Colorado Changed its Definition of Child Abuse and Introduced “Plans of Safe Care.” The Impact isn’t Clear.

A member of our circle, Jaid Redmon-Greene is featured in this story at the Colorado Trust by Claire Cleveland.

The First Tool to Name Obstetric Racism Might Finally Push Policymakers Into Action

10/4/2023 by DR KAREN A. SCOTT and INDRA LUSERO

Ms. Magazine

We cannot fix the maternal mortality problem without fixing the human rights problem at its core.

Awareness of the U.S. maternal health crisis has increased—but a parallel crisis of human rights violations against pregnant and postpartum people remains invisible or misunderstood. By convening two People’s Tribunals to End Obstetric Violence and Obstetric Racism before the end of the year, we aim to change that. The first will happen on Oct. 6 in New York City at the NYU Law School, and the second on Dec. 1 in Memphis, at BRIDGES USA. 

We first connected in 2021 after I, Dr. Scott, developed and validated the first and only valid quality instrument to name obstetric racism as an adverse event, and to demonstrate how obstetric racism violates obstetric quality and patient safety among Black mothers and birthing people and their given and chosen kin.

The Patient Reported Experience Measure of Obstetric Racism, also known as the PREM-OB Scale suite, translates the dimensions of and responses to obstetric racism—first defined by anthropologist, doula and public health scholar Dána-Ain Davis—into three independent yet related scores: humanity, kinship and racism, specifically anti-Black racism and anti-Black gendered racism. 

We collected data on the 2020 birth experiences of 806 Black mothers and birthing people, representing 348 hospitals across 34 states, including Washington, D.C. Each score varied significantly by socioeconomic factors previously shown to be associated with experiences of racism, including income and education levels.

However, each score of obstetric racism did not vary by self-reported clinical characteristics, including maternal BMI, gestational age and birth type (for example, vaginal or cesarean birth)—demonstrating that the PREM-OB Scale measures obstetric racism independent of clinical risk. Thus, hospital acts of harm as defined by patient-reported experiences of obstetric racism occurred regardless of individual, patient-level characteristics or outcomes. 

More importantly, our data demonstrated the ongoing inhumane acts committed against Black mothers and birthing people by hospital clinicians and staff.

Black mothers and birthing people who agreed or strongly agreed with the statement, “The hospital made me feel that because my baby and I survived birth, my experiences in labor, birth, and postpartum did not matter,” were six times more likely to experience disrupted kinship and anti-Black racism and gendered racism, and more than eight times more likely to experience hospitals acts of dehumanization.

Birthing in a community with a support person who is not affiliated or aligned with a hospital significantly decreased hospital acts of obstetric racism across all three independent scores of humanity, kinship and racism, our 2023 publication showed. The decrease in hospital acts of obstetric racism remained significant, even after we controlled for the effect of the relationship status of the Black mother and birthing person. 

Our data confirmed a widely unaccepted truth: There is an unrecognized, predictable and preventable manufactured crisis of obstetric racism in this country. I hoped this new data would alarm people in positions of power throughout U.S. hospitals, insurance companies, quality experts and maternity-paternal healthcare professionals to make change—but I knew this alone was not enough. That’s when I connected with Indra Lusero, a human rights attorney with expertise in this field.

I, Indra Lusero, was glad to be connected with Dr. Scott, but was discouraged to report that the pathways for accountability for obstetric racism in the U.S. were slim to non-existent.

In July 2020, I was part of a National Call for Birth Justice and Accountability, where we took out an ad in the NYT framing the maternal health crisis as a human rights crisis linked to the racial reckonings of that summer. The letter we wrote called for among other things, “mechanisms that hold health systems and government accountable for incidents of obstetric violence, mistreatment and human rights violations in childbirth.” It was not clear at the time what those mechanisms could be. 

Latin American activists popularized the term “obstetric violence” in the 1990s to call attention to human rights abuses during childbirth. This led to laws across Latin America oriented toward “humanization” of birth, including the first law against obstetric violence specifically (passed in Venezuela in 2007).

Indeed, this is a global issue, as recognized by the U.N. in the 2019 Report of the U.N. Special Rapporteur on Violence Against Women, and made visible by researchers like Dr. Scott, who have worked to categorize and measure these harms. The Giving Voices to Mothers Study released in 2019 confirmed the findings of the U.N. report in the U.S. context: One in six reported experiencing mistreatment, and the rate went up to one in three for people of color.

But I knew that categorizing and measuring these harms was not enough. Efforts to push back through litigation based on individual cases had proven insufficient. (Also, in 2019, a New York court delivered one of its worst decisions in the case of Rinat Dray, who was forced into a C-section, despite explicit refusal noted in her chart.)

Dr. Scott’s insistence that there ought to be a better way catalyzed our effort to call upon the federal Office for Civil Rights within the Department of Health and Human Services to use its power to enforce federal civil rights laws that protect people from unlawful discrimination in health services. Together with over two dozen other experts, we wrote a legal brief, “Mobilizing the Office for Civil Rights’ Authority to Address Obstetric Violence and Obstetric Racism,” and delivered it to the office in July of 2022. 

Around that same time, we started planning these tribunals, inspired by the work of Giré, a human rights group in Mexico. We knew our academic research and legal arguments could not go as far as individual stories. We both know personally the motivating impact that even one story of obstetric racism or obstetric violence can have.

People universally feel it in their gut. “This is not okay. This is not okay,” is our mantra, motivating our work and leading us to bring together over two dozen speakers, with their own stories of obstetric racism or obstetric violence, to proclaim to their community with the support of a human rights panel who will amplify it. This happened, and it was not okay.

We ask you to take note, tune in, attend in person and share the invitation with policymakers, hospital administrators, health insurance executives and risk managers. Help us ensure that attention to the maternal health crisis is not wasted on hand wringing, minor clinical modifications, or increased implicit bias training, but instead goes to the root.

We cannot fix the maternal mortality problem without fixing the human rights problem at its core.

Midwifing a Movement: Community Birth Centers and the Care Economy

Listen to this episode of the Bioneers podcast (and read the transcript) featuring Indra Lusero and Leseliey Welch.

No longer just “hippie” moms-to-be: More women delivering babies at home with Colorado midwives

No longer just “hippie” moms-to-be: More women delivering babies at home with Colorado midwives

Midwifery offers a cheaper alternative to traditional hospitals
Denver Post | MEGAN ULU-LANI BOYANTON | Oct 12, 2023

Eileen Fruithandler delivered her second child at home with a midwife in 1992 – an era when she and her late husband faced pushback from loved ones about the decision.

“I’m lying to everyone – I had to lie,” said the 66-year-old Denver resident, who splits time between Denver and Palm Beach, Fla. “It wasn’t in vogue when I did it.”

In the three decades since Fruithandler’s secretive delivery, more pregnant mothers-to-be — of all ages, backgrounds and income levels — have followed her path of using midwives.

The number of women who birthed at home from 2020-21 rose 12%, “the highest level since at least 1990” at more than 51,600 births, according to the Centers for Disease Control and Prevention. And, from 2016-21, more certified midwives — who have faced misconceptions about their educations and care historically — have joined the profession to meet the boost in demand.

“We’ve done home births in RVs,” said Jen Anderson-Tarver, a certified professional midwife at New Leaf Midwifery in Denver. “We’ve done home births in 300-square-foot apartments, and we’ve done home births in $3 million houses.”

In Colorado, midwives are seeing the same rise in interest in their services, particularly after the COVID-19 pandemic. The practice is growing because it offers individualized “high-touch” care, a more flexible timeline for birthing, a comfortable setting, access to postpartum care and a cheaper alternative to hospitals, Anderson-Tarver said.

Her services are roughly $5,000 on average for birth, prenatal and postpartum care. To birth a baby in a Colorado hospital, the average vaginal delivery costs close to $10,000, while a caesarean-section costs around $14,000, according to Denver nonprofit The Center for Improving Value in Health Care.

But costs can vary drastically based on the area, particularly in mountain towns, with a C-section priced as high as $40,600 at Valley View Hospital in Glenwood Springs, the nonprofit reports.

The state’s caesarean rate is about 27%, while Anderson-Tarver’s is around 5%. The World Health Organization recommends a rate between 10% to 15%.

Midwifery dates back to the Paleolithic era. “In the early parts of the 19th century, midwifery was the most customary practice for pregnancy care and childbirth” in the U.S., according to Oregon Health and Science University.

The trend changed with the rise of anesthesia and the formal education of male doctors in childbirth, with midwives stereotyped as “lower class.” Today, “Canada and the U.S. are some of the only developed nations with more OB-GYN doctors than midwives,” and Australia and Sweden top the charts for most midwives per capita, data gathering platform Statista reports.

The practice is made up of several types of practitioners, including certified nurse-midwives – or registered nurses with midwifery training who largely work in hospitals – and certified professional midwives with training and education to work in out-of-hospital settings.

Anderson-Tarver highlights two events that contributed to recent spikes in home births: the 2008 documentary, “The Business of Being Born,” and the pandemic. As COVID kept hospitals overcrowded, some expecting mothers didn’t want to worsen their risk of catching the illness or wear masks during birth, she said.

She’s also noticed “a movement” in the insurance sector to offer expanded coverage of home births over the past few years.

Health First Colorado, Colorado’s Medicaid program for low-income health coverage, covers home births performed by enrolled physicians or certified-nurse midwives, but it doesn’t enroll or reimburse certified professional midwives as providers, said Adela Flores-Brennan, the state’s Medicaid director.

But the department is exploring policy regarding the practice of certified professional midwives and their model of care across all birth settings, she said in a statement.

New Leaf Midwifery
Anderson-Tarver originally worked as a doula, a professional often confused for a midwife who offers emotional support to mothers, at a Minneapolis public hospital. After attending more than 100 labors, the positive experience of her first home birth changed her career path to midwifery.

Drawn to it “out of a love for women empowerment,” Anderson-Tarver finished over three years of schooling, an eight-hour board exam and four-hour skills exam before completing her registration and licensing in Colorado 12 years ago.

At a home birth, she brings medical supplies, such as gloves, catheters, oxygen, suturing equipment, IVs – “all of the things that they have at a community birth center.”

She’ll let clients curate their environments by playing music, inviting loved ones to support them or taking naps with their partners throughout the process.

“You would be surprised at the people who are birthing at home,” Anderson-Tarver said, “from Catholic families, to people who do not identify as female and are birthing, to polyamorous families, to traditional heterosexual relationships.”

Whitney Ford, 36, has always wanted a big family with her husband, Damien. A mother of four in Aurora, she called her first birth “traumatic.”

When she was 25, Ford faced complications birthing her son, Landon, over a 38-hour period at the hospital, which resulted in a C-section.

“Nothing went right,” Ford said. “As a first-time mom, I didn’t really get the voice that I felt like I deserved.”

Upfront, it cost $10,000, then “bills upon bills” arrived. “I was like, ‘Oh, my gosh, they’re charging me for warming the blankets? I wish I would have known,'” she said.

Afterward, Ford described herself as “genuinely afraid to have another baby.” So, she sought a midwife for her second pregnancy at 31 years old.

But again, she struggled with complications that landed her in the hospital with another C-section for her daughter, Elaina. “My dreams of having a home birth were pretty much shot, I thought,” she said.

With her third child, she qualified as a “very high risk” pregnancy at the age of 33, given her two C-sections, but pled with her doctor for a vaginal birth at the hospital. He gave her one hour to push her daughter out before they opted for another surgical delivery.

Throwing up, Ford pushed so hard that she birthed Melissa within minutes.

During her fourth pregnancy at 35 years old, she went to Anderson-Tarver for a home birth, although her relatives and in-laws were nervous about the decision.

Within six hours, she successfully birthed Juliana in her bedroom, with Anderson-Tarver using both of her hands to help when the infant got stuck during the process.

“I felt like I was giving birth to my baby with my aunt or my sister,” Ford said.

Costing $6,000, she called the midwife option “the cheapest way to have a baby.” But “I got care as if I’d paid $1 million.”

Paying (and bartering) for midwifery
Samantha Venn, a certified professional midwife at Lakewood’s Meadowsweet Midwifery, is part of a two-woman team serving the Denver area.

“In Colorado, midwives are able to do full prenatal care, full postpartum care, including newborn care up to six weeks,” she said. “We do all normal lab tests within our office,” only referring outside of their business for ultrasounds.

Their clientele ranges “from lawyers and doctors to stay-at-home moms who live on farms,” she said. “You’d never realize that your neighbor had a birth right next to you.”

And they’re choosing home birth for different reasons – because they were born at home themselves, were left “deeply traumatized” by hospital births or suffered losses like miscarriages.

Venn puts the typical age range of their clientele at early-to-mid-30s, as “a lot of first-time moms are waiting a little bit longer to have babies.” But they’ve aided first-timers as old as mid-40s and as young as teenagers, which resonates with Venn, once a teen mom herself.

While they charge on the higher end of Denver’s average price range of between $4,000 and $7,000, Meadowsweet Midwifery offers a sliding scale, with discounts for early payments and repeat clients.

They’ve even bartered for their services. In 2021, farmers “traded us a good chunk of the fee for organic produce and firewood,” and, this year, another client exchanged part of the fee “for website design services and headshots.”

“We have done births for just about nothing for clients who are deeply in need,” Venn said. “We just try to meet people where they’re at.”

“Such a peaceful birth”
In 1992, Fruithandler decided to use a midwife for the delivery of her second daughter, Danielle, after the birth of her eldest child, Sara, went poorly at a hospital.

At the age of 32, she planned for a natural birth without medication, but complications occurred right before Fruithandler’s water broke.

“So fast, they stuck the needle in my back,” she said. “I had the baby by caesarean section, and they cut you open. It was really awful.”

