This Black History Month, America’s Essential Hospitals spotlights Black history in the making at association member hospitals as they work to ensure the highest quality care for Black patients and pave the way for Black leaders in health care.
Historically, structural racism, implicit bias, and other social determinants of health have prevented Black patients in the United States from receiving rightful and equal health care, and the lasting effects of these barriers are especially evident within obstetric care.
According to the Centers for Disease Control and Prevention, Black birthing people are three times more likely to die from a pregnancy-related cause than white birthing people.
In California’s Bay Area, which encompasses nine northern California counties, including Alameda County, Black birthing people are three to four times more likely to die from childbirth compared with white people. Black babies in the region also are two to three times more likely to be born prematurely, be born too small, or die before their first birthday.
“The truth of the matter is we don’t feel safe,” says Danielle Davis, program specialist at the Alameda County Public Health Department.
The county’s health department and public health system — association member Alameda Health System, in Oakland, Calif. — recognized the need to create a safe space for Black birthing people that meets their unique needs and reduces the dangerous gap in obstetric outcomes.
In 2020, Alameda Health System and the Alameda County Public Health Department launched BElovedBIRTH Black Centering, a prenatal and postpartum care program designed “by, for, and with Black people.”
“We call it ‘for us, by us’ care,” says Davis, who serves as a facilitator for the program. “We have Black midwives, we have Black group facilitators, we have Black nutritionists, we have Black doulas. When you’re cared for by people that look like you, you receive better care and you’re able to be yourself.”
Upon taking and receiving a positive pregnancy test at any of Alameda Heath System’s facilities, Alameda Health System patients who identify as Black and are covered by Medi-Cal, California’s Medicaid program, are invited to enroll.
The no-cost program seeks to cultivate a positive and uplifting pregnancy experience for Black families through a centering care model, in which eight to 12 pregnant people with similar due dates can participate in 15 two-hour group visits from early pregnancy through the early postpartum period.
During the group visits, patients gain resources that can ease their pregnancies and prepare them for childbirth and the postpartum period.
“We talk about how to breastfeed, what the baby’s poop will look like after a few days [and] after a week, different moods [they] might be in and what they need, when [to] call for help,” explains Lonzaya Williams, coordinator at BElovedBIRTH Black Centering.
Participants also are offered social services, including employment and housing support, produce boxes and postpartum meal services, and support groups where parents can share experiences and build relationships.
“The community that’s provided in the group is really needed,” notes Williams, adding that group members range from all ages. “It’s just pure wisdom every time.”
Participants are even given the opportunity to do family photoshoots as they await the baby’s arrival.
“It can be really challenging trying to navigate the systems and receive overall care when you have to jump through hoops to get the service,” Davis says. “Here, we have your health care and your community support in one.”
Davis explains that the program’s uniqueness in having Black group leaders is critical for improved obstetric care in the community, as Black birthing people often struggle to find care from those who look like them, which would help them feel more comfortable and understood.
Today, just 11.1 percent of all obstetrician-gynecologists (ob-gyns) in the nation are Black.
“It’s like pulling teeth trying to find someone that looks like you to receive support, and it’s frustrating,” explains Davis, who added that her passion for creating a safe place for Black birthing people comes on a personal level.
“Having the experiences that I had going through pregnancy is really why I got into the work, because [I remember] what it was like to go to my prenatal appointments and not be listened to,” she says. She gave birth to her own two children in Alameda County and recalls feeling that her doctors did not meet her medical needs.
Davis is not alone. Black patients across the country have consistently reported feeling overlooked and ignored by their health care providers during pregnancy, and often leave their appointments with questions still unanswered, she says.
Therefore, BElovedBIRTH Black Centering’s work also revolves heavily around encouraging Black birthing people to advocate for themselves in medical settings.
“A lot of what we talk about is having your own autonomy to ask questions. To say no. To have providers explain to you what they’re doing and why,” says Davis.
BElovedBIRTH Black Centering has transformed Black obstetric care in Alameda County, empowering families and creating an environment where birthing people feel safe and heard. The program received the 2022 Quality Leader Awards Top Honor from the California Association of Public Hospitals and Health Systems and the California Health Care Safety Net Institute.
“It just feels so good to support people that look like me and hear people say, ‘I’m so thankful for this program. I don’t know what I would’ve done without you all,’” says Davis. “It gives us sort of the juice to keep going and knowing that we’re hitting the mark and we’re doing something right.”
As similar programs arise nationwide, both Davis and Williams say they’re hopeful for the future of obstetric care for Black birthing people.
“This is literally pouring into the next generation,” says Williams.