Your Maternal Health
Ensuring a safe, positive birthing experience for black women
Health information brought to you by
Blue Cross Blue Shield of Massachusetts
“What I didn’t prepare for was everything going south … I didn’t feel prepared or educated.” These are the words of elite athlete and decorated Olympic track and field star, Allyson Felix in her Center for Disease Control and Prevention (CDC)’s “Hear Her” campaign. At thirty-two weeks pregnant, Allyson developed severe pre-eclampsia (high range blood pressures). She had to be rushed to the operating room for an emergency cesarean section. Allyson was fortunate that her medical team responded quickly to her signs and symptoms during her routine prenatal visit. However, that is not the case for many Black women.
The CDC reports that 50,000 women in the United States (U.S.) suffer from pregnancy complications annually, but that Black women are at least three times more likely to die due to a pregnancy-related cause when compared to White women. Deanna Fulp, Sr. Director of Health Equity at Blue Cross Blue Shield of Massachusetts (Blue Cross), sheds more light on this: “Black women are more susceptible to socioeconomic factors that influence having chronic diseases like diabetes, high blood pressure and obesity. These chronic diseases lead to high-risk pregnancies.”
Examples of severe maternal morbidity are complications during labor and delivery that put a birthing person more susceptible to heart attacks, kidney failure, eclampsia, and sepsis. Dr. Benjamin Kruskal, MD, a practicing physician who works in medical innovation at Blue Cross, echoes these concerns: “Complications during labor, delivery and post-partum have devastating results which many times lead to death for both mother and baby up to one year after delivery.”
Dr. Anika Moore, Obstetrician, Brockton Neighborhood Health Center Photo: Faith Ninivaggi for COVERAGE
Dr. Anika Moore, an obstetrician who practices at Brockton Neighborhood Health Center in MA, cares for women from all over the world. Her patients are women of color mostly from Haiti, Cape Verde and Brazil; women at risk for pregnancy-related complications or worse dying from such complications. She promises, “… to listen, partner and connect with women to help take care of their health needs.” Dr. Moore believes “as a broader community, we need to understand that this is a problem that cannot be ignored. We all need to be part of the solution.”
While the numbers are sobering, it has the attention of care providers like Dr. Moore and health equity leaders like Deanna Fulp: “It is long past the time to end the persistent and longstanding crisis and improve Black maternal birth outcomes.”
The Birth Plan
Having a birth plan in place is one way that members of the black community can influence their birthing experience. Blue Cross’s Dr. Kruskal offers the following guidance to consider as a starting point to develop a birth plan, though anyone who is pregnant or planning to conceive should always get advice from a medical professional.
• Make an appointment with your care provider. The birthing journey should begin with a review of your health and family history, including the conception partner. This appointment could include discussing previous pregnancy issues, vaccinations (some vaccines cannot be given while pregnant), screenings (blood pressure, Hepatitis C, sexually transmitted diseases), and an overall review of your health.
• Review any medications that could impact fetal growth and development and share existing medical conditions with your care provider. Conditions like high blood pressure, diabetes, obesity, sexually transmitted diseases (syphilis, chlamydia, HIV) need to be controlled and treated. These conditions can put you and your growing infant at high risk for a poor outcome. Infants born to mothers with chronic medical conditions can have healthy infants under a professional medical team knowledgeable in delivering high-risk pregnancies.
• Prioritize eating healthy meals that include green leafy vegetables to boost folic acid is critical in preventing poor fetal development. Eat lean proteins and a variety of fruits; while reducing salt, processed foods, and sugar.
• Exercise regularly like prenatal yoga, swimming, or walking. Always check with your care provider for specifics based on your health.
• Reduce exposure to toxins and toxic chemicals like secondhand smoke, bleach, and hair relaxers; while avoiding alcohol, tobacco and recreational drugs, like marijuana. Cat owners should avoid changing their cat litter to reduce exposure to the toxoplasmosis parasite, potentially causing fetal complications.
• Choose your birth team. This includes a supportive medical team that hears and understands your desired birth journey. Will the same physician or certified midwife be a part of your care continuously from prenatal through birth? Who and how many people from your support team (ex. partner, doula — a labor and after birth coach, family member) can be in the birth room setting?
