Doctor Diane Banigo didn’t obtain her title for the reasons she originally pursued it. When she started down the pre-med track during her education, her plan was to become an OB-GYN because she had always wanted to deliver babies. But after discussions with a mentor who taught one of her classes, she decided to become a midwife. Her hope was that this path would allow her to do the work she wanted to do while maintaining a better work-life balance.

Unfortunately, this wasn’t the case. She spent a number of busy years in full-scope practices providing both clinical and birthing care before eventually going back to school to become a doctorate-prepared midwife. The reason? She was observing a lot of inequity in the care her patients received, and she wanted to get into the spaces where that inequity seemed to start.

“[Black and brown women] are three to four times more likely to have a bad outcome or not make it out of the birthing suite,” Dr. Banigo reminds us. “Black babies are born too small, too early. We know that everybody's seeing it now, everybody's putting it wherever they can put it to get attention, to get funding. But what we're not talking about are the disparities in the lived experience of birthing and being pregnant while Black.”

In this episode of Off the Charts, Dr. Banigo explains how these care iniquities are perpetuated and why community and partnership are so key to resolving them. Listen to the episode or read the transcript.

How lived experience gets missed

Microaggressions aren’t a new concept. Studies and innumerable personal accounts have shown that people make and express race-based assumptions about individuals in a wide variety of contexts. Our host Dr. Steven Jackson gives an example where he received uncomfortable, if technically positive, comments from airline staff simply for being a Black man in first class with his family. Dr. Banigo cites cases where patients and even fellow providers assumed she was significantly less qualified than she is, despite contextual evidence. It begs the question: If this happens to certified professionals, what does it mean for a Black woman getting pregnancy care?

Assumptions, invalidations and other dismissals of lived experience in daily life are one matter, but in the context of health care, there can be very real consequences. If a care provider, as an authority figure, minimizes an expectant mother’s comments about how she’s feeling, it won’t necessarily be clear to her whether it’s coming from a place of expertise or a place of prejudice. She may not know that that attitude should be challenged – and even if she does challenge it, it may not go anywhere if someone within the care system isn’t advocating for her.

People want to believe that health care professionals are giving them due consideration. But Dr. Banigo describes that she’s had to explain to women she’s worked with that their experiences were not normal, that the behavior of their care team actually undermined their care. She can identify and explain this because she’s been on both sides: She’s a Black mother who has years of experience working in health care. So what can we do to ensure that lived experience is honored on a broader scale?

Building community to change what’s “normal”

Today, Dr. Banigo has more of the work-life balance she was originally hoping for. She has a per diem position at a birth center, and that flexibility allows her to also put attention towards community engagement. Along with community relations liaison Ciana Cullens, Dr. Banigo conducts one-on-one interviews and hosts community circles for women to share their experiences.

The community circles have proven to be deeply validating for their participants. Women get to see that their experiences in various care systems are not unique, and they get to hear that they deserve better. In one sense, this is already a step towards change, as it can enable participants to self-advocate more effectively. They can go into their care systems with a fuller understanding of how they should be treated. “We can’t empower people,” Dr. Banigo says, “They already possess it. But we give them permission to execute the power that they possess.”

At the same time, these community circles also set a valuable precedent: Care providers can use their credentials to create spaces where people feel truly comfortable sharing their lived experiences – so long as the spaces aren’t controlled by those credentials. It has to be a partnership. People have to be willing to ask for space and share in it, and providers have to have the compassion to truly listen.

It takes cooperation to change a system. And ultimately, the type of relationship-building that Dr. Banigo facilitates has to be adopted beyond a single health care system, and beyond the health care industry. But as long as people keep asking for and creating space for the conversation, then energy is moving in the right direction.

To hear more from Dr. Banigo, including stories from her career, current projects and how she’s working to change the image of what care providers can look like, listen to this episode of Off the Charts.