Here's a question, Fort Wayne: 'How can we as a community raise our mothers?'

In a TED x Fort Wayne event from 2019, Jennifer Norris-Hale raises the question, “How can we as a community raise our mothers?” 

Norris-Hale is a mother of four, born and raised in Fort Wayne. In her speech, she details the experience she had as a first-time mother; 40 weeks of planning for a natural birth, followed by an unplanned C-section during a heat wave in New York City, where she was living at the time. Still loopy from the medications given to her during birth, on her first night in the hospital, she heard a nurse say of her, “The mother is not fit.’ 

Jennifer Norris-Hale, founder of Mission: Motherhood, with her children.
Those words stuck with Norris-Hale as she attempted to adjust to her new life as a mother and the overwhelming, new emotions that come with a newborn. She says she didn’t speak of the overwhelming feelings she was having, or of her worry about bonding with her son until she was on an ambulance stretcher for the second time, speaking to an EMT, who had just been called to her house for the panic attack she was experiencing.

It wasn’t until after the birth of her second child that she was officially diagnosed with postpartum depression. 

According to research by the CDC, roughly 1 in 8 women in the United States experience depression after a live birth experience. 

While race and ethnic background alone do not make a woman more or less likely to experience postpartum depression, women with certain socioeconomic risk factors, such as low monthly income, less than a college education, unmarried, or unemployed, are 11 times more likely to experience depressive symptoms postpartum than women with no socioeconomic risk factors. 

Because of long-standing systems of inequality, Women of Color are more likely to have socioeconomic risk factors, and thus, more likely to experience postpartum depression. Yet, when they speak out to receive help, they are also less likely to receive follow-up treatment or continual care.
Portrait of Jennifer Norris-Hale, founder of Mission: Motherhood.
Now, Norris-Hale has made it her mission to help other mothers in the community work through mental health struggles. Back to the question she posed in her TEDx speech, she flips the old proverb, “It takes a village to raise a child.” She says it takes a community to “R.A.I.S.E. a mother.” It’s the tagline for the nonprofit she’s creating in Fort Wayne, Mission: Motherhood.

R.A.I.S.E. stands for reverence, awareness, inclusion, support, and education. These are pillars Norris-Hale uses to help moms who might be struggling with Perinatal Mood & Anxiety Disorder (PMAD) or Postpartum Depression.

Already, Mission: Motherhood has formed a support group for moms, called “Mamas,” in collaboration with Courageous Healing, Inc. The curriculum-based support group meets once a week and is open to mothers during and after pregnancy. Norris-Hale says the group talks about different topics, like mood management, but its impact is much greater.

“It’s more than just curriculum,” she says. “It’s really forming those relationships and just being beside moms as they're trying to navigate motherhood and giving them the confidence that they can and that they're not alone. Often, as moms, we feel very alone, and we feel very much like we're against this idea of perfection or idea of what we thought motherhood looked like, and the reality can be very different. So helping to normalize what a mom’s motherhood experience is really important for her and her baby.”

Even when the pandemic kept groups from meeting in-person, “Mamas” met via Zoom, and Norris-Hale began supporting moms one-on-one, building relationships and finding ways to virtually meet them where they were.

Jennifer Norris-Hale at the Greater Fort Wayne: Climb Out of the Darkness Walk.
While her mission is focused heavily on mental health and wellbeing, Norris-Hale recognizes that moms need more than emotional support, particularly during a pandemic that has caused global supply chain shortages. She also runs a diaper bank, which unlike a lot of other local resources, requires zero prerequisites to qualify for help.

“In the community, there are a lot of programs that provide incentive-based items for families, and that’s great,” says Norris-Hale. “There’s always room for incentive-based programs. But we really saw a need for greater access to diapers. People don’t really see diapers as a need, but it is. It’s not something that’s provided by state or federal funding, so it’s not something that families can buy through WIC or anything like that.”

The diaper bank works with Connect Allen County, the St. Joe Community Health Foundation, which assists with the funding, and the Community Harvest Food Bank, where the diapers are stored and distributed. To arrange the pickup of diapers, families can text (260) 338-8939.

Jennifer Norris-Hale, founder of Mission: Motherhood, works a diaper drive event with her youngest son.
Norris-Hale isn’t the only one in Fort Wayne addressing the challenges of motherhood. Healthier Moms and Babies has been helping moms in the Fort Wayne community for 25 years. Its mission is to prevent infant mortality and improve birth outcomes in the Fort Wayne community. And in Indiana, the numbers they’re up against are grim. The state’s Infant Mortality Rate (IMR) in 2020 is 6.55 deaths per 1,000 live births, a slight increase from 2019’s rate of 6.54, compared to the national rate of 5.4. These numbers put Indiana in the top 10 states with the highest infant mortality rate in the nation. 

