>> Stewart: THE UNITED STATES

IS IN THE MIDST OF A MATERNAL

HEALTH CRISIS.

IN FACT, WOMEN IN THE UNITED

STATES ARE MORE LIKELY TO DIE

FROM PREGNANCY-RELATED

COMPLICATIONS THAN IN ANY OTHER

DEVELOPED COUNTRY.

FOR BLACK WOMEN, THE REALITY

IS EVEN MORE STARTLING.

THEIR DEATH RATE IS THREE TIMES

HIGHER THAN THAT OF WHITE

WOMEN.

AND BLACK BABIES ARE TWICE AS

LIKELY TO DIE BEFORE THEIR FIRST

BIRTHDAY.

IN TONIGHT'S SIGNATURE SEGMENT,

WE BRING YOU A REPORT FROM

TENNESSEE ABOUT ONE CLINIC THAT

IS TRYING TO REVERSE THAT TREND,

ONE WOMAN AT A TIME.

NEWSHOUR WEEKEND'S IVETTE

FELICIANO REPORTS IN OUR ONGOING

SERIES ABOUT POVERTY AND

OPPORTUNITY IN AMERICA, "CHASING

THE DREAM."

>> I MEAN, I'M EXCITED, BUT

NERVOUS, YEAH.

>> Reporter: EXPECTANT MOTHER

BRITTANY BRIGGS IS NERVOUS.

>> I'M JUST WORRIED ABOUT THE

PAIN.

YOU KNOW, I'M JUST NOT 100% SURE

ABOUT MY PAIN TOLERANCE.

>> Reporter: A YEAR AGO SHE

WOULDN'T HAVE HAD THE

OPPORTUNITY TO EXPRESS HER

CONCERNS IN A SETTING LIKE THIS,

IT'S GROUP PRENATAL CARE LED

EVERY MONTH BY MIDWIVES NIKIA

GRAYSON AND JODILYN OWEN.

THE WOMEN ARE MEETING AT

CHOICES, A PRIVATELY-FUNDED

REPRODUCTIVE HEALTH CLINIC IN

AN UNDERSERVED AREA OF MEMPHIS.

LAST YEAR, CHOICES BEGAN

OFFERING MIDWIFERY CARE.

MIDWIVES HERE HAVE ALREADY

DELIVERED 11 BABIES WITH 19 MORE

ON THE WAY.

>> WE WANT YOU TO LEAVE OUR CARE

STRONGER.

WE WANT YOU TO LEAVE OUR CARE

KNOWING HOW YOU SHOULD BE

TREATED, THAT YOU ARE VALUED.

>> Reporter: NIKIA GRAYSON IS

CERTIFIED AS BOTH A MIDWIFE AND

A NURSE PRACTITIONER.

SHE ALSO HAS MASTERS IN PUBLIC

HEALTH AND ANTHROPOLOGY.

GRAYSON FIRST STUDIED INFANT

MORTALITY IN THE BLACK COMMUNITY

AS A GRADUATE STUDENT.

>> IN THESE FAMILIES, THE LOSS

OF A BABY WAS ALMOST NORMALIZED.

OF COURSE THEY GRIEVED AND IT

WAS VERY HEARTBREAKING FOR THEM,

BUT IT WAS GENERATIONAL, WHAT I

FOUND WAS LACKING WAS ACCESS TO

CARE.

AND THEN THE TYPE OF CARE THEY

RECEIVED, AND HOW THEY DIDN'T

FEEL VALUED OR HEARD.

>> Reporter: BEFORE THE 1900'S,

MANY BIRTH ATTENDANTS ACROSS THE

SOUTH WERE BLACK MIDWIVES.

NOW LESS THAN 4% OF U.S.

MIDWIVES ARE BLACK.

>> IT WAS TAKEN AWAY FROM US, IN

OUR COMMUNITY, THESE ARE OUR

TRADITIONS, AND WE'RE TAKING

THEM BACK.

>> Reporter: GRAYSON IS ONE OF

ONLY EIGHT NURSE-MIDWIVES IN

MEMPHIS AND ONE OF JUST TWO

BLACK MIDWIVES IN THIS

PREDOMINANTLY AFRICAN AMERICAN

CITY.

IN MEMPHIS, WITHIN THE FIRST

YEAR, AFRICAN AMERICAN BABIES

DIE AT A RATE THREE TIMES HIGHER

THAN THAT OF WHITE BABIES.

>> I THINK THAT WHAT WE ARE NOW

SEEING IS A DEMAND FOR QUALITY

CARE, QUALITY CARE THAT IS

SENSITIVE TO PEOPLE'S CULTURAL

NEEDS, AND THE IDEA THAT THE

SYSTEM NEEDS TO CHANGE IN ORDER

TO PREVENT THESE MATERNAL AND

INFANT MORTALITY OUTCOMES THAT

WE'RE SEEING.

