Tiffany Vassell
“My goal and my vision is to have BIPOC be treated more equitably, and to be listened to, to actually be heard when they are delivering their babies. Far too often, your requests aren't heard, and you're treated like you don't know what you're talking about. It sets people up for failure and for traumatic experiences that have a domino effect in the postpartum period, and can lead to postpartum depression, anxiety, and other perinatal mood disorders.”
Tiffany Vassell (she/her) is a registered nurse who has worked as a labor and delivery nurse for over eight years. She has also served as a substance misuse nurse assisting patients with their recovery at clinics in Boston. She is a Black maternal health advocate who supports midwifery care, equity, reproductive justice, autonomy, and access to home births and birth centers.
She is a board member of the Bay State Birth Coalition. She founded the Nurses for Black Maternal Health and Equity Organization to diversify the perinatal workforce. She also served as Co-Chair of the Speaker Committee at the 5th and 6th Annual Black Maternal Health Conference, the country’s largest Black maternal health conference, held by the Center for Black Maternal Health and Reproductive Justice at Tuft's University School of Medicine.
She co-authored the book 'Preparation for a Hospital Birth.' In the book, she seeks to demystify birthing in the hospital in ways only a nurse can explain. She aims to educate birthing people about the many available options during labor, delivery, and the immediate postpartum periods while in the hospital to create a safer and more autonomous experience.
Tiffany serves as a member of the steering committee for Mind the Gap and Birth Equity & Justice Massachusetts. She is also a Harvard Catalyst Community Coalition for Equity in Research member, which seeks to give high-quality input on research proposals and protocols. She has sat on several panels to discuss her work and advocacy in the maternal health space and has written several articles. She recently completed the Young American Leaders Program at Harvard Business School.
She is a member of the Sigma Theta Tau Nursing Honor Society for Leadership. She is the awardee of the 2022 Image of the Professional Nurse awarded by the Massachusetts Nursing Association. She is also one of the 2022 Ten Outstanding Young Leaders awarded by the Greater Boston Chamber of Commerce.
This blog is made possible by a sponsorship from Sage Therapeutics. All content on this page has been curated by the Mass. PPD Fund without input from Sage Therapeutics, Inc.
December 2023 | Interviewed and edited by Jessie Colbert, Executive Director, Mass. PPD Fund
Tiffany Vassell is a labor and delivery nurse and a leading local and national birth justice advocate. Currently the Co-Manager of Community Engagement and Communications at Neighborhood Birth Center (NBC), Tiffany is passionate about educating birthing people and speaking out about a better way to do maternity care – one that prioritizes and empowers the birthing person as a true partner in the labor and delivery process.
Tiffany was inspired to become a labor and delivery nurse after her own mistreatment during labor. Here, she shares the challenges that came from that experience – including postpartum depression – as well as how it inspires her involvement in a “paradigm shift” on birth. She works for birth justice in many roles, including at NBC, as the founder of Nurses for Black Maternal Health and Equity, a group working to improve representation of Black and Brown nurses in labor and delivery nursing, as the author of Preparation for a Hospital Birth, a Steering Committee Member of the Mind the Gap Coalition, and more.
I’d love to start by hearing about your career path, from labor and delivery nurse to a leading state advocate on birth equity. How did you get to where you are today? What are your goals and vision?
My journey to becoming a nurse started with my own birth experience. I became a nurse later in life – it was a change of career for me. I was 30 and pregnant, I was living in New York. I decided to move back home [to Boston], decided I needed to have stability once this baby comes. I started to take my prerequisite classes while I was pregnant – it had been almost a decade since I was in college. After completing my prereqs, I applied for an accelerated program at MGH IHP [MGH Institute of Health Professions].
Prior to applying for the program, I had my baby, and the experience was so overwhelming. I remember not being listened to [during the birth]. Now when I look back, I had so many cervical exams. I swear, everybody was checking me – residents, midwives, doctors, students, everyone. I didn't know I could say no. I had my mom and three of my sisters in the room. My mom is a home-birther, but upon coming to America, her births were medicalized. She really believed in the medical system, even though her births here were traumatic. I had another sister that was the same way: you need to listen to the doctor. But I have this one sister, her name is Bev. She is a complete badass and a rebel and she was like, You do what you want to do! You do what's best for yourself, and you do what's best for your baby.
My labor wasn't going as the providers wanted it to go, so they recommended a c-section. I was mortified and absolutely refused. My mom wanted me to listen to the doctors. My sister is screaming at me that I needed to have a c-section. I ended up asking that sister to leave. Bev, on the other hand, told me to do what I wanted to do. My mom did stay. A few hours later, I had my baby vaginally — I pushed for 15-20 minutes. I knew I could do it, I just needed a chance. My baby was fine.
