内容摘要：“It’s Jennie’s National Health Service,” Joseph said with a sly smile.

“It’s Jennie’s National Health Service,” Joseph said with a sly smile.

Solutions abroad can be translated to the U.S., experts believe. For example, many European countries make it easier to get prenatal and postpartum care that involves both doctors and non-physicians like midwives, said Dr. Laurie Zephyrin, a senior vice president at the nonprofit Commonwealth Fund who studies maternal care across nations.Marie Jean Denis, left, is examined by Jennie Joseph, lead midwife and clinic director at the Commonsense Childbirth clinic. (AP Photo/John Raoux)

Marie Jean Denis, left, is examined by Jennie Joseph, lead midwife and clinic director at the Commonsense Childbirth clinic. (AP Photo/John Raoux)Joseph’s organization — called Commonsense Childbirth — is a smaller-scale example of that type of care.It has clinics, a birthing center and training for health professionals. The midwives who run the program welcome vulnerable patients that other practices turn away, such as those who are uninsured or haven’t had prenatal care until late in pregnancy.

About half the patients and much of the staff, including Joseph, are people of color. Research shows Black Americans are more likely to distrust the medical system than their white counterparts, but Joseph stresses building trust.Jennie Joseph, back left, lead midwife and clinic director at the Commonsense Childbirth clinic talks with client Regine Baramore as husband Scott holds six-week-old daughter, Yahareice. (AP Photo/John Raoux)

Jennie Joseph, back left, lead midwife and clinic director at the Commonsense Childbirth clinic talks with client Regine Baramore as husband Scott holds six-week-old daughter, Yahareice. (AP Photo/John Raoux)

“We have these four tenets that go with my model: access, connection, knowledge and empowerment,” she said. Some patients “cry because they’ve never had that kind of care or respect.”Low Medicaid reimbursements play a role in

, along with worker shortages and declining birth rates. More than half of rural hospitals have stopped offering labor and delivery services, another recent analysis from the Center for Healthcare Quality and Payment Reform showed. That can lead to longer travel times and awhen she was pregnant with her second child. There is no labor and delivery unit at the hospital in Rocky Mount, Virginia, and a hospital about 40 minutes away closed in 2022. Ratliff, who is Black, instead went to Salem — more than an hour away — for every prenatal visit. She ran through all of her paid time off, and had no paid maternity leave.

She did, however, have a doula. The doula is Black and her services were covered by Medicaid — a benefit Virginia started offering in 2022.“I really did want somebody else to just help advocate, especially since with women of color, the mortality rates are higher. So I was like, ‘anything can happen,’” she said. “My family members never had good experiences up here at these doctors’ offices, even just for regular appointments.”