Pregnant during the Pandemic: Centering Black Mamas to Catalyze Change
As the Black Mamas Matter Alliance wraps their third Black Maternal Health Week, we wanted to share how we are following BMMA’s example and #CenteringBlackMamas at Cityblock Health.
Pooja Mehta and Monique Varcianna
Thanks to disciplined advocacy, storytelling, and science from those like the Black Mamas Matter Alliance, the shameful statistic that Black women in the United States are 3–4 times more likely to die from pregnancy-related causes than White women is now well known. We know that in New York City, where Cityblock is based and where we are both from, Black women are 12 times more likely to die than their White counterparts.
This epidemiology represents historical inequity and health system failure, stemming from structural racism, not race itself. Black birthing people, their families, and communities know this reality well, making traditional systems of care harder to trust in the very moments that they are most frequently relied upon — from OBGYN clinics to hospitals, from pediatric offices and emergency rooms to WIC clinics and social work agencies.
When COVID-19 hit the United States last month, as an obstetrician-gynecologist and community-based doula respectively, we knew that high quality, reliable, respectful perinatal and reproductive services, critical components of comprehensive primary care, would only be harder to access. Were our already marginalized members with these needs going to face further barriers, and at what cost?
Cityblock Health provides integrated primary, behavioral, and social care to populations of members we identify in partnership with public payers. Our members have many needs and often many comorbidities — including vulnerability to white supremacy. We have long been inspired by Black-led perinatal models like Mamatoto Village and Commonsense Childbirth, who seek to provide affirming, whole-person care in the community to shift experience and outcomes for Black birthing people. When COVID-19 hit the city we love hard, we decided to move quickly, informed by this prior learning, to figure out what our birthing members needed.
We proactively used a combination of claims data and simple outreach scripts to identify those Cityblock members who might be considering pregnancy, are pregnant, or are within a few months of having given birth. We wove this strategy into a larger organizational effort to identify all of our members with symptoms or risk for COVID-19.
Within one week, we reached out to nearly 100 of our members whom data suggested might be pregnant or postpartum, most of whom self-identify as Black, and many of whom are essential workers. Monique used her skills as a Cityblock community health partner and doula trained by Chanel Porchia-Albert, founder of Ancient Song Doula Services, her deep experience, and personal voice to help mothers feel connected fast; offering video as an important way to put faces with voices and build trust.
We quickly learned that a primary concern of our Black birthing members was having to give birth alone during this pandemic.
In most cases, this fear layered on prior experiences of harm and fears of abandonment by the healthcare system.
One member shared a previously untold fear of being inside a hospital building alone after personally having survived the earthquake in Haiti. Another reflected that even before COVID-19, she had not had a regular OB provider: “I don’t know where to go when it’s time to give birth. I don’t feel connected to any of these doctors.” Some told us that they had not heard from their providers since COVID-19 had hit. Those who had recently given birth or experienced miscarriage or abortion were strikingly isolated, lacking clear support with tracking symptoms of COVID-19, who to call in case of early warning signs of complications, fear of the emergency room, and newborn care. Others navigated intensified threats of intimate partner violence or pregnancy ambivalence.
The stories we heard, and continue to hear, are all the blueprint we need. Our goal is simple- make sure our members know they are not alone.
In response to this rapid member-centered design sprint, we’ve launched an initial pregnancy support offering. It consists of a direct telehealth connection to a virtual pregnancy-focused care team to fill any gaps left by the pandemic’s impact on care systems that were already painfully fragmented. Our team includes a cross-trained Community Health Partner and doula focused on birth preparedness, coaching, and social support, behavioral health specialists, an OBGYN, a pediatrician, a midwife, and lactation support, all trained in a reproductive justice-informed framework, and available on-demand by SMS, video, or phone.
Adapting Cityblock’s existing, tech-enabled approach to primary and social care, we are creating member-focused care plans for each birthing parent and, if they have one, their birthing partner — focused on preparedness for birth, potential complications, and the postpartum/newborn period. This includes help navigating shifting hospital policies in New York City around who can be present at birth — currently one support for each birthing person.
We launched a virtual pregnancy and postpartum support group, open to Cityblock members and employees alike, as we acknowledge the connections between our experiences as birthing people of color. We answer questions if there are any, but the time is most useful just for our pregnant and postpartum members to build community and use each other as resources, recognizing each other’s strength and creativity. As providers, we know this strength leads to empowerment and better health outcomes, both for parent and child.
We are learning as we go: that complex care organizations cannot leave perinatal and reproductive care out, that much can be done outside of the hospital to address perinatal need during this crisis, and that by partnering with members, we can show up safely when in-person support is critical. We are supporting relationships between members and their providers where we can, while doing the complementary work that only a community-based organization can do.
On a near-daily basis we are dropping off blood pressure cuffs, glucometers, oxygen monitors, and meals on member’s doorsteps, making culturally centered connections with our members, and conducting rigorous, continuous screening for social needs as employment and childcare situations rapidly shift due to the pandemic. We naturally bridge to primary and behavioral care designed for those with many competing needs. In addition to such services, we believe that it is unconditional advocacy, coaching, and accompaniment that powers impact on childbirth outcomes like cesarean delivery and preterm birth, and business outcomes like avoidance of unnecessary, unwanted intervention and long hospital stays.
We would not have been able to act without #CenteringBlackMamas and the precedent of Black scholarship, leadership, storytelling, strength, and science that led us here — so we’re proud to have supported Black Mamas Matter Alliance and their third Black Maternal Health Week this past week. As #BMHW20 ends, we pledge that we will continue to care for, center, collaborate with, and celebrate our Black birthing members through and after this pandemic, through and after their pregnancies — creatively, and in community. If Black women are disproportionately impacted by both COVID-19 and the maternal health crisis, they certainly must be disproportionately centered in solutions. Join us as we work to build a system that works under pressure, and rewrite the narrative of birthing while Black.
Pooja Mehta is an obstetrician gynecologist and health policy expert, and Cityblock’s Women’s Health Lead. Monique Varcianna is a Cityblock Community Health Partner certified in full-spectrum doula care with a Masters in Public Health.