>> Reporter: AFRICAN AMERICAN

WOMEN ARE MORE LIKELY TO

EXPERIENCE POVERTY AND LACK

INSURANCE, WHICH PUTS THEM AT

GREATER RISK FOR POOR MATERNAL

AND INFANT HEALTH OUTCOMES.

BUT RACIAL DISPARITIES PERSIST

EVEN FOR BLACK WOMEN WHO ARE

COLLEGE EDUCATED, ACCORDING TO A

STUDY IN THE "NEW ENGLAND

JOURNAL OF MEDICINE" AND AN

ANALYSIS BY THE NEW YORK CITY

DEPARTMENT OF HEALTH.

>> THERE'S SOMETHING WRONG WITH

THE SYSTEM WHEN AFRICAN AMERICAN

WOMEN WHO ARE COLLEGE-EDUCATED

AND HAVE GREAT JOBS CAN STILL

HAVE POORER OUTCOMES THAN WHITE

WOMEN WHO ARE UNEDUCATED.

>> Reporter: LAST YEAR, THE

AMERICAN COLLEGE OF

OBSTETRICIANS AND GYNECOLOGISTS

ACKNOWLEDGED THAT: "THE RACIAL

AND ETHNIC DISPARITIES IN

WOMEN'S HEALTH, INCLUDING HIGHER

RATES OF PRE-TERM BIRTH AND

MATERNAL MORTALITY CANNOT BE

REVERSED WITHOUT ADDRESSING

RACIAL BIAS, BOTH IMPLICIT AND

EXPLICIT."

>> THE RACIAL BIAS WHEN IT COMES

TO BLACK WOMEN HAVING BABIES IS

HIDDEN.

>> Reporter: DR. KIA PINCKNEY IS

AN OBSTETRICIAN AT REGIONAL ONE

HOSPITAL IN MEMPHIS.

SHE SAYS CATEGORIZING AND

DIAGNOSING PATIENTS ACCORDING TO

THEIR RACE IS PART OF AMERICAN

MEDICAL PRACTICE.

>> THAT BIAS MEANS IT'S KIND OF

LIKE WE HAVE SHADES WHEN WE'RE

LOOKING AT THIS PATIENT.

SO SHE'S AFRICAN AMERICAN, MOST

LIKELY IT'S PREECLAMPSIA, SO

THAT PREVENTS US FROM THINKING

OF OTHER DIFFERENTIALS OF WHAT

IT COULD BE.

COULD IT BE A MIGRAINE, OR COULD

IT BE JUST A HEADACHE BECAUSE

SHE DIDN'T SLEEP LAST NIGHT

BECAUSE SHE WAS UP WITH ALL HER

CHILDREN.

>> THE TRUTH IS THAT BLACK WOMEN

ARE LESS BELIEVED WHEN THEY HAVE

SYMPTOMS THAT ARE CONCERNING,

FROM PAIN TO SHORTNESS OF BREATH

TO OTHER THINGS THAT ARE REALLY

CONCERNING.

>> Reporter: DR. NEEL SHAH IS AN

OBSTETRICIAN AND PROFESSOR OF

OBSTETRICS AT HARVARD

UNIVERSITY.

THERE IS RESEARCH BACKING HIM

UP: SEVERAL STUDIES, INCLUDING

FROM THE UNIVERSITY OF

PENNSYLVANIA AND IN THE "NEW

ENGLAND JOURNAL OF MEDICINE,"

FOUND THAT BLACK PATIENTS WITH

THE SAME SYMPTOMS AS WHITE ONES

RECEIVE LESS PAIN MEDICATION AND

ARE REFERRED TO SPECIALISTS LESS

OFTEN.

>> MY BIASES CAN CHANGE THE

DECISIONS THAT I MAKE BUT IT

ALSO AFFECTS THE PERSON ACROSS

FROM ME BECAUSE SHE CAN SEE

PLAINLY WHAT I'M NOT.

AND SO AS A RESULT OF THAT SHE

FEELS LIKE I'M NOT RESPONDING TO

HER NEEDS, AND SHE'S NOT

ULTIMATELY GETTING WHAT SHE

NEEDS OUT OF THE CARE THAT I'M

TRYING TO PROVIDE, AND IT LEADS

TO THIS SORT OF VICIOUS CYCLE OF

DISTRUST.

>> Reporter: IN A NATIONAL

SURVEY OF OVER 2,000 WOMEN, 21%

OF BLACK MOTHERS REPORTED POOR

TREATMENT FROM HOSPITAL STAFF

WHICH THEY ATTRIBUTED TO RACE,

ETHNICITY, CULTURAL BACKGROUND

OR LANGUAGE.

JUST 8% OF WHITE MOTHERS

REPORTED SIMILAR POOR TREATMENT.