Afterward, she dealt with postpartum depression, which went undiagnosed for months. Fruithandler wanted her next birth at 34 years old to go differently.

Describing herself as a “hippie” in the 1990s, she and her late husband, a chiropractor, took classes with a nurse midwife. When the midwife talked about her childhood spent on a farm delivering baby animals, Fruithandler’s decision was made.

“This woman’s been doing home births her whole life,” she said.

But her best friend, her parents, her parents-in-law and even her neighbors were against it. “If I did talk to other people about it, other people said, ‘No,’ ” Fruithandler said.

Two weeks after her due date, Fruithandler was still waddling around pregnant. Her nurse midwife advised “sex and walking” to spur the labor – and it worked.

For days, the nurse midwife and another nurse studying midwifery took turns sleeping at her house through her labor.

When Fruithandler began to deliver her daughter in her bed, the midwife caught a life-threatening problem: The cord had wrapped around the baby’s neck. She used her fingers to unwrap it as the infant’s head popped out.

“Danielle would have died at home, had she got choked by the cord and the midwife didn’t know that,” she said. “A nurse midwife checks on everything.”

The cost of delivering a healthy baby at home: $3,200. And today, she’s a mom of three, having birthed her son, Austin, at 36.

Although “I don’t think it’s for everyone,” she called the at-home process “such a peaceful birth.”

Factors to consider
While home birth is “available for people who are low risk,” Dr. Jessica Anderson, director of midwifery and women’s health services at the University of Colorado Anschutz Medical Campus, points to “people that shouldn’t or can’t birth out of the hospital,” such as those with medical conditions like high blood pressure or diabetes.

The American College of Obstetricians and Gynecologists recommends against home birth for people who’ve undergone C-sections or pregnancies involving more than one baby – or when a baby moves into an unusual position.

Anderson said midwifery is “more visible” today, with an ongoing public debate of using midwifery as an option to change “our rising maternal mortality rate or rising caesarean section rate.”

She points to more people enrolling in their midwifery program over the years, as it moved to a “more accessible” hybrid model that lets educators teach students in rural communities, different states and more.

Joy Frazer, a certified professional midwife at Durango’s Joy of Life, serves three rural counties in southwestern Colorado – Montezuma, La Plata and Archuleta – along with San Juan County in northwestern New Mexico. She regularly drives one hour in three different directions to reach her clients.

“Very few midwives” practice in the Four Corners region right now – only three, she said. The rural region has fewer hospitals, too.

“We’re limited in that way,” Frazer said. If a hospital can’t be reached within 30 minutes, “then our clients have to be comfortable with that, as far as the emergency care plan.”

The most common reason for transfer of care from homes to hospitals isn’t an emergency, she said, but “a first-time mom having a long labor, who’s getting kind of exhausted,” and seeking medications like an epidural or oxytocin.

“There’s been a lot of propaganda for many decades that a hospital’s safe and midwives are untrained and not experienced and don’t know what they’re doing,” she said.

She charges $5,200 for birth, prenatal and postpartum care, with four visits after childbirth, plus a $200 travel fee for clients outside of La Plata County.

For midwives, “the schedule is quite grueling if you’re a home birth midwife practicing alone,” said Jennifer Barr with the Colorado Midwives Association. “You’re on call 24/7 for large swathes of time.”

Midwives take on a smaller base of clientele than a birth center or group practice, “but it is not an easy job.”

First-time moms
Natalie Baca, a BIPOC certified professional midwife at Arvada’s Holding Light Midwifery, has noticed “more younger or first-time moms looking into home birth,” partially crediting that trend to YouTube videos of home births.

Baca worked as a surgical technologist for two decades, and her years at a hospital informed her perspective on the difference between medical emergencies and non-emergencies.

“There’s so much fear around birth,” she said, but, “truly, emergency C-sections happen really rarely.”

When Baca birthed her son at home in water over a 24-hour period, “I actually hemorrhaged with him,” she said. “My midwife was all over that. She took care of me – I didn’t even know that I was bleeding.”

Her fee for services is $8,500, “but most people can’t afford that.” She charges a cash discount of $5,000 instead, and can sometimes bill insurance for the difference.

Baca served as a midwife for 31-year-old Johnstown resident Nichole Wolfe to birth her first child, Wade, in May.

A month after Wolfe married her husband Spencer last July, she attended a hot yoga class with dimmed lights and lit candles, and thought, “This is how I want to bring a baby into the world” – not yet realizing she was already pregnant.

During Wolfe’s labor, she ate breakfast burritos and berries, showered and even ordered Amazon packages – all while riding out her contractions.

“Pain never was a problem for me – it was more, like, getting exhausted,” she said.

After her spouse and Baca arrived at the house, Wolfe settled into the birthing tub in her living room in front of a crackling fireplace, as rain fell outside. Her husband rotated between offering her a towel, orange juice and water until she delivered their son.

“It was just the perfect setup,” Wolfe said. “I give credit to women who do it in the hospital because I don’t know how you’re doing it.”

The couple’s insurance “pretty much covered the entire home birth” at the price tag of $5,000, leaving them to pay about $500.

She’s since encouraged her friends to try home birth. The practice is no longer relegated to “hippie” moms, although “I think now the term they’re using is ‘crunchy,'” Wolfe laughed.

Would she do a home birth again for future children? “Oh, hell yeah,” Wolfe said.

Offering support– not stigma– to pregnant and lactating people using cannabis

Parents Thrive Colorado spoke with Janelle Jenkins and Heather Thompson of Elephant Circle for this blog post.

The use of cannabis* by pregnant and lactating people, while very common, is heavily stigmatized. This stigma often prevents parents from seeking out the critical support and connection to resources they need. Fear of judgment and negative consequences (like involvement in child welfare) prevent pregnant and lactating people from trusting professionals on their support team like doctors, midwives, mental health professionals, and social workers, leaving parents alone to navigate a stressful and confusing topic. There is evidence to suggest that cannabis use during pregnancy can cause health risks, and parents deserve to know this information and receive the stigma-free support they need.

If you resonate with the stress and isolation of being a pregnant or lactating person who uses cannabis, know that you are not alone. Therefore, it is critical to work towards a culture of openness, where parents feel supported by providers to make informed, healthy decisions for themselves and their families. 

Recently, Parents Thrive Colorado had the chance to speak with Janelle Jenkins, a parent and birth justice advocate and Heather Thompson, a Co-Deputy Director at Elephant Circle, a birth justice organization that works to support and amplify the self-determination of pregnant and perinatal people. We discussed why it is so stressful to be a pregnant or lactating person who uses cannabis, and where parents can find the support they need. 

Janelle explained that she understands the mental burden that the stigma around cannabis use puts on parents. Many parents fear that if they disclose their cannabis use to a member of their support team, they risk judgment or even a report to child welfare, which is often a traumatic event for families. Janelle expressed that it would be more productive if parents could trust that doctors were solely focusing their energy on working with the patient to identify the root cause of the substance use. To get the highest quality of care, parents need to be able to be completely honest with their care team, and fear of a report to CPS makes that difficult.

It is important for parents to understand that it is within their right to inquire about an institution or practice’s policies around reporting to Child Protective Services (CPS), as these policies should be transparent. If potential involvement with CPS prevents you from having open and honest conversations with your healthcare provider, it may relieve stress to understand their reporting policies.

Heather explained that the most important aspect of supporting parents is to not be judgemental. New and expecting parents are already experiencing a stressful and vulnerable time in their lives, and their support systems need to meet them where they are if they want to provide effective care. Luckily, there are professionals like Heather available and ready to help families like yours stay healthy and safe.

While it is important to recognize the role that stigma plays, it is also critical for parents to understand that they hold power when it comes to interacting with the healthcare system. Parents deserve providers who treat them with respect and offer evidence-based information on cannabis use. Whether parents are using cannabis to address nausea, stress, anxiety, or mood problems, providers should be helpful in navigating decision-making about alternative or additional approaches. When choosing a maternity care provider, consider whether you feel respected, and if you trust them to provide the best care for you and your family. Also, don’t forget to check out the midwives in your network of care– their holistic approach to pregnancy and lactation may be a good fit for your experiences.

Because of these challenges, seeking support can be stressful, but you are not alone. Here are some resources that can help:

Are you a parent navigating substance use while pregnant or lactating? Contact Heather Thompson, who can help you access the support you need. Email Heather at heather@elephantcircle.org. 

Looking for a doula who understands issues around substance use?

Visit www.elephantcircle.net/doula-services. 

Tough as a Mother

If you are using alcohol or other drugs to cope with stress, you are not alone. Tough as a Mother offers support so you can be the strongest mom possible.

Special Connections – Substance Use Support

Special Connections, a program for pregnant women on Health First Colorado, helps women struggling with substance use have healthier pregnancies and babies by providing case management, individual and group counseling, and health education.

Thanks to New Law, Pregnant Women Can Now Avoid Incarceration in Colorado

Passed by the Colorado Legislature, HB23-1187 urges courts to offer bonds or other alternatives.

By Bennito L. Kelty

August 11, 2023 - Read this in Westword here.

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More than five years have passed since the world watched, aghast, at the video of Diana Sanchez giving birth alone in a Denver County Jail cell in July 2018. The incident was covered by countless media outlets after Sanchez's lawyer, Mari Newman, released footage of her client's horrifying ordeal in order to force Denver officials to take responsibility.

Newman scored many victories against the Denver Sheriff Department and Denver Health after that, including a $500,000 settlement for Sanchez in 2020. But one of the most lasting impacts is a Colorado law that went into effect on Monday, August 7.

HB23-1187 urged courts to offer bonds or other sentences besides jail time for pregnant women. It was passed by the Colorado Legislature in April with the help of testimony from Newman, who says that if the bill had become law earlier, Sanchez might have avoided her traumatic experience.  

"It could have saved Diana and her baby from the horrible experience that they had to endure," Newman says. "She is the exact type of person who should not have been put in jail."

Sanchez was eight months pregnant when she was jailed for violating the terms of her probation, which related to charges of identity theft for a check she cashed in her sister's name. After being incarcerated for several weeks, she went into labor a few days before her due date.

"Instead of ensuring that Ms. Sanchez was able to give birth in a safe and sanitary medical setting, Denver Health nurses and Denver Sheriff deputies callously made her labor alone for hours...because it was inconvenient to take her to the hospital during the jail’s booking process," according to court documents.

Newman released the video of Sanchez's incident the next year in response to the Denver Sheriff Department saying that it did nothing wrong and Denver Health, which is responsible for monitoring pregnant inmates, not responding at all.

"Unfortunately, over the course of my career, Diana is not the only person I've represented who had a terrible experience because she was pregnant while incarcerated," Newman says.

Her first case involved Pam Clifton, who was incarcerated and went into labor in a Colorado Department of Corrections facility. She was in labor for two days before prison staff took her to a hospital.

"The guard there decided they couldn't bother contacting the medical professional even though [Clifton] was a woman at full term and in labor," Newman recalls. "She was in labor for hours and hours over the course of which she quit feeling any fetal movement, and it turned out her baby had died."

Clifton's baby had been strangled by its umbilical cord, because of a complication known as a Nuchal cord — something Newman says she's gone through herself. Since the situation arises in nearly a third of all births, hospitals are equipped to handle it — but correctional facilities are not.

"When I had my own child, if I had not been in a hospital, the same thing would have happened," Newman says. "The difference is that I was in a position where I was free to go to the hospital. Pam was at the mercy of these incredibly inhumane guards who couldn't even be bothered to contact a medical professional for a woman who was in labor." 

Instead, guards told Clifton to go back to her prison unit because it had "plenty of women there who know how to birth babies," Newman says. "I remember the phrase because it was so shocking. If she had been taken to the hospital like she should have been, her baby could have been saved."

With the new law, pregnant women being charged criminally will have a "rebuttable presumption against detention" — which means that courts will need to prove that there's a risk to public safety if the pregnant woman is not jailed. Otherwise, she can avoid incarceration and instead receive an alternative sentence such as a diversion program, a deferred sentence or a stay of execution that would put carrying out a court sentence on hold.

In order to be eligible for such consideration, a woman will need to prove her pregnancy during each step of the criminal proceedings. Those who are already incarcerated in a county jail or correctional facility can request a pregnancy test, which has to be provided within 24 hours.

"Pregnant people should not be incarcerated," Newman concludes. "That is my fundamental belief. I think this is a good start, and there's a lot more that can still be done."

Denver doulas assist those who are pregnant or postpartum and struggling with substance use disorder

Rocky Mountain PBS published this article July 19, 2023. Elephant Circle provides the doula training for this program.

by Lindsey Ford, Dana Knowles

Denver doulas assist those who are pregnant or postpartum and struggling with substance use disorder

• Published on July 19, 2023 • Last modified on July 20, 2023

DENVER — The emotional and physical labor of birthing a child can be as painful as the physical labor of birthing a child, as many mothers can attest to — and that does not include the postpartum stress that many experience after having a baby.

Some turn to health care professionals like doulas in support of parental health during and after birth. Others turn to substances.

Birth coach Britt Westmoreland, who is in recovery from substance use disorder and the mother of a two-year-old son, acknowledges that “Pregnancy, labor, and the first year postpartum are really difficult for people. While the medical support is great, it doesn’t really wrap around the whole human. When I was in labor, I was in excruciating pain, and I wasn’t really ‘there.’ And there were these doctors who were telling me what was happening,” she said.

She might be considered one of the lucky ones: drug overdose deaths during pregnancy and postpartum have increased sharply in recent years. This is why Westmoreland decided to become a doula that specifically helps pregnant and postpartum people who are struggling with addiction or are in recovery. 

“Working with pregnant women with substance use disorder is important to me because I saw early on through my work in the field that that population has even more stigma placed on them, on top of the huge stigma that is already on people with substance use disorder,” she said. 

