Mississippi Today
Q&A with midwife Janice Scaggs
When Janice Scaggs joined the University of Mississippi Medical Center in 2020, she became part of a growing effort by the state’s largest public hospital and academic medical center to reintroduce midwifery into Mississippi’s maternal health care.
Certified nurse-midwives like Scaggs are educated in graduate-level midwifery programs and also hold an active registered nurse credential at the time of certification.
In the last three years, Scaggs, as the hospital’s only midwife, attended a little over six percent of births at UMMC each year.
In June, a second certified nurse midwife, Kim Rickard, joined the team. As part of the nurse midwifery clinical advisory committee, she and Scaggs plan to integrate a minimum of eight new nurse midwives into UMMC hospitals and clinics to offer round-the-clock midwifery care by 2027.
Midwives advocate for autonomy and comfort over efficiency for their patients, and have been proven to decrease unnecessary interventions such as cesareans in low-risk mothers โ thereby improving morbidity and mortality, as well as postpartum mental health, and lowering the overall cost per capita of care.
Doctors and OB-GYNs are experts when it comes to abnormal pregnancies, Scaggs explained, but they don’t always know how to stand back and let a normal physiological birth unfold.
โMidwives โฆ are the experts in normal, and have always been educated on a patient-centered model of care, really advocating for the patient and family, and empowering them,โ she said.
Unnecessary cesareans and their increased use in Black pregnancies are not only a large contributor of preventable maternal deaths, but also a large contributor of maternal health disparities. Maternal mortality and morbidity after emergency cesarean birth is nearly 5 times than after vaginal birth.
Midwives are proponents of simple, but successful, low-intervention practices during labor โ such as mobility and intermittent auscultation, or a technique of listening to and counting fetal heartbeats for a short period of time during active labor.
Editor’s note: This interview has been edited for clarity and length.
Mississippi Today: The term โmidwifeโ translates to โwith woman.โ How do you see your role as a midwife, and how does it differ from that of, say, a doctor?
Janice Scaggs: We have so many similarities that sometimes that’s a really difficult question, but then on the other hand it’s really not.
If you look at the midwifery-led model of care, it really focuses on the individual, on putting them at the center of care, midwives being advocates for their patients and families โ they want to empower the woman.
We focus on normal and healthy, certainly recognizing the abnormal. I look at us as the experts of that normal (births), whether it’s OB care, birthing, or gynecologic care, as well as family planning. I would say that that differs from our physician colleagues, because they really are focused on what the abnormal is, and they are experts when things are not going right.
MT: Tell me about the evidence around midwife-led care in reducing maternal and neonatal morbidity and mortality.
Scaggs: It’s well documented in other countries where midwifery is integrated into the health care system that it improves outcomes. We now have some good evidence in the U.S. to look at those evidence-based benefits, as well, including decreasing unnecessary interventions, improving the overall outcome of health โ mental health as well as physical health โ and decreasing the cost of health care, as well.
We increase breastfeeding rates, decrease preterm birth rates, and then (use) that approach of not using intervention unless absolutely necessary. We end up not performing interventions that can lead to morbidity, when maybe they didn’t need to be done, such as an unnecessary primary cesarean section.
MT: So, in today’s world, more women give birth in hospitals, and around technology, than ever before. But that hasn’t necessarily led to better outcomes. We know that because of infant and maternal mortality rates, and also high cesarean rates โ across the country but particularly in Mississippi. Tell me about your non-pharmacological approach to birth and your philosophy around that.
Scaggs: I look at non-pharmacologic support as being an option that can either be done on its own or can be integrated with medical technology and pharmacologic options for women, as well. So they don’t have to stand separated.
But if we’re focusing on non-pharmacologic, we know from research that mobility, upright positions in the first stage of labor, decreases the length of labor, it decreases other interventions, it decreases cesarean rate. It improves comfort for moms who are trying to cope with labor without pharmacologic methods.
So, giving women permission and opportunity to move in labor โ they will and they want to. If we put them in a bed and don’t encourage them to move, they won’t, because they feel unempowered, they don’t feel like they can safely move around.
That non-pharmacologic approach to giving women options, having them understand they are safe options in most settings, and we’re talking about primarily low-risk births with midwives. And then looking at things like acupressure points can be extremely helpful, using heat and cold in different aspects can be helpful. Touch โ we know that there’s therapeutic touch for all aspects of health care, and that includes in labor and birth.
