“Black Mommas”

The heart of a women is redefined when we hear the first heartbeat, feel the first bubbly flutter, jitter across the belly as if to say, “I’m in here!” Complementing both of these amazing moments... the day we finally get to take a glimpse at who has been developing in our body for the past several weeks, our first ultrasound! No matter what we see or don’t see on that monitor we know one thing for sure, we have love for whomever is in there.

Those universal moments that transpire before, during, and after childbirth overwhelm the majority of ALL birthing mothers.

Raging excitement, Glowing joy, Embraced curiosity, Head pounding worry, Silent promises, and sometimes even outbursting tears find their way onto our emotional palette. As it begins to blend into our past reflection of how our own life has taken throughout the years, especially if we were traumatized in any facet, we start building up that protective shield designing it to guard against harm by any means necessary. We start walking on a path towards anxiety, fear, frustration, and loneliness;  sleepless nights have begun to turn into depression sessions.

You try to verbally express your concerns; No communication.

You try to explain how your body is feeling; No relief felt.

You ask questions; No answers given.

Healthy mom, Healthy baby.... Life at risk!

This is the reality for Black Mommas and our beautiful Black babies. Regardless of the color of my skin, educational background, my lifestyle choices, how many children I have birthed, or how many years I have been on this earth, Black Mommas/All Mommas become extremely concerned about the health and well-being of ourselves and our baby. Unborn babies creates vulnerable spaces for the Black Birthing Momma because we have seen the failures the governmental system has been delivering. We have to rely on a healthcare system where policies and procedures don’t apply to us, protect us, or save us - even when it’s preventable measures!

Why should women of color sacrifice our lives or that of our children when we are only doing what women have been doing since the beginning of time…  PREGNANCY + LABOR +.CHILDBIRTH (should) = Healthy Mom/Healthy Baby. Unfortunately, Preventable Black Maternal and Infant Mortality rates are so extreme we must take a firm stand against such negligence!

In honor of Black Maternal Health Week, Let us give eye opening Awareness to the high rise in maternal death among Black Mommas!

Let us say “NO MORE”!

As we stay alert to the high infant mortality rate among Black Mommas compared to other mommas?

Let us say “NO MORE”!

No More inadequate health care!

No More judgment based on the color of my skin!

No More mistreatment of my body!

No More of you not listening to my voice!

No More preventable lives lost!!!

We are in a time when we (Black Mommas) must unite and come together to support one another in order to make sustainable change for our future. We must continue to fight to be heard, valued, understood, and supported during one of the most eventful, powerful, and transformational times in any birthing mother’s life...No one has the right to traumatize, degrade, agitate, or take away any of its individualized uniqueness due to implicit biases, prejudices, or opinions. Let us also embrace all who are out here doing the work to save Black Mommas and infants from a system that was created to fail us. In order for us to continue moving forward in this fight for our lives, let us continuously bring recognition to these inequities with forcefulness, togetherness, and urgency. Much love to our Midwives, Nurses, Policy Changers, Doulas, Childbirth Educators and all those in our community dedicated to Black Maternal HealthCare!

Support goes a long way…

Empathy opens doors…

Equity before trust…

Respect is not based on color

Value is worthy

We Inherently Deserve…  Healthy, Positive, Birth Experiences

Love over us all…

“Black Mommas”

This post was written by Cindy McMillan, (CD)DONA Certified Birth Doula, Trained Lamaze Childbirth Educator, Certified Breastfeeding Peer Counselor and Director of Marketing and Education with SistasCaring4Sistas. SistasCaring4Sistas' vision is to eradicate disparities in maternal and infant mortalities by providing education and doula services to families who face financial barriers and stigmas by building sustainable community capacity and connection. SC4S is a key partner with Mothering Asheville and Buncombe County CHIP.

Mothering Asheville's Journey to Sustainability

Greetings CHIP Partners! This is Maggie Adams, Project Manager for Mothering Asheville, taking over the IM Blog here for the time being! We are happy to continue to partner with CHIP to continue to battle systemic barriers women in our community face that keep them from having healthy babies. We have a lot going on: so jump right in!

