Maternal Mortality Rates and How Race is a Factor

By Dr. Nikki

While we may be hearing about it more lately, the maternal and fetal mortality rate in the black community is NOT a new issue. As a whole, the US has a higher maternal mortality rate than most other high-income countries. Now I want you to think about this… African American women (across the income spectrum and from all walks of life) are dying from preventable pregnancy-related complications at three to four times the rate of white women in the US! Severe maternal morbidity affects pregnant women across the board, but these severe life-threatening pregnancy-related complications (known as SMM) affect twice as many black women as they do non-Hispanic white women. African Americans have the highest infant mortality rate of any race in the United States which can be tied to preterm births. The death rate for black infants is twice that of infants born to white mothers. [1]

WHY IS THIS THE CASE?

Deeply-rooted structural racism in the healthcare service delivery plays a big role in these devastating outcomes. Receiving poorer quality care, as well as limited access to maternal care, results in increased levels of pain and stress which has massive physiological effects on the pregnant mom’s physical and mental well-being. These stress-induced physiological changes make black pregnant women more susceptible to conditions such as pre-eclampsia, eclampsia, embolisms, and mental health issues, threatening the mother-to-be’s life and her child’s as well. 

WHAT CAN BE DONE TO CREATE CHANGE?

1. Improve access to quality care. Oftentimes counties have what are known as maternity care deserts, where access to maternity health care is either extremely limited or completely absent. This limited access can be a result of a physical lack of care or an inability for a woman to utilize it. These “deserts” occur in rural areas, but can also exist in urban areas when hospital obstetric units close in and around cities. [2] Below is a map, from 2016, that shows the different levels of access to care throughout the United States. The red on the map indicates counties where there are zero hospitals and zero OB/midwife providers. If public transportation is limited, many pregnant women in these counties are unable to get the appropriate maternal care and even if public transportation is accessible, this places strain on surrounding obstetric facilities and can hinder the quality of care provided. Strengthening the systems that are already in place, as well as providing African American women tools to utilize the maternity health care system is essential.

2. Improve the quality of care provided to pregnant women. As one of the wealthiest countries in the world, the United States could and should be doing better (in my humble opinion) when it comes to maternal and infant mortality! Programs in which providers are trained to address racism and build a more diverse workforce have an enormous impact on the quality of maternal care for black women and other women of color. Accessibility of screenings and standardized assessments also allow for the prevention and/or prompt treatment of maternal and fetal health issues. 

3. Enhance support for families before and after birth. Community is essential during the prenatal and postnatal period. Resources such as birth education and doulas are pivotal in increasing support as well as improving birth outcomes. As a pregnant mother’s advocate, doulas can be instrumental in making sure moms are getting appropriate screenings and quality maternal care. Doulas also provide postnatal support and are in a position to make sure the baby is receiving appropriate testing and care. 

 WHAT CAN YOU DO?

You may be reading all of these alarming facts and thinking “This is horrible, but what am I supposed to do about it?” I found myself in that exact same place. I recently read the book “Untamed” by Glennon Doyle and in one specific chapter she talks about becoming a philanthropist. In this chapter, Glennon shares a quote from Archbishop Desmond Tutu that hasn’t left me, “There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.” This brings up two immediate questions, one: how can I help black mothers-to-be right now? And two: how can I help stop the root cause of the issue? 

So here’s what I’ve come up with for a starting point. The Natural Way Birthing Project, located here in Fort Worth TX is a non-profit run by a black female doula named Nikia. The mission of the project is “to help lower infant mortality risk factors and nurture participating families through education, advocacy, and support during pregnancy and beyond.” The goal of Natural Way Birthing Project is to assist in educating, empowering and navigating resources for project participants and expectant families in the city of Fort Worth and surrounding Tarrant County. [3] Through the support of donors who want to see a change, Nikia has been able to provide 12 full scholarships and 15 partial scholarships for membership and training of birth educators and doulas, as well as provide each participant with a manual. She is also able to provide a free birth education class to expectant moms and their support person once a month. To learn more about this class click here. 

If you don’t live in the DFW area and would like to contribute at a more local level for your community, please check out Birthing Project USA to find a project near you. I am beyond excited to support these volunteers who are the hands and feet in our community and are truly doing the work. 

