6 minute read
Black Birth Matters
In a radical paradigm shift to healthcare delivery, a UIC Nursing-led team is taking a novel approach to addressing stark disparities in pregnancy outcomes for Black people. Instead of focusing on just one intervention, a $7 million grant will allow researchers to implement multiple strategies to increase maternal health equity and attenuate the impacts of structural racism in healthcare.
YYmani Blake had just given birth to a healthy baby girl, but something was wrong.
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The 31-year-old, first-time mom was having hot flashes and throwing up. Her breathing was irregular. Drowsy and unable to talk, Blake only caught snippets of conversation from her hospital bed. The wrong medicine. A bad reaction. Suddenly, a dozen doctors and nurses surrounded Blake. On her left, a Black provider appeared, and Blake grabbed for her arm.
“I remember just being so lost when that was happening to me,” Blake says. “I felt like I was disappearing. When I saw her, I just felt like, ‘OK, maybe she’ll see me in this moment as a Black woman.’ It just gave me hope that someone would speak up for me.”
Blake had never met the person before—and in fact still doesn’t know who she was—but she was comforted by the color of the woman’s skin, which matched her own. Emerging research shows Blake isn’t alone in seeking out a provider who looks like her. Now, a group of researchers from UIC is exploring that idea to try to address deep-rooted disparities in maternal health.
The problem is at a crisis point. The barriers that Black patients face to getting high-quality—or even adequate—maternity care and support have led to mortality rates three to four times higher than white women. In Chicago, those numbers are even more bleak. Black women are six times as likely to die of a pregnancy related condition as non-Hispanic white women, according to the Illinois Department of Public Health.
“Many of the patients I work with are nervous,” says co-principal investigator Karie Stewart, MS ’17, CNM, MPH, who is an adjunct faculty member at UIC Nursing as well as director of midwifery care at University of Chicago Medicine. “They don’t feel trust with their providers. Patients may think, ‘I’ll try to have baby at home without the proper provider,’ and we don’t want that.”
Ymani Blake nurses her daughter, Indigo, who was born in July. After what Blake calls an “extremely traumatic” birth experience in the hospital, UIC Nursing assistant professor Kylea Liese provided Blake with a “rebirth,” an opportunity to heal from that experience by replaying Indigo’s birth at home.
ALICIA TARVER
Melanated Group Midwifery Care
A $7.1 million grant over five years from the Patient Centered Outcomes Research Institute will allow the research team to adopt the Melanated Group Midwifery Care model. The multipronged strategy will match Black pregnant people with Black midwives, a concept called racial concordance, which is intended to facilitate trust and open communication. The model also calls for prenatal care to be provided in a group setting for peer support; for a Black nurse to coordinate care and engage with patients during pregnancy and after; and for a Black doula to provide in-home support for the patients for up to a year after delivery.
“The numbers are devastating,” says Stewart. “There are lots of issues that arise during the postpartum period that lead to morbidity and mortality, but they often aren’t addressed because we just assume patients are fine at six weeks postpartum, when care typically drops off.”
Two maternal mortality review committees established in Illinois found that one-third of pregnancy-related deaths occurred more than two months after pregnancy, according to a report released in April. The leading cause of pregnancy-related death was mental health conditions, including substance use disorders. The reports found that 83% of deaths were totally preventable.
“Postpartum in-home visitation is a key recommendation of the maternal mortality review committees,” says Kylea Liese, PhD, CNM, UIC Nursing assistant professor and co-principal investigator on the project. “This study will provide evidence on whether a trusted postpartum doula can successfully support individuals after birth and help link them with mental health resources.”
Members of the research team (from left): PAMELA PEARSON, DNP ’18, CNM, RN UIC Nursing assistant clinical professor STACIE GELLER, PhD G. William Arends Professor of Obstetrics & Gynecology and director of Center for Research on Women & Gender at the University of Illinois College of Medicine KYLEA LIESE, PhD, CNM UIC Nursing assistant professor KARIE STEWART, MS ’17, CNM, MPH University of Chicago Medicine director of midwifery CRYSTAL PATIL, PhD UIC Nursing professor SARIA LOFTON, MS ’05, PhD, RN UIC Nursing assistant professor
The researchers plan to enroll 432 pregnant individuals in their first trimester of pregnancy. Half of the participants will be randomly assigned to the Melanated Group Midwifery Care model and the other half will have their usual one-on-one care with a midwife or obstetrician.
Black midwives are in short supply—only about 7% of midwives are Black, according to the American Midwifery Certification Board—but the researchers hope to help address this by creating infrastructure for more Black providers. In addition to including students on the project, UIC Nursing is also in the process of building a doula certification program on the South Side of Chicago, says Crystal Patil, PhD, UIC Nursing professor and co-investigator on the grant, which could, in turn, create a pipeline to midwifery.
A crucial part of the project is community engagement, Liese says. The researchers are collaborating with the non-profit group Melanated Midwives, which Stewart founded, and will be advised by a community advisory board of Black postpartum mothers from the South Side.
'Extremely Traumatic'
Aware of the issues that surround Black people and birth, Ymani Blake deliberately searched for a sympathetic midwife who could deliver her baby at home.
But in her last month of pregnancy, she saw her plans go awry. Her blood pressure was elevated, and her midwife referred her to an affiliated obstetrician at a nearby hospital. At her last appointment, still hopeful that she might be able to deliver at home, the doctor pushed to induce labor immediately in the hospital. Blake questioned the decision, but felt her concerns were brushed off.
“I didn’t feel heard in that moment,” Blake said. “I wouldn’t say what I experienced with that particular professional was racism, but I would say I experienced gaslighting and just very bad bedside manner.”
Blake and her daughter, Indigo, born in July, are now home and healthy. But she calls her birth experience “extremely traumatic.” She began to have distressing flashbacks a few weeks after she was home. By then under the care of Liese, Blake says she was grateful she had a support team watching for signs of postpartum depression.
“I think this grant is going to save lives,” Blake says. “I could just imagine somebody who doesn’t know they need a team like that, especially during the postpartum period. I can only imagine the difference it’s going to make in people’s lives. I’m really excited about that.”
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SIDEBAR
Alum fights for South Side birthing center
A year ago, alumna Karie Stewart, MS ’17, CNM, MPH, was featured in the Chicago Tribune and on WBEZ for trying to offer more birthing options on the South Side by building a new birthing center.
Those efforts—in partnership with Jeanine Valrie-Logan, MPH, CNM, a midwife at PCC Wellness—paid off in August when Gov. J.B. Pritzker approved a bill to increase the number of birth centers in the six-county Chicago area by 50%, from four to six. The new law also allows two, rather than one, of the centers to be owned or operated by a federally qualified health center.
“A birth center would fill a huge need and gap in the South Side community,” says Stewart, who is co-principal investigator on Melanated Group Midwifery Care with UIC Nursing researchers.
With the new law in place, they’re in the early stages of putting together an application for an independent birth center.
“It’s been a long journey,” says Stewart. “Now we get to see our vision come to life.”
