At HealthPartners and Park Nicollet, it’s part of our ongoing work to improve the health and well-being of birthing parents and babies, through health equity efforts focused on eliminating disparities in maternal and infant care. Diane Banigo, a doctorate-prepared midwife, certified nurse midwife and Park Nicollet community consultant, discusses means to be a midwife, the importance of building authentic relationships, and “birthing while Black.”
At HealthPartners and Park Nicollet, it’s part of our ongoing work to improve the health and well-being of birthing parents and babies, through health equity efforts focused on eliminating disparities in maternal and infant care.
Dr. Diane Banigo, a doctorate-prepared midwife, certified nurse midwife and Park Nicollet community consultant, discusses means to be a midwife, the importance of building authentic relationships, and “birthing while Black.”
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guest: Diane Banigo, DNP, APRN, CNM
HealthPartners website: Off the Charts podcast
Got an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.
Kari Haley:
He's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is Off the Charts.
Steven Jackson:
Welcome to our show, we are very excited to have Dr. Diane Banigo with us today. We're going to have some great conversation. Dr. Banigo is a doctorate-prepared nurse midwife?
Diane Banigo:
Yes.
Steven Jackson:
And she's a community consultant and educator. Good afternoon.
Diane Banigo:
Hello.
Steven Jackson:
Welcome to our show.
Kari Haley:
Thanks for being here with us today.
Diane Banigo:
It's good to be here.
Steven Jackson:
So there's a lot of ignorance in the world and I might be one of those ignorant folks. What is a nurse midwife?
Diane Banigo:
I always say a nurse midwife can be many things to many people.
Steven Jackson:
OK.
Diane Banigo:
There's the professional box that people place them in, but a nurse midwife is an advanced practice nurse generally at least master prepared. If you are a nurse midwife, you have nurse training and then you have special line training in birthing, maternal child health matters. But I like to extend a sisterhood and nurse midwife generally means with women and sometime I like to simplify it and say a baby catcher. But midwives do more than catch babies, we're just in a lot of places and take up a lot of different spaces. So it can be different things for different people.
Steven Jackson:
How did you get into your field of study? Your field of practice?
Diane Banigo:
Actually it was Ray De Vries. If you're listening to this come find me. But I actually was pre-med and I always wanted to deliver babies and be an OB-GYN because that's how babies come, right? You go see a doctor and I was taking a class up at St. Olaf and he was like you should be a midwife. I'm like A midwife, huh? I'm not going to anybody house. I just kind of like shoo, shoo'ed it and so then he started telling me a little bit more about it. So then I dropped out of the pre-med program, switched over to nursing and explored it a little bit more. Because I didn't want to have to have a nanny to take care of my kids. Parenting was really important to me and all the shows that I watch doctors had to have nannies and so I switched from pre-med to going to midwifery because I thought I was going to have life, work balance. Wrong.
Kari Haley:
Go on beyond that, describe what's your typical day? Again, maybe speaking from a place of ignorance for sure. What is your day like? Where do you practice? Who's your population that you see?
Diane Banigo:
So I would say my work is probably different now in 2022 than what it was when I was in full fled full scope practice, meaning you're doing clinical care, you're doing birthing. So now I practice more from a community perspective and so I do a lot of listening to women. I still do some telehealth, I just took a per diem position at a birth center and so I like to practice in and out of hospital. Even though I grew up in the hospital, I always say this was the first place regions where I caught babies back in 2006. All the way actively full fledged full scope into 2012 and then left and ventured out into the out of house put around birth experience. So it depends for different folks because I do a lot of community engagement work. My position now is a little bit different than traditional go into clinics, see patients, never sleep, catch a baby, go home, never see your family, that type of thing. So it's a little bit different now.
Steven Jackson:
It sounds like a lot of fun.
Diane Banigo:
I mean, it is.
Steven Jackson:
The no-sleep part.
Diane Banigo:
I love my bed, right? So I always say I've retired that part of my life, but actually I'm not I'm getting back into it slowly.
Steven Jackson:
That's cool. So I hear you say community consultant. Tell us a little bit more about what that is.
