Doctors and health workers in St. Louis say providing mothers with pregnancy care earlier and more consistently is essential to reducing the state’s high rate of maternal and infant deaths.
Experts in pregnancy and maternal health on a panel convened by the St. Louis Department of Health on Thursday said quality pre- and post-natal health care provided by workers beyond clinical health settings is essential to reducing maternal and infant mortality rates.
“No one person can be the be-all and end-all,” said Dr. Mati Hlatshwayo Davis, St Louis health director. “I as a physician can’t, and a nurse can’t, and a [community health worker] can’t, but together understanding the work we do is critical to each other, we can do that.”
About six infants per 1,000 born each year die in Missouri, and more than 30 women per every 100,000 people die in the state during pregnancy or within a year of giving birth. Mortality rates for Black mothers and infants are higher than for their white counterparts.
According to the state’s Department of Health and Senior Services, Black women were three times more likely to die during pregnancy or in the year after birth than white women.
Panelists advocated for increasing the use of doulas, community health workers and midwives and integrating them into existing clinical settings.
“We have not integrated [midwives and doulas] into health systems like other countries have, said Okunsola Amadou, a midwife and founder of the Jamaa Birth Village, which provides doula services to people of color in St. Louis. “Social workers, community health workers, these are people who are with pregnant women all the time.”
Having support early and during pregnancies provides emotional help to expecting mothers. It also makes it easier to integrate screenings for potential problems, including congenital syphilis, and provides an easy way for women to address health concerns.
“It doesn’t matter if your doctor is empathetic if the person who answers the phone and checks you into the hospital or the nurse who is laboring with you is not,” said Dr. Dineo Khabele, the OB-GYN department chair at Washington University. “We need everybody in health care to think about how we’re approaching the individual patients.”
About 30% of Black pregnant women in St. Louis don't receive adequate prenatal care, compared with about 13% of white pregnant women, said Yolanda Lawson, president of the National Medical Association, which represents African American physicians.
Only about half of Black pregnant people in the city got prenatal care early in their pregnancies, she said.
Care after pregnancy is just as important, panelists said. Mental health issues, suicide and substance use issues were among the most common reasons mothers die within a year of giving birth.
“At the point when somebody decides to die by suicide, there's a complete despair. And there's a huge correlation between that and lack of social connection,” said Ronke Faleti, the founder of Korede House, a social club for women in the Central West End.
The space, which offers memberships on a sliding scale, will soon host peer support groups for mothers, she said.
“Engineering that social connection and trust-building … that's our solution,” she said. “That way we can identify early, intervene early, and provide that support for whatever that temporary social situation is, instead of having a permanent solution to it.”
