#020 - What Does Respectful Care Really Mean for a Newborn?

Hello friends 👋

What happens when a neonatology fellow decides that respectful care can't stop with the mother, it has to include the newborn too? On this episode of Rupa's Fellows Friday, Rupa talks with Dr. Henna Shaikh, a third-year neonatology fellow at Seattle Children's Hospital and the University of Washington, about her path through a CHOP Global Health Fellowship, a hospitalist year, and two years living and working in the Dominican Republic. Dr. Shaikh describes her research in Nepal on respectful maternal and newborn care, born from a difficult moment she witnessed in a delivery room years earlier, and what mothers actually said mattered when she asked them directly. She also shares how that work, and the mentorship behind it, led her to pursue a third fellowship in palliative care. A candid conversation about mentorship, global health, and building a career around dignity in care.

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Short Bio: Dr. Henna Shaikh is currently a third-year neonatal-perinatal medicine fellow at the University of Washington/Seattle Children's Hospital. She has had a longstanding passion for global health, which she was able to further develop through the Children's Hospital of Philadelphia David N. Pincus Global Health Fellowship prior to starting neonatal fellowship. During this fellowship, she spent time in the Dominican Republic and Tanzania and witnessed repeated examples of how social factors shape health outcomes and how simple interventions can drastically improve neonatal health outcomes. She is very interested in the maternal-infant dyad, and as she's noticed how marginalization along lines of economic, social, and gender-based discrimination impacts pregnant and laboring mothers, she's wondered how this also impacts newborns. This led her to the burgeoning field of Respectful Maternal and Newborn Care, a World Health Organization-backed agenda that examines how structural and interpersonal factors impact maternal and neonatal health outcomes around the globe. She deepened her familiarity with this field while completing her Master's in Public Health thesis work, which reviewed low- and middle-income country-based interventions aimed at improving provision of Respectful Maternity Care in order to formulate a theory of change for future interventions. Over the last three years in neonatology fellowship, she has collaborated with Golden Community, a public health research group in Nepal, to further characterize what Respectful Newborn Care entails based on the perspectives of recently post-partum mothers. Based on survey data and qualitative interviews, they have formulated a Respectful Newborn Care workshop, which they have piloted in Nepal and look forward to implementing in other settings as well. She looks forward to continued work to develop interventions that improve provision of Respectful Maternal and Newborn Care because she knows that simple interventions that honor the dignity of mothers and newborns, like promoting kangaroo care and seeking informed consent for procedures, and doing so equitably, can have tremendous positive impacts for newborns.

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The transcript of today's episode can be found below 👇

Rupa (00:00.703)Hi everyone, welcome to another episode of Rupa's Fellows Friday. I have with me Dr. Henna Shaikh from Seattle Children's Hospital, University of Washington. She's a third-year neonatology fellow, and she's amazing, y'all — I can't wait to talk about all the fun things she's done in her career, and more things coming up as well. Welcome, Henna! I'm so excited to know more about all the fantastic things you've been doing.

Henna Shaikh (00:29.368)Thanks, Rupa. Thank you for having me. I'm excited to chat with you.

Rupa (00:31.997)That's fantastic. Just to give an introduction — Henna, you did a global health fellowship at Children's Hospital of Philadelphia prior to starting your neonatology fellowship, which is an interesting pathway to take. It sounds like you've loved global health all throughout, and a lot of the work you've done in your three years of fellowship has focused on global health, and on a really interesting concept: respectful newborn care. I'd love to first address the global health fellowship. What got you interested in that? And then, after your global health fellowship, what sparked the desire to do a three-year neonatology fellowship afterward?

Henna Shaikh (01:14.47)Great question — I can tell you a little bit about my scenic route, as I've called it. I've always been interested in both global health and neonatology. My parents are both from Pakistan, and they love to travel, so growing up we'd go back to Pakistan a lot and travel to various places in the world.

I think that, from a young age, instilled in me an awareness of how differently people live throughout the world — just seeing my cousins and what their lives were like, and acknowledging that it was through no doing of my own that I ended up with a big house in the United States, compared to the way a lot of other people live in the world. That sparked this interest in me, and an awareness that this was just a facet of how things happen to be organized in the world right now.

So, through undergrad and medical school, I was involved with various global health endeavors — I spent some time in Chile, and some time working with local refugee and immigrant populations. After residency, I was thinking about my next step, and met with several people to talk about both neonatology and global health. It felt like the time was right to do global health first, and then take those experiences and integrate them into my neonatology fellowship afterward. So I applied for, and was accepted to, the CHOP (Children's Hospital of Philadelphia) Global Health Fellowship.

