Health care program fights racism suffered by pregnant black women

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Krista Hayes, 32, of Oakland was delighted to learn that she and her husband were pregnant with their first child together. But she was also scared.

Shed saw statistics showing that as a black woman in America she was much more likely to die in childbirth, suffer from complications from labor, or have a premature baby than other women. She was worried about handing over the momentous process of having a baby to a medical system that she said had often treated her, her family members and other black people she knew with indifference and contempt.

There have always been prejudices. Whether you talk about it or not, you feel it, said Hayes. As a black person you move differently and you are treated differently.

So when a gynecologist and obstetrician at Highland Hospital in Oakland suggested Hayes join a new county prenatal care program designed specifically for black pregnant women, the mom-to-be was intrigued. As a participant in the program, Shed attends regular group prenatal education sessions and enjoys the one-on-one support of an all-black healthcare team, including midwives, a lactation consultant, a doula, and an all-black healthcare team. family resources specialist. The goal of the program, called BElovedBIRTH Black Centering, was to address precisely the issues that worried Hayes.

The program, said Hayes, looked amazing.

Research shows that Hayes’ experience with medical care is not atypical. Black women are much more likely to report experiencing discrimination in the health care system than white women. And studies indicate that racism or unconscious prejudice in medical care is the reason why black women and infants fare so poorly compared to their white counterparts.

Calls for society to do more to address the high rates of death and disease among pregnant women and black infants have been escalating for years at the local, state and federal levels. The issue gained new vigor last year following protests drawing attention to systemic racism.

In California, where African American women are more than three times more likely than white women to die from pregnancy-related causes, the state created the California Perinatal Equity Initiative, which funds 11 counties, including Alameda, San Francisco. , Contra Costa and Santa Clara to implement pilot programs to reduce black infant mortality.

The state also passed a law in 2019 requiring anti-bias training for perinatal care providers. And California’s new fiscal year budget includes extended postpartum coverage and doula services for pregnant women insured under Medi-Cal, the state’s health insurance program for residents of the United States. low income – measures that should help reduce disparities in maternal and child health.

Five Bay Area counties – Alameda, Contra Costa, San Francisco, Santa Clara and Solano launched a regional campaign this summer called #DeliverBirthJustice (DeliverBirthJustice.org), to raise awareness of the impact of racism on infants blacks and pregnant women.

At the federal level, Democrats are calling for the passage of the Black Maternal Health Momnibus Act, a set of 12 bills that includes, among other things, money for better data collection and investments in diversification of the hand -perinatal work.

In Alameda County, where more than one in 10 county residents are black, the highest percentage in the state, BElovedBIRTH has become a pioneering model for advancing reproductive health and racial justice.

Led by Jyesha Wren, an energetic young midwife based in East Oakland, the program brings together doctors from the Department of Obstetrics, Midwifery and Gynecology of Alameda Health Systems, and social workers from the Department of Public Health of Alameda County. It is based on a national program created by the Boston-based Centering Healthcare Institute that has been shown to reduce preterm birth rates, lower health care costs, and increase patient satisfaction with patients. prenatal care.

Wren and her team adapted the course content, including photos, videos, and cultural references, especially to African American women, putting their concerns, experiences, history, culture and needs first. . From the first session, BElovedBIRTH facilitators lead group discussions and activities that explore the impact of racism on black health.

For example, if a woman is uncomfortable with a proposed procedure, such as induction of labor or an episiotomy, she is encouraged to ask why it is recommended and if there are options. Subsequent sessions examine topics such as healthy eating that includes traditional black foods, and discussions about the reasons for low breastfeeding rates in black mothers, and how to overcome these barriers.

We are shamelessly black, said Wren. Having information that relates to your story, your story, your people, really allows people to use it better.

BElovedBirth has eight to 12 women with similar due dates, and they receive antenatal care together once or twice a month depending on their proximity to delivery (they also benefit from one-on-one time with a midwife. during the group course). Sessions last 2 hours, much longer than a typical prenatal visit with an obstetrician-gynecologist, meaning women have more time to learn about pregnancy, ask questions and discuss concerns, as well as to build trust with providers.

Beyond the courses, participants are provided with referrals to social services, mental health care and other types of support as needed. They receive gift bags filled with herbal wellness products such as belly balms, boxes of home delivered products, a free pregnancy photoshoot, access to a black doula during labor and restaurant meals after childbirth. Wren calls this a bundle of black love gold.

This is beyond anything that has been done before in perinatal care, Wren said. Our vision is to create a world where black people have all the support, loving care and resources necessary to have happy, healthy and safe pregnancies, births and postpartum recoveries, free from obstetric racism.

The program, which has a total of 15 sessions over about eight months, was launched in October 2020, despite the pandemic, and is now in its sixth group. Three of the sessions take place after childbirth, so they have the opportunity to discuss their birth stories, receive breastfeeding support, and get help with any postpartum issues. So far, all sessions have been online (participants receive a tablet and internet for free for one year to access the program). However, the county plans to move to in-person classes soon.

Tia Lindsey, 27, of Oakland, remembers the relief she felt when she logged in to her first class and saw more black faces appear on the screen. Shed left a previous antenatal clinic appointment in tears because she felt looked down upon by the staff. At BElovedBIRTH, there was instant warmth and connection, she said. Participants tracked their blood pressure and their baby’s growth together and had candid black woman-to-black conversations about health issues, body changes, relationships, and even fears of raising a child in a country. where people of color are more likely to be killed by police.

It was like a fellowship situation, and on top of that you have (medical professionals) who can really tell you what’s going on with your pregnancy, she said. I just felt very seen, understood and heard.

This sense of community spread to the hospital, where Lindsey and another woman in the group gave birth at the same time. During a four-day trial period, Lindsey texted with herself and other course participants. Their words of support and a visit from one of the midwives in the program got her through the experience, she said.

For Krista Hayes, BElovedBIRTH helped counter the isolation she felt due to the pandemic and her husbands demanding a work schedule and no parental leave. It also made childbirth less stressful, she said. When a nurse began to prepare her for induction, even though she wanted a natural delivery, Hayes felt confident to demand an explanation.

After the birth of her baby, Noa, Hayes became one of the first people in her family to breastfeed, thanks to the breastfeeding support she received. She also got diapers and baby clothes through the program, which has helped her family financially, she said.

I had so much good that happened – the support I got, the things I needed for my baby, she said.

The only negative, said Hayes, is that she has now completed the program and must return to the regular primary care system. Wren said the next steps for the program are figuring out how to refer participants to black providers once they leave, although this is difficult due to a shortage of black doctors.

Angie Trousdale, CEO of the Centering Healthcare Institute in Boston, called the adaptation of the Alameda County program remarkable. She said this could offer lessons to other counties and healthcare sites interested in adapting the model to black communities.

What BElovedBIRTH has done is really to focus on the needs of their community, she said.

Wren also hopes other counties and states will eventually want to adopt the program. Her team is working on creating new materials, including educational images featuring black women, cooking and exercise classes, documentaries, an inspiring coloring book, and a gift shop.

BelovedBirth exists as an example of what can be, she said. We believe it will only grow.

Claudia Boyd-Barrett works for the Center for Health Reporting at the USC Schaeffer Center for Health Policy and Economics. This project was supported by a grant from First 5 LA.

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