Black maternal mortality has reached a crisis level. Here are the Chicagoans taking steps to stem it.

For Star August, the birth of her first son did not go as planned. August hired an out-of-hospital midwife to guide her through the pregnancy but attended checkups in a hospital as a cost-saving measure. At one of her last checkups, the doctors told her that her amniotic fluid was low and wanted to induce labor.

“I wasn’t able to get a hold of my midwife, and I didn’t know what to do,” August recalls.

What happened next was a harrowing experience. After taking Pitocin, a synthetic hormone used to induce labor and speed up contractions, her son’s heart rate began to drop. August was rushed to the operating room for an emergency C-section. She wasn’t completely anesthetized before doctors cut into her skin, and they ignored her pleas to stop.

After awakening from a drug-induced coma, she saw her newborn son being resuscitated next to her. Once revived, the baby was taken to the neonatal intensive care unit. August couldn’t experience skin-to-skin contact with her child at birth, which can decrease stress in both mother and child and help initiate breastfeeding.

August’s traumatic birthing story is a familiar one, especially for Black and Brown women, who face a greater risk of trauma and death due to childbirth, compared to their white peers.

Research published earlier this month by the Journal of the American Medical Association, or JAMA, found higher maternal mortality rates in Black communities, while Native American and Alaska Native people experienced a particularly rapid rise. State median mortality rates more than tripled over the last two decades.

UNDERLYING CONCERNS

In Chicago, Black women have a maternal mortality rate that is nearly six times higher than white women and Latina women have a maternal mortality rate that is twice as high as white women.

“The root causes of disproportionate pregnancy complications in Black women are driven by inequality, discrimination and long-standing racism deeply rooted in the U.S. healthcare system,” Dr. Jana Richards, assistant professor of obstetrics and gynecology at UChicago Medicine, wrote in an article.

In late June, Cook County Board Commissioner Donna Miller, who represents south and southwest suburbs, convened a Health & Hospitals Committee hearing to discuss the maternal mortality crisis. U.S. Rep. Robin Kelly, D-Matteson, and Illinois State Rep. Mary Flowers, D-Chicago, talked about their policy efforts. Mothers, doctors and doulas described the alarming incidences related to maternal health during pregnancy and childbirth. “We can and must do better,” Miller told Crain’s.

Undergirding the disparities is the disinvestment in health care systems in predominantly Black and Brown neighborhoods, where the legacy of discrimination and redlining has contributed to shorter lifespans. On Chicago’s South Side, only three hospitals offer maternity care, severely limiting residents’ options. Food and housing insecurity and chronic stress also impact birth outcomes for mother and baby, as do the lack of paid maternity leave and flexible work policies.

When all factors are taken into account, maternal health and mortality become an economic issue, especially for demographic groups already struggling financially. A maternal death can cause economic devastation than spans generations, as over 40% of mothers are the sole or primary breadwinners for their families, according to the Pew Research Center. “The racial disparities seen in maternal health outcomes are complex and go deeper than economic resources alone: having a higher income or more education does not protect Black mothers from increased rates of maternal mortality and morbidity,” wrote Anna Bernstein, a health care policy fellow and deputy director of health equity and reform at The Century Foundation, a progressive, nonpartisan think tank.

For August, the maternal health crisis demanded that she take action. After her birthing experience, she began to train to become a midwife herself. In 2020, while hosting a conversation with local Black mothers who were interested in home births, she met Callan Jaress, who is white, and the two women decided to work on closing the disparity gap together.

“Lack of options is a form of oppression,” says Jaress, a mother of two. Together, the women founded the Holistic Birth Collective, a nonprofit organization advocating for midwife-led care models for unjustly served communities.

One of the main goals of the HBC is to have a certified professional midwife in every neighborhood so that all women have options for their childbirth experience. One study out of Michigan found that Black women prefer giving birth outside of the hospital at the same rate as white women; however, most women in the U.S. are constrained to birth in hospitals where insurers cover the cost. The study also noted a paucity of certified nurse-midwives in the state, a statistic that extends throughout the U.S.

