As we recognize Black Maternal Health Week this year, I wanted to take a moment to reflect on my personal birth experience as a Black mother. In 2021, as we all adjusted to a new normal and navigated life during a pandemic, my family was thankful for a reason to celebrate. We learned that we would be welcoming a new baby soon. Naturally, I was concerned about maintaining a safe pregnancy under the threat of COVID-19. However, this concern was quickly outweighed by the fear of what other dangers were ahead as a Black woman in Arkansas preparing to have a child.
I had spent nearly my entire career advocating for a better healthcare system and knew the statistics like the back of my hand.
Black women are two to three times more likely to die from pregnancy complications than non-Hispanic White women. Additionally, the maternal mortality rates are higher among Black and Native American women regardless of income and educational levels. Arkansas also ranks as one of the worst states in the country for maternal health.¹
I carefully weighed my options for an obstetrician and hospital for delivery. Ideally, I would find a hospital with a team of diverse doctors that could meet my needs as a high-risk patient.² Both factors would increase my chances of a healthy pregnancy and delivery. However, I had to settle for the hospital best suited for a high-risk pregnancy.
Almost four decades ago, my mother gave birth at the same hospital.
She was a young mother unsure of what to expect as she delivered her first child. Though she had regular prenatal care because of Medicaid coverage, like over 60% of people giving birth in Arkansas, she never felt like her care was adequate. Her visits were always quick and transactional. She shared the parts of her birth story with me that she could remember. Some family members were present for support. Her memory of her actual delivery was spotty because after having her labor induced, she experienced a seizure. She later learned she was given general anesthesia and had emergency surgery to deliver me. She recounted waking up to a baby with no recall of how I had arrived. She still wonders about the cause of the seizure because she did not receive an explanation for what caused it, had no history of seizures, and has never experienced another one since that day. She was also provided information about receiving baby formula through the WIC voucher program.
Her postpartum period was also challenging. After giving birth, she had to leave her job. Her job didn’t offer paid maternity or sick leave to allow her time to recover physically, and she had no options for affordable child care. Eventually, she’d find a retired relative to provide childcare. This allowed her to find a new job and attend college in the evenings.
My birth experience was different. I had comprehensive health coverage that afforded me access to consistent prenatal care, and I took advantage of every recommended screening to monitor my high-risk pregnancy. We also worked with a doula. Though my private health insurance did not cover the cost, I knew it would be worth the investment if it increased the likelihood of a positive outcome during my pregnancy and delivery. This was one of the best decisions we made. Our doula services included home and virtual visits during pregnancy and postpartum, childbirth education classes, and lactation support. Our doula was a source of education and emotional support for both parents.
Like my mother, my delivery did not go as expected and required surgical intervention. However, the hospital did several things well. Our doula helped us develop a birth plan that listed our treatment preferences, and we provided it to the hospital staff during check-in. I was allowed the option of a certified nurse midwife to oversee my care. She worked in partnership with the attending physician. While my doula could not be present due to COVID restrictions, she was a phone call away. I was fortunate to be assigned a nurse who was also a trained doula and a member of the same local doula association our doula had co-founded.³
Though we had to deviate from my birth plan, our midwife and nurse treated me with care and patience throughout my delivery. I called our doula for reassurance when I had to make several critical treatment decisions, and the nurse advocated to ensure my treatment preferences were considered. Although there were a couple of tense moments, we felt confident expressing our desires and asking questions. The hospital was also designated a baby-friendly facility, so I was supported in my decision to breastfeed. I had previously attended a breastfeeding class at no cost offered by the hospital. I visited with the lactation specialist during my hospital stay and on a postpartum visit. There was also a hotline if I needed additional support.
Lastly, I had paid short-term disability and sick leave, which allowed me to plan to return to work after 12 weeks.
The differences between my birth experience and my mother’s experience were a result of several policies and practices that can help improve maternal health and reduce the racial disparities in treatment:
- Adopt state and federal policies to promote improved access to maternal health care. One important tool to improve maternal health outcomes is to address the disparities in access to care by improving access to health coverage during, before, and after pregnancy. Adopting a Medicaid expansion policy is one of the best vehicles for reducing the coverage gap. Also, states can take advantage of the more recent state policy option to extend post-partum Medicaid coverage from 60 days to 12 months, which 38 states have adopted.
- Adopt care models that center the patient, supports their healthcare needs, and provide patient education. Prenatal and postpartum care should be comprehensive and include patient education and counseling. Models like Centering Pregnancy focus on empowering patients and strengthening the provider-patient relationship through group prenatal care and have been shown to nearly eliminate racial disparities in preterm birth. The national advocacy organization, Black Mamas Matters Alliance, also advocates for community-based doula models as a care standard. Research shows that access to doulas improves birth outcomes and reduces health disparities across race and income.
- Provide health coverage reimbursement for doulas. Payors (Medicaid and private insurance) must reimburse for their services to improve access to doulas. This reimbursement should be adequate and implemented in a manner that does not create administrative barriers for existing doulas, like onerous payment and supervision structures. There is also a potential benefit for payors since doula care has also been shown to reduce the costs of care in Medicaid programs. Currently, 11 states and DC provide Medicaid reimbursement for doulas.
- Diversify the workforce and provide culturally competent care. While access to quality care is critical, that care must be equitable and address racial and ethnic disparities in maternal health outcomes. This means increasing the diversity of the healthcare workforce and providing cultural competency training. Research shows that even access to a diverse nurse workforce reduces bias and improves communication between the patient and provider.
These are only a few solutions to address maternal health disparities and improve care for all pregnant people. Improving maternal health requires a comprehensive approach that addresses systemic healthcare racism, increases access to high-quality care, and promotes policies and programs that support maternal health. The approach must be collaborative and involve healthcare professionals, policymakers, communities, and most importantly, the people most impacted by the issue.
The most significant memory that still stands in my mother’s mind from her pregnancy and birth experience was that she never felt like she was treated with dignity and respect. On the other hand, I had people around me who supported me, advocated for me, and constantly reminded me that I was worthy of dignity and respect. This made all the difference in the world in my outcome, and I credit our doula and care team for providing my baby and me with lifesaving care.
I look forward to the day when it is the expectation and not the exception that Black moms and every pregnant person will receive equitable and adequate care.
Marquita Little Numan is the Senior Director of Equity and Impact for the Alliance for Early Success. She has spent her career in the government, nonprofit, and philanthropic sectors working with and in communities to empower marginalized people. At the Alliance, she plays a leadership role in the organization’s strategies in maternal and child health and racial equity.
¹ Arkansas has the highest maternal mortality rate in the nation, according to Kaiser Family Foundation from 2018-2020.
² Pregnant people over a certain age are at a greater risk of complications.
³ The Ujima Maternity Network is a nonprofit organization established to address the Black maternal and infant health crisis in the state of Arkansas.