Healthy Birth Initiatives in Multnomah County serves Black families to ensure healthy moms and babies

Black mothers experience higher maternal death rates than any other racial or ethnic group in the U.S. In Multnomah County, the Healthy Birth Initiatives program provides those moms with case management, respite care, breastfeeding support and access to community health nurses and other resources to support healthy outcomes for babies and families. Desha Reed-Holden, a senior program specialist, says the only requirements are that families are Black, live in the county and are having a baby. Roberta Suzette Hunte had both of her children with the support of the program. She says the culturally specific wrap around care she received was invaluable. She particularly valued the home visits and more broadly, having a buffer between herself and the rest of the maternal healthcare system. Hunte and Reed-Holden join us to talk about the need for the initiative and the results it delivers to clients.

This transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. As we’ve talked about in a few recent conversations, including just before the break, the US has some of the worst maternal and infant mortality rates in the developed world. But those dismal overall numbers mask a more terrible reality: huge disparities among different racial and ethnic groups. Studies have found that Black Americans have the highest mortality rates of all groups. Multnomah County’s Healthy Birth Initiative is working to change that. Desha Reed-Holden is a program manager for the Healthy Birth Initiative. Roberta Suzette Hunte is an assistant professor in Portland State University’s School of Social Work. She’s also a Healthy Birth Initiative client for her two children who are now six and three. They both join us now. Welcome to the show.

Desha Reed-Holden: Thanks for having us.

Miller: Roberta, first. This is very personal, but do you mind sharing with us what happened with your first pregnancy before you had the support of Healthy Birth Initiative?

Roberta Susette Hunte: So I’ve had three pregnancies: one stillbirth and two live births. And in the loss of my daughter, I had preterm labor and I wasn’t given the care that I needed to support the pregnancy and I lost her through a placental abruption. But with my sons, I also went into labor early. I went into labor at 22 weeks with my daughter, 18 weeks with my son and through the alertness of the system, I was able to get the care that I needed to preserve my pregnancy till 37 weeks.

Miller: What was different after you were a part of the Healthy Birth Initiative?

Hunte: Well, I joined the Healthy Birth Initiative really by accident. I was giving a training for Multnomah County’s Public Health Department and the former director of the program, Nurse Violet Larry, said, “Oh, you should consider the Healthy Birth Initiative.” And I said, “What do you mean?” And she said, “You’re Black and pregnant, that’s the criteria for being involved.” And I was like, well, I win, I have those two things and so I joined the program, only a couple weeks before I went into early labor with my son. So it was good fortune for me because it meant that I had someone with me that I could ask all of my questions to.

I had a nurse and a community health worker who would alternate coming to my house once a month and where I would tell them the things I was talking about with my doctor, and I had a very supportive medical team around me to support the pregnancies of my two sons. And I would tell my nurse, this is what we talked about, this is what they said, and she would explain things to me and she helped me manage my anxiety and move into “I’m having this baby, this is going to happen.” And then after a really great birth of my son, I had postpartum preeclampsia and was hospitalized and I got the care that I needed. Even though we did everything to minimize the risk of a traumatic experience, I still had a difficult experience.

So when I think about what Healthy Birth Initiative did for me and my son is it, I wasn’t alone and I had an advocate who was both educating me about how to go through this experience, how to be aware of signs of preterm labor, signs of preeclampsia, how to bring in some elements of traditional labor practices, lactation consulting, how to engage with my family around this new life that we’re bringing into our home. So it was a big part of my life for about four years, an intimate part of my life.

Miller: Desha Reed-Holden, can you give us a sense for–and we got some of this just now from Roberta–the full suite of care that you provide through this program?

Reed-Holden: Sure. The Healthy Birth Initiative is one of the 101 Healthy Start programs. Our foundational goals are to prevent and reduce the risk of maternal mortality, infant mortality, and overall illness for our moms and babies. So with that, with our particular program, each client who comes in starts with the community health nurse, who was the first case manager/home visitor that they’re served by. And so depending on the complexity of their pregnancy, they may stay with that nurse throughout their pregnancy and for up to 18 months after.

Miller: And this is with home visits.

Reed-Holden: Yes.

Miller: Why are home visits important? This is a theme that’s come up a lot in a lot of different medical conversations over the last two weeks. What do you see as the value of going to someone’s home?

