An Interview With Lucinda Koza
Longer maternity leave: Research shows that a minimum of six months of paid leave ensures the best physical and mental health outcomes for mothers. Even at six months, many new mothers are experiencing at least one symptom of physical illness such as fatigue, pain, dizziness, or incontinence.
The birthing process is one of the most significant moments in a person’s life, yet the experience can vary greatly depending on numerous factors. From the quality of care to the emotional and physical support given to the mother, there are many ways to enhance and improve this life-changing experience. As a part of this series, I had the pleasure of interviewing Joy Twesigye.
Joy Twesigye has a diverse work experience in the healthcare field. Joy currently holds the position of Vice President of Health Systems Integration at Colorado Access. Prior to this, they worked as a Principal and Consultant at Turning Point Policy, LLC.
In 2010, they served as the Maryland State Co-Coordinator at Postpartum Support International, where they were responsible for indexing trained perinatal mental health providers across the state and raising national awareness about perinatal mood and anxiety disorders.
From 2017 to 2022, Joy worked at the Baltimore City Health Department, first as the Director of Health Program Planning and Evaluation and then as the Clinical Director. Joy played a key role in expanding services, including the establishment of Baltimore City’s first telemedicine-only school-based health center.
Joy also served as the Executive Director of Baltimore Healthy Start, Inc. from 2016 to 2017, where they contributed to the organization’s success in maternal and child health.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” better. Can you tell us a bit about you and your backstory?
My name is Joy Twesigye and I am vice president of health systems integration at Colorado Access, Colorado’s largest and most experienced public sector health plan. I have been in the perinatal mood disorder field since 1998 including experience as a doula and women’s health nurse practitioner and with direct care delivery. I have a background in and passion for leading initiatives and organizations that support successful maternal and child health outcomes, including spearheading initiatives at Colorado Access to improve Black birthing health.
In the specific birthing experiences that you have been a part of or witness to, what were the key elements that seemed to have the most influence on the quality of the process, outcome, and aftermath of the birth? Can you please explain what you mean?
One important part of the birthing experience for a lot of people is knowing they have a network available to them. Calling upon their “village” can really impact the quality of the experience in a positive way. The family is able to relax, knowing for example, their older child or children are being cared for, so they can focus solely on the birth.
As a doula, I once received a call from my client’s husband asking me to come sit in the waiting room. They were having an emergency c-section for an early delivery, and they just wanted to know that somebody they trusted and cared for was ready to be of service and help. Just the peace of mind it creates, having a support person there who is on your side is huge!
Another important piece of the puzzle is ensuring the parents are heard; being that advocate to the medical team to make sure the birther is grounded and feels like their team is listening to them. Birth can be a very vulnerable time, so it’s especially important when complications arise or when difficult things happen.
Can you tell us about a birthing experience you were a part of as a professional that you actually wish had gone differently? Do you know exactly where it took a wrong turn? Do you think or know there is something someone, even you, could have done to improve this situation? Can you please explain what you mean?
Once as a student, I was in the c-section surgical suite. The epidural didn’t take, and the mom kept saying she could feel it. There was a weird silence and awkwardness because she was actually heard, but neither the surgeon nor the anesthesiologist acknowledged her and just kept going.
She kept repeating it, and even with all of the people of power in the room, nobody spoke up. That will stay with me forever. I wish I had said something, even as a student with the least amount of power. I saw her the next day, and she was so upset. I talked through it with my instructors and professors, but that was after the fact, and I wish I had the courage to say something at the time.
Which of these do you feel most in contention with, if at all: lack of time, lack of resources, lack of information regarding a patient’s specific case, healthcare worker burnout, compassion fatigue, or something else entirely? Can you please explain what you mean?
An issue that I see regularly is, because of how the larger payment system is set up, really good clinicians are not able to practice with enough time and space to really get to know the people they’re serving, and as a result, there is a lack of bond between patient and provider.
Over the course of a pregnancy, the birther is only going to spend between 45–90 minutes on average with the person who is going to deliver their baby. My issue with this is: how do you have time to address all of the things, prenatally and postpartum, during this short time? Everything becomes really transactional and things can get missed or could be addressed better, but we don’t have a system in which that can happen.
Even if you have complications, the actual interactions and your ability to learn how to properly manage them don’t really take hold because the appointment lengths are so short. It’s so regimented and becomes like a checklist as opposed to recognizing this is one of the most significant things that can happen to your body and your life, so we should make sure everything is addressed thoroughly from beginning to end. It’s this way because people need to make a living and pay their staff, not out of malice, but I still see a need for change.
In your dream world, what would a perfect shift at work be like for you? If you had a shift with back-to-back births, what else would be in place structurally that would make you feel as if you are fulfilling your dream for birthing parents? Now, how can we take this out of your dream world and root it in reality?
My favorite shifts were when I was on the postpartum unit and able to engage the siblings, having them listen to the baby’s heart and lungs and practice being gentle, and seeing all the different versions of grandparents that would come to welcome the baby — with all the blankets and all the hats — and having the time to spend with them like they were at home. Welcoming a baby in a loving and relaxed setting can make the whole process better for everyone involved.
What I really want is that same sort of relaxed environment in labor and delivery at hospitals. It’s not that it’s loud, necessarily, but there’s so much happening that it can distract from the heart of the visit, which is welcoming a new family member. There is a balance for anticipating medical complications and holding space for the new human to make its way. I enjoy birth centers and home births more because of the relaxed energy. I don’t want to be frenetic at work or deal with that energy as a patient. The environment matters and we should look at ways that we can create a healing environment at all points in the birthing journey.