Diane Banigo:
I always say that God gave you two ears and one mouth for a reason. So I was part of a small group of midwives that started the midwife practice over at North Memorial some moons back and I remember when that practice resolved. I remember thinking that I need to go back to school so that I can get the alphabet suit behind my name to be invited into spaces where these inequities happen. Because you have to have all of that behind your name to actually get the invitation, whether they listen that's a different conversation for a different day. But at least get the invitation because I saw a lot of profiling going on with the women that I was serving. So I decided to go back to school and that's when I decided to start listening with a different set of ears to what women were really saying and finding out how the cycle was being perpetuated and if I was not a part of the solution then I was a part of the problem.
So I decided to do things different and that's kind of where my focus shift from the brick and mortar, the bed time, to the community.
Kari Haley:
That's awesome. You kind of spoke a little bit here or mentioned the disparities. Can you highlight some of the disparities that are out there or that you've observed or that your practice has focused on?
Diane Banigo:
I often say thanks to social media now people know what's been going on since the beginning of time. I mean, we're not going to get biblical here but certain babies were put upstream and certain babies got to stay. So I don't think that the numbers have changed drastically-
Steven Jackson:
This is true, go ahead.
Diane Banigo:
I mean, so I don't know. When we talk about disparities and I was just googling on the way over, when did this happen? Granted I came onto the set in the early 2000s and no one talked about it. But when I'm doing the research they were always there and so we talk about Black and brown people, women particularly which they're my soft spot. We're three to four times more likely to have a bad outcome or not make it out the birthing suite, Black babies are born too small, too early. We know that everybody's seeing it now, everybody's putting it on wherever they can put it to get attention to get funding. But what we're not talking about are the disparities of the lived experience of birthing and being pregnant while Black. So I like to give voice to the narrative and when I'm in these different spaces as a community midwife to echo and amplify the things that they talk to me about in private even though it's not private. But outside of the clinic setting of birth and suites and to be a disrupter if you will.
Your perception of what it's like to be a Black or brown birthing person. Particularly most folks identify as women that I work with in these settings, so let's talk about it.
Steven Jackson:
Yeah. I love it and you've said a lot. I mean I have so many questions, so I just have to kind of slow my brain down here and we're kind of getting into inequities and you said I quote, "You're listening with a different set of ears." I want to know what are you hearing from the community and the people you serve? What are you hearing?
Diane Banigo:
I hear different things in different spaces, but I think the thing that hurts me the most when I listen is that if we're talking about the general population. Right? They're often unaware... Let's just say five years back, not now with all social media. That what they're experiencing is not normal. So I started a program with the Minnesota Community Care which is a partner here, they birthed downstairs the Diva Moms program. I found that I had to convince the women that I was serving that you fall into this certain group, this is what's happening to your people. So we have been brainwashed, if you will and been conditioned to expect or accept certain behaviors as normal and not the exception. So I find that that's been some of the most challenging work to hear it and to know that since I was silent for so long. Being a new provider, all these different things that I continue to allow these kind of micro and microaggressions to happen by not speaking up, by not advocating, by not being a disruptor to the lived experience.
So it's hard because you're hearing it from the lived experience as being able to identify as also a Black woman, as a provider. You wear these different hats as a mother, as an ed...
Steven Jackson:
Sure.
Diane Banigo:
We've missed the mark, right? So how do we pause and pivot and do something different even if it's unconventional and you can't get rich off it.
Kari Haley:
Yeah. I mean honestly that's heartbreaking to kind of hear that. That people weren't even aware of the inequities that were being placed upon them because they were so used to it or it was just deemed appropriate in normal care. That's heartbreaking to hear. What kind of strategies have you done to bring this knowledge into the community or fight for the community and be their advocate?
Diane Banigo:
I mean, I think knowledge is power and when we all do better, we all do better and I often like to remind them that. But it's not even about the experience, it's about the isms. You can put whatever you want in front of it.
Kari Haley:
Yes, absolutely.
