Understanding Black Maternal Health: Midwife Q&A

Today on At the Forefront Live, Black women in the United States experience poor maternal health outcomes including high rates of death related to pregnancy or childbirth. Both societal and health system factors contribute to high rates of poor health outcomes and maternal mortality for Black women, who are more likely to experience barriers in obtaining quality care. Of course, COVID-19 doesn't help with any of this. Advanced practice providers, Cynthia Jacinthe and Karie Stewart will answer your questions as we all seek to better understand how to manage maternal health. That's coming up right now on At the Forefront Live.


And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. Let's have each of you introduce yourselves and tell us what you do here at UChicago Medicine.


Hi, thank you for having. My name is Cynthia Jacinthe. I am certified nurse here at the University of Chicago. I have been in midwife for the last almost 13 years now and at the University of Chicago for the last four. And my current role at the university is the director of Midwifery Services.


Hi. Thank you for having us today. I'm Karie Stewart. I have been a midwife since 2017 I worked in southern Illinois as a midwife and I currently work at the University of Chicago with Cynthia and I have been there for a little over a year and a half now.


Karie, if we go with you, let's talk about Black women specifically and what happens when people don't receive the proper maternal health care and obviously, the outcomes are not where we want them.


Correct. Unfortunately, here in the United States, Black women are three to four times likely to die from childbirth or pregnancy-related conditions. And so here in Illinois, according to the 2018 Illinois Maternal Morbidity and Mortality Report, Chicago has the highest rate of pregnancy-related mortality rates. So when women don't get access to proper care and have means to do so, it can be life-threatening.


We hear a lot about some of the racial impacts that happen within health care. And I know here at UChicago Medicine, it's something we take very seriously. And your teams have certainly worked very hard to try to overcome some of those issues. What are we talking about there? What do you see and how can we be better just as a society?


We all have a part that we can play in making things better. Here at the University of Chicago, Cynthia and the OB department has been very instrumental in making sure that our staff is very diverse. We have a very diverse staff and patients are very satisfied with the fact that the department midwifery group reflects the population that we serve.


So let's talk a little bit about COVID-19 and the impact that we're seeing from COVID-19 on maternal health. And Karie, I don't know if you want to take that one as well. It seems like COVID-19 has an impact on everything. So I'm sure we're seeing things there, as well.


Unfortunately, it has. With the impact, the stay at home orders, the social distancing, children are at home now newly home schooling. And so it makes for a stressful time for our pregnant moms who are trying to handle whether they've lost their job or they're trying to find childcare, whether continue to work during the means of such a pandemic. And so we are hearing this and experience this from our patients as they're trying to find transportation and child care and income, even, at some point to prepare or feed their children and their families.


So let's talk a little bit about midwifery as well, because to me, that's very interesting topic. That's what you both do. And if we can kind of talk, what are the benefits to what you do for women who come in and give birth here? And either one of you can jump on that one.


I think Karie can answer that.


Yeah, midwifery, we are advanced nurse practitioners, both of us are registered nurses, have worked as nurses before. And that's the route that we chose. And then we went into a nurse practitioner program, and that allowed us to have more responsibilities, and providing reproductive care, and actually catching babies for many of our patients in the community and where we've serviced.


So we worked to the full scope of our practice. We provide prescriptions. We provide education. And sometimes, patients prefer a midwife, because it just feels a little bit more personal. And especially patients really want to be able to experience a provider that looks like them. And so our practice has really been purposeful in doing so-- that the community comes in and feels welcomed and joined. But we don't do surgery, but we do provide gynecological care, as well.


And Karie, part of what you do too really is advocacy for moms and getting there through the whole process. Can you talk to that a little bit?


Correct. We intentionally like our patients to come in for a preconception counseling if they desire, but sometimes, that's not always possible. But we pride ourselves on our education, doing that first visit. And we are very thorough about the things that we offer, that we don't offer.


We encourage doula support services, because it takes a collaborative effort for mom to have the experience that they desire. And that's important. They're going to be comfortable. They're going to remember this experience for the rest of their lives. So anything that the midwives can intentionally do to make that experience the best as possible, that's our goal.