Are there any innovative practices, technologies, or policies that you believe can significantly enhance the safety and comfort of the birthing process?
Again, prenatal visits are so compressed. I was lucky with my first pregnancy because I was with midwives who were doing everything they teach you to do in school. At each visit, they asked all of the recommended questions and did all of the recommended screenings. The reason that physicians don’t follow all the same guidelines is there’s no time for it, so people prioritize and cut out what they consider to be less important.
For example, doing a domestic violence screening for every patient is critical. Pregnant and postpartum people in the U.S. are more likely to be murdered during pregnancy or soon after childbirth than to die from the three leading obstetric causes of maternal death (high blood pressure, hemorrhage or sepsis). There are these windows of time that we know are specific to the perinatal period, but when we don’t follow our own guidelines and we miss opportunities, people just say it’s so sad it didn’t happen. We need to establish the time to follow our own guidelines. The American College of Obstetricians and Gynecologists put out amazing postpartum recommendations and guidelines and it’s truly incredible. It would save lives… if OBs implemented it. In reality, it requires extra staff, funding, etc. It comes back to how we pay for care and moving toward a value-based payment system.
Can you please share “5 Things That We Can Do to Improve the Birthing Experience for Mothers”?
1. Listen: CDC’s Division of Reproductive Health is committed to healthy pregnancies and deliveries for every person. The Hear Her campaign supports CDC’s efforts to prevent pregnancy-related deaths by sharing potentially life-saving messages about urgent maternal warning signs. https://www.cdc.gov/hearher/index.html
2. Ask questions: A recent study was published aimed to address part of this gap by investigating physicians’ perspectives on their personal experiences with curiosity and its role in their professional practice and medical training. The researchers primarily linked curiosity with positive emotions, while the non-expression of curiosity was associated with dissatisfaction, boredom, and exhaustion. https://pubmed.ncbi.nlm.nih.gov/39155851/
3. Treat them like loved ones: In Take Care of Them Like My Own, Dr. Stanford shares an unflinching account of her story, explaining how her experiences on both sides of the scalpel have informed her understanding of America’s racial health gap, an insidious and lethal form of inequality that exacts a devastating toll on Black communities across the county, affluent and underserved alike. https://www.simonandschuster.com/books/Take-Care-of-Them-Like-My-Own/Ala-Stanford/9781668004067
4. Longer maternity leave: Research shows that a minimum of six months of paid leave ensures the best physical and mental health outcomes for mothers. Even at six months, many new mothers are experiencing at least one symptom of physical illness such as fatigue, pain, dizziness, or incontinence. https://slate.com/human-interest/2017/06/scientific-research-on-optimal-length-of-paid-parental-leave.html
5. Paid maternity leave: The United States is one of only three countries worldwide with no national policy guaranteeing paid leave to employed women who give birth. Jessica Shortall makes the impassioned case that the reality of new working motherhood in America is both hidden and horrible: millions of women, every year, are forced back to work within just weeks of giving birth. https://www.ted.com/talks/jessica_shortall_the_us_needs_paid_family_leave_for_the_sake_of_its_future/transcript?subtitle=en
How do you ensure that there is effective communication between healthcare teams and expectant mothers to reduce anxiety and build trust during labor and delivery?
At one of my births, I really liked that I was included in the checks during the pre-op process. I’m on the table and the surgeon is making sure that everything is there that they need and that everyone is aware and ready, but I was part of that. It was done in a way where it wasn’t just checking basic facts, it was interspersed and engaging, making me feel like I was an active part of the team. They also had to stop and listen to my answer before they could move on. It’s a rare and dynamic way of being. The way a lot of care is set up is for the provider to provide wisdom, insight, etc. and the patient is passive, only there to receive information. Ideally it is a truly engaging experience with back and forth and a shared plan of care.
If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
I would fight for people to start their maternity leave while they are pregnant, so instead of working until the day of, it was normalized that at 30 or 35 weeks, people could start their (paid!) maternity leave, which would lengthen the entire leave. Birthers are often already tired when the labor and delivery happens. They need to rest in anticipation of this huge medical event. This would be a signal to societythat the pregnant person is the priority.
I tell people that this is the last time you’ll be able to sleep by yourself — go sleep! Just rest. If you could go into labor well rested and well fed, not worried about work or bills, some of those complications of pregnancy might go away or be reduced. It could be a huge shift into a better postpartum life, which is forever.
How can our readers follow your work online?
Thank you so much for joining us. This was very inspirational.
About the Interviewer: After becoming her father’s sole caregiver at a young age, Lucinda Koza founded I-Ally, a community-based app that provides access to services and support for millennial family caregivers. Mrs. Koza has had essays published in Thought Catalog, Medium Women, Caregiving.com and Hackernoon.com. She was featured in ‘Founded by Women: Inspiration and Advice from over 100 Female Founders’ by Sydney Horton. A filmmaker, Mrs. Koza premiered short film ‘Laura Point’ at the 2015 Cannes Film Festival and recently co-directed ‘Caregivers: A Story About Them’ with Egyptian filmmaker Roshdy Ahmed. Her most notable achievement, however, has been becoming a mother to fraternal twins in 2023. Reach out to Lucinda via social media or directly by email: lucinda@i-ally.com.
Joy Twesigye Of Colorado Access On How to Improve the Birthing Experience was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.