Clinical Shift

1. Currently working on creating an in-house referral system for women to SistasCaring4Sistas (SC4S)  at MAHEC OB that is easy and becomes a part of OB operations on a consistent in regular basis. Including having process to pull and enter data in EHR (electronic health record) with the help of our MAHEC Admin team!
2. We are also finishing the final drafts of a referral sheet for referrals for SC4S that come from outside of our clinic

Community Capacity Building

1. Mother to Mother (M2M) in Pisgah View Apartments continues to meet on the second Thursday of every month from 6 to 7:30 PM. If you have interest in attending, please see Mother to Mother - Request to Join or if you are interested in getting feedback that anything you or your organization are working on with partnership from the participants of M2M fill out : M2M- Request for Meeting Time.
2. The Back to School Bash, hosted by M2M and Father's Touch was postponed and we are in the process of planning another community event in it's place- please keep your ears and eyes out for more information in upcoming Blog Posts
3. SC4S is continuing to build skills, training, and capacity with the help of Michele Ashley (Couer Conscious Consulting) and Chama Woydak (Homegrown Babies). They recently have taken on new positions to increase the workload that we are hoping to grow by creating new positions. If you have certain questions regarding SC4S and the particular role they will be serving, feel free to email them directly. 
1. Cindy McMillan- Director of Education and Training, cindy.mcmillan@mahec.net
2. Nikita Smart - Director of Operations, nikita.smart@mahec.net
3. Wakina Norris- Director of Mentoring, wakina.norris@mahec.net
4. Sade Mustakem- Director of Hospitality, sade.mustakem@mahec.net

Policy and Environmental Change

1. We have some BIG things going on regarding the possibility of sustaining and creating a pathway for doula reimbursement, to learn more contact Maggie at maggie.adams@mahec.net

Want to get more involved with Mothering Asheville?

1. Sign up to help us plan our upcoming conference at MAHEC based on the Community Centered Health Model - our first planning meeting will be on October 8, 2018 at 9 AM in the Penland Board Room at MAHEC Education
2. We need to help restart the Home Visitors Collaborative - with some turnover in the last few months this group has struggled to sustain. We need someone to help lead this initiative and particularly SC4S needs your organizations help in getting referrals! How can we set up a good system?! email Maggie at maggie.adams@mahec.net
3. Does your organization want to create a way to refer to SC4S, have ideas or need to schedule a meeting to make it easier and to be sure your referrals are being taken. Email Nikita at Nikita.Smart@mahec.net
4. Visit our Google Drive for meeting notes, resources, and more! Mothering Asheville Google Drive

Building Relationships and Tackling Racism to Support Mothers and Babies

CHIP's involvement in tackling infant mortality continues in Buncombe County, mostly in the partnership and support it provides to Mothering Asheville (previously known as the Community Centered Health Home), a cross-sector collaborative advocating for institutional policies that address structural racism, implicit bias, access to care, and economic and other social factors. If you want to learn more, please review the Mothering Asheville Implementation Plan, which will also be housed on the Resources & Links tab of this blog.

The next Mothering Asheville Steering Committee Meeting is August 10^th from 1:30 -3:00 PM

join the movement!

CHIP is supporting Mothering Asheville's work mostly "behind the scenes" by making sure they and their partners have access to data that can inform their work and helping work out systems for referring to the Sistas Caring for Sistas doula services and integrating those services more fully into MAHEC OB. CHIP is also working to amplify the central message of Mothering Asheville--racism is killing babies in our community and across the country. Yes, racism. Research is clearer every day that the disparities in birth outcomes and infant mortality between blacks and whites cannot just be attributed to economics or education levels or access to health care. Even when all those things are equal, African-American women and infants fare worse than their white counterparts. And women who report higher levels of racial discrimination have worse birth outcomes. Read this excellent article from the New York Times Magazine about race and infant mortality to take a deep dive into this topic.


