Black maternal health, Forty Under 40, Jenae Sikkink
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APRIL 10, 2023
Good morning!

This week is Black maternal health week, which raises awareness about the rising maternal mortality rate in the U.S., particularly for Black parents. Local maternal health advocate Rachel Manuel Bruns penned a guest opinion piece that we’re sharing this week about the correlation between a rise in C-section rates with maternal mortality. We're running a condensed version of the column below.

We’re also running the last of our introductions of the women in this year’s Business Record Forty Under 40 class and featuring a profile of the Greater Des Moines Partnership’s Jenae Sikkink.

Lastly, in preparation for this month’s Fearless Focus event, I’m hoping to gather some reader-submitted questions to ask our panelists, who are all Iowa Women’s Hall of Fame inductees. If you have a question about leadership that you’d like us to consider asking, please send me an email!

Have a great week!

– Emily Kestel, Fearless editor

P.S.: Don’t forget nominations are open for the Business Record’s Women of Influence awards! You can find all the necessary information at the Business Record website and nominate someone at this link.

Iowa should safely reduce C-section rates to improve maternal health
While we see regular news coverage about challenges accessing maternal health care in Iowa and the related racial disparities, I rarely see the mention of higher cesarean rates as a relevant factor in these disparities.

April is Cesarean Awareness Month and April 11-17 is Black Maternal Health Week. The overlap of these initiatives is relevant given the higher cesarean rate for Black people across the country and Iowa.

A C-section is worth the risks involved when the health of the birthing parent or baby is at risk. Complications including hemorrhage, infection and organ injury are more likely to occur with a cesarean compared with a vaginal delivery and studies show C-sections are 80% more likely to have complications than vaginal deliveries. Each cesarean also increases the risk for placenta accreta, a serious and life-threatening condition.

CDC data shows the U.S. cesarean delivery rate in 2021 increased to 32.1%, while Black women continued to have the highest cesarean delivery rate at 36.8%. Iowa’s 2020 total cesarean rate was 30.2%, while Black women had a rate of 33.9%, with an overall state low-risk cesarean rate of 24.7% and 30.1% for Black women.

The WHO has reported that cesarean rates higher than 10% are not associated with reductions in maternal and newborn mortality rates. To summarize a 2019 U.S. News & World Report column, in the past 50 years the U.S. has decided to intervene with major abdominal surgery 500% more often, term infants have become 0% better off, and pregnant people have become 50% more likely to die.

Recently released CDC data shows maternal mortality in the United States rose by 40% in 2021. You read that correctly – 40%. That is outrageous. Of course, COVID is a factor in this increase; however, COVID exacerbated an existing maternal health crisis.

The U.S. maternal mortality rate is 10 times higher than other high-income countries like Australia. Countries with lower maternal mortality tend to have more midwives, lower C-section rates and universal health care.

I started my journey learning and advocating for maternal health after my own low-risk cesarean and subsequent vaginal birth after cesarean (VBAC), where I had to drive two hours for supportive care. Iowa’s VBAC rate is 16.8%, but there is room for improvement.

The Iowa Maternal Quality Care Collaborative recently completed a voluntary training safety bundle on reducing first-time cesareans, of which 43 of the state’s 56 hospital birthing facilities participated. Initial data reported shows a 16% reduction in the statewide low-risk cesarean rate. Which hospitals participated in the bundle and annual hospital cesarean rates are not available publicly at this time.

I continue to be disappointed in Iowa’s medical community that spends time lobbying against bills that would improve access to maternal health care and/or allow problematic practices to continue in hospitals while simultaneously participating in forums discussing the maternal health disparities.

Many providers in Iowa continue to use the VBAC calculator, which was intended as an educational tool and is instead being used as a screening tool to determine if a patient can access the practice. Another medical screening tool frequently used to "risk out" obstetrics patients and possibly unnecessarily increase medical interventions like cesareans is the body mass index, which has a racist history and is not evidence-based.

I have written extensively about the need to remove birth centers from the certificate-of-need law and the importance of licensing certified professional midwives. This legislative session, a bill passed the Iowa Senate that would reform certificates of need, exempting birth centers. There is also an active lawsuit against the state for imposing the certificate-of-need law on birth centers. Iowa is one of only a few states that currently have zero stand-alone birth centers.