Allen County’s IMR for 2020 was 6.9. Allen County also has some of the worst IMRs for Black and Hispanic infants, which are 15.2 and 8.9, respectively. Furthermore, Allen County is once again noted on Indiana’s discussion of Infant Mortality Rates because the 46806 zip code has some of the highest numbers in Indiana, and has been on the 2014-2018 report, the 2015-2019 report, and the most recent, 2016-2020 report.

The numbers for maternal mortality are even higher, as Indiana is notoriously one of the states with the worst maternal mortality rates. According to the Indiana Maternal Mortality Review Committee, created in 2017 to reduce Indiana’s maternal mortality rates, there were 74.2 deaths per 100,000 live births in 2019, a decrease from the 2018 numbers.
Portrait of Paige Wilkins, Executive Director at Healthier Moms and Babies.
Perhaps even more worrisome about these numbers is that the Indiana Department of Health and the Indiana Maternal Mortality Review Committee (IMMRC) determined a majority of the pregnancy-associated deaths in 2019 were preventable. In fact, the most common cause of death was accidental or intentional overdose, accounting for 33.3 percent of all pregnancy-associated deaths. 

Substance abuse is one of the issues Healthier Moms and Babies Executive Director Paige Wilkins hopes to address in the future. She says they’re creating a program, but are searching for the funds to make it a reality. Currently, they have a Baby & Me Tabacco Free Program, which Wilkins says has a 60 percent success rate of women who quit smoking and stay quit. 

When the topic of lowering a state’s maternal mortality is discussed, people often look to California as an example. As the United State’s maternal mortality rate continually spiked between 2000 (17.1 deaths per 100,000) and 2013 (27.8 deaths per 100,000 in 2013), California opted to do something about the growing issue. The California Maternal Quality Care Collaborative (CMQCC) was formed in 2006, and between 2006 and 2016, California saw a 65 percent drop in maternal mortality. 

How did they do it? The CMQCC developed toolkits that helped to address the most common, preventable maternal and infant deaths and complications. These evidence-based toolkits helped hospitals respond to Cardiovascular Disease, Early Elective Delivery, Hemorrhage (1st and 2nd editions), Maternal Venous Thromboembolism, Preeclampsia, and Supporting Vaginal Birth and Reducing Primary Cesareans. They used large-scale, collaborative roll-outs to get these toolkits to hospitals.

While Indiana’s most recent Maternal Mortality Review does address problems similar to what California addressed when they rolled out the toolkit, Indiana’s committee does not provide standardized toolkits for hospitals and care centers. Instead, it makes recommendations of what facilities and systems of care should be doing to help reduce maternal mortality. This list includes creating guidelines for prescribed medications, implementing written policies on the standard of care for pregnant and postpartum women, requiring all postpartum discharges to include education and literature on post-birth, and adopting standardized care and training for the management of pregnancies with unknown or unvisualized locations (ectopic pregnancies). 

Home visits are a key part of Healthier Moms and Babies' programs. Here a home visitor chats with a mom and her baby.
As of the most recent review, published in November 2021, it appears that the state of Indiana is taking the steps to address some of the most common causes of maternal mortality. Some of the mentioned “Work Already Underway” includes screening and addressing drug usage, standardizing healthcare treatment for pregnant and postpartum women, extending healthcare coverage for postpartum women, and addressing the need for lower-cost childcare.

(For the full list of recommendations and works in progress by the Indiana Maternal Mortality Review Committee, see pages 64-85.)

Unfortunately, improving care in hospital departments doesn’t do much for residents in the 34 counties in Indiana, counted by the IMMRC, who lack impatient delivery departments, otherwise known as “obstetric deserts.” But this is another issue being addressed by the state. Through a program called, “My Healthy Baby”, women are being connected with prenatal and obstetric care. While Allen County is not one of the counties lacking a hospital or a hospital with an impatient delivery department, it was enrolled in the My Healthy Baby rollout in 2020 because of its high infant mortality rate. 

Locally, Healthier Moms and Babies is addressing a lot of the most critical pre-and postpartum needs mentioned in the IMMRC Report. Their programs offer a variety of services, which provide support and education for the physical and mental well-being of mom, dad, and baby, including providing connections to other organizations that help prepare for birth and parenthood.

Some of the Healthier Moms and Babies programs include Healthy Start, which pairs expecting mothers with an experienced home visitor early in their pregnancy. The home visitor acts as an advocate and mentor for the mom, providing health education and encouragement.