GRAYSON HAS HEARD ABOUT POOR

TREATMENT OVER AND OVER AGAIN

FROM HER BLACK PATIENTS AND HOW

IT HAS CREATED DISTRUST AND

OTHER BARRIERS TO CARE.

>> ONE PATIENT TALKED ABOUT HOW

HER PAIN WAS NOT MANAGED WELL

WHEN SHE WAS IN LABOR, AND THAT

SHE DIDN'T FEEL THAT THEY

BELIEVED HER WHEN SHE SAID SHE

WAS IN PAIN, OTHERS HAD CHILD

PROTECTIVE SERVICES CALLED ON

THEM IF THEY EXPRESS FEELINGS OF

DEPRESSION.

AND THAT KEEPS PEOPLE FROM

COMING BACK TO CARE.

>> Reporter: THAT BIAS, COUPLED

WITH SHORT PATIENT VISITS, MEANS

OBSTETRICIANS CAN HAVE A HARD

TIME DIGGING INTO ROOT CAUSES OF

A PATIENT'S PROBLEMS, SAYS DR.

PINCKNEY.

>> I DON'T NECESSARILY HAVE THE

TIME TO SIT THERE AND DO THE

EDUCATIONAL COMPONENT OR THE

PREVENTIVE THINGS.

I DON'T HAVE THE TIME TO SIT

THERE AND SAY, "SO HOW ARE YOU

DOING TODAY? TELL ME ABOUT YOUR

KIDS," AND REALLY BUILDING THAT

RELATIONSHIP.

>> I THINK WE HAVE TO HAVE A

MORE THOUGHTFUL WAY OF THINKING

ABOUT THE WAY THAT OUR BIASES

ARE STRUCTURED INTO THE SYSTEM,

FROM THE WAY THAT WE DO INFORMED

CONSENT TO THE WAY THAT WE

INTERACT WITH PATIENTS EVERY

STEP ALONG THE WAY, FROM INTAKE,

FROM TRIAGE TO NURSING, TO THE

CARE TEAM.

>> OH, HE DIDN'T LIKE THAT.

>> NO, HE FIGHTS BACK.

>> Reporter: AND THAT IS WHERE

MIDWIVES GRAYSON AND OWEN COME

IN, WORKING TO COUNTERACT THAT

BIAS AND RE-ESTABLISH TRUST

THROUGH MIDWIFERY CARE.

AS CERTIFIED NURSE-MIDWIVES,

THEY ARE TRAINED IN THE FULL

SPECTRUM OF LOW RISK

GYNECOLOGICAL AND OBSTETRIC

CARE, SHORT OF SURGERY.

IN ADDITION TO PHYSICAL CHECKUPS

AND TESTS, THEY ALSO ADDRESS

THEIR PATIENTS' MENTAL, SOCIAL,

AND EMOTIONAL NEEDS.

>> ALL OF OUR VISITS ARE AN HOUR

LONG.

I WANT TO GET TO KNOW WHO THEY

ARE AS A PERSON AND WHAT'S

IMPORTANT TO THEM AND WHAT THEIR

DAILY LIFE IS LIKE.

SO WE TALK, AND WE TALK ABOUT

FAMILY AND STRESS AND WHAT MAKES

THEM HAPPY.

>> AND THE EMOTIONAL SUPPORT AND

THE PHYSICAL SUPPORT...

>> Reporter: MIDWIFE JODILYN

OWEN SAYS THE GOAL IS TO BUILD

RELATIONSHIPS WITH WOMEN

ALLOWING THEM TO SEE AND DEAL

WITH WARNING SIGNS BEFORE THEY

BECOME URGENT MEDICAL ISSUES.

>> IT IS THROUGH LISTENING THAT

WE START TO UNDERSTAND THE

CHALLENGES SHE'S FACING THAT CAN

CONVERT A NON-PREGNANCY ISSUE

INTO A PREGNANCY EMERGENCY.

SO IF WE ALLOW HYPERTENSION TO

DEVELOP, IT WILL DEVELOP INTO

PREECLAMPSIA.

SO IN OUR MODEL, WE'RE SAYING, I

SEE YOU ARE DEVELOPING THIS, I'M

GOING TO INTERVENE USING THE

LOWEST RESISTANCE MODEL FIRST.

>> Reporter: 75% OF THEIR

PATIENTS ARE ON MEDICAID.

FOR SOME, SIMPLY GETTING TO A

DOCTOR'S APPOINTMENT CAN BE A

CHALLENGE.

>> IF YOU IMAGINE A WOMAN WHO IS

WORKING SHIFT WORK AND HAS NO

CONTROL OVER HER SCHEDULE; SHE

DOESN'T HAVE A CAR SO SHE'S

BOUND BY A BUS SCHEDULE.

