At a time when Black babies are dying in Chester at four times the national average, a maternal health coalition has asked Gov. Josh Shapiro to take steps to change that.
In November, more than 25 maternal health organizations across Pennsylvania worked to create a list of priorities in the Collective Plan for Maternal Health to address this year.
At the end of last month, they identified workforce needs and training; access to care; supports for families and payment/reimbursement issues as a key to reversing trends seen in Delaware County and in Pennsylvania.
“Black infants in Delaware County die at more than twice the national rate and in Chester, Black infants die at four times the national rate,” Joanne D. Craig, chief impact officer of The Foundation for Delaware County, said. “We are urging Gov. Shapiro to take action on the proposed policy recommendations to improve maternal health and birth outcomes and reduce disparities.”
The foundation was one of the 25 organizations involved in this process.
Craig spoke about how the closure of Delaware County Memorial Hospital and its obstetrics department has only put more pressure on the problem.
Memorial closed its obstetrics department in January 2022 at a time when 1,800 babies a year where born there. By November 2022, the Pennsylvania Department of Health had ordered the hospital to suspend emergency services and placed a ban on admissions due to lack of staffing.
That came in the midst of Crozer Health wanting to transform the hospital into a behavioral health center. That change has been met with community resistance and litigation, led by the Foundation for Delaware County and CKHS. The matter now sits before the Pennsylvania Supreme Court, who has agreed to hear it.
“The closing of Delaware County Memorial Hospital, and the reduction of health care resources is putting pregnant people, mothers, and their babies at risk, in our community,” Craig said. “We know that these impacts are not felt equally across Delaware County and that low-income families, especially Black mothers, infants, and families are bearing the brunt of these setbacks.”
However, the Collective Plan identified steps that can be taken to start stemming the tide.
Those include highlighting culturally appropriate care by supporting the recruitment and education of maternity care teams; creating a Perinatal Behavioral Health Access Program to help providers identify and care for pregnant people with mental health or substance use-related needs; increasing enrollment in the Supplemental Nutrition Program for Women, Infants and Children; support educational campaign with trusted community partners; and reimburse doulas and community health workers.
The doula role
Karen Peterson, case management coordinator for the Foundation of Delaware County’s Healthy Start, has also served as a doula for 10 years and a doula trainer.
She explained that the case manager provides supports from birthing up until the child is 18 months old and does everything from developmental progress assessments for the baby to helping with transportation to doctor’s appointments to helping with basic necessities such as diapers to food insecurity issues.
Her role now as case management coordinator is to support the eight Healthy Start case managers, who assist more than 300 clients. Three of the case managers are bilingual.
Doulas, Peterson explained, are nonmedical support trained professionals who help those who are pregnant or having a baby navigate health systems, provide emotional support, assist with issues that arise for the family and give evidence-based information about their health while also teaching them to advocate for themselves. Doulas also provide continuous support at labor, as well as afterwards.
“Maternal mortality rates in the United States are very high,” Peterson said, adding that in other industrialized countries, it’s decreasing. “Ours is continually rising, especially for brown women and Black women.”
She noted that some people have more resources than others, but no matter what, all deserve dignity.
“People have this human right to be treated well, no matter where they come from, where they live, or what they look like or how much money is in their bank account,” Peterson said.
She shared how time has changed.
Doulas, Peterson said, were not always welcome in the birth space and their credentials were questioned. Now, Vice President Kamala Harris said they are “literally a lifeline.”
And, she said, the landscape has changed to where Peterson herself trains 40 University of Pennsylvania nursing students twice a year.
Doula ‘so empowering’
She spoke about what it’s like to be a doula.
“I have served so many types of moms,” Peterson said, adding that she always remembers when someone says to her, “I would have never been able to do this without you.”
“It’s so empowering to watch birthing people go through that process,” she said. “It is incredible.”
And, she added, “We’re also there when things don’t go well, when things don’t go as planned.”
Peterson said reimbursement could have a significant impact for the doula community, potentially allowing them to have one career as a doula, rather than working two or three jobs to garner a living wage.
“It means that there would be more doulas on the ground,” she said. And, they would come from different types of communities. “It’s going to build a workforce, giving more people opportunities.”
And, Peterson said it could change the statistics for Black and brown women, families and communities.
“Hopefully,” she said, “that we reduce maternal mortality.”
