'Change for the future': Cincinnati moms work to lower death rates for Black mothers, babies

Latosha Shelton, 28 weeks pregnant and hyperventilating, shoved aside her midwife’s advice to “wait it out,” gripped the steering wheel and headed for the hospital, screaming.

She’d spent weeks experiencing frightening symptoms – swelling feet, swelling face, headaches, stomach pains – and hearing doctors tell her that she was overreacting, these symptoms were just first pregnancy woes.

“I wasn’t listened to,” she said. “I felt like I had to be like, ‘Am I being dramatic?’ It let me ignore myself.”

Not this time. She awoke around 3 a.m. in agonizing pain and realized she had not felt her baby move all day. A midwife suggested by phone she try some sugar, then wait an hour to see if the baby was stimulated.

Shelton arrived at the emergency department with critically high blood pressure. Her platelets would not clot. Her placenta had no amniotic fluid. She had a rare syndrome called Hellp, a type of preeclampsia that causes elevated liver enzymes and a low platelet count.

“My organs were shutting down.”

Kendall Rose was delivered by cesarean section at 1 pound, 13 ounces, and her mother was stabilized.

The ordeal, Shelton said, “changed my life forever.”

'Queens' take on Black infant, mom death crisis

The U.S. medical system has a history of implicit racial bias that can include ignoring Black women's pain, and can lead to disparities in treatment and outcomes – including high rates of deaths of pregnant and new Black mothers and their infants.

Black mothers and babies in the United States are more than twice as likely to die during pregnancy, at birth or shortly thereafter than white moms and infants. The crisis started in slavery times. Now, the United States has one of the highest disparities in these mortality rates in the world’s developed countries.

The disparities are here, in Hamilton County. They stretch through Ohio and into Kentucky, and across the nation. Black babies were nearly three times more likely to die in Hamilton County in 2022, “regardless of their parents’ socioeconomic status or health behaviors,” according to Cradle Cincinnati.

Shelton wanted change for Black women. First she became a doula, a caregiver supporting other Black mothers through pregnancy and birth, in 2020. Then she joined a core group of Black mothers in Cincinnati who are working to turn around a centuries-long crisis in Black infant deaths, and now, maternal deaths.

They are members of Queens Village, a team of more than 3,000 Black women in the Cincinnati region. The group began in 2017, when four mothers and their children joined for dinner. They were hosted by Meredith Shockley-Smith, executive director of the nonprofit Cradle Cincinnati, a collaborative formed in 2013 to conquer Hamilton County's high Black infant mortality rates.

The "queens" are an essential part of Cradle Cincinnati, Shockley-Smith said. They're also a partnership for each other and for other Black women and their families.

"I feel like this is where God called me to be," Shelton said.

Hospitals rated on care of Black moms, babies

Black mothers were more than 2.5 times as likely to die during pregnancy, while giving birth or shortly after pregnancy than white women in both Ohio and the United States, state and national maternal mortality records for from 2014-2021 show. The latest rates, released May 2 by the National Center for Health Statistics vital statistics system, show a drop in maternal death rates overall – but the gap between Black and white maternal deaths is about the same.

Queens Village is working with the four major birthing hospital systems – the Christ Hospital Health Network, Mercy Health, TriHealth and UC Health – to create a website, MamaCertified.org, which makes public hospital reports detailing maternal and infant health data, and equity improvement plans.

The hospital systems have embraced the plan, the women say. MamaCertified.org was launched in February and continues to develop its content. The effort is funded by foundation bi3, Anthem Blue Cross and Blue Shield Foundation and CareSource.

“Accountability and trust are key,” the MamaCertified.org website announces to those who visit. “Together, we are working in partnership with hospitals to hold them accountable for how they care for Black people who give birth.”

The site rates hospitals' overall care of Black moms and their babies. It includes newborns' breastfeeding rates, outlines the hospitals' safe-sleep strategies and community outreach programs. It shares hospital data on newborn complications and shows how each hospital's rate compares to that of the county and state. The site gives hospitals ratings of "ally," "advocate" and "leader" based on their care. The hospitals are asked to provide annual updates for recertification.

How the MamaCertified strategy developed

Across the country, Black moms tell stories of poor or traumatic experiences at hospitals.

For the Queens Village MamaCertified Advisory Board, the issue is real in their own neighborhoods.

“A lot of women are afraid to go to the hospital because they don’t want to be dismissed,” Shelton said. “I’ve heard horror stories.”

The women in Queens Village, who meet socially for yoga, art classes, and events designed for Black women's well-being as well as for conversation about issues they face, started talking more about their shared experiences with pregnancy and birth about two years ago. Cradle Cincinnati, the Health Collaborative and Queens Village joined to develop the strategy to change the outcomes.

“Black women told us that they wanted to better understand the steps hospitals were taking to improve care for Black birthing people and babies,” Shockley-Smith said. She called the effort “groundbreaking.”

Hospital representatives applaud the effort.

“We are committed to ensuring that every aspect of our care meets the rigorous standards set by the program,” said Dr. William Moravec, UC Medical Center's director of labor and delivery.

Two of many ways UC Health has answered the mothers’ requests: Stratifying obstetric outcomes by race and ethnicity, and holding training sessions for staff on how implicit bias affects patient care.

Mia Crockett, a 38-year-old Colerain Township mom and member of Queens Village, said the women have directed every part of the website's creation, down to its colors, its design and the language used.

Crockett believes the site will enhance trust among Cincinnati mothers-to-be.

“Transparency is important for the simple fact that it provides connection,” she said.

A mother of five daughters, ages 6 to 15, and one son, 21, Crockett said she never had a traumatic birthing experience. Yet, repeatedly, she felt she was only at the hospital to give birth – not to receive care as a mother or woman.

It mattered, especially after she had two of her older girls: Crockett struggled with postpartum depression.

“Not one time did they ever ask me about my mental health,” Crockett said.

Now, MamaCertified.org lists all the hospitals’ postpartum maternal care services – including mental health.

The women deliver personal and passionate expertise that health care professionals do not have, said Lauren Bartoszek, director of community health strategies for the Health Collaborative. Efforts to improve health care for marginalized people need to include people who are most affected by the disparities, research shows.

"Queens Village reminds all of us that those closest to problems are closest to the solutions," said Kate Schroder, president and CEO of Interact for Health, a 20-county nonprofit working for equity in health. "They know their community – and what will work – and they are trusted to lead."

Local investment makes a national impact

MamaCertified is getting national attention, Shockley-Smith said. The U.S. Department of Health and Human Services invited her to Washington, D.C., in 2023 and this year, on April 12, to discuss the work happening in Cincinnati, including MamaCertified. Shockley-Smith was also invited to Vice President Kamala Harris’ office in 2023 to brief her team on MamaCertified work.

Other cities have reached out to discuss MamaCertified as an option for their communities, Cradle Cincinnati spokeswoman Jessica Seeberger said.

Queen City advisory board members Crockett and Shelton said the website is a symbol of hope for Black mothers now and a long-range vehicle for change for mothers and their babies' outcomes.

“We are looking for change for the future,” Shelton said. “Not only for our generation.”

Shortly after MamaCertified.org was launched, one of Crockett’s teenage daughters saw a billboard in their neighborhood that directs mothers-to-be to the site.

“She said, ‘Look mom! It’s MamaCertified!’" Later that day, she drew a picture of a girl wearing a T-shirt with a MamaCertified logo on her shirt.

“Our children watch us,” Crockett said, smiling. “It makes me feel good about their future.”

This article originally appeared on Cincinnati Enquirer: Moms, hospitals address Black maternal health, infant mortality