Midwifery Services for Immigrants, Refugees, and Low-Income Persons

Grantee: Neighborcare Health
Timeframe: July 2023 – June 2024 | Amount: $155,000

Ongoing racial and ethnic disparities in US maternal health care are well-documented by the government and private health care. The CDC’s 2007-2016 study, Racial/Ethnic Disparities in Pregnancy-Related Deaths confirms, “American Indian/Alaska Native (AI/AN) and Black women are 2 to 3 times as likely to die from a pregnancy-related cause than white women.” The 2022 CDC report “Working Together to Reduce Black Maternal Mortality” discusses the underlying causes of these disparities, “such as variation in quality healthcare, underlying chronic conditions, structural racism, and implicit bias.”

These disparities are reflected locally in the Public Health – Seattle & King County report “Health of Mothers & Infants by Race/Ethnicity” (Aug. 2015) which lists many daunting maternal health disparities, including:

• American Indian/Alaska Native and Black infants had an infant mortality rate at least twice as high as the lowest rates seen in King County.
• BIPOC mothers were less likely than White mothers to receive early and adequate prenatal care.
• Black and Native Hawaiian/Pacific Islander infants had preterm birth rates about 50% higher than White infants.
• Infants born to Asian mothers were 1.4 times more likely to be Low birth weight; and this is 1.7 times more likely for Black mothers, whose infants are also 2.6 times more likely to have Very Low birth weight.
• Cesarean delivery rates were 24-33% higher among Asian and Black mothers.

Neighborcare’s Midwifery Program began in the 1980s through partnerships with local hospitals who provided midwives for our clinics. At that time, Medicaid was not covering maternity care, and would only reimburse partial costs of deliveries. Although Medicaid now provides some reimbursements for midwifery, the actual costs of care far exceed the possible reimbursed income. For example, a typical birth (prenatal care, delivery, and postpartum care – not including the facility and anesthesia expenses) costs about $5,000, but Medicaid will only reimburse $2,200. For this reason, many clinics and providers restrict the number of Medicaid patients they will deliver, with some entirely refusing to provide these services to patients on Medicaid. This leaves the most vulnerable citizens at high risk for birth complications and even death. This also results in major health care disparities with more than 60% of the 73 million people on Medicaid identifying as Black, Hispanic, Asian American, or another non-white race or ethnicity (per the US DSHS).

COMMUNITY INVOLVEMENT:  The population Neighborcare Health serves is continuously involved in program planning, delivery and feedback. Neighborcare Health partners with community-based organizations to provide outside pregnancy support services (such as doula care) to our patients in those communities. For example, our partner Global Perinatal Services specializes in providing doulas from the Somali and other East African communities. When hiring for open midwifery positions, Neighborcare Health prioritizes the ability to speak any of the non-English languages of our patient base, which vary from clinic to clinic.

For planning and feedback, Neighborcare Health annually conducts patient surveys to evaluate our services and inform needed changes. A good example of this is, in 2021 Neighborcare Health found that our patients would greatly benefit from having combined care visits for both the postpartum patient mothers (obstetric care) and their newborns (pediatric care). For patients, this would cut down on number of times needed to go to the clinic thereby reducing lost work time, transportation time, babysitter costs, and more. Neighborcare Health began a pilot program in 2022 to treat these two vastly different care needs in one visit, which has been remarkably successful. Our survey return rate for 2022 was 50%. To improve this rate, Neighborcare Health will conduct in-person surveys at our clinics rather than relying solely on follow-up phone calls. For this grant, Neighborcare Health will create a dedicated survey to collect qualitative data on patient experience, as detailed in Project Outputs.

USE OF FUNDS: Funding will provide general program support for our Midwifery Program. $155,000 is approximately the equivalent of 2.81 FTE salary and benefits for our Perinatal Coordinators (PNCs), whose time is not reimbursable by insurance, yet who are a crucial component of our patients’ care and critical to our consistently excellent outcomes. PNCs serve as patient advocates, navigators and program coordinators. They also provide an extensive amount of patient education on pregnancy, birth, and postpartum care.

Over half of our PNCs speak the languages of the people they serve, providing an important community link, and resulting in critical word-of-mouth referrals. PNCs help patients overcome their many barriers to care, such as navigating public transportation, and needing to make appointments with limited/expensive minutes on their phones. PNCs also track who needs appointments, who missed a midwife or outside referral appointment, and help problem solve to keep patients on track for care. Our PNCs stay updated on all available social services, enabling them to make hands-on referrals to food banks, legal help, translation services, and much more. Without this unreimbursed, broad-reaching service provided by our PNCs, many patients would be lost to care completely, or have concerning delays in care.

SPECIFIC ACTIVITIES & STAFF: Neighborcare’s Midwifery Program strives to provide the best birth experience possible for our patients, and reduce Cesarean-section rates (C-sections), traumatic deliveries, and unneeded medical intervention. Neighborcare Health also connect patients with community resources and help them understand their health care options. Please see Outcomes below for specific activities/services.

Midwifery Program employs 10 Certified Nurse Midwives (CNMs).  Washington State certification for CNMs is extensive and thorough, including a minimum of three years of education in both nursing and midwifery. Our 5 Perinatal Coordinators work an average of .80 FTE each, for a total of 4.0 FTE. They are supported by three per diem Perinatal Coordinators who provide additional coverage as needed.

ABOUT OUR GRANTEE

Neighborcare Health

Neighborcare Health’s mission is to provide comprehensive healthcare for people with difficulty accessing care; respond with sensitivity to the needs of our culturally diverse patients; and advocate and work with others to improve the overall health status of the communities we serve. Our ultimate goal is 100% access to health care with zero heath disparities.