Tag Archives: prenatal care

It’s been almost two weeks since I had the pleasure of attending the ICTC Black Midwives and Healers Conference, and I am FINALLY getting around to sharing a couple of take home nuggets. If you had the opportunity to read my previous post about the conference, you already know what the primary take home message was for me…

WE have an epidemic in OUR community. Perinatal morbidity and mortality disproportionately affect women and infants of color, specifically in the Black Community. WE suffer the most and the disparities are alarming.  WE have to save OUR babies. WE have to save OUR sisters. The saving of OUR babies and women has to be a grass roots effort. If WE don’t do it… it won’t happen so WE must take the charge to make it happen.

During the conference, this particular message was everywhere either as the direct topic or the underlying message of every session.

Preconception Care
On a very practical note, I attended a session on preconception care.  During this participatory session, we shared ideas, concepts, and specific strategies that we can use to help bring about change in these disparities through a focus on preconception care.  Lots of perinatal morbidity and mortality can be avoided or minimized if we start off in better health.  One speaker declared “We can’t have healthy babies, if we don’t have healthy mammas.”

While this sounds like basic common sense, many unhealthy women become pregnant and as a result they have poor pregnancy outcomes.  Leading causes of maternal morbidity and mortality include high blood pressure, obesity, diabetes, and poor general health both physiologically and psychologically.  The leading causes of infant morbidity and mortality in the Black community include prematurity and low birth weight both of which are directly related to the health of the mother.

The fallacy is that we only need to plan for pregnancy when we are “ready” to get pregnant. The reality is 50% of pregnancies are unplanned. With that in mind, if we are choosing to engage in sexual relations with men, it is imperative that we plan for pregnancy at all times. It’s important to create a healthy lifestyle: exercise, learn to eat healthy, take a daily vitamin with folic acid, avoid binge drinking and drug use.  It’s important to take care of our chronic diseases:  Are you diabetic, or do you have high blood pressure? Are you taking meds for weight loss, chronic depression or anxiety?  Do you have Sickle Cell or Lupus or any other autoimmune disorder? If you do, you need to speak with your midwife, your OB/GYN, and/or your primary care provider NOW about the risks you may encounter. Learn what you can do NOW to minimize those risks and to be healthy.

As health care providers, we need to speak with our female patients about pre-conception planning. We can’t make the mistake of thinking because she is not “planning’ a pregnancy that she won’t get pregnant.  We must always remember the 50%.  One really GREAT suggestion that came from that session: partner with the churches in your community. Speak with the pastors about adding preconception counseling to the pre-marital counseling curriculum.  What better time to discuss parenting and pregnancy than this time.

Access to Prenatal Care
Increasing access to prenatal care has often been suggested as a solution to eliminating perinatal disparities.  As a result, various clinics have been erected, mobile clinics have been employed and hours have been extended. Unfortunately these things alone do not work to change outcomes.  This was made clear when I attended a session conducted by Jennie Joseph, one of my personal midwifery sheroes.  Jennie has a style of prenatal care dubbed “The JJ Way.” Through practicing “The JJ Way,” she has documented a significant decrease in preterm birth/low birth weight in the Florida county where she cares for many African American women.

Ms. Joseph reminded us that access to prenatal CARE has little to do with location, or hours of operation.  Access to prenatal CARE is NOT the presence of a building and a provider that can measure a belly and listen to fetal heart tones. That’s the myth and the reason why so many “build it and they will come” efforts have failed.  Prenatal CARE is provided when a woman feels like she is accepted and respected.  Prenatal CARE takes place in an environment where women and their families are treated with DIGNITY without judgment. So often we remember the prenatal yet we forget the CARE.

Do you want to participate in grassroots efforts to help effect change in the perinatal outcomes in the African American community?  Remember this… Women are not oblivious to the true feelings of a provider. It’s not enough to “mean well.”  We have to practice well, to treat women well, to do well.  We have to provide women with genuine CARE that is not filled with empty smiles and sympathy/empathy. We must have genuine compassion.

The Weathering Phenomena
While there were many more things discussed at this conference I want to end this post with information shared by Sister Oya who traveled from Tanzania to bring us a message that was at once fascinating, enlightening and depressing. She helped us connect more dots to understanding the effect racism has on African American women at the cellular level and how it directly affects our perinatal outcomes.  While in general this concept was not new to those of us in the audience, for many of us it was the first time that we had heard directly of the phenomena called Weathering as put forth by Arline T. Geronimus. From Wikipedia:  Weathering in geology is the breaking down of Earth’s rocks, soils, and minerals through direct contact with the planet’s atmosphere. According to Dr. Geronimus weathering for black men and women is the breaking down of our physiological/biological systems due to direct contact with our “atmosphere” – a society steeped in racism and discrimination.

Through decades of research Dr. Geronimus has documented how a lifetime of living in this type of society creates a chronic stress that makes us less healthy with each passing year. She has actually measured the affect of this weathering using various biochemical markers and has found that BLACK WOMEN show evidence of the greatest amount of weathering across all educational and socioeconomic lines.  As Sister Oya presented actual data, which included detailed information about those various biochemical markers and hormones, it became increasingly clear how at the cellular level we are affected by this long standing systematic racism.  Even women who appear by all other accounts to be healthy show signs of this weathering.  As our internal environment shifts, not only does the growth environment shift for our unborn children but their internal stress hormones and biochemical markers are changed as well.  As a result our babies are unable to grow, thrive, and be born healthy…Stressed before they even exit the womb.

Unfortunately, there is no easy or fast solution to remove weathering from our lives. Until we live in a society that does not use race, color, religion, sexuality, gender, economics, and education to discriminate, weathering will be present.

So where does this leave us???

It leaves us with the knowledge that we have to create more supportive environments. We have to get into our communities in more creative ways.  We have to be more genuine in our efforts as we care for Black Women and we have to be more interested in their TOTAL well being, not just the numbers.

We have to take care of ourselves before, during and after pregnancy.  We have to encourage and support each other through all of our challenges. WE have to take care of OURSELVES and encourage our sisters, aunts, cousins, and sister friends to do the same.  And so I end this post basically the way I started it:

WE have an epidemic in OUR community. Perinatal morbidity and mortality disproportionately affects women and infants of color, specifically in the Black Community. WE suffer the most and the disparities are alarming.  WE have to save OUR babies. WE have to save OUR sisters. The saving of OUR babies and women has to be a grass roots effort. If WE don’t do it… it won’t happen so WE must take the charge to make it happen.

In Birth and Love
Nicole