 So welcome everyone and I'd like to graciously thank our sponsors for VidM 2014 and here they are, thank you so much. Just a quick mention if you'd like to read this screen here, how to set up your audio, your chat window which I think most people are familiar with, there is a request while our presenters are presenting, please keep your chat comments to a minimum so as not to distract from our wonderful presentation today but at the end please feel free to text in longer comments. There is ability to give feedback also so if you look up on the top line there's a little person raising their hand, if you click on that there's options for agreeing or raising your hand if you have a question. As we said you can make a question or make a comment and at the end we will be able to give you a microphone but it does appear that we're working quite well just with the text box comments to the speakers at the end and this is how to connect your microphone but we'll talk more about that if we're going to connect you for a question. And then people can tell you if they can't hear you and how to adjust your microphone. Okay I've turned on record and we're all set to go I'm very happy to welcome my colleague Midwife Claudia Booker and Aisha Ibrahim and they're going to be talking about the grand challenge of increasing the numbers of birth workers of color. Thank you so much. Welcome. Welcome to the International Day of the Midwife. My name is Claudia Booker. And I am Aisha Curry Ibrahim an aspiring Midwife. We are here today to share with you our presentation the grand challenge matching scholars to scholarships to reduce disparities in birth outcomes. At the 2012 VIDM we along with Jenny Joseph presented Midwives, Safe Lives and Introduction to the Grand Midwives of the USA a pictorial history of African American midwifery. Our presentation today is a continuation of the discussion we began in 2012. It is a discussion on the immediate need to significantly increase and restore the number of midwives and birth workers including childbirth educators, doulas, breastfeeding counselors and educators of colors especially midwives of African descent. In order to increase the number of these midwives we need midwifery and birth worker training and education institutions to provide scholarships. We have woven into this call to action together with eloquent reflections of women of color who are doing the work or who have benefited from the healthcare provided by midwives and birth workers of color. We still share selected quotes from these stories but please feel free to return to this slide link at a later time to listen again and read their stories in their entirety because their stories are lengthy and they deserve to be saver. The grand challenge is a call to all midwives, birth workers and institutions to be the change in addressing health inequities and alleviating outcome disparities. We challenge each one to reach one and to teach one until all birthing women across the U.S. have a midwife and birth worker that speaks their language while providing care with cultural congruence, humility, relevance, understanding and professionalism. But what if you are a woman of color in America? Where is your midwife from your unique culture? Being aware of the grave injustice of black babies dying at twice or three times the rate of white babies in America and knowing that the disparity in maternal mortality between black women and white women is even wider in the U.S. This question takes on a dire urgency. If we believe that midwifery care produces superior outcomes and if we believe that midwifery care could be part of the solution in reducing prematurity and other causes of newborn death and if we believe that midwifery care can help mothers from harm, feed mothers from harm, then it becomes a matter of life and death that we have more midwives of color serving the population of women of color in America. By increasing the number of birth workers, especially those of African descent, the grand challenge offers one strategy for improving maternal and infant outcomes and thus reducing racial health disparities in the U.S. Thereby saving our babies, mothers and our families. Claudia, could I have a wee word for a moment, please? Sorry, is it Claudia that's speaking at the moment? You're a little bit quiet. Could you increase your microphone? There's a little drop-down thing next to the microphone at the top. Could you increase yours a little bit? You're a bit quiet and Aisha's just a little bit loud in comparison. Try again? One second. Let me adjust speaker volume. Speaker volume all the way on high. I'll just be louder, okay? I could be very loud. So I'm going to... We'll get a little bit closer to the mic. Okadoki, how's this? Oh, that's better. All right. B, no... Yep, that'll do. Thank you. No problem. I can be really, really, really loud. Being aware of the grave injustice of black babies dying at twice to three times the rate of white babies in America and knowing that the disparity in maternal mortality between black women and white women is even wider in America, this question takes on dire urgency. If we believe that midwifery care produces superior outcomes and if we believe that midwifery care could be a part of a solution in reducing prematurity and other causes of newborn death, and if we believe that midwifery care can keep mothers from harm, then it becomes a matter of life or death that we have more midwives of color serving the population of women of color in America. By increasing the number of birth workers, especially those of African descent, the Grand Challenge offers one strategy for improving maternal and infant outcomes and thus reducing racial health disparities in the U.S., thereby saving our babies, mothers, and families. The first step is underway, the development of a web-based clearing house and resource center, listing scholarships, apprenticeships, and mentoring opportunities with