Maternity Group Care for and by Black People Is Improving Outcomes in Oakland

Things didn’t go as planned when DeAnna Jones, 31, delivered her first child in Oakland three years ago.

She wanted to have a natural birth, but early contractions led doctors to medically induce her labor a week earlier than her due date. Her daughter’s birth turned out well, but she wished she had known more going into the experience.

“I did have a birth plan, and getting induced was not part of that,” Jones said. “So when it came at 39 weeks to be induced, I was like, okay … but I didn’t necessarily say why or can I wait until I’m actually 40 weeks or things that I probably should have asked.”

Jones didn’t feel mistreated during her experience at the Wilma Chan Highland Hospital Campus, but it gave her pause when she became pregnant again.

So Jones was excited when, around eight weeks into her second pregnancy, she was invited to participate in a group perinatal care program that’s trying to improve the patient experience for Black women like her who live in Alameda County. The program, called BElovedBIRTH Black Centering, is resulting in healthier births and prompting state officials to look into expanding it to other public hospitals in California.

The program groups up to a dozen Black women in similar stages of pregnancy and offers them care from a team of Black doctors, midwives, doulas, nutritionists, breastfeeding experts and other wellness professionals. Participants receive a range of services before, during and after giving birth — from childbirth education to mental health support and social services.

The program also harnesses donations from the community to give away fresh produce, baby supplies, postpartum meal deliveries and pregnancy portraits with a professional photographer.

“We have really adopted the ‘it takes a village’ mindset and the commitment to say, okay, if we know better, we have to do better,” said Jyesha Wren, a midwife and director of the program.

Wren, along with the Alameda Health System, which operates Highland Hospital and other community health centers, and the Alameda County Public Health Department, launched the program in 2020 to address the alarming rate of pregnancy-related deaths and complications affecting Black women. So far, the $3.5 million public-private initiative has served more than 200 patients who qualify for Medi-Cal because of their low income.

American women are dying during pregnancy or in the year after at a far higher rate than in other wealthy nations, and Black women are three times as likely to die from giving birth as white mothers.

While California’s maternal mortality rate has been lower than the rest of the country in the last decade, a landmark study of babies born in the state (PDF) between 2007 and 2016 found that childbirth is riskier for Black women, regardless of their socioeconomic status. The study, which examines birth, death and hospitalization records with income tax and demographic data, found that high-income Black mothers have the same risk of dying in the first year after giving birth as the poorest white mothers.

“There are many factors that may be driving this, but the primary factor behind all of that is racism in all of its forms, whether that’s structural or institutional or interpersonal racism,” said Kim Harley, a researcher at UC Berkeley’s School of Public Health. “We see that impacting the whole life course of Black birthing people, and it’s shown in the outcomes that they have during pregnancy.”

More recently, a survey of 2,400 mothers by the U.S. Centers for Disease Control and Prevention found that one in five women said they had been mistreated while receiving maternity care. Mistreatment was reported most often by Black, Hispanic and multiracial moms and those with public or no insurance. What’s more, almost half of the women surveyed said they held back in asking questions or sharing concerns with their providers because they didn’t want to “make a big deal” or not feeling confident that they knew what they were talking about.

A unique model of care

BElovedBIRTH combines several strategies, such as having a doula provide nonmedical support during a birth, that has been shown to improve outcomes for Black mothers and their babies.

While typical prenatal checkups last about 15 minutes and can leave parents feeling rushed and overwhelmed, BElovedBIRTH takes a different approach. Participants partake in group prenatal care, also known as centering, where they get two hours to learn about what’s happening to their bodies and ask questions.

BElovedBIRTH participants meet twice a month at a clinic located in a former shopping mall in East Oakland, but the setting feels nothing like a medical office. Portraits of pregnant Black people hang on the wall and mellow Afrobeat music plays in the background. There’s a lounge filled with books where women sip tea and chat with each other.

During a recent visit, six women, including DeAnna Jones, took turns going behind a room divider where a nurse measured their blood pressure and their baby’s heartbeat.

Then, they formed a circle to learn from a team of Black midwives and doulas about different methods for speeding up labor and the pros and cons of each one. They also role-played what it might be like if their deliveries don’t go as planned.

