For Medical Care Systems and Providers Serving Black Birthing Individuals

Intended Outcome (Your Baby):

Respectful treatment of Black birthing individuals in your care, as determined by Black birthing individuals, that lead to consistent safe and healthy birth outcomes.

Who Are You? (Relevant History)

• What is your organization/practice/department’s current and historical standing in the full breadth of the community you serve?
• What is your organization/practice/department currently doing to address racial disparities in birth outcomes?
• Is it visible to the community?
• Do you have an anti-racist statement and/or commitment?
• Our Commitment to Changing the Culture of Medicine and Eliminating Racial Disparities in Women's Health Outcomes
• Do you have an equity plan inclusive of a path to becoming an anti-racist organization?
• Continuum on Becoming an Anti-Racist Multicultural Organization
• Virtual Trainings - in Health Justice
• How systemic racism affects Black women's health

Your Maternal Care Environment (What Type of Environment Do You Need to Have Your Intended Outcome)

• Who interacts with Black birthing individuals in your care... from front desk staff to clinicians?
• What is their awareness of the unique challenges facing Black birthing individuals?
• What is their demonstrative understanding of explicit and implicit bias?
• Harvard Implicit Association Test
• A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test
• What is their capacity to listen, show compassion, and be respectful?
• HEAR Her Concerns Healthcare Providers | CDC
• A physician speak up champion shares stories about listening to Black women
  
• How many on your staff (doctors, midwives, nurses, administrative team, etc.) are Black? 
• Are there any in key roles, including upper management or leadership in clinical care?
• How successful are you in recruiting and retaining Black individuals in your organization/practice?
• Dismantling Anti-Black Racism in Medicine - Editorials - American Family Physician
• Stat! An Action Plan for Replacing the Broken System of Recruitment and Retention of Underrepresented Minorities in Medicine - National Academy of Medicine
• What initiatives are in place to alleviate staff burnout?
• Are there systems in place for your staff to process stress and difficult or distressing incidents or outcomes?
• Health care workers' suffering goes far beyond burnout. Self-care isn't the cure
• The Impact of the COVID-19 Pandemic on Mental Health, Occupational Functioning, and Professional Retention Among Health Care Workers and First Responders | SpringerLink
• Do No Harm
• Are your physical and virtual care spaces safe, welcoming, and accessible to Black birthing individuals?
• Are Black individuals represented in your patient education materials, welcome packets and websites? 
• Do your policies on visiting and supporting patients reflect current research on the effectiveness of Doula support for Black birthing individuals in improving outcomes?
• Life or Death: The Role of Doulas in Improving Black Maternal Health
• Community-Based Models to Improve Maternal Health Outcomes and Promote Health Equity
• What accommodations are made to embrace language and cultural differences of Black birthing individuals in your care?
• Why cultural awareness matters in pregnancy care

Your Prenatal Field of Care (Pain Management/Comfort Measures)

• What shifts has your organization/practice/department made in the care of Black birthing individuals as a result of research that shows medical professionals still under-treat pain in Black patients, particularly Black birthing individuals?
• Are your front line staff aware of this research and its impact on care?
• Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites
• Racial Disparities in Postpartum Pain Management
• Racial Biology and Medical Misconceptions | NEJM
• What is your awareness of medical conditions in Black birthing individuals that are generally overlooked that lead to near misses and/or maternal or infant death?
• With this awareness, what changes in procedures and protocols are you implementing regarding the care of Black birthing individuals?
• A simple blood test could save new mothers. Why aren’t more doctors using it?
• Peripartum Cardiomyopathy (PPCM)
• Taking the time to build trust with your patient and engage them in their care can lead to positive outcomes. Encourage patients to share any concerns they may have.
• A Physician SPEAK UP Champion Shares Stories About Listening to Black Women - Institute for Perinatal Quality Improvement
• Are you using an alternative to the BMI as an indicator of obesity when assessing an appropriate weight of Black birthing individuals? 
• Body Mass Index as a Measure of Obesity: Racial Differences in Predictive Value for Health Parameters During Pregnancy
• Is a cultural and anti-racist lens used when determining if a pregnancy is “at risk”?
• What are you doing to address preconceived notions, biases, and/or stereotypes regarding a Black birthing individual’s income, education, occupation, and marital status?

Your Labor and Delivery Field of Care (Labor Delivery)

• What is in place to ensure black birthing individuals’ birth intentions are honored and respected during labor and delivery?
• What is the basis for recommending procedures that would advance labor progress beyond what could naturally occur?
• Is there a racial disparity in your organization’s induction rate?
• If so, what is driving the disparity? Is it hospital liability, OB/midwife schedule, or birthing individual’s desires/needs?
• How does your hospital c-section rate for black birthing individuals compare to the rate of other races? Do disparities exist? If so, how are you addressing it?
• How often is “Failure to Progress” diagnosed before a C-section is recommended? Are you over-diagnosing “Failure to Progress.”
• Evidence on: Failure to Progress (Evidence Based Birth Signature Article)
• Evidence on: Prolonged Second Stage of Labor (Evidence Based Signature Article)
• When suggesting an elective induction, do you consider the values and preferences of the Black birthing individual?
• Do you make your patients aware of other proven alternatives to reducing C-Sections, including doula support, less invasive fetal monitoring, walking during labor, etc.
• The ARRIVE study - Evidence Based Birth®

Your Immediate Postpartum Field of Care

• Do your OB and Peds team uniformly promote immediate postpartum skin-to-skin when there are no clinical issues for the birthing individual and the baby for all families?

Your Postpartum Field of Care (Postpartum)

• Is there routine follow up in the immediate postpartum period for Black birthing individuals with existing or potential postpartum issues in the first two weeks postpartum?
• Optimizing Postpartum Care | ACOG
• Is your process of obtaining and following through on patient feedback effective?
• Do patients feel they were heard and their concerns were addressed?
• Do patients hear back from you after providing feedback?
• How often are patient complaints or concerns, or emerging trends regularly looked at and acted on?
• What quality protocols does your organization/practice/department have in place?
• Do you have a patient/client relations department or pathway for patient/client concerns? Is it easily accessed by your client/patients?
• Do you have a confidential anonymous way for students, faculty, trainees, patients, and staff, and all members of our community can report if they have experienced or witnessed marginalization and bias?
• What is the effectiveness of your quality assurance teams? 
• Are you consistently reporting relevant data that leads to clearer assessment on what is happening with Black maternal health?
• How are you capturing near misses and comorbidities?
• Severe Maternal Morbidity: Screening and Review | ACOG
• Say L, Souza JP, Pattinson RC; WHO working group on Maternal Mortality and Morbidity classifications. Maternal near miss--towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009 Jun;23(3):287-96. doi: 10.1016/j.bpobgyn.2009.01.007. Epub 2009 Mar 19. PMID: 19303368.
• Close Calls: The Risk of Childbirth in America | NPR
• If you are involved in research, are you examining ways in which racial biases can be accounted for or at least acknowledged in your data collection and analysis?
• SACRED Birth Study
• We are birthing cultural rigor
• What ongoing strategies do you have to address current and upcoming trends impacting maternal health, particularly Black birthing individuals?