Endeavor Health launches study to target C-section rates, disparities in Black birthing patients

Endeavor Health plans to launch a $7 million study to help pregnant patients, especially Black women, be more seen and heard during labor.

The goal of the study, called I’M SPEAKING, is to ensure patients have more of a say in what happens during their deliveries and to ultimately reduce unnecessary C-sections and health disparities at hospitals around Illinois.

Black patients are more likely to report that their team of providers didn’t listen to them, “or even that the team explicitly violated their requests or bodily autonomy,” according to research included in the I’M SPEAKING proposal.

Dr. Ann Borders, an OB-GYN at Endeavor who works with high-risk patients at Evanston Hospital, is one of the lead investigators on the study.

“In a busy labor and delivery unit everyone’s focused on safety,” Borders says. “Everyone’s trying to have mom and baby have a safe outcome and have the best experience. But things can get lost.”

The idea is to slow doctors and nurses and everyone else down during delivery, to not just provide what that patient needs medically but to do it respectfully and share in the decision making, Borders says.

In Illinois, Black women are nearly twice as likely to die from any pregnancy-related condition and almost three times as likely to die from pregnancy-related medical conditions, such as having a heart issue, compared with white women, according to the state public health department’s latest report on the issue.

The I’M SPEAKING proposal cites a variety of research, including that C-sections contribute to severe maternal morbidity or a “near miss” of death. And while C-sections can be lifesaving, they are major surgeries with potential consequences that disproportionately affect Black women, research shows, such as infections and hysterectomies.

Borders, along with Drs. Beth Plunkett and Emily White VanGompel, will roll out a program over five years called TeamBirth at 22 hospitals around Illinois. This model was developed by Ariadne Labs, a joint center at the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, and it’s intentionally simple, Borders says.

There would be a whiteboard in each patient’s room that would focus on the patient’s preferences. The doctor, nurse and patient would huddle throughout labor, talk about where the patient is at, what the patient wants for their next steps, and write it down.

“We’re able to really track that this is happening, that patients are engaged in these hurdles early in labor and throughout labor, and that they feel really a part of the decision making,” Borders says.

For example, a patient might be pushing for a certain amount of time and the talk turns to, how much longer should she keep going before a doctor recommends a C-section? Maybe the patient wants to change positions or maybe the patient just needs some more time to push.

There has been some progress in Illinois for a key metric providers follow: the C-section rate for low-risk women having their first babies. Over a decade ending in 2022, overall the rate hovered between 26 and 27%, state public health data shows. It was highest for Black and Asian patients compared with white and Hispanic patients. The national goal is just under 24%.

Illinois can look to Michigan for how the TeamBirth model might play out. Lisa Kane Low is a midwife in Michigan who helped implement the initiative there.

For her personally, Kane Low said TeamBirth is a natural fit as she delivers babies. In many ways she said it mirrors the midwifery model of care.

“In the beginning it was a little hard for me to wrap my head around the idea that we needed to gear up to do a whole program to do something that I would consider automatic standard of care,” says Kane Low, who is also a professor at the University of Michigan. “But…there were hospitals or sometimes even units (where) the culture of the unit was to just tell people what was going to happen or to set expectations in a way that didn’t give people choices.”

While the C-section rate for low-risk women having their first baby hasn’t moved much in Michigan, hovering between 28 to 29%, TeamBirth has helped patients and their families feel more engaged and valued with their providers, Kane Low says.

Karie Stewart, a Black midwife in Chicago, says the majority of her patients are Black women who have relayed stories about how they felt other providers didn’t listen to them. Many are especially scared of dying.

“I think this (study) will force providers to be more human and use their words,” Stewart says.

The I’M SPEAKING study is set to begin within the next six months.