/Inform[H]er Roundup Maternal Mortality — what’s working

Inform[H]er Roundup Maternal Mortality — what’s working

A new grant of $295,000 for Magnolia Medical Foundation over three years from W.K. The Kellogg Foundation will match five doulas to 10 mothers over 21 months. This grant, which is $295,000 in three years, will go to Magnolia Medical Foundation from W.K. It aims at improving birth outcomes and strengthening doula capacity throughout the city and possibly the state. The plan is two-fold: support pregnant women and doulas. Start a doula registry. Doulas and breastfeeding have been proven to increase the health of African American mothers as well as their babies. Black women are three to four times more likely than white women to die from complications related to birth. In addition, African American infant mortality rates are the highest. This project will reduce these terrible statistics through a comprehensive strategy that is evidence-based.” – Dr. Erica Thompson (Executive Director of Magnolia Medical Foundation) “We want to create some stability, structure, and possibly upward mobility,” Burse said. Thompson has been a long-standing partner in addressing maternal mortality risk factors in the state. We hope to either help doulas become more collaborative or to build the infrastructure necessary to make that happen. Doulas work part-time and have other jobs. So, it’s a competing interest. You want to do birth work and help women. But you also need to have an income. The new program also focuses on education and support for moms, as well as the community. It’s difficult to function in a system that isn’t designed for you. She asked how we can create parallel systems that help women navigate pregnancy, bodily autonomy, and still understand how to navigate the larger system that sometimes doesn’t work for them. Burse is uniquely positioned to help this mission move forward. Her company is focused on community-based strategies, communications, and solutions in public health. Her career has been built on the foundation of such a program. She facilitates candid maternal health discussions and then implements public health strategies across the community to achieve change. Burse said that this moment offers an opportunity to change. It’s a perfect storm for data and empowerment. I believe that part of it is the infant and maternal mortality numbers. Liberation is another aspect of it. People want bodily autonomy and autonomy. They want to be able to make the decisions for themselves and their children.” she states. “We don’t always have that kind of support so having someone like a doula to help you is really important to make sure that your decision to give birth is made in a safe and comfortable way.” Nakeitra Burse lost her aunt, her sister-in-law, and her newborn nephew to preterm labor-related deaths over the past 20 years. She was fed up with the pain of living through grief and not seeing any change and decided to create a documentary about Mississippi’s black women giving birth. It is a honest, intimate portrait of community support, grief and fear, as well as hope. “Laboring With Hope” is a story about Burse’s family, as they deal with the pain and rebuild their lives after the loss. Burse admits to the traumatizing effects of telling these stories again, but she also says that it was cathartic for her to share the pain and recovery process. Burse adds, “It was just too easy to cast it.” Burse believes that her family’s story is a glimpse into a larger story and asks the audience to confront racism inherent in the medical system that allows black women death at a higher rate that their white counterparts. It forces us to ask the question: Why? Her project aims to change the way we talk about the problem. Instead, she will focus on the causes and possible solutions. She says, “As a public-health professional who has done research but is deeply rooted in the community,”. We know the problem with maternal mortality, but we aren’t willing to discuss it. Part of the problem is racism in our health care system, which makes it difficult for people to talk about it and even harder for people to grasp. Burse, who is a black mother, believes it’s important that we have control over the narrative while empowering those most affected. It’s important to me because I see all the money that comes here as a public health worker in Mississippi. She says that outside funders come to Mississippi to do various types of work, and then they leave. There’s no money left for the community. Burse asserts that the context behind Mississippi’s narrative is critical. You don’t get to see the local stories of women such as my aunt, a black woman with a job and insurance, or my sister in-law, who shared the same story. She says that you don’t see all the types of women this impacts in the media. Noting that not only are uninsured, low-income women at risk of childbirth, but also that there are many other women. She says that there is a wide range of women affected by this documentary. It’s not just one subset of them. The film can be used to inspire emotion but also as an action tool. Every screening is followed by a discussion. Her goal is to stimulate conversation and improve maternal health policy. Nakeitra Burse says, “This is an opportunity for me to do something not only for my family but for all black women.” Doulas are paired with mothers during pregnancy and childbirth. A Jackson-based program hopes to embed cultural, community-based changes in the state’s birthing procedures. Merck & Co., a pharmaceutical giant, named ten cities to their philanthropic initiative “Merck for Mothers, Safer Childbirth Cities”. These include Jackson, New Orleans, and Atlanta. For families who can’t afford additional support, the Jackson program will pair pregnant women and doulas during and after childbirth. Doulas are non-medical advocates and doulas who can help women navigate the process from their doctor’s appointment to their medical complications. Recent research and national conversations on maternal mortality have shown that women are often not heard in labor or in the exam room. Doulas are responsible for ensuring that women have a voice in discussions with their doctors and promoting open communication between them. Merck for Mothers’ goal is to invest in local programs and community-based strategies to achieve city-specific goals that will promote more equitable birth outcomes, and reduce maternal deaths. If you are a regular reader of this newsletter, then you will know that the U.S. is not the only country to experience rising maternal mortality and that the burden is being disproportionately borne by black women. We’re not going to focus on these stats. You can find them here, if you need more information. Instead, we’re looking for solutions. The Mississippi Public Health Institute will manage the $875,000 grant investment. It will oversee the program for three years. With the goal to hire five doulas each year and work with 15 women, the Mississippi Public Health Institute will be the leader. The project will build on the existing doula network in central Mississippi and normalize doulas in Jackson’s birthing story. “In a manner we are starting from scratch and doing some things simultaneously — building knowledge, capacity among community members as doulas, as well as doulas, and providers all the while.” Thompson states that the Jackson Safer Childbirth Experience program goals are based on maternal mortality trends in the city and state. Thompson also says that the Jackson medical community must be open to learning from their families and be willing to learn from them. She says that policymakers and legislators need to focus on Mississippi’s women and infant health. “We have the stats, it is time to collectively take action.” Thompson cites an example of a timely policy shift that would improve maternal health outcomes. One-year post-partum eligibility for Medicaid extended to women who are eligible. Wengora Thompson can provide more information about the program. Only obstetricians Dr. Lakisha Krigler treats are those who are pregnant or postpartum. She sees her role in Southaven’s OBED at Baptist Memorial as an important part of lowering the Mississippi Delta’s high infant and maternal deaths rates. Although Dr. Crigler has patients from all over the state who travel to the OBED to see her, she believes it is her Delta-based patients that are most likely to reap the benefits of the service. A recent study found that infants from the Delta were more likely than those in Appalachia to die in their first year. Researchers are reminded by Dr. Crigler, an OB who sees patients every day. Pregnancy risk is not just about socio-economic status, or even women’s health. It’s also about lack of continuity in care, access, and race. Half of Mississippi’s counties do not have OB care. This makes it difficult for many to follow up during pregnancy and after birth. “Mississippi is home to clusters of health care – clusters here and clusters there. You will probably see anyone you wish to see if you live in a large metropolitan area. Good luck if you live in a rural area. We need to have difficult conversations about why economic status is not important when it comes to black women’s (risk) safety. They do not need to be educated. Their outcome does not depend on their health status. It doesn’t matter what your health status is, whether you have private insurance or not. Your risk of dying is still higher than that of your white counterparts. It is time to begin looking at how to train for bias in all areas of health care. This is a difficult code to crack.”

