It was a busy year for Samantha Pierce.
In 2009, she was a leader at a nonprofit, a wife and a mother. Pierce and her husband, Ron, were overjoyed when they learned of another addition to the hubbub of their lives — she was pregnant with twin boys.
But in her fifth month of pregnancy, Pierce sensed something was wrong. She seemed to be leaking fluid. Concerned, the Pierces went to the doctor.
The ultrasound showed the twins bumping energetically in the womb. “It was the first time we saw the babies when they were in an active state and interacting with each other and kicking each other back and forth,” recalls Pierce. “It was the greatest thing.”
The motion was a source of hope for the apprehensive couple. But as a precaution, the doctor told Pierce to drop everything. She was hospitalized and put on bed rest.
A few days later, Pierce unexpectedly went into labor and spontaneously delivered one twin. The doctor determined the other twin could not survive, so Pierce was induced.
But they were both too premature, and neither of the babies survived. For Pierce, the experience was devastating.
“I had never heard of anything like this,” Pierce says. “I didn’t know anybody who had ever delivered a baby early, or at least that they were saying. I didn’t know anybody whose baby had died.”
But as Pierce learned, she is not alone. The city of Cleveland has an infant mortality rate almost twice as high as the national average. Last year the March of Dimes gave Cuyahoga County an “F” with the highest rate of premature births in the state’s largest counties.
In 2014, 122 babies died in Cuyahoga County before their first birthday. The causes were varied, including 19 sleep-related, one car accident, another from cancer, two murders, 13 from birth defects and 76 from being born too early, like Pierce’s twins.
The Cuyahoga County Board of Health and Cleveland Department of Public Health have been working to tackle this complex problem. Recently, First Year Cleveland, a city-county collaborative, launched with hopes of uniting many ongoing initiatives.
Certainly, it is commendable that Cleveland’s largest institutions and governments are providing resources, support and leadership. But to fully deal with infant mortality, it is also critical that we assist those already on the ground with hands-on solutions and the people who live and invest in the neighborhoods where the problem is the worst. Small, nimble programs can make a difference quickly, where it matters most.
After her ordeal, Pierce, a Slavic Village resident, learned another grim statistic. Black babies die before turning 1 at a rate more than double that of white babies.
“An African-American woman with a master’s degree is still more likely to lose her baby than a white woman with a high school diploma,” says Christin Farmer, founder and executive director of Birthing Beautiful Communities.
Developed on her own, Farmer’s approach is one of the most innovative for reducing infant mortality and poor birth outcomes in Cleveland’s urban neighborhoods. It has since won grant funding from the Cleveland Foundation’s Greater University Circle Community Health Initiative, which encompasses neighborhoods with some of the worst infant mortality rates in the city.
Farmer trains doulas to work with women throughout their pregnancy, to be there at the birth and to follow the baby afterward. The key requirement: The doula must live in the same neighborhood as the pregnant woman, so she understands her needs and challenges firsthand.
A 2014 University of Cincinnati study showed that more than 53 percent of mothers delivering a premature baby had given birth less than a year earlier. Education, contraceptives and counseling from a trusted neighbor throughout the process goes a long way toward cutting down the risk of both infant death and prematurity.
So can seeing a doctor. Less than a year after losing her twins, Pierce showed up to her doctor’s office. She was pregnant again, expecting another set of twins.
The doctor acted immediately, giving her a cervical cerclage, in which the cervix is sewn closed to prevent premature labor. Pierce also stayed on bed rest throughout her pregnancy. Her second set of twins, Camryn and Caedyn, are now 6 years old.
But some women are not so lucky. They may not realize the prevalence of infant mortality and premature births, or don’t have access to care.
“Across the community a lot of people believe it’s an isolated event and not something that’s an epidemic,” Farmer says. “There’s no sense of urgency.”
To create that urgency, small-scale programs must be paired with loud awareness campaigns. One success has been Cleveland’s ABCs of safe sleep campaign: “I sleep Alone on my Back in a bare naked Crib.”
Ohio has adopted the baby box concept from Finland, which boasts the lowest rate of infant mortality in the world, by offering a cardboard bassinet with a foam mattress and other supplies.
While an affordable solution that raised awareness, there is a risk of trivializing the real problem as one that can be easily packaged and solved. There is no magic pacifier. For instance, if a baby outgrows the box before age 1, and the parents never bought a larger crib, they may put the baby in bed with them, re-creating the original problem. On-the-ground resources, like doulas, must accompany big-picture efforts, like baby boxes.
Another missing key, especially in Cleveland’s urban neighborhoods, is providing support to reduce stress for pregnant women. For Pierce, stress came in the form of a high-pressure job. But for many women in Cleveland neighborhoods, it’s from not having a job or losing money to take off for appointments or lack of decent housing.
One of the most important components of Farmer’s community doula program is to provide support and work purposefully to reduce women’s psychological stress through special awareness programs. Stress may seem like a triviality. But in pregnancy, it matters.
Cordell Arellano says it’s also critical to not forget about the fathers. He tells his story to others through the Fatherhood Initiative and his service with the Greater University Circle Community Health Initiative.
In 2013, Arellano’s son, Jay-C, was born at 28 weeks. He weighed just 1 pound, 13 ounces and spent 121 days at MetroHealth Medical Center. Arellano and Jay-C’s mom broke up during the pregnancy and argued constantly, which he says also led her to drink and smoke.
“If I could change something, it would be my willingness to compromise,” says Arellano, who lives in the Central neighborhood and works as a health fellow at Neighborhood Connections. “I had too much male pride. … Men should listen to pregnant women.”
It’s critical that Cleveland open its ears to the Farmers and Arellanos of our city. It will take a village to turn around the harrowing numbers, each representing a life in the making. But it’s time to flip our perspective of what that village looks like.
“We always focus on educating the community,” Farmer says, “but I feel the institutions actually need to be educated about the community that they are serving.”