Holistic Care Partners: A Black woman-led nurse navigation program to improve care, reduce harm, and enhance perinatal wellbeing for Black birthing people

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Project Summary/Abstract The broad, long-term objective of this research is to address inequities in birth outcomes for Black women and birthing people, which manifest most starkly in severe maternal morbidity and maternal mortality. While there are disparities in maternal health outcomes for multiple populations, Black communities are particularly affected by adverse birth outcomes. Maternal morbidity and mortality rates for the Black population are 2-4 times higher than those of the non-Hispanic White population. These disparities are even greater in some communities, like New York City, where pregnancy-associated mortality among non-Hispanic Black women remains 8 times higher than among non-Hispanic White women. Similarly, severe maternal morbidity occurs 2- 2.5 times as frequently among non-Hispanic Black women compared to non-Hispanic White women. In addition to having higher rates of medical and obstetric co-morbidities, mortality, preterm birth, and infant death, Black women and birthing people are likely to experience obstetric racism manifesting as dismissiveness, disrespect, loss of autonomy, and abuse while seeking care during pregnancy, labor, and birth. Opportunities for preventing maternal death and severe maternal morbidity have been identified at multiple levels including through clinicians, health facilities, systems, and the community. Interventions are needed at all of these levels to create systematically healthy and uplifting conditions for pregnancy and birth among Black women and birthing people. However, many upstream interventions will take considerable time to have an impact. Addressing factors that are modifiable now is urgent. We propose that important progress can be made by employing the expertise of the current perinatal nurse workforce to address information, coordination, referral, and care experience needs for Black women and birthing people seeking traditional prenatal and hospital-based maternity care. This study will evaluate the feasibility and acceptability of a Black- woman-led perinatal nurse navigation program designed to address disparities in maternal health outcomes, reduce experiences of obstetric racism, and improve maternal wellbeing by centering the needs of Black women and birthing people engaging in traditional prenatal care and hospital-based birth in New York City. The specific aims are to (1) assess the feasibility and acceptability of a perinatal nurse-led navigation program, (2) collect and examine descriptive data on program outcomes to inform future efficacy testing, and (3) explore participant, partner/support person, and clinician stakeholder responses to the nurse-led navigation program. This formative intervention study of an integrated model of supportive care will lay the groundwork for future efficacy testing. If successful, perinatal nurse navigation programs have the potential to reduce preventable severe maternal morbidity and mortality. Such programs would also have the potential for rapid scalability using an existing workforce, and for adaptation to multiple contexts and cultural groups.