Midwife Continues to Deliver Quality Maternal Care

By Malena Amusa

WeNews correspondent

Internationally renowned midwife Jennie Joseph 

cradles the baby of one of her satisfied patients.

Credit: Jennie Joseph.

When you mention the rising rates of maternal deaths in America to an active doula or midwife, get ready for the unvarnished truth.

“This is a national health crisis that too many people are ignoring,” said Miriam Perez, a New York Based- doula, activist, and founder of the Radical Doula blog.  “Not enough people know that black women are four times more likely to die during pregnancy than white women. Other women of color have higher rates as well.”

Perez thinks it's time to shake things up. “There’s greater attention to the problem of maternal mortality,” she said. “But I don’t know if the solutions are greater. We definitely need new models.”

In 2009, there were 16.1 maternal deaths for every 100,000 live births, according to unpublished data provided by the Health Resources and Services Administration - -that’s up from 12.7 in 2007. At a time when dozens of countries are decreasing their rates, conditions are worsening in America. In New York City where Perez is based, there were 69.3 black maternal deaths per 100,000 live births in 2009, the city’s vital statistics revealed. Although America spends more on health care than any another nation, being black and pregnant in New York City spells greater risks than being pregnant in Costa Rica, Iraq, or Kazakhstan. Nationally black women continue to be at a higher risk of maternal mortality and that’s despite the mother’s income or education-level. 

Perez said the hospital it not always a safe zone for mothers.  Maternity ward doctors may not treat patients in a holistic manner and insurance companies are reluctant to pay for midwives and doulas.

In Winter Garden, Fla., outside Orlando, Jennie Joseph runs a community-based midwifery clinic called the Easy Access Prenatal Care Clinic. A one-day free clinic occurring every week, this service provides a vision of how different things could be.

It caters to low-income women regardless if they can pay or not. The Easy Access clinic is funded by Joseph’s midwife practice The Birth Place -- and takes care of any woman who walks through the door.

“If you’re pregnant we’ll take care of you," said Joseph, a pioneering midwife. "We’ll get you maternal care and educational info, examine your belly and listen to the baby’s  [JJ1] heart beat. If you need a proof of pregnancy or the fax number for a birth certificate – it can be financial, medical, or social, we cover all these angles.”

These components make up “The JJ Way” which in a 2006 study of 100 women in the Easy Access program was correlated to dramatically reduced rates of pre-term births and infant morbidity.  The JJ Way Maternal Child Health Care System is specifically designed to address the perinatal health woes experienced by African American pregnant women and their infants – and has been recognized nationally as a best practice for maternal and child health. In 2010, Joseph opened her own school called the Commonsense Childbirth School of Midwifery in January 2010. The following year, Joseph’s work was featured in super model’s Christy Turlington Burns’ documentary “No Woman, No Cry,” which examined global pregnancy issues and aired on the The Oprah Winfrey Network.

“One woman came in for her first visit and her blood pressure was 210 over 110," Joseph said, explaining one patient’s struggle. "She was 21, already had two children, and was pregnant.

“That same morning we referred her to the hospital, which gave her medicine and sent her home. She had no insurance. So when she went for a follow-up visit and her blood pressure was still high, the hospital told her to see her Ob-Gyn tomorrow, but she didn’t have an Ob-Gyn because she had no Medicaid. With no one to fill that gap, she came back to me because she could. With our lab work and records, we were able to send her to a perinatologist who accepted her without insurance. Later, her Medicaid kicked in, and her blood pressure went down after getting the right kind of medicine.”

The opportunity for this highly-accessible, resources-driven, and midwife-assisted care to help women is tremendous.  Women who participated in Joseph’s internal study tracking infant outcomes lauded the clinic’s for being “really nice and personable”, “very informative” and helping women “make your own experiences.” “[I] wish there were 100 Jennie’s”, one mother reported. 

It’s not certain if this level of care will be replicated in hospitals and clinics across America, but as time goes on, it’s evident that The JJ Way is needed for mothers and their babies.

“Our health care is so compartmentalized,” Perez said. “You go to this provider for this problem and another for that problem. Providers don't have the time and framework to treat patients in a holistic manner. But you really need a provider who can see the big picture of your life. And that’s where midwifery comes in. It brings the holistic perspective to your care and is patient- centered. The patient’s needs and community are the center of it.”

Malena Amusa is a freelance reporter based in St. Louis.