Diane Banigo:
The isms, right? And how that determine the trajectory of how you're going to come. Being a wife and in communities of West African populations, knowing that it's not the same for the skin, it's not about the skin it's about the isms. So just breaking that down into digestible pieces that if you are unaware then you don't take up space. If you are unaware then you don't ask the question because you don't know what you don't know. If this is what you've been conditioned to think is normal then why now I'm tripping because I'm telling you the real. I'm telling you what they say when I'm in these white spaces because I've always predominantly been the one and only in X, Y and Z.
Steven Jackson:
Let me raise my hand real quick.
Diane Banigo:
Yeah, when it, "Oh, them." No, I am the them, I'm telling you what they're saying and they forget I'm there right? Because I'm also invisible. I've had providers within certain systems, right? "Have we met before?" "Yeah. How many Black midwives did you have working on your..." "Oh, oh. Oh."
Steven Jackson:
Oh.
Diane Banigo:
Exactly. Have we met before? But I've sat alongside in meetings, that's even as the provider. So if I'm that invisible, right? I can only empathize with the invisibility that our patients feel in some of these spaces that in progressive Minnesota, liberal Minnesota. Right? I can only imagine how people feel and now I don't have to imagine I get to hear it from them. Because I work in those spaces where we're listening, providing opportunities for women to speak up and be unapologetic about what they're experiencing.
Steven Jackson:
I'm hearing a lot of systemic components to what you're saying. We can call it systemic racism, we can call it systemic fill in the blank ism.
Diane Banigo:
Isms, yes.
Steven Jackson:
But it's something systemic because even taking it outside of the context of Black maternal health and Black infant health. I mean something as simple as somebody coming to my door and I answer it and whoever the service provider is, whether it's a cable company or a landscaping company. You know that initial two seconds of, "Oh, I didn't expect you to open the door." That kind of thing, and I tell my wife often we have to somehow change what is normal. I want to share a real quick story. I think it's still in context. We were on a plane and I can't remember where we were on the way to; it wasn't that long ago. I mean, well I flew first class. Sorry, listeners. I hope you don't have a problem with that. Anyway. So there was a gentleman, he was one of the flight attendants and he was greeting all of the first-class folks like, "Hey, how you doing mam and sir? Welcome, welcome. Good to see you, good to see you." He gets to me and my family, he says, "Did you win the lottery?"
Diane Banigo:
Oh, wow.
Kari Haley:
Oh, boy.
Steven Jackson:
Now he was "joking." But that was his response to me. Now we were the only Black family in first class and everybody else got an hey thank you, thank you for being here, da da da and then he said, "Wow, you must have won a lottery man. Good job brother. I'm just playing." The look my wife had on her face and I just said, just chill it's all good. He said, "No, I'm just joking." Even if it was a joke it still goes back to how we've all been conditioned to some degree to fall into the "normal." We have to change the narrative. We have to change what's normal because yeah stuff like that. OK.
Diane Banigo:
I mean you saying it and we'll try to pivot back this way but I facilitate appraise and positivity weekly through one of my consulting practices and we were just talking about that. I remember when they were having issues on the airlines about who can be a doctor. So I remember someone needed help and it couldn't be you, right? Because you are the help, how can you help? So I remember my husband was trying to encourage me to go back to school to get my doctorates after our midwifery practice at North Memorial had resolved and I remember just thinking to myself. You know what? I need to go back so that other little girls can know that you can be heavyset Black with dreads. I show up in usually a cut up and some kicks and be a doctor, right? So I'm investing in myself enough to go to the top of whatever field I'm going into. I'm not an OB because a double negative, yes because I couldn't hack it. I was in the pre-med program.
But because I wanted to challenge and I didn't want to be a part of a good old boys club and I wanted to give people a reflection of what you could be because no one was that for me. So how many times have I been told, can you get the nurse? This was before I went back to be the doctorate midwife. "Can you get the nurse? Do you want my tray?" What do I want with your tray? I know I look like I like to eat, so don't offer me your tray. Right? Because they thought I was the aid. No, I'm a four year prepared nurse. Not even-
Steven Jackson:
I love it.
Diane Banigo:
There's nothing wrong with being an LPN or RN, right? But I couldn't be who I was because of what you thought. So it's deep.
