Black mothers continue to die at a higher rate before, during, and after childbirth than any other ethnic group in the United States. Hundreds of soon-to-be and recent mothers in the United States die each year and 80 percent of those maternal-related deaths could have been prevented.
The Center for Disease Control reported in the fall that the maternal mortality rate for Black mothers increased in 2020 during the height of the coronavirus pandemic. Experts say lack of access to care, fear of not receiving proper care due to systemic racism, and comorbidities have contributed to the increase in maternal deaths. A litany of legislative decisions could change maternal health outcomes across the United States, but partisan politics remain at play. Amongst the urgency for change, midwives have stood out as the necessary resource to parents who want to feel seen, heard, and cared for during the birthing process and decreasing the overall risk of death—but there isn’t enough support for midwives in the communities that need them.
“The comorbidities are real,” said Pandora Hardtman, a certified and practicing midwife, and Chief nursing and midwifery officer for Jhipego, an affiliate of Johns Hopkins University.
Black women’s maternal mortality rate was 37.3 deaths for every 100,000 live births in 2018; 44 in 2019; and 55.3 in 2020. In contrast, white women’s mortality rates were 14.9 deaths for every 100,000 live births in 2018; 17.9 in 2019; and 19.1 in 2020. For Hispanic women the rates were 11.8 in 2018; 12.6 in 2019; and 18.2 in 2020.
Hardtman said that comorbidities like diabetes, preeclampsia, hypertension and mental illnesses have contributed to maternal mortality. The midwife said that now, as more stories are shared about the lack of cultural awareness and ongoing systemic racism within larger health systems, some soon-to-be mothers are fearful of seeking the care they need.
Finding care can be difficult, especially for those who live in rural areas. Hardtman said that there aren’t enough places for incoming midwives to receive proper in-person training, and overall access to midwifery care is centered in wealthy, predominantly white areas across the United States.
The Health Resources and Services Administration reported that just 13,409 nurse midwives and certified midwives were employed in the United States in 2021. The NCHWA reported that 10.3 million women lived in counties without obstetricians and that within the next eight years there will be a shortage of over 5,000 obstetricians nationwide.
Katy Maistros, a midwife in Cleveland, OH, said that when the birthing unit in neighboring Medina County closed, pregnant people didn’t have a place to go within their county to birth their babies. She said there aren’t enough midwives to serve the pregnant people in the area, and not enough Black and brown midwives to bridge the cultural gaps necessary to improve health outcomes.
Cuyahoga County, where Cleveland resides, has one of the highest infant mortality rates in the state with Black babies at risk of death 2.7 times higher than white babies. The state has not released a maternal mortality report since before the pandemic.
“The root cause is chronic stress and racism. Its dismissible, its implicit bias, it’s the attitude of the health system,” Maistros said. “And that’s coming from a white, 47-year-old woman.”
Maistros is the associate medical director of midwifery services at Neighborhood Family Practice Community Health Centers in Cleveland, OH. The practice has a partnership with the local hospital, five midwives on staff and a visiting obstetrician. The midwife said it has been difficult to find midwives of color who have finished their practicum and clinical requirements the last two years, as students were shut out of in-person programs during coronavirus.
The need for more ethnically and culturally diverse staff is proven within their client demographics. Maistros said that 35 percent of their patients don’t speak English. The practice uses philanthropic dollars to support transportation and translation services to communicate with patients who speak 11 different languages.
But more midwives won’t solve the issue if policies don’t also change, according to Maistros. The midwife said that socioeconomic factors weigh on women who don’t have access to maternal leave, who don’t have postpartum support, and are suffering mentally throughout the pregnancy process.
“Our country is abhorrent when it comes to post-partum and family leave laws,” she said. “I had a lady, who ironically was a health aide worker, leave on Nov 4th and asked me for a return-to-work order 10 days post-partum. She’s not even done bleeding. That’s really what’s killing women. We can’t afford to have a baby.”
However, the future may include further support from the government for midwifery services and to intentionally decrease rates of Black maternal mortality.
Democratic members of the Senate introduced a group of 12 bills to funnel $1.7 trillion in support for mothers and babies in predominantly Black communities. The package, or Black Maternal Health Momnibus Act of 2021, has 32 Senate sponsors and 188 in the House and is likely to be passed one-by-one or through smaller packages over time. The Momnibus Act would extend 24-month postpartum eligibility to Special Supplemental Nutrition Program and Women, Infants and Children program. It would force agencies to take action to grow and diversify the maternal health workforce, increase access to maternal care, increase research and data collection, and specifically improve maternal health among racial and ethnic minority groups.
“(Momnibus) It’s a really big deal and it is exciting,” said Erin Ryan.
At the state level, efforts to increase access are also changing. There are 27 states, including Ohio, who have increased Medicaid postpartum coverage to 12 months. There are seven more states who have proposed the extension but not yet adopted the plan.
Ryan, a midwife and global health consultant, said the investment needs to support Black mothers and Black midwives to make a difference.
“We need to be clear that it is Black women who are dying,” Erin Ryan said. “And that native women are dying.”
Advocates say the package is one small step in the direction of supporting maternal health in the United States that will take years to implement and see change.
Last summer the U.S. Supreme Court overturned Roe v. Wade, outlawing abortions at the federal level. Abortion advocates say that’s likely to increase the risk of maternal and infant deaths. Just five states used the midterm election to protect a women’s right to choice within specific time constraints of conception: California, Vermont, Michigan, Kentucky, and Montana.
“It’s not helpful to have 200,000 midwives and put them in areas of wealth with good insurance,” Ryan said. “Another factor that is going to come up in the next couple of years are restrictions on abortion and abortion bans (because of) pregnancies that have to be carried to term that are higher risk. It is going to affect anyone with of a lower socioeconomic threshold who can’t go where they need to go to receive the care that they need.”
This post was originally published on Direct Relief.