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Empowering Mothers, Saving Lives: Inside the First Steps and Beyond Initiative


Margaret Larkins-Pettigrew, MD, and First Steps and Beyond director Takiyah Durham, MBA, explain how the community-centered program ensures pregnant patients are equipped with resources while receiving equitable care.

Infant mortality rates continue to rise even with the availability of advanced resources. In response to a 2015 University of Pittsburgh study highlighting health disparities, particularly the alarming death rates among Black babies, the First Steps and Beyond initiative was launched. Highmark Health and Allegheny Health Network (AHN) joined forces to address this issue, with the overarching aim of ensuring that every Black baby celebrates their first birthday.

Margaret Larkins-Pettigrew, MD, senior vice president and chief diversity officer of Highmark Health/AHN, professor and academic chair of obstetrics and gynecology at Drexel University College of Medicine, and Takiyah Durham, MBA, the director of First Steps and Beyond at Enterprise Equitable Health Institute, and are actively engaged in this program. In an interview, they detailed the objectives and processes of the program.


Can you provide an overview of the First Steps and Beyond program and its objectives?

Margaret Larkins-Pettigrew, MD: So basically, we decided that if we put together a program that includes everyone who touches a baby, and touches a mom, then this would work. But if we didn't, if we could not pull together a large coalition of individuals, who every single day wake up trying to make sure there's a difference in the lives of all women and babies, it wouldn't happen. And that's where we started, we said, “Let's see, let’s pull together an FQHC. Let's pull together all of the large institutions and small institutions in our communities and let's make sure we're not working in silos anymore.”

So that was the drive in the first move to form First Steps and Beyond. And that's when we held a 2 day Summit, had everybody leave your egos at the door, let's talk about resources that will come into Allegheny Health Network and Highmark as a fiscal agent only, but form these committees that would make decisions around how the money is spent, where the efforts would go, and so that's how we decided to start the program and it's helped. We said, “Okay, so let's look at the evidence, look across the country look and see what are the root causes of why this happens in the first place, right?” And based on evidence, and based on all of the studies that we looked at, we found 4 major areas that we could significantly impact in order to make a change.

That first area that Takiyah mentioned, was around decreasing racism, decreasing obstetric racism, and how we listen to women and how we really communicate with them and making them partners with us as they enter this pregnancy journey–before, during, and after the pregnancy journey, and understanding the difference in what happens with black women and women of color going into a pregnancy journey. So, it was more than just how we get to that first piece as far as understanding obstetric racism, it's understanding why women of color ended up in a space where obstetric racism was a major thing we had to call out.

And we talked about the history, a little bit about the weathering, and how when we think about leaving your furniture out every single year, year after year after year, and how that furniture is just broken down. That's what happens to black women in this country, all these mini micro and macro aggressions in the country. And so, it actually physiologically changes their bodies, it makes them much more prone to infections because of their immune system, their increased stress, they have increased catecholamines. I will just also evidence that there's, what they call a shortening of telomeres, so there are physiological, psychological, emotional factors that affect black women before they even enter the pregnancy journey.

So, that first piece of obstetric racism was really, really important to really tackle. And so that's the number one problem, how do we do that? We can talk about how we do those and once we go through our objectives, that's the first key thing that we wanted to attack. And then Takiyah do you want to talk about preterm labor and preterm death?

Takiyah Durham, MBA: Yes, and as it relates to labor and preterm dads, what we do is we look at ways we can partner with our physician groups and also our partner health care system. So, we do have strong partnerships throughout our hospital system. We want to make sure in order to eliminate preterm deaths that we identify pre-existing. When a mom has any inequalities that she's facing, from a health care perspective, we know that the toxic stress will actually trickle down to that pregnancy from a birthing experience perspective. So, we do partner with our health care systems and our clinicians to make sure that mom has resources so that she can be successful.

We actually have created a resource guide so that when she's working with her care team, she can advocate for her care, she is well equipped. We are partnering with a doula work group as well so that she can have that holistic and emotional support. And then we are partnering with different work groups from a clinical perspective so that moms are well supported. We also have a community advisory board of moms to be able to guide and direct our programming so that they are a voice behind the community to be able to help guide and direct our policies and procedures.

The beauty of it all is what we go back to with the first question: a community-centered approach. The moms were very happy to be able to be in a space to say, “When I was a mom,” or “When I experienced a birthing experience, this is how I wanted to be treated,” or “When I experienced, maybe a stillborn,” or “when I experienced that toxic stress this is how I would have liked that experience to go.” So, in order to eliminate any negative birthing experience, we wanted to involve the mothers who had that lived experience to be a part of this process.

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