Black Infant Mortality and the Role of the Childbirth Educator and Doula

By Sherry L. Payne, MSN, RN, CNE, IBCLC, CD(DONA)

September is National Infant Mortality Month and today, Sherry L. Payne, MSN, RN, CNE, IBCLC, CD(DONA) shares what she and her organization, Uzazi Village, are doing to help reduce infant mortality in the Black community, where Black babies are disproportionately affected. You are invited to join Sherry and her team at a reception for Doulas of Color and Allies on Friday. See below for more information. I plan to be there and look forward to seeing many of our conference attendees there as well. – Sharon Muza, Community Manager, Science & Sensibility.

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© NationalHealthyStart.org

I am fresh off the trail, the Missouri Katy Trail, that is. From September 1-12th, I organized the Black Infant Mortality Awareness Walk. My goal was to walk across the midsection of Missouri talking to clinicians, academics, legislators, and policy makers along the way about the high infant mortality rates in the Black community. I chose to walk during the month of September because it is National Infant Mortality Month. I started off in Kansas City, MO and ended in St. Louis MO, walking along the Katy Trail and driving between towns. Now that the walk is behind me and the DONA/Lamaze Confluence ahead of me, its time to think about the message that doulas and childbirth educators need to hear about Black infant mortality. Black infant mortality is a silent epidemic, that is killing our babies and ravaging our communities.

If we don’t all experience equity in health care, than none of us really does. Sherry Payne

What is infant mortality? It is a statistical term that refers to the number of infant deaths (from birth to age one) for every 1,000 live births. Infant mortality rates are used as a sensitive indicator of community health. Counties, cities, even countries depend on their infant mortality rates and their rankings to tell them how they are doing in protecting the health and wellbeing of their most vulnerable citizens. The United States currently ranks 55th in the world for infant mortality at about 6 deaths per 1,000 live births. (CIA Factbook) That doesn’t sound too bad until you compare the US to other industrialized nations like Japan with an infant mortality rate of 2 deaths per 1,000 live births, or Canada with a rate of 4 deaths per 1,000 live births. (CIA Factbook). In fact, compared to other industrialized nations, the US does rather poorly on its infant mortality statistics.

© Jordan Wade

© Jordan Wade

What’s behind the high rates of infant deaths in the US? Well, if you look closely, you’ll see that the high numbers come from within communities of color, particularly the African-American community. In Missouri, for example, if you examine the data by race, you will find that infants in the African-American community are 2-4 times more likely to die prior to their first birthday than their Caucasian counterparts. (Missouri Foundation for Health, 2013.) According to the CDC, infant mortality rates have been dropping among all racial groups, but the difference between death rates among Whites and Blacks persist. Audiences I spoke to all across Missouri were shocked to learn that the African-American community experiences so much more infant death. Of course, its not just Missouri, these disparities are present throughout the United States.

What are the causes of infant deaths in the Black community? The March of Dimes lists the frequent causes of infant mortality as prematurity, and complications of prematurity. Other causes listed in the Kansas City Fetal Infant Mortality Review Report include; low birth weight, lack of access to prenatal care, delayed prenatal care, and poor quality of prenatal care, SIDs and unsafe sleep environments. These problems are often exacerbated by overarching systemic and structural racism that unfairly targets and penalizes African-American women. Here in Missouri, low income women can wait up to six months or more to be approved for Medicaid, and often may not be able to start prenatal care until they are approved.

What can doulas and childbirth educators do about Black infant mortality? Well plenty, actually. Doulas have already been shown to be effective in lowering induction and prematurity rates. (Hodnett, Gates, Hofmeyr, & Sakala, 2013.) Doulas and childbirth educators by the very nature of their work, assist healthcare consumers in being better informed about their childbearing options. Doulas provide the one on one support that is needed by any woman to boost her confidence in her ability to endure the rigors of childbirth without excessive use of interventions that can place a mother and her baby at greater risk. Childbirth educators can ensure that women understand informed consent and know how to advocate for it. They can both prepare a woman for successful breastfeeding which is protective for sick and vulnerable infants.

