By Foxy Robinson | Special to The OBSERVER
Black mothers and birthing people want to feel respected and supported across their perinatal and postpartum journeys. Birth workers, community organizations, and researchers across Sacramento and the Bay Area are investing in creating resources for better birthing experiences.
A single glance will not capture each barrier Black mothers and their birthing people encounter to give birth during their pregnancy.
“We saw one mom at a liquor store dealing with addiction and housing insecurity, which were challenging her pregnancy,” said Kenya Fagbemi, program director at Her Health First. “She was also raising her other kids. She didn’t have her appointments scheduled to follow along with her pregnancy.”
When mothers don’t have their basic needs met, their own health often suffers from lack of attention. Birth workers and local community organizations hope to tailor support for moms and their babies through perinatal and postpartum visits and social support services to guide Black mothers along their own path.
A Healing-Informed Care Approach
Sacramento County nonprofit Her Health First strives to reduce infant mortality and low birth weights within low-income, African American communities through education, pregnancy coaching, and doula support. African American women can enroll in their services before their 30th week of pregnancy to receive their support throughout their pregnancy and four months after birth.
According to the Sacramento County Department of Public Health, 11.4% of the county’s Black mothers gave birth to low birth-weight babies – those less than 51/2 pounds – compared to 4.9% of White mothers in 2019. Black mothers also gave birth to 12% of premature babies born before the 37th week of pregnancy, compared to 7.8% born to White mothers. Pregnant moms sit with pregnancy coaches for a pregnancy assessment to build a care plan that matches their needs. Coaches check in weekly for 30-minute home visits. During the COVID-19 pandemic, Her Health First switched to virtual face-to-face visits.
Mothers also can choose support from a doula – a trained birthing companion – in addition to a pregnancy coach while they navigate perinatal and postpartum care.
“Our pregnancy coaches come from the same communities as our mothers and have used the same resources we’re sharing with our mothers,” Fagbemi said. “It’s important for us to not just talk it, but also walk it and hopefully help moms.”
Black mothers also can find community with others enrolled in Her Health First’s services through “Mommy Mingle” monthly visits. Mothers can see each other, destress, and talk about what’s going on in the community while doing hands-on activities. It creates a sisterhood for Black mothers, and their partners are welcome to join in. And they can join “Tittie Talk,” a monthly lactation support group challenging stereotypical barriers to breastfeeding.
When the COVID-19 pandemic grew in 2020, Her Health First was among the first agencies to switch to virtual programming.
“We had low enrollment and we had to shift the way we were used to doing things,” Fagbemi said. “We were used to being in the community with our tables and our strollers to connect with people. Now, we rely on social media to connect with our community and other organizations. We also came out thinking that we wanted to practice healing-informed care – healing from trauma.”
Mental health became a greater focus since the need for support grew throughout the pandemic. Her Health First partnered with therapists to introduce therapy, meditation, and mindfulness by training their pregnancy coaches to share these tools with their mothers.
After mothers give birth, they convene for a quarterly baby shower. Each mom receives a gift to celebrate her new journey ahead.
“We want to celebrate Black birth,” said Fagbemi. “There’s often a black cloud that suggests you shouldn’t be having a baby. Sometimes it’s the family, partner, and society, especially if it’s a Black mom having a fifth kid. We want to celebrate Black women and Black life. We are not downtrodden. Giving birth in our communities should not be seen as a negative.”
Recognizing Mental Health Challenges in Moms
Many Black mothers don’t know the signs of mental health challenges or where to go when they need help. Be Mom Aware hopes to change that by serving as a community awareness campaign to reduce the stigma about maternal mental health disorders and to increase access to maternal mental health care in Black and Latina communities in Sacramento.
Be Mom Aware partners with Black Women Birthing Justice to create focus groups that identify resources needed by Black women and Latinas in the community by listening to their perspectives and challenges. It connects women to the resources they need and destigmatizes mental health management. Black and Latina mothers leave empowered with the tools and resources they need to manage their mental health and face what lies ahead.
“For a first-time mom taking care of a child in Oak Park, the father’s off somewhere taking care of things, and the bills are due, you still have to protect yourself and your mental health,” said Jessica Walker, co-chair of the Sacramento Maternal Mental Health Collective and co-chair and digital lead of Be Mom Aware. “You have to know where to put those protective boundaries and be aware of how you’re feeling. Don’t look at it as you have to know everything about yourself right now because every mom will grow with her child.”
By better understanding themselves, their stressors, and their own needs, mothers can filter through mental health triggers and find peace.
“Don’t let other people have power over you or allow things to get to you and stress you out,” Walker said. “Learn to let things go.”
She recommends Black moms give themselves two minutes twice daily to breathe deeply without distractions, including cell phones. “If you can get some more minutes, even better,” she said. “Just taking a couple minutes each day starts a meditative practice, your mind can start to focus without all of the stress, and it helps you feel better.”
She also recommends Black mothers treat themselves to a couple trips annually, which can be as simple as getting a hotel room or treating oneself to a night out.
Paving The Way For Mothers And Their Babies To Build A Legacy
“There are always challenges in perinatal care because of the way Black women are treated and not believed,” said LaTanya Mosley, senior program manager at Mutual Assistance Network and the lead for the Black Child Legacy Campaign in Arden Arcade. “They feel that if something is wrong, they run the risk of not being believed and that could lead to the loss of their life and their baby.”
The Black Child Legacy Campaign aims to reduce Black infant death by 10-20% percent in Sacramento County, targeting four main causes: perinatal conditions, infant sleep-related deaths, child abuse and neglect, and third-party homicides. The campaign operates in incubator organizations in seven neighborhoods: Fruitridge and Stockton, Del Paso Heights and North Sacramento, Oak Park, Arden Arcade, Foothill Farms and North Highlands, Valley Hi, and Meadowview.