future plans for a solution-focused discussion forum and a book in birth supply donation link. This site will provide every midwife, birth worker, and institution with the opportunity to champion the cause and participate in the solution. Let us begin with a little history. From the beginning of our transatlantic slave triangle, the mid-1400s, to the mid-1800s, over 25 million human beings were kidnapped from the continent of Africa and transported throughout Europe, the Caribbean, South, Central, and North America. Millions of women of childbearing age were kidnapped and sold into perpetual captivity. Their children were sold at a moment's notice. Among these women were traditional midwives and healers. For nearly 300 years, these midwives and the generation of African-American midwives that came after them were tasked with not only providing antenatal and postpartum care for their community of women, but also for the wives and sisters and friends and associates of those who now owned them and owned their children. These midwives were the sole healthcare providers for every member of their community and the white community regardless of age, race, or gender. With the help of indigenous peoples they met, they were able to learn how to use the medicinal herbs found in this new world. They perfected knowledge of pharmacology through the use of herbs and food-based medicinal, nutrition and diet, gynecology, obstetrics, anatomy and physiology through hands-on study, peer-reviewed through the sharing of birth stories with other midwives, and psychosocial and family counseling through their role as honored women in their respective communities. With official abolishment of slavery, the midwives migrated to the free states, Canada and the West. By the mid to late 1800s, there were African-American midwives throughout the United States. Midwives in their new homes became integral parks of their new communities, yet they were not often visible to outsiders. Though few in number, they became community midwives, elder women, healers for their newly located communities. In the beginning of the 1900s, white American-born women increasingly turned away from midwifery care for their births, leaving the changing racial dynamics and demographics of midwifery vulnerable to criticism. With the American Medical Association's systemic campaign against midwives in full swing, the passage of the Shepherd Towner Act, and then later the establishment of a children's bureau, the states began enacting statutes to limit or prohibit midwives from practicing and many of these laws remain in place today. Midwifery regulation targeted African-American grand midwives. Disempowered African-American midwives became the target because they were said to be illiterate, unsanitary and ill-trained rather than to focus on the unequal racist systems or the realities on the ground. Over three centuries, African-American midwives have delivered babies and practice folk medicine in rural counties throughout the South, serving women regardless of their race or economic status. Yet during the last two decades, reformers campaigned to eliminate the practice of community midwifery. As a result, these midwives were pushed out of the profession. Many disenfranchised African-American communities were left without any culturally competent resources for care. The campaign ignored data that showed immigrants and African-American midwives provided exceptional care. Statistics available in the 1920s and 1930s demonstrated significantly better outcomes in terms of mortality for maternal mothers among populations of women attended by both African-American and immigrant midwives than statistics from populations attended by white physician providers. The campaigns aimed at eradicating African-American community and indigenous midwives did not significantly improve the maternal and infant outcomes comparable to the general US population. Our people were left without community respected and entrusted, skilled, maternal and community healthcare providers, midwives who shared the cultural values, more race, language, experiences and perspectives as the families and communities they serve. In the first half of the 20th century, American midwifery did not disappear. It became racialized. African-Americans were restricted for mainstream professional societies as well as most medical schools. African-American and peoples of color in the US, public health and other medical societies did not begin offering services to them and their demographics until they redeemed a threat to the health of whites. Remediation was often in the form of hygiene control and simple treatment of infectious diseases. The campaigns aimed at eradicating African-American community and indigenous midwives did not significantly improve the outcomes. We really need to remember that. Despite a difficult environment and resource for demographics, the midwives offered better outcomes than physicians. This was true even for European midwives serving their populations in New York and other urban areas. Eliminating the midwife problem under the guise of public health to decrease infant mortality was really directed at not wanting the face of midwifery in the United States to be that of a black face. Although they were midwives in the mountain regions of Kentucky and Virginia, the majority of the midwives in the South, approximately 40,000 were African-Americans. In 1923, an estimated 60,000 midwives were practicing throughout the United States. By 1932, roughly 80% of all midwives still practicing were in the rural South. By the beginning of the 21st century, there were estimated to be less than 15,000 midwives of all ethnicities from all pathways. With retiring baby boomers, shifting legislation, the high cost of malpractice insurance, and the inability for many to form collaborative relationships with hospitals and physicians, the number of midwifery professionals continues to dwindle or remain