– Dr. Lakisha Krigler, OB. The two-year old OBED is part a nationwide OB Hospitalist Group. It offers a unique approach to changing the state’s infant and maternal mortality trends. Regardless of her symptoms, a postpartum or pregnant patient can be sent immediately to the OBED. Dr. Crigler explains that emergency department doctors are not all trained in labor and birth and may not be aware of pregnancy and postpartum complications. Although the targeted approach sounds obvious, the OBED is still being used. It currently operates at Jackson’s Baptist Hospital and Tupelo’s North Mississippi Medical Center. Dr. Crigler is also the lead physician of the state’s Perinatal Q Collaborative. She works closely with the Maternal Mortality Review Committee to say that extending Medicaid postpartum access is one of the most important steps in reducing maternal deaths in the state. Here are some facts: Most maternal deaths occur after birth and are due to cardiovascular problems or preventable high blood pressure. In Mississippi, Medicaid covers most births, but coverage typically ends 60 days after birth. “Even if they find these diseases while they’re pregnant, once they lose that (insurance), coverage, there’s no follow up to take high blood pressure medication or see a cardiologist for any cardiac disease that might present even after the baby is born.” This coverage gap concerns Dr. Crigler and her colleagues from the Perinatal Quality Collaborative which studies the causes and solutions of maternal deaths. She believes it is crucial to identify high-risk pregnant women early. Too often, women are not diagnosed and receive limited treatment during pregnancy, then drop off Medicaid rolls and lose vital follow-up care for other preventable diseases. These briefs were included in The Inform[H]er’s round-up section.