Exploring the Black Maternal Mortality Health Crisis in Connecticut

Kira Dixon Johnson. Dr. Shalon Irving. Yolanda “Shiphrah” Kadima. Amber Rose Isaac. Tatia Oden French.

Unique, vivacious, educated women from all walks of life, yet they share three things in common. They were Black, pregnant and, tragically, all died in childbirth due to pregnancy related complications.

These women are revealing yet another problem in America that can’t be ignored: the Black maternal mortality crisis. The CDC has confirmed this in their “Racial / Ethnic Disparities in Pregnancy-Related Deaths – United States, 2007-2016” Infographic, where they state the following about this important issue: “Data confirms significantly higher pregnancy-related mortality ratios among Black and American Indian/Alaskan Native women.” They continue to report that “about 700 women die every year in the United States due to pregnancy or its complications.” However, they continued to report that both “American Indian/Alaska Native and Black women are 2 to 3 times as likely to die from a pregnancy-related cause than white women.”

If this report was not devastating enough, the CDC also shared that the “inequities are increased by age, with the disparity for Black and American Indian / Alaska Native women older than 30 years four to five times that of their counterparts.”

While the Black maternal mortality crisis is a national crisis, it is also happening within our state of Connecticut. According to the “Maternity Mortality in Connecticut Data Report for 2015-2017”, there were “32 pregnancy-associated deaths,” which are defined as deaths that occurred during pregnancy or within one year of the end of the pregnancy or within one year of the end of pregnancy regardless.” However, when it came to “pregnancy related deaths, which are defined as being casually related to pregnancy or its management,” this report shares that people of color were “overrepresented among these deaths.” It goes on to say as about 64% of the “pregnancy related deaths were those of Black and Latinx people. Yet, in contrast, people of color accounted for about 45% of live births in Connecticut in 2015-2017.”

With all these statistics on the table, Connecticut has begun to take steps to address this. In the medical field, two doctors of color have made this their mission to combat the Black Maternal Mortality Health Crisis.

Dr. Shontreal Cooper, MD, an OBGYN and Maternal Fetal Medicine specialist works in multidisciplinary team care for mothers and babies through the entire pregnancy process at UCONN Health in Farmington. She shares the following ways in which she combats this crisis.

I am big on patient health advocacy and I do so through community efforts, my TikTok social media page, and my blog site HerPower Movement. I think it [is] important that all women develop a birth plan. Pregnancy is just like applying or starting new job. You [are] bringing new life into the world—and just like you prepare your resume or application for a new job, the same should happen for pregnancy and postpartum care. Creating a birth plan can help you and your healthcare provider address your concerns and follow your wishes during delivery.”

She also recommends for women to seek out doulas, whom she describes as “a trained birth coach which can provide informational, emotional and physical support throughout the pregnancy journey. Doulas can help in creating a birth plan and make themselves available to the mother to discuss any issues or questions leading up to the birth.”

Lastly, Dr. Cooper actively engages herself in research around maternal health disparities, saying the following about how this helps her to combat this crisis. “Research brings money. Money helps bring about changes. So, a lot of my research is focused on maternal health disparities and the term “Maternal Weathering”, which addresses the long-term physiological effects of stress on women.”

Dr. Veronica Pimentel, MD, MS, FACOG, and an OBGYN trained in Maternal-Fetal Medicine, is currently a practicing physician in Hartford. She shares how she works to combat this crisis.

“I have led a movement to acknowledge the contributions of enslaved Black women to the field of ObGyn, including dedicating Feb 28 and March 1 to Betsey, Anarcha and Lucy, three of the enslaved Black women that Dr. J. Marion Sims [known as the father of modern gynecology] experimented and developed his fistula surgery.  This acknowledgement allows us to learn our history, how we got here and avoid mistakes from the past. Governor Lamont signed a proclamation this year acknowledging this history.”

Along with leading this critical movement, Dr. Pimentel has also partnered with the American College of Obstetricians and Gynecologists in advocacy work around this issue.

“Along with ACOG, I also have been advocating nationally and in CT for extension of Medicaid coverage up to 12 months postpartum because women die from pregnancy-related complications up to 1 year from birth.  I supervise and conduct research aimed at lowering the rate of preeclampsia and preterm birth.”