Using things like birthing balls when women are either in the bed, when they may be tired, either with epidurals or without epidurals, for positioning, can be extremely helpful in opening the pelvis to its most optimal position so that the fetus can get into the most optimal position. Babies come out a lot easier if they are head down and looking down, in relation to mom’s body, as opposed to what I would call sunny side up or coming down a little bit crooked. Changing the shape of the pelvis and having mom moving, whether it’s in the bed or out of bed, does lead to better outcomes, insofar as getting baby in a good position and having a faster labor.
It als just helps mom to cope better. When you’re hurt, you want to move. And if women stay in one position and don’t move, then we know that they’re not going to cope as well. I always talk to students and moms about how part of my job is to help you recognize when you’re suffering and to help you cope and to limit suffering. We know that doing that for women in labor actually improves our mental health outcomes and in the postpartum period it decreases anxiety and depression. And we know that that is something we should all be focusing on, and we’re just beginning to see more attention to that mental health aspect of the process of labor and birth.ย
MT: So, midwives primarily use intermittent auscultation, as opposed to electronic fetal heart monitoring, to listen to fetal heartbeat. Can you explain the difference between the two and how EFM can increase one’s chances of an unnecessary cesarean?
Scaggs: Continuous electronic fetal heart monitoring has two small, round devices โ plastic devices that fit on mom’s belly. One graphs on a computer system to show when (the mother) is having a contraction. The other one is a little ultrasound piece. It’s not an ultrasound visually; it’s for hearing. We hear the heart rate, or auscultate the heart rate. And on these monitors, you can have continuous monitoring of the fetal heart rate, as well as uterine contractions.
We introduced this thinking we were going to decrease the overall cerebral palsy rate and we didn’t quite have the evidence to support that. And we have found now, 25, 35 years later, that for high-risk women, it’s extremely advantageous to have continuous electronic fetal monitoring. But for low-risk women, who are in spontaneous labor, who don’t have risk factors, we many times actually offer or perform interventions that aren’t necessary because (the continuous electronic monitoring) really sometimes provides more information than we need to have.ย
If we use intermittent auscultation, which is using either a handheld little Doppler which is another ultrasound device to hear heart tones, or even the old fashioned fetoscope that looks like the ear trumpet, that we can use to listen on mom’s belly. We listen before a contraction, throughout a contraction and one minute after the contraction, and we do that every 15 minutes during labor and five minutes during active labor and every five minutes when they’re pushing. And in doing that, if we hear anything abnormal we then can transition to more continuous monitoring to find out how the fetal heart is and to assure that we actually have a healthy baby. But you’re not having to be strapped down and continuously monitored. It may be that if everything sounds good and normal, that you never have to utilize the continuous electronic fetal monitoring.
MT: Tell me more about that relationship between a traumatic birth and postpartum depression.
Scaggs: Well, I can’t define trauma for somebody else, but if I don’t ask the right questions I’m not going to know if there’s been trauma.
I’ve had women who have come to postpartum visits, who I thought had the most beautiful birth and labor experience ever, and who seemed wonderful, and I find out a couple weeks later that there was something that caused them a trauma โ whether it was terminology that was used, whether it was moving forward with a plan that maybe was not clear to them.
I’ve seen women have emergency cesarean sections who really needed them who show no signs of trauma, and then women who have planned cesareans who have trauma related to that. I think there are so many small things we can do to decrease trauma for women and that’s going to be, number one, communicating and finding out what helps them the best, not necessarily ourselves.
And as a provider, of any kind, whether you’re a midwife, a physician, a nurse, you can love your job so much and impose what you think somebody else should need. Being very self aware and self reflective, having humility of the process of labor and birth, is one of the best ways I think we can eliminate severe trauma.
MT: Do you think Mississippi will ever have a birth center? Would that be helpful here?
Scaggs: I think it would be wonderful if we could have regional freestanding birth centers that are supported by nurse-midwives with, you know, appropriate consultation, collaboration and referral to OB-GYNs and maternal-fetal medicine physicians for care as needed.
It would give us a better sense of community support in places where we don’t have as good of access. It could provide prenatal care, as well as care for labor, birth and postpartum period, as well as family planning.
