By Emily Blobaum, Fearless editor
Last year, Olivia Samples had a dream of starting a conference around Black maternal health.
Samples, a nonbinary Des Moines-based doula who serves Black and queer families, decided the conference would uplift the positive things happening in the community. It would center Black birthing people, and the joy in Black parenthood. It would focus on solutions to the maternal mortality crisis. It would be broadcast through a holistic lens where people could show up as their full selves. It would create space for discussions around reproductive justice and bodily autonomy.
It would do these things because “stopping at disparities helps no one.”
Born after months of planning, A Celebration of Black Kin Conference, held during Black Maternal Health Week (April 11-17), did just that. Here are four takeaways from a few of the sessions that I was able to attend.
‘Are we confident that we’ve made any progress on eliminating disparity? I’m not sure we have.’
Disparities within the field of health care are plentiful. Stephen Pedron, maternal fetal medicine specialist at UnityPoint in Cedar Rapids, wasted no time listing off concrete examples: Medicaid eligibility and reimbursement, electronic health record efficiency, language, transportation, child care, trust, lack of providers in general and specifically providers of color and differences in culture.
Addressing these disparities starts with communication, panelists said.
Having an initial meeting with patients and not just handing them a pamphlet in a rush and hoping they’ll read it on their own time is important, said Ayah Bilbeisi, dentist at Cedar Ridge Dentistry in Urbandale.
Sarah Bradbury, a certified nurse midwife at Broadlawns, emphasized the importance of providers being aware of barriers. “It’s easy for a provider to say, ‘Pick up this prescription and come back in or give me a call if you have issues,’ but we often don’t take transportation or reliable phones into account. We have to be mindful of people’s life situations.”
By doing that, health care providers also have the responsibility to help educate patients so they can make informed decisions and advocate for themselves.
Sabbath Schrader, registered nurse at Broadlawns, argued that ultimately the burden falls on providers to recognize the needs and wants of the patient. “Yes, absolutely patients can and should do things to improve their ability to maneuver health care systems. But what are we [as providers] doing to improve our ability to help with that in the moment? It’s on us. It’s not just treat and street.”
There’s no silver bullet to improve pregnancy outcomes of Black and Brown women, but there are known solutions.
One solution? Increasing midwife-led care. Iowa is one of only a handful of states that don’t provide licensing for certified professional midwives.
Certified nurse midwives — registered nurses who have graduated from a nurse-midwifery education program — are available. However, they mostly work in hospital settings because of the difficulty in establishing birthing centers.
“We have to work on the nurse midwifery situation in this state,” Pedron said.
In the April meeting of the Iowa chapter of the International Cesarean Awareness Network, chapter leader Rachel Bruns cited statistics of VBACs (vaginal birth after cesarean) and cesarean births in the state.
The cesarean rate in Iowa is about 30%. Ideally, that rate should be somewhere between 10% and 15%, according to the World Health Organization.
A 2019 story in the New York Times stated that birth complications linked to surgical deliveries are among the biggest factors of maternal deaths.
“One in three American mothers delivers her baby via cesarean section, a rate that has increased more than 500 percent since the 1970s. While C-sections can often be lifesaving for both mother and baby, the surgery involved also carries serious risks,” the article read. “’Caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons,’ a 2015 report from the World Health Organization said. The report found that C-section rates higher than 10 percent were not associated with reductions in maternal and newborn deaths.”
For birthing parents who have already delivered a baby via cesarean section, it can be difficult to find a provider that supports VBACs. While a successful VBAC is associated with fewer complications than a repeat cesarean section, although rare, a uterine rupture is a risk.
The rate of VBACs in 2018 was only 14%, which means that 86% of birthing people with a prior c-section birth had a repeat c-section. Of the roughly 34 labor and delivery units in the state, only one-third offer any kind of trial of labor after cesarean section or VBAC care policy.
As part of the Iowa Maternal Quality Care Collaborative, Iowa hospitals have an opportunity to enroll in a free patient safety bundle through the Alliance for Innovation on Maternal Health, or AIM, that focuses on reducing primary cesarean sections. Hospitals need to enroll by May 1.
Another action step? Making sure doulas are covered by insurance, including Medicaid, Schrader said.
The number of Black doulas offering services in Iowa is increasing
Just a few years ago, there were no known Black doulas serving clients in Iowa. Recently, that’s changed. Three Black doulas, Jazzmine Brooks, Linda Brown and Ebonie Bailey, all shared their experiences as birth workers and why they felt called to the profession.
All of their personal stories had one common thread: They felt as though they needed to serve Black and other underrepresented families the way they deserved — in a way that allowed them to be heard and listened to.
Bailey, who is based in the Quad Cities, gave an example of a birth she had to attend to virtually, due to the pandemic. Through the video call, she witnessed the nurse on duty ignoring and doubting her client’s knowledge and awareness of her own body. Bailey stepped in and yelled instructions through the phone, walking her client on how to push.
“This is why I do what I do,” she said. “To be able to give voice, guidance and help. Not speaking for, but allowing women or birthing families to feel empowered enough to speak up when it’s hard.”
Black doulas wanting to enter the field face barriers like burnout, cost and implicit biases, but having someone who looks like you while you give birth can help drive down maternal mortality rates.
“Black moms are being supported by Black doulas who understand them, who can build a connection, who want to help them,” Bailey said.
‘We can’t put an end to taboos if we don’t talk about them.’
Why are people embarrassed to ask for menstrual products? Why do people with periods still feel as though they have to hide tampons in their pockets when they go to the restroom at work?
“Why do we feel shame around things that are perfectly natural?” Seeta Mangra-Stubbs, owner of Whole Damn Woman, asked rhetorically during her presentation.
She cited a Thinx study that found 58% of women have felt embarrassed when being on their period. “That’s a lot for something that’s natural,” Mangra-Stubbs said.
The consequences are great, she said, giving examples like the impact that periods have on education, pink taxes and suffering from conditions like PMS and PMDD.
The same goes for birth control. Assumptions about people on birth control being “sinful, slutty and sex-crazed” can lead to unwanted pregnancies and unwanted body changes, Mangra-Stubbs said.
What can we do about the shame? Normalize body autonomy, share resources, support comprehensive sex education and talk about it, she said.
“We can’t put an end to taboos if we don’t talk about them.”