Lastly, as an Assistant Professor of Obstetrics and Gynecology at the UCONN School of Medicine and the Frank H. Netter MD School of Medicine, Dr. Pimentel makes sure that she is sharing her knowledge with her students and other physicians and medical professionals about health disparities on a local and national level.

While both doctors acknowledge that Connecticut has begun to start the conversation around this topic through conferences, collaborations with individuals who can work on future projects, and developing task forces teams who are solely dedicated to focusing and developing solutions to combat this crisis, they also feel that the state has a long way to go in this fight of the Black Maternal Health Crisis. 

One of the tasks forces created is the CT Maternal Mortality Review Committee and Program. Established in 2018, they begun its crucial work of “reviewing all CT maternal deaths for pregnancy-relatedness and to develop recommendations for prevention at the patient, provider, facility, system or community levels.”

In speaking with Kelsey Reid RN-MSN, it is clear that the work this committee is doing is needed within our state, as she shares her thoughts about Black maternal health, as a Black Pediatric Nurse working in a local hospital.

“[There is] a misconception that we [Black women] have a higher pain tolerance, [are] drug seeking, are exaggerating [when we speak of having pain], [and are] not as intelligent.” With this perception active within the medical community, she talks about how crucial it is in her work to collaborate and connect her patients to community resources. “It is crucial. Black people are not as vocal about [their] needs. [They are] afraid or unsure where resources are.”

Some of the community resources that are addressing the Black maternal mortality crisis in the state include mental health services that primarily work with people of color.

Dayeshell Muhammad, who has a doctorate in Education with an emphasis in Performance Improvement and Leadership, manages the Female Empowerment Program while also serving as the Director of Operations at My People Clinical Services, LLC. While she specializes in working with young women of color in general, some of her clients who have been pregnant and giving birth have come to her with their own specific needs, such as navigating the impact of having a baby on their familial relationships, financial and education dynamics, along with other obstacles that will have an impact on their pregnancy experience.

 “In a perfect world, when adult women get pregnant, it’s a joyful time…but if you think about a lot of these young women, there’s a lot of fear associated with [their pregnancy]. Most of them are not living on their own – they are living with family, living with their parents, and some of them do not have stable housing already, so it is a very challenging experience for those young women because they might be happy, but everybody around them may not be. So [they] might have to go through some shaming, some guilt, stress, anxiety, self-doubt, [and] questioning.”

Muhammad’s role for these clients is to be a confidant to them, creating a safe space for them to share their feelings and be vulnerable. She provides a listening ear, to provide an alternative perspective on their situation, and to guide them on where they desire to be, along with a no judgment zone for her clients. However, she wants to make it clear that not every pregnant young woman she has worked with has not had support from their families, as every client’s situation is different. Yet, her clients always know that she is there to talk to them.

“I have girls that I have worked with, and they call me still. We are about eight years, nine years since they have been in my programs. When they are in need, trust me they come right to the door. Sometimes it’s just for conversation.”

Samantha Smalls, who has a doctorate in Social Work, has founded and created New Chapter Counseling Services, LLC., in Bloomfield, CT, which focuses on perinatal mental health work with primarily women of color during the pregnancy process. This can include working through post-partum, pregnancy loss, miscarriages, birth traumas, and other things that may occur during this period, from conception to about one to two years postpartum.

 “Those who have had a traumatic birth…they have struggled with seeing their primary care doctors [and] not trusting the medical system. And not all of it is just based on a birth, sometimes it is just based on a treatment that their receiving at hospitals. [They] are feeling like they are not heard, misunderstood, [or] feeling dehumanized.”

What makes her work valuable is that Smalls provides a safe space for Black women to talk about these difficult topics that happen throughout the pregnancy process, and after, saying the following: “In the Black community, [these topics] are not really talked about. A lot of women have suffered through some kind of post-partum, depression, anxiety, and even some psychosis. Those who have struggled with breastfeeding and had depression because of that.”

While breastfeeding may be a struggle for some mothers, Amy Gagliardi, a leading Maternal/ Child Health Professional and Certified Lactation Consultant in the Greater Hartford area, talked about the benefits and disparities of breastfeeding for African American women.

 “If you look in wealthy communities in Connecticut, lactation consultants are in private practice. They are not interested in Medicaid reimbursement, they are seeing people who are paying out of pocket for breast pumps they rent and sell, and they do lactation care, and they are very good at it…. They are very skilled practitioners.”