It worked out nicely, actually, because there was a gap year between residency and starting that fellowship, and in that time I got to do a neonatal hospitalist year in Seattle, which worked out really well. Then I went to the Dominican Republic and lived and worked there for two years — I worked in two general pediatrics clinics, but they also knew I was interested in neonatology, so I did a research project in a NICU (Neonatal Intensive Care Unit) there and got to shadow and observe in some of the NICUs there as well. It had always been the goal to do neonatology fellowship after that, and I think having the global health perspective really shifted how I've moved through fellowship, and how I've processed and integrated all the learning from it, and what my goal is for using those experiences going forward.

Rupa (04:36.873)That's just fantastic — I'm in awe of all the places you've explored and how that's impacted your career choice in so many ways. I do agree, having come from a developing country myself — I also did my training in India — and my first experience as a neonatology fellow was, wow, this is amazing: ventilators, high-frequency oscillators, all of it. Not that those aren't available in India, but they're just not as common in a lot of the lower-income areas of the country, so it can be quite variable.

But that's fantastic. It sounds like you've been working in Nepal specifically during your fellowship — share with us the project you did there, and your scholarly activity in fellowship in general.

Henna Shaikh (05:35.895)So, trying to think about where to start — I got interested in this domain of respectful maternal and newborn care, which is the work I've been doing in Nepal. I think I came to medicine because of an interest in using medicine as a tool for social activism, particularly thinking about women's rights and women's status in societies throughout the world. That was underlined for me when, in medical school, I did a rotation in the Dominican Republic and had the opportunity to observe in a public delivery hospital.

I was taken aback by what the labor and delivery unit was like — it wasn't something I'd seen before. It felt like mothers were lined up on beds, sometimes multiple mothers to a bed, and then they'd be moved to a delivery room for the delivery. There was a C-section (Cesarean section) in particular that I observed, where the mom was on the table with her arms spread out on the armboards. They did the surgery and delivered the baby, and then the baby was promptly brought to another room, and the mother was sewn up and left on the table, shivering, as you often do after a C-section — with no one there with her, and without even her baby. I felt really sad about that, and that experience stuck with me. I started talking to people about it and thinking more about it, and I realized there was a whole body of people doing research on this, trying to capture these experiences that women have around the time of childbirth.

I learned that there's a field that initially grew out of an advocacy campaign for more humanized childbirth, particularly in Latin America, which evolved into the terminology of obstetric violence there specifically. It acknowledges that while there's a degree of medical intervention that's absolutely indicated, and we're fortunate to have access to it, sometimes things become over-medicalized — a woman is separated from her infant for various reasons, or isn't told what procedure is about to happen to her. That realm of things has come to be called obstetric violence, which people now understand as a form of institutionalized gender-based violence.

As I kept reading and thinking about this, I learned more and more. The WHO (World Health Organization) took a lot of the research that's been done since about 2010 and reframed it as an advocacy campaign, or policy agenda, called respectful maternal and newborn care — thinking about what types of care, what types of actions, we should aspire to provide for mothers and newborns around the time of childbirth. That's how I got interested in it, and I did a master's in public health focused on that, which let me really learn about how people around the world are thinking about, and trying to promote, respectful maternal and newborn care.

While I was doing my hospitalist year at Seattle Children's and UW, there were a lot of people doing global health work there, so I was putting out feelers, chatting with people, and learning about their experiences and paths. I talked with someone who became my mentor, Sarah Burklehammer — we chatted, I shared what I was interested in, and she told me about her path. About a year and a half later, while I was in the Dominican Republic doing my global health fellowship, she reached out and said, "I work with this group in Nepal, and the wife of a man I've collaborated with is currently doing her PhD work in respectful maternal and newborn care — if you're interested, we could chat with them about a possible collaboration for a fellowship project."

