Editor’s note: This story is part of a series on maternal mortality in the U.S. and health center 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, Mich. — Jessica Jackson’s days are filled with back-to-back appointments at the Detroit-based Community Health and Social Services Center, Inc., known as CHASS.
The certified nurse midwife works with expecting and new moms at the community-based nonprofit health center. In the evenings, Jackson hosts a small prenatal group for expectant moms to learn about the birthing process and build community with one another. It’s one of several ways the health center is increasing access to maternal care as maternal mortality rates increase nationwide.
According to the Centers for Disease Control and Prevention, the maternal mortality rate 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 decrease Black maternal mortality deaths, which have been significantly higher than white or Hispanic mothers for years. However, in 2020, the maternal mortality rate for Hispanic women significantly increased from 11.8 to 18.2 deaths per 100,000 live births, with the greatest increase for Hispanic women aged 25 to 39. In 2021, the Hispanic maternal mortality rate increased again to 27.5– more than double the pre-pandemic rate.
The CDC also reported that coronavirus contributed to the rise in maternal mortality rates in 2020 and 2021. About 25% of those maternal deaths were Covid-19 related.
CHASS served over 8,700 patients in 2021, most of whom are Latinx. Over 6,000 of those patients are best served in a language other than English, according to the health center’s data records. Most CHASS patients live at or below the poverty line and are either enrolled in Medicaid, or Medicare or don’t have insurance. CHASS provides care no matter a patient’s circumstance
Dr. Felix Valbuena, CEO of CHASS, said the health center spaced out maternal care appointments during the coronavirus because so many patients were afraid to visit in person after being told to stay home to stay safe. The health center encouraged patients to get vaccinated for coronavirus and continued to pay close attention to expectant moms with diabetes, hypertension, and depression, which historically have resulted in low-birthweight babies and increased risk of death.
At CHASS, maternal care includes pap tests, blood pressure checks and diabetes screenings throughout a woman’s childbearing years. They talk to patients about birth control options, pregnancy tests, emergency services and outpatient services related to pregnancy.
The certified nurse midwife said since 2020, many of her patients have expressed higher levels of stress from isolation, trauma, and not knowing how to advocate for themselves.
“So many times, because people are just happy to have something, there’s not a lot of questions. And in our community, we are thankful for what we have and respect towards healthcare providers is paramount. So that’s part of the problem,” Jackson said.
The reluctance to ask questions, lack of dependable travel, language barriers, and ability to meet physicians during specific times of the day have attributed to accessing care more difficult for Hispanic women, according to Jackson. Additionally, the 2020 coronavirus pandemic resulted in significantly higher rates of stress among her patients.
To address higher stress levels, CHASS employees talk to patients about the coronavirus vaccine, give away baby necessities like diapers and bottles, host prenatal group meetings in the evenings, and have included “Social pieces” in maternity packets for moms on their way to deliver babies at the hospital.
The social pieces include speaking to patients in Spanish so they feel at ease, giving them pictures of signs to help navigate the hospital, and who to call for help with transportation. The health center works with the local Henry Ford Hospital, where most of expectant mothers give birth. Residents spend one day a week working at CHASS to learn about the cultural needs of the community and to get to know the patient base so that families feel more comfortable when it’s time to have the baby at the hospital.
The certified nurse midwife saw Yocasta Emilio Medina on Tuesday for a prenatal check-up. Medina, 27 years old, is three months pregnant with her second child. Her first baby was born six years ago, and her pregnancy symptoms are different with the new baby. Medina said she feels nauseous and vomits regularly, which didn’t happen during her first pregnancy.
Medina, who prefers to speak Spanish, went to CHASS for a pregnancy test and said she’s yet to miss a doctor’s appointment since. Medina said she feels comfortable asking her provider questions about the process.
“They know that we’re happy to care for them as opposed to caring for people as a task,” Jackson said.
Another patient, Kayla Bocanegra, 19, said her baby is due on February 6. Bocanegra said she took a pregnancy test at home last year. When it returned a positive result, she began going to CHASS for regular doctor appointments.
Bocanegra, who said she is nervous about the birth of her son, has talked to her provider about whether she has had any pain throughout her pregnancy, how she feels day-to-day, and remaining in good spirits because to her, having support means being able to have a trusting relationship with her doctor.
The evening prenatal group furthers the health center’s efforts to create an inclusive community of support, especially for those who felt alone during the beginning of the coronavirus. The program is hosting its fourth cohort in a way for expectant moms to gather in a safe, small group. Over six sessions, the moms learn about nutrition, anatomy, what to expect at 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 made it difficult to sustain in the past.
In the meantime, Jackson continues to work with Henry Ford to ensure CHASS and Henry Ford have a common understanding of “baby-friendly” practices. For example, allowing the baby to stay in the same room as the mother after birth, providing lactation services, and showing moms how to care for a newborn in a language that they understand.
