The Problem
Significant racial disparities in health outcomes exist for pregnant and postpartum patients in Nebraska and across the U.S. Nationwide, maternal mortality rates have been climbing rapidly over the last 5 years, with Non- Hispanic Black mothers experiencing an excessively high burden of mortality. Nebraska is no exception to these alarming rates and inequities in the burden of excess deaths. More than 80% of pregnancy-related deaths are preventable. Furthermore, about 30% of Black, Hispanic, and multiracial women report being mistreated while receiving maternity care. A patient-centered approach can improve obstetric care for Women of Color.
Birth Equity (BE) Initiative Aim
By December 2025, more than 75% of NE birthing hospitals will be participating in the Birth Equity Initiative and more than 75% of participating hospitals will have all key strategies in place to address maternal disparities and promote birth equity between October 2023 and December 2025.
Developed with Intentionality
NPQIC began conceptualizing the Birth Equity Initiative in 2021. Community partners, clinical leaders, and patient voices have provided crucial input for key strategies and resource development. In Phase 1, the initiative will be implemented in the birthing facilities in Douglas and Lancaster Counties, which serve the largest proportion of Nebraska’s birthing people who identify as Black or people of color. NPQIC will then utilize early feedback to make any necessary updates and disseminate the initiative statewide in Phase 2.
We'd like to specifically recognize I Be Black Girl, the Nebraska Black Doula Collective, and A Mother's Love for working with us to develop this initiative with patient-first, culturally appropriate considerations. Additionally, we thank the community of Black doulas who have shared their lived experiences and wisdom with us
Birth Equity Resources
National Guidance
ACOG Committee Opinion 729: Importance of Social Determinants of Health and Cultural Awareness in the Delivery of Reproductive Health Care (January, 2018)
ACOG Committee Opinion 825: Caring for Patients Who Have Experienced Trauma (April, 2021)
Joint Statement Obstetrics and Gynecology: Collective Action Addressing Racism (August, 2020)
ACOG Committee 736: Optimizing Postpartum Care (May, 2018)
CDC Vital Signs: Many Women Report Mistreatment During Pregnancy and Delivery (September, 2023)
- Full MMWR Vital Signs Report: Maternity care experiences — United States, April 2023 (September, 2023)
Patient Education Maternal Urgent Warning Signs
AIM “Urgent Maternal Warning Signs”
Postpartum Care
MMHLA: The Fourth Trimester Fact Sheet
Respectful and Equitable Care Resources
Diversity Science: Dignity in Pregnancy & Childbirth: Preventing Racial Bias in Perinatal Care (Free)
March of Dimes: Awareness to Action: Dismantling Bias in Maternal and Infant Healthcare
AWHONN: Respectful Maternity Care Implementation Toolkit (RMC-IT)
ACOG: Respectful Care e-Modules (Free)
Doula Friendly Practices
NEW NPQIC Brief: Findings from Focus Groups with Black Doulas
NEW NPQIC Brief: Findings from the Nebraska Provider Survey
CMQCC: Strategies for Doula Implementation, (2022
New York Coalition for Doula Access: Principles of a Doula-Friendly Hospital
Improving Patient-Reported Race and Ethnicity Data Collection
American Hospital Association:
HPOE: Reducing Health Care Disparities: Collection and Use of Race, Ethnicity and Language Data
NPQIC Process Flow and Sample Language for Collecting Data on Patient Race & Ethnicity (Adapted from ILPQC)
Review of Hospital Maternal Health Data by Race, Ethnicity, and Medicaid Status
AHA: Framework for Stratifying Race, Ethnicity, and Language Data
MassDPH: Racial Equity Data Road Map
Engaging Patients and Community in QI
CDC: Personal Stories of Pregnancy-Related Complications
AHRQ: Guide to Patient and Family Engagement in Hospital Quality and Safety
AHA: A Playbook for Fostering Hospital-Community Partnerships to Build a Culture of Health
Webinars
- Birth Equity Kickoff 11/8/23
- Optimizing Race and Ethnicity Data Collection 12/2023
- Operationalizing Race and Ethnicity Data Collection 1/2024
- Respectful and Equitable Care 2/2024
- Implementing a Comprehensive Implicit Bias Training for Provider and Nurse Education 3/2024
- Engaging Patient Partners 4/2024
- Integrating Doulas into the Care Team 5/2024
- Postpartum Safety Education 6/2024
- Actionable Respectful Care Practices and PREM Implementation 8/2024
- Patient Engagement Strategies 9/2024
- Strategies to Increase PREM Survey Completion 10/2024
Birth Equity Toolkit
BE Key Strategies for Improvement
BE Hospital Data Collection Form
PDSA Worksheet
Patient and Community Engagement
Respectful and Equitable Care Practices
Respectful Care Practices Poster
Respectful Care Handout
Patient Reported Experience Measure (PREM) Survey
PREM Survey Flyer with QR Code (Available on Request)
