Centering Community-Based Maternal Telehealth Support Services for Black Birthing Persons
By: Shubhecchha Dhaurali
America’s Healthcare Conglomerate was built on the bodies of Black women. Major modern medical innovations and research can be accredited to their pain, suffering, and imprisonment– one procedure in particular saved my mother and sister’s lives when we first came to America 18 years ago. The stains of slavery still persist today in the US’s medical system as Black women are three-four times more likely to experience pregnancy-related deaths and maternal health complications than white women. Structural racism and discrimination are major drivers in maternal health disparities and are prominent social determinants of health. COVID-19 has exacerbated these disparities, but innovative solutions such as the use of telehealth services alongside community-based support models can help in preventing the deaths of Black mothers.
The US is one of the wealthiest developed countries in the world, yet rates of pregnancy-related mortality have more than doubled in the past 30 years. In traditional healthcare settings, one in six women have reported experiencing one or more types of mistreatment, such as the loss of autonomy and being ignored when asking for help.
Community-based maternity healthcare models are a solution to these alarming rates of maternal mortality and mistreatment as they offer enhanced care and support. These models include Doula and Midwifery services during labor, perinatal & postpartum periods. Doulas and Midwives address social factors negatively affecting maternal and infant health. Their work operates within multiple levels of the socioecological framework as they provide psychosocial support to bridge cultural gaps between providers and clients, and care coordination grounded in reproductive justice.
Doula-assisted mothers were less likely to have low birth weights, experience birth complications, and were significantly more likely to initiate breastfeeding– improving the overall health of both mother and child. Literature has shown the continuous benefits of Doula care such as a decreased incidence of cesarean deliveries and negative childbirth experiences. These impacts are much more valuable to Black women who systematically experience higher rates of poor birth outcomes such as higher rates of Cesarean deliveries, preterm births, low birth weights, and infant deaths.
There have been tremendous hurdles and uncertainties for pregnant and birthing persons in the past year. In order to prevent the spread of COVID-19, clinical settings/providers have understandably prohibited partners/birth supports during pregnancy processes such as attending labor and delivery. While well-intentioned, policy changes have had negative impacts on birth outcomes such as increased cesarean deliveries, heightened separation anxieties of mothers and newborns, and over medicalization, especially with Black mothers. Upholding the rights of birthing people and decreasing the risk of COVID-19 transmission are NOT mutually exclusive.
In order to continue providing perinatal services and support during COVID-19, many providers have increasingly switched to remote and virtual care options in order to reach their clients. The current pandemic has brought about “remarkable ingenuity” with telehealth and telemedicine technologies providing expecting families healthcare services through online video appointments and virtual chat windows allowing for quick and convenient access to providers. With 98% of maternal-fetal medicine specialists located in cities and the majority of Black women being left without access to care in rural areas, using telehealth and medicine will help close racial and maternal health disparity gaps.
Though virtual models of healthcare include a variety of benefits, opponents argue that virtual settings might do more harm than good. In order to receive virtual healthcare, one must have internet access and associated software to communicate with their providers. Even in the 21st century, an era of major technological innovation, access to broadband is limited. To combat this, it should be noted that women currently living in maternity care deserts, the majority Black, would greatly benefit from any available maternal healthcare services– be it virtual or in-person.
The pandemic has only exemplified the need for community-based maternal telehealth support services for black birthing persons as the work Doulas and Midwives do to provide empathy and greater mental and emotional assistance to women are incalculable. The compassion and established community support system that they provide is associated with overall greater maternal satisfaction during labor, birth, and postpartum which can be emulated through a virtual setting during these unprecedented times. The implementation of this model will ultimately work to eliminate preventable maternal deaths in the USA and save Black mothers’ lives.