Improving outcomes in medicine often requires a change of heart. That’s the thinking behind a $5.4 million study aimed at reducing the maternal mortality rate among Black women. Temple physicians and researchers have teamed up on the project with community-based providers from Maternal Wellness Village, a Black birth worker collective organized through the Oshun Family Center.
The study, which is known as Change of HEART (Here for Equity, Advocacy, Reflection, and Transformation), is grant-funded by the Patient-Centered Outcomes Research Institute (PCORI), a Washington, D.C.-based research organization. Change of HEART focuses on reducing heart disease risk factors, which are one of the primary drivers of adverse pregnancy and birth outcomes.
Over the last three decades, pregnancy-related mortality rates in the U.S. have increased by more than 140%, with heart disease as the number one cause of death. In Philadelphia, Black and brown women are even more likely to be impacted: a report released by the city’s Maternal Mortality Review Committee found that 77% of pregnancy-related deaths occurred among Black and brown individuals, who make up just over half the city’s population.
Change of HEART addresses this crisis by comparing the effectiveness of two approaches to supporting Black patients during pregnancy. In the first approach, patients receive text messages encouraging healthy nutrition and physical activity, as well as guidance on self-monitoring their blood pressure. In the second approach, patients are connected with Black birth workers, who provide them with doula care, mental health services, and lactation counseling during pregnancy, birth, and postpartum.
The study’s goal is to determine whether these additional supports lead to lower blood pressure, reduced feelings of social isolation and depression, and increased experiences of respectful care for patients, at both six weeks and 12 months postpartum. 145 patients are already enrolled in Change of HEART, and researchers hope to triple the number of participants before the study’s conclusion.
A Community-Centered Partnership
“Our vision is to create a model of care that centers Black birthing people,” says Sharon J. Herring, MD, MPH, Professor of Medicine and Associate Professor of Obstetrics & Reproductive Sciences at the Lewis Katz School of Medicine at Temple University, and dual Principal Investigator for Change of HEART. To do so, Dr. Herring and her fellow researchers knew that community partners had to be at the center of the process.
“We knew our own work using an individual-level approach only went so far,” she says. “We couldn’t really move the needle with cardiovascular health enough. The key was really listening to Black women and birthing people. Too few clinicians and researchers talk to the people who are most affected.”
That meant working side-by-side with Saleemah McNeil, Founder and Executive Director of the Oshun Family Center. To identify the supportive services they would provide to participants in the study, McNeil and her team drew on their own experiences as Black mothers. “We looked at all the deficits we experienced in our own birthing journeys and asked, ‘What did we miss?’” McNeil explains. “We missed lactation support. We missed having doulas. We missed having mental health support.”
Those were the services she and her colleagues made sure were included in Change of HEART, and that she and Dr. Herring envision using to create guidelines for inclusive care that can be used nationwide. “We’re hopeful that we’re going to learn and develop a model that we can then disseminate outward,” Dr. Herring says.
Leading the Way in Equitable Care
As we move closer to the official opening of Temple Women & Families—which is now offering outpatient services, including OB/GYN, Pediatrics, Radiology, and Family & Community Medicine—improving prenatal and postnatal care and outcomes for mothers and birthing people is one of the top priorities. The new campus will offer services like a doula program, patient-first spaces and trauma-informed communications, and a Perinatal Community Health Worker (pCHW) program, which will pair at-risk pregnant patients with a trained maternal health advocate who will work with them from their very first appointment until one year postpartum.
We’re also at the forefront of efforts to reduce patients’ experiences of racism in healthcare, which is another key component of Change of HEART. As a part of the study, Temple Health clinicians and staff can choose to participate in the Intercultural Development Inventory: an assessment tool designed to educate users on how structural racism impacts patient care and help them realize their biases. They can then take self-paced video lessons to further their understanding.
“What we hope to see is a cultural shift in how providers are interacting with and treating patients,” McNeil says. “It’s our hope that the clinicians are more person-centered, and that they’re more collaborative with the patients.” It’s an essential component of a model of care that puts patients first, and that prioritizes the kinds of support that mothers in our community need. It’s also how we can get to the heart of the Black maternal mortality crisis—and ensure their pregnancies are as healthy and joyful as they deserve.