African American babies are impacted by infant mortality more than twice as often as non-Hispanic whites, according to the Department of Health and Human Services. In the state of Ohio, African Americans are at least three times as likely to suffer from infant mortality.
“In Cuyahoga County, in Cleveland, last year African Americans suffered six times the infant mortality rate than Caucasians,” stated Silas Buchanan, co-founder and president of OurHealthyCommunity.com. “More focus on social determinants of health could certainly help remedy some of the issues.”
Seventy-two percent of infant mortality loss results from premature births, which can in large part be driven by stress as an external factor, Buchanan explains. “When you look at the fact that an African American female with a PhD, or an MD is more likely to lose her infant than an uneducated Caucasian woman who lives in the inner city, you might ask—is systemic racism possibly a driver of stress?”
There’s also the issue of culturalism, he said. “Many grandmothers slept with their babies and will tell moms ‘I slept with you, you’re fine.’ Yet, we hear so many stories where a parent or loved one rolls over their child and they are killed. So we need to get the message delivered to grandmothers to deliver downstream to new moms so that we can change this behavior.”
Health doesn’t always happen inside a health system or a clinic, but it always happens within communities. “If you’re a relatively healthy person, you may only spend around 20 minutes per year at the doctor’s office. However, if you’re a spiritual person and go to church every week, you’ll spend around 70 hours a year in church or supporting your church,” said Buchanan. “Empowering trusted voices within communities—whether it’s a pastor, a barber, the owner of a corner store—could be very helpful.” Buchanan emphasized the importance of having technology-based tools in place to reach these trust brokers, and the fact that messages from trusted and known community figures can sometimes have the most impact.
“If my doctor tells me something, or social service agency tells me something, or a public health official tells me something, I may believe it, I may not. But if my pastor delivers that same information, or if I’m sitting in the barber shop and that conversation is happening in a trusted environment—or if you’re talking to the corner store owner about it, who you’ve known for 15 years—it may resonate more powerfully,” Buchanan said. “That layer of faith and community-based organizations should not be overlooked or excluded.
Perfecting the right combination of people, innovative thinking and protocols involved is critical to reducing infant mortality. With more ways to support women before, during and after pregnancy, there is increased potential for improved outcomes and eliminating health disparities.
“We recognize that the leading cause of infant mortality in the black population is premature births, and premature births are tied to stress, and fathers are saying, ‘How can I support my partner and be an advocate? How do I know what signs to look for in stress? How can I sit alongside her in the doctor's office when I’m generally ignored and be an advocate for her?’” said Leslie Evans, director of professional development at HIMSS.
“When dad feels out of the loop, it can create stress inside the relationship,” Buchanan explained. “If we can find ways to better engage dads in the pregnancy—that could alleviate this stress.”
Watch Joia Crear-Perry, MD, founder and president of the National Birth Equity Collaborative, explain the elevated rates of maternal mortality across socioeconomic and racial lines, and describe how tech-driven connection to care can help in a HIMSS TV interview.
The best way partners can reduce stress for expectant moms is by making sure they are well-connected with all the resources they need to feel empowered, healthy and prepared as they enter motherhood. A variety of digital health tools exist that are focused on improving patient-provider communications through real-time tracking of progress throughout the pregnancy.
One example is Ochsner Health System, which works with expectant moms using integrated smart phone tools that can connect to scales and blood pressure cuffs. Data from weight and blood pressure readings transfers directly to the patient’s medical record so that health coaches and obstetrics care providers can review and monitor the data continuously. This increases the speed of provider intervention when needed and reduces visits when not medically necessary. It’s also a way to reduce visits for expectant mothers located in rural settings or living longer distances from their healthcare providers.
People and shifting mindsets can often be the missing piece of the puzzle when it comes to improving healthcare outcomes—which is why the inclusion of midwives hold immense potential to improve outcomes. A study on midwives in the healthcare system found that states with high midwifery integration like Washington and Oregon had better birth outcomes then states with the least integration.
Though roughly 10% of births in the U.S. involve midwives, in other industrialized countries, midwives participate in half or more of all deliveries. With the help of a midwife, soon-to-be moms can be less stressed and better supported in ways that doctors and partners may not always be able to. This role can serve as an advocate and a coach before, during and after the pregnancy, focused on compassionate care and guidance that does not overlook one’s desires and expectations throughout the entire process, providing a more holistic form of care.
According to the World Health Organization, women who receive midwife-led care are:
There’s a clear need for improvement in how expectant moms interact with and are cared for in the healthcare system. Activating change starts with incorporating new people, processes and technology that empower and prepare women for what’s ahead for both them and their child.
To reduce the negative impact of stress on one’s health, these changes are critical. Future generations will be better served by moms who enter motherhood in a happy, healthy and stress-free state.
The World Health Organization declared this The Year of the Nurse and the Midwife. Our Nursing Informatics Community and supporters are coming together to celebrate the tireless and inspiring work of nurses around the world, today, this year and beyond.
Originally published September 13, 2018; updated May 11, 2020