This is part of a series of stories about people working on solutions to New Hampshire's maternity care challenges. Catch up on more of our coverage here.
In New Hampshire, there are many factors that determine the quality of maternal health care and wellbeing.
Dr. Trinidad Tellez is a family physician and a health equity practitioner. She’s also a Democratic state representative from Manchester. NHPR’s All Things Considered host Julia Furukawa spoke with Tellez about how to improve the quality and access to maternal health care for all of New Hampshire’s birthing communities.
Transcript
What do we know about the disparities that exist in maternal health care here in New Hampshire?
New Hampshire is like the rest of the country, in that we see the kinds of disparities and differences in outcomes. We know we have a problem of maternal health deserts and limited access for many of our populations who live in more rural parts of the state, which is a significant fraction of the population. We know that access to care is partly determined by health insurance access [like] Medicaid.
There are some numbers about entry to prenatal care. Ideally we want all people to enter prenatal care early in the first trimester and we have seen that there are differences by population groups. It's a little bit lower for Black or African American women in New Hampshire than it is for white, non-Hispanic and Asian women. And we have a history in this country of there being good reasons for why some communities aren't necessarily as eager to seek out health care.
So in a recent project, you and several others heard from nearly 50 postpartum people across the state on their perinatal experiences. What did you hear from them?
So the kinds of comments that were shared, there was a lot of describing a lack of communication, which caused a breakdown in trust between them and the health care providers around them. Sometimes it led them to question motives behind decisions being made about their care. Sometimes they shared challenging interactions with health care staff. So we have a few quotes.
“I felt humiliated when the nurse laughed at me and said, good luck with that. When I told her I wanted a natural birth.”
“I was pushed to do an induction by being told that more time in the hospital would cost more money.”
When we sit back and listen to those quotes, we might say, “Ah, that's not a big deal, right?” Especially if you work in a health care setting [and] you see people every day. But for some people, this is a new experience. They might be alone. They might be afraid. And so, they feel like their concerns are discounted or they're made to feel dumb or inadequate for having and sharing those concerns.
I think what we uncovered was this disconnect, this gap, between what patients are experiencing and describing versus what we think we're doing as very well-intentioned [and] caring providers. Some of the findings in the conversation, especially as we talked about mental health and postpartum depression, participants revealed this desire for being able to get support in the community.
How do community-based systems fit in with efforts to address these disparities?
So we want to think about how to reshape, recreate and re-envision the way we think about maternal health care so that it's more of a conversation between community needs and health care systems.
We really thought that what would be lovely would be to have a combined community health worker, doula, and mental health support role. We know there's some projects going on in New Hampshire where maybe community health workers are combined with doulas. The bottom line is that having an ability to have people who are from the community, who are trusted people, that without having to touch a health care institution, could be accessed and they can serve as a source of support. And then also, when they recognize a need, someone who can help link, refer, provide resources and connect people to care when it's a more acute need for actual health care.
We want to hear from you: What do you wish you knew before you had a baby here? What made a difference for your family when you, or your partner, were pregnant? Where were you surprised to find support — or, where did you feel like you needed more help? Let us know at voices@nhpr.org, and your stories could help shape more of our journalism on this topic.
