The maternity care crisis in the U.S. affects millions of women and babies each year, but it disproportionately impacts minorities and the underprivileged. Black women and babies, for example, are several times more likely to die from childbirth-related causes.
One woman is doing something about it in Florida. With more than 25 years of experience under her belt, British midwife Jennie Joseph has developed The JJ Way – a care model that seeks to “eliminate racial and class disparities in perinatal health and improve birth outcomes for all” – and runs The Birth Place birth center – where no one is turned away, regardless of her ability to pay.
Implementing a “high touch, low tech,” evidence-based, family-centered model for at-risk moms and babies has yielded health outcomes that are far superior to the rest of the state—while saving hundreds of thousands of dollars. In 2011 and 2012, preterm birth rates at The Birth Place were between 1.75% and 5.8% — compared to the rest of Florida, at 14%. C-section rates, likewise, are significantly lower than the state average.
So, what has this midwife in Florida, serving underprivileged and at-risk populations, figured out, that our most expensive institutions haven’t?
We asked and she answered:
IB: For the average person out there who may be aware that there is “some” racial or socio-economic disparity in American maternity care, can you explain what exactly that looks like?
JJ: Unfortunately, for many years, there’s been a continuing disparity in birth outcomes for women of color and white women. The most stark difference is between the African-American race compared to the Caucasian race in the areas of low-birth weight, prematurity, infant mortality, and maternal morbidity and mortality.
IB: Who is receiving different care, and how is that care different?
JJ: It seems then that there may be an element in the way that care is delivered as well as the way the care is accessed. We can only surmise that because it is across racial lines, there’s an element of racism that is impacting the way women in America are receiving or accessing prenatal and intrapartum care as well as postpartum and interconceptional care.
IB: What barriers do these women have to great care?
JJ: Often, there is not an option for choice in care. Clinics are busy and impersonal. Sometimes practitioners are hurried and disinterested. Women are feeling that cultural competency is not necessarily there. There may be issues of transportation. Certainly, the biggest barrier, it seems, is insurance or Medicaid and the bureaucratic barriers to being eligible for services. In rural areas, obviously, there is lack of access due to very few providers or very few areas which have agencies for providing the prenatal care for women.
IB: How are you working to provide excellent care to all moms and babies, regardless of race, background, and ability to pay? What’s different about the care a woman might receive from you or one of your colleagues than what she might receive routinely in the traditional system?
JJ: The Easy Access Clinic is part of The Birth Place practice where we provide clinic services for women who are not necessarily seeking midwifery care, but simply need an access point to start and continue their prenatal care.
In our case, the better care is the JJ Way system that has as its four tenets: access, connections, knowledge, and empowerment.
The access piece is that no one is turned away regardless of their insurance status or lack thereof or their financial status or even their obstetrical status. We will triage everybody that presents for care and then try to make the best referrals, liaise with other partner agencies, or provide care onsite, depending on what’s needed.
The connections are made immediately because a relationship of trust is developed very quickly. Women feel safe that they are going to receive care because we have one interest and that is that they have a healthy birth outcome, that they go to full term, that they understand what is going on with their health and with their body, and that they are empowered to make decisions about their health and their bodies.
The other two tenets of knowledge and empowerment are woven into the fabric of everything we do when we provide this care.
IB: What kinds of health outcomes do you have?
JJ: Our outcomes are phenomenal. We have all but eradicated low birth weight and prematurity from the women in the practice who had previously been at risk for those outcomes. We see very few women with preeclampsia. We do have some diabetic women who get their diabetes under control very quickly and manage to go to full term and have healthy outcomes.
As far as postpartum, we have seen more women breastfeeding – certainly more women attempting and starting breastfeeding than previously and longer term breastfeeding.
IB: Does it cost more to provide better care?
JJ: No, because we are using the resources we already have. For example, we do not need extra space, we do not need extra staff. We used our same staff but we changed our system of delivering the care. We used the same space but we changed the system of hosting clinics. So, in other words, we went with what we had and were able to implement it immediately.
IB: What does excellent, top-quality prenatal care look like? How does a woman know if she is receiving the best care possible?
JJ: A woman will feel it. In her heart, in her spirit, in her soul. She’s going to know it in a way that’s hard to describe. She will have a sense of peace, a sense of empowerment, a sense of safety.
IB: How does a great care provider treat women?
JJ: If a provider is willing to treat her in an equitable way, from a humanistic point of view, then the cultural competence piece comes into play easily and readily and the woman and her family can tell.
IB: What do we tend to miss in typical prenatal care that you think is most important?
JJ: We have taken the humanity out of providing care. We have become frustrated with a system that doesn’t work but continue work inside of that system without really figuring out how bring change to the system. One of the things that we found with our model was that the change was so quick and so efficient that it’s almost new for us, but it’s important and we see the future of humanity in how women and babies are treated during birth.
IB: What do you consider healthy? What does “well-being” mean to you? Is it more than a baby with good Apgars and a mom who can leave the hospital without surgery?
JJ: Healthy is when a woman can look at her experience and feel complete, feel whole. Her achievement of her own goals will connote the health that she was looking for. So if a woman feels more comfortable and safe in a hospital environment and wants to have access to pain relief medications, then for her having had that happen and come out the other end with a baby and herself intact, she’s going to consider that healthy, her well-being is intact.
IB: What does the future look like for maternity care in the U.S. and for the population that you serve? Do you see it getting better or worse? If it’s going to get better, what can we do to make that happen?
JJ: The future is really looking hopeful if we can engage more people to see that there is a different way we can deliver care for low-income and uninsured, disenfranchised populations. It could get better if people are willing to serve everybody. It would get better for everyone else if we made an effort to serve the underserved right now because the benefits of doing so would cross all segments of society.
IB: What are your plans for expanding the birth facility (if any) or implementing your model in other places? How can people support your work?
JJ: I have plans to replicate my model and have a vision of having centers like mine throughout the United States. People can support our work by going to our website, learning more about what we do, donating to our cause; by sharing with people who may be in positions where they could do a similar program in their area and by generally speaking to pregnant women, encouraging them to constantly search for the most empowering and holistic support to help them through their pregnancy, birth, and postpartum period.
Learn more about Jennie and her birth center here:
Vimeo: The Birth Place
Safe, supported, respectful birth shouldn’t be a matter of privilege. It is a human right of every woman, and every baby.
And, as Jennie Joseph has proven, providing excellent maternity care to those who need it is not overly expensive, or difficult, or out of reach. There’s no reason many, many more women and babies don’t benefit from scientifically proven, respectful, family-centered practices.
It’s a matter of having the will and the compassion to just do it.
Infant Mortality poster