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In 2009, there were 16.1 maternal deaths for every 100,000 live births, according to unpublished data provided by the Health Resources and Services Administration - -that’s up from 12.7 in 2007.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

When It Comes to Your Health, Your Zip Code Matters More Than Your Genetic Code

Today is the one year anniversary of the passage of the Affordable Care Act and guess what? According to a recent survey, over one half of Americans don't think health reform is actually a law.

It is folks.

I'm marking the one year anniversary by attending the National Association of Black Journalists Media Institute on Health, Health Policy and Health Disparities in Washington, DC.

I heard two very profound statements today that tell the story about rampant health disparities impacting communities of color. Those two statements were not long prognostications about the social determinants of health or the root causes of these racial and ethnic inequities.

The comments indeed were about those things, but they were short enough for Twitter but utterly profound in answering those questions.

Comment #1: "Your zip code may be more important than your genetic code when it comes to health disparities."

Comment # 2: "We have a sick system not a healthcare system."

Comment 1 struck me because it alarms me that where you live is one of the key drivers of your health. According to the World Health Organization, Report on the Social Determinants of Health, avoidable health inequities arise because of the circumstances in which people grow, live, work and age and the systems put in place to deal with illness. In turn, the conditions in which people live and die are, in turn, shaped by political, social and economic forces.

That's why I was really impressed with a new initiative by The Joint Center for Political and Economic Studies, called Place Matters, which seeks to address conditions in the natural environment, built environment and social environment that lead to poor health. The goal is to eliminate health disparities by identifying the complex underlying causes and defining strategies to address them.

I am convinced these issues play a significant role in maternal and child health.

Comment # 2 was just too simplistically truthful to ignore. Healthcare is a misnomer for our system. It takes care of your sickness but does little to protect your health. In fact, today I learned that for every $1 spent on healthcare only 5 cents goes to prevention.

This is pathetic because so many mothers wouldn't needlessly die if there were more prevention programs and community-level interventions.

FDA Formula Probe Is Good News for Mothers, Babies

The FDA announced last week that it is planning to look into the health claims of infant formulas. I couldn't be happier. One of the biggest or should I latest of the formula industry's misleading claims is for omega-3 fatty acids--DHA, in particular, which misleads mothers into thinking formula is just as good as breast milk.

Specifically, the FDA says it wants to: "assess women's understanding of and response to various statements on infant formula labels. The study results will be used to help the agency to understand the role that certain types of statements on infant formula labels have in influencing formula choice…The study will focus on purchase choice, perceived similarity of the formula to breast milk and perceived likelihood that the formula has certain health benefits."

This is great news. For years, the infant formula companies have successfully marketed their formulas as just as good as breast milk without any such evidence. This marketing has been particularly aggressive in the black community. In a recent interview, a lactation consultant told me of a mom was asking for "the formula with breast milk in it." Wow!

No such thing actually exists, but it highlights the dangerously successful marketing by deep pocketed formula companies that leave moms confused and about what formula is and isn't.

Having been an intrepid business reporter for many years and a former senior writer at Fortune magazine, I can certainly understand the business dilemma of the formula makers: There is no money to be made from breastfeeding. Plain and simple.

When your number one competition is free, and you can't compete on price, you have to be creative. Really creative. And even misleading.

Meanwhile, market competition pushes formula companies to improve their product by adding so-called nutrients--especially the ones that can be considered "conditional" by the FDA. A conditional nutrient is one that might have some benefits under some circumstances. Even if the health benefits are minimal or questionable, they can still be used in advertising.

As a result many formulas have added fatty acids such as omega 6 arachidonic acid (ARA) and omega-3 docosahexaenoic acid--the same ones that are in fish oil. These two fatty acids are naturally present in breast milk and are reported to help infant brain development and vision.

But here's what happened behind the scenes: Formula makers were able to get the FDA to agree that ARA and DHA are normal components of food (which is true) and, therefore, are Generally Recognized As Safe (GRAS). They were then free to add ARA and DHA to infant formulas without having to prove that either of them really did anything useful or beneficial. But the mere mention of such additives, gave them breast milk cred. Even worse, instead of marketing formula as a safe alternative if you can't breastfeed, they tried to make it appear just as good as breastfeeding for all mothers.

I mean, why bother to breastfeed if I can give them the same nutrients from formula, a mother could reason. The problem is, you can't.

And it's high time the government stopped allowed deceptive marketing of formula at the cost of infant and maternal health.

If you agree, please join me in letting the FDA know that this study is welcome and long overdue.

You can also file comments at http://www.regulations.gov. Refer to Docket No. FDA–2011–N–0098

Gratitude: Yes, We Are Still Breastfeeding

(WOMENSNEWS)

Let's start by putting the pertinent details right out there on the table: I'm Black. I'm the mother of a nearly 2-year old daughter. And yes, we are still breastfeeding.