And we're getting some questions from viewers and these are great questions. So I'm going to throw Cynthia, we'll give you the first one. And this one they're asking is University of Chicago encouraging rooming in for COVID-positive moms and their newborns after delivery? Because I'm sure there are some instances where we do have some moms that have tested positive for COVID.


Yes, so we do have a current policy that we do allow rooming in, but we also give you the option whether you want the baby to be separated. So at the time of admission, we test all moms, whether they are symptomatic or not, to make sure they're not COVID-positive. And if they are, there is another discussion of whether they want us to allow the baby to stay with them or have them separated for safety.


But if the babies decide to stay, then we still have to adhere to those precautions. We advise moms to still wear the masks, visitors wear the masks, and have the cradle six feet away. You can still breastfeed, you can still bond, you can still do skin to skin. So we give moms that option. But we give them the full patient counseling beforehand to make an informed decision.


I was going to ask about breastfeeding, because I think that's always, obviously, a pretty important topic for new moms. And if a mom does step parent test positive for COVID, does that impact breastfeeding or not?


They should be breastfeeding. Breast milk is the best milk. And of course, if the patients are struggling, we have a wonderful lactation consultant team that will assist them in that. And not everybody can breastfeed. And we are very respectful and understanding of that. And we do provide a formula if they need to go that or desire to go that route. But we encourage breast milk. And it's very helpful for moms to have support in that process, as well.


That's great. Another question from a viewer and either one of you can take this one. This question is, as a pregnant Black woman, I hear a lot about how I'm impacted by health disparities and higher rates of death, but I don't hear as much about how to advocate for myself during the labor and postpartum periods, particularly during a pandemic with limited resources and decreased ability of advocates during care. How can I ensure that I'm taking care of well and I'm safe? So I think that's a great question. How do people advocate for themselves?


Karie, you can start and I'll jump in.


You know, within our practice, we are very diligent about our patients having a birth plan. Now we are very aware that sometimes that birth plan may go a different route, but we have a beginning, a basis of how you would like things to go and what your desires are. And our very first visit is pretty thorough that we talk about what we offer and what we recommend.


And then halfway through the pregnancy, we continue to have these conversations so that some of the things that may arise on the labor and delivery floor when you are in labor, it's not a surprise. You've been very prepared for some of the things that you might experience. And if you don't experience them, great. But we're very prideful in the fact that we want our patients to have a birth plan, write that out, so we can discuss those desires.


If you can have a doula, have a doula. We are allowing your partner and your doula into your delivery. And so if your partner knows your wishes, your doula knows your wishes, and then your midwife knows your wishes, you have three advocates right there.


You just-- I'm sorry, Cynthia.


Sorry. Just to also really speak up and advocate. It is a collaborative agreement. We're working collaboratively with you. I am not in control of your body, I'm not in control of your birth, I'm not in control of the labor. All I'm here is to facilitate an uncomplicated, smooth, natural, physiological process.


And at any point, feel free to ask your midwife, your doctor, whomever is taking care of you, saying, hey, what's going on? I don't understand that this is. Is this necessary? Just really ask us any questions as you need to really get a better understanding of what's going on, especially when things change. Like Karie said, the best laid plans, things happen, and I think go unexpectedly. But the best thing to do is really advocate for yourself, talk up, ask questions, and make sure you understand what's going on before moving forward.


It's interesting, because I know you've received questions in the past about visitors and people being there during the actual birth process. And Karie, just mentioned that partner can be there, a doula can be there. And so you actually can have that support while you're going through the birthing process, which I think is obviously very important. Can one of you talk to us a little bit about the doula's role and what does a doula do?


Yes. That's a really common question-- what's the difference between a midwife and the doula. And they think you have to have either/or, you can't have both. So the main role of a doula is to provide support for that woman in that time of labor and birth and sometimes even postpartum. So they're there to provide recommendations for position changes, sometimes, they provide massage with permission. They advocate for you when we're talking about change of plans that happens sometimes during labor.


They help you during the pushing phase. They help you with breastfeeding. They help you during the postpartum period. So the main focus of that doula is just to be with the mom. Her focus is just on you. With the midwife, sometimes, we have another patient that's in labor. We come in and guide you through the labor and birth. And we actually check your service, how your progressing, and usually, we obviously do the birth.


