When you are flying solo on parenting a three day weekend isn't much of a treat. However, through all of the yelling and wrestling and mess I am trying to remember what a privilege it is for me to be able to stay home with these little munchkins - to be here for and with them. Not everyone is afforded that gift: not my husband, many thousands of miles away, for instance. As I break up the 100th fight today, I try to hold on to this feeling of gratitude - and my mind flits to the reason the kiddos are home from school in the first place. Martin Luther King Day. An incredible man, father, activist. His children were still small when he was taken from them. A tragedy brought about by hate. A very visible, tangible hate.
It's easy to snap a quick MLK quote on Facebook today while mostly relegating the man and what he stood for to the dusty past.
His work is not done.
Every single day hate rears its ugly head. The stuff we see on the news is visible. Tangible. But there is so much more than meets the eye going on. Things we may never see, if we aren't awakened to them.
To the point: I'm talking about systemic racism as it pertains to maternal and fetal healthcare outcomes. You may or may not be aware of the recent outpouring of dissatisfaction with maternal healthcare here in the United States. Here are just some quick facts to catch you up:
"more American women are dying of pregnancy-related complications than any other developed country. Only in the U.S. has the rate of women who die been rising." (source)
"African American mothers are dying at three to four times the rate of non-Hispanic white mothers." (source)
"Black infants are four times as likely to die of complications at birth and twice as likely to die before their first birthday." (source)
"Arkansas ranks 4th among states with highest maternal death rates." (source)
When confronted with something so seemingly intangible we almost feel helpless - what can we even do to change it? Generally speaking there are some things we can do to combat institutional racism; listen, validate, practice empathy, self search, see something/say something, get involved. As it specifically pertains to birth, what can we do?
Since the system we have isn't working for us, I think it's time for a change. And I'm not alone:
In 2016 the Black Mamas Matter Alliance finalized a “policy toolkit” of recommendations to improve maternal health. These include improving access to reproductive healthcare, bettering the quality of maternal health care, providing appropriate services for women most at risk, and ensuring nondiscrimination in access to care.“There is often an effort … to have a one-size-fits-all solution when we can see clearly that the outcomes are so drastically different [for black women] that we need specialized solutions,” Jackson said." (source)
Birth centers, such as the one in Washington DC and Winter Garden, FL are showing incredible results at leveling the playing field with a focus on some key elements: comprehensive care models, women of color making up the majority of staff, as well as emphasizing respect, connection, education and empowerment.
These centers aren't the only ones seeing results in improving maternal healthcare in general:
"The American Association of Birth Centers (AABC) was awarded a multi-year grant (2013-2017) by the federal CMMI to enroll women covered by Medicaid in birth center care at 47 participating birth centers, then monitor carefully how they fared with birth center care....
Women who received prenatal care in Strong Start Birth Centers had better birth outcomes and lower costs relative to similar Medicaid beneficiaries not enrolled in Strong Start. In particular, rates of preterm birth, low birthweight, and cesarean section were lower among Birth Center participants, and costs were more than $2,000 lower per mother-infant pair during birth and the following year." (source)
With incredible statistical results, and other studies being done that show birth centers are not only a safe choice, they are a fiscally responsible one, what's to lose? Well, for Arkansas, we need to lose some rather ugly regulations and some ingrained prejudice against midwives. Currently there is not a single birth center in the state, after the sole birth center in NWA closed last year due to financial hardship. And consumers are so fed up they are suing the Health Department over it's draconian home-birth regulations. The recent closure of St. Vincent's L&D and the effect this will have on the already over worked doctors/nurses can't be overlooked as another piece in the puzzle that is maternal healthcare here in Arkansas. And one more darn good reason to get on board the birth center train.
The path forward is unclear. I don't personally know what steps we need to take to bring these dreams to fruition but I know that dissatisfaction is growing. We cannot and must not accept the way things are.
I'll leave you with a few more applicable words of wisdom from the man of the hour:
“Take the first step in faith. You don’t have to see the whole staircase, just take the first step.”
“If you can’t fly then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do you have to keep moving forward.”
“Courage is an inner resolution to go forward despite obstacles; Cowardice is submissive surrender to circumstances. Courage breeds creativity; Cowardice represses fear and is mastered by it. Cowardice asks the question, is it safe? Expediency asks the question, is it politic? Vanity asks the question, is it popular? But conscience ask the question, is it right? And there comes a time when we must take a position that is neither safe, nor politic, nor popular, but one must take it because it is right.”
“Law and order exist for the purpose of establishing justice and when they fail in this purpose they become the dangerously structured dams that block the flow of social progress.”
“Our lives begin to end the day we become silent about things that matter.”
“Almost always, the creative dedicated minority has made the world better.”
“We must accept finite disappointment, but never lose infinite hope.”