HF 265, which would license certified professional midwives, passed the full House chamber and the Senate State Government and Ways and Means committees. We now wait to see whether it will hopefully advance to the Senate floor for debate and passage.

Those opposed to the midwifery licensure bill, including the Iowa Hospital Association, the Iowa Medical Society and physician groups, want an amendment that would limit the scope of certified professional midwives to not allow them to attend VBAC, breech or twin births, which are within the training and scope of certified professional midwives. With over a dozen certified professional midwives currently attending these births in Iowa, limiting their scope would end up harming pregnant people and likely result in increased maternal mortality and morbidity.  

If you are an obstetrics provider, the scope of practice of another profession is not a threat to you, especially in the current environment where Iowa is ranked 11th as a maternal health desert and is currently experiencing an OB-GYN shortage, which is predicted to only get worse.

Reading about maternal health can often be depressing given the continued and alarming rise in mortality and morbidity. If you are pregnant, avoid consuming these negative stories when possible. Seek out stories of positive birth experiences and take charge of your own birth education. If you’re feeling overwhelmed, reach out to a peer support group like ICAN, Postpartum Support International or the Black Doula Collective Parent Support Group.

Rachel Manuel Bruns is a maternal health advocate and chapter leader for the International Cesarean Awareness Network (ICAN) of Central Iowa. Professionally, Rachel is chief engagement officer for America’s Service Commissions, which supports national service and volunteering throughout the country. She lives in Des Moines with her partner and two children. Rachel can be contacted at

Meet 8 women in this year's Forty Under 40 class
This year, 26 of the 40 young professionals in this year's class of the Business Record's Forty Under 40 are women. We'll introduce you to all of them in upcoming newsletters. To read their full profile, click on their name.
Candice Revita-Ramirez, assistant director of events, Des Moines University
What's your biggest passion, and why? What fills my cup is making others feel heard. Holding space for one another as we experience the ups and downs of life is the definition of community. Whether personal or professional, we want to be heard and understood, but not all are granted the opportunity to fully express themselves. I’ll always commit to fostering an environment safe for vulnerable connection and active listening.
Bridgett Robinson, diversity and inclusion mortgage loan originator and outreach coordinator, Neighborhood Finance Corp.

What is it that drives you?
Seeing others like myself succeed. Going from level 1 to 100 because they put in the work, asked questions and were true about who they really are. It's OK to have setbacks, we all do, but it's OK to ask for help as well.
Madison Sconiers, training specialist, Polk County Treasurer’s Office

What is it that drives you?
Doubters are my motivation. Early in my career, I was continuously doubted and made to prove myself for things I had already earned. This took a huge physical and mental toll, but I never stopped advocating for myself and eventually decided to go where I was celebrated, not just tolerated.

What is it that drives you? The first decade of my life was spent in and out of foster care. I’ve experienced how systems crush, exploit and dehumanize. Successful pursuits eliminate disparities, advance equity and create communities where all people know they are loved, feel they belong and fulfill their potential.

What's your biggest passion, and why? Planning and being organized. Professionally, I enjoy implementing a personalized estate plan for a client’s future that they understand. Personally, nothing brings me more satisfaction than an organized pantry and junk drawer. Planning and being organized brings a sense of calmness to our busy lives.

What is it that drives you? A healthy dose of John Grisham novels and my internship with the Davenport Police Department affirmed my drive to pursue a career in law. As an immigration attorney, I combine my desire for justice and my desire to break language barriers by speaking Spanish on a regular basis.

What is it that drives you? My kids are the biggest reason I pursue things I’m passionate about. I feel responsible to ensure they inherit a better world. A few years ago, our family suffered tragic losses that gave us a new perspective. Each day is a gift. We should be intentional about how we spend it.

What's your biggest passion, and why? I'm passionate about supporting entrepreneurs and growing vibrant cities and small towns. I love to see transformative projects and businesses that create a sense of community pride and are good for the environment.
Left: Astronaut Chiristina Koch. Center: Filipina tattoo artist Apo Whang-Od. Right: Basketball player Caitlin Clark.
In the headlines
NASA will send four astronauts into space to fly around the moon in 2024, and for the first time a woman will be assigned to a lunar mission. Christina Koch, who holds the world record for the longest spaceflight by a woman, will join three men in the Orion capsule.