Gagliardi also addressed how C-Sections are negatively impacting African American women’s ability to breastfeed. “Who has the most C-Sections in America? African American women do. Well, having a C-Section is a risk factor for not getting to breastfeed off to the right start. So, there are a lot of things working against African American women to breastfeed, and they do not know the information.”

Struggling to breastfeed or having to choose not to breastfeed due to having to return to work causes many African American women and their babies to miss out on some of the primary benefits, according to Gagliardi. Some of these include protecting their babies from the most common things that make them sick, such as upper respiratory infections, vomiting, diarrhea, and inner ear infections.

Another great resource for women of color is having a doula. Whitley Mingo, MSW and Certified Doula, has created and founded her doula company, NuBeing Doula Services, in Hartford.

 “I conduct my prenatal visits. I provide services either in home or in the office…what we do is we support the family pre-natal throughout the birth, and then post-partum period as well. So, we provide a few post-partum visits just to ensure that everyone in the house is on the same page, everyone else is knowledgeable about what that perinatal care really would look like, and that everyone is able to support the mother so that she can support the baby.”

Some of the services that she provides have included instant CPR classes and other parenting classes, such as prenatal yoga, post-partum Mommy and Me yoga, and a wide variety of classes to support the community. Mingo also provides doula packages to choose from, along with two support groups for mothers via Zoom.

“The primary way I see it dismantling [this crisis] is having an extra body in the room that challenges the medical professionals to ensure that they are listening to the client and are not just brushing over a question or issue that has been brought up by the family.”

Another Doula business for pregnant women of color is Earth’s Natural Touch: Birth Care & Beyond, in Bridgeport, founded by SciHonor Devotion, eCID, CLC, MCHS. A Doula herself, she created this Doula and birth care center in order to “ensure that there were competent and racially/culturally diverse Doulas and Perinatal Health Advocates supporting families.”

Within the State of Connecticut, they are both the principal group of Black/ BIPOC Doulas and hold the rank of the largest Black-owned training company of Doulas. Some of their Doulas are located “in several states across the country,” as they deliver in-person and virtual Doula services for either “Homebirth, Hospital, and Birth Center families.” Along with their primary doula services, they also provide culturally relevant childbirth and education support courses, such as their Mocha Milkshake Café class, which specifically assists Black parents with breastfeeding their baby by working to remove some of the barriers that prevent breastfeeding for Black mothers, which “are due to lack of access to lactation professionals, limited options for culturally aligned support, generational trauma, misinformation / myths, and more.”

Despite the success of her Doula program, she still runs into medical professionals who do not consider doulas as valuable members of the medical team. One of her Doulas, Cynthia Hayes eCID, CLC, MCHS, shared why this may be happening.

“In my own personal assessment and experience, that part of it has to do with training. When you are trained to be a medical provider, you are trained to do medical interventions. They are often thinking and trained to believe that pregnancy is a medical illness, instead of just a natural part of a woman’s life. That’s part of it, so the training just hasn’t caught up with the fact that, it hasn’t become more evolved.” 

Devotion also talked about the financial barriers that Doulas face in order to become certified. Along with paying them and renewal fees, you have to attend at least three paid births. While this may work in neighborhoods where their neighbors can afford to pay them while assisting in the births, this does not often work for many doulas of color – as they may have to work for free, as many neighbors do not have the funds to provide so easily. Many times, Doulas of color will train with the white created-doula organizations due to their popularity and support, politically and financially. Devotion is against this, as they are not meeting the standards that they need to work in communities of color, and doulas end up spending money just to say that they trained with them and for their name on their resume, ultimately burdening Black doulas.

So what can we do to help stop the Black maternal crisis? For medical professionals, please take the advice of Dr. Shontreal Cooper, who said the following:

 “We must stop and listen to Black mothers and patients. They know [their] bodies better than we do. As medical care providers, we need to provide quality care to Black mothers at all times. It is also important to offer the full spectrum of care — from family planning and preconception to postpartum and into the first year of the child’s life.”

For those of us who are not medical professionals, here is what we can do to combat this crisis. First, support those in Connecticut that are doing the work. SciHonor Devotion is in school right now to become a midwife. If you want to contribute to her business and schooling, here is the link. Second, call your legislators and ask them to support bills that help all mothers. Lastly, share this article with a medical professional, as it just might safe a Black woman’s life.

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