Kari Haley:
Yeah. I mean I'm just really honestly just absorbing all of that. Because I think that for people who don't know others who've experienced that in their life, this is something that probably just like... You don't even know what to say sometimes. Because you have zero context of that in your bubble, your box, whatever you want to put it as. I think that you speaking, especially speaking for community of women who may not feel like they have a voice is so important and so admirable. Have you gotten feedback from the community in any changes that they've observed? Or any let's go for positive things that maybe they've seen in the last few years because their voices maybe being heard a little bit better?
Diane Banigo:
I would say a good example I came from a meeting this morning and I would say there are some systems that talk about it and there are some systems that are about it, right? I would have to say I have a soft spot for the HP-PN (HealthPartners-Park Nicollet) system. Because you guys are actually stepping out in the water and in trying to make a difference and not just talk about it or put it in your policies. So the work that I've been doing for this organization recently as a community consultant was a part of the Black pregnancy and post-birth journey through the heart of the customer project they were working on within the system. We just had our reveal of all of the months of listening and one-on-one interviews and community circles that I've been facilitating with my partner, Ciana Cullens, through Igniting Power of Woman, iPOW. Go, iPOW. Anyhow. So one of the things that the women said is that they like being in community, right? They like having their feelings validated and a lot of people use the word empower.
We can't empower people, we already possess it, but we give them permission to execute the power that they possess.
Steven Jackson:
Now you're preaching, OK.
Diane Banigo:
So that's what we like to do in those spaces and when we... The harder the customer was a little uncomfortable about changing their strategy to elicit these women's lived experiences. But I appreciate that they were willing to trust me and my partner as community experts to say, no this is what I do. This is not my job, this is who I am, listen. So they were allowed us to do these community circles and when we shared back how the women felt revived to have a space. A safe space with folks that look like them that can code-switch if we need to let them just release. Release. So because it was so therapeutic, cathartic almost if you will for the women. Now we're doing a pilot starting July 12 for Black and brown pregnant and post-birth people to host community circles for them and the project is almost over.
Kari Haley:
That's amazing, yeah.
Diane Banigo:
So they listen and so hopefully they'll find funding because they want to see this thing through. You've trained the staff, but how do you continue to hold folks accountable if you're not continuing to listen? Even if they're saying the same thing that they said 50 years ago, right? But it's not what your mama did it's what you're doing now. So if they're still saying the same thing then you still have the opportunity to get it right. So I would say just to echo that, some people are really trying to do something differently even if they don't know what that is and we don't even know what that is. But we're creating a space that we can customize to be what the women need while they're in it.
Steven Jackson:
Wow, is there anything that you can tell our listeners if they're again Black and brown... I'm going to mess it up
Diane Banigo:
Pregnant and post-birth?
Steven Jackson:
Pregnant and post-birth people.
Diane Banigo:
Yeah.
Steven Jackson:
Say that fast three times.
Diane Banigo:
Yeah. Tongue twister.
Steven Jackson:
If they are interested in the pilot, is there any kind of general information that's that's available for folks to be involved?
Diane Banigo:
Yeah, ask your clinic. I mean, if you continue to ask for us then they'll make sure that we're available. But I know they just created the flyer, so there's a QR code that they can just scan and sign up and kind of get plugged in. We're going to offer the second Tuesday from 11:30 to 1:00 a circle for the women that don't have to work or can't work, right? Whatever. Then we'll host a circle on the third Tuesday of the month from 6:30 to 8 for the people that need to come in the evening and just to have some real conversation. In that space I'm not the doctor midwife, right? So I won't wear my medical hat necessarily but I can allow people to continue to go down the wrong way. So I will make sure that I give and set some boundaries to make sure that we're not talking down and we're getting it wrong. But just for women to just come and be in community because there's so much learning. We have been told that we don't know anything.
We have to come and get all the answers from the provider because you know all be all, but it's supposed to be a partnership. So what we want to do is to have women love on women and to encourage each other to just look within, to be a part of the solution. Because they say everything you need is already in the house. So how do we collectively lock arms? That's what we do in our how when women lock arms things change. How do we lock arms and support each other so that we can continue to journey on?