“We must become the change we want to see in the world.” ~ Mahatma Gandhi

RESOURCES

1) (May 2, 2019) Eliminating Racial Disparities in Maternal and Infant Mortality. Retrieved June 24, 2020. https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/

2) (2018) Nowhere to go: Maternity Care Deserts Across the US. Retrieved June 24, 2020. https://www.marchofdimes.org/materials/Nowhere_to_Go_Final.pdf

3) Retrieved June 25, 2020. http://thenaturalwaybp.org

4 Things To Do Now Before You Have Your Baby

Dr. Nikki

The big day is coming soon! You’ve finished your delivery classes and read pregnancy books. You’ve been diligent with your doctor appointments and taking your prenatal vitamins. And now that urge within you is starting to stir. You feel the need to get your home and yourself prepared for what’s to come after you give birth.

Most of the focus during pregnancy is on growing a healthy baby and preparing for your delivery day. Much less attention seems to go towards what you do when you bring this new life home. There’s no doubt that the postpartum experience can be quite challenging. You’re tending to a new baby and new routines — all while your body is exhausted and healing.

But a little planning can make a major difference during those first few weeks with your newborn. Here are four ways to help you get ready.

1. PREPARE A BATHROOM CARE KIT

After delivery, you will be sore and wiped-out. If you had a vaginal birth, you might have had a vaginal tear or episiotomy during childbirth. This wound could hurt for a few weeks. Regardless of how you delivered, your body will begin to shed the lining of your uterus. This will result in a bloody discharge, much like having a heavy period.[1,2]

Having a care kit at home will prepare you for the challenges of caring for your body after delivery. Don’t get caught off-guard. Consider keeping a basket of the below items next to the toilet in every bathroom you have.

• Extra underwear. Save your favorite undies, and go with disposable or throwaway ones while you heal. The hospital will give you mesh underwear — take as many pairs as you can. Then buy a package or two of disposable, dark-colored underwear. “Granny panties”, or high-waisted panties, are great, especially if you had a C-section. Disposable and comfortable are key.

• Pads. Make sure you stock up on different sizes — from large, overnight maxis to regular-sized pads. Buy a few packages. You’ll be going through quite a few during your early days.

• Adult wet wipes. You can buy wipes that are flushable and designed to be gentle and soothing.

• Peri or squirt bottle. Most hospitals will give you one. Consider having an extra for your second bathroom or if you travel. This bottle will seriously become your new best friend in the bathroom. Fill it with warm, soapy water (use a mild soap), and have it on-hand to keep you clean as your perineal area heals.

To make it easier for you, some stores sell postpartum recovery kits already assembled. Click here to check out one on Amazon that even comes with a tote to store on top of your toilet.

2. PLAN TO EASE ACHES AND PAINS

Coming home from the birthing center or hospital can be exciting and overwhelming. Your body has gone through a tremendous ordeal — one that can be painful or uncomfortable. Preparing in advance can help minimize discomfort. You may wish to include some of the noteworthy items below in your pain plan:

• Padsicles. These are lifesavers that help with pain and reduce swelling. And they’re simple to make.[3] Click here for a DIY guide. Ice packs can also work.

• Witch hazel. You can buy this in either pad or liquid form. It helps to soothe pain around your genital area.

• Lidocaine spray. This will help with the discomfort of postpartum hemorrhoids.

• Sitz bath. Use this to bring comfort to hemorrhoids or perineal tears. A sitz bath will cleanse the perineum and also bring relief to pain or itching in your genital area as you heal.

• Heating pad. Use this if you feel aches and pains in your breasts.

• Nipple cream and breast pads. This will help relieve discomfort, regardless of whether or not you breast-feed.

• Over-the-counter pain relievers. Talk with your health care provider about the best option for you.

• Stool softeners. Sometimes constipation can occur after delivery. Or there may be a fear hurting the perineum or episiotomy wound.[4] Eating plenty of fiber or taking a stool softener can help. Check with your doctor on what would work best for you.

3. PREPARE YOUR SUPPORT TEAM

In our American culture, it’s difficult sometimes for women to ask for help. Remember to be kind to yourself, especially during these first few weeks. Having a newborn is hard. 

Preparing a support team before delivery can help. Here are a few areas to consider:

• Meal planning. From meal trains to cooking parties, your friends and family can prepare meals for you. Make sure they’re freezer-friendly, so, on those exhausting days, you can grab one and just reheat it. Aim to have at least one healthy, nutritional meal a day that you can easily pop in the oven or crockpot.

