Despite income and other socioeconomic factors, Black people are two to three times more likely to die during childbirth or within the year after than white people, and Black babies are three times more likely to die than white babies in the U.S., says Dr. Jennifer Savitski, Cleveland Clinic Akron General chair of obstetrics and gynecology.
“We are really facing a crisis,” she says. “Institutional and structural racism exists within our communities.”
Racism can affect relationships with doctors and create mistrust. A George Mason University study showed the infant mortality gap is smaller when Black doctors care for Black babies versus white doctors. Other factors include quality in health care, underlying chronic conditions, implicit bias and more, according to the Centers for Disease Control and Prevention.
To combat this, Akron General is one of four U.S. hospitals to take part in the Maternal HealthCare initiative, a partnership between the March of Dimes and U.S. Department of Health and Human Services. An aspect of that is TeamBirth, which was developed by Ariadne Labs and is enacting Maternal HealthCare recommendations to address disparities.
Akron General is adopting recommendations including ensuring it has accurate race and ethnicity patient data, enacting anti-racism practices, considering recommendations from a March of Dimes community accountability panel and creating more transparency for patients.
For the latter, a solution is a planning board with the pregnant person’s team members and preferences, plans for the patient and baby, labor progress and when the next assessment occurs — so patients have more autonomy in labor, which doesn’t always happen.
“We have changed the way the conversation happens so that the patient is a part of it,” says Savitski, offering an example of a mother who struggles with addiction. “What does narcotic use mean to them? What does it mean to the baby or the labor progress? We shouldn’t be embarrassed or reserved about having an open and honest conversation.”
Another disparity is cesarean section rates, which are 35.8 percent for Black women and 30.9 percent for white women in the U.S., according to the March of Dimes. A goal of TeamBirth is to reduce C-sections, which Savitski says increase the risk of problems for the patient during labor and subsequent pregnancies. By getting patients more involved in their health care, TeamBirth can reduce risks and potentially save lives.
“This model forces us to find language and ways to care for patients that put them at the center of the care,” Savitski says, “not what we want but what’s best for the patient and what the patient wants.”