To see the Malena Amusa's full story go to:  http://womensenews.org/story/reproductive-health/120729/us-health-law-may-curb-rising-maternal-deaths

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 [JJ1]…and here, may ‘listen to the baby’s….’ or ‘hear the baby’s heart beat’

Battling the Bulge from Birth

This is the time of year when everyone is thinking about eating lots of good food with family. Then in a few weeks, we will all make new and not-to-be kept resolutions about losing the weight gained by eating those same meals and many others throughout the past year.

But to really battle the bulge, not just for ourselves but for our children, we have to start early, avoid empty promises and face the facts.

Now, for the most part we black women love our curves and really have no use for the latest crash diets. The way we walk, talk, and dress says "I am bold and beautiful, love it or leave it!" But at as fabulous as we think we are, obesity is still a prominent issue in the black community.

I have heard every excuse from "My family is big- boned" to "queen- sized" and my favorite "That just means there's more of me to love!" And, while these statements and mantras seem to scream I am confident and love my body, we need to address why statistics show that six out of every ten African American women are overweight and four out of every ten is morbidly obese. There is a huge difference between having a little belly or being a little hippy and packing on 30 to 100 extra pounds or more. 50 percent of African-American women are obese compared to only 40 percent of Mexican-American women and only 30 percent of White women.

While we already know that the high rates of obesity in our community is linked to the prevalence of diseases such as heart disease, diabetes, high blood pressure, stroke, arthritis and cancer. We don't see too many people addressing prevention strategies for all of these diseases that start at birth. If we really want to curb the obesity epidemic in our community we have to start well before childhood. We can start as soon as the baby is born.

Breast-feeding helps us lose the weight we gained during pregnancy and has many other health benefits for us too.

Breastfeeding is proven to reduce your baby's chance of being obese. The breastfeeding-obesity link is now recognized by key government agencies and professional groups, Including the U.S. Centers for Disease Control and Prevention and the American Academy of Pediatrics. Experts at the CDC in Atlanta estimate that 15 percent to 20 percent of obesity could be prevented through breastfeeding. Here are some of the reasons why:

• Breastfed infants may be better at self-regulating their intake. Mothers cannot see how much milk their child is drinking, so they must rely on their infant's behavior, not an empty bottle, to signal when their infant is full. Thus, breastfed babies might be better able to eat only as much as they need.
  
  
• Breastfed infants are more likely than formula-fed infants to try and accept new foods. Acceptance of new foods is important because a healthy diet should include a wide variety of foods, especially fruits and vegetables. Because breast milk contains flavors from foods eaten by mothers, breastfed infants are exposed to a variety of tastes early in life. In contrast, artificial baby milk (formula) always tastes the same.
  
  
• Breastfeeding has different effects than formula feeding on infant's metabolism and hormones such as insulin, which tells the body to store fat. Formula-fed infants tend to be fatter than breastfed infants at 12 months of age.
  
  
• For us to make a real impact on obesity in our community, we have to start at birth. It's really that simple. Resolving to breastfeed more and support any breastfeeding mother you know, is a real resolution for change.

Talking Midwives in Midtown: an Aha! Moment

Yesterday, I met an old friend for breakfast. We met at Norma's in Le Parker Meridien hotel. As we noshed on a delicious breakfast, pondered who has actually ordered the $1,000 caviar breakfast item, we had a ground shaking conversation about the role of midwives in changing the landscape for maternal health.

My fellow diner was my good friend Shirley McAlpine, a beautifully statuesque British woman. She became my friend when I lived in London and is now doing some amazing work in the U.K and U.S. about prenatal education and natural childbirth through her popular Birthwise DVD http://birthwisedvd.com/us/ and consulting work. The tagline for Birthwise is "Your Creation. Your Choice." I love that.

Shirley had just returned from the Midwives Alliance of North American conference in the Nashville, Tenn., area and she was buzzing. Her energy was infectious. And while we are both involved with maternal health issues across the board, as two black women we are also particularly concerned about the issues in our community. So the questions began to roll. Could midwives be key to helping reduce the high pre-term birth and low birth-weight baby rate that continue to plague black women of all socioeconomic levels? Could midwives help reverse the high exceptionally C-section rates among black women and reduce the shamefully rising maternal mortality rates among black women?

Shirley and I are convinced, yes. And birth center models like The Birth Place, http://thebirthplace.org an unique midwifery and women's health center in Winter Garden, Florida run by Jenni Joseph, show impressive results in reducing pre –term births.

But, why? The answer, as it unfolded before us, was in the education that midwives provide. Expecting moms who work with midwives are more informed about the birth process than women who work with doctors only. We all know that most doctors prefer that you know less, and trust them more, so that they can do what works best for them and not deal with any pesky little questions about your own life that you may have.

After all knowledge is power.

So when a woman who has had a midwife is told she needs to be induced. She knows she can ask why, if the baby's heart rate is fine and other measures she's been educated on are still ok.