Pictures with their home visit nurse, this mom and baby graduate from the Nurse Family Partnership Program at Healthier Moms and Babies.
They also offer the Nurse Family Partnership, where an RN is paired with a first-time, low-income mother to provide support, advice, and information for the new mom. Both programs last until after birth, providing support through the “fourth trimester” or the postpartum period. Wilkins says moms are usually with their home visitor or RN for 2-3 years, which allows them to bond and build relationships. 

Additionally, they provide mental health support through their Maternal Mental Health Program, and they support dads with the Fatherhood Initiative, where dads are paired with a mentor for education and encouragement.

A program unique to Healthier Moms and Babies is the Own Your Journey Program, which is focused on preconception and interconception health. Wilkins says this gives them a chance to address health concerns and other factors that might affect a pregnancy before conception. 

“When somebody comes into our services and they're pregnant, we're trying to put out a gazillion fires, and if some of those risk factors would have been addressed and mitigated before they became pregnant, their birth outcomes would be so much better off,” Wilkins says. “So we're working with women before they become pregnant on helping them, making sure they go to a well visit, making sure they know how to live a healthy lifestyle. That also includes financial and mental health.”

Addressing the risk factors helps, even after conception. Data from 2020 shows that 10.4 percent of babies born in Indiana that year were born preterm, which means their born before 37 weeks of pregnancy. Wilkins says only six percent of the babies born in a Healthier Moms and Babies program are born preterm, which she credits to the education, support, and self-advocacy of clients. 

Wilkins says they’re really one of the only local organizations that serve women during the prenatal period. That time is critical to the well-being of both the mom and baby, as moms who go through their programs are 10 times more likely to celebrate their first birthday with their baby. 

Women graduating from the Own Your Journey Program at Healthier Moms and Babies.
Another indicator of poor birth outcome Healthier Moms and Babies pay close attention to? Birth spacing.

“Women need to wait 18 months before having another baby,” says Wilkins. “So say, for instance, if we have a woman that comes into our services, and she just had a baby six months ago, she's already at like high risk of a poor birth outcome because she didn't wait the appropriate 18 months. It takes a while for your body to heal. What you went through is major, so 18 months is that indicator.”

Family planning is interwoven in the education provided by Healthier Moms and Babies. Wilkins says they discuss all types of birth control, including natural family planning, which gives women the chance to make a decision. 

“They're able to go into their doctor and say, ‘Okay, this is what I'm kind of leaning toward,’” says Wilkins. “She and her doctor can make the decision that best works for them.”

PATH4YOU, which stands for Pregnancy at a Time that’s Happy and Healthy for You, is another Indiana project focused on lowering maternal and infant mortality rates by providing free birth control.

“We are the first intervention in our state to focus upstream on this idea of helping people plan their pregnancies by giving them free access to birth control,” says the project’s principal investigator, Dr. Tracey Wilkinson, M.D., who is also a pediatrician and a pediatric health services researcher.

Portrait of Dr. Tracey Wilkinson, M.D., the Dr. Tracey Wilkinson, the principal investigator on the PATH4YOU project.
How exactly does free birth control lead to lower maternal and infant mortality? Not only does it allow for birth spacing for women who are already mothers, which gives them a better chance of having a healthier birth, but also, it allows women to decide when is the best time for them to have a child, or if they want to have one at all. 

PATH4YOU is based on three pillars: Pregnancy Intention Screenings, Comprehensive Contraception Counseling, and Same Day Access. Patients are asked about their pregnancy plans and their birth control wishes and experiences in an online “Birth Control Explorer.” Then, they are given information on the contraception options that might work best for them, based on their answers. After that, they schedule an appointment, where they get to discuss their options and choose what’s best for them.

Wilkinson says PATH4YOU makes sure that whatever method a patient picks, they get for free, that way cost doesn’t affect their choice, and they can choose based on what will work best for them. 

PATH4YOU tries to ensure that all patients receive same-day access, which eliminates more barriers for some. In a typical doctor’s office, patients must return on a different date to receive certain birth control methods. This is unrealistic for someone who might need help with transportation, childcare, or cost. 

Additionally, patients don’t always get fair treatment in a doctor’s office, and they might be rushed or coerced to pick a birth control method, or their experiences might be overlooked. Wilkinson says this type of treatment doesn’t happen at PATH4YOU.

“We do all of this under the framework of reproductive justice, which is really important to us in terms of a lot of the work that we do,” she says. “The reproductive justice framework was started by Women of Color back in the 1990s, where it states that it's a human right for bodily autonomy and to make decisions about to parent or not to parent in communities that are healthy and safe. We make sure that these decisions are patient-centered and led.”

Jennifer Norris-Hale, founder of Mission: Motherhood, works a diaper drive event with her youngest son.
It all goes back to Jennifer Norris-Hale’s question: “How can we as a community raise our mothers?” 

Through Reverence, Awareness, Inclusion, Support, and Education.