Last year, Black infants born in Alameda County were more than twice as likely to die before their first birthday than white infants, according to data from the California Department of Public Health. Black newborns were also twice as likely to face low-birth weights compared to white newborns, a condition that can result in immediate and long-term health problems. These statistics reflect systemic racial inequalities in the delivery of healthcare to pregnant people.
A group of Black birth workers in Oakland are organizing to reverse these trends by providing a new model of care.
“It’s really an empowerment-based model where people get to take more ownership and learn more about their own health,” said Certified Nurse-Midwife Jyesha Wren.
Wren co-founded BElovedBIRTH Black Centering in 2018 to provide better prenatal and postpartum care “by, for, and with Black people.” BElovedBIRTH’s organizers say they are already seeing higher enrollment rates compared to other prenatal care programs in the Alameda Health System, the county’s public hospital network.
BElovedBIRTH’s work is based upon a combination of three evidence-based strategies. The first of these is a nationally used approach called Centering, a model of prenatal care that offers group meetings led by healthcare professionals throughout the course of pregnancy. Participants are grouped by due dates so they can form relationships with others at a similar stage in pregnancy.
Typically, Centering groups meet in person and participants receive individual health evaluations from their midwives, and also share their experiences with the larger group. Adapting to a virtual platform due to the pandemic, BElovedBIRTH provides participants with blood pressure cuffs and teaches them how to take their own vitals at home, as well as document their health in a pregnancy log.
During virtual meetings, healthcare providers lead informational sessions on topics such as nutrition, stress management, labor and delivery, and breastfeeding. Centering has been implemented in over 400 sites nationally and has reduced the risk of preterm births by 41% among Black parents, according to the Centering Healthcare Institute.
The Centering approach traditionally does not require that caregivers and participants share the same race, which is where BElovedBIRTH’s model differs. Wren said that “racial concordance,” or the intentional practice of matching patients with healthcare workers of their own race, is the second strategy of BElovedBirth Black Centering.
“When we have this racial and cultural concordance, the overall quality of care improves, the communication improves, the level of trust and understanding improves,” said Wren. “All those things are so important in a patient not experiencing discriminatory, racist care.”
After delivering two children, one in a birthing center and the other in a traditional hospital setting, Oakland resident Danielle Mason was determined to have her third birth at home. Mason, who is Black, said that the legacy of medical racism shaped her previous experiences with health care.
“I think a lot about the history of Black people in the medical-industrial complex, and how we have been subjected to a lot of experimentation, a lot of death, and different things that have impacted our trust in the system,” said Mason. “The history of how we’ve been treated, and the way that we continue to be treated, it just really inhibits birth. It really makes it hard to speak up when you’re having pain and makes it very difficult to feel like you’ll be trusted or respected in these environments.”
Though Mason has participated in traditional Centering in the past, she said she hasn’t felt comfortable talking about these topics in groups with moms of other races. “It makes it much harder to speak about those things in spaces where you feel like your experience will be belittled, judged, or ridiculed.”
When Mason first became aware of BElovedBIRTH Black Centering, she was willing to put her reservations aside and give the program a chance. One week before her due date, Mason said the experience “completely restored my faith in what medical practitioners can offer.”
Research has shown that birthing outcomes are influenced by a number of factors, including the race of the newborn’s physician. A study published in the Proceedings of the National Academy of Sciences in September 2020 found that “when Black newborns are cared for by Black physicians, the mortality penalty they suffer, as compared with white infants, is halved.”
BElovedBIRTH’s founders believe something similar might apply to prenatal care, and that Black birth workers may be able to improve care for Black pregnant people before they go into labor.
“Having a space to really talk about the issues that surround birthing while Black is so rare because it’s such a sensitive topic that it’s often swept under the rug,” said Mason. “We talked a lot on our first day about what it means to be Black. One part of that was diversity; we still have a world of diversity within Blackness, we know that everyone isn’t the same. But still, to have that structure of recognizing that we do have something in common really does set the tone of safety and connectedness.”
Dr. Kerry Ann Kelly, an OB-GYN at Highland Hospital and director of the Alameda Health System Women’s Reproductive Health Equity Fellowship, is involved in the research and implementation of medical practices that reduce disparities in birthing outcomes. According to Kelly, the positive effects of being cared for by someone of your own race for Black people are significant.
“What I’ve understood from my patients is that they need a level of trust and a level of comfort. Oftentimes, they don’t feel that they can get that if their provider is not Black,” Kelly said.
The third strategy that sets BElovedBirth apart from traditional prenatal and postnatal care programs is what Wren calls “wraparound social support.” It’s not enough to just care for pregnant people; they and their families need income, food and housing security, and other resources.
BElovedBirth has partnered with Alameda Health System and the Alameda County Department of Public Health to connect families with resources. The group also provides direct support to families with newborn babies.
“We got care packages, stuff for the babies and for the moms, essential oils, body butters—things that we can actually put into use,” said Mason. “We were even connected with an organization who provided Christmas toys for the kids and the new baby.” BElovedBIRTH also provides up to six weeks of free postpartum meal and snack deliveries in partnership with Mothers for Mother’s Postpartum Justice Project’s NOURISH! Initiative.
As obvious and real as racism in the healthcare system is, Wren said that convincing some people of the necessity for BElovedBIRTH Black Centering was still a challenge. The group initially received funding from the California Department of Public Health’s Perinatal Equity Initiative. A portion of the donations from a GoFundMe created by Highland’s midwifery team was also offered to BElovedBIRTH Black Centering, but it wasn’t until the summer of 2020 that Alameda Health System extended its support.
“We had been stalled, stalled, stalled, and then George Floyd was murdered, and our Black Lives Matter movement kicked off in its current manifestation,” said Wren. With increased attention on racial justice issues, the group was more able to find support. BElovedBIRTH now receives funding from the California Department of Public Health’s Perinatal Equity Initiative.
“While I’m happy that we were able to get the green light, it’s obviously frustrating that this is what it takes,” said Wren.
Wren also said that in order for BElovedBIRTH to operate most effectively, there needs to be greater change within Alameda Health System as a whole, including the need to pay other birth workers like lactation consultants to conduct home visits and ensure all patients can be provided with doula services.
Oakland isn’t alone in seeing increased interest in birth work that consciously counters racism in the healthcare system. Similar programs are popping up in other states, including Florida’s Commonsense Childbirth and Oshun Family Center’s Maternal Wellness Village in Pennsylvania. UCSF also offers the EMBRACE program in San Francisco.
Black birth workers, said Wren, are creating a more promising future for the babies they help deliver, and each program is designed to fit the needs of the community it’s located in.
“We really believe that models of care need to be of the community,” said Wren. “Group Black care might look really different in another location than it does here in the East Bay, and it should.”
Correction: A previous version of this story overstated the likelihood that Black newborns born in Alameda County would not survive to their first birthday last year.