But we can't be at the bedside all the time, unfortunately. We try to be as supportive as possible, but if we have two women in labor at the same time-- sometimes three-- that's happened before-- having that extra support person, having that doula who will physically be there constantly for you and with you at the bedside to provide support. And basically, your cheerleader as well, because sometimes, labor is a long, long process. And you need somebody that's going to continue to help you get through and give you positive affirmations and really support you through that process.


That's great. So let's talk about how things have changed a little bit during COVID, because I know that's been a real issue we've received many questions over the past few months on. People that to some degree might do a little afraid to come into the medical center, which there's no reason to be afraid. But one of the reason ways that you reach out to your patients is through video visits.


And I know we were speaking before the program that you all have those happening, in fact, this afternoon, so we've got to make sure we get out on time. But talk just a little bit about video visits, your thoughts on that, how well they've worked for you. And Cynthia, I don't know if you want to start with that, because we were talking about it before the show.


Yeah. So I embrace video visits. It's really a good tool to still engage our patients when they can't come in for those visits. So as we mentioned before, we have a kind of hybrid template, where we alternate in-person visits with video visits. And we try to limits those in-person visits to the times that you need ultrasounds or lab work. We try to make it an all-encompassing visit and to see your provider, do the usual and listen to the heartbeat.


But the video visits can be used a majority of the time just to do a quick check and see how you're doing. You can actually see our patient's faces now, because in the hospital, we actually do universal masking. So it's another way to kind of continue to connect and bond with our patients. It's still limited. Obviously, we can't do a physical exam, we can't always look for heart tones. But we're reassured when we talk to our patients that they're feeling fetal movement, they're not complaining of any pain or bleeding. If anything changes, there is always an opportunity to come into the clinic if necessary. But if everything is fine and the pregnancy is going well, both video visits give us an opportunity to stay connected with our patients and allow them to adhere to social distancing amidst the COVID.


You all are doing house calls again?


Basically. 21st century house call, that is a great way of saying it there. That is perfect.


And it's funny, because one of the other providers had mentioned that to me. And it just really kind of just like the light bulb went off over my head. It's like, that's exactly what you're doing. And you can actually interact with other family members that way. And that's pretty neat, really, I think. It's a great, great, great tool, and I'm glad we're embracing that here at UChicago Medicine.


And Karie was going to say something real quick.


Sure, Karie. Go ahead.


Just to echo on back on what Cynthia was saying. Our patients really enjoy them, because it allows us to talk a little bit more about things. When you come into the office, you're on a time a little bit. You have only 15 minutes, and you kind of got to get those important questions in. And so the video visits allow us to have a little bit more thorough conversation if we want to know about what's happening at home and are you feeling supported, and do you have the things you need, and how is work going, and are you wearing your mask.


You know, just making sure the overall, not just their pregnancy, but mentally and physically and emotionally that they're supportive. This is a tough time for everyone. And especially to be pregnant during this time, we want to make sure our patients are supported.


And I mentioned, Karie, for a lot of the patients, it's probably a little bit more of a comforting atmosphere for them, because they're home.


Right, right.


So we have a couple more viewer questions that I want to get to as we have about 10 minutes roughly left in the program. One is, how do I get a doula?


We work closely with Chicago Volunteer Doula. So that's one resource. And just look in your community, ask around. A lot of our patients have used doula services in the past and they refer them out. So there's a lot of opportunities to find that will work for you.


Great. Another question from a viewer. And Karie, if you can take this one. Are there specific communities that don't get enough support with breastfeeding? Would you be able to talk about first foods insecurity in Chicago?


On the South Side of Chicago, we have experienced food deserts. And now that we're in the midst of a maternal health desert, it adds to the stress. So when patients don't have access to the means to have the healthy foods, they only choose what's offered and what's available. And so unfortunately, we want to be able to promote those healthy choices. Iron-fortified foods, fruits and vegetables. And we need entities to provide those.


The neighborhoods surrounding University of Chicago has been very purposeful in providing for stores, but we need more options. And especially with these times, we want to make sure all of our patients have access to what they need nutritionally.


