a q&a with fellow shantell mclaggan

What was your initial impression when you first learned about the effects of colonialism on pregnancy and birth rates? How did the doula idea come to fruition?

Being Black, I had an understanding about how harmful colonialism and its effects (capitalism, racism, etc) were to the maternal/child health outcomes in certain communities in the US prior to coming to Cherokee. Because this area of healthcare has been a lifelong passion and interest of mine, I knew that I needed to have some sort of impact on these poor health outcomes specifically. This all got started last April, when I attended a conference at Mountain Area Health Education Center where we discussed women's health disparities in the Black community, specifically in western North Carolina. I learned that a way that the community was working to address some of these very negative outcomes was through implementation of a doula program, specifically for Black women and by Black women. I thought that the results were remarkable and brought what I learned back to the prenatal and pediatric providers at our monthly prenatal work group meeting. After many of them said that their patients had expressed interest in a similar program, I started looking into logistics. I shared my progress with a coworker, and she connected me to her niece, a doula and International Board Certified Lactation Consultant (IBCLC) in Sylva, NC. It was she who connected me to the NC Breastfeeding Coalition (NCBC). In May, we both met with the grant coordinator for NCBC and were able to secure grant money for supporting Cherokee moms. The year-long grant will cover training for three Cherokee women to become DONA-certified doulas and breastfeeding peer counselors. They will also be on-hand to attend live births.

What role did you play in creating the role and funding for a doula?

In compliance with the grant requirements, Cherokee Indian Hospital Authority (CIHA) must be certified by the NCBC as a mother-baby friendly clinic, which involves many items, one of which is a written policy on breastfeeding/education. I am responsible for creating this policy and communicating it to clinical staff and other administrative tasks to ensure compliance. 

Has this experience in any way changed or challenged your values or preconceived notions about women's health?

Women's health has been a lifelong passion of mine and is something I think I advocate the most for, but this opportunity has taught me so much. While I have always valued breastfeeding and understand that it is usually the optimal form of feeding, I did not realize just how many health benefits there were to gain, both for mom and baby. I also wasn't aware of just how much of an impact doulas could have on a patient's pregnancy, so being able to work with NCBC has been so rewarding and informative for me so far. 

Tell us about the women you've been able to meet through this initiative.

In general, I have been able to connect with women all across the state who are members of the NCBC, and typically themselves are lactation consultants or doulas. They are some of the most passionate and knowledgeable people I know. Also, I have met many moms through shadowing Dr. Houser, one of our family medicine doctors, when she does prenatal clinic on Tuesdays.

How has this impacted your relationship with the broader community?

Being able to work on this project and helping to bring another service to our patients makes me feel closer to them in my heart, even though many of them have no clue who I am. They are definitely family to me.

Has this impacted how you approach your clinical work?

This experience has definitely made me more inquisitive when it comes to our patients' backgrounds and life stories, as well as more aware of the potential barriers to care that they often face. Applying historical context as well as personal life situations to giving care feels more natural to me now than it ever has.

What challenges have you faced in this work?

Policy writing has been a bit of a challenge for me, only because this is the first policy I've ever written and there are so many moving parts and key stakeholders involved for whom I need to account. There are also times where I wonder how a policy coming from someone so young and inexperienced in the field will feel for long-time providers and other clinical staff. I love everyone in primary care, but it can be intimidating disrupting their status quo. I do, however, have some great mentors who have been helping me and providing feedback on the policy along the way. 

We're also interested to hear about your greater involvement with the community. Can you tell us about your time with Big Brothers Big Sisters Western NC and your involvement with the harm reduction center?

I've been volunteering with BBBS in Swain County since August of last year, and it has been so amazing! The organization has been something that I've wanted to be involved in literally since I was 8 years old and needed a mentor, so I'm super excited to now be able to lend myself to a child who needs it. I have the sweetest Little Brother, and I have to say, as much as I've been able to teach him and enrich his life, he has done the same for me.I've been volunteering with Smoky Mountain Harm Reduction since I moved here in 2018. I met the founder of the organization, Stephanie Almeida, at Cherokee's annual Rally for Recovery over the summer and asked her if she needed volunteers. I have been working with her and learning from her ever since. There, I've been able to help assemble Narcan kits, organize donations, and participate in fundraisers for the community. A few months ago, Stephanie also asked me to join the nonprofit’s board as a member. There is a very large need; we are the only needle exchange west of Asheville, and with us being so close to both Georgia and Tennessee, we see a lot of out-of-state clients as well. Prior to coming out here, I had very little knowledge and zero experience working with communities affected by IV drug use or those in recovery, so this has opened my eyes to a different side of healthcare about which I have become truly passionate.