But aren’t low income African-American women, the women most likely to be affected by poor birth outcomes, the least likely to interface with doulas and childbirth educators? Yes, that is true. One of the ways to solve that problem is to recruit, promote, and support candidates of color into these fields. There are plenty of women of color who want to do this work, but they often lack the resources. They need the help of allies to provide resources, scholarships, internships, discounts, etc. to assist in getting through expensive trainings. Not all women of color need financial assistance, but for those who do, it can be a formidable barrier. They also need accessible pathways into the profession. If your organization is hosting a training, communicate that within your local communities of color, so that others have a possibility of sharing in the educational opportunities. Do you have women of color as clients in your practice? Invite them to consider becoming doulas or childbirth educators when the time is right for them. They may not consider it a possibility until someone else brings it up as an option.

To learn more about how doulas and childbirth educators can positively impact infant mortality in the Black community, attend my session at the upcoming conference, “Doulas in the Hood: Improving Outcomes Among Low Income Women.” You’ll learn about programs in Missouri and other states that have created successful models that link doulas with low income women. You’ll hear what we are doing here in Kansas City to bridge the needs gap for low income African-American women, for breastfeeding support, for culture specific childbirth education, and for peer model doulas.

Do Black women need Black doulas and childbirth educators? In a perfect world, my answer would be yes. It is important for a woman to have a doula or childbirth educator that shares her cultural/world view and understanding of birth and parenting. However, while there simply are not enough African-American doulas, and childbirth educators out there, those who do serve African-American clients have a responsibility to educate themselves about the issues that impact communities of color. Examine your own internal biases (everyone has them). Take a look at your practice. Would it be inviting to other women of other cultures, races, and ethnicities? Refer to Science & Sensibility’s Welcoming All Families: Working with Women of Color post from earlier this year.

Until we begin to see the problem of Black infant mortality as a problem for ALL of us, the problems will persist. If we don’t all experience equity in health care, than none of us really does.

I would like to invite any and all of the confluence attendees to join the Board of Directors of both Lamaze International and DONA International and my Uzazi team at our Uzazi Village Reception for Doulas of Color and Allies, on Friday evening, September 19th, 2014 at 7 PM. Uzazi Village is located at 3647 Troost Ave, Kansas City, MO, 64109. Hear about programs that are working to lower the infant mortality rate among black infants in our community and connect with others who share your concern and desire to affect change.

References

Amnesty International. (2010). Deadly Delivery: The maternal health care crisis in the USA. Published by Amnesty International.

Beal, A., Kuhlthau, K., and Perrin, J. (2003). Breastfeeding Advice Given to African American and White Women by Physicians and WIC Counselors. Public Health Reports. Vol. 118. p. 368-376.

CIA World Factbook https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

Cricco-Lizza R., (2006)., Black Non-Hispanic mother’s perception about the promotion of infant feeding methods by nurses and physicians. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, Mar-Apr; 35 (2): 173-80.

Fetal Infant Mortality Review 2013. A Program Report of the Mother and Child Health Coalition. Kansas City, Missouri.

Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. (2013). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews. In: The Cochrane Library, (9).

Kozhimannil K, Hardeman R, Attanasio L, Blauer-Petersen C. (2013). Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries.
Am J Public Health 2013;103(4):e113-e121.

Lee, H., Rubio, M.R., Elo,T., McCollum, F., Chung, K., Culhane, F. (2005). Factors associated with intention to breastfeed among low-income, inner-city women. Maternal & Child Health Journal Sep; 9 (3): 253-61

Missouri Foundation for Health (2013) Health Equity Series: African American Health Disparities in Missouri. Missouri Department of Health and Senior Services, Section for Epidemiology and Public Health Practice, St. Louis, MO.

MMWR Morbidity and Mortality Weekly Report. (2002). Infant mortality and low birth weight among black and white infants–United States, 1980-2000. Centers for Disease Control and Prevention (CDC). Jul 12;51(27):589-92.

Morbidity and Mortality Weekly Review (2013). Progress in Increasing Breastfeeding and Reducing Racial/Ethnic Differences — United States, 2000–2008 Births 62(05);77-80 Retrieved from CDC: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6205a1.htm?s_cid=mm6205a1_w

National Center for Health Statistics. National Vital Statistics Reports (NVSR). Deaths: Final Data for 2011

Newborn loss. (n.d.). Neonatal death. Retrieved September 15, 2014, from http://www.marchofdimes.org/loss/neonatal-death.aspx

Van Ryn, M. (2002). Research on the Provider Contribution to Race/Ethnicity Disparities in Medical Care. Medical Care. Vol. 40, No. 1 pp. 140-151.

