New partnership aims at improving birth outcomes for African American mothers and babies

Rebecca Polston first became interested in becoming a midwife when, while making a documentary film about pregnancy and Clinton-era welfare reform, she realized that she wanted to play a different role.

“I put down my camera,” Polston said. “I wanted to support the mom.”

From that early realization that she was deeply interested in “pregnancy and reproductive rights and the transformative nature of childbirth,” Polston, a former community organizer, eventually made midwifery her second career.

She started out assisting clients giving birth in their homes, but soon discovered that she wanted to help a wider range of families.

“As a homebirth midwife,” she said, “I wasn’t serving the people I wanted to serve. It is expensive. It is exclusive. It is not something that’s very accessible to regular folks.”

In 2015, Polston opened Roots Community Birth Center, an independent, free-standing clinic in a cozy brick building on 44^th Avenue N. in Minneapolis’ Webber-Camden neighborhood.

At Roots, Polston wanted to create a space where women could get focused pre-and post-natal care, where they could give birth in a quiet, welcoming space assisted by midwives, doulas and physicians who understood their unique needs. Most of all, she wanted to upend what she saw as a racially biased health care system that had created stunning disparities in birth outcomes for African American women and their babies.

“I knew that I wanted to do non-institutionalized births,” Polston said. “The framework I started Roots from is that increased contact with racist systems isn’t going to improve the outcomes for Black women.”

The Roots approach to prenatal care and birth appears to be working. In a state where Black women are 2.3 times more likely to die in childbirth than white women, where the infant mortality rate is 9.3 per 1,000 for African Americans vs. 4.1 for non-Hispanic whites, Roots’ outcomes are impressive: A less than 1 percent pre-term birth rate, a Caesarian rate of 4 percent, and a breastfeeding rate of 99.9 percent at six months.

“We are looking to change the outcomes for African American birthing people,” Polston said. “We are succeeding at that.”

Transfer trauma

Independent birth centers can only serve clients whose pregnancies are considered low risk, but there are times when a client in labor or their unborn child shows signs of distress. In those cases, birth center staff will call an ambulance and transfer the client to a hospital.

The experience of a hospital transfer can be traumatic for some clients, Polston said, especially those who have intentionally avoided institutionalized care for their birth or have histories of negative experiences in medical settings.

“A lot of people come to us when they don’t trust the system,” Polston explained. “We want to build that bridge of trust so that people get that level of care that they deserve and desire.”

Some Roots clients have had negative experiences during hospital transfers, Polston said.

“One time, I transferred a mom to a hospital for prolonged rupture,” she said. “She was an African American woman with a planned home birth. She was married. This was her fourth baby. When we walked into the hospital the nursing staff — these were colleagues I’ve worked with in the past — said, ‘The alleged father of this baby needs to stand against the wall,’ and pushed him to the side.”

A week later, Polston was back in the same hospital with another client, a white woman. This time, her client’s treatment was overwhelmingly positive, she said: “It was such a night-and-day difference. It was so clearly about race.”

Over years in practice, Polston and other Roots staff came to see that the best transfer experiences usually happened at North Memorial Health Hospital, a bustling hospital in the inner-ring suburb of Robbinsdale, a little more than two miles away from the birth center. The physicians and nursing staff at North Memorial treated Roots clients sensitively and fairly — no matter their race, Polston said: Clients who ended up with a hospital birth at North consistently told her they felt like their needs and concerns were addressed.

“I’ve seen the leadership at North to be really committed to engaging racial disparities,” Polston said. “They are committed to trying to change the outcomes for our mothers. It is an amazing team that is responsive to our Black clients.”

Expanding their relationship

Inspired by this commitment, Polston and the OBGYN staff at North Memorial recently formed a partnership. Though the birth center and the hospital have worked together with transfer patients many times over the years, in 2021 they officially agreed to expand their relationship.

Beginning this fall, new hires at Roots — two family practice physicians and a certified nurse midwife — will be qualified for official hospital privileges at North Memorial, meaning they can accompany transfer clients to the hospital — and continue to assist in their labors there.

Todd Stanhope, medical director for OBGYN hospitalists at North Memorial, explained that the new hires helped make his hospital’s collaboration with Roots work even more smoothly.

“There are varying certifications that a practicing midwife can have, based on her training and credentials.’ Stanhope said. “There are some certifications, including certified midwives and certified nurse midwives, that traditionally qualify for hospital privileges.”

Until a year and a half ago, Stanhope said, Roots had been staffed by certified professional midwives, who traditionally have not been granted hospital privileges: “These midwives do a great job caring for the women in their care, but their leadership in that care ends when they arrive in a hospital.” The addition of three new employees with the required qualifications will make transfer births less disrupting for Roots clients, he added.

Polston said that expanding her center’s partnership with North Memorial felt like a no-brainer. The official partnership is a continuation of a years-long collaboration between the two organizations, and an acknowledgement of the high-quality care the hospital has provided to families. She even has personal experience with the North, having given birth to her second son there, after being transferred from a home birth.

“We wanted to provide this continuity to our clients,” she said. “It is hard to do all this work on a pregnancy and labor and then have to lose all access and care if the client has to be transferred to the hospital.” The expanded privileges gained by the center’s new hires, she continued, “allows us to deepen our relationships with our clients and stay involved as we go over into this other setting.”

New equipment

Another part of the Roots/North Memorial partnership is the hospital’s purchase of new equipment that can make ambulance transfers of mothers and their newborns feel less disruptive.

“To make our neonatal transport smoother we have purchased equipment that will safely secure the baby to the mom while the mom rides in a stretcher in the ambulance,” Stanhope said, describing transfer situations where a newborn in distress is moved to the hospital accompanied by the mother. “That way we can get the benefit of the mother/baby contact in the first few minutes of life as we transfer the baby to the hospital.”

Polston said that this partnership feels exciting and hopeful, a sign that the work that she and her colleagues at Roots have done over the years to make the birthing experience better for women in the community is being recognized as groundbreaking, effective and worthy of support.

“This is North saying, ‘We’re going to provide access to our amazing resources because we see that this kind of care can make a difference in the community,” Polston said. “My goal is to assist in as many healthy, full-term pregnancies as possible — regardless of where the baby is born — and this is going to help me do that.”