Black women's maternal mortality 3 times higher than white women. Local nurse has solution

By the time Naima McCaskill was holding her newborn son and “ugly crying” with joy, Jatu Boikai had long left her side.

But the nurse had already made a lasting impact on the new mother.

McCaskill credits Boikai, the only Black nurse manager of maternity services in Ohio, with helping her have her best birth experience — and she's had four children.

“I don’t know if I would’ve made it without her,” said McCaskill, who nearly died giving birth to her eldest daughter seven years ago when she suffered a post-partum hemorrhage. “I am so grateful.”

In June, McCaskill went to Mount Carmel Grove City in labor. As soon as Boikai walked into her room, she felt relief and a connection with the other woman.

Seeing someone who looks like them at the hospital can take some of the stress and strain off Black expectant mothers, Boikai said, and it may even help in trying to bring down the high maternal and infant mortality rates that disproportionately plague Black mothers and babies,

Black women are at least three times more likely to die due to pregnancy-related causes than white women, according to the Centers for Disease Control and Prevention (CDC). And while infant mortality has gradually gone down overall over the past decade, the rate is still 164% higher for Black babies in the state than for white babies, according to a report by the Health Policy Institute of Ohio.

Lack of access and poor quality of care for pregnant Black women are leadings factors, but research has also shown that bias and stereotyping of people of color can impact their health outcomes, too.

Nurses of color can help make health care more equitable for diverse patient populations, leading to higher patient satisfaction and resulting in improved health outcomes, according to the National Advisory Council on Nurse Education and Practice and a 2019 study in the Journal of the National Medical Association.

“Our patients deserve to have a staff taking care of them that mirrors our population,” said Boikai, who has worked at Mount Carmel Grove City since late 2020.

Of the 5.2 million registered nurses nationwide in 2022, only 6.3% were Black, according to the American Association of Colleges of Nursing. Black people account for about 13.6% of the nation's population, according to the Census Bureau.

To try to reduce these disparities, Boikai hired 25 Black staff members working in different positions since she started as nurse manager over labor and delivery and mother/infant units.

“I've been very intentional about making sure that I hire people who look like me,” Boikai said, adding that it's important because there's a "trust factor" when it comes to representation.

Navigating the system

Though Black women are predisposed to certain health issues such as stroke and heart disease, recent studies also show that racism, bias in health care and discrimination play a part in the numbers.

Boikai recalled a time when a lactation consultant decided a Black mother wouldn't want to breast feed because of her race without even asking her.

“I’ve seen providers disregard, disrespect, mistreat Black women and call it something different," Boikai said.

Having more Black women in health care can help prevent the negative experiences that many Black women have endured, said Dr. Kamilah Dixon, an OB/GYN and an associate professor of obstetrics and gynecology at Ohio State University Wexner Medical Center.

Dixon, who sought a Black obstetrician when she gave birth to her son, said she's overheard other providers immediately assume a Black female patient was a single parent because her husband hadn't come with her. When Dixon worked in Texas, she said another health care worker asked if the doctor could believe that one Black patient's four children all had the same father.

Facing assumptions like these can be stressful for patients, Dixon said. "You walk into that experience, and you're just trying to have your baby," she added.

Black women are also less likely to be offered all treatment options and more likely to be directed to open surgery, which tend to have longer incisions and scars, than minimally invasive options, Dixon said.

'She really listened'

McCaskill said she's been told what's right for her and has felt "bullied" into making certain choices while delivering her two older children.

But she said Boikai heard her birth plan — to deliver as naturally as possible — and didn't argue. Instead, she worked with McCaskill to make her as comfortable as possible during labor.

McCaskill, who now lives in Maryland, knows the statistics when it comes to Black maternal and infant mortality. She’s even lived it; her oldest child was stillborn in 2015.

“It’s hard being in such a vulnerable space and not feeling listened to and not feeling valued and not feeling seen,” McCaskill said. “She really listened.”

Grassroots work to prevent women from falling through the cracks

In addition to hiring more Black nurses, Boikai is finding other ways to help improve Black women's birthing experiences, especially those at special risk.

In May, she started mOBiNurses Inc, a nonprofit group that offers doulas and free support services to vulnerable women, from when they're pregnant to a year after they give birth.

"For women of color and low-income women who suffer from substance use disorder, the prison population, teen moms, just all those pockets of the population that are still very much at risk for maternal mortality, that sort of fall through the cracks,” Boikai said.

She is also working with Mount Carmel’s human resources and recruiting departments to bring in more diverse candidates to fill positions at the hospital. And she has formed a partnership with Fortis College, a private, for-profit career college in Westerville that has a diverse student body, so their students training to be licensed practical nurses can do their obstetrics clinicals at Mount Carmel Grove City.

Victoria Belin, a patient care technician hired by Boikai about two and a half years ago, said she feels more comfortable in her own skin working with the other Black woman. And Belin said she knows her patients feel the same way.

“We know you’re all here for care and that you’re supposed to get the right care, but what about when you feel uncomfortable about a question or if you just don't know if they’re going to understand you? " Belin asked. “It goes a long way to see somebody that looks like you.”

dking@dispatch.com

@DanaeKing

This article originally appeared on The Columbus Dispatch: Why does this Columbus nurse want Black moms to have Black nurses?