April 11 marks the beginning of Black Maternal Health Week, a week of awareness and activism started by Black Mamas Matter Alliance (BMMA) five years ago and formalized by the White House on April 13, 2021. This year’s theme commissioned by BMMA, Building for Liberation: Centering Black Mamas, Black Families and Black Systems of Care, “reflects the critical need for learning about Black Feminist and womanist approaches in strengthening wellness structures within our communities, across the Diaspora, as a revolutionary act in the pursuit of liberation and in the global fight to END maternal mortality.” At Friends of NYC-NFP, expecting and new Black mothers make up more than a third of our clients. It is crucial to discuss the disparities in access to quality healthcare Black women face daily and to highlight solutions combatting these racial practices.

Not a luxury, but part of history 

Ariana applied to Friends Heart’s Desire Scholarship in 2022, to pursue training as a Doula and less than two weeks ago received her certification. After giving birth to her son she developed a passion for helping people birth safely and comfortably. With an award from Friends, she is now a Doula Trainee with Mama Glow meaning she has completed all necessary classes and training pertaining to the stages of pregnancy, labor and birth, the post-partum period and high risk births. According to Ariana, “Friends has played such an integral part in me obtaining my Doula trainee certificate by awarding me my tuition for Mama Glow training. Without that support, I wouldn’t be a doula trainee today. It was more than a scholarship, I was able to put my energy into my studies and family without having the stress of financing my training.”  In her essay Ariana wrote, “During my pregnancy, I knew of 3 black women who died during labor at hospitals-one in a hospital in Brooklyn. Maybe if they had someone advocating for them besides their partner, they would have still lived. I want to be that person. Homebirths, midwives, and doulas are not a luxury; they are our history! I want to carry the baton and positively impact a mother’s birthing experience thus positively impacting future generations. How you birth affects your life and how you show up in the world.”

Framing the Disparity

In 2018, the New York Times Magazine published an article analyzing data from the CDC and the government, stating “Black infants in America are more than twice as likely to die as white infants, […] a racial disparity that is actually wider than in 1850.”This crisis extends beyond infants, including high Black maternal mortality rates due in large part to dismissal of both symptoms and pain in Black mothers by medical professionals. Data from the CDC reveals nationally Black women are three to four times as likely to die from pregnancy-related causes as white women. According to the NYCDOHMH, this statistic doubles when considering only women in New York City

A 2020 NYCDOHMH report stated, “In 2017, there were 117,013 live births and 58 pregnancy-associated deaths in New York City” wherein 40% of those deaths were attributed to black mothers. Furthermore, Black women were 2.4 times more likely to experience severe maternal morbidity events, such as complications and health issues due to pregnancy or childbirth, than their white counterparts. 

What more can we do?

At Friends of NYC-NFP,  our goal is to ease financial burdens and encourage personal growth for the mothers in our Friends community. In addition to supporting clients in pursuing careers in the maternal health field, we fund emergency medical needs not covered by insurance to protect the health of mothers during pregnancy. For example, we have funded clients to acquire the necessary test strips for gestational diabetes that are costly and not covered by insurance. Furthermore, we cover Uber rides or transportation for clients who have hypertension or other health issues and may need to see their health professional more frequently than they can afford. And, Friends aids in the continued education of NFP nurses so they can be up to date on best practices for assisting and protecting expecting women and new mothers. 

Ariana described her nurse as “a motivational force during my journey of motherhood with educating me,  supporting me at all stages of my journey and being an extended hand caring for my son.” It’s connections like these that help reduce risks and ensure the health and safety of black mothers and babies. Inspired by her journey, Ariana now seeks to “get involved in community organizations like Nurse Family Partnership and Caribbean Women’s Health Association that have positively impacted my life during my pregnancy and early stages of postpartum. Through them, I took childbirth classes, joined breast-feeding support groups, and had access to a plethora of resources like doulas. Eventually, I would like to develop a support space for my clients’ needs. Having people you can support or can support you is also very special during pregnancy and postpartum.”

How can expecting women and new mothers be their own advocate? 

A comprehensive four-part plan co-authored by Erica Chidi and Erica P. Cahill, M.D calls out the need for understanding the historical implications of racism in healthcare, the conditions Black women, and particularly Black expecting women, are at a higher risk for, such as hypertension (pre-eclampsia) and cardiovascular disease, and how to confront racism in the pregnancy process to ensure the healthiest possible outcome for mom and child. It also outlines action items for OBGYNs, nurses, and other medical professionals to do their part to protect mom and child. The steps are as follows: acknowledge race and racism in the room, create a care plan anticipating that racism may impact pregnancy, identify how racism may impact labor, and identify how racism may impact postpartum. At Friends, staff member Alex Albert, led a LEAP event for our community of mothers on “How to Be Your Own Health Advocate” entailing the components to a good or bad first doctor appointment, what it means to be your own health advocate, how to prepare for a health appointment, what questions to ask, and steps to follow after an appointment, including follow-up, calling for back-up, and seeking a second opinion if necessary. 

