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In 2009, there were 16.1 maternal deaths for every 100,000 live births, according to unpublished data provided by the Health Resources and Services Administration - -that’s up from 12.7 in 2007.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’

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.

SisterSpace: I Will Not Write a Blog for Infant Mortality Awareness Month

This is not a blog for infant mortality awareness month. Something so weighty deserves more than to be relegated to web log. I will not make any witty observations. I will not use any metaphors, similes, idioms, or analogies. There will be no alliteration or onomatopoeia used to help you get it.

There will be no opinions, only facts. The jarring sort that aren't typically welcome in a blog. This will not be entertaining. You will probably not "Like" this.

This is my virtual moment of silence for the babies who needlessly die every year. This is my silent cry in the blogosphere for greater awareness in the African American community where our babies are 2.3 more likely to die before their first birthday than in the white community. This risk exists for all black women regardless of income or education.

This is my anti-blog for the unborn who deserve to live to see their first birthday and my homage to those who didn't.

• Currently, the national infant mortality rate for Black babies is 13.7 per 1,000, compared to a rate of 5.6 per 1000 for White babies, 3.5 per 1000 for Asian babies, and 5.3 to 6 per 1000 for Latino babies.




• Black babies are four times as likely to die as infants due to complications related to low birth weight as compared to non-Hispanic white infants.




• African Americans have 2.3 times the infant mortality rate as non-Hispanic whites.




• African Americans had 1.8 times the sudden infant death syndrome mortality rate as non-Hispanic whites.




• College- and graduate-school educated black mothers have a higher infant mortality rate than white moms who didn't finish high school.




• The infant mortality rate for African American mothers with over 13 years of education was almost three times that of non-Hispanic white mothers.




• Black women who get prenatal care in the first trimester have double the infant mortality rate of white mothers with first-trimester care.




• Only 17 percent of all U.S. births were to African-American families, but 33 percent of all low-birth weight babies were African-American, according to one report.




• Black women with similar levels of prenatal care as Hispanic women (generally less educated and with lower incomes than blacks) have higher rates of low birth weight, preterm deliveries, and infant mortality.




• According to Dr. Michael Lu, assistant professor of obstetrics and gynecology and public health at UCLA, researchers have found that even when they control for such varied factors as poverty, housing, employment, medical risk, abuse, social support and so on, 90 percent of the differences in birth weight between black and white moms remains unaccounted for.

"Most studies have looked at black-white differences during pregnancy, for example, differences in prenatal care utilization or maternal behavior," he says. "What we're finding is that these differences really explain very little of the disparities in birth outcomes."

Black women are dying! Enough scaremongering, it's time for solutions!

Lately, I've been extremely frustrated by all the news reporting about maternal mortality. Yes, it is a terribly frightening and frighteningly embarrassing issue. Women are dying during childbirth for preventable reasons, and African American women at even more shocking rates and something must be done. Like now.

A recent study by Amnesty International, entitled "Deadly Delivery", reports that deaths from pregnancy and childbirth in the United States have doubled in the past 20 years--from 6.6 per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006. Pregnant women and new mothers are dying because of "systemic failures" in the current health system, the Amnesty report said.

The alarming data on maternal mortality is even more shocking for African- American women. We are three to four times more likely to die during childbirth than white American women. And even wealthy black American women have a higher rate of mortality during childbirth than wealthy white women.

Yeah. It's serious.

Now I understand the power of fear as a coercive tool in the media world and in political circles, but my personal fear is that all the negative reports and doom and gloom coverage makes the situation seem hopeless. It makes women, particularly Black women, feel powerless to a force that no one can succinctly explain or otherwise tell them how to prevent.

People don't get behind hopeless. Research money doesn't come to hopeless. And the right kind of awareness that actually empowers women to have healthy childbirths and live healthier lives overall doesn't come from hopeless. It comes from hope.

That's why I'm so excited about the work of Dr. Michael Lu, an associate professor in both the UCLA School of Public Health and the David Geffen School of Medicine at UCLA, and one of the influential thought leaders who's talking about new solutions to the maternal health problem. It's pretty clear the old ones aren't working.

Dr. Lu's work focuses on the "life course perspective," a simple yet groundbreaking premise that rests on one simple truth: you cannot correct the outcomes of childbirth simply by looking at the 40 week gestational period. Saying that black women need better prenatal care is a start but not the complete answer. We need a longer term "life course perspective" to address the issue, which includes rethinking how healthcare is delivered, how we look at life stressors and how we get back to focusing on mothers and communities.

I've been a fan of Dr. Lu for some time. In fact, his work was one of the research inspirations for writing my first book, The Mocha Manual to a Fabulous Pregnancy (Amistad/HarperCollins). At the time, it was the first-of-its-kind book for African American women that looked beyond the nine months of pregnancy to offer advice on all areas of life that could affect a woman's pregnancy outcome from her finances, relationships, life stressors, cultural taboos and her medical history. It was the "all you" approach to pregnancy for black women, and I'm grateful to Dr. Lu's work for inspiring me to develop that concept.

I'm also very grateful and excited that Dr. Lu will be speaking this week at our Black Maternal Health conference and sharing his insights and answering your questions on what we need to do now to close the gap in maternal and infant health disparities for African American women.

Please join us on April 28th at our NYC offices at 12:30 p.m.(simply rsvp with your name and affiliation to rosemary@womensenews.org) or click here http://www.ustream.tv/channel/wenews to watch live via our webcast.

We've read the depressing headlines. It's time we start talking about solutions. Please be a part of the conversation.