Reed-Holden: It’s relationship building. It’s the opportunity to really get to know someone, to really get to know their goals and to be able to create care plans and action plans that are gonna work for them as an individual. It’s not the same thing as going into a health care appointment where you have 15 to 20 minutes to talk and providers kind of have a checklist of things that they’re going to talk about. And it’s not that our nurses and community health workers don’t have a list of things that they need to talk about either, but they’re afforded the opportunity to build out relationship and so they can get all of those same pieces of information that they need through a conversation, and it never feels like they’re checking things off of the list.

Miller: My understanding is that your staff is Black. What difference do you think that makes for the people that you’re serving?

Reed-Holden: Dr. Hunte actually wrote an article that was put in the Journal of Transcultural Nursing earlier this year. The title of it was, “We Experience What They Experience” and she was talking to some of our community health nurses and community health workers along with some others about their experience and service. And that’s literally what it is, being Black and serving in this program, when we go to see our health care providers, we experience the same barriers, we have nurses who feel like they need to wear their nurses’ badges when they go to the doctors so that they can be treated with decency and respect. We literally have that lived experience of what it means to be navigating these health care systems as Black people.

Miller: If your clients then seek out Black OB-GYNs or nurse midwives or doulas, can they find them?

Reed-Holden: Yes. And the population for healthcare providers in the way of midwives and OBs that are culturally responsive is very small, of course here in Oregon. Doulas - the population is growing because there’s been some intentionality put behind diversifying the field and removing barriers for people who want to be doulas and to be trained as doula. And so we prioritize making sure that we are as a program building relationships with healthcare providers who look like us to make sure that they know about our programs, to make sure that they know about how to refer clients to us and we know how to refer clients to them. But we’re also with the healthcare systems in the area, building relationships so that they know to refer their clients that would qualify to our program, even if they don’t have a cultural congruent provider within those health care systems.

Miller: And as we heard earlier from Dr. Hunte and what she was told was that to qualify, you need to be pregnant and Black meaning not means-testing. This is not, say, income based. Why not?

Reed-Holden: Well, as you alluded to earlier around the disparities, there was some data that was put out earlier this year that showed that across the nation, [for] Black women from less than high school education to having a master’s or doctorate, the risk of preterm birth is 9.37%. And when they’ve not even finished high school and when they’ve got a master’s or a doctorate, the risk is still 8.4%. That’s a very small gap. Education is shown not to be a protective factor. For income, the same. Of course, as we normally correlate education and income together, they’re not protective factors for our moms and babies.

Whereas a white woman who hasn’t finished high school has a risk of preterm birth at 15.65%. And if a white woman has a doctorate or a master’s, the risk goes down to 5.57%. That’s a much wider gap where you can see where education and the subsequent income of having advanced education has afforded more support and that relates to a better birth outcome than it does for Black families. And actually, statistically speaking, the Black population is the only population where education and income are not protective factors for our moms and babies.

Miller: Roberta, you’re in this interesting position where you have been both a client, a participant in the Healthy Birth Initiative, and somebody who’s now studied it. I’m curious what you’ve learned from focus groups with patients who take part in the Healthy Birth Initiative.

Hunte: That for many of them, their experience with their Healthy Birth Initiative, a nurse or a community health worker may be the only Black person who is with them during their pregnancies, that having that experiences of clients, the experiences of those working in the program like Desha said, are shared. We navigate racism in our world and our community health workers are navigating that as well at the same time. There’s an understanding of what we are experiencing as clients that is not shared very often for people when for Black people, when we go into healthcare settings and that being seen is critical in helping people navigate this system. That the community health workers in many ways are acting as advocates and they provide a buffer for people as they move through the system. That they are also helping people advocate for themselves, which is critical.

I think there’s also something very normalizing about working with the Healthy Birth Initiative crew for families that’s incredibly important. The other side of it, too, is that as advocates, the community health workers and nurses are helping people as they are confronted with CPS, or Child Protective Services, as they are confronted with housing insecurity and some of the different ways that racism manifests throughout our institutions. Because one of the things about the work of community of the home visiting is that it takes perinatal care, it expands it beyond the medical moment to your life, which is really what saves people.

Miller: Roberta Suzette Hunte and Desha Reed-Holden, thanks very much.

Hunte: Thank you.

Reed-Holden: Thank you.

Miller: Roberta Suzette Hunte is an assistant professor at the University of Portland School of Social Work. Deesha Reed-Holden is the program coordinator for Healthy Birth Initiative in Multnomah County.

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