Dressed in a T-shirt that exposed her full belly, Jones went over a scenario where she was admitted to the hospital with high blood pressure. A midwife suggested speeding up contractions with medication or a balloon-like device to widen her cervix.

Jones weighed the risks and benefits of using either method or doing nothing at all and asked: “Is there a possibility that I can wait a little bit?” A doula stepped in and asked if she needed more time to discuss the options.

Jones said, “Yes,” seemingly relieved to have that choice.

The purpose of the exercise was to empower patients to make informed decisions.

“These things may seem kind of simple and basic, but the sad reality is that in most medicalized health care, they’re not happening,” Wren said.

“There’s no time for them to get information. There’s no time for them to be actually taking charge of their health care in that way and knowing what’s going on with their bodies and making their decisions and having them respected.”

In an independent survey of Black moms who participated in the program, the majority said they felt less stressed during pregnancy and more prepared to advocate for themselves.

Taj’ae Harris, 20, said before coming here, much of what she knew about childbirth came from TikTok and YouTube.

“But then actually coming in here and learning even more stuff, it all, like, pieced together,” she said. “So I’ve been learning a lot of things, like the steps, like coping during labor, different tools being used, different things to ask the doctors, different things to make you feel safe.”

Meanwhile, Jones said she feels more confident as she prepares for her second delivery.

“I wish I had this program then, but now that I’m in it, I’m excited and ready to go,” she said.

An ongoing study led by Harley, the reproductive epidemiologist at UC Berkeley, found that the BElovedBIRTH participants’ babies had a higher rate of being born at full term and with a healthy birth weight than other Black babies born at Highland, which is Alameda County’s main public hospital.

The California Department of Health Care Services, which administers Medi-Cal, is exploring ways to make a program like BElovedBIRTH financially sustainable so it can be implemented in other public health systems.

The program would expand the state’s recent efforts to improve health equity for new parents and babies. The state already expanded postpartum care and access to doulas for Medi-Cal patients. It’s starting to offer unconditional cash, ranging from $600 to $1000 per month, to pregnant people in certain communities who are at high risk for preterm birth or postpartum complications. The state’s pilot project is an expansion of a San Francisco experiment that provides extra cash and doula care for Black and Pacific Islander pregnant people — two groups that have the highest preterm birth rate in the city.

The state is also putting pressure on perinatal care providers to comply with a law requiring that their workers undergo unconscious bias training.

But two years after that law took effect, an investigation by the state Department of Justice found only 17% of those providers began training their employees.

Wren said mandating unconscious bias training is a step in the right direction, but she thinks advancing health equity will also require empowering pregnant Black people so that they can demand a higher standard of care and holding health care providers accountable.

“It really is a matter of life and death for our health system to do things differently because we know that if we continue to deliver health care in the way that we have, we’ll continue to have preventable morbidity and mortality,” she said.

A legacy of fighting for health equity

Wren says the BElovedBIRTH Black Centering is thriving because of grassroots support in a community with a tradition of activism. It draws inspiration from the Black Panthers Party, which operated more than a dozen free medical clinics for Black communities in Oakland and elsewhere in the 1960s and 70s.

They “really recognized the health impacts of racism in all of its forms and the need to do community-centered health care work that was by and for us,” she said.

The Oakland area also benefits from having a larger than usual pool of Black midwives, doulas and maternity care providers.

Wren credits the former head of Highland Hospital’s Maternal and Child Health department for taking the unusual step in the 1980s of including midwives in the labor and delivery room. That wasn’t common practice then but has since been shown to lower birth complications. The move created a robust midwife department, and some of its staff members are now supporting BElovedBIRTH participants.

The doctor who advocated for midwives was James Jackson. His son, James E.T. Jackson, is now CEO of Alameda Health System.

“He understood their value, and what the Beloved program has shown is that the cohort model and working with midwives and doulas create a safe space for these mothers that they did not have before,” he said.

Alameda Health System is encouraged by the outcomes, the younger Jackson said and is looking to expand the program to other ethnic groups experiencing disproportionate rates of maternal and infant mortality.