To me, there's nothing particularly radical about what I've just told you about myself. Motherhood and nursing are mine by choice; my skin color and curly hair are factors over which I had no more control than any other person born into this world. But sadly enough, the convergence of these three aspects of my identity – my blackness, my role as a mother, and my decision to nurse, especially into the toddler years – makes me a rather unconventional bird, indeed.

If you've paid any attention to the data on rates of breastfeeding among Black women, you'll understand what I mean. While women overall are now initiating breastfeeding at a rate of 75 percent, Black women trail the pack, initiating breastfeeding in just 54 percent of births. Look beyond the initiation phase (i.e. those first hours and days after birth when most of us would try anything), and the news gets even worse for Black babies. Though the American Academy of Pediatrics recommends "exclusive breastfeeding to age 6 months and continued breastfeeding for at least the first year of life," by the time our children reach 12 months of age, only 11.7 percent of them are still being breastfed, as compared to 24 percent of Hispanic babies and 21 percent of white babies.

(And at two years? I couldn't even find data for that. But if my personal experience is any evidence, let's just say we're a teeny, tiny drop in a bucket that's far too small overall.)

Statistics like those drive me beyond mad – both because I'm saddened to think about how many Black babies are missing out on the kind of nutrition baby docs have acknowledged is ideal, and because I'm sick to death of seeing poll after poll highlighting just how far behind the Black community lags, in a host of important categories (don't even get me started on the achievement gap).

But I have to be honest: frustrating and scary as those numbers are, they aren't what got me breastfeeding in the first place, or what have kept me at it for so long. The factors driving those truths are far more personal, as I'm sure they are for every mother out there, whether they choose to breastfeed or not.

My family's history with breastfeeding has already been beautifully documented in a Women's eNews video by Malena Amusa, so I won't go into deep detail about why I, like a minority of other Black women, did in fact chose to breastfeed.

The short version is that I knew many women who did breastfeed, had done my research on the topic, and decided that it made sense to me to at least give it a try and see how things went.

Luckily for me, things went beautifully: my newborn daughter turned out to know much more about breastfeeding than I did; she latched on right after her birth, and never looked back. I'd like to stress again here that I consider this pure luck – there's nothing I did or didn't do to wind up with a baby who breastfed well, right from the beginning, and I'm very clear about the fact that things could have gone just the opposite way.

I'm isolating this luck factor because I think it has everything to do with why, nearly two years later, my daughter and I are still enjoying a healthy, happy nursing relationship. Nursing was never, ever a source of stress for us. If it had been, I think it's quite likely that we would have weaned far earlier than now.

The other piece of luck that went into this particular equation was the fact that I was able to decide, not long after my daughter was born, that I no longer wanted to work full time outside of my home. Making that decision wasn't easy, but my particular profession gives me the latitude to work more or less from anywhere.

From a nursing perspective, this was an absolutely key choice. I was never a big fan of pumping, and I am almost 100 percent certain that if I had had to pump at work on a daily basis, I would have struggled to breastfeed even for a year. The luxury (and it is nothing short of that in this country, sadly enough) of being able to work from home has meant that I can largely nurse on demand. It has made nursing easy, and, again, mostly stress free. It's become a natural and soothing (for both of us) part of our daily routine, and therefore a practice it's been easy to continue as my daughter has grown from infant to toddler.

My point in sharing all of this is not, I promise, to ask you to bask with me in the rosy haze of self-satisfaction that can become the norm among some breastfeeding advocates.

I share my story with you precisely because the circumstances that have made my breastfeeding experience possible are so exceptional and rare. Some of our success, as I've said, had to do with the luck of the baby draw, and the fact that I didn't struggle with milk production. But our ability to succeed long term also had everything to do with the early and continuing support I received from my community (the women around me who were also breastfeeding, my doctors, my partner, my mother and on), and with the good fortune of being able to make choices about my work life that, coincidentally, made breastfeeding easier. Those are luxuries that few women in America have – and among Black women, the number is once again smaller still.

In a better version of America, all women would have the opportunity to make choices for themselves and their families that feel right to them -- as my choices have felt right to me. If we lived in a nation that truly valued the health and well being of women and children – where extended and paid parental leave was the norm; where all hospitals promoted breastfeeding, and provided women with the support they need to continue breastfeeding once they are on their own – then breastfeeding for a year and beyond might not have to depend so much on the existence of "exceptional" and "rare" circumstances that made it possible in my own case.

That, to me, is something to aim for.

