Black Maternal Health Week 2024: An interview with prof. Alexis Dunn Amore

This week, on April 11, begins Black Maternal Health Week, a campaign to build awareness and activism around the healthcare experiences of Black mothers, who have mortality rates three times higher than that of White women.

Alexis Dunn Amore, PhD, CNM, is a clinical professor at NYU Rory Meyers College of Nursing whose practice, teaching, and research is focused on addressing racism and bias in midwifery and nursing, and improving Black maternal health. She is a fellow of the American College of Nurse-Midwives and the American Academy of Nursing, as well as vice president for the American College of Nurse-Midwives.

Q: You’ve spent years working as a clinician and researcher to identify the root causes of the disparities in maternal healthcare and address them. You’ve also experienced your own health challenges when you were pregnant with your first child. How did your experience as a patient inform your work in practice and research?

A: When I first came into the field, I thought 'I’m going to be a midwife and I’m going to help people' and then I got into the practice and saw these disparities emerge in real time. And that’s what really shifted me back into my research career because I wanted to dig into the why. Whenever I would ask that question, people would say 'Oh, that’s just how it is’ and that wasn’t good enough for me.

But also, I had severe preeclampsia and I was very ill at the end of my pregnancy. I remember how scary it was for me when I had to go through the hospital system to have the baby. The difference is that I am a midwife and I had the protective factor of having doctors and midwives around me who knew me personally and gave me one-on-one attention. That made a difference in my outcome, but it made me realize, in a new way, that there are people who are entering this healthcare system who don’t have the protection that I did. They don’t have that circle, that community, and a safe space to birth.

I started focusing my research on how to empower birthing people with the tools to help them know what they should be asking for in healthcare settings. So, I created an app called Mama Love.

Q: What is Mama Love exactly?

A: You can go on the app and it gives birthing people the tools to help them identify dangerous symptoms. You go in and take a survey about your physical health, mental health, and the social conditions in which you live. There’s an algorithm that says things like - 'This is a life-threatening symptom, you should call 911' or it says 'This is something you should follow up on with your provider. Here are some resources that can help you.' Based on my own experience while pregnant and hearing what my clients reported to me made me want to develop something that is for the general public - more community-facing initiatives, more public scholarship that helps people protect themselves. So, that’s a way that my personal experience influences my work.

Q: What areas of research have we yet to thoroughly cover when it comes to Black maternal health and racial equity?

A:  I think we need to explore systems a little more thoroughly. Right now, a lot of it is focused on what the individual-level risk factors are that increase maternal morbidity and mortality. I think there needs to be a more robust evaluation at the system and policy level. For instance, we know several states have limited access to abortion since the Supreme Court overturned Roe v. Wade. So what is the impact of that change on maternal health outcomes? How can we support someone who is dealing with the decision to be pregnant?

Mental health is also an area that we will always need to keep unpacking. I’d like to see more positive studies that focus on people who are having good outcomes and what is contributing to that. Right now, the conversation is about all the bad things that can happen to a Black woman during pregnancy. But there are a lot of good things, too. So let’s talk about what are the factors that confer protection that lead to happy deliveries. What things are going on in those pregnancies that optimize health? If we can show what they are, then they can be replicated.

At the clinic I work in  – Choices Center for Reproductive Health (in Tennessee) -  we provide care in this beautiful space and a lot of us are multi-race nurse practitioners and healthcare providers. It’s a very joyful, happy space. It’s different from what you hear in mainstream conversations. There’s a difference between awareness and fear. Women come in so afraid that we have to be careful how much we perpetuate that fear in the public. There is joy for Black and Brown birthing people.

Q: What kind of training or education is necessary to help patients advocate for themselves and healthcare providers to listen better? 

A: That’s the hard part because when things happen in a hospital you're worried and you have heightened emotions. It's really important that people do their homework before they choose their provider because the key is to find a provider you already feel safe and comfortable with. You can have a midwife advocate for you. Midwifery takes into account the whole family. If someone does something to make you feel uncomfortable, you need to call it out and if it continues, you should remove yourself from the situation. You, as a person, have expertise in your own body, and so healthcare providers have to see that and listen to that. As a midwife, I need to listen to that. The challenge is how do you make providers listen? It’s not easy, but something I always say is: If a provider disrespects you to your face, how can you trust them with your body?

Q: What legislation - local, state, or federal - would make the most difference in closing racial and ethnic disparities in maternal health care?

A:  There are a lot of restrictions on midwifery. If you look at states where midwives are allowed to practice independently - largely in the West - you see maternal health outcomes are better and mortality is lower. I would say - don’t impede the practice of nurse practitioners and midwives. Allow them to practice to the full scope of their training.

I also think there’s work to be done on reimbursement rates. As a nurse midwife, sometimes it’s hard to be reimbursed at the same rate as an OB-GYN or another provider. So, we have to fight these battles to be paid for services. Another thing would be tort reform, having more support about the risk of being sued for malpractice. Malpractice insurance rates for obstetrics are much higher than many other specialties.

When you see cities or counties that don’t have enough - or in some cases even one - providers for OB-GYN services - these are some of the factors that contribute to that lack of access.

Q: What roles can communities play in improving Black maternal health? How can communities support Black mothers before, during, and after pregnancy?

A: I think we have to consider how we can maximize and optimize the interactions in the settings where people are naturally coming together - churches, sororities, and similar networks. How do we infuse more healthcare and education and information into those settings? 

That’s one of the most profound things I want to do with the Mama Love tool - take it and create these educational pieces that we can use to work with a women’s group inside a church, for example. You teach them about the signs of preeclampsia. You teach them about the signs of postpartum depression. There are basic things you can teach people about warning signs so they can be protective in their communities. They can say to each other 'Hey, I’m seeing that you are showing some signs of being depressed' or 'Hey, I noticed you’re having a lot of headaches, what was your latest blood pressure reading?'

Q: The theme of this year’s Black Maternal Health Week is: Our Bodies Still Belong to Us: Reproductive Justice Now. A lot of the conversation about Black maternal health is focused on the maternal mortality rate but this theme is highlighting the continuum of reproductive health care. Why is it important to talk about reproductive care more broadly?

A: Because you’re not just a birthing person. As women, we are often seen as our parts or what we can produce. But we have desires and wishes for our bodies that don’t have to do with having babies. You can’t just start with that and focus only on pregnancy. You have to focus on the whole thing, the reproductive journey. 

You should have the right to decide if you want to have a baby, if you don’t, and be able to decide how you raise a family. So really thinking about justice, you can't just start with pregnancy. You have to think about the full spectrum, right? It’s about your health and your well-being as a person. And when you’re a Black woman having a baby, that speaks to our history in this country, and about how everything about the Black woman was about what her body can do, whether that was her ability to work in the fields or have babies.

So when you focus just on pregnancy, rather than the reproductive journey, you perpetuate a lot of those harms that have historically been done to Black women. You have to shift the healthcare conversation to be more expansive because we are more than just a uterus and a mom or a worker. The theme of Black Maternal Health Week addresses the full journey and the whole person.