Vogue Philippines has revealed tattoo artist Apo Whang-Od as the cover star of its April issue, a move that makes the 106-year-old the oldest person ever to appear on the front of Vogue. Whang-Od has tattooed since she was a teen, and lives in the mountain village of Buscalan, about 15 hours north of Manila. She’s considered to be the country's oldest mambabatok — or traditional Kalinga tattooist.

The NCAA women’s basketball tournament was one for the history books. Iowa’s Caitlin Clark set several records and was the first player in tournament history – men or women – to have a 40-point triple-double. Average ticket prices for the women’s Final Four were $97 more than the men’s Final Four. Furthermore, the championship game between LSU and Iowa drew an average of 9.9 million viewers, making it the most-watched women’s college basketball game in history.

MercyOne Des Moines has decided to shut down its midwifery service June 30 — the result of ongoing struggles with inflation and workforce shortages, hospital officials told the Des Moines Register. Nurse midwives have often been touted as a way to fill the gap in maternity health care access as more hospitals in Iowa and across the country have shut down their maternity wards. Both UnityPoint Health-Des Moines and Broadlawns Medical Center employ nurse midwives to provide women's health care as well as birth care services.

The Small Business Administration is expected to open 15 new women’s business centers by this fall to help address obstacles faced by female entrepreneurs by offering resources to start and grow their business through training, counseling, contract support and access to financing opportunities. More than 10 million Americans submitted new small-business applications in the past two years. Female entrepreneurs own 12 million businesses around the country and they also created almost half of the new businesses started in 2021, according to the White House.

The Count the Kicks stillbirth prevention program has launched a new web-based tool to make kick-counting more accessible. The new platform allows expectant parents to track movements from a desktop or laptop computer, using the model of the Count the Kicks mobile app, which launched in 2015.

Worth checking out
Is empowering corporate women enough? (New York Times). The boom in female authorship (Planet Money). How a hand gesture dominated an NCAA game and revealed a double standard (NPR). Tired, cranky and very hungry: Life as a mom during Ramadan (Elle). Jamaica-born Waterloo labor leader gives back (View from the Cedar Valley Substack).
Fearless Focus: Leadership
The barriers that women face in ascending to formal leadership positions, or even just being a leader in their everyday lives, are plentiful. Everyone’s journey is different, however. In this conversation with Iowa Women’s Hall of Fame honorees, we’ll talk about their experiences in leadership, how they got to where they are and what support systems have helped them the most. Come ready to be inspired and learn tips you can apply to your own career or community involvement.

Featured panelists:
  • Dianne Bystrom, director emerita, Carrie Chapman Catt Center for Women and Politics, Iowa State University
  • Christine Hensley, retired Des Moines City Council member
  • Mary O'Keefe, retired chief marketing officer, Principal Financial Group; owner, A&E Balm Co.
  • Mary Swander, artistic director, Swander Woman Productions; executive director, AgArts
  • Dr. Deborah Turner, Board member, League of Women Voters

Join us for this free virtual Fearless Focus event on Thursday, April 27, at noon.

A Closer Look: Jenae Sikkink
It doesn’t take long to hear the passion in Jenae Sikkink’s voice as she talks about her role as senior vice president of talent development at the Greater Des Moines Partnership. Sikkink joined the Partnership in September in a position that she says is a "bucket list" position for her career.

A lifelong Pella resident and Central College alum, Sikkink worked for Central College as director of external engagement before joining the Partnership. Prior to that she worked as public liaison in the administration of then-Gov. Terry Branstad, and then moved into deputy communications director and became a scheduler and communications person under Gov. Kim Reynolds. She worked as a Republican campaign consultant during the 2014 and 2016 election cycles before moving back to Pella and beginning work with Central College, where she first worked as the college’s social media director before becoming director of external engagement.

But it’s her current position that Sikkink describes as her dream job, and she tears up talking about the opportunity it presents to help others and to do something greater.

Be fearless with us
At its core, Fearless exists to help empower Iowa women to succeed in work and life. We believe that everyone has a story to share and that we cannot progress as a society unless we know about one another. We share stories through featuring women in our reporting, featuring guest contributions and speakers at our events.

We are always looking for new stories to share and people to feature. Get in touch with us!

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