Political reporting on health care needs to move beyond the capitol

When I began to understand the crucial role doulas play during pregnancy and labor and how they can significantly improve health care outcomes for the parent and baby, I was in Nevada’s state legislative building in a dull committee hearing room — but the stories I heard were rich with life, passion and care. 

Assemblywoman Shondra Summers-Armstrong, who co-sponsored legislation to triple the Medicaid reimbursement rate for doulas, gave moving testimony about the support she had received from a midwife while her military husband was stationed in Germany. Despite a language barrier, the lawmaker felt she had someone by her side when she needed it. That’s something parents told me repeatedly throughout my reporting: This kind of support feels like a lifeline.

The hearing spurred my four-part series, “The Long Road to Maternal Care,” in English and Spanish for KUNR Public Radio, with guidance and mentorship from the USC Annenberg Center for Health Journalism National Fellowship and Community Engagement Grant. 

According to the March of Dimes, more than half of Nevada’s 17 counties do not have a hospital that offers routine labor and delivery or OB-GYN providers. My reporting covered maternal health care deserts in rural Nevada, the patchwork of resources such as rural emergency medical services (EMS) and traveling health care providers, and the unique support rural doulas provide.

I’m a political reporter at heart, so I wanted to discuss all the intricacies of the Medicaid legislation. But my editor pushed back and told me to focus on the reason the bill was needed (gaps in health care) and the resources available (besides doulas), and to talk to people affected (expectant parents in rural Nevada). Moving away from legislative jargon is essential; between work, child care, and life, most people don’t have the luxury of following every government meeting. The role of a journalist is to break down complicated policy and provide the public with information on how it will directly impact their lives. 

Here are some ways I broke out of the state capital, Carson City, and drove more than 2,100 miles over four months to meet people and tell the stories of those deeply affected by a lack of maternal health care services in rural Nevada.

1. Attend events and make your presence known

I met sources through events directly related to or adjacent to my topic: maternal health care symposiums, events discussing rural health care overall, and rural pop-up clinics. The most memorable event was an annual rural EMS conference, a four-hour drive away from my newsroom. With support from the community engagement grant, I printed a sign that read, “Talk to me about maternal care.” It served as a huge attention grabber. 

Rural emergency medical providers, many of whom are volunteers, stopped by my table to tell me minute-by-minute details of how they had helped deliver a baby far away from a hospital. I met a mom who was an emergency medical technician in rural Nevada and had delivered her baby in an ambulance with the crew she was training with. I wouldn’t have gotten these stories if I had not attended this event and asked rural EMS responders about answering maternity calls. 

2. Meet people where they’re at 

Because I was doing my fellowship project about what it’s like to travel to access maternal health care, I needed to understand what that drive was like. Sources appreciated that I was willing to drive to meet them, but I noted that I was making the trip for my job and not for a more unpredictable, time-sensitive, and meaningful reason, like giving birth. On those drives, I tried to put myself in their shoes and imagine what the trip meant to them. 

Being present in someone’s community also helped me understand their story, primarily since my series focused on rural living. I saw firsthand why people chose to live where they do:  They live down the street from school so their kids can walk, there’s less traffic and a strong sense of community. For one story, the photographer and I spent time with a mom and her two young kids at their family ranch while they fed herds of cows and lively horses. That experience helped me paint a fuller picture of their life and shine a light on her perseverance, especially because her two births didn’t go as she had hoped. 

If someone wasn’t comfortable with me coming to their home, I found local libraries to be a valuable and quiet meeting place.They typically have a meeting room you can reserve, and there are activities to occupy the kids. 

3. Look into solutions

In every interview, I asked the same question: What solutions would you like to see to increase access to rural maternal health care? It was vital for me to hear from community members who are directly affected by the issue or passionately work within rural maternal health care, since they are the experts. I learned about various solutions, such as birth centers in rural Nevada, more opportunities for medical students to practice in rural Nevada, and additional insurance options covering doulas and other types of birth workers.

It’s imperative to ensure your sources feel heard. In the middle of the reporting, and with support from the community engagement grant, I hosted a roundtable with two rural doulas, a rural doula in training, three rural moms who utilized doulas, a rural midwife, and a community health organization, to give them an opportunity to talk about solutions. I asked each participant to bring a question of their own. One of the doulas asked, “What can I do better?” Those seated around her provided concrete ideas, including asking if she’d be willing to barter for her services and accept food or website design as partial payment. 

Meaningful conversations were possible because people were among neighbors, not being questioned by a journalist.

4.  Bring it back to the lawmakers 

I know I’m arguing for taking one’s legislative reporting outside the capitol, but it’s still important to be on the lawmakers’ radar. After the series was published, I moderated a virtual webinar on rural maternal health care with the lawmaker who sponsored the doula legislation, a doctor who travels once a month to a rural community to treat women, and a doula who works in rural communities. People joined from across the state.

The conversation centered on solutions. Some listeners responded that they learned about doulas for the first time, and others wanted to know how they can support people interested in entering the profession. Assemblywoman Summers-Armstrong emphasized a critical point. 

“This is a time where we can reimagine how we have children and it's up to us to push the issue,” Summers-Armstrong said. “Please talk to your legislative leaders and your local leaders. Nothing gets changed if we’re quiet. We have to move in a way that is forceful to make this change that we need both in our rural communities and in our urban communities, that are basically health care and food deserts.”

What started as reporting on a bill to increase the reimbursement rate for doulas became a four-part series, rich with visuals and sound, on what families face in maternal health care deserts and how far a doula’s support can go. Throughout this fellowship, I learned that political reporting must happen outside of the legislative arena and center everyday people affected by the issue, who don’t have the luxury to participate in politics but have great ideas about solutions.