by Olivia Lewis
Editor’s note: This story is part of a series on maternal mortality in America and the Centers for Health’s actions to address the issue. This story was produced as part of a joint editorial initiative by Direct Relief and the National Association of Community Health Centers.
DETROIT, Michigan — Jessica Jackson’s days at the Detroit-based Center for Community Health and Social Services, Inc., better known as CHASS, are filled with appointment after appointment.
Certified nurse midwife works with pregnant and new moms in a community-based non-profit health center. In the evenings, Jackson hosts a small prenatal group for expectant moms to learn about the birthing process and build community with each other. It’s one of many ways the health center is increasing access to maternal care as maternal mortality rates rise nationwide.
According to the Centers for Disease Control and Prevention, maternal mortality rates increased for black and Hispanic women from 2018 to 2021. National data for 2022 has not yet been released. Organizations nationwide have supported efforts to reduce the black maternal death rate, which for years has been significantly higher than that of white or Hispanic mothers. However, in 2020, the maternal mortality rate for Hispanic women increased from 11.8 to 18.2 deaths per 100,000 live births, with the largest increase among Hispanic women ages 25 to 39. In 2021, the Hispanic maternal mortality rate rises again to 27.5. double the pre-pandemic rate.
The CDC also reported that the coronavirus contributed to an increase in maternal mortality in 2020 and 2021. About 25% of those maternal deaths were Covid-19 related.
CHASS serves more than 8,700 patients in 2021, the majority of whom are Latinx. According to health center data records, more than 6,000 of these patients are better served in a language other than English. Most CHASS patients live at or below the poverty line and are either enrolled in Medicaid, or Medicare, or do not have insurance. CHASS provides care no matter the patient’s condition
CHASS CEO Dr. Felix Valbuena said the health center separated maternal care appointments during the coronavirus because so many patients were afraid to meet in person after being told to stay home to be safe. Health center encourages patients to get vaccinated for coronavirus and continues to pay close attention to expectant mothers with diabetes, high blood pressure and depression, which have historically resulted in low birth weight babies and an increased risk of death Is.
In CHASS, maternal care includes Pap tests, blood pressure checks, and diabetes checks during a woman’s childbearing years. They talk to patients about birth control options, pregnancy testing, emergency services, and outpatient services related to pregnancy.
The certified nurse midwife said that since 2020, many of her patients have expressed high levels of stress due to isolation, trauma and not knowing how to advocate for themselves.
“A lot of times, because people are happy to have something, there aren’t a lot of questions. And in our community, we’re grateful for what we have and respect for healthcare providers is paramount. So that’s part of the problem.” Jackson said.
A reluctance to ask questions, a lack of reliable travel, language barriers, and the ability to meet with physicians during specific times of the day have made accessing care more difficult for Hispanic women, according to Jackson. Additionally, her patients had significantly higher rates of stress as a result of the 2020 coronavirus pandemic.
To address high stress levels, CHASS staff talk to patients about the coronavirus vaccine, dispense baby necessities like diapers and bottles, hold evening prenatal group meetings, and deliver include “social pieces” in maternity packets for mothers in the U.S. Children in the hospital.
Social pieces include talking to patients in Spanish so they feel comfortable, giving them pictures of signs to help them navigate the hospital, and who to call for help with transportation. The health center works with the local Henry Ford Hospital, where most expectant mothers give birth. Residents work at CHASS one day a week to learn about the cultural needs of the community and to get to know the patient base so that families will feel more comfortable when it is time for the baby to be in the hospital.
A certified nurse midwife saw Yocasta Emilio Medina for a prenatal checkup on Tuesday. Madina, 27, is three months pregnant with her second child. Her first child was born six years ago, and she has different pregnancy symptoms with the new baby. Medina said she felt nauseous and vomited regularly, which was not the case during her first pregnancy.
Medina, who prefers to speak Spanish, went to CHASS for a pregnancy test and said she still hasn’t had a doctor’s appointment since then. Medina said she feels comfortable asking her provider questions about the procedure.
“They know that we’re more than happy to take care of people instead of taking care of them,” Jackson said.
Another patient, Kayla Bocanegra, 19, said her baby is due on February 6. Bocanegra said she took an at-home pregnancy test last year. When it came back positive, she started going to CHASS for regular doctor appointments.
Bocanegra, who said she was nervous about her son’s birth, talked with her provider about whether she had any pain during her pregnancy, how she felt day-to-day, and how she felt. Being in good spirits because of the support means being able to have a trusting relationship with your doctor.
The Evening Prenatal Group leads the health center’s efforts to build an inclusive community of support, especially for those who felt alone during the onset of the coronavirus. The program is hosting its fourth group, a way to gather expectant moms in a safe, small group. Over six sessions, moms-to-be learn about nutrition, anatomy, what to expect in the hospital, labor precautions, dental needs, and what to expect post-partum, among other things.
The health center used to offer a doula service, which CEO Dr. Felix Valbuena said they are working to bring back later this year. Valbuena said the high cost of the program had made it difficult to maintain in the past.
Meanwhile, Jackson continues to work with Henry Ford to ensure that Chase and Henry Ford have a common understanding of “baby-friendly” practices. For example, allowing the baby to stay in another room after birth, providing breastfeeding services, and showing mothers how to care for the newborn in a language they understand.