stagnant at best today. According to the 2010 US Census, approximately 36.3% of the population currently belongs to a racial or ethnic group, yet midwives of color represent at best less than 5% of the current practicing workforce. Additionally, due to regulatory standards and language requirements of a various credentialing pathways, midwives immigrating to the US from other countries have little to no chance of continuing the legal practice of their tradition and profession among the communities that they have always served. Why the Grand Challenge? African American women need support and resources from providers that understand the dynamics of being black in America and how these stressors can contribute to poor outcomes and birth. In July, 2012, Mercy in Action School of Midwifery made public a simple scholarship program for midwifery students of color in the United States to address these issues. Founder, Vicky Pinwell, modeled this new scholarship program after their decades-long scholarship program in the developing world, where Mercy in Action staff trained national midwives from first-world economic countries at no charge, supporting the program with a tuition charge to students from developed countries who come to study. In fact, for her entire 33-year career as a midwife and educator, Vicky has always offered unpublished scholarships for low-income women from America. Wow, wow, but it was never formulated or advertised. And it is not specific to the issue and it was not specific to the issue of creating more midwives to serve the populations that had the worst outcomes in birth in the United States. Today, sorry, it makes me emotional. Today, they are changing that in a deliberate way. Vicky's idea to promote scholarships to women of color in America came from discussions with friends and colleagues who are themselves women of color in the United States. They shared with her that due to economics, few women of color have access to becoming CPM out-of-hospital-based training programs within the United States. This is why we see more, though not many, C&Ms of color than CPMs or direct entry midwives because the access to scholarships and funding programs is greater for the mainstream RN and C&M route to midwifery. I believe that being serviced by a midwife of color is a viable part of the solution to improving maternal and infant health outcomes. In the same skin, caregiver and patient sit on a common level of the social pyramid, although their walks of life may differ. As a midwifery student of color, I anticipate the privilege of care for fellow African-American and Caribbean-American mothers. It will be my honor to be the face that greets them and have our minds and souls connect in a way that says, I understand the stigmas that you may have faced in life because I have faced them too. So the care I give to you is tailored just for you and others like you. However, if we are to right a century's old wrong, it is going to take more than a handful of black and brown midwives. A population of midwives must reflect the population of birthing women within this diverse nation. The death of a woman during pregnancy at delivery or soon after delivery is a tragedy for her family and for society as a whole. Sadly, about 650 women die each year in the United States as a result of pregnancy or delivery complications. African-American babies have two to three times the infant mortality rate of the national average in America. African-American women are three to four times more likely than white mothers to die of birth complications. African-American women need support and resources from providers that understand the dynamics of being black in America and how these stressors can contribute to poor outcomes in birth. The death of a baby before his or her first birthday is called infant mortality. This rate of infant mortality is often used as an indicator to measure the health and wellbeing of a nation because factors affecting the health of the entire population can also impact the mortality of its infants. There are obvious differences in infant mortality by race, age, and ethnicity. For instance, the mortality rate for non-Hispanic black infants is more than twice that of non-Hispanic white infants with approximately 25,000 infants dying each year in the US. One need only look at the disparities to realize the inequities that exist. For this reason, mercy in action is offering scholarships to African-American women who will become midwives to serve their communities in America. The situation is also grim for Native Americans, Alaska Natives. If anyone from these ethnic and racial groups want to become a midwife to serve her own people, mercy in action will do all they can to help. So how do we grow a midwifery workforce in the United States? A workforce that is representative of the community it serves, a workforce that embodies with women and exemplifies the midwifery model of care so that all pregnant persons feel valued, respected, and nurtured? Well, in the United States, we have several pathways and traditions in midwifery. A certified nurse midwife is an individual trained in the two disciplines of nursing and midwifery who possesses evidences of certifications according to the requirements of the American Midwifery Certification Board. CNMs provide well-women and prenatal services in clinics and offices and hospitals and provide birth services primarily at hospitals and birth centers with a slow and increasing presence in home birth. A certified professional midwife, like myself, is an individual trained in the discipline of midwifery through self-study, apprenticeship, a midwifery school program, or a combination of these. My training does not require that I receive a college baccalaureate certificate. A CPM is a knowledgeable, skilled, professional, independent midwife practitioner who meets the standards for certification set by the North American Registry of Midwives, NARM, and