Advocates strive to improve maternal mortality rate among Blacks in Las Vegas | Congressman Steven Horsford
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Advocates strive to improve maternal mortality rate among Blacks in Las Vegas

January 7, 2022
When Erika Washington was giving birth on three separate occasions, her doctors would yell at her or contradict her, saying she was not in labor and instead give her an Ambien.

She felt intimidated to ask questions.

"We have war stories," Washington, executive director of Make It Work Nevada, said during a recent listening session about Black maternal mortality with Nevada Democratic Rep. Steven Horsford. "I never thought about the fact that it really shouldn't have been that way. I really shouldn't have had all of this trauma."

Many Black women have had similar experiences to Washington when giving birth, and advocates are pushing for increased access to alternative birthing methods, such as doulas and midwives, to help improve equity in health care for Black and Latino women.

Between 2000 and 2015, 67 pregnancy-related deaths occurred in Clark County, according to a 2016 study in the Journal of Forensic and Legal Medicine. Thirty-seven of those were labeled as "unnatural." Of those 37 unnatural deaths, 21.6% were Black and 45.9% were White.

Considering Las Vegas' population is 61.88% white and 12.23% Black, the data shows proportionally Black women are more likely to die in pregnancy-related deaths. Nationally about 700 women die each year from pregnancy-related causes, according to the federal Centers for Disease Control, and Black women are 2 to 3 times as likely to die from a pregnancy-related cause than white women.

One of the reasons there is a disparity is due to a lack of cultural competency and a lack of interest in listening to Black patients, said Democratic Assemblywoman Shondra Summers-Armstrong. There is a false narrative that is repeated in which Black people are strong and don't need this or that, she said, or that they are being dramatic when giving birth, she said.

"Those wrong ideals are leading to health professionals in many instances not listening to what we're telling you that our bodies are telling us," Summers-Armstrong said.

Nevada Democratic Assemblywoman Clara "Claire" Thomas thinks Black women are being victimized through the health care industry.

"They have determined that we can withstand so much pain, that we can withstand childbirth and that we don't have any problems that they recognize," Thomas said. "And this is not true."

Thomas has four healthy grandchildren, but there could have been a death due to the lack of care from her daughter's doctor, she said. During her daughter's first pregnancy, her daughter had preeclampsia, a pregnancy complication, and did not know about it until two weeks before delivery.

"If it hadn't been for a nurse practitioner who had seen the symptoms, we probably would have lost my daughter along with my first grandchild," Thomas said.

"When we tell people that our doctors, that we trust, are not paying attention to us," she continued. "This is an issue that we have to ring that bell real loud and clear. That this is something that is vital to our Black community. Because our babies matter."

Advocacy groups have been brainstorming solutions to help remove barriers and hurdles for Black women, Washington said.

"Most people don't even realize just how dire it is," Washington said. "We are literally basically a Third World country when it comes to giving birth as a Black woman."

Increase access to alternatives

Make It Work Nevada, an advocacy group for women of color and the issues they face, conducted a survey of 1,217 Black women and found that only 1 in 4 felt "entirely heard" by their doctors. When brainstorming solutions through focus groups, the organization found that expanding doula services will help, said Deputy Director Quentin Savwoir.

Using doulas and midwives to give birth have been on the rise in recent years, especially with the onset of the pandemic when people opted for at-home births instead of the hospital. Advocates also think that using community-based doulas and midwives could help bridge the equity gap for Black and Latino women.

Doulas are birth workers who are trained to provide physical, emotional and informational support to pregnant people in the prenatal, birth and postpartum periods, according to the Center for American Progress. Midwives focus on the baby, providing prenatal care and delivering the infant.

Research from underserved populations shows that doulas have a positive influence on labor and birth outcomes, according to the Journal of Perinatal Education.

Doulas can shorten the length of labor and lower the rates of epidural use and cesarean surgery. If a mother still wants to deliver in a hospital, the doula can advocate for the mother in the hospital room.

Make It Work Nevada successfully pushed for Medicaid coverage of doula services in the 2021 Nevada Legislative session, and that law (Assembly Bill 256) went into effect Jan. 1. The bill also requires a doula to report if a patient they are seeing has signs of abuse.

A'Esha Goins, organizing coach for Make It Work Nevada, said the group was increasing the number of birthing professionals to make sure the law has success as it rolls out. The organization put together a cohort of birthing professionals to learn what their needs are, what they need more of and what they don't have, Goins said.

"We're not just amplifying the space for doulas," Goins said, "but that we're really conscious of creating a new industry. Even though doulas have always been recognized as their services being important, when you put policy in place you're saying this is a new industry, and we recognize this."

Jollina Simpson, a traditional midwife, doula trainer and lactation consultant, runs a community-based support system for Black and Latino people who are lactating as well as doulas in the community to help them continue working.

"We want to make sure that we are establishing a community that is there not only to support the birthing people, but also the people doing the work who can maintain and sustain so they can continue to fill the pipeline with Black and brown midwives, doulas, lactation consultants."

Another bill that went into effect at the start of the new year is one that provides regulation for free-standing birthing centers, which would create another healthy birthing outcome option for families, said Democratic Assemblywoman Daniele Monroe-Moreno, who sponsored the bill.

"I was one of those moms that the doctors wouldn't listen to when I said there is something going on with my body and almost died because of it," Monroe-Moreno said. "It hits home."

The law is especially important for rural areas where people do not always have access to hospitals, she said.

Assembly Bill 119, which passed at the 2021 session and went into effect in May, authorizes the Maternal Mortality Review Committee to identify and review disparities in maternal mortality and provide a summary of those disparities to the director of the Legislative Counsel Bureau.

"Black women are dying at a rate that is higher than any other ethnic group," Thomas said. "That should not happen. Why is it happening? So Assembly Bill 119 will address that."

And while laws are going into effect that will aim to address birthing inequities and reduce Black maternal mortality rates, advocates continue to push for more.

Melva Thompson-Robinson, a professor in social and behavioral health at UNLV and the executive director of the Center for Health Disparities Research in the School of Public Health, said she was working on a project that would integrate maternal and child health as well as nutrition services in the West Las Vegas area.

They will be conducting interviews with medical care providers, pregnant women as well as women with children under the age of 2 to get a better idea of what kind of services are being accessed and what kind of services are needed, Thompson-Robinson said. Then they will come up with an intervention and will pilot test it.

"We could really rethink health care for Black moms, if we really had all the things at our fingertips and what that would look like," Goins said. "How would we really want our children to be born, and how would we want our mothers to be taken care of? … What are the places that we're missing? And then let's think about that and create policies that would strengthen that and bridge that gap."

For his part, Horsford said he would take the women's messages to Washington and advocate on their behalf.