How Inland Empire providers are working to improve Black maternal health

Black mothers in California have a two times higher rate of fetal mortality compared to White mothers and two and a half times higher than Hispanic mothers, according to the California Department of Public Health.

CDPH data also shows that babies born to Black mothers are two and a half times more likely to have a low birth weight compared to babies born to White mothers and almost two times more likely than babies born to Hispanic mothers.

State and local programs are looking to change that.

Black Infant Health, a statewide program, emphasizes equitable healthcare, providing mothers with alternatives and other assistance, including transportation, to overcome obstacles preventing them from receiving timely and frequent care.

In the Inland Empire, organizations supported by BIH, such as the NAEBOR Clinic in Rialto and Sankofa Birthworkers, are working to provide essential services to Black mothers.

Gaps in care

Dr. Guillermo Valenzuela, who owns and operates the Mommy and Me Clinic group specializing in obstetrics, gynecology and pediatrics, recognized a gap in care available to Black mothers and began exploring how to provide those services.

“We have a really dynamic team and we try to care about what’s going on in the population in our area,” Valenzuela said. “At one point, we said, ‘What can we do?’ We’re aware of the mortality rate for Black women … what can we do for our population?”

In 2018, Valenzuela and two colleagues, Kendra Flores-Carter and Dr. Kristy Roloff, began working to open the NAEBOR Clinic at the Mommy and Me Clinic in Rialto to provide care tailored to Black mothers. The clinic opened in 2022.

Combatting mortality and birthweight risks for Black mothers and their babies are a priority for the NAEBOR clinic, according to Flores-Carter, program director of social services.

Key to the clinic’s success, Flores-Carter said, is providing care through a culturally responsible lens, fostered in an environment where every practitioner and staff member operates with their patients’ past experiences and traumas in mind.

An associate professor of social work at Cal Baptist University, Flores-Carter designed policies she and the clinic team hopes will be widely implemented in other clinics and hospitals, such as ensuring patients clearly understand their options so they can make informed choices that are not based in fear.

For example, Valenzuela said, many first-time moms are not given the opportunity to labor long enough, which can lead to medical interventions such as cesarean sections.

“We said ‘we’re doing too many’ ” C-sections, Valenzuela said, “so we made a plan to bring it down.” The clinic has worked to lower C-sections from a rate of 25% among first-time mothers to about 18%, he said.

That approach falls in line with the U.S. Department of Health and Human Services’ goal to see fewer C-sections. The department’s own data shows C-section rates are worsening for low-risk, first-time mothers and are linked to increased risk of infections and blood clots.

The NAEBOR Clinic has a contract with Arrowhead Regional Medical Center in Colton. The hospital was recognized for lowering C-section rates in first-time mothers in both 2023 and 2024, according to the annual Maternity Care Honor Roll by Cal Hospital Compare and the California Health and Human Services Agency.

Improving lives

Care for NAEBOR patients goes beyond lowering C-section rates, Valenzuela said, adding the clinic team takes great pride in its cleanliness, appearance and compassionate staff to provide a place where patients want to be.

The clinic also offers mental health services and assists patients with applying for social programs such as food and housing assistance.

Roloff, the medical and project director at NAEBOR Clinic and a maternal-fetal medicine physician, said her primary job is to use science and data the clinic collects to develop interventions that will improve patients’ lives.

Roloff stressed the importance of clinic practitioners embracing a trauma-informed approach to care, which involves medical staff understanding and taking into consideration the past experiences of the patients they treat.

“We see a patient as a person. They’re not just patients. We recognize that we all come with baggage, whether that’s from adverse childhood experiences, things like a family member having gone to prison, or a death in the family, at a young age,” she said. “We think in the NAEBOR Clinic (that) experiences with racism and discrimination create toxic stress.”

Toxic stress does not immediately disappear for patients once they leave a medical facility, Roloff said, explaining it can have an impact on all future medical interactions.

“In order to interrupt that toxic stress and put an end to that kind of thing, we all need to work together to interact in a way that’s conducive to progression in health,” she said.