is qualified to perform midwifery model of care. The CPM is the only national credential that requires knowledge about and experience in out-of-hospital birth settings. Although this may differ by state, CPMs provide professional care in offices or homes and provide birthing services and birth centers in homes mostly. We also have the licensed midwife or direct entry midwife, and that person is an individual who's an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school program, like she is not a nurse. LMs, EMs offer their care in offices and homes and provide birthing services and birth centers and homes. Yet, how do we sustain a model that is easily accessible and welcoming, driven by quality and patient center, culturally validating, offering mother and baby center, kind maternal child and family care? As a future midwife, I think a lot about the changing demographics of the United States and how this will impact the relationships between midwives and the communities they serve. I find myself looking forward to the challenges and rewards of reevaluating my skill as a culturally inclusive midwife. I hope that my experience as an adoptee might help inform the thoughtfulness with which I approach each family that I work with, serving as a reminder to let go of assumptions. She knew safe and natural ways to keep me healthy when doctors did not. I am fully satisfied with my experience and have gratitude. I am in support of midwives of color as our communities benefit from the connectedness and love that they offer. Yet, there are barriers that prevent aspiring midwives of color from serving the very communities that need them the most. Under the CPM route to becoming a midwife, a student has the option of obtaining her didactic and clinical training with a preceptor using the apprenticeship model and preceptor supervised or self-study. It's called the portfolio method, it's our PEP. Or a combining the clinical components with a preceptor and getting her didactic training through a auspices of a formal midwifery school of program. With these options, a student is often responsible for finding her own local preceptor for hands-on clinical skills training because of the limited number of robust local midwifery practices who are willing to accept apprentices or have space for more apprentices or do not charge for precepting or charge a modest fee and allow a preceptors and apprentices flexibility to work and the apprentices time to raise their children. It is often difficult for an apprentice to find a local preceptor. So formalized schools and programs can be distance-based, online or a local brick and mortar school structure. Those potential midwifery students considering attending a formalized didactic training, there are approximately 50 or fewer midwifery schools and programs in the US. Few are qualified to offer federal financial loan assistance to a student and even less offer scholarships designated for students of color. Without federal student loans, grant and loan repayment options, this route to midwifery is often too costly for most potential students. Yet, the grand challenge offers a solution. Other widely known, those seldom discussed midwifery classifications include indigenous, traditional, community and spiritual practitioners. These midwives are often vetted by the communities they serve and remain unaccounted and unregulated, discreetly navigating outside the law. A quote from Reclaim Midwifery and Healing Services states that indigenous healing practices are an ancient, intact, complex, holistic healthcare system practiced by indigenous people worldwide. The healing traditions of indigenous people of North America, for example, have been practiced on this continent for at least 12,000 years. Medicine women and men were long recognized by colonizers as a principal barrier to the eradication of indigenous cultures. Therefore, traditional healing was made illegal and the skills of traditional indigenous medicine was driven underground. By forbidding indigenous languages, spiritual practices, freedom of movement, familial structures, teaching styles and beliefs, as well as through genocide, threats of coercion, indigenous healing practices were greatly damaged by colonialism. She so truly believed in the miracle of birth and maintained her confidence in women's ability to do so. She comforted me and reassured me that babies know how to be born and that my body would know how to respond naturally. From the year 2000 to 2005, infant mortality rates did not change significantly in the United States, but in the following four years, most U.S. racial and ethnic population groups saw a significant decrease. American Indian, Alaska Native populations, however, actually saw an increase in infant mortality rates during the time period. The figures on this chart show, this is a very important chart, the figures on this chart show infant mortality rates by race and Hispanic ethnicity of the mother. In the United States during 2000, 2005 and 2009. During 2000 to 2005, the U.S. infant mortality rates did not decline significantly for the total population or for any race or ethnic group. However, in 2005 to 2009, the rate declined significantly for all racial groups except for the Native American and Alaska Native. Infant mortality rates in 2009 were higher than the U.S. average, 6.39 for non-Hispanic blacks, we were 12.4, and American Indian and Native Alaskans, they were 8.47. The use of my sister is a term of endearment representing a fictive kinship where people regard it one another as being part of a family even though they are not related by either blood or marriage bonds. Fictive kinship may bind people together in times of affection, concern, obligation, and responsibility. I was vital in my sister's recovery. What my sister told me she needed the most was attention and sincerity. She felt like she was discriminated against because she was obese, on Medicaid, and African