In addition to making midwife care more accessible, pregnancy and childbirth experts across the city are researching ways to improve prenatal and postnatal care for Black and Brown women and to enact maternity leave laws so that working women can continue to participate in the labor market after childbirth.

Regarding the practice of midwifery in Illinois, Gov. J.B. Pritzker signed the Licensed Certified Professional Midwife Practice Act in 2021, which licenses individuals who have earned the proper certification necessary to perform out-of-hospital births. The law, however, does not allow licensed midwives to be covered by Medicaid. Seeing the disparity, the HBC championed SB 1041, a measure extending the use of certified professional midwives to Medicaid patients.

After August, a mother of four, became the first person of color credentialed as a professional midwife in Illinois in 2021, she and Jaress set out to increase the racial diversity of midwives by developing a Licensed Midwife Education Program on Chicago’s South Side, which has been labeled a maternal health desert.

“We need to put these programs where they are needed,” August says.

IMPROVING HEALTH BEFORE PREGNANCY

After experiencing oppression and systemic racism firsthand growing up in an impoverished neighborhood in Detroit, Dr. Melissa Simon was determined to change that.

Simon, a professor of obstetrics and gynecology, preventive medicine and medical social sciences at Northwestern University’s Feinberg School of Medicine, has focused her career on advancing health justice.

“For me, it’s about how to improve health care access and health care delivery conditions to ensure everyone has an opportunity to achieve health regardless of the color of their skin,” says Simon, founder and director of the Center for Health Equity Transformation at Northwestern.

Simon is working on the Optimize study out of Northwestern, a five-year cluster randomized clinical trial in partnership with AllianceChicago and the Access Community Health Network that explores how to improve care for prenatal and postnatal African American/Black patients. The study’s goal is to increase pregnant women’s ability to attend prenatal and postnatal visits, to receive comprehensive care at these visits and to connect with resources that address social determinants of health.

Simon says that the first prenatal appointment should be focused on building trust with the patient.

Prenatal appointments are especially important for Black women because research shows they face a higher risk of pregnancy complications, including hypertension (pre-eclampsia) and gestational diabetes. If complications are not identified and treated, they could lead to death, as was the case with Tori Bowie, an Olympic athlete who died this year. Autopsy reports showed she was eight months pregnant and in labor at the time of her death, which was likely caused by eclampsia, a severe complication of pre-eclampsia when high blood pressure results in seizures.

POSTPARTUM IMPROVEMENTS

“Black women are not only dying during pregnancy, there’s so much disparity in how people are being followed postpartum” says Dr. Sarosh Rana, a professor of obstetrics and gynecology at UChicago Medicine and section chief for maternal and fetal medicine.

Disparities can begin even before a woman makes it into a clinic, Rana says, enumerating barriers that include lack of access to clinics, increased health risk factors (such as obesity), lack of transportation, lack of child care, restrictions with insurance, gun violence in the community, domestic violence, lack of education and awareness among patients and providers, and health care system/provider implicit bias.

To address these issues, Rana, an expert in the diagnosis and management of women with pre-eclampsia, created the Systemic Treatment & Management of Postpartum Hypertension program, which standardized care so that every woman who came into the clinic received the same hypertension education material, a blood pressure cuff for continuous monitoring and a treatment plan that includes follow-up appointments.

She created a quality-improvement initiative consisting of a bundle of clinical interventions, including health care professional and patient education, a dedicated nurse educator, and protocols for postpartum hypertensive disorders of pregnancy care in the inpatient, outpatient and readmission setting.

Rana says these changes made a big difference in outcomes. Home blood pressure monitoring increased patient satisfaction and reduced hypertension hospitalizations. Rana is working to see how she can expand the program to other institutions.

Postnatal care is also important for mental health. Research shows that postpartum depression affects 1 in 8 new moms, and mental health issues are the leading causes of pregnancy-related death in the U.S. (including deaths by suicide and poisoning/overdose). Research also shows that postpartum depression is more common in women of color who have less access to treatment.