Recent Mothering Asheville Highlights Include:

• SistasCaring4Sistas traveled to the DONA International Summit in Fort, Lauderdale Florida to continue professional development as trained doulas, connect with doulas across the country, and learn more about how to develop their work. Nikita Smart and Chama Woydak presented at the conference. 
• SistasCaring4Sistas has contracted Michele Ashly of Couer Consience Consulting to provide ongoing professional development, organizational development, and sustainability building. 
• SistasCaring4Sistas at MAHEC has hired two additional Community Based Doulas! Please welcome Chaka Gordon and Latisha Collington!
• Mother to Mother is planning a community engagement event in partnership with Father’s Touch called Back to School Bash on the afternoon of August 25th (more details to follow)
• You can also check out the recent media articles about their work, including the work of Sistas Caring 4 Sistas doula program, here and here. However, please note these corrections/ clarifications from Maggie Adams, Project Manager of Mothering Asheville, who wants to make sure this innovative work is represented accurately:
• Mothering Asheville is a community led collaboration that has existed for over three years and is led by community members, community partner organizations, and healthcare providers. Partners include: Community Residents, Pisgal Legal Services, Children First/CIS, the YWCA of Asheville, Buncombe County Health and Human Services, ABIPA, NC Center for Health and Wellness, Homegrown Babies, Nurse Family Partnership, CHIP, Mission Hospital to name a few. The grant vision, goals, and objectives were written as a collective over a 6 month period. 
• Mothering Asheville is based off a model designed by the Prevention Institute called the Community Centered Health Home
• For the first year and a half the initiative was focused on building relationships; mainly through a group called Mother to Mother where community residents and community organizations met monthly. 
• Out of an event planned by the members of Mother to Mother, the community residents represented in Mother to Mother , after meeting and learning from Chama at Homegrown Babies about what doulas were; decided on that doulas would be a great way to help women with the support needed during pregnancy in birth.
• After being trained as doulas, the core four, decided to develop SistasCaring4Sistas
• As a way to be able to support SC4S in being compensated to work with women that might not normally have access to doula care, the doulas were onboarded as MAHEC employees.
• Amanda and I are not working to address disparities by ourselves, we are only supporting and providing resources ALONGSIDE our partners from what Mother to Mother and SC4S and the Mothering Asheville Steering Committee have led the charge on.
• We have been on an uphill battle to address many of the institutional policies that prevent women from having healthy pregnancies and it has not been easy and it is hard for healthcare providers to stomach the idea of institutional racism as the reason for health INEQUITIES.
• Mothering Asheville is not just a community based doula program . SC4S is a community based doula organization
• Mothering Asheville is a movement that believes that we have to make a clinical shift to address how care is given, community capacity has to be the core focus of the movement, and we have to address policies that are in place that are built off the white supremacy culture that we live in.

2017 Year-End Summary

Buncombe County’s Infant Mortality work has been mainly led by two cross-sector groups this year: the Community Centered Health Home Grant, based at MAHEC, and the Home Visitors Collaborative, led by the YWCA. 

The Community Centered Health Home Initiative started from a relationship with Children First/CIS’s advocacy initiative, The Success Equation, to address policy issues related to the social determinants of health and received funding from Blue Cross Blue Shield of NC.  It is based on a successful and paradigm-shifting model from the Prevention Institute that prioritizes engaging residents of a particular community in long-term leadership and relationship as they identify strategies and work together toward improving the health of their neighbors, making clinical changes based on resident feedback, and addressing policies that are preventing people from reaching their full health potential. The key to this initiative’s success has been using shared decision making which included many key partners in a Steering Committee: MAHEC, Pisgah Legal Services, ABIPA, resident leaders from Pisgah View and Hillcrest Apartments, Children First/CIS, the YWCA, Homegrown Babies, North Carolina Center for Health and Wellness,  Buncombe County Health and Human Services, Buncombe County Government, CHIP, Nurse Family Partnership, WNCCHS, Community Care of WNC, Vaya Health,  The Buncombe County Initiative originally engaged with women in Pisgah View Apartments, but it is now growing to be more of a county-wide “movement.” CCHH has had some major achievements over the past year:

• Six resident leaders of Pisgah View Apartments and Hillcrest completed training to become birth doulas and are working on their DONA certification through a training with local organization, Homegrown Babies, to work with lower-resourced African-American women who would otherwise not have access to this kind of birthing support, now operating under the name Sistas Caring 4 Sistas