American. I was simply a doula, one woman providing love and support to another woman during a major life transition, be it life or death. What a sacred honor. Latina mothers in the United States enjoy surprisingly favorable birth outcomes despite their social disadvantage. This Latina paradox is particularly evident among a Mexican-born woman. The social and cultural factors that contribute to this paradox are maintained by community networks, informal systems of prenatal care that are composed of family, friends, community members, and lay health workers. This informal system confers protective factors that provide a behavioral context for a healthy birth. US-born Latinas are losing this protection, although it could be maintained with the support of community-based informal care systems. We recommend replicating and harnessing the benefits of these informal systems of prenatal care, evident in Latina communities to meet the increasing needs of pregnant women everywhere. As I confide in my faith in her, she did the same to me. She so humbly followed my lead in letting my own wisdom in my body guide her practice. I felt empowered and strong. Birth should be beautiful in the place of the family's choosing, and I am proud to represent that right for all women. As for the scholarship challenge being based on race, Vicki Penwell, the issuer of the grand challenge, states that, yes, for her, it is absolutely a biblical, moral, and ethical question. Of course, any good midwife can care for any woman and should, but experts say that it is easiest for people from the same self-cultured to understand and care for each other in the context of healthcare. This is a well-known fact, and one that must be acknowledged when the race that is dying most in childbirth in America, black, is different from the race that produces the majority of midwives white. Vicki goes on to say that if we believe that midwifery care works to reduce prematurety and other pregnancy problems, then helping create more midwives will be one concrete way to the current nightmares and outcomes in America. This scholarship is only until black babies and white babies die in America at the same rate, and white and black mothers lose their lives in childbirth at the exact same rate. Until then, it is not about judging someone or giving charity to someone in justice for all. Vicki agrees wholeheartedly with the words of Dr. Martin Luther King, Jr., and she too dreams of a day when all people will be judged by their character and not the color of their skin. Like she says, think of it this way. We cannot judge the character of a people who are dead. We never even got a chance to live until birth survival is equal for all races in America. She will work hard to explain and promote this challenge to train more midwives of color in America so that once again, midwifery will reflect our wonderfully diverse population of pregnant women in America. Addressing the inequities and eliminating disparities is not that complicated. It is just a matter of life and death. The World Health Organization reminds us that the overwhelming majority of babies in the United States are born healthy and their growth brings joy and comfort to their parents. But across the country, there is a whopping disparity in birth outcomes based on race. Black women fare worse than white women in almost every aspect of reproductive health. The World Health Organization defines an external death as the death of a woman while pregnant or within 42 hours of termination of pregnancy, irrespective of the duration and the size of pregnancy from any cause related to or aggravated by pregnancy or its management, but not from accidental causes. Look at this chart. With each child. Thank you. With each child, I felt the presence of those women who came before, some in agony, pain, and suffering while others were uplifted, sustained, and supported and loved. It is imperative that sisters support each other. Point blank, period. I felt that my love and care ethic would be healing to the mother's giving birth and that I had a special ability to offer emotional support to these mamas and could stand tall with them as they brought their babies into the world. I need him to be in a space where the warrior can be left outside and he is only as strong or as soft as I need him to be. When I give birth, fair treatment is not something I want him to be thinking about. I don't want to wonder if the nurses assume we smoke marijuana because his locks reach his waist. I don't want to assume that the doctor is aggressive with or dismisses above him because he is wearing a dashiki. I don't want to be asked standard but insulting questions about our relationship status. I want him to be in a space where he is seen and recognized, a space where our birth attendants know our first and last names and the names of all our children. For me, it was the things I could leave unsaid that made the experience of working with Black birth workers so amazing. As an African-American woman, I wanted an African-American midwife in Dula when I found out I was pregnant the first time. It is important to me because I feel like I can be the most vulnerable with women who look like me and my family. This was a powerful experience that would change my life in a positive way. I know the importance of advocating and empowering our mothers. I am easily accessible, welcoming, quality, patient-centered and driven, culturally validating, mother and baby-centered, kind, maternal, child and family. Poverty often renders these women politically voiceless and left to suffer lesser quality care and less satisfactory birth experiences. Women of color within the maternal health system are in dire need of culturally empathetic care. Cultural differences in diet and lifestyle, as well as relationship dynamics can have a negative effect on pregnancy. Navigating these differences is not something that is taught in a conventional childbirth