Roloff also emphasized the importance of recognizing one’s own bias as a practitioner and the need to set it aside when making medical decisions for patients.

Proof is in the patients

Cherie-Amie Tshimanga, a NAEBOR Clinic patient who recently had her third child under its care, said her first birthing experience at a Los Angeles hospital was less than ideal.

Tshimanga, originally from Congo, moved to the Inland Empire while pregnant with her first child but was afraid to begin care somewhere else, so she chose to stay with her physician in L.A., traveling there for appointments and the delivery of her baby.

“I would say that the doctors were not too friendly. I was so big in my pregnancy, and my baby was so big, so they made me so uncomfortable every time I went in. They would say, ‘Oh, you’re too big. I told you to stop eating,” she said. “I’m not even a good eater, but they made me feel like I was eating too much, and that’s why my baby was big.”

She said staff told her there was no way she would have a natural birth and C-section was her only option.

“I was pushed — it’s not something that I wanted,” Tshimanga said. “Coming from a foreign country, it’s not something that we usually do. We don’t really believe in C-section.”

With her second pregnancy, she opted to find care locally and her physician referred her to the NAEBOR Clinic.

The clinic’s practitioners were kinder in their approach, Tshimanga said, and helped her formulate a healthy diet while pregnant.

“You eat very little, but it’s not good for you during pregnancy. So with this pregnancy, they told me exactly what to eat and they told me how to do exercise and the types of exercise that I needed to do, which really helped,” she said.

The experiences with her second and third pregnancies with the NAEBOR Clinic were very different from her first experience in L.A., she said.

“When I started coming in, I didn’t feel like I was coming to a clinic,” she added. “I feel like I am coming to my second home. Every time I come in, I’m very much welcomed. I can ask any question without fear.”

Sankofa Birthworkers

Dr. Sayida Peprah-Wilson, a clinical psychologist, doula and founding member of the Sankofa Birthworkers, a collective of Black maternal care practitioners that includes doulas and midwives, also recognized the gap in care for Black mothers in the Inland Empire and worked with her colleagues to change that.

Peprah-Wilson said the collective is working to increase the number of certified doulas and midwives to better serve the community, particularly through Medi-Cal, the state’s Medicaid program, thereby providing wider access.

“We’re doing a lot of advocacy on the diversity side with Medi-Cal to push for Medi-Cal to cover as many of these services for people who can’t afford to use those services on their own,” she said.

Practitioners in the collective, which began in 2018, have reported issues with private insurers refusing to sign off on care, but they continue to advocate for alternatives and work to grow the network in the Inland Empire.

Deidre Medley Coutsoumpos, a doula and founding member of Sankofa Birthworkers, helps train incoming doulas for service.

“I was raised with and have really fostered this idea of community and how we aren’t meant to do this (motherhood) alone,” Coutsoumpos said.

She said that she knew others were looking for community and help during the birth process, just as she was, and wanted to build one.

“If you want to go fast, go alone; if you want to go far, go together. I wanted to see significant change in the work and sustainability for those who are doing the work,” she said. “The collective was born out of, ‘Where are all the other Black people at?’ ”

The collective started small, she said, but continued to grow every time it met. The group switched to online meetings during 2020 to weather the storm of COVID and now offers both in-person and virtual networking.

According to Coutsoumpos, the collective is an interdisciplinary network that includes lactation consultants, maternal mental health professionals, pelvic floor specialists, yoga teachers, and birth and maternal educators.

“We truly wanted to create a space that would support us by us,” she said, “because it’s hard up here in these streets when it comes to not just race, but practicing in general.”

Coutsoumpos said the collective is working to attract more members by offering comprehensive, free training for doulas who live and work in the Inland Empire, and there are plans to establish a nonprofit to raise funds to expand services and reach.

“I really consider myself a maternal health advocate, or a conduit for community connections, because I love bringing the people together,” Coutsoumpos said. “I love helping to create safe spaces, curate safe spaces for us because we do not get a lot of places to be soft and our whole selves, and just be with all of the things that make us who we are because we’re human.”