Brittany "Tru" Kellman sometimes starts her day two hours before Jamaa Birth Village opens at 10 a.m., stashing diapers and snacks for the dozens of people who will come through the Ferguson nonprofit’s doors. She gives everyone a hug when she meets them.
Jamaa is different from other pregnancy clinics. It provides care for women of color by women of color. After traumatic experiences as a teen mom, Kellman was determined to create a better alternative for black women.
“Creating Jamaa Birth Village is a kind of a re-creation of the type of care and support I gave myself when the system failed me,” said Kellman, the center’s founder.
Missouri has one of the highest black maternal mortality rates in the country. For every 100,000 live births, 65 black women die, compared with 28 white women. The statistics are also startling for their babies.
For every 1,000 black babies born, 11 die. That’s twice the mortality rate of white children.
Through offering support and guidance, connecting women to midwifery care and building trust with providers, Jamaa aims to help foster healthy moms and babies.
After doctors ignored her wishes to give birth vaginally during her first two pregnancies, Kellman decided to use a midwife for her third. The experience transformed her. She decided to become one herself. She even went to Ghana to study traditional birthing techniques.
In 2015, Kellman opened Jamaa, which means "family" in Swahili.
Since then, the organization has helped more than 350 people. It connects women of color with doulas, who support women during pregnancy, and midwives, who often help give birth outside a hospital at home or in a birthing center. Jamaa offers doulas to patients on a sliding scale. The cost for patent varies, from $360 to $960.
Jamaa also offers chiropractic care, birthing, breastfeeding and parenting classes and support groups and discussion circles for new and expecting moms, their spouses and their families. That kind of support is vital for healthy black babies, experts say. It’s a safe place for people that exists outside a medical system that is increasingly under fire for failing black mothers, said Kellman, who this year will become the state’s first black professional certified midwife.
Severed Trust
Several women who came to Jamaa for help said they didn’t think hospital doctors were taking them seriously.
For Kellman, the women’s experience mirrors her own. When she first gave birth at 14 in 2001, Kellman thought her doctors would be a source of guidance and support. Instead, they ignored her, she said. Her obstetrician scheduled a cesarean section for her against her wishes.
"I was terrified," - Ashley Atkins, mother.
“At the time, she said it was because my baby seemed small for its gestational age,” Kellman said. “I later found out she was going on vacation and was bringing all her clients in to be induced before she left."
Many women who came to Jamaa described similar experiences. Another mother, Ashley Atkins, also had a traumatic experience during an earlier birth. During the birth of her first child, doctors insisted she receive an epidural, which she didn't want, she said.
"I was terrified," Atkins said. "The anesthesiologist came in, he had the needle ready and was squirting the stuff out. He said, 'Oh, are you ready to be paralyzed for life?'"
When her second son was born, she went into labor inside a hospital bathroom. When nurses saw she was giving birth, they told her to wait for a doctor and started screaming that they didn't know what to do, she said.
In a national poll of black Americans sponsored by NPR, the Robert Wood Johnson Foundation and Harvard’s T.H. Chan School of Public Health, nearly one third of 802 respondents reported being discriminated at the doctors office. One fifth of respondents said that made them avoid seeking medical care.
Studies have found that black women suffer more complications after pregnancy and are more likely to receive medically unnecessary C-sections.
Public attention focused intensely on the disparity in care last year when international tennis star Serena Williams complained doctors had ignored a life-threatening condition after delivering her baby.
The day after she gave birth, Williams, who had a history of pulmonary embolisms, felt blood clots might be forming again and ordered blood thinners and a scan of her lungs. Nurses ignored her requests for a scan and gave her an ultrasound instead. Finally, a CT scan confirmed Williams’ fears. She spent the first six weeks of her daughter’s life in bed.
Doctors need to pay more heed to what black women are telling them, said Katherine Mathews, a OB-GYN at St. Louis University and SSM Health St. Mary’s Hospital who studies race and birth outcomes.
“But what’s layered over this is decades how the community has had health care delivered,” she said. “There’s a feeling of uncertainty — if I’m a black woman and I go into a health-care setting, am I going to be treated respectfully, am I going to be listened to?”
Building trust
Kellman, the Jamaa founder, has started advising area hospitals such as Mercy Health System to help educate them on how to confront their own biases in care and build trust with black patients.
Research shows continuous support, like the kind Jamaa provides through midwives, doulas or support groups, can help pregnant women have fewer C-sections and fewer premature births.
Jamaa also identifies health centers in St. Louis that work with midwives and doulas and are known to deliver what Kellman calls “culturally congruent” care.
That was vital to new mom Ashley Atkins. She was pregnant and already busy with two children when she moved to St. Louis last year. She was stressed with a new job in a new town.
“I didn’t know anyone or where to get connected,” Atkins said. “Jamaa was the hub for me.”
With Kellman’s help, Atkins found a midwife at Mercy Hospital.
“To know they were connected to Jamaa, that made it full-circle for me,” Atkins said.
Fatal Stress
Black women’s harmful stress begins before they check into the hospital. The everyday discrimination black women face in daily life, on the job and in society puts their bodies in a state of constant stress. That stress is associated with serious health complications and higher rates of infant and maternal mortality, a concept called “weathering,” a term coined in a landmark 1992 study by Arline Geronimus.
That’s proven by high black maternal and infant mortality rates, which occur regardless of a mother’s income or social class, Mathews said.
Reducing that stress is key for healthy babies and families. Research shows continuous support — like the kind Jamaa provides through midwives, doulas or support groups — can help pregnant women have fewer C-sections and fewer premature births.
Having a place specifically for women of color is important, said Kendra White-Drayton, a 25-year-old first-time mom from St. Louis. She became depressed when she was left alone after her husband’s two weeks of paternity leave ran out. She says “mommy judgment” made it hard for her to reach out to people she knew.
“Where I work, it’s not many moms, young moms, or women of color who are moms,” said White-Drayton, a graduate student at Washington University. “Seeing moms of color talking about breastfeeding, encouraging me to take my baby on a business trip so I can have her there to nurse her, it’s nice to have that kind of support.”
Growing and Giving
Since it opened in 2015, Jamaa has helped more than 350 women, Kellman said. This year, Jamaa is getting bigger. Thanks to a community-based fundraiser and the donation of a clinic from a retiring Ferguson doctor, the clinic will be able to move from its current 1,200-foot space.
The three-room space Kellman rents for the birth village isn’t big enough to hold the big plans she has for Jamaa. The new clinic will house mental and primary health care, a birthing suite, and will house the region’s first equal-access midwifery clinic, where women will be able to receive midwife services regardless of their income.
Letting go of Jamaa’s original building will be emotional. Kellman said. “But it just wouldn’t be able to hold those wishes and those dreams of having a safe, sacred space for you to have care and deliver your baby in.”
Correction: Ashley Atkins received an epidural during the delivery of her first child. A previous previous St. Louis Public Radio report mistated when she received an epidural.
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