education certification course. I have the unique ability to communicate information and strategies to help families of color to experience healthy pregnancies and birth. This is why we need more midwives of color. Trained immediately, we have a crisis in maternal and child health care and who is gonna stand for the women of color. If we do not do it, who will? I learned that the love and connection through the care that I give a client, called Midwifery Care, saves lives. The grand challenge is doing the work and offering a solution. We are building a virtual clearinghouse and resource center for scholarships, apprenticeship opportunities, mentoring opportunities, a book and supply donation match and a forum for continued solution-focused conversations. By increasing the number of midwives and birth workers of color, we hope to increase their accessibility for all and improve the outcome for those with the greatest disparities. You can be part of the change by raising awareness and acknowledging that the problem is real and that exists. Begin by researching the perinatal outcomes for your county, state, region and country. Raise awareness through your networks to common authority on the disparities in your area. Support your Midwifery School or program, including overseas clinical sites. Find out if your alma mater or your current Midwifery School has a scholarship program for midwives of colors and let them know why they need to have one and why you would support them in this effort. Create a scholarship fund from scratch or partner with existing funders. Raise funds to ensure that your Midwifery School or program has a robust library of books, digital media and other resources that address issues of disparity, birthing issues of people of color. Encourage the speaker's committee for your school to find and pay the expenses of speakers of colors to speak on various topics pertaining to the entire world of Midwifery. Insist that your school or program hire lecturers, teachers, assistant professors, advisors, counselors and staff members of color. Become a donor. Become a preceptor. Intentionally mentor. Be a placeholder. Be a crusader. Theirs listed is the website for the grand challenge. The results we expect are lofty yet attainable. For professionals who should be equipped with a skill, knowledge and attitude that value the diversity of the families they serve while contributing to a prenatal and perinatal health delivery system that cares for mothers. As a result of the grand challenge, we fully expect to see an increased number of midwives and birth workers providing access to care in their communities, which should result in improved work outcomes for communities of color. We look forward to fostering solution-based, focused conversations regarding inequities and witnessing greater cultural concern and fluency in the professions, along with collegial responsibility among birth workers for all pregnant persons, in addition to increasing the number of pregnant persons being served by midwives. Not only my doula, but my sister friend and mother. Because of her, I truly understand the importance and magnitude of birth and freedom and expression. From the Akhan people of Ghana, we are gifted the term Sankofa, which translates, it is not wrong to go back for that which you have forgotten. We had to Sankofa or go backwards and tap into the ancestral energies of the grand midwives and find the right one to bring our firstborn son into the world. Mama Nankululeku treated me just as a loving mother would treat her child and handled me with such sensitivity. I never felt like a science experiment being poked, prodded and examined like I experienced at my hospital births with people who did not mirror my lifestyle or in my opinion, have my best interests in mind. I always felt loved and powered and appreciated under the care of my midwife. Not only did we have an amazing and memorable birth experience, we activated ancestral DNA when we went back to the old ways and consciously chose a midwife who represented my people. Knowledge is like a garden. If it is not cultivated, it cannot be harvested. We want to personally thank all the mothers and birth workers of colors who honored us by submitting their photos and testimonials for us to share with you today. Arshay, we hope that today's presentation has provided you with inspiration. We'll now take your questions. Aisha, can you advance to the slide with the references and resources? Yes, yes, I will advance all of them. There's a question, Claudia, creating the clearinghouse itself takes funding. Have you identified any sources for this yet? Thank you. I've applied. We hope we have applied for a FAM grant and the FAM voting should start this week. We have Vicki and Mercy in Action were kind enough to get the website set up and to do the preliminary infrastructure work for the website. We have had committees and need more. We need more people who will help us get the clearinghouse information populated onto our database. We need more help with this. We need more help. This is a volunteer effort. We are doing this because we believe in it. We are doing this because we know it's right. We're doing this because it's life and death. And we need more people who will spend time googling programs for doulas, childbirth educators, breastfeeding education, midwifery programs around the United States so that we can enter the information into our database so that it will be available for people who are looking for ways for doors to open, to make a way for them to become midwives. And we need your help to do this. We have an article in this month's squat. We have an article in last month's midwifery today. If you go to our website, we have a AOL address that you can write if you wanna volunteer sometime. When I say time, I'm talking about a day. Eight hours on the internet. Late at night, when you're not sleeping, Google stuff. Go look at programs, download