MT: What do you think is needed to shift the paradigm from the hospital model of birth, which relies so heavily on technology, to a model of fewer interventions for low-risk pregnancies and empowering women to give birth according to their own plan when safe?
Scaggs: That’s a big question and I think it has a multifaceted answer. I think it always comes down to: what is the culture for supporting intended vaginal birth? What is the culture for putting women in the center of care? And what the relationships are between health care providers and nurses within a hospital, and support from administration for the type of training that is needed to be able to do things like intermittent auscultation. There’s a specific way to do that. So there needs to be education for nurses to be able to learn that; there needs to be a better nurse to patient ratio. So, we have some workforce issues. There’s also financial issues, educational issues. The bottom line is it’s really difficult to change culture. It takes time.
The more we can lean into family-centered, patient-centered, care, the more we can use the evidence that we currently have around us to improve outcomes.
If Mississippi can integrate midwifery into the health care system, that’s going to be the simplest answer. Who better to change the culture than midwives, who are the experts in normal, and have always been educated on a patient-centered model of care, really advocating for the patient and family, and empowering them, as well. The more we can empower women to have these choices and to understand they have these choices is really going to help.
MT: Is there anything else you’d like to add about midwifery in Mississippi?
Scaggs: I would like to say that I have been very supported within the university and from the chair of the department (Dr. Marty Tucker), to be able to grow midwifery. He’s the one who initially reached out to me when I had moved to Mississippi and was trying to navigate and figure out where jobs were and not finding many. He believes in midwifery being integrated into our model of care.
And I think if we had more physicians and administrators who understood midwifery and were open to hearing about it and really looking at the evidence, that we would have more midwives in Mississippi. But it takes us partnering to do that. I need them, and I need for them to realize also that they need my profession in order to best care for women in the state.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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Mississippi Today
On this day in 1875
Nov. 2, 1875
The first Mississippi Plan, which included violence against Black Americans to keep them from voting, resulted in huge victories for white Democrats across the state.
A year earlier, the Republican Party had carried a majority of the votes, and many Black Mississippians had been elected to office. In the wake of those victories, white leagues arose to challenge Republican rule and began to use widespread violence and fraud to recapture control of the state.
Over several days in September 1875, about 50 Black Mississippians were killed along with white supporters, including a school teacher who worked with the Black community in Clinton.
The governor asked President Ulysses Grant to intervene, but he decided against intervening, and the violence and fraud continued. Other Southern states soon copied the Mississippi plan.
John R. Lynch, the last Black congressman for Mississippi until the 1986 election of Mike Espy, wrote: โIt was a well-known fact that in 1875 nearly every Democratic club in the State was converted into an armed military company.โ
A federal grand jury concluded: โFraud, intimidation, and violence perpetrated at the last election is without a parallel in the annals of history.โ
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Mississippi Todayโs NewsMatch Campaign is Here: Support Journalism that Strengthens Mississippi
High-quality journalism like ours depends on reader support; without it, we simply couldn’t exist. That’s why we’re proud to join the NewsMatch movement, a national initiative aimed at raising $50 million for nonprofit newsrooms that serve communities like ours here in Mississippi, where access to reliable information has often been limited.
In a time when trusted journalists and media sources are disappearing, we believe the stakes couldn’t be higher. Without on-the-ground, trustworthy reporting, civic engagement suffers, accountability falters and corruption often goes unaddressed. But it doesn’t have to be this way.
Here at Mississippi Today we act as watchdogs, holding those in power accountable, and as storytellers, giving a platform to voices that have been ignored for too long. And we’re committed to keeping our stories free for everyone because information should be accessible when it’s needed most.
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This year’s NewsMatch campaign runs from November 1 through December 31, giving us a special opportunity to make each dollar you give go even further. Through matching funds provided by local foundations like the Maddox Foundation, and national funders like the MacArthur Foundation, the Rural Partner Fund and the Hewlett Foundation, your gift will be matched dollar for dollar up to $1,000. Plus, if 100 new donors join us, we’ll unlock an additional $2,000 in funding, bringing us even closer to our goal. Boiled down: your donation goes four times as far.
