Lowering the high maternal mortality rate among Black mothers in Mississippi is a central aim of Raven Burrell, PA-C, MSPAS, MPH, CPH, an Ob/Gyn PA at the Delta Health Center in Mound Bayou — the first Federally Qualified Health Center in the United States. In addition to helping patients safely deliver their babies, clinicians at the center use prenatal visits as a jumping-off point to connect patients to ongoing preventive care and specialty care. We spoke with Burrell about the innovative ways she and her colleagues are overcoming barriers to care in their patient population following the overturning of Roe v Wade legislation.
Q: What is your day-to-day practice like? What challenges are your patients facing?
PA Burrell: Our new prenatal patients most often present in the second or third trimester and many have high-risk pregnancies because they have diabetes or hypertension. In addition to getting these patients up to date on ultrasounds and glucose screening, we think about their care holistically. If they are first coming to us at 26 weeks of pregnancy, what are the social determinants of health that create barriers to care and follow-up visits? How can we overcome these factors?
This visit is not just a focused prenatal visit but rather a comprehensive visit where we talk about the risk associated with initiating care later in pregnancy and link them to resources such as social workers, counselors, and specialty care.
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In Mississippi, we are working with a vulnerable population in which maternal mortality rates are extremely high and increasing. Non-Hispanic Black pregnant persons in Mississippi are now 4 times more likely to die during any term of their pregnancy, as well as up to 1 year postpartum, compared with non-Hispanic White individuals.
Maternal Mortality Facts in the United States
| 84% of pregnancy-related deaths in the US are preventable |
| The maternal mortality rate was 32.9 deaths per 100,000 live births in 2021, up from 23.8 in 2020 and 20.1 in 2019 |
| Among non-Hispanic Black women, the maternal mortality rate was 69.9 deaths per 100,000 live births in 2021 |
Mississippi has not expanded Medicaid eligibility, as is allowed under the Affordable Care Act. Therefore, we have to consider that the lack of access to health insurance, which starts at birth, plays a role in why our maternal mortality rates are high. We have patients coming in for prenatal care who have never been treated for hypertension. We also have to consider that maternal mortality may occur up to a year after delivery because of postpartum hypertension, poorly controlled diabetes, and postpartum depression.
Q: How are you and your colleagues working to lower the risk of maternal mortality in your patient population?
PA Burrell: It is a multifactorial, collaborative effort that takes place among advanced practice providers and our Ob-Gyn colleagues. At Delta Health Center, we are a holistic one-stop shop where patients have access to psychologists, psychiatrists, as well as social workers who can network and provide different resources that our patients may need to overcome barriers to care, such as transportation. We offer transportation within the county so that our patients can make it to their appointments.
We try to make health care more accessible with telehealth and we are developing a program with community health workers to improve the social determinants that prevent patients from attending their appointments. For example, if we have a patient who has missed multiple appointments, we inform our social worker who provides home visits to provide a wellness check-in and then remind them about the importance of regular follow-ups, especially if they are a high-risk patient. Improving access to community health workers can ensure that patients are managing their blood pressure correctly and monitoring their glucose levels.
Q: How has the overturning of Roe v Wade affected your patient population?
PA Burrell: It definitely has had a direct impact on our patients. For patients who choose to terminate their pregnancy, legally there is limited information that we can provide. Some of our patients have shared their stories about accessing legal resources outside of Mississippi while others will have to go through an unplanned pregnancy. Our patients have many barriers to travel including access to transportation and limited finances for room and board. Patients have to navigate that whole system on their own.
Resources available to patients via pregnancy counseling include www.bedsider.org and www.all-options.org. However, my collaborative physician and I are not legally allowed to prescribe any medications for termination of pregnancy, and that unfortunately limits how we can provide the best medical care for our patients.
Q: How has the new post-Roe v Wade landscape affected you and your coworkers?
PA Burrell: It had a tremendous effect on the entire team in terms of how we provide care for our women’s health services. We have improved our advocacy and strengthened patient education about their reproductive health and rights. We are the first health center in the Delta to provide access to all forms of contraception. Our mission is to ensure that our population has reproductive freedom and a choice to have a planned pregnancy.
Q: What was your path to becoming a PA and how do you encourage young people to join the profession?
PA Burrell: I come from an underserved area and starting in middle school, I went to the Medical Counseling, Organizing, and Recruiting (Med-COR) program at the University of Southern California (USC) every Saturday. The program encourages students from disadvantaged backgrounds, especially from Title I schools or low-resource underserved schools, to enter into a health care profession. This program introduced me to the PA profession and then from there everything lined up for my path to becoming a PA.
It is now my duty and my passion to give back so that we can have a diverse set of providers to give back to our community. As an undergraduate, I worked with the EAOP (Early Academic Outreach Program) at the University of California, Irvine (UCI) to counsel students from Title I schools on how to receive acceptance into college, especially in the University of California School system. All students were evaluated and counseled on their prerequisites, extracurricular activities, and personal statements. Today, it is still important to me to mentor PA students and recent graduates. For me, I have always wanted to give back what has been poured into me.
Q: Who are your mentors?
PA Burrell: Through the African Heritage PA Caucus, Reesa Roberts, PA-C, has provided me with a good foundation to help me transition from education to practice. I also had great mentors in the Med-COR program as well as at A.T Still University School of Health Sciences in Mesa, Arizona, where I am an adjunct faculty member. Tessa Tibben, DHSc, MS, PA-C, for example, has encouraged me to become an educator by impacting the next PA providers through research and innovative presentions. Dr Tibben’s and I will be presenting at AAPA 2023 on the topic of “Disparities in Dermatology: Improving Visual Recognition and Representation from Book to Bedside.”
Q: Is there anything else you would like to tell our readers?
PA Burrell: I encourage more PAs, advanced practice practitioners, and Ob-Gyn providers to practice in Mississippi, especially the Mound Bayou area to expand our resources and improve the health and well-being of the population. This gap in health care access, this gap in maternal mortality, this gap in uncontrolled hypertension and diabetes is something that we can collectively work together on to improve our entire population.
