Authors: Meghan Etsey, Victoria Chebaibai, Dr. Janelle DeJesus on Behalf of AMWA Gender Equity Task Force
“Our Voices, Our Future” is a podcast by the Gender Equity Task Force of the American Medical Women’s Association that explores the challenges, stories, and successes of those working to advance gender equity in medicine. Through candid conversations with changemakers, advocates, and leaders, each episode dives into issues like pay gaps, leadership disparities, and inclusive workplace culture. Tune in to be inspired, informed, and empowered to take action. Full episode listening links are available below the transcription.
Meghan Etsey: Welcome to Our Voices, Our Future, the podcast where we amplify the voices driving change and equity within medicine and beyond. Brought to you by the Gender Equity Task Force, a committee of the American Medical Women’s Association, we’re here to challenge norms, break barriers, and ignite conversations that matter.
I’m Meghan Etsey, and in each episode, we’ll bring you candid discussions with leaders, change makers, and advocates working to create a more inclusive and just world. No more silence, no more waiting. Listen to Our Voices, Our Future. Let’s get into it.
Today we are welcoming Dr. Janelle DeJesus. Dr. DeJesus is a passionate OBGYN, content creator, women’s health advocate, and brand new port mom. She completed her medical degree at Nova Southeastern University College of Osteopathic Medicine, followed by a transition year internship in Middletown, New York, in her OBGYN residency in Gainesville, Florida. She now practices in San Juan, Puerto Rico, where she combines bedside care with a broader mission, empowering women through education and advocacy.
On her public platforms, Dr. De Jesus engages patients, colleagues, and the general public on topics ranging from patient autonomy and consent to social determinants of health, obstetric violence, and gynecologic pathology. She hopes to use her voice to shift the culture of women’s healthcare toward greater equity, respect, and empowerment. Thanks for being here, Dr. De Jesus.
Dr. Janelle DeJesus: Thanks for having me.
Meghan Etsey: Yeah. So just to start off, can you kind of share your journey in medicine and what led you to an interest in maternal health and that kind of perinatal care?
Dr. Janelle DeJesus: For sure. So in high school and college, it all started more so with an interest in the sciences, anatomy and physiology, how the body works. For me, it was super interesting to see how the body is able to literally just keep itself alive for such a long period of time and seeing how the body works both in health and in disease, how a tiny little cancer cell can grow to potentially cause so much damage.
So that kind of peaked my interest in medicine overall. In medical school I started, I had no idea what specialty I wanted to go into. Ironically, I was completely uninterested in OBGYN. They put a C-section on the big screen in medical school and I was like, oh, not this, this is not it.
Then I went to an ACOG conference, that’s the American College of Obstetrics and Gynecology. I did a bunch of simulations and practice first, you know, simulations for deliveries, ultrasound procedures. I just absolutely loved how hands on it was.
When I started my clinical rotations, I just fell in love with the patient population. The thing that kind of attracted me the most was the fact that, you know, when it came to delivering babies, for instance, it was the only potentially good reason that you’re going to be in a hospital setting, which was awesome. It is such a universal, but still such an intimate and mysterious part of so many people’s lives.
I knew I wanted to be a part of that. Each delivery felt like, oh my god! You were winning a Super Bowl or something. I loved being able to also follow patients from their first period, to their first baby, to perimenopause to menopause and everything in between.
Most patients kind of feel like close friends or almost like they can be my best friend. Honestly, that’s something that I feel like is so unique to this specialty specifically.
Later on, I came to fall in love with the advocacy aspect, the fact that, you know, sadly, there’s still so much work to be done within the realm of women’s health and in terms of pharmaceutical and diagnostic research, patient advocacy, maternal morbidity and mortality, obstetric violence, like you mentioned. Those are things that I can talk about all day.
I knew I wanted to be a part of improving that, improving those metrics and improving women’s lives in turn.
Meghan Etsey: It’s incredible. So from your experience and the path you’ve had, how would you describe the current state of the pre and peri and postpartum care that we have in the United States right now?
Dr. Janelle DeJesus: It’s abysmal. It’s abysmal. Having experienced it as a physician, I knew how difficult it was for myself and my colleagues to navigate it. Having also experienced it just recently from a personal standpoint, I just had my baby seven weeks ago now. Experiencing it from the patient’s end was a completely different experience.
I really thought I knew, but yeah, it’s tough for a myriad of reasons. To start, you know, insurance issues amongst both the patient side and the physician side. Compensation of maternity care as a whole indirectly cuts the time for prenatal visits.
This is going to give clinicians minimal time to address questions, concerns, pathologies. Follow up plans for a lot of very high risk pregnancies doesn’t give us a lot of time to obtain consent in the proper way so that the patient understands what we’re talking about.
From a physician standpoint, our average time with the patient is anywhere from 10 to 30 minutes, usually on the lower end of that and sometimes even less. That gives us minimal time really to address all of that, which further leads to issues down the line with patient trust, adherence to treatment plans, that sort of thing.
