Hoosier women are less likely to survive childbirth than women in Iran and the Gaza Strip, according to the Central Intelligence Agency (CIA) Factbook.
The CIA Factbook estimates in 2017, 16 Iranian women out of 100,000 and 27 women in the Gaza Strip out of 100,000 died as a result of childbirth. The maternal mortality rate among white women in Indiana is 41.4 out of every 100,000 births, according to America’s Health Ranking and Indiana’s Department of Health.
For Black women throughout the state, the disparity is even worse. Black Hoosier women die at a rate of 53.4 out of every 100,000 births.
These jarring statistics are part of what led Indianapolis resident Joi Barnett to use a midwife for the birth of her fourth child and become a midwife shortly afterward.
Midwives have on average two years of medical training and help guide expecting mothers through pregnancy and labor and help her deliver the baby.
“With my midwife, my [prenatal] appointments were about an hour long, face to face,” Barnett said. “I often had a comfy couch to sit on, there was tea if I wanted something to drink. We went over everything, not just the baby. We talked about how I was doing from head to toe; she dealt with my brain.”
After three days of labor — an experience she assures wasn’t terrible — Barnett gave birth to a healthy daughter. This experience was a stark contrast to the birth of her third child.
After giving birth to her third child — a daughter — in Lexington, Kentucky, Barnett complained of pain. She said nurses at the hospital ignored her and didn’t check for blood loss, disregarding standard procedure. When Barnett stood up, the issue was clear: she was hemorrhaging.
Not being heard
After a stint in nursing school, Barnett knew what medication to ask for, massaged her pelvic area to alleviate the blood clot she felt when she stood. The birth of her daughter was traumatic from the start, with hospital staff breaking her water without consent.
Despite the negative experience, Barnett could have faced a worse outcome. According to Community Health Network in 2018, African American women die at three to four times the rate of white women nationwide due to childbirth. The Centers for Disease Control and Prevention (CDC) estimated that roughly 60% of these maternal deaths can be prevented with better health care and communication.
“What happens a lot of the time is that we’re just not listened to,” Barnett said. “We go to a doctor with a concern, and we aren’t taken seriously, so intervention options are limited because we’re written off.”
Not listening to Black women is often a result of racial bias in the health care system and the cause of disparities in national maternal mortality rates, according to the American College of Obstetricians and Gynecologists.
In addition to her experience, Barnett cited the death of Kira Johnson in 2016 as an example of the consequences of ignoring Black women.
Johnson, 39, went to Cedars-Sinai Medical Center in Los Angeles for a scheduled cesarean section. After delivering her son, doctors ignored Johnson’s complaints that something was wrong. During emergency surgery hours later, doctors discovered her bladder was nicked during the C-section.
Johnson died of internal bleeding just 12 hours after giving birth. Her husband, Charles, became an advocate for better maternal health polices nationally.
“Simply being listened to goes a long way,” Barnett said. “When Black women complain of pain, we’re ignored, we’re overlooked. It could be as simple as a headache, or as extreme as leaving her [Johnson] lying there in a hospital bed bleeding out.”
As a midwife, Barnett hopes to close the gap in maternal and infant mortality rates between white and Black women in Indiana. After nearly two years of training, she follows the JJ Way, a method started in Florida, a state that has significant racial and socioeconomic disparities in birth outcomes, according to the Association of Maternal & Child Health Programs.
“The program has had some really phenomenal results,” Barnett said. “In 10 years, the practice hasn’t lost a mom or a baby, and all of the babies have been appropriate birth weights. Those are my goals.”
In 2019, Gov. Eric Holcomb announced an initiative to decrease both infant and maternal mortality throughout the state — Indiana has the seventh highest infant mortality rate in the country.
In 2016, 623 babies in Indiana died before their first birthday, according to Community Health Network. To put that into perspective, it is roughly 42 school buses at maximum capacity. Black children made up the plurality of those deaths that year, at 14.4%.
Community Health Network found many of these infant and maternal deaths were caused by issues such as hospitals not having universal protocols for obstetrical emergencies and a lack of adequate postpartum education and follow-ups.
Doulas are another tool to help reduce the number of maternal and infant deaths. Doulas typically do not have medical training and are there to guide mothers through pregnancy and labor, which can include being an advocate for expecting mothers during hospital visits.
“Having a doula is really helpful because they’re there for support and are great sources of information,” Barnett said. “You can’t necessarily call your midwife for every little thing, but you can have a conversation with a doula. They can’t give you medical advice, but they can tell you if you need to contact your care provider and can sometimes go with you to appointments, not to speak for you, but to help you get your voice heard.”
Ajaya Divine has been an active doula for one year. After completing a six-week course in Dallas that focused on working within the African American community, Divine, 33, now works in Indianapolis. Taking on one to two clients at a time for full doula services, Divine provides expectant mothers with prenatal care, tips on how to deal with pain and other pregnancy symptoms, as well as preparing women for birth, either at home or in a hospital.
“A healthy woman can have a baby at home,” Divine said. “Hospitals are relatively new to birthing. We [Black women] are not as believed when we report symptoms, and inherent racism within the medical world makes birth play out differently for us.
Doulas are a great advocate for mothers who may not know what the doctor is talking about,” she continued. “… A doula is a protection barrier to catch all of the mistakes and other issues that can fall through the cracks during birth.”
Doulas can also provide postpartum care that many hospitals cannot.
While it ultimately depends on what the mother wants and needs, Divine aims to visit her clients twice in the six weeks after birth. During these visits, she can talk to the mother about issues related to motherhood, physical pains, or even help run errands.
“Postpartum care is valuable in that adjustment period,” Divine said. “Mothers need support, and I believe that a doula is very valuable for mothers who don’t have huge support systems after they give birth.”
Contact staff writer Breanna Cooper at 317-762-7848. Follow her on Twitter @BreannaNCooper.