It was then that I knew that I wanted to become a labor and delivery nurse. I wanted to help women that look like me, because if this happened to me, I know it’s happening to other people. I was accepted and went through the ABSN [Accelerated Bachelor of Science in Nursing] program at MGH IHP.
Now, when you’re a new grad, it is difficult to start in labor and delivery because you don't have experience. So initially I was a nurse at several methadone clinics, helping patients with their recovery and their mental health. I was then able to obtain a maternity position at Cambridge Hospital because I had a friend whose cousin was a Nurse Manager there, and she recommended me. I started as a postpartum nurse, which evolved into an LDRP [Labor, Delivery, Recovery, and Postpartum] position, so I worked everywhere on the unit. After a while, the unit decided to scrap that model, and management asked me where I wanted to be on the unit: I picked labor and delivery.
My goal and my vision is to have BIPOC be treated more equitably, and to be listened to, to actually be heard when they are delivering their babies. Far too often, your requests aren't heard, and you're treated like you don't know what you're talking about. It sets people up for failure and for traumatic experiences that have a domino effect in the postpartum period, and can lead to postpartum depression, anxiety, and other perinatal mood disorders. I want people that work on labor and delivery units to be cognizant that patients are entrusting us with their lives, with their babies. We need to show up and really listen, really pay attention, really give people the excellent care that they not only need, but that they deserve.
Can you share how you then got involved as the Co-Manager of Community Engagement and Communications at Neighborhood Birth Center (NBC)?
This role came around at the perfect time. I just had my son [her second child] last year, and I was fortunate enough to have six months of maternity leave. I know I’m beyond fortunate, because some people don’t even get two weeks, some people have to return to work immediately. That also affects your mental health, because you’re in no state to return to work a week after, or two weeks after, or even six months! You’re thinking about your little person that you just had, and here you are at work having to do these tasks – in my case, care for someone else who is having their baby.
After returning to work, I realized how hard it is physically. I was a night shift nurse. Coming off of nights and going home to a six-month-old was not easy. I am dead tired because I just worked 12 hours, I really want to sleep. I barely got home safely! To get home to my wide awake six-month-old, and I also have an 11-year-old who's like, Mom, I'm hungry. Can you make me breakfast? It was overwhelming and I couldn’t do it anymore.
It was at the same time that NBC was looking for a Manager for their Community Engagement and Communications role. I just felt like the stars aligned! It was like, Oh my God, this is me! It worked out that I got the role, and I'm so grateful because I am using my labor and delivery experience in such a different way. I'm getting to use all that knowledge that I've accumulated to educate people in my community, and tell them about the hospital process. People understand the physiological process [of birth], but they don't realize that there's a hospital process, and there are policies. Once you step into the hospital, all those wheels start turning and churning. And sometimes the outcomes can be bad. I get to educate people about bodily autonomy – their right to access, their right to consent. A lot of times we rely so heavily on providers to tell us what to do, when you are your body’s expert. You have the right to say, Pause, I need to think about this, and ask [myself] if this is okay for me and my baby. Let me make a decision for myself.
The organization you founded, Nurses for Black Maternal Health and Equity, is also a key piece of your advocacy work. Can you share more about the organization and its goals?
What my organization seeks to do is to bring more People of Color into the perinatal health space. A lot of people don't understand the pathways to A, becoming a nurse, and then, B, getting onto a labor and delivery unit. So what I do is talk to a lot of community members about the different pathways to nursing. A lot of institutions are now asking for a bachelor's degree – it’s not enough to just be an associate-prepared RN, at least here in Boston. And then, a lot of times, it's not what you know, but who you know, so networking is a really important component, creating those relationships and always putting your best foot forward. Showing you're passionate, showing that you're always seeking knowledge about birth and labor and delivery. Those are the things that my organization seeks to do in the community.
Let’s turn to your perinatal mental health journey. When did things start to become more difficult, and how were you able to get some help and support?
Prior to having my daughter, during my first pregnancy, I felt like my life was kind of in upheaval, but I was able to manage. I was doing classes trying to prepare for the ABSN program, so I was under a lot of pressure. And then when you add my birth experience, and the way I felt pressured and I had to really push back, I think that added to the trauma. As I mentioned, I had so many cervical exams. When I think back, I almost feel violated. After having my daughter, I started to kind of spiral out of control. I started to develop depression and I didn't realize it! At my six-week appointment with my midwife, she kind of broached the subject, and I said, I think I'm okay, I'm fine. I think it was mostly embarrassment why I didn’t want to share that something was wrong.