Every dollar raised strengthens our ability to serve you with fact-based journalism on issues that impact your everyday lifeโwhether it’s covering local election issues or reporting on decisions affecting schools, safety and economic growth in Mississippi. Your support makes it possible for us to stay rooted in the community, offering nuanced perspectives that help Mississippians understand and engage with what’s happening around them.
Special Event: โFreedom of the Press: Southern Challenges, National Impactโ
As part of the campaign, we’re excited to host a special virtual event, โFreedom of the Press: Southern Challenges, National Impact.โ Join Deep South Today newsrooms Mississippi Today and Verite News, along with national experts on press freedom, for an in-depth discussion on the unique challenges facing journalists in the Deep South. This one-hour session will explore the critical role local newsrooms play in holding power accountable, highlighting recent restrictions on press freedom such as Louisiana’s โ25-foot law,โ which affects journalists’ ability to report vital news.
We’ll examine what’s at stake if local newsrooms lose press freedoms and will discuss how you, as members of the public, can help protect it. This event is open to Mississippi Today and Verite News members as a special thank-you for supporting local journalism and standing with us in this mission. Donate today to RSVP!
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Together, let’s ensure Mississippi has the robust, independent journalism it needs to thrive. Your support fuels our ability to expose the truth, elevate marginalized stories and build a more informed Mississippi.
Thank you for believing in the power of journalism to strengthen the communities we loveโnot only during election season but year-round. With your help, we’ll keep Mississippi informed, engaged and connected for generations to come.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Hinds County loses fight over control of jail
The Hinds County sheriff and Board of Supervisors have lost an appeal to prevent control of its jail by a court-appointed receiver and an injunction that orders the county to address unconstitutional conditions in the facility.
Two members from a three-judge panel of the 5th U.S. Circuit Court of Appeals agreed with decisions by U.S. District Judge Carlton Reeves to appoint a receiver to oversee day-to-day jail operations and keep parts of a previous consent decree in place to fix constitutional violations, including a failure to protect detainees from harm.
However, the appeals court called the new injunction โoverly broadโ in one area and is asking Reeves to reevaluate the scope of the receivership.
The injunction retained provisions relating to sexual assault, but the appeals court found the provisions were tied to general risk of violence at the jail, rather than specific concerns about the Prison Rape Elimination Act. The court reversed those points of the injunction and remanded them to the district court so the provisions can be removed.
The court also found that the receiver should not have authority over budgeting and staff salaries for the Raymond Detention Center, which could be seen as โfederal intrusion into RDC’s budgetโ โ especially if the receivership has no end date.
Hinds County Board of Supervisors President Robert Graham was not immediately available for comment Friday. Sheriff Tyree Jones declined to comment because he has not yet read the entire court opinion.ย
In 2016, the Department of Justice sued Hinds County alleging a pattern or practice of unconstitutional conditions in four of its detention facilities. The county and DOJ entered a consent decree with stipulated changes to make for the jail system, which holds people facing trial.
โBut the decree did not resolve the dispute; to the contrary, a yearslong battle ensued in the district court as to whether and to what extent the County was complying with the consent decree,โ the appeals court wrote.
This prompted Reeves to hold the county in contempt of court twice in 2022.
The county argued it was doing its best to comply with the consent decree and spending millions to fix the jail. One of the solutions they offered was building a new jail, which is now under construction in Jackson.
The county had a chance to further prove itself during three weeks of hearings held in February 2022. Focuses included the death of seven detainees in 2021 from assaults and suicide and issues with staffing, contraband, old infrastructure and use of force.
Seeing partial compliance by the county, in April 2022 Reeves dismissed the consent decree and issued a new, shorter injunction focused on the jail and removed some provisions from the decree.
But Reeves didn’t see improvement from there. In July 2022, he ordered receivership and wrote that it was needed because of an ongoing risk of unconstitutional harm to jail detainees and staff.
The county pushed back against federal oversight and filed an appeal, arguing that there isn’t sufficient evidence to show that there are current and ongoing constitutional violations at the jail and that the county has acted with deliberate indifference.
Days before the appointed receiver was set to take control of the jail at the beginning of 2023, the 5th Circuit Court ordered a stay to halt that receiver’s work. The new injunction ordered by Reeves was also stayed, and a three-person jail monitoring team that had been in place for years also was ordered to stop work.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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