Dri'Symoan Hicks was a teenager when she was pregnant with her first child and unsure what to expect as her pregnancy progressed.
She credits the staffers who are part of the JUST Birth Network at Providence Swedish in Seattle for an uncomplicated natural delivery that followed the birthing plan those staffers had helped her create. "I just felt really supported," Hicks says. "They were really helpful. They gave me a lot of information."
Providence Swedish, part of Providence St. Joseph Health, is seeing early success in improving the outcomes of women of color like Hicks since starting JUST Birth and another initiative called TeamBirth three years ago.
JUST Birth's mission is to empower "Black, African American, African, Native American, Alaska Native, Native Hawaiian and Pacific Islander women and people from across the sex and gender identity spectrum" during their pregnancies and when they give birth. JUST is an acronym for Justice Unity Support Trust.
Through the initiative, Providence Swedish provides expectant mothers with birth and postpartum doulas, childbirth educators and cultural navigators, who guide patients and their families throughout the pregnancy and birthing experience.
When Providence Swedish launched JUST Birth, it also began TeamBirth, which ensures obstetrics patients — and the clinicians caring for them — have shared input and understanding. The program calls for team huddles at key decision points: admission to the hospital, when there are changes to the patient or baby's condition, when decisions are made surrounding delivery, and any time the patient or a team member requests a huddle.
Monitoring success
Providence Swedish is watching various metrics to monitor the success of JUST Birth and TeamBirth. It can already point to one: a standard assessment in obstetrical care known as the nulliparous, term, singleton, vertex cesarean birth rate, or NTSV for short. The measure relates to first-time mothers who underwent C-sections when giving birth at or beyond 37 weeks' gestation to one baby who was in the typical head-first position. C-sections have been shown to pose risks for mothers compared to vaginal births, such as higher incidences of postpartum readmissions and emergency department visits.
Between August 2022 and January 2023, Providence Swedish found its C-section rate among mothers in the NTSV category was 44.7% for Black patients, compared with 26.7% for white patients. Between August 2024 and January 2025, after the new initiatives were in place, the rates changed to 27% for Black patients and 27.6% for white patients.
Dr. Tanya Sorensen, a maternal fetal medicine specialist and executive director of Women's Services for Providence Swedish, says she was stunned by the change. "When I looked at the data, I just didn't believe it," she says.
While the finding covers only a proportion of obstetrics patients, Sorensen says it is significant. The specificity of the category ensures that hospitals "are comparing apples to apples" when they look at C-section metrics, she notes. Meanwhile, reducing the number of C-sections means more patients with shorter recoveries from delivery and more patients who are less likely to need the procedure in future pregnancies.
Sorensen adds that Providence Swedish's focus on C-sections doesn't equate to labeling those operations as bad or in all cases unnecessary. "Obviously, we don't want to not do C-sections when we need to be doing C-sections because they're lifesaving, but we also want to do the right number," she explains.
Showing traction
Sauleiha Akangbe is the founder of the JUST Birth Network and birth equity manager at Providence Swedish. When she saw the drop in NTSV numbers for Black patients, she was emotional. "It's like, finally, we're seeing that traction that we know is there, that we know exists," she says.
JUST Birth evolved from the Black Birth Empowerment Initiative, which Akangbe founded at Providence Swedish in 2020. That earlier initiative addressed maternal disparities in the Black community, such as disproportionately higher prenatal complications, stillbirths, postpartum complications, and increased mortality rates for both the mothers and children. JUST Birth covers a wider population.
Adding the TeamBirth initiative brought providers on board the effort to empower patients, Akangbe says. That initiative, she says, encourages caregivers to ensure patients are at the center of every decision.
Happier patients
The NTSV numbers aren't the only indicators that the initiatives are succeeding, Akangbe and Sorensen say. Another is patient surveys, which show a high rate of satisfaction. For example, on the question of how satisfied JUST Birth patients are with the program's cultural navigators, Akangbe says 98% said "they felt like their navigators were able to really amplify their voice and advocate when necessary."
Sorensen says that for centuries the voices of women, and particularly women of color, have been silenced in maternity wards. She says that ensuring patients are heard is at the heart of both Providence Swedish initiatives, and the surveys show patients are happy with the changes.
"They feel like they're being listened to," she says. "They feel like they're part of the process."
Hicks was so happy with the care she received during the birth of her son in 2022, including help to overcome challenges with breastfeeding, that she came back to Providence Swedish this year when she was pregnant again. This time, the delivery wasn't as smooth. Her daughter was breech and she had to undergo a C-section.
One of those at her bedside for each birth was LaShaye Stanton-Phillips, a member of Providence Swedish's Doula Services program who is part of JUST Birth. For that second birth this September, Stanton-Phillips was there to hold Hicks' hand and assure her all would go well. And it did. Within days, Hicks and her baby girl were home without further complications.
Stanton-Phillips is confident that JUST Birth is improving birth outcomes for women of color, who face greater odds of poor pregnancy outcomes. "I think it's incredibly important, because a lot of people of color do not have confidence in the medical system or medical providers, and so they're usually already on the defense when they come in," Stanton-Phillips says.
'We have to sustain it'
Stanton-Phillips came to her role as a doula at Providence Swedish four years ago, at the urging of a friend. "It's actually everything I love to do: advocate for others, help, be a resource, think out of the box, fill in the gaps," she says.
She has seen the JUST Birth and TeamBirth initiatives create what she considers a "well-oiled machine" that merges the skills of clinicians, doulas and navigators. "Because we have such good relationships with the providers, the patients see that and they're a little bit more trusting of the providers, they're a little bit more open," she says.
Putting the initiatives in place wasn't a simple process, Sorensen points out. It took buy-in from leadership, including providing financing, and cultural changes in maternity units, such as getting doctors and nurses to accept doulas as equal partners in care.
And even with both initiatives well established, Sorensen says their long-term success is not guaranteed. The initiatives' champions, like her and Akangbe, have to keep up their advocacy and continue to show through various measures that the programs are improving patients' experiences.
"We have to sustain it," Sorensen says. "It's not like we're sitting on our hands and saying, all done. No way. We've got lots of work to do."