Mutual Assistance Network houses the Black Child Legacy Campaign for families in the Arden Arcade neighborhood, providing services and resources for families and their needs as a family-resource network. Mutual Assistance Network, recognizing that Arden Arcade needed financial support, food security, medical care resources, and personal protective equipment, maintained operations throughout the COVID-19 pandemic.
Families can connect with Mutual Assistance Network or receive a referral from their health care provider. From there they can be connected with the Black Infant Health Program to understand what medical neglect looks like and options for moving forward, the African American Public Health Nurses to build support for postpartum care, or obstetric care if they haven’t received care before their pregnancy. They also advocate for Black mothers to receive additional ultrasounds during pregnancies as a preventative measure that could help mothers and care providers determine risk of stillbirths or health conditions.
“A lot of times, if mom is experiencing postpartum depression and a high-stress lifestyle, and those risks have been neglected, it could lead to self-harm,” Mosley said. “We try to give short- and long-term support for financial, physical, and mental health needs.”
Mutual Assistance Network also gives out diapers, clothing and baby formula to help families along and ease stress.
“There’s a part of me that sees mothers getting connected to support and resources through my work at this amazing organization and another part of me that feels that there should be more done to support Black mothers,” Mosley said. “Seeing that doctors are not listening to their patients and it’s documented. Black mothers have different experiences than White mothers and are treated differently. We shouldn’t have to fight so hard for something that should be a given. I’m hopeful as a Black mother that this will be something my kids might not have to face.”
Implicit Bias Training Opens Door For Black Women’s Experiences
“Mothers want to have a birth filled with celebration,” said Linda Jones, birth and postpartum doula, co-founder of Black Women Birthing Justice, and advisory board member of the California Preterm Birth Initiative. “They should be able to give birth without leaving with PTSD. At the Black Birth Workers Forum, we’re noticing that it’s hard work fighting with racist structures in medical places and it creates more work for Black women.”
Senate Bill 464, the California Dignity in Pregnancy and Childbirth Act, required implicit bias training for health care providers every two years to reduce Black maternal and infant mortality starting in 2019. The legislature does not fund hospitals to create their own training with their community members or patient population. Providers instead can access one of three leading online trainings, including Diversity Science’s “Dignity in Pregnancy & Childbirth: Preventing Racial Bias in Perinatal Care,” following a patient’s visit and experience in the online training modules.
Although SB464 requires providers to take implicit bias training, it does not follow-up on how physicians have incorporated these lessons into training and practice. Physicians contracted into hospitals also may be able to opt out of the training depending on individual hospital policies. The state attorney general’s office has requested that hospitals report their implicit bias training completion rates. No report on the findings has been released yet.
The Multi-Stakeholder Engagement with State Policies to Advance Antiracism in Maternal Health (MEND) project aims to engage Black women in focus groups and clinicians in the Bay Area to understand how to make SB464 more effective for Black women by voicing their experiences.
“We asked mothers in our focus groups, ‘How do you want to be treated?’” Jones said. “Ninety-five percent said that they wanted to be treated as a human being. We are hoping that by sharing these stories, people are able to relate to them.
“Black mothers want to gain knowledge to ask questions about what their rights are and have choices for informed consent. We want to feel supported in their choices of where they are having their baby and before they have them.”
Health care provider perspectives exist on a spectrum. Some clinicians are ambivalent, unaware of issues to access to care. Some clinicians identify as antiracist, eager to make change.
Implicit bias cannot solve the disparity of maternal and infant mortality on its own. It can open more doors to systemic change, access to high-quality perinatal and postpartum care, and improved relationships between Black mothers, birthing people and the health care system.
“We need to make sure that the time providers are taking for implicit bias training is protected,” said Sarah Garrett, health policy fellow at the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco. “The physician can be between patient visits and that can be the only time they have to spare for training. There also needs to be time for reflection, where providers can ask their colleagues and share feedback.”
Real stories and experiences resonate with people, offering them a window into the experiences of each other where each can learn and change their perspectives. Black mothers hope that sharing their stories will hopefully change their health outcomes.
“It’s really rewarding to see our mothers on the other side of their worries,” Fagbemi said. “The lady we first met at the liquor store got her own place after her pregnancy. She’s clean from her addiction and living with her other kids. Investing in Black mothers works.”
More information and resources for families
Her Health First
4000 Fruitridge Road, Sacramento 95820
Be Mom Aware
Black Women Birthing Justice
Black Infant Health Program
9616 Micron Ave. Suite 670, Sacramento 95827
Black Child Legacy Campaign Incubator Locations Mutual Assistance Network
Serving: Arden Arcade
2427 Marconi Ave., Suite 101, Sacramento 95821
Roberts Family Development Center
Serving: Del Paso Heights and North Sacramento
3725 Marysville Blvd., Room 203, Sacramento 95838
Impact Sac at Liberty Towers
Serving: Foothill Farms and North Highlands
5132 Elkhorn Blvd., Sacramento 95842
Sacramento Building Healthy Communities
Serving: Fruitridge and Stockton, 4625 44th St.
Rose Family Creative Empowerment Center
7000 Franklin Blvd., Suite 1000, Sacramento 95823
Greater Sacramento Urban League Oak Park
Serving: Oak Park
2331 Alhambra Blvd. Suite 300, Sacramento 95817
South Sacramento Christian Center Valley Hi
Serving: Valley Hi
7710 Stockton Blvd., Sacramento 95823