“I treat all my patients the same” is a statement that’s been echoed among healthcare workers for many years. But a recent push to reduce severe inequities among Black mothers and their babies has revealed this to be the wrong approach.
“We’ve come to understand that this could be part of the barrier because all patients are not the same,” Rev. Dr. Candace Kelly, birth equity lead at MemorialCare Miller Children’s & Women’s Hospital Long Beach, told the Business Journal. “They are different, and so our patients need individualized care.”
Kelly said that “aha” moment came during the early phases of Miller Children’s & Women’s hospital’s participation in a two-year cohort with Cherished Futures for Black Moms & Babies.
The impetus for a new birth equity initiative has spurred training for the hospital’s staff which largely focuses on listening to the needs of pregnant Black women, who repeatedly report that they feel unheard, disrespected and excluded from their own birthing plans.
Largely, it is believed that implicit bias and structural racism has long plagued the healthcare system.
“Recognizing and understanding the historical implications of obstetric abuse and racism and its consequences is essential to the work that we’re doing,” Kelly said.
The hospital, which serves one of the largest numbers of Black mothers across Los Angeles County, was among two other hospitals within the county selected to participate in the cohort.
After a year of research and planning, the hospital is currently in its second year of the program, an implementation phase that involves teaching and training for nursing and hospital staff alike.
“We know from the data and from many stories, Black mothers have increased morbidity and mortality rates,” Susan Herman, chief nursing executive of Miller Children’s & Women’s Hospital said. “How do we make sure that we listen to their unique needs and their perspectives to give them what they would like, in the best possible way for their birth plan?”
Recent data tells a dire story: The preterm birth rate among Black women is 50 percent higher than for white or Asian women, according to the LA County Department of Public Health Maternal Child Health. According to the LA County Lamb Survey, Black women are four times more likely to die from pregnancy-related complications compared to white women.
“We need to change practices forever to eliminate these things,” Kelly said.
Black women also report discrimination when getting medical care more than other racial and ethnic groups, according to the Lamb Survey.
“We’re trying to overcome all of those barriers to make them feel heard,” Herman said.
One clear example of this has been the prioritization of vaginal deliveries for patients over cesarean sections, which requires general anesthesia for the surgical delivery of a baby through the abdomen.
“There’s a tendency to perhaps rush things along and maybe say ‘Let’s just do a C-section. It’s easier, it’s more convenient,’” Herman said. “There’s less risk to the mother if they have a vaginal delivery.”
A vaginal delivery is the most natural form of labor and when it’s feasible, it’s the safest way to deliver a baby. Alternatively, a C-section should typically be reserved for emergencies. Hospitals are also rated on a measure that reports the proportion of babies born through a cesarean section procedure.
Last year, Miller Hospital reported that its cesarean birth rate was about to meet the statewide target of 23.6%, down from 35% nearly four years ago.
“Our task is to honor and to sit with our patients to find out exactly what they need, and then we can treat them accordingly—with respect and dignity,” Kelly said.
But the effort isn’t just focused on the delivery of the baby. Promoting prenatal care and post birth care should also be wrapped into a healthy plan for pregnant mothers.
“Someone that comes in just to deliver is certainly at a higher risk because we don’t necessarily know their condition or the baby’s condition,” Herman said.
That’s where community partnerships come in. Through the birth equity effort, the hospital aims to connect patients with organizations like the California Breastfeeding Coalition and Food for the Soul.
“Women of color have lower rates of breastfeeding, so we’re working with Cherish Futures, who have women advisors in the community,” Herman said.
A patient survey conducted by the hospital at the start of the birth equity initiative revealed that the hospital staff wasn’t doing the best that it could, according to Herman.
“And so how do we redirect them, retrain our staff?” Herman said.
Within the hospital, through a partnership with AWHONN, an association that helps provide training and support for nurses, the hospital has adopted the Respectful Maternity Care initiative to help retrain staff in five areas.
“Agreeing to sit with our patients, provide evidence based medicine, listen to understand, be present and [to be] open to our patients past and present experiences to make sure that we talk with them in creating the experience that they desire,” Kelly said.
Herman also stated that the hospital does not discriminate in any way based on a patient’s ability to pay.
“Everyone is welcome here, that’s never a question,” she said.
The results have already pushed the hospital’s scores, surveys and patient-reported experience metrics up in a positive way, Kelly said.
While the collaboration with Cherished Futures will end in December, Herman and Kelly say the Long Beach hospital is currently in talks to figure out how the program can be sustained.
“We certainly will continue this incredible work that we’re doing, because it works, we’re getting results,” Kelly said. “Our mommies are happier and we’re just very pleased all around for what we’re seeing in our families and our birthing experiences.”