the information for us onto our databases that if you sign up, we can send you. This is something that each of us can do without spending any money. We can do it in your PJs. You can do it at the beach. You can do it when you're not paying attention in class. You can do this for us. This is not a Herculean task. Getting our database populated. And then you accepting responsibility, talking to your preceptors, your school, give us money. Support this program. This is gonna be something that like many of the changes in the world, we'll run on the hearts and the backs and the minds and the hands of the people who know this is right. We have two asking what, if anything, are NARM or ACNM doing to help with this effort? Nothing. I can say that MANA listed, I think MANA listed our program in one of its constant contacts for Black History Month and NACPM listed this program in its constant contact for Black History Month in February. However, we hope to put pressure, have people who will help us, put pressure on all the midwifery organizations, be they trade organizations, certifying organizations, credentialing organizations or social organizations to get them to take this cause on by sending out letters to their constituents and putting it on their website. Taking an active part in encouraging people to join this crusade. Come, be a crusader. Come, champions. Champion this change that can help improve birth outcomes in the United States. This is not about affirmative action. This is not about finding jobs for Black people. This is about saving mothers and babies. This is about what we are committed to do, what we have signed on to do, what we have given our hearts and bodies to do, to save mothers and babies. And this is the way we can all do that. There's a question from Lori asking if MOCs are even on the radar, midwives of color, or even on the radar with ACNM, and I can answer that by stating that they do have a midwife of color section for those women who self, those women are providers who self identify as midwives of color and for their allies and supporters, what their efforts are up to this point in terms of growing the population of midwives of color. I'm not aware of. You know, you have to remember that we have to look at birth and especially Holmberg as something that, in the 1970s, started off looking like a white hippie movement. And the fact that African-American, indigenous midwives of new immigrants to the United States had always been doing Holmberg, never went anywhere. We've never gone anywhere. We've always been here working hard, but in the history of midwifery as it exists in America, we weren't included in the history. And because you're not included in the history, people think you don't exist. We're always here and we need to now step up and realize that if we're going to save mothers and babies of our communities of color, we have to go back and figure out how to recruit, train, support and protect women who speak the same heart language, share of the same culture of the women. We're the one, we're ready to do the work. We're ready. We're ready to go save our communities. We need more comrades. We need more crusaders. We need scholarships. We need apprenticeships. We need books. We need dopplers. We need all those things. We'll go do the work. Just help us get ready to go out there so we can save mothers and babies who look like us. An interesting comment has been presented by Tiffany Carter-Skelling. It's not actually a question, but she states that it would be great to get U.S. mayor's attention to the WOC Clearinghouse. The U.S. mayor workgroup includes representatives from MANA and ACPM, NARM, MEG, ACNM, ACME and ACMB. And I'm sure that as those who are aware of the history of Mitt Wifery in the United States and our current present day focus of Mitt Wifery, the U.S. mayor is definitely underway doing something about Mitt Wifery and it's not necessarily specific to reaching communities of color, but I think that in the years to come we'll see some very dynamic changes and it would move everyone to read about what those pending changes are in terms of legislation, in terms of pathways to Mitt Wifery, in terms of access, and see exactly what are we repeating in present day Mitt Wifery, I think. And I have to politically add to this because this is a touchy point with me, U.S. mayor. If you look at the groups that represent midwives that were invited there, ICTC, International Center for Cultural Traditional Midwives, the organization that represents Black Midwives was not included in the U.S. mayor. So that's one perspective on merit. They did not include as a representative of the organization that represents Black Midwives. Second off from the changes that have been talked about in the goals that were released in the two, the ACNM report and the U.S. mayor report, it's gonna be more incumbent upon apprentices moving forward to have some more formalized training that in some ways comports or meets with the Meek standards and Meek schools are expensive. So we're once again back to having even more of a need now to have scholarships available for birth workers and midwives of color to be able to go to Meek accredited schools so that once the new processes that have been decided upon by U.S. mayor are in place, more midwives of colors will have more opportunities to become midwives, have more funding available so they can become midwives, not be excluded, further excluded from the mix. Okay, if I can just interrupt now. We're coming to the end of your most moving and thought-provoking presentation. I think this is really a conversation that could be continued tomorrow when we have our final meeting at six p.m. Eastern time in America. I'm not quite sure what time it is for everyone else out there but I think this conversation has got a long way to go. So thank you so much to my wonderful colleagues and we look forward to continuing this conversation. Thank you so much.