Westmoreland said she witnessed how pregnant and postpartum people with addictions were treated. “I wanted to get my foot in the door and make a change,” she added. 

She was able to make that kind of change through an initiative started by the University of Colorado College of Nursing. The college trains doulas who are in recovery to work in the peer recovery doula program.  

“What we’ve noticed in the state of Colorado is that we have an issue with pregnant and postpartum people dying [of overdoses, both accidental and intentional] because of substance use disorder,” said Jessica Anderson, the director of midwifery and women’s health services at the CU College of Nursing. “We decided we wanted to provide more support to the patients that we are caring for in our practices.”

Anderson believes that trained doulas with a history of addiction are the best doulas to help pregnant people who have also struggled with substance use disorder.

“I can’t have a conversation with someone with substance use disorder because I haven’t lived it. I don’t know what it’s like. I don’t know what the challenges are. I can make assumptions, but I really don’t know,” Anderson added.

“People with that lived experience, they have additional support and training and they’re able to connect with people at a different level that is just so much more meaningful than anything I could say as a provider or something that I learned in school or [that I] learned from a journal article or a textbook,” Anderson added, explaining that emotional connection during healing is paramount.

The recovery doula program has 10 patients and two doulas. Westmoreland recently helped in her first birth. The parents are both in recovery and sometimes still struggle with substances.

“The birth really impacted me. I started crying watching the dad meet the baby,” she said. “It’s important for my recovery because first and foremost, I couldn’t do this if I was under the influence of substances— and it’s not something I’m really willing to give up.”

Colorado mothers speak out against OBGYN racism to try to reverse decades-long trend of dangerous care

This article was published in the Colorado Sun by Tatiana Flowers on Jul 19, 2023

This topic is related to our Birth Justice Tribunal and our effort to support people making complaints to the federal Office for Civil Rights.

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Medical anthropologist Dána-Ain Davis coined the term “obstetric racism” in 2018 after spending years interviewing Black women about their birthing experiences

Two weeks before her due date, Stephanie Watson-Lewis began feeling ill. She went to the hospital multiple times asking doctors to use a fetal monitor to check on the health of her baby.

But staff there would tell Watson-Lewis her baby was healthy, or they’d say the end of a pregnancy is simply uncomfortable, before sending her home. Within 48 hours of her final visit to the hospital to ask for help in November 2014, her unborn baby, Cassius, stopped moving and died in her womb. 

An autopsy report confirmed baby Cassius had been healthy. But the umbilical cord was wrapped through his legs and around his neck multiple times, Watson-Lewis said.

“It should have never happened,” she said in an interview earlier this month. “My son should not be dead.”

Watson-Lewis’ experience is eerily similar to accounts from other pregnant people of color, who have been speaking up for decades about callous medical treatment during their pregnancies. 

Doulas and researchers interviewed for this story said medical providers often do not notice their own biases, and therefore, don’t recognize the ways in which they contribute to a system still providing racist and dangerous care.

Obstetric care is often still centered on the needs of white pregnant people, according to a recent study led by researchers at the University of Colorado, which found racist care is leading to increased labor inductions in Colorado and across the country.

The foundation of the American medical system is rooted in experimentation and exploitation of Black people especially, the researchers wrote. 

“And that reverberates today in how medical providers learned,” said Lauren Smith, Black civil engagement and policy manager for Elephant Circle and Soul 2 Soul Sisters, racial and reproductive justice organizations. “There are still textbooks out there that say that Black people have a higher pain tolerance, for example.” 

Medical anthropologist Dána-Ain Davis first coined the term “obstetric racism” in 2018 after spending years interviewing Black women about their birthing experiences, which included accounts of being disrespected, discounted, neglected and ignored — and in even more extreme cases — they described being coerced to undergo unwanted procedures or said doctors performed procedures without their consent.

The CU study builds on the groundbreaking work of Davis, who works at City University of New York, but study leaders did not interview her or any pregnant people of color who have experienced obstetric racism, said Indra Lusero, director at Elephant Circle.

“The study had — from what I can tell — all white authors. So that’s a great example of how any system can focus on the needs of white folks and not people of color,” Lusero said. “Nobody ever thinks to talk to a Black woman or a Latina woman and say, ‘Hey, what do you need?’ But the other sad truth is that this system was not built for any pregnant person. It’s not structured around the needs of pregnant and laboring people. It’s much more structured around providers and the facilities.”

The study focused on population analyses and aimed to add to existing anecdotal research about obstetric racism already discussed in interviews, said Ryan Masters, an associate professor of sociology studying health and mortality at CU and senior co-author of the study. It’s always important to include researchers who are people of color, he said, but that’s often a challenge in a profession with its own inequities and little racial diversity.

Increasing labor inductions

Systemic and interpersonal racism are drivers of inadequate obstetric care and are responsible for devastating health outcomes for pregnant people of color in the U.S., according to the study Masters helped lead, which was recently published in the Journal of Health and Social Behavior.

“The story about my son dying is terrible,” Watson-Lewis said. “But dealing with my daughter was also crazy.”

About a year and a half after Cassius died, Watson-Lewis was nearing the delivery date for her daughter. Near the end of her pregnancy, she told hospital staff she feared her daughter may have turned into a breech position, which occurs when the baby’s butt, feet or both are positioned to come out first during birth rather than their head.

Hospital staff told Watson-Lewis she had recently had a sonogram and that it was unlikely the baby was breech. She was sent home where she called a friend who is one of a few obstetricians willing to deliver breech babies in Colorado. 

When Watson-Lewis arrived at that doctor’s office, she and a midwife discovered the baby was indeed breech, and that her child was wrapped in the umbilical cord. Her daughter was safely delivered during an emergency cesarean section.

“I am so lucky because I had a friend,” said Watson-Lewis, whose daughter is now 7 years old and healthy. “Nobody should have to call in a personal favor to be heard. I could have had another fatality.”

The recent CU study examines the increasing use of inductions to deliver babies, which have nearly tripled since 1990, and have shortened U.S. pregnancies by about a week on average. Induced labor requires medicine to initiate uterine contractions. The procedure speeds up the birth and can be necessary if the baby’s or parent’s life is in danger, among other reasons, according to the American College of Obstetricians and Gynecologists.

CU researchers used state-level data from the National Vital Statistics System to analyze single-child first-births to more than 45 million Black, white and Latina women, tallying whether they were induced and when, and noting the overall health of the pregnant person.

From 1990 to 2017, the average induction of labor rate among Black mothers in the U.S. increased to 33.8% from 10.7%. For Latina mothers, the average rate increased to 31.2% from 10.5%. And for white mothers, the rate increased to 35.9% from 13.9%, according to the National Vital Statistics System. 

Colorado rates within that same timeframe for each racial group are slightly lower but the numbers may not be comparable. The analytic sample for births to white women included all 50 states and the District of Columbia, while the sample for births to Black mothers was limited to 43 states and the District of Columbia, and the sample for Latina mothers was limited to 47 states and Washington, D.C.

The spike in labor inductions for white women is explained by changing demographics, such as the age of the mother, and an increase in higher-risk pregnancies such as from hypertension, obesity, diabetes and drinking or smoking while pregnant. 

But increases in labor inductions among Black and Latina mothers are not associated with changes in demographics or risk factors and the trend appears to be medically unexplainable, study leaders wrote. 

Instead, increases in national labor induction rates among Black and Latina women were strongly shaped by changes in the demographics and risk factors of the white childbearing population, researchers wrote. 

In other words, decisions about care for Black and Latina mothers appear to be based on trends in the white childbearing population, which shows obstetric racism persists, adding to a growing body of literature that implicates the pervasiveness of racism across U.S. institutions, according to the findings.

“The development of norms, culture, training, institutional-level practices and hospital policies are very much oriented in a way that tries to standardize care, and they standardize that care on what they perceive to be the typical or the normative patient, which, within the U.S. context historically and contemporarily still is the dominant white population,” said Masters, the study’s co-leader.

Increasing mortality rates

Racism in health care has contributed to the perception that Black and Latina women are less healthy and more likely to have high risk pregnancies when compared with white women, according to the study. These biases, the researchers said, may be causing health providers to intervene in pregnancies unnecessarily and induce labor in pregnant people of color more often than needed.

Increasing mortality rates, the continued heightened attention that comes with the trend, and a health care education system rooted in a history of racism that continues to inform training and guidance received by providers are likely influencing clinicians’ perceptions of the health and needs of pregnant patients of color in delivery rooms. As a result, some providers are likely assessing and treating patients based on their skin color or on racist perceptions of their family background and communities, rather than providing person-centered care based on individual risk factors and listening to the needs and preferences of patients, according to the study.

That trend is particularly concerning, study authors said, because their previous research has shown inducing early labor can lead to low birth weights among babies and subsequent health problems later in the child’s life. 

The findings come amid rising concerns about maternal mortality rates, especially among Black mothers, who are three times more likely to die from pregnancy-related complications compared with white mothers, according to the Centers for Disease Control and Prevention. 

The “medicalization of birth” has left little room for nuances in pregnant people’s individual experiences and allows racism and systemic inequities to proliferate when a patient is seen as a number on a chart, said Smith, from Elephant Circle and Soul to Soul Sisters.

The “medicalization of birth” has also meant a hospital’s financial interests are often directly at odds with allowing labor to unfold naturally, she said.

Study authors said reducing obstetric racism requires everyone, including clinicians, to acknowledge and work toward dismantling their own implicit biases. 

But that’s easier said than done, Smith said. “How do we hold people accountable to recognizing what actions they’re taking that they don’t even realize are part of their implicit biases? We can’t really do that if we don’t have that accountability loop.”

There are few ways to hold doctors accountable for initiating a high number of labor inductions, or for racking up too many complaints about obstetric racism, aside from proving that they were involved in malpractice, said Lusero, who also is an attorney specializing in birth justice. 

“It is hard, verging on impossible, to prove that something like initiating labor inductions is malpractice,” Lusero wrote in an email.

Another stillborn

While Jasmine Ellington was pregnant, her obstetrician recommended that she have a cesarean birth in case she had complications from diabetes or any other health emergency. So when Ellington went to the hospital, shortly before she was expecting to be induced and told doctors that she was feeling ill and wanted them to use a fetal monitor, she expected her obstetrician to be there to deliver the care.

But when Ellington got to the hospital, a different obstetrician was there, and he declined to perform the cesarean section because, he said, Ellington has diabetes, and that her disease — even if it was under control — could cause complications. A cesarean birth, he said, would also likely keep her out of work for more than nine weeks.

“I was taken aback because I had had diabetes the whole pregnancy and my original doctor did write an order in case of an emergency saying they can perform a C-section,” Ellington said. “I don’t care how long I’m out of work. He prioritized me being out of work over my baby’s life.”

Soon after, a different obstetrician came in to deliver Ellington’s baby vaginally. But by then, Ellington knew her baby — who hadn’t moved in hours — had probably died. Ellington said the second doctor was rude and condescending and ridiculed her for not pushing hard enough during contractions. He said she was much weaker than the other 8,000 moms whose babies he had delivered during his career. 

At one point, he asked doctors and nurses to push down on Ellington’s stomach to drive the baby out. Ellington said she still has pain from the birth in October 2018.

Hospital staff allowed about 35 people into Ellington’s delivery room that day without her consent, she said. And at one point, a nurse told Ellington she was the only Black patient on the obstetrics floor that day.

“I feel like that was her way of letting me know that they were going to handle me differently,” Ellington said. “And I feel like she died because of the doctors’ decisions. They didn’t really give me a choice. I would have rather had a C-section.” 

Ellington began yelling at hospital staff when they offered her a list of funeral homes and expressed plans to discharge her soon after her daughter Azalia’s death. That was before she even got a chance to hold her baby and grieve, Ellington said.

Obstetricians eventually sent Ellington to a psychiatric hospital across the street because, they said, she became too aggressive after Azalia was born dead. 

“I shouldn’t have been there,” Ellington said about the psychiatric facility where she was held for four days. “I needed grief help and no one was helping me.”

Ellington wrote a formal complaint to the Colorado Medical Board, which regulates doctors, and is also composed of doctors. 

She shared a copy of the board’s response with The Colorado Sun, which says the facts Ellington presented do not amount to malpractice, and don’t warrant disciplinary action for the obstetrician who delivered her baby. 

A representative from the Colorado Department of Regulatory Affairs said in an email, any information about complaints to the medical board board are confidential and are not available for public inspection if the board doesn’t impose public disciplinary action.

Ellington said she wouldn’t name the doctor or the hospital that delivered her baby in news articles because she fears legal retaliation. 

“I take things day by day,” she said. “I am hoping that when I stand out and stand up for myself, it will bring people to want to do the same.”

Watson-Lewis has been a doula for 20 years, long before Cassius’ birth. And Ellington became a doula shortly after her daughter Azalia’s stillbirth. 

Both mothers advocate for all pregnant people, especially people of color, who are most at risk for obstetric complications and death. Helping others move more smoothly through their pregnancies has helped Ellington and Watson-Lewis on their healing journey, they said.

Senate Bill 288, signed into law May 30, requires the state Department of Health Care Policy & Financing to create a process to promote the expansion and use of doula services for pregnant and postpartum people on Medicaid, no later than Sept. 1.

The law requires HCPF to seek federal authorization for Medicaid providers to begin supplying doula services to pregnant and postpartum people by July 1, 2024. 

The law creates a doula scholarship program to provide financial assistance to people pursuing doula training and certification and requires the Colorado Division of Insurance to hire an independent contractor to study the potential health care costs and benefits of providing coverage for doula services in health benefit plans. 

The bill also requires the Division of Insurance to submit a report to the Colorado General Assembly detailing the results and recommendations for fiscal year 2024-25.

