A way to progress: Addressing racial disparities in maternal health
My path to midwifery blossomed from my first pregnancy as a young Black woman in Montgomery, Alabama. My excitement of becoming a new mom was quickly overshadowed by the negative treatment I received throughout my prenatal care. As a Staff Sergeant in the U.S. Air Force working in health care, I was sure I’d have no problem sharing my desires, asking questions, and playing an active role in my care. Unfortunately, I felt unheard, unseen and ignored by the OB/GYN and clinic staff while being hustled through each visit. As fate had it, my OB/GYN was not available at the delivery, and I ended up in the care of a midwife. Her gentle touch, compassion, respect and support through my labor was miraculous. Everything came full circle for me, and it was then that I knew I was called to the service of midwifery.
On my midwifery journey, I worked for several years as a labor and delivery nurse. I recall a statement a fellow RN made, that “Black moms always have small and preterm babies.” I asked an OB/GYN for his insight. “That’s just how it is. Who knows - a lot of them don’t take care of themselves and they have a lot of complications.” This unnerving statement stuck with me and unfortunately remains a critical issue, along with the horrifying, but oft-quoted, statistic that Black pregnant people are three times as likely to die from pregnancy-related complications as their white counterparts. The reasons behind this fact are often explained away, concealed or touted as the result of Black mothers’ “own doing” and “fated misfortune.” But we know this is not the case.
Racial disparities in maternal health have real and explainable causes: unmet social needs and the stress that results, generational trauma resulting in high Adverse Childhood Experiences scores, a lack of mental health resources during the pregnancy, anxiety and distrust of what the health care system can provide, and the racism that Black patients endure throughout their pregnancy care.
Structural racism is something people have been talking a lot about, especially after the murder of George Floyd. Those structures are deep and complex and show up too in the daily interactions of Black patients with the maternity care system. Here is how:
- When your family medicine doctor disregards your pain and doesn’t spend time digging into the causes, but validates a white patient’s pain symptoms
- When you go through a visit without a single nurse or provider making any eye contact with you
- Being informed that you have high blood pressure and are told to take medicine without any explanation about the diagnosis
- Being told that if you cared about your baby, you will make it to all your appointments, without any further interest in why appointments were missed
- When no one on your care team takes the time to tell you about the resources that are available to you
- When you downplay your pain out of fear that you will be perceived as complaining or seeking drugs
By listening to and addressing the lived experiences of Black birthing people, we can design policies and systems that earn back the trust of people of color and drastically improve maternal and infant health outcomes.
A way forward is to build trust with the patient and increase access to quality reproductive, perinatal and postpartum care for Black birthing persons. We know that midwives drive better birth outcomes and patient satisfaction, and doulas drive down C-section rates by 59 percent by advocating for their patients. Providing Medicaid coverage of doulas and paying midwives to recognize the high-quality care provided by these birth workers could drive better outcomes. Infant mortality is shown to be lower when Black babies are cared for by Black providers. Establishing grants to increase the number of Black, Indigenous and people of color (BIPOC) midwives and doulas would go a long way.
Legislators should expand funding for community-based organizations and local health departments, as highlighted in the Black Maternal Health Momnibus package, especially those offering evidence-based programs such as Nurse-Family Partnership (NFP) and Child First. NFP utilizes a home visit model provided by specially trained nurses who support and provide care for pregnant people and first-time parents facing poverty and other adversities. Child First provides mental health support to vulnerable children and their families to heal from the damaging effects of adversity, trauma and chronic stress. Open Arms Perinatal Services pairs clients with doulas while taking into account cultural context, to improve maternal health.
Policymakers should incentivize state and local health departments to evaluate data by race, ethnicity and other key demographic indicators. Doing so enables decision-makers to make community-specific changes to tackle social inequities in areas such as transportation, access to quality health care, mental health services, nutritious food, and safe homes and spaces in which to live, work and play.
Changing how Medicaid and other payers pay for maternity care is critical to improving quality of care for Black persons. Value-based payment models that link high-quality, patient-reported experiences, cultural competency and evidence-based outcomes to reimbursement will address implicit bias and promote correct behaviors of health care providers and institutions.
I joined Quilted Health because we have built an evidence-based pregnancy care model which puts patients at the forefront of our care, led by our experienced midwives and doulas. We provide whole-person care and connect patients to community-based organizations for assistance with critical services including healthy food, housing, and insurance enrollment because we know that social determinants impact maternal and infant health outcomes. Our staff looks like our patient population because we know the fastest way to eradicate systemic racism in healthcare is to match patients with providers who look like them. As an accountable provider, we structure value-based contracts that incentivize us to drive equitable, high-quality results.
By listening to and addressing the lived experiences of Black birthing people, we can design policies and systems that earn back the trust of people of color and drastically improve maternal and infant health outcomes.
Quilted Health is funded in part by BlueCross BlueShield Venture Partners, L.P., a corporate venture fund licensed by the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. The fund invests in promising emerging companies of strategic relevance to Blue Cross and Blue Shield Plans.