A 2017 systematic review analyzed 26 studies of at least 15,000 women in 17 countries to determine the importance of continuous support for mothers throughout childbirth. Researchers found fewer Cesarean-sections, shorter labor times, and increased spontaneous vaginal births, among women who received continuous doula support throughout their pregnancy. But what would be considered “continuous support”? Researchers define continuous support as “a person who is present solely to provide support, is not a member of the woman’s own network, is experienced in providing labor support, and has at least a modest amount of training such as a doula”. NFP nurses provide valuable guidance to clients on red flags early in the pregnancy to watch closely and seek medical attention for if necessary. Their expertise and continued support to expecting women is fundamental in ensuring positive health outcomes for mom and baby. 

When asked what role doulas played in reducing disparity, Ariana said, “I believe doulas are key in reducing the disparities women of color endure because doulas advocate against a system that is designed to work against us. Doulas provide resources and information; educate clients on options and risks; assist with pain management and much more. As doulas, we create a safe space for our client to birth comfortably and confidently. Statistics show that having a doula reduces the risk of C-sections, increases positive birthing experiences, and reduces the use of pain medication just to name a few.”

Exacerbated by COVID

The story of Sha-Asia Washington’s death is a tragic yet all too common example of how racial disparities in maternal healthcare have been exacerbated by the pandemic. Washington went to Woodhull Medical Center in Bed-Stuy to undergo a routine stress test on July 2, 2020. What happened next was unexpected and heartbreaking. After noting an abnormally high blood pressure reading and a late due date, doctors induced labor and pressured Washington to accept an epidural. She went into cardiac arrest during the induced pregnancy and though her baby, Khloe survived, Washington’s heart stopped. Washington’s death was heartbreaking. 

Telehealth and new barriers to parenthood during the pandemic are not amenable to safe pregnancy practices. It is far more challenging for expecting women to make the necessary routine appointments to monitor their overall health and the health of the pregnancy. Furthermore, the most obvious risk created by the pandemic is the implications of pregnant women contracting COVID-19, including a much greater likelihood of requiring ventilation and intensive care. Many doulas have anecdotally discussed the challenges presented by the COVID-19 era hospital restrictions to the atmosphere of the delivery room. In most cases, doulas could not be present to support mothers through the labor and in some cases, partners were not allowed to be in the delivery room either. Without the assurance and support of a doula and family, Black women are faced with further challenges advocating for their health during labor and immediately after childbirth. 

We asked Ariana about her hope for her community and the importance of Black Maternal Health Week. She said, “My hope for my community is to save lives and families, lessen the negative birthing experiences, and to have women feel supported throughout  pregnancy, birth, and early postpartum. I hope to do this through education and being an extension of their support group. We need Black Maternal Health Week to bring awareness to what is happening to our sisters and families. As a mom, it hurts me to my core that there are mothers who are not able to see their children grow up and there are incomplete families due to very preventable issues that lead to their mothers’ deaths. This could be any one of us or our loved ones. Some people coin doulas as a luxury, but in reality it is our history and we can serve to combat the black maternal mortality issue we are currently facing. Black Maternal Health Week also sheds light on new or existing solutions that healthcare professionals can be part of.”

For truly successful health outcomes, providers play a fundamental role in respecting the agency of Black expecting women and mothers, recognizing bias, and proactively addressing concerns about stress, hypertension, or other conditions before they have irreversible effects. An integral step in this direction is to prioritize the health of mother and baby throughout all stages of pregnancy by creating a supportive community consisting of a doula, a nurse, family, or a community advocate. Friends understands it is crucial to highlight racial disparities in healthcare access, to advocate for Black women and new mothers, to assist in the continued education of our clients and support of NFP nurses, and to provide financial relief where possible. We are honored to support women like Ariana to ensure more healthy outcomes for moms and babies.  

As for why she pursued a career in Black maternal health and this new certification, Ariana expressed “My goal is to empower mothers in making the best decision for their families. Through education and resources, I want my clients to feel confident in the decisions they make as opposed to feeling forced or rushed. Birth and Motherhood is such an AMAZING yet transformative space where a mother is extremely vulnerable, so I want to make sure every mom has autonomy over her body and the well-being of her family.” At Friends, we ultimately do not want new mothers to just survive but to thrive.

By Colleen Marcoux