From awareness to action: How to make pregnancy and childbirth safer for Black and Native communities
Having a baby comes with increased risk of health disparities.
This post was provided by PeaceHealth’s Perinatal Safety Officer, Michele Kulhanek, MSN, RNC-OB, C-EFM, C-ONQS.
Pregnancy and childbirth can be a time of excitement and anticipation. But expecting a baby can also be a period of worry and stress.
At least 60,000 people each year in the United States experience severe complications related to pregnancy and childbirth. And some of them don’t survive. Maternal health is a serious topic and one that we all can work to better understand and address.
A growing concern
Since the 1980s, maternal deaths have increased across the nation, CDC data shows . The risk isn’t shared equally, though. Pregnant people of color are more often affected:
- Black women are three to four times more likely to die from a pregnancy-related cause than white women, national data shows.
- In the Pacific Northwest, American Indians and Alaskan Natives are eight-and-a-half times more likely to die during or shortly after pregnancy. Yet researchers found that 80% of these deaths were preventable.
Addressing these disparities in maternal health takes time and effort. But when we know what’s behind the numbers, it can increase our opportunities to act.
What’s behind the statistics?
Common causes of pregnancy-related deaths in all races and ethnicities include:
- Mental health conditions such as anxiety and depression
- Suicide
- Substance use disorder and accidental overdose
- Infection
- Complications from preeclampsia and other conditions related to high blood pressure in pregnancy
Causes of maternal health differences
Overall, people of color have a harder time staying healthy even before pregnancy. That’s because of historical inequities in our society, which public health researchers call social determinants of health.
These are nonmedical factors that influence how long — and how well — we live. They include things like education, income and housing stability, access to clean air and water, community and personal safety, and affordable healthcare, among others.
Social determinants of health are a driving force behind inequities in pregnancy and childbirth outcomes, too. Causes of maternal health differences include:
- Limited access to primary care and prenatal care, which can lead to undiagnosed conditions such as high blood pressure, high blood sugar, and other complications in pregnancy.
- Underlying chronic health conditions, especially ones that are undiagnosed or undertreated.
- Lack of access to housing, nutritious foods, adequate income and reliable transportation.
- Structural racism, mistreatment and bias in healthcare that affects the quality of care certain groups receive. In a recent study , one in five women said they had been ignored, shouted at or threatened with having treatment withheld during maternity care. People of color and those without private insurance reported higher rates of mistreatment.
What can we do to close gaps in maternal health?
The causes of maternal deaths can seem so big, it’s hard to know where to start. Yet we each can take steps to make things better.
If you’re pregnant:
- Find a provider who you can build a trusted relationship with. Family medicine, OB/GYN or midwifery practices are good places to start.
- Consider working with a doula. These trained professionals support your physical and emotional needs during pregnancy, birth or postpartum. Find a doula in Alaska , Washington or Oregon .
- Learn the urgent warning signs for concern in pregnancy and post-pregnancy. You can also download and keep this card and conversation guide to help talk to your provider.
- Find resources that respect your culture and traditions, like the Hear Her Campaign for American Indian Alaskan Native (AIAN) people.
If you’re a healthcare provider or work for a healthcare system, hospital or clinic:
- Identify individual biases, advocate for and attend implicit bias training offered by your organization.
- Find ways to undo structural racism. Here’s one place to start .
- Listen to pregnant and postpartum women when they voice concerns.
- Help patients understand the urgent maternal warning signs and the need to get medical attention.
- Learn more about the causes of maternal death such as mental health issues and substance use disorder by attending perinatal mood and anxiety disorder training.
Educational resources
We can all educate ourselves about what is happening in the Pacific Northwest and nationwide to improve maternal health in our communities. Here are trusted sources of information.
Alaska:
Washington:
- Washington State Perinatal Collaborative
- Safe Deliveries Program at Washington State Hospital Association
- Maternal Mortality Report and Recommendations
- Blue Band Initiative to raise awareness of those people most at risk for preeclampsia
Oregon:
Other states and national:
Resources for pregnant and birthing people
The following resources and organizations offer support during pregnancy and after delivery. Your healthcare provider or doula may have suggestions, too.
Mental health:
Alaska:
- Alaska Department of Health offers a program to help pregnant people and babies before, during and after birth.
Oregon:
- Oregon Health Authority can connect you to prenatal care and other parenting resources.
- Oregon MothersCare offers help with prenatal care and other services.
Washington:
- Apple Health offers extended post pregnancy coverage.
- Clark County YWCA provides a safe place and support groups.
- First Clinic offers legal advocacy for parents with substance use disorder. It focuses on recovery from addiction and keeping families together.
- Perinatal Support Washington has support groups, online therapy and other new parent resources.
What’s next?
The communities most burdened by the maternal health crisis also have the experience and the cultural knowledge to lead solutions to reduce maternal deaths. We are working to build and strengthen relationships within these communities to continue the momentum.
Michele Kulhanek is an experienced labor and delivery nurse. She has worked both at the bedside and in leadership in a variety of settings, from a community hospital to a high-risk obstetrical academic medical center. Michele is responsible for creating, leading, implementing and achieving results to improve outcomes for pregnant and birthing persons. She is passionate about quality improvement in perinatal care, birthing people, newborns, families and the providers who care for them.
