As a health-care administrator for the state of California, Kathryn Hall knew all about the high cost of caring for seriously ill babies.
The numbers went something like this: Comprehensive prenatal care costs around $2,000 and greatly improves the chances that a woman will give birth to a healthy baby, while neonatal care for a premature and sick baby can cost $150,000 or more.
But the stark difference in costs did little to convince the state to focus on prevention. In fact, during the 1980s, Hall said, “I saw the public health budget just being stripped to pay for hospital care. One of the places it was being stripped was with something called drug babies.
“All of a sudden, the hospitals were deluged with babies that cost between $150,000 and $300,000 to keep alive. So when you have a baby that’s sick, you don’t say, `Let’s put the money into prevention.’ You’re going to take care of that sick baby that’s there in your face right now.”
Hall was especially dismayed at the disproportionate number of deaths among African-American babies. Something everyone in the health business knows, Hall said, is that death rate for black babies is typically double that of whites.
“When you talk to people, they’re not surprised if the baby lives or dies,” she said.
In 1988, Hall set out to design a program that would encourage African-American women with high-risk pregnancies to get prenatal care.
“I thought that a way of addressing that would be to take moms who were at risk of having a baby that was going to be a high-cost baby and pairing them up with someone, a community volunteer, who would make sure that the women got into care — and would be there to reassure the woman that she needs to feel good about herself because that also was a piece that was missing.”
Hall said she didn’t want simply to tell her boss about her idea — she wanted to show him. Thus was born the Birthing Project and its first Baby Bunch, a group of 10 volunteers, or “sister friends,” and 10 pregnant women, or “little sisters,” who were all due around the same month.
“I wanted to demonstrate that if you took these 10 women, adopt them through their pregnancies and through their babies’ first year of life, that their outcomes would look a lot different than equivalent women who did not have that kind of support,” Hall said.
“That was about 3,000 babies ago. I really intended to only do it once just to show them, and then someone else could do it. I didn’t think it was going to be me.”
But something happened during the Birthing Project’s first round of births that changed Hall’s life forever.
“I had a little sister just like everyone else had a little sister. And my little sister’s baby died. I think I went into this kind of as a health administrator, and I was really looking at the cost and looking at what the outcome would say in terms of the difference it would make fiscally. And when I got involved with my own little sister, then it became more than just a demonstration project. It was my own sister that this was happening to. And I think I lost objectivity.
“When her baby died, it changed my whole life. I think I lost my mind for about three months. That was the first time I understood that infant mortality meant counting dead babies.
“I had been a health administrator for many, many, many years, and I think I used the term infant mortality or infant morbidity probably every working day of my life. And until I held my sister’s baby, that word was not real for me.
“It seemed really absurd, knowing everything that we know in this country and having all the services that we have, that we count as many dead babies as we count.”
In her little sister’s case, Hall thought the baby should not have died. And she felt somewhat responsible.
“Just like any mother, she looked at me and said, `Why did this happen?’ because she expected me to take care of her. And I couldn’t explain it — I mean, I could explain it, but I didn’t like the explanation myself. I couldn’t really explain it to me. It felt like my side of it fell through.”
Hall’s little sister, a diabetic, had been dropped from prenatal care because she had missed several appointments.
“As a health-care provider, I understand that,” Hall said. “If you are an obstetrician and you keep women in your care who don’t come to see you, it increases your risk and it makes you pay a lot more for your insurance, to the point where you might not be able to provide any care at all because you can’t pay the insurance.
“She didn’t have a car, and she didn’t have a phone. In one case she missed an appointment because she was trying to get to the bus stop and she literally passed out, and the people who helped her didn’t take her to her appointment, they took her home. It wasn’t that she missed appointments because she didn’t care; she missed appointments because she couldn’t get there.
“I think a lot of the poor care that my little sister received was because the health-care providers thought that she didn’t care. So she taught me a lot, and her baby taught me a lot. And that’s probably why I’m here and not working for the state anymore.”
What the Birthing Project has been able to do is help women stay pregnant longer, which increases the chance they’ll have a healthy baby.
“That’s why the medical community has been very interested in the Birthing Projects because the birth outcomes are actually better,” Hall said. “And it doesn’t cost a lot of money to do it. You’re basically finding a volunteer to be with the woman helping her stay pregnant as long as possible.”
Hall uses the first baby born in the Birthing Project as an example of how the program can work. After the little sister’s baby was born, the sister friend showed her what she did as a nurse for the county health department.
“Now I love it,” said Hall. “When I walk into the medical center, here the first person I see is that little sister, who’s now the admissions clerk.
“That’s the Birthing Project at its best,” Hall said. “That’s what you hope to have happen.”
Successes such as that keep Hall going. But it hasn’t been easy. At first, the Birthing Project received funding from a private foundation. After three years, Hall decided she wanted to build a clinic so she could provide more services to women. The result is a homespun clinic that opened three years ago and is staffed by and for women from the community.
“What really makes our services different is that the women we tend to see for medical services need more than medical care to have a healthy baby,” Hall said.
“They also need to heal themselves. We really practice making the woman feel real good about herself. And the better she feels about herself, the more likely she’s going to do the things she needs to do for herself and for her baby.
“The hard part,” Hall said, “is making a business out of an idea.”
In fact, the Birthing Project clinic was on the verge of closing last year. Hall’s savior came forward as she was recognized with an award from Essence Magazine. At the awards ceremony, Brian Marks, the owner of African Pride hair-care products, offered Hall $25,000 to keep the clinic open.
“This is the hardest thing I’ve ever done in my life,” Hall said. “It’s hard because I feel responsible to my community. I feel responsible because African-American infant mortality is really a serious issue in our community. And I thought someone else was taking care of it.
“What I have found out is we don’t have a special czar or bureau or branch or director or anyone at the national level whose job it is do something about African-American infant mortality. We give a lot of lip service to it. But there’s not one person you can call who’s an expert in it. So the Birthing Project has become that organization. That’s one thing.
“The other sense of responsibility is that I really do think we have some answers, and we need to figure out a way to talk about those answers.”
One way is through Birthing Project USA, which has helped women in 35 cities establish Birthing Projects of their own. The first one outside Sacramento started in 1991 in Phoenix. Soon after that, Essence Magazine ran an article about the project and Hall was overwhelmed with calls from people who wanted to start projects of their own.
“That’s how Birthing Project USA got started. They call us the underground railroad. We do training by phone, fax and mail.”
Some of that may change soon. Marks is providing funds for training and support of the satellite projects.
“I think I do understand how Harriet Tubman felt,” Hall said. “It’s like you’ve gotten to Canada and you go, `Whew, that’s one.’ You go back and do it again, and each time you realize that something could happen that could cause you to lose everything. But you keep on taking the chance to do it because it’s worthwhile, and as long as you have breath in your body and your heart is beating you’re going to do it, but you know success is not a given. Each time it’s like a miracle. Each time we get a baby that’s OK and a woman that’s OK, it’s like getting to Canada.”
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For more information, contact the Birthing Project at 916-552-7872.