How long will I continue to breastfeed my daughter? I've got no more definitive answer to that now than I did back when breastfeeding was a concept, not a practice. All I can say is that I believe, wholeheartedly, that my daughter and I will come to an understanding about when it's time to stop, when it feels right and good for both of us. At the moment, that time is not here – and that's perfectly fine with me. But when that day comes, that will be just fine, too. Fortunately, we get to figure it out as we go along. Every mother and baby should be so lucky.

Elizabeth G. Hines, a New York-based writer, is co-author of the award-winning bestseller Black Titan: A.G. Gaston and the Making of a Black American Millionaire

Demanding More For The Future Black History Makers And The Mothers Who Birth Them

As Black History Month comes to a close I've been reflecting on the history of black women as mothers. Thinking about our legacy as the women who tirelessly carried our families and communities. Mothers who didn't listen when the world said we were thoughtless breeders and our children were mere commodities to be bought or sold. In more recent history, black mothers have been publicly shamed as crack mothers, welfare queens and the face of "baby mama drama." Black single motherhood is blamed for all sorts of social ills from crime to drugs to "wilding" teens. And black mothers are often represented in popular culture as neck-rolling domineering household managers who run circles around our men.

Let's face it. The historical misperception of who we are has not been very flattering.

But I'm asking you to stay true to what you know: These stereotypes are very far from the truth. In truth, black women today have redefined black history and created a new conversation about our roles as mothers. For example, when I watched the Brady Bunch and Happy Days and reruns of Leave It To Beaver, the subtle messaging was that being a stay at home mom and catering to your child's every need was a white woman's pleasure. Black women have always worked--as slaves, as cleaners, as teachers, as doctors, as lawyers. Even our TV mamas (Claire Huxtable included) always worked outside the home.

Today more and more black women are stay at home or work at home moms (myself included), we have robust national organizations like Mocha Moms http://mochamoms.org/ to support women who are making motherhood their career (even if just for a few years or so).

We have a First Lady who epitomizes everything modern black motherhood is about, career success, loving partnership and commitment to being the mom-in-chief of your own family command center.

This shift in our motherhood experience may seem subtle, but in the framework of our history, it is groundbreaking. And thrilling. It not only speaks to how far we have come as a people, but how far we have come as black mothers, who went from having no control over our children to taking control of our children, our lives, and our families' financial future. We now have varied and different motherhood experiences yet we still know we are doing important work that goes well beyond our home.

Yet, there is much work to do. We still need to increase our breastfeeding rates, to give our babies the healthiest start in life and improve our own health as mothers. We need to demand answers to why our maternal death rate is double and is some urban cities seven-times that of our white peers, and start questioning the quality of care we receive.

As we celebrate our history as black Americans, we must protect the next generation of black history-makers currently growing in wombs across the nation. And we must demand better care for the mothers who bring them into the world.

Is Black History Month Doing Us Any Good?

Three weeks ago, I started a discussion on my website, Mochamanual.com concerning whether or not Black History Month was still relevant or even necessary today.

I was starting to wonder myself.

The responses from our mocha (Manual) moms were eye opening. Several moms stated it's not about "them" (the white majority) learning our history, but more about "us" teaching our children our own history. And that as black mothers, we cannot properly prepare our children for the future if they don't know their past.

Also, Black History Month gives us a chance to correct the record books and to reflect: Where are we now? Can we do better? they said. And many commenters also feared that, with a black president, we could easily become complacent about how much further we have to go.

All good stuff.

One week later, I continued this lively dialogue over on Baby Center's blog, Momformation.com, hoping to share this message with a more mainstream audience. Imagine my surprise when things took a shockingly heated and disastrous turn for the worse. Some responses erred on the side of ignorance, while others were just blatantly racist. Some of the many contributors' comments included the following:

"I Don't Think We Need It At All… We Have A Black President What More Do You People Need????….. And The Slavery And Black People Issues Are Gone. So NO I Don't Think We Need A "Black History Month!"

"I think honestly black people are the ones that separate themselves. I'm not trying to be rude, but most "white" people see black and white people as the same, but black people still think that "white" people see them as maybe inferior or as "them and us," so please get over it, we are all the same."

"It seems however that black people don't really want what they are preaching; equality. They still want the segregation and to remind white people of how the past was. Your use of "us" and "them" is why "your" race is holding themselves back. I think the better lesson for all would be: Who really has the problem with racism? … As a white woman, I am saddened that people are still making this a huge issue. It happened, it is over, move on. Make the world better. If the focus and energy used on "race" was applied elsewhere, this world would be amazing!"

"It's separatist and serves to create an "us vs. them" atmosphere. If we truly want color to be a "non-issue" why have a BLACK history month? Is there an Asian history month (May)? A WHITE history month (uh, no)? A Native American history month (November)? That get the PR of black history month? Nope."