• A group of women meet in Pisgah View Apartments once a month, Mother to Mother,  to share ideas, create relationships and determine the best steps to creating the community capacity the community wants to see

• Five of the resident leaders completed training to be a Breastfeeding Peer Counselor

• Two of the resident leaders completed the Tobacco Cessation Specialist training

• One of the resident leaders completed the Community Leadership Essentials training through the Center for Creative Leadership

• Doulas entered into a contract with the YWCA Motherlove program to provide doula services to teen mothers 

• One of the resident leaders, Nikita Smart, joined the CCHH Board

• Nikita Smart wrote and was awarded a Tipping Point grant from Buncombe County to further the ability of the doulas to serve more clients

• MAHEC joins with Pisgah Legal Services to have on-site legal advice and support for patients dealing with housing uncertainty, eviction, and other economic conditions that directly impact health.

• MAHEC providers and staff begin to be trained in the Racial Equity Institute's two-day anti-racism training, to address implicit bias and structural racism within the healthcare setting 

• MAHEC will be entering into a redesign of the physical structure of the clinic to be more open and inviting

• Four resident leaders were trained to provide Lamaze Childbirth  Education classes

• Four Doulas became MAHEC PRN staff members to provide more reliable way to compensate them for services.

• Doulas have had/currently 19 African-American clients and 13 high-risk women of other demographics for a total of 32 clients.

• MAHEC received a two-year implementation grant from BCBS, continuing the work CCHH started in 2015, that was a grant co-written by all of the partners engaged in the initiative over a 6 month period that prioritizes building community capacity, making clinical shifts, making environmental and policy changes, and creating a strategic communications plan to further this model. 

The Home Visitors Collaborative includes participants from Nurse Family Partnership, CCWNC, Asheville Buncombe Institute for Parity Achievement (ABIPA), Project NAF (Nurturing Asheville and Area Families), Motherlove, and Verner's Early Head Start, Buncombe County Prevention Services. This group just formed at the start of 2017, so the first several meetings were devoted to participants learning about the various programs and establishing both the logistics and the shared vision for future meetings. The group has also researched and shared information on successful models in other communities (the Home Visitors Collaborative in Kalamazoo was the basis for this collaborative). They have broken their work into three areas with initiatives active in each:

• Customer Service: 
• Exploring ways to collect information from mothers who have recently given birth about their prenatal and birth experience, social support, etc.
• Creating an inter-agency brochure/rack card with all the program's eligibility and referral information to educate providers and community about options.
• Awareness and Training:
• Supporting ABIPA in disseminating their recently-created preconception health presentation (targeted at teens)
• Identifying common trainings for all agencies with home visitors (including Racial Equity Institute)
• Sharing more ACEs/Resilience information with clients and community
• Data: 
• Currently creating a "wish list" of data they would like to be able to get from other sources to inform their services and also their reach/impact (possible sources: MAHEC/Mission/Medicaid...)
• Identifying measures the home visiting programs currently collect that could be shared/aggregated to better measure their reach and impact

October 19th Workgroup Meeting Agenda Notes & Update

Thank you for the great energy and work at our October 19th Meeting! We are grateful for the time you took out of your day to join us for this meeting, and we are honored to work with all of you!

Update since the October 19th meeting:

Amanda Read, YWCA MotherLove Program and LaVie Montgomery, Project NAF, will be visiting Kalamazoo, Michigan for Kalamazoo Infant Mortality Community Action Initiative's 3rd Annual Strategic Intent Meeting where they will learn more about how Kalamazoo is combating infant mortality in their city. Dr. Arthur James will be the keynote speaker at the event, and they also plan to attend a luncheon with Dr. James as well.  Amanda and LaVie would like to know if you have any questions or input that you would like addressed on their visit to Kalamazoo. Please send your thoughts to Amanda at amanda.read@ywcaofasheville.org by 11/15.

