Roots Community Birthing Center, North Minneapolis
Listen to the patient: Rebecca Polston checks in with baby Zinachimdi and her mother, Fehintola Eboagwu.
Step into the bathroom at Roots Community Birth Center in north Minneapolis, and you might forget why you’re there. The soft lighting, stone laminate flooring, and gray paint suggest the powder room in one of the neighboring houses, rather than a place to deposit a urine specimen. You’ll find no instruction card on which wipes to use, no window to pass your cup into a lab. Here, clients weigh themselves and even check their own urine with a test strip to make sure it falls within a healthy range.
“We don’t do things to people,” says Rebecca Polston, the center’s owner and a midwife, during a recent tour. “Even things like doing a vaginal swab. People do that themselves. We don’t need to disempower them by always having them recumbent and passive in their health care.”
In well-heeled suburbs, plenty of birth centers provide these types of amenities: luxurious bedding, an extra-large tub in the birthing room, a full kitchen, a yoga studio. But the purpose of Roots, in the Webber-Camden neighborhood, goes far beyond its hippie-spa vibe.
As one of five African-American–owned birth centers in the country, Roots represents an attempt to solve some of the starkest disparities in health care. Black and Native American women and babies suffer almost three to four times more mortalities than white women and children, during and after childbirth. Black women in Minnesota also experience a much higher rate of premature birth, an important marker for a child’s health. And, according to a recent national March of Dimes report, that gap has only widened in recent years.
Just as startling, perhaps, is research that shows these outcomes exist regardless of income level.
“This is not a function of poverty,” says Polston, who is one of Minnesota’s few midwives of color. “We can’t educate or earn ourselves out of this disparity.”
Instead, “what we need to be talking about is racism,” says Rachel Hardeman, an assistant professor of health policy and management at the University of Minnesota. Hardeman’s studies of health equity and birth outcomes have brought her into collaborating with Polston to examine the work at Roots.
Back in 1992, University of Michigan health researcher Arline Geronimus first attributed the birth disparities to racism. But the idea is just recently gaining wider understanding and acceptance in the field.
“She saw that black women, throughout their life course, found their health deteriorating due to the buildup of experiences of discriminations,” Hardeman says. “Microaggressions were slowly chipping away, so that they were weathered or stressed going into pregnancy.”
For example, in focus groups at Roots, women of color have talked about learning their urine has been tested for drugs without their knowledge. They’ve also encountered offhand remarks about the number of children they’ve had. Even tennis star Serena Williams, who gave birth in September, said her instincts were ignored during a postpartum crisis that ended in multiple surgeries.
“Serena Williams is the perfect example of an ‘I’m the doctor, I know what’s best’ situation,” says Hardeman.
Citing negative experiences like these, Geronimus postulated a reason why younger black women may have registered better birth outcomes (compared to same-age peers) than older black women. They’d had less time to be discriminated against.
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Hardeman and Polston—both black mothers themselves—knew that addressing these challenges would demand a different approach. That included locating the birth center in a predominantly black and mixed-race neighborhood. And they’ve embraced a concept of diversity that includes trans parents.
The center, which opened in 2015, sees about 100 births per year. (Other services include prenatal classes, doula training, yoga, and postpartum home visits.) About 85 percent of the babies born at Roots report at least one parent of color. It’s close enough to some clients’ homes, Polston says, that a husband recently ran home, in the middle of labor, to get his wife a bowl of cereal.
“There’s a big movement in the black birthing community in trusting black women to make their own decisions and know what’s best for themselves,” Hardeman says.
Rachel Hardeman and Rebecca Polston
No scrubs: Researcher Rachel Hardeman and midwife Rebecca Polston believe in a birthing center without the clinical vibe.
Two weeks ago, Rikyrah Snow, who lives in Northeast Minneapolis, gave birth to her first baby. She and her boyfriend chose Roots because they wanted a natural birth and appreciated the center’s African-American ownership. The baby was running almost two weeks late. So the caregivers at Roots suggested some natural tricks: pineapple, dates, spicy foods—and a castor-oil smoothie.
“That’s something that’s not happening at hospitals to get contractions going,” Snow says. “They didn’t force me to do anything I didn’t want to do. I was in a lot of pain, but they really helped me get through the process.”
She walked up and down the block while labor progressed, while preparing for a water birth. “The difference between that and hospitals, where you don’t have a say in a lot of what happens—I’m glad we didn’t have to be surrounded by that craziness,” Snow says. The community setting felt important, too. “I am a black woman, and there was more of a cultural connection—seeing people like me and being able to connect on that level.”
Hardeman suspects that practices such as longer pre-natal visits and postpartum home visits may help build that connection. But little has been proven about whether these practices may result in smaller racial disparities. (Hardeman’s collaborative research at the University of Minnesota suggested that doula support may disrupt the race effects in birth.) Roots Community Birth Center provides a place to continue that research. The goal, Hardeman says, is “to build the evidence around why this works and why it’s important, so we can go and say, ‘Hey, this is improving outcomes.’” Early data points toward success, though there isn’t enough yet to draw definitive, scientific conclusions. In its three years of operation, with about 250 births logged, the birth center reports the following:
- A 4 percent C-section rate (compared to 31.9 percent nationally)
- A breastfeeding rate of 99 percent at one year (compared to 35.9 percent nationally)
- A 97 percent success rate for vaginal births after cesareans (compared to 60–80 percent nationally)
- A 0 percent pre-term birth rate for U.S.-born African-American mothers (compared to 14 percent of births to African-American women in the United States)
Standing in the birthing room, Polston and Hardeman agree there’s another telling statistic to consider: readmission rates. Clients leave Roots within hours of giving birth, and newborn screenings take place at home. One of the clinic’s three midwives arrives for a home visit within 24 to 36 hours of each birth, and then again after three days, and again after one week. Because of state regulations, Roots doesn’t get reimbursed for these visits. But they can be lifesaving, Polston says.
During one of those visits, Polston noticed the new mother’s walking appeared ungainly. A trip to the hospital confirmed the woman was suffering from deep-vein thrombosis (as it happens, the cause of Serena Williams’s post-birth complications). Having caught this diagnosis early, the new mother avoided a pulmonary embolism.
Hardeman hopes her research could bolster the case for legislation like the Maternal Care Access and Reducing Emergencies (CARE) Act, a 2018 bill aimed at reducing racial disparities in maternal mortality and morbidity, introduced by Kamala Harris, the junior U.S. senator from California.
“We want to carry this forward not just in this practice but in other practices around the country,” Polston says. “We need to scale it.”
In the meantime, Polston is busy expanding the offerings at Roots. Lactation classes start up soon, and she’s hoping to hire a full-time family-health nurse practitioner to provide more ongoing client and baby care.
“It’s challenging to develop these wonderful relationships and then say goodbye to people at six weeks postpartum,” Polston says.
Snow, for one, hopes to avoid saying goodbye as long as possible. She plans to take baby Yolanda—a healthy seven pounds, seven ounces, 20 inches at birth—to Roots for her well-child care.