When a woman whose water has broken is told that she must be induced, a woman with a midwife may have been taught that actually unless other indicators show otherwise a baby can be fine for up to 24 hours after the water breaks. It is Hollywood that has told us otherwise, and turned the water breaking into the mad dash to the hospital event that makes for great cinema but woefully misinformed moms to be.

And when a woman has a true (not Hollywood or doctor-friendly) understanding of how long the labor process can be, she won't stand for being told that a C section is necessary because it's been five hours and she hasn't dilated. She will also have been educated on the real signs of labor, so she won't go the hospital too soon where labor can be stunted by laying in a bed and you are more likely to be given unnecessary medical interventions.

These are key pieces to the puzzle. As we know, the answer is not in the prenatal care. Women are getting that. But that hasn't improved matters. The key is in the education--an education that often does not happen in its full measure at a traditional doctor's office. And that midwives can provide.

And that nuanced understanding of how black women end up on the operating table more and remain six times more likely to die from pregnancy-related complication is worth more the $1,000 caviar.

Breastfeeding On My Time

By Tangela Walker-Craft
WeNews guest blogger

I decided to breastfeed my daughter until she was 2 years old. I was the first person in my family to practice what is called extended breastfeeding since the introduction of baby formula.

I thought this was a personal decision, between me and my husband and my child, but boy was I wrong.

I taught her a few baby signs by the time she was about 9 months old, so she knew how to tell me when she wanted to be nursed. During the first year she was exclusively breastfed. By the second year she had a diet consisting of breast milk and toddler appropriate foods. During her second year, she breastfed less than the year before.

Unfortunately, unwanted and unwelcomed advice on when I should wean her came from everywhere. People that have never breastfed a day in their lives will offer their advice about when's the best time to wean YOUR baby. Even people that have never had a child will somehow know when you've breastfed long enough. Unbelievable!

If you resist their unsolicited advice, people may even switch from asking when you plan to wean to trying to scare you into weaning.

You'll likely hear, "If you don't wean her soon, you won't be able to do it." You may even get the, "She's going to start biting you when she gets teeth," threat. It's funny how most people accept that a baby will start to walk when he or she is ready, and talk when he or she is ready, but they think that there is a magic age when all babies should stop being breastfed.

Once threats don't manage to scare you into submission, the attempts to shame you into weaning may begin. You'll get the loaded, "You STILL breastfeeding that child? How old is she?"

Family members and people that feel that they can will make snide remarks about how your
child might be driving, married, or doing something else that's totally ridiculous before you wean him or her.

Things were particularly challenging because breastfeeding, especially extended breastfeeding, is not necessarily encouraged in Black families.

Like many breastfed babies, my daughter lacked the "baby bloat" that frequently occurs in formula fed babies. My well-meaning grandmother asked me dozens of times if I was sure my baby was getting enough to eat. She'd ask me, "Are you sure you're making enough milk?"

She and other members of my family refused to believe that my baby could survive on just breast milk. I was constantly guarding against my family's threats to give my daughter "real food". formula.

After breastfeeding six children of her own out of necessity, my 85-year-old grandmother seemed to view my decision to voluntarily breast feed as something out-dated or odd.

I think that moms that do not practice extended breastfeeding sometimes secretly resent moms that do. There is a competitive spirit that makes women want other women to make the same child care decisions that they've made. Women that do not, or did not practice extended breastfeeding, may feel that moms that do are judging them for their choice.

Contrary to the warnings, weaning for me was easy. Taking natural cues from my daughter during that second year, I breast fed less and less during the day time. Breastfeeding became more of a bonding and comfort activity for us at night. When I sensed that she was ready, I began telling her that mommy wouldn't have any more milk soon. My breast naturally responded by producing less milk because of the less frequent feedings.

My daughter's nursing slowed down to a few minutes only at bed time.

Over a three day period I cut the feedings down to quick bouts, which culminated in the end of what was one of the best experiences of my life. I am glad I never succumbed to the pressure to wean before we were ready, but it bothers me that such pressure exists.

Why are we so uncomfortable with extended breastfeeding?

Tanglela Walker-Craft is the creator of Go Pillow! a patented, multipurpose childcare item that allows moms hands-free breastfeeding with comfort and president of Simply Necessary Inc. After nursing her own daughter for two years, Walker-Craft, realized that there was not a product on the market that allowed mothers to have nursing privacy and cradling comfort when others were present. Existing nursing pillows were too bulky and cumbersome for travel and cover-ups on the market required too much manipulation. The GoPillow! satisfies the needs of both breast feeding and bottle feeding mothers and caregivers.


