The Black maternal health crisis: taking action‍

Bonnie Zell
Chief Medical Officer
at Delfina
min read

Racial disparities in maternal health and pregnancy outcomes are well documented: Black pregnant people experience maternal mortality at rates 3x higher than white people, and suffer disproportionately from severe maternal morbidity. Adverse pregnancy outcomes like hypertensive disorders of pregnancy and stillbirth are also more common in Black patients. Moreover, new research has clarified that these disparities persist regardless of income level: infant death is more likely for the wealthiest Black mothers than the poorest white mothers.

As an OBGYN who has built a career in clinical obstetrics, quality improvement, building new models of care, and telehealth, I am committed to finding novel solutions to the way that the current medical system fails Black pregnant patients. I joined Delfina because I believe that our model has the potential to reduce racial disparities through evidence-based care driven by increasing accessibility, and culturally-competent care. We are building relationships with community-based organizations, and developing programs with community members as Delfina Guides. Delfina Guides work in each community we serve to deeply understand patient  circumstances, needs, and opportunities best. Our Delfina Guides also work to connect patients to appropriate community resources. 

Our model of evidence-based care is grounded in rigorous data collection and equitable AI models. Machine learning and AI have great potential to improve pregnancy outcomes through remote monitoring that can facilitate early interventions, and increasing access to care for the most vulnerable populations. To counteract the potential for racial biases in these algorithms, we work closely with clinicians and health disparities researchers to include and collate data on the social determinants of health, and are intentional in collecting data from geographically, racially, and economically diverse communities in the U.S. In addition to AI technology, our platform also features telehealth capabilities. Telehealth has the potential to provide ongoing support and increase access and adherence to prenatal care, and has been found to result in similar or improved clinical outcomes and patient satisfaction. I observed these positive effects on patient adherence at Lemonaid Health (acquired by 23andme), which I co-founded prior to joining Delfina.

In a study of low-income Black patients and healthcare workers, patients reported that their care felt overly standardized and impersonal. Effects of structural racism, like implicit biases held by healthcare professionals, result in Black patients being treated unfairly and not listened to by their providers. Even Serena Williams, one of the most celebrated U.S. athletes, describes needing to forcefully persuade nurses to listen to her concerns after a C-section. Williams had a history of blood clots, and could have died soon after giving birth to her daughter had she not ultimately been heard by her providers. 

In order to ensure that our patients are heard, that their experience is personalized, and their care team is attentive, we aim to give patients agency over their own pregnancy journeys: their care on their terms. From each patient’s Delfina Guide, a trained doula who serves as a non-clinical support contact throughout pregnancy, to in-app nutritionists and psychologists, to easier, faster communication with their OBGYNs, Delfina Care is built to give patients the tools to understand and manage their pregnancies with ongoing support. 

Our Delfina Guides’ doula training enables them to be compassionate, informed supporters to patients, and enablers of extended support with on-the-ground community contacts. We often find that pregnant patients are unaware of community resources designed specifically to help them. Delfina is addressing this gap in multiple ways. We inform our partner practices about community-based resources that are available and make sure they convey that information to patients using Delfina, or connecting patients to community organizations directly through the app.  We aim to ultimately bridge the chasm for patients between clinical care and needed community resources by providing access to all social and clinical resources.  We strive to directly address social determinants of pregnancy outcomes such as food insecurity, housing needs, and transportation challenges with support from our Delfina team members who live and work in these communities we serve.

With a combination of community health workers, advocates, and care navigators bridging the clinical and the social aspects of care, we can build a system that brings community resources to people who need them. Our first step in realizing this vision is convening a Delfina Community Advisory group that is bringing together community advocates, community based organizations, physicians, and clinic practitioners. We understand our own healthcare lens limitations in addressing community needs as providers. To appropriately address racial disparities in maternal healthcare, we are actively learning from folks serving their communities on the ground, and can help us connect patients to resources currently missing from their traditional pregnancy care system. 

A community-based approach is a crucial facet of our effort to eliminate racial disparities. We will use this approach to provide a healthy, safe, and supported journey for every pregnancy, particularly for Black patients and other marginalized communities. If you are also passionate about this mission, check out organizations like the Black Mamas Matter Alliance.

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