About three months after my six-week visit, I saw my NP who also is a Black woman. She’s been my NP for a really long time. She asked me the same postpartum questions, but I felt like she kind of digged a little more. She's like, No, Tiffany, this is not your usual self, I think there’s a little something more. I think it was then that I kind of admitted, Yeah, I'm having these thoughts. I don't feel so well. I feel overwhelmed. And she really helped support me, and helped me to get some medications. I started therapy at that time. I felt like she took the time – it wasn’t just like, ask these questions and then move on to the next thing. I know a lot of times providers can't do that because they're not afforded that time. But she really did take the time that day, and it really helped. I'm super grateful for her.
And with this go-round with my son, she knew already. She was like, Tiffany, it may reoccur. You know, you’re exhibiting the same things again. How are you feeling? I was more upfront. Especially with going back to work and the lack of sleep, I was starting to spiral again. And [I said to myself], You’re really experiencing this again, and you’ve really got to get a handle on it. You’ve really got to be willing to talk to somebody and not be, like, this savior-hero. I really credit her with helping me get the help that I needed.
My baby just turned one and I'm still trying to balance, and find the right medium. Even forming a sister circle of friends I can chat with, because your therapist isn’t on speed dial 24-7! Even just sharing it with my mother. My mother is 83, she comes from a time where they don't share these things. But reaching a point in our relationship where I can be like, Can you watch the kids so I can have a break for a little bit and kind of recoup? Just her really understanding and wanting to support me, and not feeling embarrassed. Talking about it with my dad – who really talks about these things with their dad, you know? We’re West Indian, we’re Jamaican, and in our culture we kind of brush things off. You're supposed to be strong, supposed to go work, supposed to be there for your family. I can have these conversations with my dad now. Just getting the real support that I need.
Thank you for sharing. How can we improve maternity care so that birthing people can have a better birth experience, and one that sets them up for success postpartum?
That’s a difficult question. It’s so multitiered, and it’s a heavy lift. it's gonna require a complete paradigm shift. It’s going to require a lot of people changing the way that they practice. Providers have to really become patient-centered, patient-focused. Policies are going to have to change in the hospital. Let's be realistic; a lot of people won't do things unless it's required of them. Laws are going to have to be created and instated to force people to change.
PNQIN [the Perinatal-Neonatal Quality Improvement Network of Massachusetts] is doing some amazing work. I love the fact that they've created these dashboards that hospitals can throw into their medical record system to help assess what's going on with patients, so we have the data to back things up and figure out next steps.
I feel like society does not support families in general, not just struggling people. It even starts before you're pregnant. A lot of us are going through a lot of things, just day to day in the world. We're dealing with inflation, we're struggling to buy groceries, just even basic things to live, and we have the right to reproduce. Our government doesn't necessarily support us, they don't enact laws and rules to help us. So it’s just a slippery slope. Before you know it, you're suffering from all these disorders. We need the resources to support each other and to get through this together.
I am a huge supporter of the Moms Matter Act. It's so important to have [mental health providers] that look like you that you can connect with. There's research that shows that when you have providers that look like you, you actually have a better experience and receive better care. This Act will help to diversify the space, and I think that diversity makes things better. It's important that we really give access to the community that that needs it. We need our legislators to support it, to pass it, fund it – it’s so important.
Thank you, absolutely. What about what birthing people themselves can do to feel more empowered?
Knowing what a birth plan is and creating one. Not being super rigid about it, but saying, these [things] are what I want. And learn about the process. At NBC, we have our Empowered Birth workshop. It's about those concepts, those things that are never discussed -- bodily autonomy, access, equity. Choosing your provider. Do you know you can fire your provider? Knowing the major interventions, like, what are some meds that you can receive during your labor process? What do those meds do? You don't have to be able to recite them from memory, but just have a general understanding. When you're in labor, it shouldn't be the first time you're hearing about it. This is why I wrote my book, Preparation for a Hospital Birth. I see the questions that patients, family members, and friends asked me, and I wanted people to have this tool.
And then, know your community resources. Like, if I need a therapist, where can I go? If I need a lactation consultant, where can I go? What if I need breastfeeding medicine? Because that's a thing. If I need a moms’ support circle, is there one in my community? Where are the places I can get food? Formula is expensive. Am I eligible for WIC? Kind of having that list, maybe even during pregnancy, and you know the steps you have to take to access those resources. Just so you're knowledgeable, because once the baby is here, you're exhausted.
Lastly, for those who are less familiar with the midwifery and birth center model of care, can you share more about that model and its positive impacts?
Midwives are the experts on physiological births, they are the original birth workers. They provide holistic care, they listen to people, they spend the time – that's the biggest component of the midwifery model. Really listening to people when they're laboring and going through the process. We need to get back to that. Birth has become extremely medicalized, overly medicalized. Not to say that there aren’t some folks that really need to deliver in the hospital, but most births are normal. We’ve just got to give people the chance, and give their bodies the chance to do what it does. This is what Neighborhood Birth Center and our midwives are going to do. Midwives are literally the solution!