Learn more at:
http://www.simplynecessary.com/

-- Kimberly Seals Allers is on vacation this week. --

Intensely aware of what health care advocates gently refer to as "health disparities," members of state coalitions meeting over the weekend confessed that they were struggling to find a best strategy to promote breastfeeding among African-American mothers.

Studies to date indicate that African American mothers are least likely to breastfeed--even though they are more at risk for breast cancer, obesity and high blood pressure. In addition, they are more likely to give birth early and breast milk can literally save the lives of preemies in a way formula does not.

As more than 300 breastfeeding activists--physicians, nurses, lactation consultants, and health activists-- gathered in Arlington, Va. to expand the support for breastfeeding in hospitals, families, law and workplaces, the toughest question was how can we be more successful with African American mothers and mothers-to-be?

http://www.usbreastfeeding.org/

Part of my work at the conference was to discuss at a breakfast table how Women's eNews is changing the media narrative about African maternal and infant health. I talked about Women's eNews'Black Maternal Health project and the value of shifting breastfeeding news focused on babies to the lives of the mothers, particularly black mothers.

http://www.womensenews.org/story/090922/black-maternal-health-legacy-and-future

Black moms are three-to six times more likely to die during pregnancy and during the post-partum weeks and thus they are the face of our country's most acute maternal health problems. If the United States can mend poor health outcomes among black women and their infants, certainly the entire health care system will benefit.

But confronting the reality of black maternal health and breastfeeding at the conference is not so easy.

"Nooo," said Lorine Bizzell, a regional nutritionist with the United States Department of Agriculture, in Atlanta. That was her response when I asked for her input on the fact that that college-educated black women breastfeed less than low-income moms, teen moms, and moms with only 12 years of schooling.

http://www.womensenews.org/story/black-maternal-health/090922/breastfeeding-not-you-sisters-listen

"That's hard to believe. Young black career women that I know are all nursing their children under a variety of challenging circumstances."

Laura Sinai is a North Carolina-based pediatrician. She works in a private practice outside Charlotte and a third of her clients are black. Talking to black mothers about breastfeeding has been difficult. "They just say, 'You don't know my life. I will not breastfeed.'"

Melissa Bartick, a physician with the Massachusetts Breastfeeding Coalition, spearheads efforts for hospitals in the state to become Baby Friendly, an award given for prioritizing breastfeeding in maternity wards and backed by the World Health Organization.

After I asked Bartick how she's targeting black mothers, she took a deep breath and said: "Yes, there are disparities. They do exist."

"Where do I find black women who want to be lactation consultants?" said Anna Uttar, the regional director of the International Board of Lactation Consultant Examiners in Falls Church, Virginia. "They are not coming out to get trained."

As the conference was coming to an end, I was starting to worry that the question of how to increase breastfeeding among black mothers was left hanging, like a great news story unpublished.

Right as I gathered my bags and headed out the conference hall, Napiera Loveless approached me.

She is co-founder of MamaTotoMatema, a Cincinnati agency urging breastfeeding among African-American families. We got to talking and laughing and sharing how we wished the conference had a dance party.

http://www.mamatotomatema.com/

Loveless told me about how she reports to black women and activates their interest. Immediately I realized she should have been a keynote speaker; she was a guru of connecting ideas to messages, to challenges.

When talking to low-income black women, Loveless appeals to fashion. Many young black women like the bling, she said. The shiny things. The nice clothes. "I tell some mothers, 'You know how you like your Dereon jeans and Gucci? Well breast milk is the name-brand jeans. Formula is the rip-off!'"

When talking to upper-income black women, Loveless said that family support systems may be lacking. Many families look to a high-earning black woman for financial and emotional support, so a lot is riding on her shoulders.

"I want to find out who their support system is," she said. "It might be her best friend or her co-worker. Can your co-worker help you on the job? Watch your work while you get a chance to pump?"

She said her strategy is gaining effect in Ohio.

As I left the Third National Conference of State/Territory/Tribal Breastfeeding Coalitions, my heart was warmed by Loveless, and the many leaders talking about black maternal health. My mind was racing.

There is always a way to get through.

Malena Amusa is a reporter living in New York City.

We Need Our Village Back

For some time now, I've been lamenting the demise of our "village."

When our parents grew up the whole neighborhood helped raise them (and probably had spanking privileges). And when I grew up you could best believe that any neighbor would quickly tell my mother or father if I was ever seen someplace I wasn't supposed to be. There was an "we're all in this together" mentality and a thinking that my child is my responsibility and your child is my responsibility because at the end of the day, we are all in this community together and one success is our collective success and one failure is our collective failure and affects us all.

