African American women must have access to more expansive choices in birthing options and prenatal care, which can lead to more positive birth experiences and healthy pregnancies. The Los Angeles Urban League, in conjunction with other organizations such as the March of Dimes and the King Drew Medical Center, is working with a number of organizations to address this important issue through community outreach focusing on building a base of knowledge around this important issue as well as building leadership training, developing a network of advocacy for prenatal and postpartum support.
While some types of midwifery care are covered in state Medicaid programs, more can be done to fully integrate midwifery care into state health systems and expand insurance coverage of doula services.
Both doula services and midwifery care are key to promoting birthing choice and reproductive autonomy for low income women and women of color. These services should be available to all pregnant women, regardless of their source of insurance or income level. Health literacy and education can also support African American women and help them feel more autonomous over the health care decisions they make for themselves and their families.
Increase Range of Birth Options
Women may benefit from a range of birth options that include hospitals, birthing centers, and planned home births that are attended by a physician, midwife, or doula. Regardless of where women give birth, access to a doula or midwife can provide additional support to women and potentially reduce C-section rates that put women and infants at risk.
Different birth settings and health care providers can lead to healthy births and positive birth outcomes for some mothers and infants. Although most investigations of planned home births show positive maternal outcomes—including fewer maternal complications, such as hemorrhage; greater satisfaction; and fewer medical interventions— infant outcomes are more mixed. Evidence from countries such as Australia, Canada, Japan, and the Netherlands show similarly positive infant health outcomes across settings. In the United States, however, studies suggest home births are associated with an increased risk of poor infant outcomes, including neonatal seizures, and infant death. Home births are safest when skilled midwives are in attendance; there are practice guidelines limiting home births to medically low-risk women following appropriate screening; and there are good working relationships between birth workers and transferring facilities.
Given that black women and other women of color often receive poorer quality care and are victims of racial bias in traditional health care settings, expanding birth options and increasing access to midwives and doulas in hospitals may lead to better outcomes for some populations. To this end, women should be given the full range of options and information before deciding the most appropriate setting for them. Opportunities to make nonhospital settings more accessible to women of color warrants further consideration.
In the United States, there are about 35,000 births that take place at a woman’s residence each year, which makes up about 0.9 percent of all U.S. births. The rate of home births has increased in recent years: Between 2009 and 2010, the rate of non-hospital births among white women jumped from 1.09 percent to 1.75 percent. 119 In 2010, the rates for black and Hispanic women, by comparison, were 0.48 and 0.41 percent, respectively, pointing to barriers to accessing home births among women of color compared to white women. Among the contributing factors for this disparity is a dearth of black midwives. It is vital that efforts to expand birthing options include promoting diversity among the providers most involved in-home births—midwives and doulas.
*Portions of this article was taken from a Center for American Progress report.