More non-white people use food centers

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Rhonda Okoth had visited her hospital twice when her water broke, but no one listened.

The first time, Okoth was told that her water had not broken and that she needed to go home to do some exercises to speed up her labor pains. The second time, still leaking fluid, Okoth was told she had just urinated on herself and was sent home to spend the night in adult disposable underwear. Okoth, a black woman, is a trained nurse.

The third time, medical staff were alerted because her amniotic fluid sac had ruptured – she needed an induction and an emergency caesarean section.

“I was thinking, ‘You did not listen to me yesterday,'” she told The Washington Post in an interview. [to machines]. [My baby] did not tolerate the induction because there was no liquid left around him. In between, his heart rate was falling. “

This experience – with her worries being ignored and rejected somewhere she wanted to feel safe – influenced her decision to have her next birth in the comfort of her home in July 2020, while the pandemic raged, with the help of a midwife team and doulaer.

Okoth is among a growing number of non-white women giving birth, seeking hospital alternatives for their birth and childbirth, as the health of the non-white mother population lags behind that of whites, according to a new report released by the National Partnership for Women and Families (NPWF). ), a non-partisan and non-profit advocacy firm working on public policies and education about women and families.

The report found that births in the local community, as it defines as births at home or at birth centers, increased by 20 percent from 2019 to 2020 with increases across racial and ethnic lines. Non-Hispanic black women used birth alternatives 30 percent more during that time, and Native American women 26 percent. The increase was also seen in Latin American, Asian and white women, who logged at 24 percent, 18 percent and 18 percent, respectively, according to the report. Native Hawaiian or Pacific Islander women had a reported 13 percent increase.

The report also highlighted better outcomes for healthy mothers, which it said would be more likely to have vaginal births and less likely to have perineal tearing. As more mothers, especially those of color, learn how dangerous pregnancies, contractions, and births can be, more and more people turn to opportunities where they feel seen, heard, and cared for by people who look like them and want to see them and their babies. Direct. Doctors and advocates for birth control told The Post that the health care system should be improved, and they noted that the addition of midwifery and doulas services, with some caveats, could lead to improvements for people giving birth.

Black women are three times more likely to die of a pregnancy-related cause than white women, according to the Centers for Disease Control and Prevention. The Federal Agency noted that variation in quality health care, chronic conditions, structural racism, and implicit bias contribute to these statistics. Native American / Alaska Native women and Asian / Pacific Islander women also had higher death rates compared to white women, according to the health agency. More than 800 women died of maternal causes in 2020, an increase from 754 in 2019, with black and Hispanic women showing significant increases, according to a CDC report released this year.

Mortality rates for black babies are dramatically reduced when black doctors take care of them after birth, researchers say

For some, by 2020, hospitals became scary places where people feared being exposed to coronavirus against the backdrop of a country struggling with its racist past, said Sinsi Hernández-Cancio, one of the co-authors of the report and the group’s vice president of health initiatives.

“Now, more than ever, it’s important to find ways to support these choices in many ways that could be life-saving,” she said. “Most women giving birth can feed safely in a maternity ward or at home, but availability is very limited.”

Hernández-Cancio and partners in the report, including the American Association of Birth Centers and the American College of Nurse-Midwives, recommended two dozen policy considerations to federal and state decision-makers, which they say would make community birth access more accessible and reimbursement more widespread. for these services.

“If the insurance does not cover midwives or pay them so little that they can only take a few patients, or doulas can only have so many under their care,” Hernández-Cancio said. “… The economic scaffolding around childbirth is completely prejudiced against high-intervention births.”

She stressed that many women giving birth need medical intervention such as surgery or medicine, including her own acute caesarean section, but she stressed that there should be more than one path to safe labor and delivery that health systems do not support in many areas of the country. .

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Vanessa Barnabei, professor of obstetrics and gynecology at the University of Buffalo’s Jacobs School of Medicine and Biomedical Sciences, said most of the results from the NPWF were credible, and she agreed that integrating midwifery services into traditional practice can help patients, their babies and doctors.

Barnabei, however, was concerned about the report’s claim that infants in the birth center were 26 percent less likely to be born prematurely compared to those born in hospitals, a state she called misleading.

“They should not make premature births in non-hospital settings,” she said. “… It’s hard to figure out where they have that number and how relevant it is.”

Barnabei said parents should meet with various providers. If they choose to give birth outside of a hospital, they should make sure their provider has a backup plan in case something goes wrong.

“If you’ve already sacrificed nine months of your life taking care of this fetus inside you, then why would you take the risk of giving birth in a home or a birth center?” she said. “Although it is not necessary so often when it happens… it is just tragic to have invested all these months of your life. It just scares me. It is clear that I have a medical perspective. ”

Edward Hills, professor of obstetrics and gynecology at Meharry Medical College in Nashville, said maternity centers, midwives and doulas have a responsibility to weed out unhealthy potential patients, though he said he is unsure if their facilities have the medical abilities to achieve it.

Still, he said, these services should be supported.

“The big issue now is that women should have reproductive justice and that they should have reproductive rights and social justice,” he said. “For me, justice means equal access to health care, without taking into account race, poverty and income levels.”

The sacrifice and associated risks of home births were never factors for Shanille Bowens, whose fifth pregnancy left her intimidated and unheard of, she said.

“In my previous pregnancy, the doctor threatened to drop me because I preferred not to be catheterized because it is very painful,” she said. “I withdrew, but I was a little out of options. Not too many providers take you after a certain point. I felt a little stuck in him. The only thing that went through my head was: Never again.”

Bowens, 38, wanted her sixth birth experience to be more special.

She had a meeting with a black nurse-midwife who had started her own practice. Bowens, who is black, formed a relationship with her midwives and doula team, she said.

She said doctors saw her as a high-risk patient because of her previous abortions, but Bowen’s fear of that brand did not stop her from choosing the care she wanted for the first birth she would have without her husband, who had died shortly. before. she found out she was pregnant.

The day of her sixth child’s birth in 2018, she woke up ready to take a maternity photo shoot, asked her eldest son to take a picture of her because she thought her baby could come that day, and then went shopping for beauty items and fabric. . That was when she felt pain and wrote a text message to her midwives for safety.

They told her they were on their way.

When she returned to her home, all of her five children and her birth team were on hand to help.

Bowens gave birth to his son on the couch in the bedroom as his older siblings watched with tears of happiness and gratitude in their eyes.

“Even if my husband was not there to see our son being born, the children would not have been able to attend it if I was in the hospital,” she said. “It was an appreciation of their little brother. We call him ‘Little Blessing Baby’. ”

Bowen’s and Okoth’s experiences with midwives were so helpful that they inspired them to become doula.

Bowens, who is studying midwifery, attributes the pandemic to her path in labor, which her eldest daughter also wants to pursue.

“In some ways, covid came in and threw us off, made us step into our purpose and go in that direction,” she said. “It really opened people’s eyes to what they were missing and what was needed.”

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