Somewhere along the way, we lost this village mentality. The changing economic climate has dictated that we move away from relatives or that we move often because of job opportunities. As a result, we never really grow roots in our communities anymore. We don't have our extended family of aunties, uncles and grandparents nearby anymore.

This week Women's eNews hosted a screening of Tonya Lewis Lee's powerful documentary on reducing infant mortality and improving maternal health, in celebration of the second year of The Black Maternal Health Project. It was a full house. The film, Crisis in the Crib--Saving Our Nation's Babies (view the trailer here) speaks directly to preconception health, mobilizing young people as peer educators in the movement and putting a face and voice to the infant mortality issue. The conversation afterward with Tonya and our fabulous guests was even more empowering.

We couldn't understand while infant mortality remains a taboo topic in our country's agenda. Even when you remove African American statistics from the equation, the United States still had an embarrassing ranking as far as infant mortality is concerned. We couldn't understand why maternal health is absent from the current debate about healthcare reform. And we certainly couldn't understand why very little is being done to save our most vulnerable population. There was so much that didn't make sense.

But here's what was crystal clear. We can't wait for the government to solve this crisis. Yes, we have to push for laws. But we also have to advocate in our communities to remove some of the social barriers to our health issues. We need to advocate for safe places to exercise, removing toxins from our communities, having fresh fruit and vegetables available in our communities and more.

It was clear that we need our village of womenfolk. And then some.

In Crisis in the Crib, the 'Healthy Baby Begins With You' Campaign,  takes on a peer education model. It uses college students to go into their own communities and also speak to high school students about preconception health. It goes back to that "village" mentality.

That night of the screening we deployed our own village, a room full of women of all races with personal and professional interests in embracing mothers and producing healthy babies. We thought of ways we could let our own network know about the OMH campaign, spread more awareness about the problem, or help be a part of the solution.

We saw the powerful ripple effect that could be sparked just from those in the room doing one thing. For that evening, we brought our village back. And it felt oh so good.

What can you do to help bring our village back to our babies? What more can we be doing? I'd love to hear from you. Please post a comment here.

Folic Acid and You—What Every Woman of Color Needs to Know

It’s the New Year! And who knows what 2010 will bring. According to recent stats approximately 50 percent of women aged 15-44 have at least one unplanned pregnancy in their lives. That means a good number of us may have an surprise in 2010.

 

That also means every woman of childbearing age, should be thinking about their health all day, every day. That’s why I wanted to tell you that this week, January 4-10^th, is Folic Acid Awareness Week. Sponsored by the National Council on Folic Acid (NCFA) http://www.folicacidinfo.org/pages/folicacid_info.php, the week is intended to educate all women about folic acid. If taken before and during early pregnancy from a multi-vitamin or fortified foods, folic acid can prevent from 50 percent to 70 percent of some forms of serious birth defects of the brain and spine, called neural tube defects (NTD).

 

Getting the right amount of folic acid is particularly important to Black and Latina women. Not only do Latinas have higher rates of NTD-affected pregnancies, they also have the lowest awareness about folic acid than women of other ethnic groups, and lower consumption of folic acid than white non-Hispanic women, according to recent studies.

 

In addition to preventing NTDs, increased folic acid has been linked to preventing preeclampsia, a form of severe high blood pressure that usually occurs after 37 weeks of pregnancy. The potentially fatal condition is more common in black women. Studies indicate that when black women have preeclampsia they tend to have a severe form of the disorder and experience it as early as six months in the pregnancy compared to the typical ninth month. 

 

Doctors have not yet pinpointed exactly why this disparity exists, however, one study found that black women had less folic acid and more of a certain amino acid than white women as a pre-existing condition, which put them at a higher risk during pregnancy. The findings suggest that black women take more folic acid before and during pregnancy and as early as possible. (http://www.msnbc.msn.com/id/4781703 )

 

The easiest way to make sure you’re getting enough folic acid all the time is by taking a multi-vitamin, B vitamin complex pill or folic acid pill and eating fortified foods like grains, pastas or breakfast cereals. Folate is found naturally in foods such as leafy green vegetables, beans, liver and some fruit. But for some reason, scientists have found that folic acid, the synthetic version of folate, is actually easier for your body to absorb than folate.

 

Even if you don’t have a planned or unplanned pregnancy in the cards, folic acid is pretty important to your healthy living. Studies show that folic acid reduces the risk of certain cancers; cardiovascular diseases including coronary heart disease and stroke; and cognitive diseases or mental conditions such as Alzheimer's disease, age-related dementia or cognitive decline and depression. We can all use that.