About Sherry L. Payne

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© Sherry Payne

Sherry L. Payne, MSN RN CNE IBCLC CD(DONA), holds a BSN in nursing and an MSN in nursing education from Research College of Nursing/Rockhurst University in Kansas City, MO. She is a certified nurse educator and an Internationally Board Certified Lactation Consultant. She presents nationally on topics related to perinatal health and breastfeeding among African-American women. Ms. Payne founded Uzazi Village, a nonprofit dedicated to decreasing health inequities in the urban core. She is an editor for the Clinical Lactation journal, and participates in her local Fetal Infant Mortality Review Board (FIMR) Board, where she reviews cases and makes recommendations for improvements. Her career goals include opening an urban prenatal clinic and birth center. She would also like to work towards increasing the number of community-based midwives of color and improving lactation rates in the African-American community through published investigative research, the application of evidence-based clinical practice and innovation in healthcare delivery models. Ms. Payne resides in Overland Park, KS with her husband , where they have nine children, six of whom were home-birthed and breastfed. Contact Sherry for more information about her programs.

7 Comments

Black Infant Mortality and the Role of the Childbirth Educator and Doula

September 16, 2014 07:00 AM by Alice
You continue to open my eyes Sherry. Will post widely.

Black Infant Mortality and the Role of the Childbirth Educator and Doula

September 17, 2014 07:00 AM by Tawana Morgan
I too have noticed a increase in trends such as lack of prenatal care to low-income women not so much african-american women but also across the board. In North Carolina particular Wake County some women whom I speak with either dont know there health options or what a child educator/doula can asist with or another misconncepetion is that they work with child protective servics which is not true.Getting back to my point what can be done to improve over all health in the low-income community? I am planning on volunteering as a birth doula at my local hospital though I feel like I am not at all wanted there. Thanks for the great article it was very informational and as much as I would like to attend your conferance I can not. Will it be availale online? Thank you gain.

Black Infant Mortality and the Role of the Childbirth Educator and Doula

September 17, 2014 07:00 AM by Tawana Morgan
Sorry about the misspelling it's 3:00a.m here.

Black Infant Mortality and the Role of the Childbirth Educator and Doula

September 17, 2014 07:00 AM by Linda Stobinski-Johnson
One of the things that we now know is that preterm labor is not one thing, it is a syndrome. Dr. Robert Romero of the Pernatology Research Branch in Detroit, working with Dr. Sonia Hassan has found that for women with a short cervix (formerly called incompetent cervix) decreased their risk of a preterm birth by 40% when using a specific type of progesterone. Babies of mothers who used progesterone also has less need of artificial ventilation or supplemental oxygen. This finding is so important because 99% of the women that were part of this study over the last 2 decades are African American, with 95% of the population served using medicaid for insurance. The diagnosis of short cervix requires very close follow up and ultrasounds to check cervical length, treat any infections such as bacterial vaginosis. The city of Detroit, the March of Dimes, Meridian insurance, and other organizations are coordinating efforts to help women access quality, consistent prenatal care and the medications needed to ensure a term birth for every baby possible. If you would like to see the details on a program that is having a positive impact on lowering preterm birth rates in the African American community then check out Make Your Date https://makeyourdate.org/ Doulas and childbirth educators can help women access care, but more importantly they can bring awareness to a program that evidence shows is helping to decrease preterm birth and to lower infant mortality.

Black Infant Mortality and the Role of the Childbirth Educator and Doula

September 17, 2014 07:00 AM by Scientist Mom
We definitely have a problem with disparate impact of premature birth and infant mortality in this country. How exactly does Utazi Village work? Does it help connect women and families with social services? Provide prenatal care to women still awaiting Medicaid? Offer peer emotional support to parents going through difficult pregnancies, NICU or perinatal loss? I'm curious.

Black Infant Mortality and the Role of the Childbirth Educator and Doula

September 22, 2014 07:00 AM by Christine H Morton, PhD
Thank you for sharing this information. It was lovely to meet you however briefly in Kansas City, and I look forward to learning and working together

Black Infant Mortality and the Role of the Childbirth Educator and Doula

September 28, 2014 07:00 AM by Janice Hackney, RN, BSN, LCCE
Wonderful!!!! there are some doulas that work with low income women in Harlem NY. Should be offered more throughout the city...Induction of labor and c/section is the norm at my place of employment. Working on changing that around....

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