The consequences of longstanding inequality in healthcare access and delivery has been well documented. Racial and ethnic disparities in pregnancy-related deaths are alarming; Black women are 3x more likely to die during pregnancy and childbirth than their white counterparts, irrespective of income or education levels.

"At Cedars-Sinai, the whole issue of equity has been a focus point from the top down, which has been a really positive way to empower change across the institution. These are uncomfortable conversations to have, but they need to be had."

Studies reveal that improving culture competence—the ability of providers and organizations to effectively deliver healthcare services that meet the social, cultural and linguistic needs of patients—is one way to make lasting change. Cedars-Sinai is working to improve cultural competence by focusing on the care women of color receive right from the beginning of pregnancy.

Improving outcomes and providing "cherished futures" for Black mothers

Cherished Futures for Black Moms & Babies is a collaborative effort between Communities Lifting Communities, the Public Health Alliance of Southern California, and the Hospital Association of Southern California. Cedars-Sinai is one of five California health systems piloting the pioneering program. 

One initiative under Cherished Futures involves partnering with community-based childbirth advocates and doulas to provide care that helps ensure a more inclusive, positive experience for Black women giving birth. The program holds the ambitious goal of reducing infant mortality rates by 30% by 2023 while improving the healthcare and safety of Black mothers. 

"In terms of childbirth experience and from my own body of research, I've found that there are differences in how people perceive respect based on race and ethnicity," explains Kimberly Gregory, MD, MPH, director of Maternal-Fetal Medicine, vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology, and Helping Hand of Los Angeles–The Miriam Jacobs Chair in Maternal-Fetal Medicine, who is helping to lead the Cherished Futures initiative at Cedars-Sinai. "Some people just want to be heard, some want you to take into consideration their religious beliefs, and for others, it's how well you treat their partner. All of this contributes to the childbirth experience," adds Gregory.

Through the Cherished Futures program, Cedars-Sinai physicians and clinicians have learned to prioritize sensitivity to patients' cultural backgrounds and consider how race, ethnicity, age and language impact their patient care. 

"We can't assume that we know people's race or ethnicity. That's one issue the program has helped to address," says Gregory. "We've developed specific language and simulations to help our care providers become comfortable asking patients about how they identify themselves."

Read: Making Birth Better: Kimberly Gregory, MD, MPH

Gregory explains that women in labor or who have just given birth may feel disrespected when referred to with a familiar "mom" by physicians and staff members. Care teams now ask patients directly what their naming preference is and post it on a whiteboard so that anyone entering the room knows where to look and how to appropriately address the patient. 

"It seems like a simple thing, but it's really important, and can help women feel comfortable with treatment recommendations," Gregory adds. "We also emphasize the availability of translators if the patient feels she needs one."

Building on the Cherished Futures initiative, the Department of Obstetrics and Gynecology at Cedars-Sinai is also focused on reducing the Nulliparous, Term, Singleton, Vertex (NTSV) cesarean birthrate for first-time moms to less than 23.9% and breaking out quality indicators by race and ethnicity. 

Continuing the change conversation

Along with the Cherished Futures program, the Cedars-Sinai Department of Obstetrics and Gynecology, under the direction of the Helping Hand of Los Angeles Chair in Obstetrics and Gynecology, Sarah Kilpatrick, MD, PhD, is making other changes across the women's health service lines to help physicians provide equitable, personalized care to all patients, regardless of race, ethnicity, religion or background.

The department hosts a monthly speaker centered around diversity, equity and inclusion and has a dedicated diversity team that can address issues witnessed throughout the system. Patients and providers can anonymously report experiences of implicit bias, microaggressions and other issues related to cultural disrespect.

"At Cedars-Sinai, the whole issue of equity has been a focus point from the top down, which has been a really positive way to empower change across the institution. These are uncomfortable conversations to have, but they need to be had," says Gregory.

In Discoveries: Research Frontier: Pregnancy and Heart Health