“Doulas can help reduce the impacts of ethnic/racial bias in health care on pregnant people of color, by providing individually tailored, culturally appropriate, and patient-centered care and advocacy,” Rep. Junie Joseph, a Democrat from Boulder who co-sponsor of the bill, wrote in an email. “This policy will not only help women of color. It will help all women.”

Another study

A Colorado Department of Public Health and Environment report released July 1, showed hospitals, health systems, insurers, maternal care providers, pharmacies and other related sectors do not universally collect information on experiences, meaning there’s limited data on incidents of disrespect or mistreatment of people who are pregnant statewide. 

Patient satisfaction surveys and complaint documentation are the primary methods for collecting information about disrespect or mistreatment toward pregnant people. However, the tracking mechanisms are not universal and the data often isn’t shared publicly, according to the report.

Recommendations in the report focus on improving collection and reporting of perinatal data by encouraging organizations to begin standardizing data collection and reporting those efforts.

Organizations that collect and share all critical data on perinatal conditions and outcomes can help influence state policy and resource allocations for maternal health, according to the report, which works to achieve equity in perinatal health experiences and outcomes.

When Kayla Greathouse learned she had a short cervix, doctors told her she needed a cervical cerclage, a procedure that closes the cervical opening with stitches to prevent premature birth.

When she woke up from the surgery, she vomited from the smell of anesthesia. A nurse who was standing near her was distracted and did not see that Greathouse was panicking and choking on her vomit because she was talking to another nearby provider about her personal life.

When a doctor saw Greathouse choking, he instructed the nurse to turn Greathouse and wipe vomit off her mouth. The nurse did, Greathouse said, but she did not clean all of it off. Greathouse said she feels the nurse would have been more attentive if she were a white mother.

During her pregnancy, Greathouse said she was swapped among at least five doctors, who often had drastically different ideas and recommendations for obstetric care. “I almost never saw the same doctor,” she said.

When she talked to white women in the hospital who were also pregnant, Greathouse said they were given clear directions by their doctors, and that they never seemed as confused as she was about obstetric care.

Irth, a new “Yelp-like app” allows people of color who are pregnant or new parents to review their care providers. The app aims to end racism in maternity care by creating accountability and meaningful data to push for a more equitable health care system, according to the website. 

Watson-Lewis, the doula, is an ambassador for the app, and said people who have had bad pregnancy and delivery experiences feel it’s up to them to keep medical providers accountable when they provide inadequate care. 

“There’s no (accountability), so now we have to do the work ourselves,” Watson-Lewis said. “We have to do the research. We have to tell the stories. We have to do all these things so that our community isn’t robbed.”

Charges against Aurora parents in co-sleeping death of 2-day-old baby draw condemnation from pregnancy justice groups

Their attorneys, advocates say the case should alarm the public

By SAJA HINDI | shindi@denverpost.com | The Denver Post

PUBLISHED: May 25, 2023 at 10:42 a.m. | UPDATED: May 25, 2023 at 11:12 a.m.

The criminal case of an Aurora couple charged in the co-sleeping death of their 2-day-old baby has spurred outcry from state reproductive justice groups who describe the prosecution as part of a growing trend across the country in which pregnant and postpartum people are facing more criminalization.

Brittany Diekneit, 27, and her husband Sean Byrne, 26, are each facing a felony charge of child abuse resulting in death. Diekneit and baby Walker returned home from the hospital on Sept. 22, and Walker died sometime that night or early morning. In April, three months after the autopsy was completed, arrest warrants were issued for the pair. The Aurora police arrest affidavits allege that the couple was drinking alcohol before sharing a bed with the baby and “ignored the substantial and unjustifiable risk of co-sleeping with Walker while being incapacitated and they were thus unable to check on him.”

The 18th Judicial District Attorney’s Office also upped the detective’s initial charge of a class 3 felony (criminal negligence in the death) to a class 2 (knowingly or recklessly causing the death) – increasing possible sentencing and fines.

Diekneit’s attorney Adam Yoast argues that not only is there no clear evidence to explain what killed the baby, he also points to blood tests the parents took that show they were not intoxicated. The couple’s defense teams say the young parents’ lower socioeconomic status and backgrounds likely factored into how they are being prosecuted.

“The crux” of the case is that the District Attorney’s Office has “made sleeping with an infant in your bed a criminal action, essentially,” said Alan Davis, Byrne’s attorney.

Nonprofit organizations Elephant Circle, Soul2Soul Sisters and ProgressNow Colorado penned a letter to the DA denouncing the case against Diekneit, citing systemic failures as more to blame than the parents for the death. Nationwide, groups have been raising alarms about criminalization involving pregnancies — most often affecting women of color and those who live in poverty — which they fear will get worse.

“Advocates need to have the frame of reproductive justice to a different degree now, post-Dobbs (the U.S. Supreme Court case reversing abortion rights),” said Kayla Frawley, ProgressNow’s legislative director. “We have to see how these cases relate to the criminalization of pregnancy itself now. … We know the gravity of these cases and that they’re happening and they’re often not amplified and not publicized because they’re done to families that are very low-resourced.”

The nonprofits advocating for equity and reproductive justice also argue that the charges go against Colorado’s policies, which favor education, treatment and keeping families together over prosecution.

The District Attorney’s Office declined to comment on the case.

Since Walker’s death, the couple’s 2-year-old daughter and Diekneit have been living with Diekneit’s parents because she and Byrne aren’t allowed to be alone with the toddler or have contact with each other.

“I can’t make sense of it,” Diekneit said. “I can’t. I know I did not hurt my son. And I know I knowingly did not hurt my son. I would never ever, ever, ever, ever hurt my children.”

The night of Walker’s death

On the night of Walker’s death, Diekneit and her husband ordered Chinese food for dinner and celebrated the baby’s arrival with some drinks.

Diekneit – who was not breastfeeding – said she had two mimosas that night. Byrne told the officer he had four or five over the course of several hours before feeding Walker at about 1:30 a.m. and going to bed, according to the affidavit.

Shortly after 6 a.m., Diekneit woke up in a panic. She hadn’t yet looked at the time, but she knew it had been too long since Walker woke up to be fed, and he wasn’t crying.

“I don’t relive this day in my head often,” she said, as she cried. “I just instantly start saying that he’s dead. ‘He’s dead. He’s dead. He’s dead.’”

Attempts to revive Walker by his parents and then by police and paramedics were unsuccessful. He was declared dead at 7:13 a.m.

In the arrest affidavit, a detective included pictures of empty alcohol bottles found in the trash and kitchen and empty containers of dabs, a form of THC concentrate, in the bathroom as part of the officers’ investigation.

The parents also took blood tests. Although Byrne’s showed THC in his blood, his test and that of Diekneit came back negative for alcohol. The arrest document stated this was unsurprising because of the length of time between consumption and testing. But Diekneit said she also took a urine analysis test — which can sometimes show alcohol for three to five days — for the Department of Human Services, and it came back negative.

Yoast called the investigation a sham to make the couple look bad by repeatedly referencing alcohol, despite little evidence that alcohol caused the baby’s death. Davis referred to the discussion about alcohol in the case as “outside noise.”

Police noted in the affidavit that Byrne had a criminal history involving alcohol and drug use, including a prior case involving his daughter — he received a deferred sentence and was required not to consume alcohol or drugs as part of a protection order.

Diekneit’s only prior criminal charge was a 2017 misdemeanor DUI charge from when she turned 21. But Diekneit hasn’t had any issues with drinking since, she said, including during her two pregnancies. She spent time in a rehab facility years ago, where she met her now-husband, and she said the couple has worked hard to make a better life for their family. They’ve also complied with a Department of Human Services plan set up for their daughter, which they’d expected to conclude until they were charged in Walker’s death.

Yoast said the case is a clear example of government “placing their perceptions on how mothers and fathers should raise their children.”

For Byrne, the months since Walker’s death have been a nightmare.

“The best thing that happened to me was both my kids, and the worst thing that happened to me and my wife is the worst thing that can happen to any parent,” he said.

The autopsy

The autopsy results of Walker’s death were inconclusive, citing only “environmental unsafe sleep and exposure to sertraline” as “significant conditions” in the baby’s death.

Including these conditions seemed unusual to Heather Thompson, one of the deputy directors of Elephant Circle — a birth justice group behind some of the advocacy for Diekneit. The sertraline likely transferred to the baby during Diekneit’s pregnancy when she used her prescribed antidepressant Zoloft, according to the autopsy, with studies showing it has a very low risk of problems for babies. 

As a postpartum doula, Thompson talks to new parents about co-sleeping and bed-sharing, including associated risks. She also served on a National Institute of Health task force about the issue.

Part of the problem with co-sleeping recommendations is parents are expected to do “Herculean things,” she said, especially in the early days of little sleep — and there’s a rush to judge parents, without compassion, if something happens to a child.

“That response causes trauma and harm above and beyond the loss of their child,” Thompson said.

Co-sleeping can increase the risk of what’s referred to as Sudden Infant Death Syndrome or the risk of accidental suffocation, but studies show bed-sharing is on the rise, even if people don’t publicly admit it. Bed-sharing is more commonly accepted in other countries, though experts say Western beds make it less safe in the U.S.

“Few imagine that the decision to co-sleep could lead to so harsh a penalty as this family is facing, especially because it is so common and problems so rare,” the Colorado advocates wrote to the DA.

The American Academy of Pediatrics recommends co-sleeping – having a baby sleep in the same room for at least six months to a year, but warns against bed-sharing or sleeping with a baby on a couch. However, the 2022 recommendations acknowledge it does happen, providing tips about what to do if a person falls asleep with a baby in bed.

When leaving the hospital, Diekneit said she received a pamphlet about co-sleeping, but she and Byrne had shared a bed with their first baby with no issues. Before the arrest, Diekneit was in a Facebook group of moms who talked about safe ways to bed-share.

While Thompson tells parents not to sleep in bed with infants if they’re intoxicated, she said the evidence in this case appears to show that both parents were not inebriated.

“I think that many, many people, both in and out of the judicial system, would hear that series of events and reach the conclusions that the parents must be drunk and smothered their baby, and that, in my opinion and experience, is as much a cultural response and it’s rarely rooted in data,” she said.

Regular postpartum drinking, she added, is culturally acceptable in society “unless something like this happens and then we vilify it.” Others involved in the case have noted how common it is for parents to be around their kids and drinking, including in public.

“Postpartum mothers and pregnant people and people in the prenatal period are treated differently in the way where it’s as if their bodies need to be controlled … We hold them to a different social standard, so when something like this happens, we’re going to be really punitive as a society and a system,” said Frawley, who’s also a certified lactation consultant and former doula. “And it’s really inequitable, and it’s wrong.”

She hopes the case will inform future legislation, whether it’s shortening the length of time it takes for families to get autopsy reports, not removing kids from homes immediately after the death of another child, or providing training to authorities on sleep-related infant deaths.

Bed-sharing in the U.S.

The number of autopsy reports for babies that cite an undetermined cause of death has increased across the country, Dr. Fern Hauk of the University of Virginia School of Medicine noted. Hauk’s research focuses on sudden unexpected infant death and strategies to prevent it, and bed-sharing across cultures. She has no ties to or knowledge about the Aurora case.

Medical examiners will sometimes identify a cause of death as “undetermined” based on a history of those around the baby that may cause concern or if there are conflicting stories that can’t be proven by autopsies, Hauk said. They could also use that designation if a baby died of Sudden Infant Death Syndrome (a specific diagnosis) or if a baby accidentally suffocated while asleep with no evidence of trauma.

Still, as the use of bed-sharing goes up, Hauk said unless there’s clear evidence of criminal intent, it’s better to educate parents about safe sleeping and minimizing risks than to prosecute. Medical professionals haven’t been successful in getting their message out, she said, especially in Black communities where mothers are sometimes uncomfortable not having their babies in sight so they can protect them.

“I think the important thing is we need to figure out ways to make our recommendations culturally acceptable and really work harder at figuring out ways that we can move the needle on this infant mortality,” Hauk said.

Criminal prosecutions in pregnancy and postpartum

Eric Ross, spokesperson for the 18th Judicial District — Arapahoe, Douglas, Elbert and Lincoln counties — said in an email that “co-sleeping in itself often wouldn’t result in charges,” though he did not address this case specifically.

“There is usually some other type of factor present such as alcohol or drug use prior to co-sleeping,” he wrote.

Criminal charges related to co-sleeping are uncommon — the Arapahoe DA’s office hasn’t prosecuted any of these types of cases in the last three years. However, another couple in Aurora was charged in the 2016 co-sleeping death of their 3-month-old — the second of their babies to die during co-sleeping — with misdemeanor child abuse resulting in death. The father told police that the parents had been drinking and smoking weed before the baby died

Other co-sleeping criminal cases have occurred across the country, including last year in Ohio, and in 2020, in North Carolina.

In the Colorado groups’ letter, they wrote that a conviction in Diekneit’s co-sleeping case wouldn’t improve outcomes for newborns but instead could dissuade families from seeking help in the future.

Diekneit has a preliminary hearing Friday. For now, she continues emailing her son on the account she created for him, writing that she knows they’ll meet again in heaven.

Dari-speaking doulas are part of a new wave of birth workers in Colorado

by Amanda Horvath Published on May 15, 2023 at Rocky Mountain PBS

AURORA, Colo. — Marina Kohistani makes every guest who visits her apartment in Aurora feel welcome with a warm smile and plates upon plates of food. Kohistani is a mother of four and an expert in caring for others — something that is evident in her new career as a doula. 

“My highlight of my work is when the mother calls me and says ‘I’m ready to give birth, can you escort me to the hospital?’ I really enjoy that part, and I get to be a part of the whole thing,” Kohistani explained with the help of translator Maryam Farhang. 