And I've seen some of the community gardens also that exist that are great, but they can only do so much. And of course, during the winter, that's a little bit more of a challenge and less food has been put up. So to your point, I think there needs to be more help in that area. And it's difficult-- if you don't have transportation, you can't go five miles or 10 miles to a grocery store. So that's got to be pretty challenging for moms that are in situations where they just can't get the food that they need that's good for them and their baby. More questions--


The South Side--


Sure. I'm sorry, go ahead.


Just thinking about how the South Side organizations have also been very supportive of families and moms during this time, putting together packages for pregnant moms and families and their children. Some of the neighborhood schools are still offering the meals that they would normally have during the school. So it's been a collaborative effort to make sure the community is taken care of. And it has to continue that way.


Great. Another question from a viewer-- and we were talking a little bit about the video visits just a moment ago-- this is a great question. How video visits mitigated for women that don't have access to maybe some of the tech that is needed?


You can just transition to a telephone call. If your phone doesn't have a camera or you don't have a computer or a laptop or anything like that, we could easily transition that to just the simple phone call. As long as you're still being seen or speaking to a provider, that still counts as a telemedicine or telehealth visit.


And we do want to remind people that it is safe to come to campus. If you really need to see a provider, we certainly want encourage people to make the appointment and come in, because your health is obviously more important than anything. And we will be very careful. Our providers are very careful. And so if you need to see one of our providers, please don't avoid that because you're afraid of COVID.


That's one of the things that I think we're all a little worried about-- that there are people that are putting off care. And I've spoken with some providers who said they've seen examples of that. And it's to the detriment of the patient. So we don't want that to happen. Come in if you need to come in. More questions.


Yes, please.


This one, Karie, is for you. Any current health initiatives or legislation to help support and improve maternal health outcomes for Black women? What's going on there?


Absolutely. Lots of stuff happening in 2020. Lots of good stuff still happening in 2020. So in March, Senator Kamala Harris and Congresswoman Lauren Underwood and Alma Adams brought to the table the Black Maternal Health Omnibus Act of 2020. And so this bill is to end preventable maternal mortality rates in the US and close disparities that happen in pregnancy.


There's nine individual bills that were supported and sponsored by the Black Maternal Health Caucus. And they are very important to changing these numbers that we're experiencing here in the United States. Unfortunately, the United States is experiencing more deaths than other countries, and it should not be that way. We are a very wealthy country and so we should be able to support our patients and listen to our patients. And make sure they're involved and educated and supported initially to make sure that they feel comfortable in asking us questions. To ask and carrying that through their pregnancy.


Well, it's nice to hear we have some positive things happening in 2020. It's been a rough year so far. So another question from a viewer. If you learn that an expectant mom-- and you kind of already spoke to a bit, but maybe we can get into a little bit more detail-- but if you learn that an expectant mom is having some challenges at home-- food security, maybe financial issues to get to and from the hospital, that sort of thing, can you connect them with programs that can be of assistance? And if people do need this assistance, how do they reach out?


So luckily, we have an amazing social work system, an amazing social worker dedicated to the OBGYN department. So when we identify these issues with any of our pregnant patients, we refer to that resource immediately. And she has a slew of resources available at her position just to share with women and just to make sure. We have really good follow up just to make sure that-- sometimes, you just fall through the cracks or you aren't able to follow up for whatever reason-- we do check in just to make sure, did you reach out to the department. Did you reach out to this program that we talked about.


And we just continued to follow up. And that's why I'm having these conversations is really important. Having the time for these visits is really important. And that's another benefit of the video visits that Karie alluded to-- it allows more time for it to identify these issues.


And another good thing about video is if you can do it on camera, you can kind of see what's going on in the background in your patient's home. Is it unkempt, is it clean, is there a lot of clutter going on, are there family members, is she supported, is she kind of hiding out? You can kind of sense what's going on through the video visits, whereas when you're in a clinic, you have no idea what's going on at home.


So it's like a little bird's eye view also into what's going on. So we definitely have resources for our patients. We definitely refer them to social work, if needed. Also, in terms of mental health and follow up in postpartum, we keep in close contact with you, as well, during those times. And we have resources for all those.


You know, I'm glad you say that, because I think a lot of times, people, they either don't know to ask for help or don't want to ask for help. And the help is out there. And nothing is worse than somebody missing out on the opportunity to get some help when they really need it. So hats off to both of you. It's wonderful that you do that, because I think that's just so important.


