was saying when I was growing up, it’s a community thing. It’s a great thing. Bringing another life into this world, it’s a great thing. And I’m sure a lot of your listeners already on the right step, listen to the podcast, Wolomi has an app. Surrounding yourself with as much information as not in a way that gets you stressed, but in a way that you feel empowered through the journey. Finding your community and your tribe, that’s the way to go. You are just making sure that you are informed of your decisions. At Wolomi, that’s what we call owning your pregnancy. No longer can we let pregnancy just happen to us. We have to be the center of that pregnancy and knowing yourself and knowing that, okay, if I’m going to this doctor and she’s not listening to me, or he’s not listening to me, I’m responsible for that as a pregnant woman it sucks. Still, I’m responsible for finding another person. Just being on top of that, of owning your journey in your pregnancy,

Vanessa: You’re right. If you want to advocate for yourself, you have to be somewhat educated. Because it’s hard to have that conversation, for anyone. The way that our health system is, decades ago, if your doctor told you something, that was it. You would never question it. I’ve been doing the Pregnancy Podcast now for about five years. I started this because there was a lack of evidence-based information. Even looking at how the healthcare system works, a lot of that is not evidence-based.

Advocating for Yourself

Layo: If I could add one example to what you said, like the whole idea of evidence-based. I remember when I was pregnant, I had switched providers. My first provider is what we call culturally competent in her care. I had this situation where I had to check my urine a lot every time I came in for an appointment to make sure that I didn’t have an infection. I had something called a sickle cell trait, and that’s common with black people. She knew that because of that trait, I might not show symptoms of infection. If she didn’t know, if she wasn’t competent in that, I would probably go to somebody who, when I switched my provider, the new provider didn’t know. It’s because my first provider was so culturally competent she told me about that, that is why she checked my urine every time to make sure I didn’t have an infection. When I went to the second provider, she argued with me. Can you imagine? She was like, no, you don’t need that. Why do you need that? I was like, I’m telling you that this is a thing. Because as a black person with sickle cell trait, if I get a urine infection, I might not show the symptoms you would look for. Before you know it’s too late, it’s spread, and that’s a bad situation. But eventually, she was like, okay, I’ll check it. And she checked it, and she was like, Oh, can you believe there’s a CPT code for this? A CPT code is how you code stuff to get paid. I was like, wow.

Vanessa: Wow. That’s crazy.

Layo: Yeah. When you talk about whatever the doctor says, it’s golden. But now it’s like, it’s not.

Vanessa: You’re such a great example of somebody who’s advocated for themselves. As you said, you had a therapist, you had a doula, you had all of these resources. Do you have any specific, actionable tips for somebody who’s trying to advocate for themselves? Whether it’s asking for a specific test or if they’re getting a lot of that pushback from their doctor. Aside from changing to another provider, which you can do. I recommend that if you’re not happy with your current doctor or midwife, you should find someone you’re comfortable with and who’s supportive of the birth you want. Do you have any specific tips on how people can deal with getting pushback from their doctor and not feeling like they’re being supported or seen or understood?

You Are the Expert of Your Body

Layo: Yeah, the first thing I would say is to know yourself. You are the expert of your body. When you feel like something is not right, when you feel like something is just not completely wrong, but about to be wrong, you have to know yourself. Communicate that, and don’t take no for an answer. The first part of getting there is knowing yourself and then building your community. Because often when you have those crucial conversations you need reinforcement. Your community doesn’t have to be a doula. It doesn’t have to be, although I recommend it. It could be your family member. It could be your spouse. It could be your partner and discussing what you’re feeling with your tribe and just saying, Hey, I want to have this discussion with my provider. If you go into that conversation feeling defeated, sometimes it doesn’t go the way we want. And I think that being knowledgeable, going into the conversation empowered helps. You want to go into a conversation empowered. You want to go into conversation like, you know, where you’re talking about because the fact is you do. You may not have gone to midwifery school or med school, but you are the expert of your own body. So know yourself, build your tribe and your community to get reinforcement when you are having this conversation.

