In the United States, Black women face maternal mortality rates higher than some developing countries—a stark reminder of persistent healthcare inequities. Rachel Robins, a Certified Nurse Midwife, Certified Lactation Counselor, and PhD candidate at Pace University, is working to change this reality.
As the Assistant Nurse Manager of Labor and Delivery at NYU Langone Health, Robins brings valuable clinical expertise to her research on postpartum depression among Black women, investigating whether disparities stem from underreporting, misdiagnosis, or inadequate screening. Her work examines the intersection of race, mental health, and maternal outcomes to advance meaningful solutions for Black mothers.
Can you provide the community with a little bit of your background and what you’re studying right now?
I’m based in New York City. I currently work as an assistant nurse manager at NYU Langone health. I have a background as a midwife there as well, that I worked at 2 years. I am doing my PhD in nursing research, focusing on postpartum depression among Black women and just looking at if there’s misdiagnosis, mistreatment in that area. And so that’s kind of where I’m at right now.
What are some challenges that African American women face when trying to find or access quality, prenatal and postpartum care?
I think the biggest is probably social determinants of health, insurance, access and healthcare access. I think New York City does a really good job with access to care, but sometimes, like what we have, are health H. And H. Hospitals that do take Medicare Medicaid, and not all hospitals that have access to all the resources, take those insurances. That’s kind of one of the biggest things. There is really good care in those H. And H. Hospitals, but it’s kind of a little push for Black women that need to advocate for themselves and have other people to advocate for them.
Are there any resources and organizations that come to mind, that Black mothers can seek that also make sure that they’re culturally competent and effective?
March of dimes is really good. It gives like a kind of quick informational about certain things. If you were to Google. There’s the Black Mothers matter alliance that provides like across the country, information which is really nice. And then in New York City there’s ancient song and Mama Glow Doula services. So, they’re both Black owned. And they’re really passionate about Black maternal health. They’re really, a big part in Black maternal equity as well. Just seeing they offer dual services, and seeing if that can be something that you use both in prenatal care and postpartum care.
What are some of the things that Black mothers can do to advocate for themselves in hospital settings?
I would say definitely, advocate. I think one of the biggest thing is having a birth plan. I do like to tell people that with birth. There are changes so not to have something concrete kind of be flexible.
That’s 1 of the biggest things, and just have that plan and discuss with either your partner or your Doula and your provider kind of what you’re looking for before you even get to the hospital, because birth kind of has a whole bunch of emotions, and you really forget all the things that you discussed prior to. So, if you have those things already set in stone, and have those people kind of there for you to advocate your needs. That really helps.
What are some of the common pregnancy complications that disproportionately affect women of color? And how can they be managed?
With Black maternal mortality, it is the highest in the United States, even like higher than some developing countries in the world. So, I would say, preeclampsia, which is high blood pressure for women who are pregnant. Gestational diabetes preterm both. And then, postpartum hemorrhage, which is just certain number that we hold in the hospital. I would say those are like the top causes for that. But there are certain things like, I think, in news outlets that post. There’s someone who Serena Williams, for example.
She had an issue where she had to fight for herself. And that doesn’t necessarily like I, you know, like I mentioned before, social determinants of health like, Serena Williams has lots of money and has like access to the best resources. There is a structural racism issue as well that we need to address, because that does sometimes get in the way of complications. Just knowing about the top complications that Black women at our higher risk, for again, that would help them advocate for themselves.
They can look for the signs and symptoms of what that looks like. If they’re in a situation where they’re feeling something different, the main thing is to trust their body and bring their issues to their providers.
What are some of the benefits of working with a midwife compared to a traditional birth setting?
Midwives do birth and prenatal care in many settings. A lot of times, people think about midwives, and they think about like lay midwives which really held the foundation for midwifery care, especially in the Black community. Who started midwifery were Black women, and then it just changed trajectory. And now, there’s nursing midwives. There are certified midwives that don’t have a nursing background.
They all can have a different scope of practice. But I’m a nurse midwife. So I did nursing school for 4 years, and then I did another 4 years for my master’s, and certified to become a nurse midwife. I have the ability to see patients, prescribe medications, see patients by myself without having an authorized physician. A lot of people don’t know that. And then, provide gynecological care as well.
Not only pregnancy and birth, but I think midwifery care kind of has that nursing background. It’s very like holistic, and it looks at the patient as a whole. And that’s a different approach to birth when a lot of times, on the medical side or OBGYN side, they’re really looking at more of just the physical and not so much of the mental. And with pregnancy and birth, it kind of takes everything that you have to include in order to have a successful birth, and whatever that looks like for that person. That’s where midwives come in.
What are some things that Black families should know when they’re getting midwifery care, as it relates to being uninsured or underrepresented?
Midwives, they are really up front in what’s going on with Black maternal health and health care. At least the midwives that I interact with in New York, they all know that this is an issue and are really working to battle that I think if you’re looking for care and uninsured, the good thing with pregnancy, I don’t know about other states, but in New York you do get health insurance, even if you’re uninsured.
As soon as you become pregnant, you do have access to get health insurance. and a couple of weeks after postpartum as well. So, that is something that does take away the stress from a pregnant person. Like with midwives, they do take like Medicaid Medicare Insurance. So, if that is a worry of like, I don’t know if my insurance will be taken. They do. Some people don’t want to go to hospitals, and they want to do home births and that is something as well that they do take Medicaid and Medicare Insurance. They work really hard to make sure that that person gets the best prenatal care and birth and postpartum care as possible.
What are some essential postpartum resources for Black mothers, including mental health support and lactation consulting?
A lot of midwives are lactation counselors. We do get that certification like, I have that certification, because I just want to make sure, like I’m a one stop shop for someone. There’s little HA league that helps mothers who want breastfeeding support. There’s also usually in the hospitals. They do have someone that you can contact after, like postpartum, for postpartum depression.
It is a little difficult, especially when it comes to Black women, which is what really fueled my research that I wanted to do, because a lot of times, like the strong Black women that persona and framework kind of affects the way that Black women present in postpartum depression.
And so, being comfortable and sharing what’s going on. It may not necessarily look like what the provider is telling them, whether they’re saying, “are you feeling sad? Are you feeling tearful, or you’re not able to go to work?” For Black women, they do need to go to work a lot of the times, and they don’t really have an option. They just push forward. And they’re like. I can’t do that. I’ll do it later.
So, just expressing all of those and not so much worrying about. If there’s a problem with social work or anything like that, that’s a big fear that I see. Just being open with the providers, or, seeking out mental health support is really important. And I mean, you did mention something good like being a man. Postpartum depression. But postpartum depression also does affect male partners as well. That is something to take into consideration. You also are supporting someone that’s going through a mental health crisis. That’s also important to let the partners know, you should also reach out for resources as well to make sure you’re supported as well.
Do you recommend any culturally specific childbirth education classes and resources for Black families?
The ancient song. Mama glow like those both offer childbirth education classes, and a lot of like Black, owned Doula companies do offer childbirth education. It’s really important to just take a childbirth education class as 1st time parents. There’s a lot of things that people are like, “oh, I’ll just see it in a prenatal visit.” But prenatal visits are so fast that you can’t really ask that many questions, and a lot of times they skip that part and that’s really important.
There’s books that are out there as well, just to know what questions to ask. You don’t need to know everything. But, if you see it, you’re like, Okay, let me put that in my back pocket. Take a note on my phone. So I can ask my provider about these questions. So you’re not totally in the dark, once it’s time to give birth.