Next Steps

The strategies/actions that arose from our meeting were:

Action Item	Follow-up
Root Causes of Death data Expand Child Fatality Prev. Task Force to include MAHEC Ob/Gyn physician to go deeper into mother’s health record and social determinants of health as possible contributors to infants’ deaths	Dr. Jennifer Mullendore and Dr. Cindy Brown will work with the Child Fatality Prevention Team to expand representation and gather this data.
Home Visiting Programs   Convene all programs that currently do home visitation (NFP, Project NAF, Motherlove, CCWNC, Verner, etc.) to identify where the gaps are, etc. (There was discussion about this growing into a longer-term home visitation collaborative, if useful). Pilot post-partum (health care) home visitation	CHIP staff will work with Ami Greene and Dr. Beth Buys to explore next steps
Advocacy Advocacy implementation plan around NC Perinatal Health Strategic Plan	Dr. Arthur Ollendorff and Greg Borom will meet to finalize plan. If you are interested in participating in this effort, please contact Maggie Adams, Community Centered Health Home Project Coordinator at maggie.adams@mahec.net

Below are links to the meeting materials as well as the scorecard below:

• Slides from meeting can be found here:
• Kalamazoo County- A Community Combating Racial Disparities in Infant Mortality presented by Ami Greene
• NC Perinatal Health Strategic Plan presented by Arthur Ollendorf, MD

• A link to the scorecard can be found here.
  
  

Diving Into Health Disparities and Health Equity

It has been a few months since we last met.  Since that time, CHIP Partners have had many opportunities to learn about the issues that frame our CHIP priorities -specifically around health disparities & health equity.  For a summary of two of these events, please click here. In addition to these events, we've also completed the first iteration of our Infant Mortality scorecard, as well as conducted research into data and strategies.

It's now time to reconvene and determine which strategies we collectively want to work on. Our next meeting is scheduled on:

October 19th; 3-5pm

Cherokee Room, MAHEC Education Building

121 Hendersonville Road, Asheville

DRAFT AGENDA

New information/data on the curve(s) we are focused on turning

• Root causes of death- update from BC Child Fatality Prevention Team
• Other data we need?

New information or insight on the story behind those curves

• Reflection on our time with Dr. Arthur James
• Update on movement/activity since then

Partners with a role to play (Partner Updates)

• Community Centered Health Home
• Buncombe County Health & Human Services
• Other updates?

New information on what works to do better in our community

• NC Perinatal Health Strategic Plan
• NICHQ recommendations

Between now and our meeting, I also ask that you visit the scorecard and provide feedback on what is missing or needs to be changed. The following link is to the main Buncombe County CHIP Scorecard that includes all of our priority work.  A brief video tutorial is provided to help you learn how to navigate the scorecard.  Scroll down the page to find our Infant Mortality Result where all our work to-date has been captured.  

Exciting Events Informing CHIP Work

August was a busy month filled with many opportunities for CHIP partners and the community to learn about the issues that frame our CHIP priorities –specifically around health disparities & health equity.  For a summary of two of these events, please read below.

An Evening with Dr. Arthur James

On August 18^th, over 60 community shareholders, leaders, and health providers spent an evening with Dr. Arthur James, a pediatrician and obstetrician, who has had positive success in reducing disparities in infant mortality in Ohio and Michigan through community-wide efforts. Dr. James' presentation highlighted for our community that WE CAN make a difference. 

This event was sponsored by the Community Centered Health Home (CCHH) team in order to bring awareness to this issue.  This event launches the CCHH team's advocacy efforts that will work to eliminate disparities in pregnancy and birth outcomes in Buncombe County. If you would like to learn more about the efforts of the CCHH, please contact Maggie Adams at maggie.adams@mahec.net. Please click here for Dr. James’ presentation.

The 2016 Diversity Summit: Transforming Healthcare Equality into Equity

On August 19th, MAHEC and Mission Health hosted The 2016 Diversity Summit: Transforming Healthcare Equality into Equity. Over 130 participants were challenged to make equity a priority in their lives, communities, and organizations. The keynote address by Dr. Arthur James from Ohio State University inspired all in attendance. The afternoon gave us an opportunity to work in small groups on how to achieve equity. New relationships and partnerships were formed and current relationships were deepened. MAHEC's Regional Education is very proud to have been able to bring a diverse group of presenters together to affect lasting change in our community.  Please click here for Dr. James’ presentation.