I remember there was a mom who is part of the Wolomi tribe that takes her husband. Now it’s hard with COVID, but you could have your husband be on Zoom, or on a virtual meeting, just to give you some reinforcement. Make sure you write down the things that you want to communicate with that provider. If you’re not getting what you want, I would strongly, strongly suggest changing. Because the reason why I’m saying that is that at the end of the day, when there’s a decision to be made, a life or death decision, it’s up to that provider. You have to make sure that you are with a provider that you trust, that you jive with. I know sometimes that’s kind of, that is sometimes difficult depending on the insurance or all those other complications.

Choosing the Right Provider

That’s why we teach in Wolomi, and we encourage mom to make sure you get the provider you like at the very beginning. It’s like going shopping. You are not going to keep the bag that you bought that you don’t like. Most of us wouldn’t. Even if you’re on Medicaid, even if you’re private insurance, somehow you are contributing to that payment of healthcare. You’re paying for it. With your copay with the money that is taken out of your work every two weeks or every week. It isn’t like the insurance is doing you this big favor. You’re contributing. Consider that as you are the one going shopping for something. You’re not going to keep something you don’t like. So then don’t, don’t keep a provider that you don’t trust to make the right decision for you.

Vanessa: Spending a little bit of time upfront. I say a little bit of time, which could be several hours to several days of vetting different care providers. I’ve had a pregnancy where I had a provider that I was not thrilled with and switched, and it was a night and day difference. I’ve also had a birth where I had a complication, and there was a moment that was a little bit scary. I was so thankful that I completely trusted my midwife to do the right thing. I was fortunate in that. Your birth experience for sure will go so much better if you’re with a provider that you trust that you know will support you.

The Importance of Community

Layo: Yeah, you have to trust. I was gonna say that one of the things that happen sometimes is. For example, through the Wolomi app, we bring a lot of experts. We have chat with the black OB, chat with a black midwife, chat with the black dermatologist. Often, even when you’re when your insurance doesn’t, you might be living in a place where you don’t have a lot of those options. Somebody who is culturally competent or understand. Not to say that you have to be with the same race provider to be culturally competent. The idea on the app you might be going through some of those things, but you could chat and say, Hey, I’m feeling this, this is what I’m thinking. Then you could get that validation. From that pediatrician or from that OB on the app, and they will say, you should have this conversation. Often we feel like, oh, I’m just, it’s just little me. How could I ask my provider that? Sometimes hearing from another expert who is qualified, that’s saying, yes, you should. Or hearing from a peer saying, yeah, I went through the same thing. I think that’s a space that’s missing in the conversation. There are so many complications, like insurance. I had a mom who said, you know what, I am just going to save up and use this midwife or this person. My insurance doesn’t cover that provider, but we would rather be with that person. It’s so important to me that this is a midwife that I want to be with, and she saved up money. So you never know, but the most important thing is that it takes work.

Vanessa: It does, but I think, well worth that investment of the time you put in up front will pay off. I do love the whole idea that Wolomi is centered around community. I think that’s insanely important right now with COVID-19. I think everybody’s feeling a little bit isolated. Do you want to talk more about the app, how it works, and how you’ve built the community?

The Wolomi Community

Layo: One of our slogans is to leave the stress, find joy. Meaning, find joy in the community. Being with women going through the same thing or that have gone through the same thing or about to go through the same thing and women you feel represent you, that shared experience. What the app does is find a place of joy that we could, like we were talking about previously, that could focus on the positive things that will get us to the next place that we need to be, which is a good birth outcome or a birth outcome that you plan for. As we said earlier, many of those things have that outcomes in pregnancy, as things that are preventable. Finding joy and getting the knowledge that you need to have those crucial conversations is really what the app is about the peer to peer community that you get, that you could just see anything that you are going through. You find the sisterhood that would help you through it.

