By Genoa Barrow | OBSERVER Senior Staff Writer

Black women have long had to advocate for their own well-being, navigating the health and health care space and the disparities and disrespect they often encounter along the way. Local obstetrician/gynecologist Dr. Oyenmwen “Joy” Inneh equips local women with another tool: a birth plan.

The OBSERVER sat down with Dr. Inneh to talk about Black Maternal Health Week, celebrated April 11-17, and efforts to raise awareness for equitable maternal health outcomes. Black women still have three times the maternal mortality rate of white women.

Having a birth plan, Dr. Inneh says, can help mothers feel more comfortable throughout their pregnancy journeys.

“There’s very little control we have in pregnancy and labor and delivery, but things that we can control, let’s try to so you can feel empowered,” she tells the patients she sees at Kaiser Permanente’s South Sacramento hospital.

A birth plan can include anything from whether a mother wants pain medication during delivery to who she wants to cut the umbilical cord. The birth plan helps patients communicate to their providers things that are important to them, their health, and their child’s health.

“It’s an all-encompassing, communicative method,” Dr. Inneh says.

There is a long-standing mistrust of the medical profession and institutions due to a history of racism and bias. Mothers carrying babies often fear that something can go wrong. Having a document that puts mothers in the driver’s seat is important, Dr. Inneh says.

A major concern for Black women is not being listened to when it comes to their own bodies and their own health.

According to the nonprofit Kaiser Family Foundation’s 2023 Racism, Discrimination, and Health Survey, 22% of Black women who were pregnant or gave birth in the previous 10 years said they were refused pain medication they thought they needed. One in five (21%) Black women said they’d been treated unfairly by a health care provider or staff because of their racial or ethnic background.

Plan Of Attack

The current president’s recent anti-equity mandates have many who address disparities in health and social justice waiting to see how the axe will fall on their programs, Kaiser Permanente plans to continue addressing the higher prevalence of hypertension among pregnant Black women through a remote perinatal monitoring program for high-risk patients.

“Having a leader who cares, regardless of how it looks, is important,” Dr. Inneh says. “One reason why I came on is because I felt that people here at Kaiser, the administration leadership, were really focused on still improving outcomes for people, for our patients with disparities, and so people have to just care and continue doing that.”

Black babies matter, she says.

“I’m really proud of what we’re doing here at Kaiser,” Dr. Inneh adds.

The South Sacramento and Roseville locations are on Newsweek’s national list of best maternity hospitals. At a time when maternity wards and birthing centers are closing across the state and throughout the country, Kaiser is expanding. A new medical center being built near the Sacramento Railyards will have maternity services.

“We’re adding more points of access for people,” Dr. Inneh says. “ I’m just incredibly lucky to practice here.”

While she wants to normalize inclusion of birth plans, Dr. Inneh says regular communication between patients and their care providers is also crucial.

“As a provider, I make sure that I ask pretty early on, maybe in the second trimester or early third trimester, when birth is somewhere around two months away, ‘Hey, let’s start talking about this right now.’” 

Some have had bad outcomes with previous pregnancies. Dr. Ineh is happy to give her patients peace of mind when she can.

“I validate their experiences because it is their experience. I give them tools to say you can speak up or you can bring somebody with you and have an advocate, you can have a doula.

“We’re rolling out a doula program. Actually, I think it’s for medical patients. They’re now covered for a doula who can be in the room and advocate for you, and/or translate what we’re saying to you in different words. There are options and tools for how we can make you feel heard and listened to when you’re vulnerable.”

Plans aren’t written in stone. Mothers, Dr. Inneh assures, have the right and power to change their minds.

“A birth plan is what we know you want, and your desires and wishes. We know that things can be fluid and move, but that will always come back to you; no one can do anything without your consent.”

Having culturally competent care in the maternal health space can also reduce poor outcomes. 

“That comes into play a lot, especially with our staff in general in South Sacramento,” Dr. Inneh says. “They’ve seen many different patients from many different backgrounds. They kind of understand the different nuances and complexities of cultural education. I think that’s really important for us as providers.”

Family Planning

Formal, written plans have risen in usage in the last 20 years. Some hospitals, like Kaiser Permanente, include templates in the material expectant mothers get at the beginning of their pregnancies.

“In my entire career, it’s always been the thing, the birth plan,” Dr. Inneh says. “I think it’s getting popularized by things like TikTok and Instagram, or you have these maternal pages where people are gathering around, talking about their experiences and the importance of the birth plan.”

Several Black celebrities have also been vocal about their birth experiences in recent years, empowering others to be more assertive regarding their own needs.

Kyla Pratt, known for roles in “One on One,” “The Proud Family,” and “Doctor Dolittle,” has spoken about being dismissed by a health care provider while she was in labor with one of her daughters, leading to her having to advocate for herself and her unborn child.

Tennis icon Serena Williams has also shared publicly a near-death childbirth ordeal following the emergency Cesarean section delivery of her first daughter, Olympia, in 2017. Williams was diagnosed with a pulmonary embolism and other blood clots in her lungs, leading to several surgeries and a six-week recovery period. She had to advocate for herself to receive appropriate care.

“Fresh Prince of Bel Air” star Tatyana Ali says she was traumatized by “obstetric violence” when her birth plan for her first son was ignored. The baby spent four days in the NICU after she says she was pressured to take an epidural she didn’t want and faced other unnecessary medical interventions.

“The things that they’re speaking up about, like Serena and her blood clot, these are things … that we can look for in the hospital,” Dr. Inneh says.

“These are things that we want to be aware of and we want to be able to reverse.”