The Cherese Mari Laulhere BirthCare Center at Miller Children’s & Women’s Hospital welcomes more than 5,500 babies each year, caring for families across Los Angeles and Orange counties and reflecting the rich diversity of the greater Long Beach community. That diversity is both a point of pride and responsibility, bringing a wide range of health needs, social realities, and barriers that shape pregnancy, childbirth, and postpartum recovery.
For Black women in the United States, pregnancy and childbirth continue to carry a disproportionately high risk. In 2021, the Centers for Disease Control and Prevention (CDC) reported a maternal mortality rate of 69.9 deaths per 100,000 live births among non-Hispanic Black women — 2.6 times the rate for non-Hispanic White women. Provisional data shows maternal deaths rose again in 2024, reaching 19 deaths per 100,000 live births overall, with Black women continuing to experience the greatest risk at47.5 deaths per 100,000 — more than triple that of white women.
These outcomes are not inevitable; they reflect systems and practices that can be improved. At MillerChildren’s & Women’s, we’re shifting the culture of care before, during and after birth, with a focused commitment to reducing inequities impacting Black moms and babies.
Why Birth Equity Must Be a Priority
Maternal mortality is often described as a national crisis, but its weight is not evenly carried. Differences persist even when education and income are comparable, highlighting broader systemic forces such as structural racism, chronic stress, and biases within medical environments. Public health experts increasingly recognize that respectful communication, shared decision-making, and timely recognition of complications are essential components of safe care.
In Los Angeles County, local data and lived experiences reinforce national trends: Black mothers are more likely to experience preterm birth, pregnancy-related complications, and report feeling unheard or dismissed. When symptoms are minimized or context is overlooked, risk increases in moments when timely action is critical.
This is why our approach at Miller Children’s & Women’s extends beyond a single protocol or training. Advancing birth equity requires changes to communication practices, quality metrics, data use, and the role of community voices in improvement efforts.
A High-Acuity Center in a High-Need Region
Miller Children’s & Women’s is the only hospital in Los Angeles and Orange counties with both a Level IV Maternal Care Center – the highest designation from the American College of Obstetricians and Gynecologists – and a Level IV Neonatal Intensive Care Unit (NICU), the highest designation available by the American Academy of Pediatrics, under one roof, providing 24/7 specialized maternal and neonatal care. This integrated structure is significant for complex pregnancies and high-risk deliveries — and it also supports equity, enabling care teams to respond rapidly when complications arise.
Yet advanced clinical capability alone does not ensure equal outcomes. Birth equity requires us to ask deeper questions: Are we treating each patient uniquely, and are all patients benefiting in the same way?
What Drives Disparities in Maternal Outcomes
There is no single cause of inequity in maternal health. Instead, disparities emerge from a combination of factors that often reinforce each other:
- Implicit bias: Bias can influence how pain is evaluated, how symptoms are interpreted, and how quickly concerns are escalated, while systemic inequity shapes living conditions, stress, and access to care.
- Delayed or inconsistent prenatal care: Barriers such as transportation, childcare, and insurance challenges can disrupt continuity and delay detection of conditions like hypertension or diabetes.
- Toxic stress and weathering: Chronic exposure to racism and adversity can trigger physiologic responses that increase pregnancy risks, including preterm birth.
- Communication gaps: When patients feel dismissed, they may hesitate to raise concerns, leaving clinicians without critical information.
Recognizing these factors helps us move beyond one-size-fits-all approaches. Equity means ensuring each patient receives the support they need to be safe and heard.
Changing the Culture: What Miller Children’s & Women’s Is Doing Differently
A significant step in our equity journey is joining the Cherished Futures for Black Moms & Babies initiative in Los Angeles County. The program brings together hospitals, public health partners, health plans, and Black community leaders to co-design data-driven, community-informed solutions.
Cherished Futures emphasizes institutional accountability and meaningful practice change — not just education, but measurable improvements across clinical, organizational, and community systems. This collaborative approach matters because maternal inequities extend beyond hospital walls.
Alongside regional partnerships, improving everyday interactions remains essential. How a nurse responds to a concern, how a clinician discusses treatment options, and how a care team revisits birth preferences all influence patient experience and safety. Local reporting on our efforts highlights training focused on strengthening listening skills, enhancing respect, and supporting patient involvement in care decisions.
Cultural competency and bias-awareness training help teams recognize assumptions, ask better questions, and create reliable pathways for escalation when needed.
Traditional quality metrics focus on clinical outcomes, processes, and safety events. These remain vital. Yet birth equity also requires assessing experience, communication, and trust — factors that directly affect how and when patients speak up about symptoms.
Miller Children’s & Women’s has adopted tools to better understand patient perspectives and use that insight to guide improvement. A recent collaboration with the Irth App involves getting real-time feedback from Black and brown birthing people and translates lived experiences into actionable data to strengthen prenatal, birthing, postpartum, and pediatric care.
Extending Care Beyond Birth
Maternal health risks continue after delivery. Complications such as hemorrhage, infection, blood pressure spikes, and cardiomyopathy can arise days or weeks later, making a clear follow-up plan essential.
National clinical leaders stress the importance of postpartum monitoring and supportive pathways, particularly for higher-risk patients. At Miller Children’s & Women’s, our equity efforts focus on making sure every patient feels supported — with clear guidance on what symptoms may need urgent attention, easy ways to reach help, and resources that remain accessible throughout recovery.
What Birth Equity Looks Like in Practice
Equity becomes real when it shapes the care patients receive. Examples of practical shifts — many of which our teams are prioritizing — include:
- Clear escalation pathways: Standardized responses to symptoms such as severe headache, chest pain, shortness of breath, or heavy bleeding help eliminate delays and reduce subjectivity.
- Respectful communication: A listening-first approach builds trust and supports more accurate clinical decisions by encouraging patients to share concerns early.
- Data-driven improvement with community partnership: Initiatives like Cherished Futures demonstrate the impact of integrating patient stories and hospital data to guide solutions.
Safer Births and Better Experiences for Every Mother
CDC data shows that while maternal mortality rates fluctuate year to year, the disparity affecting Black women persists. That persistence underscores the need for long-term, sustained work toward equity.
At Miller Children’s & Women’s, our commitment is rooted in the belief that every patient deserves to be safe, heard, and treated with dignity. That includes clinical readiness, cultural humility, transparent measurement, and accountability to the community.
With thousands of births each year, even small improvements can have a meaningful impact. A clearer discharge plan, a more effective handoff, a faster escalation, a more respectful conversation — these are the building blocks of safer care.
Moving Forward: Equity Work That Lasts
Improving maternal outcomes for Black women requires more than a short-term initiative. It calls for sustained attention, transparent measurement, and the willingness to change. Programs like CherishedFutures demonstrate what is possible when hospitals collaborate with community leaders and public health partners to redesign systems with accountability.
As we continue this journey, our commitment remains focused on advancing maternal health equity and driving meaningful, lasting change.
Sign up to attend a maternity tour or call (562) 933-2415.
Edited by: Lauren Yu, M.D., OB hospitalist, Cherese Mari Laulhere Birth Care Center, Miller Children’s & Women’s Hospital
