Supporting Pregnant Black Women during COVID-19: The Essential Role of Perinatal Support Professionals

Overview: This study examined pregnancy and birth experiences of Black women in Cleveland, Ohio during COVID-19. In-depth interviews were conducted with women who were pregnant or had recently delivered, and focus groups were conducted with perinatal support professionals (PSPs) who adjusted their service delivery model due to the pandemic’s restrictions.Proposal text: The United States is the only industrialized nation with a consistently rising maternal mortality rate, despite spending more per capita than any other country on healthcare (World Health Organization, 2015). These unacceptable statistics are also prevalent in Cleveland, Ohio, where a Black, non-Hispanic baby is nearly three times as likely as a white non-Hispanic baby to die before their first birthday despite Cleveland’s being home to several world class medical institutions (Ohio Department of Health, 2020). Chronic stress, especially stress associated with persistent experiences of implicit, explicit, and institutional racial discrimination are important risk factors for infant mortality (March of Dimes, 2019). Black pregnant women commonly experience race-related stress with most experiences being reported at work, school and in public settings (Salinas & Salinas, 2021). Interventions are beginning to recognize the importance of culturally matched services for Black women, specifically, addressing race-specific stressors. Birthing Beautiful Communities (BBC) fills this need in Cleveland and Akron, using Black perinatal support professionals (PSPs) to provide intensive perinatal support to pregnant Black women. This study examined pregnancy and birth experiences of women enrolled in BBC, who were pregnant and/or gave birth during COVID-19. We interviewed 30 clients in individual interviews and 12 PSPs in focus groups about their experiences during COVID. We asked the following questions: (1) What were pregnant women’s experiences during COVID-19? (2) How did perinatal support change during COVID-19? Using thematic analysis, we identified three key themes: (1) COVID increased social isolation; (2) COVID had silver linings; (3) PSPs provided unique support despite COVID. Our participants felt that being unable to interact in-person with their PSP was a loss, and social isolation and mental health issues were concerns. Other participants felt that staying home allowed them to keep their babies healthy and have more bonding time. Despite COVID's barriers, women appreciated their PSPs' social, emotional, instrumental, and informational support, delivered through Facetime, texting, and phone calls, and/or in-person, taking appropriate COVID safety measures (e.g., meeting in a park). Both PSPs and clients relayed mixed experiences interacting with health providers (some positive, some negative). In contrast to our 2017 study in which women emphasized the importance of PSPs’ presence at their prenatal medical appointments, we found that regulations meant almost all women attended appointments alone. This meant that they missed out on important support including transportation to appointments, childcare during the appointments, and most importantly, translation of medical terms, interpretation of health concerns and advocating for their birthing rights. Given the strong evidence of (in-person) continuous labor support being associated with more positive birth outcomes (Hodnett et al., 2013), these services should be considered essential, particularly for groups at high risk of negative birth outcomes. We will argue that PSPs are vital members of the birth team and should not be excluded from accompanying women to prenatal appointments and births. Attendees will learn about the benefits of perinatal support to Black pregnant women, options for providing support during a pandemic, and the importance of advocating for such professionals’ being considered essential workers.