Steven Jackson:
Well, I agree with you that the HP-PN family they're about it, not just talking about it and I like the fact that as a fellow care provider. I too have been given an opportunity to take the message to the community, not only by way of this podcast but different buckets of work that I'm involved in. I think about our mission and our values and our vision and our values. Always think about epic because that's the way I can remember it. But excellence, partnership, integrity and compassion, I think about partnership what you just said. Prime example of how it's not just a plaque in an executive conference room, but you're just another manifestation of how we are living our values and taking it to the people that need it and so just really appreciate that.
Diane Banigo:
And to continue to make space for people of the community to broker that conversation. Especially when you're... I mean there's so many intersectionalities, right? We wear so many different hats. But to value community with lived experience and alphabet super credentials to actually broker that conversation and not to try to take it from them and then put your brand on it. Right? They're good at that, systems. But how do we continue to build authentic relationships? Compassion is something that a lot of health systems miss and so even in this listening. It was a year, some people were pregnant when we started the project now their baby's are six months. We've been with these women-
Kari Haley:
It's been a while.
Diane Banigo:
It's been a while and so just to listen. Some of the things that they bring into the systems when they show up are baggage that they carry from other systems. But if we're the only ones trying to be great that's the problem, right? Because the thing that I often challenge when I'm in systems and invited to meetings that you have no ownership over these people. Granted, you got to keep your doors open right? We get that. But if they can be better served by someone else that's doing it better then you want them to be better served? Because when we all do better, we all do better/ so to continue to have those conversations about ownership and partnership and compassion, what does that really look like? How are you held accountable on your compassion? Until it's attached to dollars we ain't going to see the changes that we need to see. But it can't just be in health care, health care can't be the only ones. We need to talk about rail line, housing, employment-
Steven Jackson:
Yes, education.
Diane Banigo:
Education, the training, right?
Steven Jackson:
Yes.
Diane Banigo:
Because if we are conditioned and we perpetuate the isms, the bias known and unknown into how we practice care. This came up at the meeting today. A lot of times when you do see someone that look Black or brown or of color, right? Then you're disappointed because they're just like no offense, they just like some of the other people and I call them mainstream. They're mainstream, right? So you're off now because you expected more but why? When they've been conditioned and trained to do and perpetuate the other isms. So then we're double damned, right? Because we can't win for losing because now we're not part of the community now we're part of the system. Why can't we make space for us to be both?
Steven Jackson:
Yeah.
Kari Haley:
No, that's really powerful and just that partnership, that feeling of just that human to human connection and I think the work that you're doing is so important. I'm so glad that the HP-Park Nicollet people are being a part of this and investing in it. Because it's hard enough to be a mom, it's hard enough to be pregnant. It's hard enough to not have any of the isms or only a few of the isms and go through that, let alone be part of all of the isms and go through it.
Diane Banigo:
COVID has done damage, but it also has done a lot of good more people are listening to podcasts. I did one with Dr. Paul Batalden just about the co-partnership, just what does that really look like? So to know that people want to hear and want to do something different and just to have the freedom to co-create. I think that is so important and a lot of times we just don't do that or we don't have time, right? We can't put our views on that so we can't monitor, we just can't... So time is money. So how do we really just give systems permission to do over to do better? So I think when we have these different things like this it's so important to keep people... Midwives in particular, we need to be in all spaces because our job is to be with women. To have people in those spaces and that continuously listen. Continuously listen, not don't have a listening and strategic meeting and have these plans and then OK I consulted with you and now Diane, you're gone. Right, Dr. B?
What are they saying now? Are we doing better? So I think the co-creation of what medical care could be, we need to continue to have ears to hear.
Steven Jackson:
Have you had any aha moments? Or "success stories"? Particularly in situations where maybe some of your clients, maybe they didn't trust health care. Maybe they didn't trust you because of bad experiences in the past and now they're thriving. Anything that comes to mind?
