Linda Sloan Locke, CNM, MPH, LSW, combines her experience in social work, midwifery, public health, and nursing in direct service to underserved populations. She recently joined the Quality Institute’s Board of Directors.
What drew you to becoming a midwife?
I have been a midwife for 44 years. So, the 1970s was when I began thinking about career options, and back then nursing was largely limited to care at the bedside. I wanted a more independent and active role in patient care. Few areas of nursing had an independent focus besides midwifery and anesthesiology. I wasn’t sure I wanted to focus on putting people to sleep and waking them up. And back then midwives were scarce. But once I got into OB, I loved it. To see life coming into the world! I met a midwife by chance through a friend and I thought, “This is what I really want to do.” I wanted the ability to be an independent practitioner especially at this time, as we were beginning to move away from the medicalization of birth.
How does your work as a mental health provider in the field of social work connect with your work as a midwife?
As a midwife, we do annual checkups and I found so many of my patients wanted to talk about what was going on in their lives. I felt ill equipped to respond. I thought of becoming a psychiatric nurse practitioner, but I think social work fits well with midwifery. I heard the phrase, “The social worker is midwife to the soul.” It’s really true. As midwives, we help women give birth to their babies. As a social worker, I help women give birth to themselves, in a way. With my training I understand the relationship between the body and mind and understand the interaction of mental health and physical health. There is a great deal of synchronicity.
You are among the professionals participating in the Quality Institute’s Medicaid Policy Center and you helped design a Maternity Episode of Care Model. How do you see payment reform improving maternal and child outcomes?
Payment drives care. Reforming payment is essential to providing quality care in any sphere, and I think particularly in maternal child health. We see the value of extending Medicaid coverage to 365 days after a woman gives birth. In the Episode of Care, payment is tied to quality. There was a big push in quality for a while and then it got lost. We’re setting the bar higher rather than lower and basically incentivizing quality care. It’s the carrot rather than the stick approach, which drives more value.
Why did you want to join the Quality Institute board?
Linda (Schwimmer, President and CEO of the Quality Institute) approached me. I was impressed with the Quality Institute, but it did not occur to me to join the board. As I began to look and learn more about the Quality Institute I realized this is an incredible opportunity to be part of an organization that can have such an impact on the quality of health care in our state.
You have researched racial disparities in health care. This is a tough question, of course, but can you tell us why you think we’ve been unsuccessful in closing the racial gap and what you think needs to be done?
Up until relatively recently, there has not been much of a focus on racial disparities. The focus was more on social determinants of health, and racial disparities were looked at only as they related to poverty, lack of health insurance, etc. Only recently are we looking at other issues in our society such as implicit bias, racism, the tradition of denigrating certain races — and how all those issues impact health. It took us a while to understand the relationship of health, mental health, and the mind-body connection as well as the effect of long-term stress and intergenerational trauma on health. There is no quick fix. You have to address these other issues, and you have to make sure that care is appropriate and respectful.
As we introduce you to our membership, can you tell us something about yourself that people might be surprised to know?
Well, I have ten grandchildren. And I have been working on getting a private pilot’s license. My dad (John Steward Sloan, Sr.) was a pilot. He was a Tuskegee Airman, and so, that was my introduction to flying. My Dad wrote a book, Survival! A Purple Heart Tuskegee Airman. People often are surprised to hear that.