Improving Maternal-Fetal Outcomes Begins with Community

It has been proven time and time again that the solution to improving maternal outcomes starts with community.
— Lisa Groon

 AUTHOR: Lisa Groon, Founder Ovo Birth Center

AUTHOR: Lisa Groon, Founder Ovo Birth Center


There were 3.978 million births in the United States in 2015. When compared with all other developed countries, the United States has the worst maternal mortality rates. The worst. Why? Because on the most basic level, we just aren’t listening to mothers. And when we don’t trust women and the physiology of birth, we see unusually high inductions and cesareans and women experience excessive medical interventions like episiotomies, and ultimately, we see higher mortality rates. Our society is no longer talking about normal, physiologic birth, and it’s resulting in dire consequences for moms and babies. Not only do families deserve a model of care that honors the whole family, but they deserve a community, because research has told us time and time again that the health in moms and babies lies in the presence of a supportive community. When families have seamless access to health care providers, resources, and most importantly, a diverse group of people who can offer a comprehensive array of options, lessons, and wisdom, they are more educated and involved in their care.

In a small study with a Northern Plains American Indian tribe, the researchers described how a community-based approach that includes elder women, fathers, midwives, and other important individuals not only increases utilization of care during pregnancy but also empowers women before, during, and after pregnancy. They also specifically requested to have midwives provide their care. Separately, a large study in India showed that implementation of community-based interventions led to reduction in neonatal mortality, increased rates of early breastfeeding, and ultimately, significant decreases in neonatal and maternal morbidity. In the 2011 Surgeon General’s Call to Action to Support Breastfeeding, societal factors including lack of knowledge, social norms, poor family and social support, embarrassment, among others were cited as having a significant impact on low breastfeeding initiation and duration rates in the US.

An approach by a midwife in Florida called the JJ Way utilizes four core tenants to address maternal health outcomes in her clinic; Access, Connection, Education, and Empowerment. Her model demonstrates consistently better health outcomes compared to the national average and she does this first by ensuring that all women who seek care, receive care and then her team invites them into a supportive community which offers kinship, wisdom, and empowerment. As her team has shown, community-based care is an important component of providing a continuum of care for low-resource communities.

It has been proven time and time again that the solution to improving maternal outcomes starts with community. It starts with making midwives available to Native American women and Centering Pregnancy programs to women in urban communities so that women can experience more favorable birth, neonatal, and reproductive outcomes. It starts with bringing back a village of families where we know our neighbors and deliver meals to new moms, breastfeed in public, and watch the other kids at the park without question.  We know that organized social services and programmatic medical care works to improve mortality rates and we can continue to improving these outcomes through collaborative systems approach, involving providers, friends, family, and neighbors. It truly does take a village to raise a child.

References

1.      Martin JA, Hamilton BE, Osterman MJK. (2016, September). Births in the United States, 2015. NCHS data brief, no 258. National Center for Health Statistics.

2.      Andrea T. Roche, MS, RD, Kimberly B. Owen, MS, Teresa T. Fung, ScD, RD. (2015). Opinions Toward Breastfeeding in Public and Appropriate Duration, ICAN: Infant, Child, & Adolescent Nutrition, Volume: 7 issue: 1, page(s): 44-53.

3.      Ickovics JR, Earnshaw V Lewis JB Kershaw TS, Magriples U, Stasko E, Rising SS, Cassells A, Cunningham S, Bernstein P, Tobin JN. (2016). Cluster Randomized Controlled Trial of Group Prenatal Care: Perinatal Outcomes Among Adolescents in New York City Health Centers, 2016. American Journal of Public Health. 106(2):359-65. doi: 10.2105/AJPH.2015.302960.

4.      New York Times (2018, February 4). Making Pregnancy Safer for Women of Color. Retrieved from https://www.nytimes.com/2018/02/14/opinion/pregnancy-safer-women-color.html

5.      Lassi ZS, Kumar R, Bhutta ZA. Community-Based Care to Improve Maternal, Newborn, and Child Health. In: Black RE, Laxminarayan R, Temmerman M, et al., editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC):

6.      The International Bank for Reconstruction and Development / The World Bank (2016 April 5). Chapter 14. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361898/  

Sinha, B,  Chowdhury, R., Sankar, M.J., Martines, J.R., Taneja, S., Mazumder, S., Rollins, N, Bahl, R., & Bhandari, N. (2015, July 16). Interventions to improve breastfeeding outcomes: a systematic review and meta‐analysis, 2015. Acta Piadatrica. https://doi.org/10.1111/apa.13127