Diane Banigo:
There is a one particular patient, I say when we started out DIVA. I got fired like me, who fires Dr. B, right? For real? Anyhow, she fired me because one of the things that I tell you is that if I see something I'm going to say something. I believe that families do well when all or both parents are participating and this particular patient had a Jerry Springer kind of situation to kind of and this she's with child. But she really wanted the father baby to be involved and so I provided an opportunity for him to be involved even though their relationship was supposed to be incognito. So anyhow, we have this conversation and I told her what he said. I told her the truth and that was so hard for her to hear and she fired me because she didn't expect me to do what I said I was going to do.
So she was like... Nothing wrong, but oh my God she was just devastated because I followed through, right? So she thought when the truth came out about their situation I was going to judge her and she didn't want to show up because she was worried about how I was going to look at her. So then we hosted an event and then I invited her to come and she brought her baby and I remember her baby and I just held her daughter and she came back and apologized. She said, "Diane, I didn't realize how much you love me that I really can show up and be who I am and this was a judgment free zone. But when I saw how you hugged my baby girl I knew that you loved me." And I'm like all of that. But to know that sometimes we have to set the bar high, especially in the Black community. We lower the standards because we want them to meet it, but you set the bar high and work with them to get to where they're trying to go.
But if you say you're going to do something do something, follow through, be true to what you're going to do and know that we may not always get it right but we have to just continue to try. But if you're about it and if you're compassionate people will see that it don't matter if you're Black, brown, pink, clear, whatever you want to be, right? Compassion is felt, it's not always seen. So we need to make sure that we're checking on the people that are being disruptors, racial inequity directors which I kind of call myself and the class I usually teach. Check on your people that are creating spaces like this where we're talking about the things that are uncomfortable. Right? Because we're receiving it on both ends because we are living it and then we're having to work in it. So we have to be better allies to check on each other and say, no sis are you OK? Are you really? I don't care if they're of color or not. If you're in this space and you're trying to do this work, you may need a little extra compassion and some grace.
So I encourage us to be better stewards of our compassion and to really check on folks. But to also do this work and give yourself some grace because it is hard work. I always say with DIVA it's hard work and heart's work with a T and sometimes we need to be checked on. The ones that are doing the disruption, the ones that are standing in the gap and we just don't do a good job of being our brother and sister's keeper and I think we can all do better.
Steven Jackson:
Wow. I just want to highlight to our listeners both those that identify as patients and also those that are care providers, that it is OK to love the people you serve. I tell people, for me the definition of compassion is to truly care about the people you care for and I think that comes out and like you said you can't always speak compassion. It may not be recognizable in particular language or particular words, but you can definitely see it in action, you can definitely feel it. Like Maya Angelou said, "You may forget what a person said or did but you won't forget how they made you feel." I think at the end of the day when we think about building trust. Patients go back to the provider that they know cared for them and not only know care for them, but they felt that they were cared for and those are the people that they will wait to see you. "Well, somebody else is available." "Nope, I want to see Dr. B."
Diane Banigo:
Yep.
Steven Jackson:
Because she cares for me, she loves me and that's definitely one of the central themes to our show is building trust and letting people know that we care for you and we will care for you. So that's really great.
Kari Haley:
You've just said a lot of things that I'm going to process. But your work that you're doing just sounds amazing and I think it's so great that we have somebody like yourself who has the knowledge, who has the education and is also out there in the community talking with women. Being their advocate, standing up for them and putting yourself kind of out there for these systems and for others to kind of be able to, hey we got to listen, we got to do this. So thank you so much for being here one and two, for all the amazing work that you're doing. It's much needed.
Diane Banigo:
Thank you, and I just say we can't just build the gaps we got to stand in there with them until we fix them.
Steven Jackson:
Yep, we're bringing you back. Yep.
Kari Haley:
100%.
Steven Jackson:
Dr. B, you're awesome. Thank you so much. Just like my co-host said, we really appreciate your time and on behalf of all those that you inspire and touch thank you for what you do.
Diane Banigo:
Thank you for having this space.
Steven Jackson:
Off the Charts is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with creative by Peggy Arnson, Tina Long, Tim Myers and Jeff Jondahl.
Steven Jackson:
Production services provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.