And this is not a question, but it's addressed to both of you, and it comes from Facebook, from our audience. I think this is really. Nice. This is a confirmation that I needed. I'm switching to the University of Chicago. So job well done, you guys. That's awesome.


But again, it shows that we've got caring staff here. That's 100% true. And when they interact with you all and the other providers, it's very, very obvious. And it's a nice thing to see. We got time for one final question and this is a big question, so both of you-- I'll just throw this open to both of you. It's just, what is the future of Black maternal health and midwifery look like in Chicago and the US?


It looks promising. It looks great. Go ahead, Karie.


Yes, yes, very promising. Unfortunately, we are experiencing a health desert-- a maternal health desert and a health desert, period, on the south side with a couple of closings of labor and delivery units. And so patients are being feeling very stressful. And so we really want to make sure our patients are supported, that when they come to the university or any other hospital, that they are empowered and have all the information that they need about their care.


This is what I've had, this is what I've been diagnosed with, these are my labs. We want to make sure there is a collaborative effort in the community. We want to provide other maternity delivery options. And midwifery is not a one size fits all situation. We have home birth midwives, we have birth centers, we have midwives that work in the hospital. And then we also have the doctors that need to handle those patients and their conditions, as well as high-risk doctors.


So it's a culmination of teamwork. And the University of Chicago has the opportunity to provide that broad spectrum care. No matter where you fall, we can take care of you. And so that's what I hope that South Side of Chicago will look like in the future. There's no pregnant woman we can't provide services to.


Great. Cynthia?


Yeah, we play, an integral role into that-- just like something Karie alluded to-- it is a team effort. So if you're a low risk, uncomplicated, no issues-- the majority of women can fall within midwifery care. So if you're part of that risk group, you could get midwifery care. But like we said, at University of Chicago, we have opportunities to see maternal fetal medicine. You have the opportunity to see our regular OBG. If anything comes up that we could do work collaboratively-- oh, if, we need to transfer your care.


So there's opportunities to see different providers depending on where you fall. And allowing midwives to work to their full capacity-- last year, happily, the state of Illinois allowed full practice authority for certified nurse midwife. And that allows us to open our own practices for some people if you want to. We don't need to collaborate no longer with the physician. You can actually practice the full scope of your ability, providing preconception counseling, family planning, GYN care, annual exams, childbirth education. The full spectrum of maternal health care can be provided by a midwife.


So more states that come on board and allow for full practice authority for midwives, allowing more opportunities for midwives to be included in the hospital system or in the clinic system. And allowing opportunities for patients to have options besides just a one size fits all. Because maternal health and birth and labor is not one size fits all. And I think just giving women options will help with overall maternal health, especially among Black women.


Well, Cynthia, you're a veteran of the show. As always, a fantastic job. Karie, you're a rookie this time, but nobody would have known that. You were great, as well. So we'd love to have you back on, both of you, anytime we can do this in the future. That was really, really good. Cynthia, I know you have a patient, so we need to get this done. We'll let you go.


Yes, thank you


That's all the time we have for the program today. We'll have another At the Forefront Live next week. And please remember, check out our Facebook page for our schedule of programs coming up in the future. Also if you want more information about UChicago Medicine, take a look at our website at uchicagomedicine.org. If you need to schedule an appointment, you can us a call at 888-824-0200. Remember, you can also schedule your video visit by going to the website. Thanks again for being with us today and I hope you have a great week.

Last Edited by John Dickow on 08/14/20,

Studies show that Black women in the United States experience poor maternal health outcomes, including higher rates of death related to pregnancy or childbirth.

Additionally, as a result of both societal and health system factors Black women are more likely to experience barriers in gaining access to quality care.

University of Chicago Medicine certified nurse midwives Cynthia Jacinthe, DNP, APN, CNM, and Karie Stewart, APN, MSN, MPH, CNM, discuss these disparities and answer questions about maternal health for Black women, especially during these challenging times.

Our Certified Nurse Midwives

With expertise in evidence-based practices, personalized prenatal care, and hands-on labor support, our certified nurse midwives play a unique role in optimizing birth experiences.