Kohistani is one of 24 women who participated in a new training program to become a doula. Conducted over four days in January through a partnership with the International Rescue Committee in Denver, or IRC, Elephant Circle and Empowering Communities Globally. The women were taught how to provide mental and emotional support in the birth room.

“Doulas protect that space and let women labor the way we were supposed to labor,” said Whitney Buckendorf, a doula who co-lead the training. She also works for the IRC on housing, leasing and maternal health care. 

This work isn’t new for Kohistani. In Afghanistan, she worked as a midwife. Her husband worked for the U.S. Embassy. After the United States removed its forces from the country and the Taliban took control, he applied for Special Immigrant Visas for himself and his family. They fled the country with nothing on August 28, 2021. For Kohistani she couldn’t leave her midwife certificates behind.

“When the Taliban took over, I remember I was holding this very close to me because this was very important for me to bring,” Kohistani said as she held the folder of the certificates close to her chest. “But the rest just stayed.” 

After a few months of transitioning to their life in the United States, Kohistani and her family settled in Colorado. Her husband found a job working at a McDonalds at Denver International Airport, and Kohistani longed to continue her career. 

While attending a hospitality class through IRC, she spoke with Buckendorf and revealed she was a midwife in Afghanistan and wanted to continue birth work here. That’s when Buckendorf knew Kohistani would be the perfect fit for this new training program.

Buckendorf first started with IRC in 2020 and has always made maternal health a priority. The fully formed idea for this specific training didn’t come until last March when she spoke with another organization that serves the immigrant population —Lutheran Family Services Rocky Mountains.

“I think one of the biggest issues with resettlement is that we all kind of silo ourselves. We don’t work across teams very well,” Buckendorf explained. 

Lutheran Family Services was looking to connect some of their clients with doulas and at the same time Empowering Communities Globally noticed a need in prenatal care that wasn’t being met. Buckendorf said immigrants were going to critical doctor’s appointments without translators or other support systems — that's exactly where a doula can step in to help. 

“We work for the families, not the hospitals. We’re their advocate,” Buckendorf stated. 

Maternal mortality rates increased by 40% from 2020 to 2021, according to a report released by the Centers for Disease Control and Prevention (CDC). The rate for the U.S. in 2021 was 32.9 maternal deaths per 100,000 live births, which is significantly higher than other developed countries including Australia, Japan, Germany, Spain, France, Italy and the United Kingdom, according to data from the World Health Organization and other global organizations.

The CDC also published the data on the U.S. maternal mortality rate based on racial groups which showed Black and Brown mothers are more at risk than white mothers. Specifically, Black maternal mortality rate out of 100,000 live births was just shy of 70%. 

The idea is that doulas can help change these statistics, Buckendorf said.

“We are birth professionals, we're experts in birth, we understand its physiological process,” Buckendorf explained. “When hospitals push these interventions that are not necessary and lead to C-section and lead to postpartum depression and lead to mortality, they have an advocate by their side saying, ‘What are the alternatives?’”

The data supports the theory that doulas can make a positive difference. A report published at the end of December 2022 from the Department of Health and Human Services, concluded that doulas are an effective best practice for birth.

“That's why Colorado is starting to consider having Medicaid compensate doulas because there's an exorbitant amount of research that shows doulas drive that rate down,” explained Buckendorf, “especially when doulas look like the mothers they're serving, which was why is really important for our refugees to be doulas for other refugees.”

This is something that one of Marina Kohistani’s six clients pointed out as a significant impact on her birth earlier this spring.

“I greatly appreciate the help that Marina has done for me,” Wazhma Karimi said through translator Maryam Farhang. “She has a total knowledge of everything, maybe she doesn’t know the language but she was comforting me, she was very present for me, and all that. She helped me a lot through the process.”

Karimi is also from Afghanistan and evacuated in August 2021. Like Kohistani, she was a birth worker previously and took the doula training class. 

“When you are pregnant, if you can find someone with your own language, that you can just talk to someone, it just gives you some kind of comfort,” Karimi explained. 

Getting immigrant birth workers the training needed to become a doula comes with one big challenge — the language barrier. That’s why in this first training module, real-time interpreters were offered in Dari and Arabic for the four days. The plan is to offer more training in other languages to focus on other immigrant and refugee populations in Colorado like those from Southeast Asia or Central Africa. 

The language barrier is also why Buckendorf and other advocates do not want Colorado to require certification to become a doula. (The state does not currently require certification.)

“While they do have to regulate it to some degree of who's claiming to be a doula who's coming in the hospitals, certification and testing is very difficult to be translated. It's why Marina can't be a midwife right now because of the language barrier,” said Buckendorf. 

That’s Kohistani’s dream — to go back to being a midwife here in the United States. As much as she has loved the doula work so far, it also presents more barriers including transportation to home visits as opposed to working in a hospital. Also, as a doula, you’re restricted from giving specific medical care, something Kohistani really wants to be able to do again. She may get her wish. 

Buckendorf said advocates are pushing for a Colorado bill in the next legislative session to make midwifery one of the accessible educations. This would mean if someone has a midwife certificate from another country, they only need supplemental education to get certification in the state. 

There is also a push from advocates to get funding to pay doulas for their work with mothers who are on Medicaid. Right now, the 24 mothers who did the training through IRC are receiving payment from Elephant Circle if mom is using Medicaid.

“Since it would be the first time the state has ever compensated or recognized doulas in that way, that training should suffice because we do believe doulas are an emotional, physical and mental support for pregnant women,” Buckendorf said. 

The hope is to continue to grow and expand this training. As Buckendorf explained to Rocky Mountain PBS, the need is apparent. She said some people were hoping to join the training the day of and there are midwifery groups that are now referring clients to these newly trained doulas. 

Kohistani has no shortage of clients herself. She is working with six more mothers who are preparing to give birth in the coming months. All 12 are from Afghanistan, and she said they really appreciate having someone like her be by their side.

“The moms are very happy to have a baby and you’re pregnant and to talk to someone from the same culture, the same background, the same language. They can talk to me freely without any judgment because we have the same background,” said Kohistani. 

While she waits for that next call, Kohistani will continue to do her work and cherish it along with every mother and child she has helped. 

“When the mom is all together after the birth and you give the baby to the mother and the whole thing is just … the happiness you see … it’s just amazing.”

Colorado’s doctors and nurses are still disproportionately white. These groups are trying to change that.

Studies have found benefits to Black patients from being treated by Black providers

By MEG WINGERTER | mwingerter@denverpost.com | The Denver Post

PUBLISHED: May 14, 2023 at 6:00 a.m. | UPDATED: May 14, 2023 at 10:01 a.m.

Neko Upson doesn’t have to wonder whether she’s making a difference for her patients. She sees it when she walks in the room and their tension drains away.

“They see someone who looks like them, and you can see them relax,” she said.

Upson said she’s one of only four certified nurse midwives in Denver who are Black. While her white colleagues also can provide high-quality care, they have to work to break through the distrust that many patients of color have in the health system, while people from the same background have an easier time forming a relationship, she said.

In Colorado, as is the case nationwide, Black and Hispanic people working in the health field are overrepresented in lower-paid jobs, like aides and support staff, but underrepresented among doctors, nurses, midwives and other jobs that pay more and require more education.

As of 2021, about 1.4% of people working as health care providers in Colorado were Black and 8.2% were Hispanic, according to data from the U.S. Census Bureau. In contrast, about 7.5% of those working in “health care support” were Black and 28.2% were Hispanic. Black and Hispanic people make up about 4.7% and 22.3% of the state’s population, respectively.

Providers, advocates and corporate philanthropic organizations are trying to diversify the state’s base of health care providers, both in the hope it leads to better outcomes, and because there simply aren’t enough people of any race working in these roles.

While it’s possible for providers to give empathetic, effective care to someone of any race, studies have found benefits to Black patients from being treated by Black providers.

A study of more than a million births in Florida found that Black newborns were about 39% less likely to die if the doctor overseeing their care was of the same race. Black adults also tend to live slightly longer in areas with more Black doctors — though it’s difficult to know if that’s because they receive better care, or because of other factors.

When patients have a provider who looks like them, they’re more likely to trust their doctor, and in the case of kids, more likely to see health care as a career option, said Dr. Johnny Johnson, a retired obstetrician who mentors medical students through the Mile High Medical Society, a Black physician group.

“It makes just a world of difference,” he said.

Even when a group is well-represented in health care as a whole, it can sometimes be a struggle to find providers who are a cultural match. For example, while Asian Americans make up a larger share of doctors and other high-paid professions as a whole, they’re underrepresented in the mental health field, according to the Health Resources and Services Administration.

Even U.S.Surgeon General Vivek Murthy reported it was a struggle to find a provider who was familiar with South Asian cultures when family members needed psychological help. Health systems need to do more to hire and support providers of color, which will then encourage others who are wondering if the mental health field has a place for them, he said.

“Our equity goals should be on par with our financial goals,” Murthy said during a stop in Denver earlier this year.

Upson said she only knew that midwifery was an option because the provider she saw when she was a teenager happened to be a midwife. Now, she occasionally speaks at high schools and nursing schools to get students thinking about the field.

While midwifery has a long history in the Black community, not many people know what certified nurse midwives do, Upson said. In Colorado, they must complete a graduate degree and practice in hospitals. While much of the job focuses on offering prenatal care and assisting with low- to medium-risk deliveries, certified nurse midwives also can provide routine gynecological care.

“You don’t know it’s an option, and if you don’t know, you don’t go to school for it,” she said.

Indra Lucero, founder of the nonprofit Elephant Circle, said they’re trying to diversify the maternal health field by focusing on careers that don’t require as much specialized education.

The group has held classes for aspiring doulas, focusing on recruiting immigrants, people of color and LGBTQ people. A doula acts as an advocate and guide during pregnancy and birth, and people who go on to work as certified professional midwives — who work in homes or birth centers — often get their start there, they said.

“We need low-barrier entry points,” Lucero said.

Students, providers need support

Ideally, students would meet and learn about people of color working in science and medicine throughout their whole education, since kids can quickly get the message those subjects aren’t for them if they don’t see themselves represented, or if their teachers don’t think they’re smart enough, Johnson said.

The Mile High Medical Society has been focusing on outreach to students at the University of Denver who are interested in health care, as well as mentoring those who enroll at the University of Colorado School of Medicine, he said.

A study of more than 81,000 people found that Black, Hispanic and American Indian students who took the standardized test for medical school faced more barriers to getting in. They were more likely to report they couldn’t afford help preparing for the test, that their parents hadn’t attended college, or that their advisers discouraged them from applying to medical school, which contributed to lower acceptance rates.

Acceptance to medical school also correlates strongly with family income, and Black, Hispanic and American Indian families are less likely to be wealthy than white families.

Getting students into medical school is only part of the battle, though, said Dr. Terri Richardson, a retired internal medicine specialist and member of the Mile High Medical Society. The group “adopts” students at the CU School of Medicine, taking them home for holidays and holding social events. For Black students who didn’t grow up in Colorado, it can be difficult to find where they belong, because the Denver area doesn’t have obvious Black neighborhoods, she said.

“The students need people they can connect to and bounce things off of,” she said. “Our organization isn’t large, but we’re trying to do a little piece.”

Perhaps the most helpful thing they do is help students to handle discrimination if they encounter it, Johnson said. For example, larger Black men can be labeled as intimidating even though they’re not behaving aggressively, and responding in the wrong way encourages that label to stick and causes more problems, he said.

There has been some progress over the decades in making education and medicine more inclusive, but students are still reporting that teachers ask if they’re in the right class when they take advanced math and science, Richardson said.

“I’m discouraged when I hear young people saying (they heard) some of the things I heard,” she said.

Rasheeda Ouedraogo, a school psychologist in the Denver area, said that the emphasis has traditionally been on bringing more people into the health field, rather than supporting those already working in it.

School-based mental health workers often struggle when administrators don’t understand their role, and those who are people of color are more likely to have their expertise dismissed, she said.

For example, at a meeting to discuss a student who needed an individualized education program for a disability, Ouedraogo said she raised concerns about friction in the student’s home life.

“I think it was a science teacher that said, ‘You don’t have to listen to her. It’s OK if you don’t get along with your son,'” she said.

The other people around the table didn’t say anything, and the parent dismissed her efforts to talk more about how a positive relationship helps students to thrive, Ouedraogo said.

“I would love to say that’s rare, but it isn’t,” she said.

Some people leave for private practice or go to other settings, but those who stay do it because they know students need someone advocating for them, Ouedraogo said. Still, it’s challenging to their mental health when they know they could face retribution if they raise something that makes people in authority uncomfortable, like disproportionate discipline for kids of color, she said.

“It’s almost like we’re falling on the sword daily,” Ouedraogo said.

“We’ve never been great at growing our own”

While the role of race might be most obvious when counseling a patient about something personal like mental health, every medical field benefits when it mirrors the community, because patients have greater trust in someone from the same background, said Adeeb Khan, executive director of the Delta Dental Colorado Foundation.

The foundation recently announced grants to four colleges to create slots for about 75 new dental hygiene students, with some starting new programs and others adding a “second shift,” he said.

The number of people working as dental hygienists has largely stagnated since 2020, and about 92% of dentists who were trying to hire hygienists in March 2022 said it was challenging to recruit people, according to the American Dental Association.

Colorado’s maternal death rate is rising. A new report says the answer is prenatal care, mental health screens.

April 13, 2023

By Jennifer Brown in the Colorado Sun

About 25% of pregnant people did not get prenatal doctor’s appointments in the first trimester. People of color were less likely to see a doctor in the first three months.

—————

About a quarter of Colorado pregnant women on Medicaid insurance do not go to a doctor’s appointment during the first trimester, a statistic that likely contributes to the state’s rising maternal death rate. 