Kristine Sand, Director of Health Equity at Blue Cross indicates that many childbirth-related complications can be prevented. One way to prevent these complications is with the support of a doula: “Birth doulas provide advocacy and support through your pregnancy, birth, and postpartum. A birth doula can help to prevent not only these complications but reduce the inequities our Black members face today.” In other words, Ms. Sand and her health equity team are dedicated to ensuring all women but especially women of color are treated with the dignity and respect they deserve in their health care journey.
How can women ensure a trusted birth team? Dr Anika Moore reveals, “first, I tell my patients, become an educated consumer. Be aware of disparities in care. And when you go to get your prenatal care, ask questions.”
• Do your research around your desired birth setting, by allowing yourself to imagine the ambiance and mood you wish to create and the type of care provider to facilitate. Every woman deserves to give birth in a safe space where they feel respected, heard, and comfortable. For most women, this consideration has a financial impact. Therefore know what your health plan offers.
Know your benefits
Blue Cross Blue Shield of Massachusetts recommends familiarizing yourself with your medical insurance plan’s coverage and benefits. It’s important to know what your plan will cover and what birth settings (hospital, birth center or at-home) are in-network (less expensive) and out-of-network (more expensive) to provide a framework for one’s choices. There may also be benefits and resources you didn’t know you had access to. For example, Blue Cross offers its members reimbursement for birth classes, lactation support and savings for breast pumps. Check your own medical plan to understand what benefits are available to you.
• Consider where you want to give birth. There are various birthing settings you might consider: a hospital, a birth center, and a home birth. Listed below are starter discussion points for you to familiarize yourself with as procedures can vary within each birth setting.
• Learn about pain management. Find out which birth setting offers the type of non-medicated vs. medicated techniques you desire:
Non-medicated techniques: reiki, aromatherapy, water therapy (including hot tub, shower), TENS aka transcutaneous electrical nerve stimulation, massage, hypnobirth, acupuncture, and acupressure.
Medicated: epidural, nitrous oxide (aka laughing gas), spinal block or combined epidural spinal block. In the case of an emergency, general anesthesia will most likely be given.
• Consider seeking a professional therapist to help manage stress and trauma. While most women know they should eat healthy and exercise, they don’t always think to boost their mental wellness. Thinking about conceiving or already pregnant brings up a lot of emotions not only because of the hormonal fluctuations causing mood swings and but also feelings around the alteration to one’s body.
One in every eight mothers will experience postpartum depression. Symptoms include a lasting anxious, sad, or empty mood, feelings of worthlessness and the inability to care for your infant. According to Dr. Tracy Mullare, professor of psychiatry at Harvard Medical School, “It’s a very natural response to the physical toll of childbirth, sleep deprivation, the pressures of caring for a newborn, and the sudden drop-off in pregnancy hormones. But help is available. It’s just important to reach out.” Postpartum depression is a common and treatable condition. Dr. Mullare adds, “There should be no stigma or shame around postpartum depression. Many cities and towns offer a range of maternal health programs and support for pregnant families and improve birth outcomes. Contact your city or town hall to find out what is available to you that you might include in your birth plan.
Your birthing journey
Lastly, it is important that women thinking about conceiving or currently pregnant recognize that everyone’s journey is individual and personal. There is no one size fits all. A birth plan allows mothers to create a framework for a respectful, safe birth and post-partum experience. However, it is also important to recognize that sometimes we can desire to execute a perfect birth plan, but complications arise. Remember Allyson Felix’s experience, she explains that her pregnancy appeared uncomplicated. However she had to have an emergency cesarean section; her birth plan was immediately modified. Be sure to have some flexibility built into your birth plan.
The framework of a birth plan allows women autonomy and shared decision-making. Women have choices when deciding their selected care partner, and support team members, like adding doulas in their desired birth setting when giving birth. This coupled with a pregnancy plan; a guidance of best practices for a healthy delivery allows optimal health outcomes and a positive birth experience for mothers and infants. This process is personal and looks different for everyone.
The birth experience in Massachusetts, and in United States, should be safe for all women. Black women should be no less sure of having positive birthing outcomes. The maternal health alarm has been sounded, it is a complex problem requiring action and solution from many stakeholders, and with the help of health equity partners, maternal health advocates, care providers and hearing the voices of Black women.
Portions of Dr Anika Moore’s comments were originally published in Coverage, a news service of Blue Cross Blue Shield of Massachusetts.
