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January 31, 2020

Taking the Risk Out of Motherhood

The increased maternal mortality rate among black women holds true across income and coverage status.

The country with the most expensive health care costs in the developed world is also the most dangerous one for women to give birth.

If you’re black, the risks are three to four times greater.

Black infants also are twice as likely to die in their first year, and up to three times more likely to be born prematurely or underweight, which can lead to a lifetime of health challenges.

Then why is there a prenatal and postpartum care clinic in Orlando where those numbers don’t hold true?

It might be because women there are welcomed with respect and support, regardless of circumstance.

“When women are shamed, treated poorly, turned away, and left to fend for themselves, we won’t acknowledge the impact it has on outcomes. We’re not judging them or rolling our eyes when they’re 36 weeks along and haven’t seen a doctor yet, or five minutes late after taking three buses to get here,” said Jennie Joseph, a licensed midwife and the founder and executive director of The Birth Place in Orlando. She recently opened a second Orlando location. She and a team of about ten serve 800 to 900 women a year.

Joseph calls her approach the “JJ Way,” based on “the premise that every woman wants a healthy baby and deserves one.”

Some 700 women die from pregnancy-related complications every year in the U.S. The majority could have been prevented, according to the Centers for Disease Control and Prevention (CDC). The majority of deaths occur postpartum, in large part because of heart disease and stroke, high blood pressure, severe bleeding, and infection.

The research points to determinants such as access to affordable health care coverage.

Though insurance has obvious value, the increased maternal mortality rate among black women holds true across income and coverage status.

“Insurance doesn’t matter when there’s a stigma attached to it,” Joseph said.

One emerging theory behind the increased maternal mortality rates among black women is toxic stress.

Implicit racial bias in health care can affect patient-provider interactions, treatment decisions, patient compliance to recommendations, and patient health outcomes, according to a report by the CDC.

But Joseph and her team mitigate stress by acknowledging that every woman who walks through the door is capable of fulfilling the role of motherhood, even in cases of drug use, homelessness, or those deemed “high risk” by mainstream practitioners. She believes this is why almost all her patients buck the statistical odds and have healthy outcomes.

“We’re not blaming or scaring them or wagging a finger in their face. That alone impacts physiology. It’s not that complicated or hard. It’s about the societal and political will,” she said.

Medicaid, a safety-net program for those with limited income, pays for more than half of Florida births and typically covers mothers only through 60 days postpartum.

Two bills in the Florida Legislature, Senate Bill 6128 and Senate Bill 6106, aim to expand Medicaid coverage from 60 days to 12 months postpartum.

While that’s a step in the right direction, it will have little impact on how Joseph and her team operate.

Her long-term goal is to make her clinic, “retail and franchise it. Then we might see some real impact on the disparities. We’re just a drop in the bucket,” she said.

This story comes from Aspirations Journalism, an initiative of The Patterson Foundation and Sarasota Herald-Tribune to inform, inspire, and engage the community to take action on issues related to Age-Friendly Sarasota, Suncoast Campaign for Grade-Level Reading, National Council on Aging and the Suncoast Nursing Action Coalition.

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