SHE'LL WALK IN 15 MINUTES LATE

AND THEY'LL TELL HER SHE CAN'T

BE SEEN THAT DAY.

SHE'S BEEN SITTING ON A BUS FOR

AN HOUR AND A HALF AND IS PRETTY

SURE SHE'LL NEVER DO THAT AGAIN.

>> WHEN YOU ALL TOLD ME YOU HAD

SOMEBODY LAST WEEK...

>> Reporter: AND SO, GRAYSON AND

OWEN GO OUT OF THEIR WAY TO MAKE

SURE THEY ARE AVAILABLE TO THEIR

PATIENTS.

>> WE MEET THEM WHERE THEY ARE,

BOTH LITERALLY AND FIGURATIVELY

WE VISIT MANY OF OUR PATIENTS AT

HOME.

A LOT OF TIMES THAT THEY HAVE AN

APPOINTMENT TO COME TO OUR

OFFICE AND THEY DON'T MAKE IT,

WE'LL CALL THEM AND LIKE OKAY,

ARE YOU OKAY, DO YOU NEED US TO

COME SEE YOU?

>> Reporter: AND THE COMMITMENT

DOESN'T END WHEN THE BABY IS

BORN.

>> THE POSTPARTUM CARE THAT WE

PROVIDE FOR THEM IS REALLY,

REALLY KEY IN THE MIDDLE OF THE

NIGHT THEY KNOW THEY CAN TEXT US

OR CALL US.

>> Reporter: ALEXIUS HILL STILL

REMEMBERS THE MULTIPLE VISITS IN

THE WEEKS AFTER GRAYSON AND OWEN

DELIVERED HER DAUGHTER CHLOE

NINE MONTHS AGO.

>> JODILYN AND NIKIA WOULD COME

AND CHECK ON HOW CHLOE WOULD

LATCH ON, CHECK ON IF I HAD ANY

BLEEDING, ASK ME ABOUT ANY

CONCERNS I MIGHT HAVE.

THEY MADE SURE I ATE RIGHT STILL

EVEN AFTER DELIVERING CHLOE,

MADE SURE I CONSUMED ENOUGH

WATER.

SO EVEN UNTIL THIS POINT NOW IT

STILL FEELS LIKE THEY'RE THERE.

>> Reporter: IN 2014, THE

MEDICAL JOURNAL "THE LANCET"

CONCLUDED THAT INCLUDING

MIDWIFERY CARE IN HEALTH SYSTEMS

REDUCES MATERNAL AND NEWBORN

MORTALITY.

AND A STUDY IN "THE AMERICAN

JOURNAL OF OBSTETRICS AND

GYNECOLOGY" FOUND THAT

PARTICIPATING IN GROUP PRENATAL

CARE CAN REDUCE THE RISK OF PRE-

TERM BIRTH, ESPECIALLY FOR BLACK

WOMEN.

>> WHEN WE LOOK AT WHAT'S

OBVIOUSLY DIFFERENT BETWEEN THE

WAY WE ORGANIZE OUR MATERNAL

HEALTH SYSTEM AND THE REST OF

THE DEVELOPED WORLD, MIDWIVES

ARE ON THE PERIPHERY IN OUR

COUNTRY, AND THEY'RE RIGHT AT

THE CENTER OF CARE EVERYWHERE

ELSE.

REALLY IT SHOULDN'T BE ABOUT

MIDWIVES VERSUS O.B.'S.

THAT'S REALLY NOT WHAT IT'S

ABOUT.

IT'S ABOUT TRYING TO PROVIDE

WOMEN OPTIONS FOR CARE, AND ALSO

IDEALLY ACCESS TO BOTH.

>> Reporter: GRAYSON AND OWEN

AGREE, AND HAVE FORMED

PARTNERSHIPS WITH MEMPHIS

OBSTETRICIANS, INCLUDING DR.

PINCKNEY.

>> WE NEED THE MIDWIVES AND THEY

NEED US IF THEY NEED A SURGEON,

IF THERE'S AN EMERGENCY THEN WE

CAN BE THERE FOR THEM.

>> THE NORM OUGHT TO BE

PROVIDING PEOPLE WITH CARE

THAT'S SAFE AND SUPPORTIVE AND

EMPOWERING.

WE SHOULD BE ABLE TO DO ALL

THREE.

>> Reporter: GRAYSON AND OWEN

ARE PLANNING AN APPRENTICESHIP

PROGRAM AT CHOICES TO TRAIN MORE

MIDWIVES OF COLOR.

>> IT'S A PRIVILEGE FOR ME TO BE

ABLE TO PROVIDE CARE TO BLACK

WOMEN.

WHEN THEY FIND ME THEY ARE

RELIEVED, AND THEY TALK ABOUT

THAT.

I THINK THEY SEE IN ME THEY SEE

THEMSELVES.