That’s according to the latest “maternal health equity report” from the Colorado Department of Health Care Policy and Financing, which matched health records with 2020 birth certificates across the state. The Medicaid program, called Health First Colorado, covers 40% of all births in the state, or nearly 26,000 births in 2020. 

The maternal death rate examines the time period of a pregnancy through one year following the birth. A previous report from Colorado’s Maternal Mortality Committee found the leading cause of maternal death was suicide, followed by accidental overdose.

A recently released national report from the Centers for Disease Control and Prevention found that the maternal death rate increased by nearly 40% from 2020 to 2021 and was 2.6 times higher for Black women compared with white women. The increase was attributed in part to the effects of the COVID pandemic, including isolation.

“We are equivalent to a Third World nation in terms of our maternal health,” said Lily Griego, regional director for the U.S. Department of Health and Human Services, who spoke Wednesday to Colorado Medicaid officials and nonprofit advocates who want more equitable maternal health care. “Most folks are in shock about this.” 

Colorado’s report from the state Medicaid division had other grim news, too. 

The number of Colorado babies born chemically dependent on opioids and other drugs rose by 31% in one year, keeping with a national trend that has seen the rate of “neonatal abstinence syndrome” climb in the past decade. About 3.8% of newborns in 2020 whose mothers were on the government insurance program for Coloradans with low income were born with chemical dependency. That was up from 2.9% in 2019. 

Nationally, the number of addicted newborns jumped 82% from 2010 to 2017. 

Colorado is working with the federal Medicaid department on a five-year, $4.6 million program to provide better services for pregnant women who are addicted to opioids. The program sites are Denver Health, River Valley Family Health Centers in Montrose and Southern Colorado Harm Reduction Association in Pueblo. 

Also, only 8.2% of pregnant people received a prenatal screening for depression, according to 2020 Medicaid data. That’s an undercount, however, because many patients likely received a screening for depression but it was not captured in the system because doctors’ offices often don’t bill for that as a separate service, Medicaid officials said. 

An analysis of claims data found that in 4,405 births, about 17% of patients, there was at least one behavioral health visit. 

The number of Medicaid patients who received screening for substance abuse or addiction treatment was also low. Statewide, just 49 pregnant people had such a screen, but Medicaid officials believe that’s also an undercount since doctors don’t often submit claims for a separate, 15-minute substance abuse screening. 

Colorado now allows all pregnant people to continue their Medicaid coverage for 12 months after giving birth, regardless of whether they meet the income eligibility requirements. Medicaid officials said the new policy is key to lowering the maternal death rate, including by making sure new parents have access to mental health treatment. Prior to the change, people maintained coverage for just 60 days after giving birth. 

Additional reforms include Medicaid coverage for doulas beginning next year. State officials also are considering eliminating coverage restrictions at birthing centers, which are operated by midwives. More women are seeking to give birth in a birthing center instead of a hospital, an alternative that grew more popular during the coronavirus pandemic. The number of people who chose to give birth in a birth center rose almost 19% from 2019 to 2020.

Prenatal care visits remained stable from 2019 to 2020, with 76% of pregnant women receiving care in the first three months of pregnancy. Black patients were less likely to receive care, at 70%. And Native Hawaiian and other Pacific Islander people were the least likely to see a doctor in the first trimester, at 58%. 

Previous research has found that Native American women in Colorado are almost five times more likely than other women to die in pregnancy or in the year following a birth.

Pia Long, with the reproductive justice organization Elephant Circle, said that eliminating racial inequity in maternal health care will require a system in which people can choose how and where to give birth. 

“That’s what equity looks like, is birth choice and reproductive choice,” she said. 

Colorado’s Maternal Mortality Review Committee has not yet released data from 2020, but health officials suspect that the maternal death rate worsened during the early days of the COVID pandemic the same way it did nationwide. The increase was due to COVID infection, as well as delays in seeking health care, and mental health and substance abuse issues brought on by social isolation. 

As Colorado's Black maternal death rate increases, mothers turn to doulas

April 13, 2023 by Micah Smith of Denver 7. Watch the video here.

AURORA, Colo - According to the latest Colorado Maternal Health Equity report, Colorado’s maternal death rate is rising, and Black mothers are almost three-times more likely to be impacted.

“I've been doing midwifery work for almost 20 years. And I think the past five years is the first time that I've heard a black pregnant person say they were scared to die,” University of Colorado Director of Midwifery Services Jessica Anderson said.

Anderson said there are several contributing factors.

“We know that in our systems, racism exists, implicit bias and care looks different in certain areas of our communities, meaning people don't have access,” Anderson said.

Some of her patients are taking matters into their own hands, turning to doulas, trained professionals who help expectant mothers with physical and emotional needs.

“My personal reason for getting a doula was to help navigate a very racist healthcare system,” Christina Yebuah, who gave birth two months ago said.

“A lot of people were like, ‘why do you need a doula, your mom is there, your auntie is there, whoever?’ And it's like, they're also not experts in the way that doulas are. So I think having a person in the room with who is specifically there to be your advocate, and is not so focused on like, just experiencing the full emotionality of what it’s like giving birth, it's, it's just really nice.”

Elephant Circle Co-Deputy Director Vita Malama said having a doula present can change outcomes.

Elephant Circle is non-profit organization that focuses on birth justice and equity.

“We actually do full wraparound services, from doulas, to supporting birth workers to supporting families. We are on the forefront of advocating as well as making sure that when policies are being changed, when things are being sunset, we are there to support those birth workers and to continue these choices, not only for birth or pregnancy, but to where people can have the birth that they want, where they want to happen." Malama said.

"Whether it's, you know, in a hospital setting, or whether it is in a home setting, or whether it's in a birth center setting, it's really important for those options to continue,”

Mama Bird, a maternity wellness spa in Aurora also provides doula services for new moms.

Many of the doulas who work at Mama Bird, are women of color.

“I think that one thing that sometimes families don't consider that creates a lot of conflict around the birthing in general, is that for a family member to serve as your doula, not understanding how to serve as a doula, it takes away their opportunity to play the role of sister, aunt, grandmother. Because those roles are vital,” Mama Bird Doula Nadiyah Grace said.

“My first pregnancy was during COVID, when everybody was paranoid about everything in regards to going to the hospital, and then certain disparities were exposed. So there was a paranoia around my ability to choose and the amount of advocacy that I would receive at the hospital, you know, in the midst of all of these new changes,” Lehanna Jones, Mama Bird patient said. “I had to home births…I had my Doula and with my first experience, it was life changing care.”

But there are still some barriers to having the support of a doula.

“I think it's also partly affordability. We don't live in a society that offers universal free quality health care. So when you think about going down the list of everyone you have to pay to just give birth, the OB the hospital, if the hospital, then after you give birth, if you need extra support, like I had to go through pelvic floor therapy for months afterwards and still have chronic pelvic floor pain…And so I think sometimes when you think about like all the people who need a cut out of your birth, sometimes being able to afford a doula, you just can’t,” Celeste Rios, Mama Bird Doula said.

“There's also like an education piece too, that's lacking like in our community, because a lot of people don't know what a doula does. And then, because of how it's portrayed to some, they look at it like a luxury as opposed to a necessity. And it's not, that's not what it is. So like just switching that mindset is also something that, you know, is a work in progress,” Mama Bird Doula Imaan Watts said.

Mama Bird offers financial help to some patients.

“On our nonprofit side, we have partnered with Colorado access to provide at least 40 Black families with full spectrum doula support. So we are pretty much supporting the family all the way up from the beginning of their pregnancy all the way until their postpartum. So they get a prenatal appointments with us, they are offered yoga, they get newborn care,” Jahala Walker, doula said.

Walker said most importantly, they help mothers advocate for themselves.

Changes to Maternal Health Policy in Michigan Could Save Lives

Michigan Live covers this topic here.

By

• Alyssa Burr|aburr@mlive.com

Elon Geffrard was five years old when she saw her mother give birth with the support of a midwife. She said from then on, she wanted to make a career in “catching babies.”

After years of caring for Black and brown women in metro-Detroit as a doula and co-founder of Birth Detroit, she has a deeper understanding of how the health of a community can be reflected in the women and children in it.

If you were to look at the women and children here in Michigan, “Michigan is not doing well,” she said.

Birth justice advocates like Geffrard say racial disparities in Michigan’s maternal health system are creating a crisis for Black mothers and birthing people. These advocates, as part of a coalition called MI State of Birth Justice, intend to present the issue to the state legislature in the form of a comprehensive package of bills.

Aptly named the “Momnibus”— a combination of the terms “mom” and “omnibus”— the package would increase access to alternative birthing care throughout the state, such as birthing centers and midwives, while addressing systemic racism to improve outcomes for Black mothers.

Nationwide, Black women die from pregnancy-related causes at a higher rate compared to white women. In Michigan specifically, those odds are three times more likely, according to the latest data from Michigan’s Maternal Mortality Surveillance Program.

Racism is embedded in the history of women’s health, Geffrard said. She pointed to Dr. J. Marion Sims, “the father of gynecology” who used unethical experiments to study on enslaved Black women in the 19th century.

“Racism is an ideology. It is a belief that individuals who belong to certain groups are less or that devalue, dehumanize,” Geffrard said. “We see that show up very easily in institutions like health systems and hospitals, because that is how medical education was shaped.”

Nicole White, a certified midwife and co-founder of Birth Detroit, said racism is why some women still don’t have a safe option for birth care, and eradicating this harmful factor is one of the important messages of the Momnibus.

“I think we’re going to look back on this time in history with embarrassment and shame,” White said.

The proposal would require the use of the PREM-OB Scale, a tool to help measure the experience of Black mothers in hospitals across the state. It also suggests the creation of a formal complaint system with the state’s health equity commission specifically for obstetric racism.

Tatiana Omolo, government and policy affairs director with Mothering Justice, a Detroit policy advocacy organization, said supporters looked to ensure the Momnibus was as extensive as possible to cover many multifaceted inequities in maternal health.

“We wanted to be really careful about who to include, how to include them and to make sure that we are not forgetting who this bill really is for, and it’s for communities of color,” Omolo said.

The Michigan Momnibus builds on similar legislation federally and in other states. The Black Maternal Health Momnibus Act was introduced in the U.S. House in 2021, and Colorado also passed its own Birth Equity Bill Package that same year.

A key component of the Michigan Momnibus proposal is the licensing of birth centers and the reimbursement of midwifes to better the access of care throughout the state.

Michigan is one of 10 states that does not license freestanding birth centers– a health care facility for childbirth that is not a hospital and where midwives provide care. Without birth center licensure, midwives working in these settings are not reimbursed by Medicaid.

Birth Detroit has campaigned to open Detroit’s first free-standing birth center since its inception, White said, but the coverage that would improve workforce development and retention of midwives is not yet available.

“We were going to do a birth center and then when we recognized we can’t get paid for the care that we give in the birth center, then that’s just the sustainability,” White said. “We have to rip those legislative barriers down so that we can give this quality care for years and years and years.”

Possible birth center expansions would also positively benefit low-income families by lowering the cost of birth down to about $4,000, a significant difference when compared to hospital births, Geffrard said. “Obstetric deserts” like in the Upper Peninsula or in rural areas where families have to travel long distances to receive care, may also benefit.

The package focuses on several other areas like diversifying data collection to include LGBTQ people and people with disabilities, and integrating health systems so patients could be better transferred from birth centers to hospitals.

Currently, advocates are working on finalizing the details before the bills are ready to be presented to the legislature.

Some Democrat lawmakers, Omolo said, are hesitant to support the package in fear of it coming across as too radical or unappealing for their base.

Shanayl Bennett, a doula and black maternal health and reproductive justice organizer for Mothering Justice, said some of those feelings may stem from a lack of understanding about alternative birth practices.

A doula is a person who provides emotional and physical support before, during and after childbirth. Doulas are not medical professionals, but offer services such as developing a birth plan, breastfeeding education and help the family as a whole navigate life with a newborn.

Like doulas, midwives offer childbirth education to families, but they also have the needed medical training to assist during labor and delivery.

“I think the thought of midwifery care is still kind of out there to some people,” Bennett said. “They just can’t wrap their minds around why people won’t just go to a hospital.”

Sen. Erika Geiss, D-Taylor, who Omolo identified as being an essential partner in the legislature, said it may be a matter of time for legislators to learn about these issues as the new term has just begun and Democrats get acquainted with their role as the new majority. She’s hopeful her fellow lawmakers will begin to look at affording people the type of maternal care they want and need in Michigan.

“I am hopeful and cautiously optimistic that now we can have these very real conversations about how to advance some of these policies,” Geiss said.

Colorado has taken steps to improve maternal care, but more work needed to advance health equity

State looks to collect more data through Health eMoms survey, pay for doulas

By MEG WINGERTER | mwingerter@denverpost.com | The Denver Post

Behind a paywall: https://www.denverpost.com/2023/03/16/colorado-maternal-infant-mortality-health-care/

March 16, 2023 at 6:00 a.m.

Colorado passed laws two years ago to try to reduce the problem of women being ignored or mistreated during their pregnancy care, but advocates say more needs to be done — particularly for mothers of color.

In 2021, Colorado adopted a law requiring the state’s Civil Rights Division to accept complaints about mistreatment in medical settings during pregnancy and the postpartum period, though the division is not required to investigate all claims. The Civil Rights Division declined to release any information about the number or type of complaints it has received.

Senate Bill 21-193, which mandated that the division accept complaints, also required hospitals and other facilities where patients give birth to have policies that mothers be allowed to bring a support person or doula, in addition to their romantic partner.

Another law passed that year required the state’s maternal mortality review committee to recommend ways to collect more data about marginalized groups of people, including any mistreatment they may have experienced.

