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Focus on the Fourth: A Commitment to Maternal Health & Equity

By Lourdes Rodriguez, DrPH, Senior Program Officer

Published July 20, 2020

Understanding The Fourth Trimester

I vividly remember the births of my first and second children; the third one, however, I remember painfully. Each birthing story is unique and deeply personal, each bringing its moments of joyful highs and challenging lows. I was already in my thirties when I became pregnant the first time. I quickly found that no number of years in formal training on maternal, child or public health would prepare me for the necessary – and at times dull – journey of prenatal care. I found myself being disappointed. I longed for more than simply being monitored from a clinical standpoint by my doctor and her staff. While the care I received was the standard model, I was expecting more. What truly prepared me for birthing and motherhood – and complemented my clinical care – were the powerful experiences of mothers, doulas, midwives, the first-hand accounts of relatives and friends, and the unwavering support of my partner. Through this, I became a better everything after I became a mother: a better public health practitioner, a better neighbor, a better friend to other pregnant women.

Before experiencing this personally, I simply did not have the words to describe what I can now recognize as the fourth trimester – a crucial period in the months following the birth of my children where the need for support, community and access to healthcare is at its most critical. After nine months of such diligent and high-touch care as an expectant mom, I quickly found myself navigating a whole new world for my child and me with much less formal support. My motherhood journey had just begun and here I was with little context of what to expect physically, emotionally and mentally now that my child had arrived.

Recognizing Others’ Disproportionate Experiences
After my first pregnancy, I recall returning to work and connecting with a colleague who had been pregnant at the same time. I asked about her birth, eager to share my positive experience, only to see her face drop when she shared that her baby boy had died shortly after birth. Since that day 15 years ago, similar questions were met with the same painful and heartbreaking news – more than I’d like to count. Each story was shared with me by a woman of color, like me, who had experienced a miscarriage or who was only able to hold their newborn for a few brief days or months. I stopped asking new moms about their births and newborns and now wait until people show their baby pictures.

Despite all the advancements we’ve made in medical care in the United States over the last half century, a shocking fact remains: the U.S. has the highest maternal mortality rate of any other developed country. Each year, thousands of women suffer injuries or complications from childbirth, with women of color twice to three times as likely to suffer pregnancy-related issues than their white counterparts according to 2019 CDC data.

Decreasing maternal mortality and morbidity are within our reach

I keep the women who shared their stories with me and the countless others in my heart as I join St. David’s Foundation overseeing the work in our Women’s Health Program. I am eager and grateful to continue the work started by my predecessor to raise awareness about the critical importance of the fourth trimester. Unlike diseases for which we have no cure, the answers to decreasing maternal mortality and morbidity are within our reach. We have an opportunity to build awareness and think about how we organize clinical care and work to reduce barriers and stressors for women experiencing the greatest health inequities.

My work at the Foundation began as the COVID-19 pandemic turned our world upside down and inside out. As a community scholar, public health practitioner and Latina, I already had a front row seat to the health inequities that exist and are fueled by systems and structures that value and serve people differently based on racial and ethnic background, education, social and financial standing. The current coronavirus pandemic has served as a magnifying glass for inequities as evidenced by the disproportionate number of people of color who are impacted by the crisis. In April, the CDC analyzed COVID-19 patient information of individuals for whom race and ethnicity information was available. Data shows 33% of patients were black compared to 18% in the community. And race and ethnic information for New York deaths indicate the death rates of Black and Latino individuals were significantly higher than those of white counterparts, at 92.3 deaths per 100,000 population and 74.3 respectively.

While schools, businesses and places of worship have closed to stem the virus, pregnancies do not wait for a more convenient time. Now more than ever, we must ensure that we not only meet the needs of women to improve maternal health outcomes, but also maintain the early traction and progress we have made on the importance of good mental health during pregnancy and postpartum.

Deepening Our Commitment to Empowering Women
As part of this work, St. David’s Foundation has launched the Focus on the Fourth initiative to support maternal health during the “fourth trimester,” the year after childbirth, for women experiencing the greatest health disparities, especially women of color. To date, the initiative has funded grants to 10 organizations totaling more than $2 million. We believe that healthy women are the cornerstone of healthy families, communities and economies, and the Foundation is committed to enabling access to services that help women care for their health and well-being, as well as their families. We work alongside our grant recipients and community partners to empower women to attain good health, advance health equity, breakdown the social determinants of health preventing care, and build capacity within community-based organizations to help more women and babies stay healthy through their first year.

Amidst this time of uncertainty and social distancing, this work is even more vital as mothers are cut off from the support they can typically rely on from friends and relatives. You can learn more about St. David’s Foundation Focus on the Fourth initiative here and read the stories of the organizations working to provide care and support to Central Texas women. We will also be hosting the Advancing Women’s Health in Central Texas: From Data, to Analysis – to Action webinar on August 5, 2020 where we will explore and discuss three recent studies on maternal health disparities in Central Texas. Learn more and register here.