Besides for the fact that I always have to SMH whenever anyone says black people should "get over" slavery, I find it particularly sad that many people don't understand the legacy of slavery. (They also seem to forget that 246 years of slavery was followed by roughly 100 years of Jim Crow laws that lasted until 1965).

They don't see how race plays into everything, and I do mean everything from politics to education to health care reform to birth outcomes to cancer survival to maternal mortality rates. All of it has racial undertones. And sometimes overtones. (It's a word to me, :-))

They don't see the health disparities, wealth gap, employment gap or education gap as a byproduct of the systemic racism that still exists in this country.

They don't see it because they don't live it. Or live near it. In fact, they probably only drive past it. And very quickly with the doors locked.

What really saddens me is that this audience is moms. Parents. People responsible for shepherding young lives into the world--filling their brains and shaping their values. People whose children will be sitting in class next to my beautifully brown son and daughter.

Even more frightening, these people are policemen, teachers and, God help us, doctors and nurses, charged with our care. And our babies care.

Houston, we have a problem.

And the problem is a subtle bias lingering in the minds of many Americans.

And I'm just not sure if a million Black History Month's can ever fix that.

What do you think?

Will Health Care Reform Help the Racial Legacy of Health Disparities? Or Will Race Matters Get In The Way?

With people of color representing 50 percent of the uninsured in America, the new Affordable Health Care Act stands to represent the biggest social movement to impact our communities since civil rights.

But will it solve the health disparity issues that continue to plagues African Americans?

Recently, I attended the Families USA conference in Washington, D.C., where among other distinguished speakers, the 44th President of the United States, Barack Obama, spoke live addressing the conference attendees.

The president eloquently spoke of the benefits of the act, which has already dismantled that pesky "pre-existing condition" clause, which forced millions of Americans to be uninsurable by deep-pocketed insurance companies and caused thousands of others to die because of it. He was candid about the flaws in the law and reiterated his willingness to make changes in some areas.

As a self-employed mother of two who has struggled with my own health insurance issues, I listened intently to the debate that preceded the current law. And the still unfolding drama since it became law---and I just couldn't figure out why there was so much vehement dialogue against health care reform.

Was it really debatable that our system needed a major overhaul?

Having lived in London, England, and having experienced their medical care for myself and my children, I couldn't really understand what was the real problem with a universal health care system. Or with creating more options and lower costs. Not the political excuses and grandstanding, but the real issues. Especially since most of the most vocal objectors have some of the best health coverage this country has to offer. Lucky them.

The answer came to me at the conference in a dynamic panel discussion led by an extremely passionate woman--Gail Christopher, vice president for health at the W.K. Kellogg Foundation. (Full disclosure: The Black Maternal Health Project is funded by the Kellogg Foundation)

After sharing her personal story of arriving at a hospital to deliver a baby only to be left in the corner because someone just assumed she was a black woman on Medicaid, she said something so simple, yet true: "Where you stand is often based on where you sit."

It took all my strength not to jump out of my seat with an uncharacteristic, "You said it, sister!!"

I clapped instead.

But where most detractors "sit" is at the table of the haves with little concern for the have-nots and a lot of selective amnesia.

They've forgotten that this country got its haves by raping, killing and stealing from the people of color they found when they got here. They forget that their history of racism and segregation, left blacks concentrated in communities with severe health risks and without access to any remedies. They choose to ignore the cumulative impact of this racial legacy and the scores of women and vulnerable children it disproportionately impacts.

They forget about environmental racism, doctor deserts, food deserts and other gaping holes that have created and maintained a systemic inequity in access to health care.

An inequity and legacy that plays out every day in high maternal mortality and infant mortality rates and poor birth outcomes in black women across all socioeconomic levels, among others.

And multiple studies have already proven that people of color receive inferior care regardless of their insurance status or socioeconomic status. (I was happy to learn that the health care law has over 75 provisions to address equity issues, including more community based health care services.)

This is an important step in the right direction.

And so, unfortunately, like so many other issues in this country, it really comes down to race. Racial tensions in this country are getting worse, not better.

Everybody knows the true wealth of a nation is the health of its people. Yet, in this country any concept of a publicly supported health care system has a stigma of helping poor people. And by poor, they think lazy. So what if your children suffer? This stigma needs to be removed.

Politicians have pulled off a near-Reagan like maneuver duping Americans into believing who really benefits from the new health care act.

Every one benefits.

But the same patriotic, Federalist Papers-reading countrymen who "want their country back" should take a fast forward real look at the country they hold so dear. By 2042 it is estimated that one in four people will be a person of color. You can take the health care reform issue to the Supreme Court if you'd like, masking your political agenda in a baseless legal challenge. But we're all in this together, with our futures inextricably linked. And we are a constituency not to be ignored.

Because unfortunately for you, my memory is not like your memory.