Indra Lusero, director of the nonprofit Elephant Circle, said the organization is still working on getting state and federal agencies to take mistreatment in health care settings seriously as a form of discrimination and to investigate it. Elephant Circle focuses on people of color and LGBTQ people who can give birth.

A bad birth outcome is traumatic on its own, but there’s another layer of pain if a family feels that it could have been prevented if providers had listened to them, said Lusero, who uses they/them pronouns. Since medical providers are trying to avoid legal liability, it’s rare for a family to get acknowledgment of a mistake, let alone any kind of assurance that anything will change — particularly if the mistake happens during birth, with doctors and nurses who the parents may never see again, they said.

“People feel particularly harmed by the fact that they weren’t listened to, and it’s a distinct kind of violation,” they said.

Brace Gibson, director of policy and advocacy at the Colorado Perinatal Care Quality Collaborative, said the state is revamping its Health eMoms survey to ask about bad experiences with health care during pregnancy and birth. Currently, the survey has questions about whether mothers are breastfeeding, their opinions on vaccines, if they use certain drugs and whether their families are facing financial struggles.

Having data on experiences with health care, particularly when it’s broken down by demographics like ethnicity, will help gather support for changes, Gibson said.

“We’re hoping more policy efforts will come out of that,” she said.

The Colorado Department of Health Care Policy and Financing has requested about $918,000 in state funds to cover doula services for people insured by Medicaid, as six states have done. Doulas are trained in supporting clients during pregnancy, birth and the postpartum period, but aren’t medical professionals.

Staff for the legislative Joint Budget Committee recommended the additional funds, but noted concerns that Colorado may not have enough trained doulas to meet demand, particularly since most now work with affluent clients who pay out-of-pocket.

A bill in the legislature to allow Medicaid to pay for community health workers could also present an opportunity to bring peer support specialists into maternal health care, if it passes, Gibson said. Peer support specialists share an experience with their clients — such as recovering from addiction — and have received training about when they can talk a client through a struggle and when to call for professional help.

For those who are pregnant or who have given birth, that could mean pairing them with a more-experienced mom who’s been trained, either via a community group or a doctor’s office, Gibson said. It can be a fine line to integrate peer support into medical care, however, because clients may not be comfortable with someone they see as part of the system, she said.

“We had Sisters who lost babies”

In 2020, Colorado had about 4.8 infant deaths per 1,000 babies born alive, which was the 14th-lowest rate in the country, according to the Centers for Disease Control and Prevention.

Black infants were about twice as likely to die before their first birthday as white infants, though, and Hispanic babies were also at increased risk in Colorado, according to March of Dimes. Asian babies had a similar risk level to white babies, and the number of American Indian infants was too small to make meaningful comparisons.

It’s more difficult to compare Colorado’s rate of maternal mortality to the rest of the country, because the state counts deaths up to a year after the birth, while the CDC’s statistics cut off at six weeks postpartum. In Colorado, Native American women and those who didn’t attend college were more likely to die during or after pregnancy than other groups, according to the state’s maternal mortality review committee.

Nationwide, Black women also are at elevated risk of maternal mortality, and Colorado’s review committee suggested the state health department should also keep an eye on that group, given the disparity in the country as a whole. The number of maternal deaths in Colorado is small, with 94 recorded between 2014 and 2016, so a few people who were lost — or saved — can make disparities appear much larger, or smaller.

Velveta Golightly-Howell, CEO of the Black professional women’s group Sister-to-Sister and a member of one of the first committees advising the state health department about racial disparities, said it’s particularly difficult for Black women to get adequate care. Medical providers are particularly likely to dismiss Black patients, underestimating their pain and not believing that they know their bodies, she said.

“We had (members of) Sisters who lost babies. We had Sisters who developed chronic conditions,” she said.

Golightly-Howell said her own family experienced dismissal in medical settings: After her sister passed out while shopping, the emergency room doctor wanted to send her home with some pills. Golightly-Howell told her not to leave without additional testing, which uncovered that she’d had a small stroke.

Golightly-Howell said Sister-to-Sister is working on developing workshops for providers to make them aware of disparities and unconscious bias, and for patients on how to advocate for themselves. People can’t always do that during a medical emergency, though, so expanding access to patient-focused providers like doulas could help, she said.

“We want to get to the heart of the problem,” she said.

“Not a check box for what is the person telling me”

Providers tend to make negative assumptions about Black patients, which doesn’t allow for helpful conversations, especially when combined with short appointment times, said Alliss Hardy, community and family development manager at Families Forward Resource Center in Denver.

“They tend to think we’re argumentative and we’re not going to listen and we don’t care” about our health, she said.

Families Forward offers lactation support, help paying for utilities, guidance on signing up for health insurance and finding a doctor, parenting classes, and free diapers and other baby items, depending on what a family needs. They also try to give clients the confidence to push back if they feel their health concerns are being ignored, Hardy said.

“The No. 1 thing is for the birthing person and the family to be knowledgeable of themselves and their bodies,” she said. “It’s OK to leave and find someone else to care for you.”

The CDC has started a campaign called “Hear Her,” urging health care providers to take time to listen to their patients’ concerns, and to educate them about symptoms they should never ignore.

Those include:

• Headache that won’t go away or gets worse over time

• Dizziness or fainting

• Vision changes

• Fever of 100.4 degrees or higher

• Extreme swelling in the hands or face

• Thoughts of harming oneself or the baby

• Trouble breathing

• Chest pain or fast heartbeat

• Severe nausea or vomiting

• Severe abdominal pain that doesn’t go away

• Fetal movements stop or slow down

• Swelling, redness, or pain in arms or legs

• Vaginal bleeding or fluid leaking during pregnancy (or severe bleeding after birth)

• Overwhelming fatigue

It’s crucial that government agencies like the CDC and large organizations such as the March of Dimes prioritize maternal health and equity, because they have the resources for those kinds of campaigns, said Katie Breen, vice president of programs at the Colorado Perinatal Care Quality Collaborative.

“Having the federal government’s support is crucial, because a tiny nonprofit’s not going to be able to pay to have something translated into 20 languages,” she said.

The CDC also offers patients a rough script for raising concerns, including a reminder to describe the symptoms in detail and keep track of how long they’ve lasted. Marginalized patients can still be in a bind, though, knowing they need to speak up for themselves but also that they could be labeled as argumentative or accused of drug-seeking, Breen said. That makes it particularly important for patients to have an advocate who can speak for them, she said.

It’s not necessarily that medical providers decide they’re going to dismiss a patient’s concerns, but the health care system is set up to emphasize expertise and things that can be measured, Lusero said. That’s a problem, because the patient is assumed to know less than the obstetrician and nurses, and feeling that something is wrong isn’t quantifiable, like someone’s pulse or blood pressure, they said.

“There’s not a check box (in the medical record) for what is the person telling me,” they said.

“It’s the system”

Nonprofits in Colorado are trying different models to provide advocates who patients trust, but who can also speak to providers in ways that seem credible.

Allison Mosqueda, program director for the Nurse-Family Partnership at Invest in Kids, said the twice-monthly nurse visits the program offers aren’t meant to replace primary care, but the nurses can help families navigate the system and coordinate with their doctors if they hear something worrisome.

The nurses are able to meet with pregnant patients and new mothers for an hour at a time, giving them a better view on families’ needs than their obstetricians can get in a 20-minute visit, Mosqueda said. Mothers who participated in the Nurse-Family Partnership were about 35% less likely to develop high blood pressure during pregnancy, and 18% less likely to give birth prematurely. Maternal and infant mortality are rare enough that they haven’t shown a decrease among participants.

“You think about the complexity of a person’s life, especially being pregnant for the first time,” she said. “It’s not the fault of individual providers. It’s the system.”

Shawn Taylor, director of programs at Families Forward Resource Center, said it would help if Medicaid and commercial insurance covered doula services, though some grant-funded programs make them available for low-income women at a higher risk of complications.

“It goes back to us not getting the quality of care we need,” she said.

Having a doula or support person present can help, but may not overcome the “expertise hierarchy,” particularly if the doula is a person of color, Lusero said. Doulas aren’t medical providers, and doctors or nurses can order them to leave if they push back too hard, they said.

“Doulas don’t really have any power,” they said. “Even after we passed that law (requiring hospitals to allow a doula or support person), we hear the same things keep happening.”

Dayna Bowen Matthew, dean of the George Washington University School of Law, spoke in Denver in February about addressing the disparities in maternal and infant mortality, which she said may take a change in the legal system.

She said that, given that the increased risks to women of color are undisputed, health care providers should have a legal obligation to do more to mitigate them, whether that’s expediting appointments with a specialist when something goes wrong or helping to meet social and economic needs.

Until a Supreme Court case in 2001, people who were affected by a policy that had discriminatory outcomes — say, a hiring practice that technically applied to everyone, but in practice disproportionately excluded people from one group — could sue under a doctrine called disparate impact. Now, only agencies can file disparate impact suits, but states could use the idea as a model for a policy giving people the right to take legal action when the health system isn’t serving them, Matthew said.

The general trend in states has been to make it harder to sue health care providers, because of concerns that large jury awards would drive doctors away. The goal isn’t to punish providers for what they can’t control, but to give them a clear incentive to fix what they can when the stakes are so high for families, Matthew said.

For example, they could show they were making reasonable efforts to address disparities if they diversified their workforces, were more hands-on in managing high-risk patients and put a greater emphasis on understanding how biases, such as the idea that Black women exaggerate their pain, affect care, she said.

“The most direct and impactful actions are from health providers,” she said.

A Los Angeles Family Seeks Answers — And Accountability — After Black Mom Dies In Childbirth

A Los Angeles Family Seeks Answers — And Accountability — After Black Mom Dies In Childbirth

April Valentine died at Centinela Hospital. Her daughter was born by emergency C-section. She'd gone into the pregnancy with a plan, knowing Black mothers like herself were at higher risk.

By  Mariana Dale

Published Feb 27, 2023 5:30 AM

Read the full article here: https://laist.com/news/health/april-valentine-childbirth-death-centinela-hospital-los-angeles-black-maternal-mortality-investigation

Colorado bill providing alternatives to jail for pregnant defendants advances

Colorado bill providing alternatives to jail for pregnant defendants advances

Courts could consider alternative sentences for pregnant defendants

Watch the video here: https://www.denver7.com/news/local-news/colorado-bill-providing-alternatives-to-jail-for-pregnant-defendants-advances

By: Brandon Richard

Posted at 2:53 PM, Mar 04, 2023

and last updated 2023-03-05 12:01:44-05

DENVER – Colorado lawmakers are considering a bill that could provide alternatives to jail for pregnant defendants.

The bill directs courts to take a defendant’s pregnancy into account when deciding punishment and “to consider whether the defendant poses a substantial risk to the public and whether that substantial risk outweighs the risks of incarceration.”

It suggests deals could be worked out to keep pregnant defendants who pose no risk to the public out of jail.

Sponsors of the bill say the final decision is still up to prosecutors and a judge.

“It doesn’t say they have to. It doesn’t say if you’ve committed a violent crime that you aren’t going to pay a penalty for that. It just says if it’s possible for you to be in an alternative sentence, and you meet all the criteria, that they will consider that,” said State Rep. Judy Amabile, D-Boulder.

Lauren Smith is with Elephant Circle and Soul 2 Soul Sisters, two Colorado organizations pushing state lawmakers to adopt the bill.

“We recognize that jails and prisons are unsafe places for pregnant people,” said Smith. “They're not equipped to address care that is needed.”

Smith said they have heard stories of pregnant inmates suffering in jail.

“We've had so many conversations over the past several years with people who've had a specific experience, experiences of giving birth alone in their cells, experience of not getting the care they need when it comes to substance use disorders and having a miscarriage as a result,” said Smith. “We know that this is something that's happening here in Colorado.”

During public testimony before the House judiciary committee, women shared their stories of being incarcerated while pregnant.

One Colorado woman shared her story about suffering a miscarriage at 16 weeks because jail officials didn’t provide her with medicine to treat her opioid addiction.

“The jail left me in withdrawal the entire day because the nurses were behind on bringing meds and I didn't get my dose until bedtime,” the woman said. “The next morning at breakfast I was in intense pain and spotting…In my experience jail is not the place to be at while you're pregnant because they are negligent in care towards helping incarcerated individuals, even in life-threatening situations.”

Opponents of the bill argue it will result in gangs and other criminals exploiting pregnant women, including their wives and girlfriends, by forcing them to commit or falsely admit to committing crimes in hopes of a lighter sentence.

“We don’t want to create a perverse incentive for people who are already committing criminal acts and who don’t respect women to try to monopolize and capitalize upon the considerations of this bill,” said State Rep. Gabe Evans, R-District 48.

That concern is why sponsors of the bill supported an amendment warning that people who coerce or extort a pregnant or postpartum person should be investigated and prosecuted.

The bill also requires jail staff to provide pregnancy tests to inmates within 24 hours after receiving a request.

“Requesting the test, taking the test, and results of the test are confidential medical information and must not be disclosed, except when the defendant receives medical care,” the bill reads.

State Representatives Jennifer Bacon and Judy Amabile and State Senators Julie Gonzales and Rhonda Fields are listed as the bill’s primary sponsors.

The bill passed the Colorado House of Representatives by a vote of 49 to 19.

It must now be considered by the Senate.

Pregnant defendants could get alternatives to incarceration under Colorado bill

Sara Wilson reported in Colorado Newsline on February 24, 2023, after HB23-1187 was heard in the House Judiciary Committee.

A bill recently introduced by Democratic lawmakers at the Colorado Legislature would require courts to consider alternatives for pregnant defendants in order to pursue the best outcome for the pregnant person and their child.

House Bill 23-1187 suggests diverted sentences, deferred judgments or an unaccompanied furlough as possible alternatives to incarceration for pregnant defendants.