• A bouncer. Your family and friends are excited about your new baby. But you may be too tired or emotionally drained to entertain. Setting boundaries in advance can help, but what about those spur-of-the-moment requests? Consider asking a special someone to run interference on your behalf until you feel up to hosting.

• A social media SOS. Maybe you have a last-minute need or just want a friend to sit with you while you cry. Post where you feel comfortable or have some go-to friends in mind for when those moments strike.

• Postpartum doulas. Postpartum doulas can be true angels! Their main goals are to “mother the mother” and help transition the family during this new time.[5] They provide a wealth of services: breast-feeding support, light housekeeping, running errands, and assisting with your newborn’s care.

4. ATTEND A WORKSHOP

Preparing for life after delivery can feel overwhelming. You know things will be significantly different, but maybe you aren’t sure what all you need to do. Sometimes it helps to have a person to talk to in real life.

SOURCES

1.  (2018, May 11). Postpartum care: After a vaginal delivery - Mayo Clinic. Retrieved February 10, 2020, from https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/postpartum-care/art-20047233

2.  (2018, May 11). C-section recovery: What to expect - Mayo Clinic. Retrieved February 10, 2020, from https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/c-section-recovery/art-20047310

3.  (2019, December 18). Padsicles: How to Make Them, How To Use Them ... - Healthline. Retrieved February 10, 2020, from https://www.healthline.com/health/pregnancy/padsicles

4.  (2018, May 11). Postpartum care: After a vaginal delivery - Mayo Clinic. Retrieved February 10, 2020, from https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/postpartum-care/art-20047233

5.  (n.d.). Postpartum Doula - American Pregnancy Association. Retrieved February 10, 2020, from https://americanpregnancy.org/first-year-of-life/post-partum-doula/

Sharp Curve Ahead

By Dr. Nikki

---

This afternoon, my co-pilot pup, Rocky, and I went out for a walk along the Trinity Trail. As we strolled along, we came across a sign that said “Sharp Curve Ahead”. I found myself thinking ”Wouldn’t it be nice if we had signs like that for life??” You know, signs that said “job loss ahead” or “cross-country move ahead” or even “illness ahead”. One of the biggest unexpected “sharp curves” that come up in life are health issues. I wonder if we knew ahead of time that a specific disease was headed our way, would we live our lives a little differently? Oftentimes, we spend the first half of our lives chasing wealth to then spend the second half of our lives chasing health.

The good news is that while we may not have a sign telling us what lies ahead in regards to our health, we can make decisions on a daily basis to prolong our years with a healthier life! Here are five basics that we can all implement right away. While they may seem simple, I find myself needing reminders on all of these at some point throughout a given day, week or month.

1. Get sleep! Sleep is imperative for our brain and body to heal. It also greatly impacts our immune function and cognitive ability. 7 - 8 hours of sleep per night is a great goal!

2. Hydrate! Our bodies are over 55% water and we use it in every single cell, organ and tissue. It is essential for the regulation of all bodily functions. Aim for 50% of your body weight in ounces of water per day!

3. Taste the Rainbow! Getting a variety of fruits and veggies in our diet is essential. By including a “rainbow” of colors in produce on our plate, we are increasing the amount and variety of vitamins and minerals that we are consuming.

4. Stay Active! Maybe crushing a workout at the gym isn’t your thing, that’s ok!  Whether it’s going for a 20 minute walk, going for a bike ride, taking the stairs, trying a pilates or barre class or simply letting loose and dancing, movement is the key!

5. Find Your Tribe! As humans, we were created to be social. I know some of the introverts may be cringing right now, but it’s true! Make sure you have one or two people who you can bounce things off of and just do life with! It doesn’t need to be a quest for popularity, just a few people to hold one another accountable and lift each other up in times of need.

While I didn’t include chiropractic care in the 5 basic tips, regular chiropractic adjustments are extremely beneficial in maintaining proper function of the spine and nervous system. Since this is what allows our brain to talk to our body and our body to talk to our brain, it’s kind of important! To schedule your next appointment with Dr. Nikki, click here and if you have any questions about any of the other tips for staying healthy, we would love to hear from you!