Posted by Brigham and Women's Hospital August 1, 2013
Birth outcomes in this country, as in other developed countries, are considerably better than those in developing nations. However, when compared solely with other developed countries, our report card no longer looks so good.
Some of this poor performance can be attributed to the significant health disparities among different US communities. African Americans, for instance, have the highest rate of infant mortality among all our nation’s major racial and ethnic groups. In our own neighborhood, Boston, a black baby is three to four times more likely to die by their first birthday than a white baby.
But it doesn’t have to be that way, says Brigham and Women’s Hospital (BWH) obstetrician Audra Robertson, MD, MPH, and she’s helping to do something about it.
Dr. Robertson led the establishment of the Birth Equity Initiative (BEI) at BWH, a program created to improve birth outcomes and eliminate inequities in infant mortality and birth weight in the Boston area, particularly among African American women.
According to Dr. Robertson, the high number of pre-term births (before 37 weeks) among African American women is the number one cause of the community’s high infant mortality rate. And Dr. Robertson says that many of the factors contributing to this high pre-term birth rate can be put into a single category.
“In a single word, it’s ‘stress,’” says Dr. Robertson. “Research points to or implicates stress as a major reason why black women experience the worst birth outcomes of preterm births and low birth weights.”
This stress can come from a variety of sources, many of them related to social status – housing insecurity, poverty, and stress related to racial discrimination. These issues, however, aren’t easy to erase overnight, so the BEI team works to create programs to improve birth outcomes for all women. Among our clinical programs, the BEI team helps women develop life skills and coping strategies. Instrumental in this effort is the BEI’s Health Care Coach, who helps young mothers take care of their overall (mental and physical) health.
In addition to combating stress, the BEI also helps women focus on the factors that are more easily controlled, such as adequate nutrition, proper pre-natal care, and choosing the right time to become pregnant. “If women are choosing to become pregnant at a time when they are at their healthiest, that increases their chances of having a healthy pregnancy and a healthy birth,” explains Dr. Robertson.
When it comes to pregnancy, being very young isn’t ideal. Similar to women who have children later in life, mothers who have children very early in life (17 or younger) naturally bear a high risk for having a pre-term birth. Dr. Robertson thus believes that targeting adolescent and young adult women is important because teen pregnancy is a major contributing factor to poor birth outcomes.
The CenteringPregnancy® program, a cornerstone of the BEI and offered/facilitated by the BWH Midwifery Group, focuses on helping this vulnerable group. Participants in CenteringPregnancy meet in interactive peer groups, both during and after their pregnancy. This collaborative model serves to extend each woman’s support network, develop their confidence, and provide greater opportunities to share best practices.
Dr. Robertson says that teens openly express how much they enjoy the program, an enthusiasm that should lead to significant benefits for their babies. A 2007 Yale study has shown that women who participate in these types of groups demonstrate better use of prenatal care, are more vigilant about breastfeeding, report higher patient satisfaction, and have children with higher birth weights.
Although the BEI is focused eliminating the statistic of poor birth outcomes for African American women, Dr. Robertson applies the program’s practices and successes to all women who are going to have a child.
“Ultimately, we want to enhance preconception health and obstetrical care for all women,” says Dr. Robertson. “We’re trying to improve birth outcomes for everyone.”
To learn more about the Brigham and Women’s Hospital Birth Equity Initiative and CenteringPregnancy, please visit www.brighamandwomens.org/birthequity.– Chris P