“Pregnancy is a time-sensitive process that has many potential outcomes and variations. That time sensitivity doesn’t always fall in line with the criminal justice process. A big purpose of this bill is to help refocus, at least for those who are experiencing pregnancy or the loss of a pregnancy or postpartum, to help figure out how that can align in the criminal justice system,” bill sponsor Rep. Jennifer Bacon, a Denver Democrat and the House assistant majority leader, told a panel of lawmakers during a Wednesday hearing for the bill.

She said pregnancy, the loss of pregnancy and postpartum should be treated as legitimate medical conditions that judges weigh at all points during the criminal justice process.

According to the bill, the judge would need to consider whether a pregnant person is a substantial risk to the public, and whether that substantial risk is larger than the risk of being pregnant while incarcerated.

The bill would also require officials to give people in county jail a pregnancy test if they request one.

If the bill passes, it is unclear how many people this type of policy could affect. There are around 23 new commits who are pregnant each year within the Department of Corrections, according to a nonpartisan state financial analysis of the bill. That only accounts for the prison population, and doesn’t include pregnant people in the state’s jails.

Pam Clifton, the communications coordinator for the Colorado Criminal Justice Reform Coalition, was four months pregnant when she began a six-year prison sentence in 1998. When she began feeling contractions at the end of her pregnancy, prison staff did not immediately take her to receive medical care.

“I stopped at control, which was across the hall from medical, and I explained my situation to the guard on duty. She told me, ‘Get back to your unit, there are plenty of women down there who know how to birth babies,’” she testified to lawmakers.

Two days into her labor, and after a medical provider at the prison told Clifton she didn’t believe she was in labor, she finally arrived at a hospital. Her daughter had already died during that time — the umbilical cord had wrapped around the infant.

“Losing a baby is a tragic and traumatic event in the best of situations, but in a jail or prison setting where adequate medical care may not be available, it may be even more devastating. The experience of losing a child while incarcerated can be isolating and traumatic, and you feel disconnected from any support,” Clifton said.

The legislation is opposed by the Colorado District Attorney’s Council and the Colorado Association of Chiefs of Police.

Along with Bacon, it is sponsored by Democratic Rep. Judy Amabile of Boulder, Sen. Julie Gonzales of Denver and Sen. Rhonda Fields of Aurora.

The bill was approved by the House Judiciary Committee on a 9-4 vote along party lines. It is scheduled to be considered by the entire House of Representatives next week.

A private equity firm closed one of Colorado’s few birth centers. The community brought it back.

A private equity firm bought Seasons Midwifery and Birth Center in Thornton and then shut it down. It’s now been resurrected as a nonprofit.

Claire Cleveland 4:15 AM MST on Feb 8, 2023. Published in the Colorado Sun.

When a private equity firm closed Seasons Midwifery and Birth Center in Thornton in October, Colorado lost one of its few non-hospital birthing centers and 53 families with pregnancy due dates in November and December were left scrambling to find providers.

But then staffers and community advocacy groups stepped in to fill the void for the suburban Denver community and its patients, many of whom rely on Medicaid, the federal-state insurance program for people with low incomes. They reorganized Seasons as a nonprofit organization and struck a note of triumph and defiance in announcing its reopening in January as the free-standing Seasons Community Birth Center. Seasons has five deliveries scheduled in February and and another 30 expected starting in March.

“With the closing, we decided we’re not going to let capitalism take us down,” said Justina Nazario, a Seasons birth assistant. “We’re going to bring these really important qualities that you don’t get in the medical-industrial complex.”

Over the past two decades, the number of at-home and birth center deliveries nationwide was on the rise — until the COVID-19 pandemic hit. The number of out-of-hospital births increased 22% from 2019 to 2020 and an additional 12% from 2020 to 2021, according to a Centers for Disease Control and Prevention report.

Nationally, birth centers — medical facilities for labor and childbirth that rely on midwives to help with healthy, low-risk pregnancies — have lower rates of preterm births, low birth weights, and women transferred to hospitals for cesarean sections.

While C-sections can be lifesaving, they are major surgeries that come with significant risk and cost. A 2013 study of about 22,400 women who planned to give birth at a birth center found that 6% of those who entered labor at such a facility were sent to a hospital for a C-section. By contrast, about 26% of healthy, low-risk pregnancies in hospitals end in C-sections.

Before Seasons closed, staffers transferred about 8% of patients to a hospital for a C-section.

The funding model for birthing centers is complicated: In Colorado they are regulated and licensed by the state health department, yet because they’re not hospitals, they can’t bill insurance in the same way as a hospital. So Seasons, for example, receives about $4,000 per birth from private insurance, said Heather Prestridge, the clinic’s administrative director, while a hospital birth costs on average $19,000 and is reimbursed by insurance for about $16,000.

The only option for patients who don’t have private insurance and cannot pay out-of-pocket is to deliver in a hospital. Most birth centers don’t accept Medicaid, but Seasons is different. Before its closure, about 40% of its clients were on Medicaid, which reimburses less than other insurance providers, Prestridge said.

“Every time we take a Medicaid client on, we lose money,” Prestridge said. “It’s so important for everyone to have access to this kind of care, so we continue to do it anyway.”

Medicaid’s restrictions and low reimbursement rates have led to financial problems for birth centers, including Seasons, despite their being inundated with patients. In Colorado, 19% of the population and 36% of births were covered by Medicaid in 2022.

As a nonprofit, Seasons will need to lean on fundraising to fill the gaps, Prestridge said.

Colorado has seven birth centers, including Seasons, which often have rooms that look more like bedrooms than hospital rooms, and bathtubs as an option for delivery.

In 2018, two other Colorado birth centers — associated with hospital groups but owned by a for-profit parent company — closed. The two Denver-area practices primarily served patients who had low incomes or were refugees, The Colorado Sun reported.

“It came as a shock to us, but unfortunately it has become our reality,” Miki Tynan, co-founder and managing director of Colorado Birth and Wellness said of the birth center closures.

When Seasons closed Oct. 4, Colorado Birth and Wellness, a collaboration between birth centers in the Denver area, took on more than 60 of its clients.

The physicians group that started Seasons in 2019, called Women’s Health Group, partnered with a private equity group, Shore Capital Partners, in late 2020 and became Elevate Women’s Health. Executives there determined that Seasons was unprofitable and closed it, said Aubre Tompkins, clinical director at Seasons Community Birth Center, and others who worked for Seasons at the time.

“It was pretty devastating,” Tompkins said. “There were a lot of tears, there was a lot of anger, there was a lot of confusion.”

After the closure was announced, Elephant Circle, a reproductive justice organization, reached out to Tompkins with a plan to raise money for Seasons to reopen as a nonprofit. The organization’s founder, Indra Lusero, said members wanted to save Seasons but also wanted to invest in making the nonprofit model work more broadly.

“There’s been some investment, there’s been federal studies, there’s great data — all the things saying, ‘Hey, I think this model looks like it could work. We should invest in this model,’” Lusero said.

As a nonprofit, Seasons plans to expand its services to include gender-affirming care and train more people as midwives and doulas to increase diversity in the field. Seasons offers annual gynecological exams, contraceptives, lactation services, and newborn care through the first two weeks of life.

Tompkins is a member of what she described as an emergency and temporary task force that reopened the facility with a reproductive justice mission. Nazario will also sit on the board, along with representatives from the Colorado Organization for Latina Opportunity and Reproductive Rights, or COLOR; Elephant Circle; and Soul 2 Soul Sisters, a racial justice organization.

Nazario, who describes herself as Afro-Latina, has experienced firsthand how essential her identity and experiences are to her work in birthing. Potential clients often reach out to her saying they had been looking for someone like her, someone like them.

Katherine Riley, who gave birth to her daughter at Seasons last year, is policy director at COLOR and a member of the Seasons Community Birth Center board. She said she’s excited to advance Seasons’ mission and expand teaching opportunities for future midwives.

“The practice of midwifery, I think, in itself is an act of resistance,” Riley said. “There’s a long history of racism and patriarchy in ousting midwives, and so I think returning as a community to that is so important.”

Birth Justice Advocates Finds New Challenges—and Opportunities—Post-‘Roe’

JAN 23, 2023, 9:55AM - Rewire News Group

THALIA CHARLES

Roe's reversal affects the birth justice movement's ability to grow.

In the months since the Supreme Court overturned Roe v. Wade, pregnant people with ectopic pregnancies and fetal abnormalities have had to wait until they are essentially at death’s door to receive treatment—usually via abortion care—because hospitals fear state abortion bans. This denial of care exacerbates existing inequities surrounding childbirth.

Before Roe’s downfall, the United States had the highest rate of maternal mortality compared to other high-income countries. Because of systemic racism, lack of access to prenatal and postpartum health care, maternity care deserts, and weathering, Black, Asian, and Indigenous women and birthing people face higher rates of maternal mortality than their white counterparts.

In response to the Black maternal health crisis and other instances of birth injustice, primarily Black mothers, parents, activists, and maternity care practitioners birthed a movement in the late 2000s and early 2010s. The birth justice movement works to create a world where women and trans people control “when, where, how, and with whom to birth” and are free from medical abuse and reproductive oppression. The movement includes efforts to increase access to and affordability of doulas and midwives, legalize home births, create birthing centers, and end obstetric violence.

Achieving birth justice is more crucial now than ever: Recent research shows that in 2020, maternal mortality rates were 62 percent higher in states that heavily impeded abortion access than in states with fewer restrictions. Unfortunately, the rate of birthing deaths in abortion-hostile states will increase now that Roe has been overturned, which underscores the interconnectedness of abortion and birth justice.

Shamika Boone, the community-based doula program manager at Tulsa Birth Equity Initiative—an organization that trains community-based doulas to help guide women and birthing people through prenatal, perinatal, and early parenting experiences—said abortion bans complicate access to doulas or midwives.

“Generally, in the birth work space, when a family comes to us they have already decided to have their child,” Boone said.

Now, with Roe overturned and abortion outlawed in Oklahoma (except in cases of “medical emergencies”), Boone said a pregnant woman or person might seek out birth services because of “an unwanted pregnancy or experience that they have to go through with now.” The use of doulas and midwives has been linked with healthier birth outcomes and the empowerment of birthing people.

Unfortunately, a pregnant person in an abortion-hostile state who cannot afford to travel out of state for abortion care likely cannot afford a doula or midwife. Of the more than a dozen states that have criminalized abortion, at least eight have proposed some action to provide doula-adjacent services for low-income birthing people since 2019, according to the Doula Medicaid Project. Yet none of these states, including Oklahoma, offer Medicaid reimbursement for doula services.

“We’re still working on Medicaid reimbursement in Oklahoma. … Anyone [on Medicaid] who seeks a doula has to pay out of pocket,” Boone said. “They may not be able to afford a doula who costs $1,000. They’ll just go to the hospital because they’re on SoonerCare and can’t afford to do that.”

According to Boone, the high cost of doulas in Oklahoma may deter people from having the birth experiences they desire.

“It’s important to be able to receive Medicaid reimbursement to have a doula along with your Medicaid insurance, and have that additional support because of the possible inequitable treatment that could happen in the hospital,” Boone said.

Denials of reproductive autonomy snowball. Abortion bans put birthing people at risk of having unfavorable, traumatic, and potentially fatal birthing experiences.

Roe’s reversal also impacts the birth justice movement’s ability to grow. Indra Wood Lusero, founder and president of the Birth Rights Bar Association, a group of legal advocates that develops and provides legal responses and solutions to issues surrounding birth, shared that the organization is concerned that funders will hesitate to invest in broad reproductive justice work because of the abortion rights crisis.

“Just in the past few years, there was greater attention about how birth connected to abortion rights,” Wood Lusero said. “Some funders are starting to fund solutions to maternal mortality racial inequities. The overturning of Roe complicates it because of political will and momentum.”

According to Wood Lusero, synchrony between these movements is important.

“Black women, through [the] Black Mamas Matter Alliance, raised awareness about racial inequities with regard to maternal mortality,” they said. “If that wave of attention is not connected to the philosophical thinking of reproductive justice, that is not going to work. Access to abortion rights is one form of discrimination on the basis of pregnancy, but another piece is lack of access to evidenced-based care, of which midwifery is a part. We need a reproductive justice approach to improve maternal mortality.”

Wood Lusero believes that funding is important for developing the birth justice movement’s lawyering aspects. They said birth justice lawyers know that understanding legal issues is necessary to achieving birth justice.

“We have to hold a space for that to even be possible because there’s no law school curriculum that is training about birth justice. … It’s not like you can take a birth justice class in a law school at this point,” Wood Lusero said. “If there is no investment in developing new legal theories and better legal arguments, we’re not going to have them.”

Funding birth justice lawyering is more crucial now that legal advocates have the opportunity to create new arguments about a person’s rights during childbirth.

“One of the problematic things about Roe is the viability framework, which complicated the end of pregnancy,” Wood Lusero said. “The law has been developed around abortion. There is very little law that’s been developed specific to childbirth. The way that the law gets made in this country is precedent. We have to be in conversation with what exists.”

Wood Lusero pointed to the 1991 Colorado Supreme Court case People v. Rosburg, which held that Roe’s right to privacy did not include the personal choice of whether to have a midwife-assisted childbirth because the state’s interest in fetal life superseded the pregnant person’s autonomy once viability was reached.

Now, 50 years after Roe became the law of the land, abortion access is in shambles. Yet perhaps new life can sprout from this culled forest.

“What got us Roe was an ahistorical view of law and policy related to reproduction. If we’re going to do better, we have to learn from history,” Wood Lusero said. “Now is an important moment to look carefully not just at Roe, but a hundred years before Roe, and a hundred years before that and the evolution of the architecture of pregnancy care. We can learn a lot about how it got shaped and reshape it. I think we do want to reshape it. Losing Roe gives us a chance to get something better.”