At least two times a month, we have experts come in and you can ask questions. We have therapists, I mentioned earlier OBs or midwives. We just got a dermatologist on our team, which I’m very excited about because let me tell you that there are so many cultural issues that happen when you were pregnant as a woman of color with your hair. I’m sure it happens with all women, but I have had a hard time finding a dermatologist that understands my skin and my hair and my everything. I’m excited about that. That’s really what the app is about to form a community. You could post your picture of your journey, pregnancy picture, post a picture of your baby with celebrating as a community. We talk about the community where you have the expert come in or ask questions to any of the other moms.

We have the Memoriam because of a lot of the suffering that affects the black and brown community. We know that with trying to get pregnant, also comes a lot of loss. We have a high risk of many other things that prevent us from getting pregnant, just because of the stress and all the things that we’ve discussed at the beginning of the podcast. There’s a lot of pregnancy loss that happens. We want to, as much as possible, recognize that journey. We have something that we call the Memoriam on the app, where you could, if you’ve lost a baby, you are welcome to place the name of the baby. If the baby was named. If the baby wasn’t named there are options to just memorialize and give honor to that baby. Sometimes what happens during that fertility journey is that we, as moms, we know the baby inside us. The world might not know the baby, but often we start to feel a bond to that baby. If it ends in a way that the pregnancy is terminated, then you know, it’s kind of like, we don’t have a special place to just say, Hey, this baby was part of us. We want to celebrate that in the community. The app has that too. That’s the community. The community is on the app.

More Information on Joining Wolomi

Layo: To join, you sign up on the website and get your membership. Then you download the app. I would love for it to be free. We do have free aspects of the app, like pictures and recipes, and all of those things are free. I would love for everything to be free, but it’s really hard to be an entrepreneur and then a black woman entrepreneur who had to find a way to make it sustainable.

When you join the membership and do a paid membership, that’s how you’re supporting the work that we’re doing. So I want people to think about it that way. If you do a year membership, you’re getting it at the price of $5.99 a month. If you don’t do a yearly membership and you do monthly, it’s $8 a month.

One thing that we also do aside from the app is we have a monthly pregnancy circle. You could sign up for a premium membership. Premium membership is $18 a month, and you can join the once a month pregnancy circle, which is a great time. We do that with the midwife and me. It’s a great time to ask questions and go through different topics every month. If you do a yearly membership for that, it’s $15.99, but you get a month free. Just think about supporting us to help black and brown women. I would love to do it for free, but you know, that’s not where we are today.

Vanessa: It has to be sustainable. Thank you so much for everything you’re doing. I love that you came on the podcast today to talk about this. I know this topic is not discussed a lot. Especially in circles where we don’t necessarily have some of the same concerns. I’m so glad to talk to you today. I will link to Wolomi to join the community or to check out the app. I do encourage anyone that’s interested to check that out. Building a community will help you so much as you are transitioning into parenthood. Those small monthly charges will be a very sound investment.

Layo: Thank you so much for having us and for giving us the platform for talking about this. I want to say that if you are a mom out there and you’re struggling, and you feel like you, you could use this and you feel like I’m not quite brown or I’m not quite black, you can join. I just want to make sure because, honestly, I do have friends that are on the platform that are not black or brown, but they are pregnant. They felt like it was useful for them, so they joined. The U.S. health outcome is not where it needs to be. We all can use a little help. As long as when you join you’re respectful of the space.

Vanessa: Before we wrap up, is there anything else that you want to share?

Layo:  Follow us on Instagram @_Wolomi. Join the community. When you join, please participate. It makes the community robust when we have moms participating. I am often one of those who go online and just don’t say anything, but I’m gaining all the knowledge. We want more participation, so definitely join us.

Vanessa: Thank you so much, Layo, for joining us on the podcast today. I appreciate it.

Layo: Thank you so much. It was great to be here.

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