Editor’s note: This story was first published by East Bay Times on August 21, 2021 and written by Claudia Boyd-Barrett.
Krista Hayes, 32, of Oakland was delighted when she found out she and her husband were pregnant with their first child together. But she was also scared.
She’d seen statistics showing that, as a Black woman in America, she was far more likely to die in childbirth, suffer labor complications or have a preterm baby than other women. She feared entrusting the momentous process of having a baby to a medical system that she felt had often treated her, her family members, and other Black people she knew with indifference and contempt.
“There has always been bias. Whether you talk about it or not, you feel it,” said Hayes. “As a Black person you move differently and you’re treated differently.”
So when an OB-GYN at Highland Hospital in Oakland suggested Hayes join a new county prenatal care program designed specifically for Black pregnant women, the expectant mom was intrigued. As a program participant, she’d attend regular group prenatal education sessions and get individual support from an all-Black health care team, including midwives, a lactation consultant, a doula, and a family resource specialist. The goal of the program, called BElovedBIRTH Black Centering, was to counter precisely the problems Hayes worried about.
The program, said Hayes, “sounded amazing.”
Research shows Hayes’ experience with medical care is not atypical. Black women are far more likely to report experiencing discrimination within the healthcare system than white women. And studies point to racism or unconscious bias in medical care as a key explanation for why Black women and infants fare so poorly compared to their White counterparts.
Calls for society to do more to address the high rates of death and disease among Black pregnant women and infants have been building for years at the local, state and federal levels. The issue took on new vigor last year in the wake of protests drawing attention to systemic racism.
In California, where African American women are more than three times as likely as White women to die from pregnancy-related causes, the state has created the California Perinatal Equity Initiative, which gives funds to 11 counties – including Alameda, San Francisco, Contra Costa and Santa Clara — to implement pilot programs aimed at reducing Black infant mortality.
The state also passed legislation in 2019 requiring anti-bias training for perinatal care providers. And California’s new fiscal-year budget includes expanded postpartum coverage and doula services for pregnant women insured under Medi-Cal, the state’s health insurance program for low-income residents — moves expected to help reduce maternal and infant health disparities.
Five Bay Area counties — Alameda, Contra Costa, San Francisco, Santa Clara and Solano – launched a regional campaign this summer called #DeliverBirthJustice (DeliverBirthJustice.org), to build public awareness around racism’s impact on Black infants and pregnant women.
At the federal level, Democrats are seeking passage of the Black Maternal Health Momnibus Act, a package of 12 bills that provides, among other things, money for improved data collection and investment in diversifying the perinatal workforce.
In Alameda County, where more than 1 in 10 county residents are Black – the largest percentage in the state — BElovedBIRTH has emerged as a pioneering model for advancing reproductive health and racial justice.
Led by Jyesha Wren, an energetic young midwife based in East Oakland, the program brings together medical practitioners from the Alameda Health System’s Department of Obstetrics, Midwifery and Gynecology, and social service workers from the Alameda County Public Health Department. It’s based on a national program created by the Boston-based Centering Healthcare Institute that’s proven to lower preterm birth rates, reduce health care costs, and increase patients’ satisfaction with prenatal care.
Wren and her team have tailored the course content, including photos, videos and cultural references, specifically to African American women, placing their concerns, experiences, history, culture and needs front and center. From the first session, BElovedBIRTH facilitators lead group discussions and activities that explore how racism impacts Black people’s health.
For example, if a woman does not feel comfortable with a proposed procedure, such as a labor induction or episiotomy, she’s encouraged to ask why it’s being recommended and if there are options. Later sessions examine topics such as healthy eating that includes traditionally Black foods, and discussions about the reasons for low rates of breastfeeding among Black mothers, and how to overcome those barriers.
“We are unapologetically Black,” said Wren. Having information that “relates to your story, your history, your people, really allows people to use it better.”
BElovedBirth groups eight to 12 women with similar due dates, and they receive prenatal care together once or twice a month depending on how close they are to giving birth (they also get individual time with a midwife during the group class). The sessions last 2 hours, much longer than a typical prenatal visit with an Ob-gyn, meaning the women have more time to learn about pregnancy, ask questions and discuss concerns, as well as build trust with the providers.
Beyond the classes, participants receive referrals to social services, mental health care, and other support as needed. They get gift bags filled with herbal wellness products such as belly balms, produce boxes delivered to their homes, a free pregnancy photoshoot, access to a Black doula during labor, and delivered postpartum restaurant meals. Wren calls it a “gold package of Black love.”
“It’s above and beyond anything that’s been done in perinatal care before,” Wren said. “Our vision is to create a world where Black people have all the support, the loving care and the resources needed to have happy, healthy and safe pregnancies, births and postpartum recoveries, free from obstetric racism.”
The program, which involves a total of 15 sessions over about eight months, launched in October 2020, despite the pandemic, and is now on its sixth group. Three of the sessions occur after participants give birth, so they have a chance to discuss their birth stories, receive breastfeeding support, and get help with any postpartum concerns. Until now, all sessions have been online (participants receive a tablet and free Internet for a year to access the program). However, the county plans to transition to in-person classes soon.
Tia Lindsey, 27, of Oakland remembers the relief she felt when she logged on to her first class and saw other Black faces pop up on the screen. She’d left a previous prenatal care appointment at a clinic in tears because she felt disregarded by the staff there. At BElovedBIRTH, there was instant warmth and connection, she said. Participants tracked their blood pressure and babies’ growth together and had candid conversations “Black woman to Black woman” about health concerns, bodily changes, relationships, even fears about raising a child in a country where people of color are more likely to be killed by police.
“It was just like a sisterhood situation, and then on top of that you have (medical professionals) who can really tell you what’s going on with your pregnancy,” she said. “I just felt very seen and understood and heard.”
That sense of community carried over to the hospital, where Lindsey and another woman from the group went into labor at the same time. During a four-day labor ordeal, Lindsey texted back and forth with her and other course participants. Their supportive words, and a visit from one of the program midwives, helped her get through the experience, she said.
For Krista Hayes, BElovedBIRTH helped counter the isolation she felt because of the pandemic, and her husband’s demanding work schedule and no parental leave. It also made giving birth less stressful, she said. When a nurse started preparing her for induction, even though she wanted a natural birth, Hayes felt confident demanding an explanation.
After her baby, Noa, was born, Hayes became one of the first people in her family to breastfeed, thanks to the lactation support she received. She also got diapers and baby clothes through the program, which helped her family financially, she said.
“I had so much good that happened — the support I had, the things I needed for my baby,” she said.
The only negative, Hayes said, is that now she’s finished the program and has to return to the regular primary care system. Wren said next steps for the program include figuring out how to refer participants to Black providers once they leave, although this is challenging due to a shortage of Black doctors.
Angie Trousdale, chief executive officer of the Centering Healthcare Institute in Boston, called Alameda County’s adaptation of the program “remarkable.” She said it could offer lessons to other counties and health care sites interested in tailoring the model to Black communities.
“What BElovedBIRTH has done is really zero in on what their community needs,” she said.
Wren too hopes other counties and states will eventually want to adopt the program. Her team is working on creating new materials, including educational imagery featuring Black women, cooking and exercise classes, documentaries, an inspirational coloring book, and a swag shop.
“BelovedBirth exists as an example of what can be,” she said. “We think it will only grow.”
Claudia Boyd-Barrett reports for the Center for Health Reporting at USC’s Schaeffer Center for Health Policy and Economics. This project was supported by a grant from First 5 LA.