It took off from there. We met with them over Zoom — they have a very well-established public health research group called Golden Community, with a lot of infrastructure for doing research, and they were interested in continuing to investigate respectful maternal and newborn care. Given my background in neonatology, we thought it would be interesting to delve particularly into the respectful newborn care side of things, in part because at that point there were already 15-plus years of literature describing mothers' experiences around the time of delivery, through maternal interviews, direct observations, and survey studies. But thinking about how the newborn is treated, and particularly about the maternal-newborn dyad, is a bit newer — people really started thinking about that around 2017 or so. Right now, most of the conceptualization we have around how newborns should be treated around the time of delivery comes from expert opinion and consensus — things like, if able, do delayed cord clamping, make sure you're giving the newborn necessary medications like vitamin K, and do the best you can to bring mother and newborn together for skin-to-skin time. When I was learning about those recommendations for respectful newborn care, I thought, yes, I'm sure mothers care about being able to hold their newborn immediately, but I'm less certain they care whether delayed cord clamping was performed, for example. So I was curious, from mothers' perspectives, what do they actually care about in terms of what's done for their newborn? I think the reason this is so important is that we know, from the respectful maternity care literature, that mothers who perceive disrespect around the time of delivery are less likely to deliver their next infant in a hospital setting, and we know that hospital-based delivery is associated with better survival and outcomes for newborns. There's also literature suggesting that if mothers perceive their newborn was mistreated around the time of delivery, the same thing applies: they're less likely to come back and seek care again, which makes a lot of sense. So it felt important to understand, from mothers' perspectives, what would make them feel comfortable coming back to care, versus what would disincentivize that.

Rupa (13:56.094)That is so interesting, and I think so valuable for countries where access to care can already be challenging on top of everything else — that little bit of respect they get during such a stressful process goes such a long way. This is such impactful work, Henna, that's wonderful. Could you share with us how you went about doing your project, and what you found?

Henna Shaikh (14:23.318)Definitely — and maybe I'll just interject with a caveat, that this is a problem that exists everywhere in the world. There have been studies from the US, Canada, and Europe showing that many women, especially women from racially marginalized backgrounds, or women who have public insurance, feel that they experience disrespect around the time of childbirth and delivery as well. But, as you alluded to, in settings where resources are more constrained, and where the neonatal mortality rate and rates of neonatal morbidity are already higher, that compounds the urgency of thinking about this problem.

Rupa (15:15.241)Certainly.

Henna Shaikh (15:17.888)In terms of how I went about this project — dovetailing from what I just said, I think it's a sensitive topic, and I certainly didn't want to be the American who came in wagging my finger, saying "you were providing disrespectful care." So I think that's partly why it worked out so well that—

Rupa (15:37.863)Yeah.

Henna Shaikh (15:46.211)—my mentor already had this connection with someone doing this work in respectful maternal and newborn care, and that they were really interested in continuing the collaboration. So we conceptualized a project together, thought about what it would look like, and applied for some grant funding, which helped the research group, Golden Community, hire research assistants to carry out the research activities in Nepal. We did a mixed-methods study. First, a qualitative portion, where we recruited mothers to participate in focus group discussions to understand their perspectives on the care their newborn had experienced in the hospital. We talked with women whose babies were healthy and didn't require any resuscitation after delivery, and with mothers whose newborns required NICU admission. We tried to filter for infants who weren't very sick — just a little bit sick, needing a NICU admission of less than seven days. We conducted interviews with those women in Nepali, which were then recorded, translated, transcribed, and analyzed. We used the data for a couple of things. First, to develop a respectful newborn care workshop that could be given to providers in the hospital where we worked. I should say all of this paralleled a similar process the research group had done previously to understand respectful maternity care more broadly. In the couple of years preceding this project, they'd gone through a very similar process — interviewing mothers about their experiences with maternity care, and using that to inform a workshop with providers, which is what we did again here. From that workshop, we shared the findings on respectful care with providers, and talked with them about what they perceived as barriers and facilitators to providing respectful care, and small ways they might improve it. The additional piece we did was to use our qualitative data to inform a maternal survey that could track experiences of respectful newborn care, in parallel with other surveys that exist for respectful maternal care, but specific to the newborn.

Rupa (19:05.417)Listen, that is so awesome. Thinking about this, and I think it goes hand in hand with your future plans — what was the final takeaway from that project? And how do you envision taking those findings forward as you advance in your career? You mentioned you'll be pursuing another fellowship, in palliative care medicine, which is just fantastic — how does that tie in to this decision as well?

Henna Shaikh (19:36.803)Thanks for that question — I think the key takeaways for me were, one, that we try to think about the newborn's care and the mother's care and the dyad's care separately, but what my work highlighted is that it's really impossible to think about those separately. This agrees with what others have been emphasizing: you can't really think about respectful maternity care without thinking about the newborn, so it really does have to be respectful maternal and newborn care. And I think the value of incorporating mothers' voices into that thinking is really important, and that's something I'd love to continue working on going forward.

