The story of the birthing unit at Memorial Hospital of RI is one of evolving maternity care in the American hospital system and the health disparities within it. The community’s fight to keep the labor and delivery unit open revealed many beautiful personal stories of how one obstetrical unit can hold the heart of a community.
At a recent protest rally, hundreds of mothers gathered with babes in arms, and every one of them had a story to tell. From the mother whose daughter was born with a complex medical condition that was elegantly handled by Memorial staff, to the mother who was greeted at Memorial with electric candles and a massage, to the mother whose nurse patiently positioned an IV between contractions, every woman’s story shared an important element: They were treated like they mattered. The professionals at the birthing unit have ushered in hundreds of lives annually, yet they treat each birth – of baby, mother and family – like the precious, monumental and life-changing event it is.
The Memorial birthing center is unique in Rhode Island. With an emphasis on joint decision-making with patients, practitioners have nurtured a culture of co-operation and respect. It’s committed to preserving physiology in birth as a standard practice and it developed the method called gentle Cesarean birth (4). It also pioneered family-centered care by giving patients access to doulas, midwives, family doctors and OBs working in collaboration. These points of connection provide high-risk patients with additional support that can improve the health outcome in a woman’s pregnancy. The unit also offers full primary care with family doctors, nurse practitioners and midwives, who teach rotating fellows from Brown’s Alpert Medical School this model of care.
Our nation is challenged in providing care that creates equal health opportunity for all American families; however, women of color and their children are at highest risk for delayed prenatal care, premature birth and lifelong health issues. We live in a developed country that ranks poorly in comparison to many other nations on maternal and infant health outcomes. Amnesty International identified disparities in maternal healthcare as a human rights issue, and the World Health Organization has made recommendations for maternity care that the US chronically fails to meet.
Central Falls, which Memorial serves, is 72% non-white and is one of four RI urban core communities. These urban core communities have the highest rates of childhood poverty and racial and ethnic health disparities. Memorial Hospital also serves Pawtucket, and 19.4% of that city’s population lives below the poverty line. Pawtucket families have long been assessed as being at higher risk for health issues than families in many other categories (3), and they often are in need of high quality primary and maternity healthcare. The birthing center at Memorial combats healthcare disparity by offering these cities care that is community-centered and culturally sensitive.
At Memorial’s birthing unit, the nursing staff is lead by nurses who were some of the first doulas in the community, and it has a volunteer doula program that provides no-cost support for all families who want it. Laboring women who have doula support show a reduction in surgical intervention in birth and increased satisfaction. But the health outcomes are only one part of the story; the details reveal a very human narrative about respectful, collaborative and family-centered care.
The RI Department of Health, now under new administrative leadership, described disparities in healthcare as one of the major public health issues of our time. How wonderful that a RI hospital has become a leader in providing the kind of maternity care that exemplifies a commitment to equalizing the disparities that face many in Central Falls, greater Pawtucket and the surrounding areas. Because of its unique approach, people travel from all over the state — and other parts of the country — to receive care at Memorial’s birthing unit.
I first encountered Memorial Hospital as a photographer making work about the cultural systems that are part of care in pregnancy and birth. A mother myself, I found the process of finding maternity care and experiencing birth in different environments fascinating. Why do we choose certain providers? Can we have a say in where we give birth, how it happens and who is present? As I laid the groundwork for this documentary project, I had this conversation with providers, mothers and fathers, childbirth educators and doulas. What choices do families have in a profit-centered, high volume maternity care system? Is this a systemic problem and are there exceptions? Solutions?
These questions became a rich ground from which my photo documentary work grew. And with it I grew as I observed maternity care as a journalist, an artist and a doula. I saw how relationships with care providers were pivotal, and how the subtleties of clinical environments and protocols affect the quality of families’ experiences. My first encounters with care providers at Memorial were unique. Doctors and fellows were interested in discussing how the belief systems of families and the care they provided were equally important.
At Memorial, I often was allowed to photograph Cesarean births — an honor that few journalists have. As a doula, I saw the importance of my continued support in Cesarean births, and saw parents’ joy at having images of their child’s first moments of life. My work as a doula and photographer evolved into work around child loss and bereavement support. When I attend to a family in birth or loss at Memorial, I’m greeted as a community member. The nurses and staff know my name — we have grieved together and we have celebrated life together.
Perhaps this article is only a swan song of an important and beloved place. In the last weeks, thousands of community members have expressed what the care at the Memorial birthing center has meant to them. This is a place that holds the joys and sorrows of many, a place that has welcomed generations of New England families. There are not many medical facilities that are as much a part of the community, and for all its humble being, Memorial birthing center has been loved by the community it fought so hard to serve in its most sacred moments of life.