Sun Sentinel Palm Beach Edition
Black women seeking better births
Hospitals avoided due to pandemic, racial inequities
Anastasia Onque was born just before midnight on a January evening in New Jersey. Jamira Eaddy-Onque pushed her out into the hands of a midwife, who set the baby on her mother’s chest. Ali Onque, the baby’s father, stretched a newborn hat over Anastasia’s wet hair, kissing her again and again as he lay with her and Eaddy-Onque in a wide, comfortable bed. The lights were dimmed and soft music was playing.
The little family was safe and healthy.
But this birth took place in a distressing context: New Jersey has the fourth-highest maternal mortality rate in the U.S., which as a country has the worst rates of maternal mortality in the industrialized world. Increasingly, experts are concluding that these grim rates are caused by racial inequities in America’s health care system.
Black mothers in the United States are four times as likely to die from maternity-related complications as white women. In New Jersey, it’s even more alarming: A Black woman is seven times as likely to die from pregnancy-related causes as a white one. The problem has become so dire that in January, the state introduced a strategic plan to eliminate racial inequities and lower the rate of maternal mortality by 50% in the next five years. Gov. Phil Murphy has proposed a budget that will pay for many of the plan’s recommendations.
A growing awareness of these disparities, along with the fear of giving birth in a hospital during a pandemic, is leading some pregnant Black women to seek other options. It’s one of the reasons Eaddy-Onque decided to use a birthing center when expecting her second child,
Anastasia.
Birth centers are sort of halfway points between hospital births and home births. They serve women with low-risk pregnancies and use midwives, who have medical training, and doulas, a nonmedical position focused on emotional support, physical comfort and patient advocacy.
Giving birth presents a number of risks to mother and child, and those risks are difficult to measure. A government-financed study showed that clinical outcomes for mothers using birth centers and those using hospitals were virtually identical for low-risk women.
But birth centers are not necessarily a safe option for everyone.
“Even in a low-risk labor, there are situations that can arise where you very quickly go from a low-risk situation to a high-risk situation or emergency,” said Dr. Timothy Fisher, medical director of
the Northern New England Perinatal Quality Improvement Network. Those risks can be minimized through careful assessment of patients and communication between the midwife and their client, he said, and by having a “local system of care that’s well oiled to deal with those times when transfer and transport are necessary.”
The Birth Center of New Jersey in Union, New Jersey, where Eaddy-Onque gave birth to Anastasia, has been increasingly busy during the pandemic. Founded and owned by Dr. Nicola Pemberton, a Black obstetrician-gynecologist, the facility is unusual in that it is run by a medical doctor who has admitting privileges at a nearby hospital and that it primarily serves people of color.
When Eaddy-Onque’s labor was taking longer than expected for a second-time mother, midwives used a variety of techniques to move
her baby into a more optimal alignment. They squeezed her upper hips to open her pelvis and used a woven scarf to shake her hips. The team had her lie on her side, sit on a birthing ball, walk the hallways and use the shower and tub. The techniques were successful, helping her avoid a medical intervention like a cesarean section.
Free-standing birth centers are uncommon: There are only 400 nationwide.
Birth centers are also often unavailable to the low-income communities, partly because they usually involve high out-of-pocket costs. Though the centers’ approach is said to save the health care system money, they often face low insurance reimbursements and can lose money when caring for patients using Medicaid. These financial factors are part of the reason birthing centers tend to avoid locating in poorer areas.
For Eaddy-Onque, her experience at the birth center was a welcome contrast from her first birth, where she said a doctor behaved like he was “at an auto body shop.”
“You’re supposed to be relaxed, trying to literally bring life into the world,” Eaddy-Onque said.
She had heard of Black women losing their babies or dying during childbirth, and she didn’t want COVID19 protocols to dictate who could be with her during labor.
“I don’t need to be further inconvenienced by a system that’s not going to listen to me,” she said.
“We’re talking about people who are at greater risk of experiencing racism, implicit bias, being marginalized in the health care setting,” said Rachel Hardeman, who researches reproductive health equity at the University of Minnesota. “There’s more of a need for people to be able to cultivate a space that feels good and feels safe for them. There are fewer opportunities to see that happen in a more traditional health care setting, and that’s problematic.”
This also influenced Laneta Lafayette’s choice to have her first child at the Birth Center.
“I wanted to feel more in control or informed,” she said, “like I could identify with my birth workers in the same way that my grandmother was born with midwives in the South. It was this community experience where everyone rallied together as a part of the culture to guide this mother through her birth.”
Lafayette had a long and challenging labor, which began Jan. 27. Pemberton induced labor in several ways before transferring her to a hospital for more monitoring and, ultimately, a cesarean delivery. All birth centers have relationships with hospitals for when medical interventions become necessary, but it is less common for a doctor at a birth center to have admitting privileges at those hospitals. Pemberton does, which is a tremendous benefit for Birth Center patients who need medical intervention.
Lafayette was relieved to feel Pemberton’s familiar hand on her belly and hear her voice in the operating room. She trusted that she had exhausted her options for a vaginal birth and that, given her lack of dilation and the concerning fetal heart tones, a C-section was truly necessary.
Gabriel-Caldwell was with Lafayette and her husband throughout her labor, giving her back massages and sips of apple juice, coaching her through contractions, tucking her hair back and firmly instructing her to relax. She was with her at home, in the birth center and in the hospital after her baby, Nova, was born.
“I want to change the narrative of birth,” Gabriel-Caldwell explained.