In today’s day and age, we have so much information that is openly accessible to the patient. Unfortunately, it’s not all correct information or truthful information or information that is evidence based. I would argue that we need even more time to combat that and build a sense of trust and rapport with our patients so that they’re able to make informed decisions.
Really it’s us against the clock, us against insurance companies, us against a lot of misinformation online. Unfortunately, a lot of patients have been traumatized by obstetric violence and having procedures done on them where they weren’t properly consented. That trauma rightfully forms their experience and perception of obstetricians.
There’s a lot of work to be done internally, both myself and my colleagues on that end as well.
Meghan Etsey: I think we’ve kind of hit on the next question, but if you have anything else to add, what would you say are some of the biggest challenges for patients during pregnancy and after childbirth, and where do you kind of see the gaps that are within care?
Dr. Janelle DeJesus: No, definitely. I think one of the biggest gaps that I see is just an overall lack of resources. One of the things that I see very often is that a lack of resources can sometimes be disguised as postpartum depression.
A patient will come into the office. She’s really sad. She doesn’t have a whole lot of help. She doesn’t have the ability to come to all of her postpartum appointments in spite of all of the issues that she’s having.
She writes on her questionnaire that she’s feeling all types of sadness, and she’s not sleeping well, and she’s not eating well. She doesn’t have a whole lot of help for whatever reason and many times she meets the criteria for postpartum depression.
A lot of the times this lack of resources gets disguised as postpartum depression, but they’re not necessarily the same thing. One can lead to the other surely, I can’t argue that, but at times these things can be completely isolated issues.
One is treated with medication and the other one doesn’t necessarily need to be every single time.
Other challenges include affordable healthcare, Medicaid, almost 50 % of deliveries that happen or patients that we’re seeing are actually Medicaid patients, affordable childcare. I’m looking at childcare myself and it’s like, in certain states, it’s like a rent basically.
Access to mental health, pelvic floor physical therapy. You go get a knee replacement and the first place you’re gonna get sent is physical therapy. I don’t understand why delivering a baby anywhere from five to 10 pounds doesn’t warrant the same thing.
And then contraceptive counseling, of course, fifty percent of pregnancies are actually unplanned and many of those happen in the almost immediate postpartum period.
Meghan Etsey: Oh wow. So kind of building off of those challenges you see, how would you say social determinants of health like race, socioeconomic status, geographic location, kind of impact the maternal outcomes that we have?
Dr. Janelle DeJesus: So this is a tough, this one is a really really tough topic in part because I think that there are many populations and many demographics that can look at objective data and still deny that this is an issue. But we do have pretty well documented literature that states that these social determinants of health impact maternal outcomes, that race, systemic racism is still affecting maternal outcomes.
Access to care and geographic location is also a huge issue plaguing the country right now. Labor and delivery units are shutting down all over the place, which essentially will leave people without care, without a place to deliver their babies.
Where I attended residency, we had people traveling up to two hours just to come to a hospital to be able to give birth. I’ve worked out in rural areas of New Mexico and people would have to take helicopters and planes over to either the next facility or in Texas just to be able to see, for instance, a high risk specialist.
These lead to delays in care, delays in management, and can sometimes lead to very catastrophic results within the pregnancy. Definitely all of these things play into maternal outcomes in this country.
Meghan Etsey: So could you share with us kind of an example of a program policy or initiative that you’ve seen successfully improve pre and postpartum care?
Dr. Janelle DeJesus: Yeah, so my favorite one, and I’m so proud of California, even though I’m not Californian and I don’t claim anything Californian. However, the California Maternity Quality Care Collaborative, CMQCC is what it’s called.
Essentially what this was, this was a statewide initiative where they wanted to implement very standardized protocols and training and simulations and things like that, as well as collecting data for outcomes, in order to be able to see how they were doing in terms of improving maternal morbidity and mortality.
This was a huge deal because they found that from the years 2006 to I think it was 2013, they saw a 50 % decrease in maternal mortality while the rest of the country’s rates were actually on the rise.
The reason this is such a big deal is because in all of the developed nations, the United States is actually one of if not the highest in maternal morbidity and mortality. I think I read as far as statistics is concerned, we have more women who die in childbirth than police officers, like active duty police officers here in the United States.
That’s a big deal. That’s basically saying it’s more risky to give birth in the United States than to be a police officer in the active line of duty.
The CMQCC essentially set a huge example and displayed the importance of having these systems in place in order to decrease morbidity and mortality. In my opinion, the rest of the states should follow suit.
Many hospitals in different states nationwide have followed their example. I know the hospital from my residency program adapted a lot of the things from that quality initiative. Many hospitals have seen a decline in morbidity and mortality as a result of implementing a lot of those systems.
Meghan Etsey: So how would you say that health providers are like a single person and then institutions as a whole can adapt to kind of better support patients with mental and physical health when these women are in their postpartum period?
Dr. Janelle DeJesus: Yeah, so postpartum honestly is a really difficult time. I’m going through it right now so I can say this. This is the hill I would die on.
