Birthing Black in America:
Centering Community-Based Maternal Telehealth Support Services for Black Birthing Persons
Written by: Shubhecchha Dhaurali, Brenna Miller, Melissa Wu, Divine Origeva, Beverly Udegbe, Inricka Liburd, Kelechi Offor, Paige Feyock
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. 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. Due to COVID-19, these disparities have only been exacerbated, but innovative solutions such as the use of telehealth services alongside community-based support models could be promising in preventing the deaths of Black mothers.
The US is one of the wealthiest, developed countries in the world, yet rates of pregnancy-related morbidity and maternal 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: loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests 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, and postpartum periods. Doulas and Midwives address social factors negatively affecting maternal and infant health, provide psychosocial support to bridge cultural gaps between providers and clients, and provide care coordination grounded in reproductive justice.
Doula-assisted mothers were four times less likely to have low birth weights (LBW), two times less likely to experience birth complications, and significantly more likely to initiate breastfeeding – improving the overall health of both mother and child. Though official research on Doula care efficacy is limited, with the research that has been done, studies have reflected the continuous benefits of having a Doula such as a decreased incidence of cesarean deliveries and negative childbirth experiences. These impacts are that 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, some previously mentioned 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. It is important to note that policies that uphold the human rights of birthing people and policies that decrease the risk of COVID-19 transmission are NOT mutually exclusive.
In order to continue providing perinatal services and support, many providers have increasingly switched to remote and virtual care options in order to reach their clients due to the impacts of COVID-19. The current pandemic has brought about “remarkable ingenuity” with telehealth and telemedicine technologies providing expecting families health care services through online video appointments and virtual chat windows allowing for quick and convenient access to providers. Many believe this will help close the gaps in racial and maternal health disparities as currently, the vast majority (98%) of maternal-fetal medicine specialists in the are located in cities, and pregnant patients living in rural areas, most often Black women, are left without access to care.
Though telemedicine and virtual models of health care include a variety of benefits, opponents of such models argue that virtual settings might do more harm than good. In order to receive virtual heath care, one must have access to the internet and associated software to be able to communicate with their providers. Even in the 21st century, an era of major technological innovation, not everyone has access to broadband, nevertheless access to reliable broadband. To combat this point, it should be noted that women, the majority Black, currently living in maternity care deserts would greatly benefit from any available maternal healthcare services– be it virtual or in-person.
This past year’s 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 unsurmountable. 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. Maternal health is the health of our humanity, making the eradication of such disparities that much more important.
The authors of this blog post are members of the Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R.) Lab working to research maternal health disparities and advocate for policy changes. You can learn more about MOTHER Lab at motherlab.org.