BY LIZ MUGAVERO

When a woman receives the support and care she needs during her pregnancy, labor and delivery— and through postpartum—everyone benefits: the mother, the baby, the family, the community in which they all live. When health care, economic resources, healthy food and community support are difficult to access—and racism and bias are present—the pregnant woman’s health and life are in danger, as well as the lives of her infant, family and community.

The reality is that a disproportionate number of pregnant Black women and other women of color in the St. Louis area and across the United States are dying because they don’t have consistent, affordable access to the unbiased health care and support needed to get through pregnancy and delivery safely.

ACCORDING TO A REPORT FROM ST. LOUIS COUNTY FOR YEARS 2018-2022, PREGNANCY-ASSOCIATED DEATHS FOR BLACK WOMEN WERE THREE TIMES THE RATE FOR WHITE WOMEN.

Illustration courtesy of Shutterstock

The statistics are stark and sobering: The Centers for Disease Control and Prevention (CDC) in 2021 reported that for Black women in the U.S., the mortality rate was 70 deaths per 100,000 live births—more than two times the rate for white women. In a report looking at years 2018-2022 published by Saint Louis County, pregnancy-associated deaths for Black women were three times the rate for white women. Clearly, strategic changes must be made to address this significant problem.

Identifying “why”

“It’s structural racism and implicit bias,” says Yvonne Smith, director of patient care for women and infant services at Barnes-Jewish Hospital. “It’s an environment that puts a different level of stress on people of color in particular as they access health care, regardless of socioeconomic status.”

In the face of racism and bias, Smith notes, many Black women don’t feel they’re taken seriously when communicating with health care professionals about their health. “The data shows that Black women often feel unheard and disregarded when expressing health concerns,” she says. “And if you feel like you might be treated poorly, you’re less likely to share your concerns or trust the advice providers might give.”

Additional factors contributing to Black maternal mortality include inadequate access to quality health care—including comprehensive prenatal care—and socioeconomic barriers that limit access to other important resources. Some of these barriers include lack of transportation, lack of affordable and healthy food and safe housing, and insufficient green space for adequate time outdoors.

Implementing solutions

Addressing a problem as significant and complex as Black maternal mortality requires a multifaceted approach that cares for the individual while addressing the overarching system that negatively impacts that individual. In St. Louis, health care institutions and providers, community leaders and neighbors, are working to develop new community policies, rebuild health care frameworks and forge community partnerships to support women in need.

“Change happens through state policy,” says LaToya Daughrity, director of the neonatal intensive care unit (NICU) at St. Louis Children’s Hospital. “Black mothers need better access to health care. We must focus on resources and programs for moms when they discover they are expecting.”

Recent changes in state policy include Missouri’s decision in 2023 to extend Medicaid benefits for new moms from 60 days to a year postpartum. However, Daughrity notes, pre- and postnatal mental health coverage remains inadequate.

At a more local level, another policy change involves the use of doulas during pregnancy. A doula is a trained professional who can provide physical, emotional and informational support to a pregnant client before, during and after childbirth. A doula acts as an advocate and, as many research studies indicate, can positively affect the outcome of the pregnancy for mother and baby, and help protect the mother’s physical and mental health. As advocates, doulas can play a critical role in addressing biases in health care, especially when many health care providers don’t share a similar lived experience with the pregnant patient.

BJC HealthCare and its hospitals Barnes-Jewish Hospital and St. Louis Children’s Hospital have developed policies designed to support women who choose to work with a doula. Doulas are invited to attend all prenatal care visits, and they can be present through the childbirth experience and postpartum care, including when a newborn must receive care in the NICU.

The cost of working with a doula, however, can be prohibitive, as it is not covered by insurance. BJC is working to address this problem by advocating for payors, Medicaid and private insurance companies to reimburse doulas for the critical services they provide. Policy change can be a long-term process, however. In the interim, BJC has offered support to three local doula organizations. Additionally, the BJC Community Health Improvement team is collaborating with Jamaa Birth Village, Missouri’s first Black-owned midwifery clinic. These efforts are aimed at improving outcomes for pregnant Black women by helping ensure they have access to a doula should they choose to work with one.

Training and education to address racism

The availability of culturally congruent care can also have a positive impact on pregnancy, labor and delivery, and postpartum outcomes. This approach to health care honors the cultural beliefs, traditions and values of a patient and their community. BJC provides training for its clinical-care team members that emphasizes the need for culturally congruent care.

These educational efforts also emphasize the value of a trauma-informed care framework. This approach to care, Smith says, emphasizes safety, empowerment and healing. “It’s asking women what’s happened to them instead of what’s wrong with them,” she says. “It’s about providing a safe, nonjudgmental space for care.”

BJC’s required training programs on equity, implicit bias and trauma-informed care have helped caregivers recognize bias and take ownership in making a difference, Daughrity says. Both existing team members and new employees receive this training, she adds. “It’s helpful when you understand the culture,” she says. “And to do that, we have to center our patients and communities in our hiring process.”

Collaborating within the community

Community awareness is another step in addressing the problem. Daughrity notes that outreach is taking place in the form of community health fairs, community baby showers and collaborations with community organizations, including Jamaa Birth Village, St. Louis Doula Project and St. Louis Area Diaper Bank. These kinds of collaborations work to connect more pregnant Black women to resources and education.

Ultimately, both Smith and Daughrity say it’s incumbent on health care institutions and providers to work within the community to help design solutions. And pregnant Black women are at the center of that equation. “We want our patients to tell us their experiences so we understand where we can improve. And we need to remember, they are the experts of their bodies,” Smith says. “We have to listen to what a mom says.”

Originally published by BJC HealthCare.