Black maternal health has been a professional passion of mine since completing an internship focused on data informed policy solutions to Black maternal health issues while in graduate school. As a Black woman, it has also been a personal passion. When I became a mother in August of 2022, this issue only became dearer to my heart. I wanted to keep myself safe during pregnancy, labor, and postpartum and I want to find solutions that will keep my daughter safe once it’s time for her to become a mother.  

Black Maternal Health Week was first implemented by President Biden in 2021 (1). This week is focused on bring awareness to the pregnancy-associated health issues experienced by Black women in the United States. Maternal mortality, or pregnancy-related deaths, refer to any death during pregnancy or within the first year after birth that is caused by or exacerbated by pregnancy (2). National trends in the U.S. show that Black women have a maternal mortality rate 2.9 times higher than the maternal mortality rates for white or Hispanic women and, alarmingly, rates have increased since 2019 (3). In 2020, Indiana had the third highest maternal mortality rate in the entire country. Black Hoosier women had maternal mortality rates almost twice as high as white Hoosier women and almost three times as high as Hispanic Hoosier women (2). As a response, the Indiana state legislature passed SB 142 in 2018 (4) which established the maternal mortality review committee (MMRC). This committee is responsible for investigating the deaths of pregnant women or women up to 1 year postpartum, which are required to be reported by all health care providers in Indiana. Indiana cares about Black Maternal Health and has implemented state policies to improve it. The theme for Black Maternal Health Week this year is “Our Bodies Belong to Us: Restoring Black Autonomy and Joy”, and it is true – Black mothers can take control of their birthing experience.  

Lessons Learned

I’ve learned some things through my journey to motherhood that I’d like to share.  

1. Know Your Options. There are many different maternity care providers in Indiana, from traditional OB-GYNs to Advanced Practice Registered Nurses or Certified Nurse Midwives. Along with different providers, there are a variety of settings within which maternity care can be provided such as hospitals, birth centers and even within your own home. Don’t be afraid to shop around to find a provider that aligns with your values and your desires for your birth.  

The Bowen Center has published a detailed Maternity Care Workforce Assessment, which can be found here, and an accompanying brief, here. This resource details characteristics of all physicians or Advanced Practice Registered Nurses who report providing maternity care services. I personally chose to deliver in a hospital setting with a Certified Nurse Midwife. I also chose to have a doula as research seems to indicate the presence of a doula can reduce risk of maternal mortality and adverse birth outcomes (5,6).  

2. Be persistent. Diversity in medical providers can reduce risk of maternal mortality which led me to personally prioritize finding a provider that was from a racial minority group that is underrepresented in medicine (2,7). The Bowen Center has recently published a series of reports and briefs detailing diversity in a variety of healthcare professions. You can currently find the methodology here and the report on physicians here. Reports for registered nurses, pharmacists, dentists and other healthcare professionals are forthcoming.  

 In my own experience, I found it difficult to find a provider who accepted my insurance, was from a minority group and could see me without a long wait. I even switched my provider when I was 8 months pregnant because I felt I wasn’t in alignment with my first one. Be persistent, and don’t be afraid of uncomfortable conversations.  The payoff of having a maternity care provider who aligns with your values is worth the effort required for your best experience during pregnancy and childbirth.  

3. Prepare for postpartum. I spent a lot of time preparing for birth and preparing for bringing my sweet baby home, but not a lot of time preparing for my postpartum experience. The postpartum experience can be very difficult as you physically heal from giving birth, deal with sleeping less than before, adjust to your new role as a mother AND learn to care for a baby! It’s imperative that mothers have access to resources to deal with these changes. In 2022, Indiana passed HB 1140 which extended pregnancy Medicaid coverage to 1 year past birth to help ensure access to healthcare services during this sensitive time (8). Each legislative session, the Bowen Center posts bi-weekly updates on the progress of bills, like HB 1140, that are related to health or the health workforce. Whether it’s a health care provider to check on you physically or mentally, or a postpartum doula to help with laundry and the dishes, don’t be afraid to ask for help. There are options available for you.  

Becoming a mother has been the most joyful and fulfilling experience of my life and getting to watch my beautiful baby girl learn and grow is the best part of my life. Every mother deserves to experience that. I am very thankful to work on projects that highlight opportunities to enhance health workforce diversity. In fact, I am honored to have the opportunity to speak on this topic at my first national conference in Washington D. C. in May. I hope that the health workforce research I am involved in will improve Black maternal health enough that my daughter will not face the challenges that I faced when searching for a Black maternity care provider who shared my same vision for my birth.  

Be well.  

-Mykayla Tobin

Sources:

1. A Proclamation on Black Maternal Health Week 2021. Available at https://www.whitehouse.gov/briefing-room/presidential-actions/2021/04/13/a-proclamation-on-Black-maternal-health-week-2021/

2. Maternal Mortality in Indiana. Available at https://policyinstitute.iu.edu/doc/maternal-mortality-brief.pdf

3. Maternal Mortality Rates in the United States, 2020. Available at https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm

4. Senate Bill 142. Available at https://iga.in.gov/legislative/2018/bills/senate/142

5. Advancing Birth Justice. Available at https://everymothercounts.org/wp-content/uploads/2019/03/Advancing-Birth-Justice-CBD-Models-as-Std-of-Care-3-25-19.pdf

6. Doula care across the maternity care continuum and impact on maternal health. Available at https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00261-9/fulltext

7. Nurse workforce diversity and reduced risk of severe adverse maternal outcomes. Available at https://www.ajogmfm.org/article/S2589-9333(22)00121-5/fulltext#relatedArticles

8. House Bill 1140. Available at https://iga.in.gov/legislative/2022/bills/house/1140