Sitting in the small midwifery office at Neighborhood Family Practice on the West Side of Cleveland, midwife Katy Maistros discusses the mothers she’s helped give birth — many of them refugees from different parts of the world.
"We don’t like to say we deliver babies, because women deliver their own babies … but we catch them," Maistros said.
Most recently, she’s noticed high levels of stress in her Hispanic patients. Many fled gang violence or poverty in Latin America, only to face immigration and deportation fears once they arrived in the U.S.
Her Hispanic patients are also often undocumented and uninsured, which impacts their healthcare decision-making.
"We had a mom who had a 20-week loss whose partner was in jeopardy of getting deported right before she had her pre-term birth," Maistros said. "You don’t have insurance, you’re un-insurable. We had a mom from Venezuela who was seeking asylum. She was measuring small. She didn’t want to get a second ultra-sound because she didn’t have insurance. You know, those are real, true decisions that women are making."
Maistros believes it’s this kind of stress that may be behind premature births and infant deaths among Hispanic women who have delivered through Neighborhood Family Practice in the last year.
"In the last two years, the stress level has skyrocketed," Maistros said. "I know multiple women whose partners have been deported during their pregnancy. I had a mom who had to move to Chicago during her third trimester because her husband got arrested and deported, and she had no one to support her."
Maistros is careful to frame her comments as anecdotal, because there’s been no research yet on what’s driving the numbers.
All that’s available is 2018 preliminary data from the Cuyahoga County Board of Health that shows an increase in the number of Hispanic women losing babies before the age of one in the last year.
"It is the first time in the last 15 years that it would be increasing. It is definitely an emerging trend that we need to focus on and watch and try to tackle as much as possible," said Cuyahoga County Board of Health data analyst Richard Stacklin.
According to the Centers for Disease Control and Prevention, the Hispanic infant mortality rate nationally rose slightly in 2017. 2018 data still isn’t available, and researchers warn it’s too early to call it a trend because this data can fluctuate.
Local groups working to reduce infant mortality are grappling with how they might address this potential increase. Many organizations are focused on the African American infant mortality rate, which historically has been higher than any other racial group, and continues to be.
First Year Cleveland, the group tasked with reducing infant mortality in Cuyahoga County, says the main way they’re currently targeting the Hispanic community is working with MetroHealth to translate safe sleep materials into Spanish.
"Every population is impacted. So we want to try to be as inclusive as we can and make certain that people get the information in the best way so they can see it, digest it, and understand it," said MetroHealth's Rita Andolsen.
Back at Neighborhood Family Practice, Katy Maistros cites a Centering Spanish group that focuses on the Hispanic community and aims to reduce stress among pregnant women.
"One of the things we started in the last year that I think is really great that we’re trying to get going is a Spanish-speaking prenatal care group — centering," Maistros said. "We have a group of Spanish speakers and we have a midwife who’s proficient in Spanish. So they meet once a month on Tuesdays for prenatal care. I think that a support group could help something like this, but we don’t have the numbers or the data to see if it will make a difference."
For now, she hopes Neighborhood Family Practice’s focus on personalized, individual care — from not only midwifes but their team of other health providers — may help hone in on some of these stressors affecting Hispanic women.