It’s a really difficult time because as physicians, I don’t necessarily think that it’s just a healthcare thing. It’s such a unique aspect of medicine and healthcare as a whole because it’s not just healthcare that happens after that. Your life has changed forever.
We as healthcare providers tend to fixate on the medical aspects, your postpartum hemorrhage, your severe preeclampsia, those sorts of things. Postpartum really is so much more than that.
This is where I think the lines get blurred a lot. For example, like I mentioned before, there’s this notorious lack of resources. Which in an ideal world, I would love to see more of these things implemented that allow resources to be more accessible outside of healthcare and within healthcare as well.
Things like more affordable childcare, insurance coverage for wider aspects of postpartum, not just your postpartum visit, that just goes in the global fee. Pelvic floor therapy for longer chronic issues like painful intercourse after delivery, or pelvic organ prolapse or incontinence these issues are very, very common.
Mental health, things like lactation counseling, which I’m learning firsthand. Breastfeeding is not easy. Pumping is not easy. That alone is enough to take a toll on your mental health.
It’s more all encompassing. Until we acknowledge that postpartum is more than just a relationship with your obstetrician. Until we can acknowledge that, it’s not going to improve.
Meghan Etsey: So what role would you say advocacy, education, and community engagement could play in improving this pre and postpartum care for women?
Dr. Janelle DeJesus: We won’t get better outcomes without acknowledging that there’s a problem to begin with. We need to have these conversations. We need to be less afraid to critique each other, colleagues, physicians, healthcare clinicians overall.
We need to critique ourselves and question our own practices and ask whether they’re affecting our patients in a way that’s healthy and positive and uplifting. This is why I find myself on social media engaging in these conversations with both my colleagues and my patients all over the country.
If we don’t have these conversations we are not going to get anywhere. That is both advocacy and education for me, just because I am seeing so much misinformation on social media. People will find misinformation on social media, I also need to be on social media so people can also find information and education there as well.
Community engagement, the only points of view I see are from my perspectives I have had as a patient, those of my patients. Content creation as a whole, not only did I do it for advocacy, but I also wanted to hear stories from people all across the United States to be able to talk about these experiences.
It’s really interesting, sometimes people will share horrific experiences that I would never imagine are still happening in this country. We have to acknowledge that these things are still an issue.
The history of obstetrics and gynecology is not a pretty one. It’s one at times we have made a lot of advances, but at times it’s hard to be proud of. Some of those elements weave themselves into the care we give today and can be paternalistic in nature. We definitely need to keep having those conversations.
Meghan Etsey: So just as a whole, what general piece of advice would you give to either aspiring physicians or healthcare professionals who want to make that meaningful impact in maternal health?
Dr. Janelle DeJesus: We have to keep making noise, especially within the realm of women’s health. If it took patients posting on TikTok about their experiences with IUD insertions in order to change guidelines for pain control for IUD insertions and office procedures as a whole, that’s proof that silence and complicity does not elicit any change. And sometimes in the most unexpected ways that you are able to make waves. Now there are conversations centered around the women’s health initiative, and why it’s so important to have studies centered around women, specifically, as a patient population as a whole.
We make up 50% of the population, but when it comes to the research, we are still the minority. That definitely plays a role as well, and we have to acknowledge that. We have to make noise, ultimately, if we don’t know it’s a problem, and we can’t acknowledge that it’s there, there is no way we are going to be able to fix it or improve it.
Meghan Etsey: And we are here, that is why we are doing things like these podcasts, and you have your social media. Yeah, I love it. Thank you so much for this talk today. It’s been very nice.
Dr. Janelle DeJesus: Of course. Thanks for having me.
Meghan Etsey: So that’s a wrap on this episode of Our Voice is Our Future. We hope today’s conversation inspired you, challenged you, and reminded you of the power of raising your voice. The fight for equity doesn’t stop here. Join us in the movement. Subscribe wherever you get your podcasts. If you love this episode, share it with someone who needs to hear it. Until next time, stay bold, stay vocal, and keep the conversation going. This is Our Voices, Our Future.
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About the Authors
Meghan Etsey, MS4
Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.
Victoria Chebaibai, MS1
Victoria Chebaibai is a first-year medical student at St. George’s University. She earned her Bachelor of Science in Nursing from Oral Roberts University and completed a Medical Science certificate through Oklahoma State University Center for Health Sciences. Before starting medical school, Victoria worked as a Registered Nurse for 12 years, with experience across the NICU, postpartum, med-surg, and veterans care. She is involved in the American Medical Women’s Association, Women in Medicine, and the American Medical Student Association (Grenada chapter). At SGU, she has served in student leadership through the Student Government Association as a class representative and a member of the Student Affairs Committee, advocating for campus initiatives and student support. Outside of medicine, Victoria enjoys spending time with her husband and kids, staying active through Zumba, and hanging out with her cocker spaniel, Timmy.
Formatting, publication management, and editorial support for the AMWA GETF Blog by Vaishnavi J. Patel, DO