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‘Concordant care’ called crucial in improving Black childbirth outcomes


‘Concordant care’ called crucial in improving Black childbirth outcomes

May 21, 2024 | 6:37 pm ET
By Bhaamati Borkhetaria
‘Concordant care’ called crucial in improving Black childbirth outcomes
Photo courtesy of CommonWealth

TO BE A BLACK WOMAN giving birth is to face a much higher risk of complications and death during childbirth. One thing that could help, according to panelists at a maternal health event, is “racially concordant care” – care provided by a physician who shares the racial identity of the patient. 

“We want to see more Black and Brown doctors because what we know is that when our healthcare is more concordant, it does improve clinical outcomes,” said Dr. Lucy Lomas, an OB-GYN who serves as the director of community, health, and wellness for New England Medical Association, a Black physicians group. 

Lomas was one of several panelists who spoke at a maternal health event sponsored by GBH News and CommonWealth Beacon on Monday evening. The discussion, moderated by Saraya Wintersmith of GBH, was wide-ranging, but a recurring theme was that people of color, and Black women in particular, benefit from having their care provided by someone who looks like them and who understands their experience in the world. The belief, and there is evidence to back it up, is that “concordant care” can lead to better communication between patient and physician, which in turn can lead to better health outcomes. 

According to Ndidiamaka Amutah-Onukagha, a professor of maternal health at Tufts University, racism plays a major role in deterring diversity in the medical field.

“The lack of diversity in our workforce is visible,” said Amutah-Onukagha. “We are failing so miserably on the healthcare front and racism front. The racism is just embedded into the training throughout education, into the policies, and this is how structural racism shows up.”

‘Concordant care’ called crucial in improving Black childbirth outcomes
Dr. Lucy Lomas of the New England Medical Association (left) and Nashira Baril of the Neighborhood Birth Center. (Photo by Maeve Duggan)

Rep. Brandy Fluker Oakley of Boston said racism leads to disproportionate numbers of Black people dying in childbirth. “The truth of the matter is, it’s not because we’re Black that we’re dying. It’s because of environmental racism that we experience,” Oakley said. “People want our ‘Black girl magic’ but they don’t want to lift up the mantle to carry the weight of this.”

In the last 10 years, the rate of severe health complications following childbirth nearly doubled in Massachusetts with Black women experiencing the highest rates of issues with labor and delivery, according to a report release last summer by the Department of Public Health. Rates of severe maternal morbidity are more than twice as high in Black non-Hispanic people than rates among White non-Hispanic people. 

Sen. Liz Miranda, also of Boston, expressed frustration that Black mothers still face such terrible outcomes and that such racial health disparities exist in the area of reproductive justice.

“I’m tired of hearing about my own death. I’m tired of hearing about Black people’s death, Black women’s deaths,” said Miranda. “I will go on and on where Massachusetts is number one, but we’re also number one in ensuring that Black women do not survive, and that should be the urgent call to action that we should be doing everything we possibly can to get to zero [deaths]. If we are not at zero, we are not exceptional.” 

‘Concordant care’ called crucial in improving Black childbirth outcomes
Sen. Liz Miranda of Boston. (Photo by Maeve Duggan)

One approach that has proven sucessful has been getting midwives and doulas into delivery rooms or facilitating home births with licensed midwives present.

Midwives are healthcare professionals with medical training and a master’s degree in nursing with a speciality in midwifery. Doulas provide emotional support before, during, and after birth, which has been shown to improve birth outcomes. Doulas can accompany those who are giving birth in hospital delivery rooms to help advocate for the patient and assist during childbirth. 

Panelists lamented the fact that inadequate insurance rates make it difficult for people to access midwives and doulas. There also aren’t many birth centers where people can go to access personalized care as an alternative to hospitals. Massachusetts only has one birth center and a second one is scheduled to break ground in Roxbury later this year.

Miranda said she is pushing a maternal health omnibus bill on Beacon Hill that would require MassHealth to cover midwifery care, require pediatricians to screen new parents for postpartum symptoms, and change regulations to make it easier for birth centers to operate in the state.

However, midwives and doulas can’t fix the overall problem of structural racism, according to Nashira Baril, the executive director of theNeighborhood Birth Center, which is scheduled to open in Roxbury.

Baril said doulas can be great advocates for people giving birth, but she warned that society can’t expect doulas to solve all the problems facing mothers of color. She said sometimes having a doula in the room just means two people are battling racism in health care,

“I love doulas, but we can’t just add doulas and stir,” said Baril.

Lomas agreed, adding:  “Doulas are not going to fix the problem. It’s far more complex than that. This is about hierarchy and power.” 

Lomas also emphasized that traditional physicians need to get in the fight.

“Doulas and midwives definitely help people find their voice,” said Lomas. “ We also have to acknowledge that our healthcare system and more of the traditional physicians just really need to listen to Black women. We have to change the culture so we can help people feel they are well taken care of and supported,”