One of the lessons this highlighted for me is just thinking about why we're doing all the things we're doing — why we're waking up so early, coming to the hospital every day, working so hard, studying so hard. It's so that, at the end of the day, a healthy baby can go home with their mother and continue to have a life of thriving and flourishing at home. So really thinking about how everything we do in the hospital impacts life for the mother, the family, and the maternal-infant dyad — that perspective is partly what led me to pursue this palliative care fellowship.

In terms of future interests, I'd love to look at how mothers' perspectives on respectful newborn care are similar or different here in the US, for example — I think that would be really interesting. There were a lot of interesting things that came up in our study about the physical handling of the baby, and separation between mother and newborn. And I think it would be interesting to see how that's similar or different in our setting.

Rupa (22:05.095)That's a beautiful goal to look forward to, because I think there are a lot of differences in practices here, and it would be interesting to see that play out with mothers here too. It sounds like all of this also went hand in hand with fantastic mentorship, both in fellowship and before. Share with us what your journey has been in finding a mentor who'd work well for you, and how that relationship worked during fellowship — because it sounds like you had a lot of trips and a lot of projects going on. How did you balance that with maintaining a good, stable relationship with your mentors?

Henna Shaikh (22:53.218)That's a great question. I'll give the hugest shout-out to Sarah for all her amazing support — none of this would have been possible without her. She's been my biggest cheerleader, giving me endless pep talks when needed, and just supporting me endlessly, which is really wonderful — a giant thank you to her.

I think I got really lucky, both in finding her, and in that she was connected to this group in Nepal, which made this project make a lot of sense. It's worked out really nicely — I think our personalities are somewhat matched, and we'll start talking about one aspect of the project and end up on Zoom for an hour-plus, thinking, my gosh, where has the time gone, as we dream up a million other questions to look at or ways to think about things. That's been really fun, and wonderful to work with her, and to learn from her energy — especially in global health, learning from the way she connects with other people, bolsters the work others are doing, and helps them access resources that support the fantastic work they're already doing.

Rupa (24:41.257)Fantastic. What's the one big piece of advice you'd give to an incoming fellow — sounds like that's happening in a few weeks, or days — who's interested in your line of work? There's a lot of interest in global health coming from different perspectives. What's your big advice for them?

Henna Shaikh (25:01.698)That's a great question. Thinking about people who are interested in global health — there's so much to say about it, but I think the biggest thing is really just finding mentors who've done this work and can help you navigate some of the trickier aspects. Global health is a challenging field to work in from so many angles — the logistics can be hard, and so can the emotional and intellectual processing of, what am I doing here, is this really what I should be doing, is this just making things worse. All of that can be challenging. So finding a really good mentor who appreciates all of those aspects, and who can help you honestly and carefully reflect on those questions, would be my biggest piece of advice.

Rupa (26:21.801)That's fantastic. It sounds like you're headed to do your third fellowship — I want to ask you one last question. What got you interested in this fellowship, and how do you plan on using it going forward, this extra year of fellowship?

Henna Shaikh (26:38.882)My third undercurrent of interest has always been palliative care as well. Throughout NICU fellowship, I've found myself drawn to families with complex medical needs, who have a lot going on and need a lot of regular conversations, explaining things and helping figure out the next best course of action — that was part of it. I also got involved with an AAP (American Academy of Pediatrics) group working to establish a palliative care toolkit that could be used globally. That, combined with my interest in respectful maternal and newborn care — which, as I did more of that work, I came to appreciate overlaps a lot with provider burnout, and with seeing death and illness over and over again in a lot of settings, particularly seeing that in places where the tools exist in the world to prevent what you're seeing, but you just can't access them — and appreciating how that can lead to a sense of burnout, numbing, and detachment. All of that combined led me to want formal training in palliative care. Going forward, I'd love to use that training to help guide families in our own units in the US, and support providers here, and also help fill a real gap for providers abroad, in settings with lower resources, where frankly death is much more common — helping support them in how to care for themselves, so they can care for families in those situations too.

Rupa (28:51.667)That's amazing. I can't wait to see the fantastic things you're going to be doing in the future, Henna. So nice talking to you, and I'm sure you're inspiring so many of our listeners who are contemplating a global health pathway, or contemplating multiple fellowships and multiple feathers in their cap, as they transition from fellow to attending. I'm so glad we got to chat — thank you so much for joining us today.

Henna Shaikh (29:17.294)Thank you, Rupa. Thanks so much for having me.