Iowa State University Alumni Association| online edition | summer 2008
Ann Bryant Borders admires Victor, the day-old son of LaTonya Patterson, at Northwestern Memorial Hospital.

 


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HEALTHY MOMS, HEALTHY BABIES

Tameka Jackson* was desperate.

She had left Milwaukee and moved to Chicago to care for her dying father. In the process, she had lost her home and her job. She was living in an abandoned apartment in Cabrini-Green, a housing project that had become a national symbol for problems associated with public housing.

Jackson had two young children, and she was pregnant. When the pregnancy became complicated, she regularly walked nearly two miles for her doctor’s appointments in downtown Chicago.

She had an aunt in Bloomington, Ill., who was willing to provide a safe haven. But Jackson couldn’t afford
the bus fare.

One day, everything came crashing down: The housing authority padlocked her apartment. And the father of her child – a drug dealer with a history of domestic violence – was being released from jail.

Jackson didn’t know what to do. So she called the one person she could trust: Her doctor.

She called Ann Bryant Borders, the physician who had been caring for her high-risk pregnancy.

“She didn’t feel safe,” said Borders. “She was standing in front of Cabrini-Green with all of her belongings. She had her kids with her and she didn’t know what to do. She wanted to go to Bloomington to be with this aunt, who was a very stable person with a job and a house, but she just didn’t know how to make it happen.”

Borders could have called a social worker and recommended her patient be placed in an emergency shelter. But she was worried about the baby’s father finding the family. She could have given her $100 for bus fare, but there was no one to pick her up at the bus station.

So she drove to Cabrini-Green in her Dodge Neon, picked up Jackson and her children, loaded in a laundry bag filled with all of their possessions, and drove them to Bloomington.

In hindsight, Borders says the decision to go to Cabrini-Green and remove her patient from a dangerous, unhealthy situation was made in the moment when she asked herself, “As a physician, what is the most important care I can provide to this woman?” And the answer was, “Get her to a
safe place.”

Ann Bryant Borders (biology ’94) wants moms and their babies to be healthy. But it isn’t easy. As a physician in Chicago, many of her patients are uninsured, don’t have access to health care between pregnancies, and live with chronic stress. Most have low incomes and worry every day whether they will have enough food to feed their families, worry that they’ll be evicted if they can’t pay the rent, worry that their electricity will be turned off.

Borders sees a correlation between the chronic stress of daily living for these women and the high incidence of preterm births in low-income, minority populations.

An assistant professor at Northwestern University’s Feinberg School of Medicine, Borders is conducting a study on chronic maternal stress and disparities in preterm birth, funded through a Women’s Reproductive Health Research grant.

“For African-American women, the rates of preterm birth are twice to three times as high as the rates in white women,” she said. “It’s a huge disparity. In fact, our preterm birth outcomes are on par with countries
in Africa.”

She says that if researchers can identify women most at risk, then potentially they can develop interventions to improve pregnancy outcomes.

She’s working to improve the prenatal care at Northwestern’s Prentice Ambulatory Care (PAC) Clinic by developing prenatal education and support systems at the same clinic where women are receiving their health care. She cites evidence that shows that when prenatal care goes hand-in-hand with more education and more support, women have a lower chance of preterm delivery.

Borders balances her research with a clinical practice and new motherhood – she and her husband, Will, have a daughter, Vera, born in May 2007. Borders says becoming a parent has made her a better physician.

“I always considered myself a very empathetic doctor and someone who connects emotionally with patients and tries very much to understand what a patient is going through – you know, walk in their shoes. But I think after going through a pregnancy and a labor and a delivery and then going through a year of being a parent it really has changed my perspective.

“Pregnancy is emotionally and physically challenging. And I’m not coming home trying to figure out where to get food to feed my family. I’m not trying to figure out how to get home from work. So I think it redoubled my efforts to think about it from a patient’s perspective, what it feels like to live the life they’re living and go through a complicated pregnancy, how emotionally and physically overwhelming it can be. It just gives me pause sometimes when I see what my patients are able to handle.”

Borders’ passion for the issues of pregnant women began gradually.

When she started medical school at Harvard University following graduation from Iowa State, she wanted to be a neurologist or a neurosurgeon. Obstetrics and gynecology was too predictable for a female doctor, she thought.

“I put my OB-GYN rotation last because I thought it was the last thing I was going to want to do,” she said. “But I got in the rotation and I just realized that it really all came together for me, that reproduction, getting pregnant, having babies – the whole field of obstetrics and gynecology – is a very important point in people’s lives, and I felt really strongly about being able to be there in that moment.”

She got her medical degree at Harvard and a master’s in health policy at the London School of Hygiene and Tropical Medicine. She followed that with a residency and fellowship in obstetrics and gynecology, a post-doctoral fellowship in health services research, and a master’s in public health.

Borders believes that “making a difference is all about taking advantage of an opportunity in front of you, seeing the possibility for change, believing in yourself, and having the energy and drive to make it happen.”
Here’s an example:

As a fellow in maternal fetal medicine at Northwestern, Borders joined with four other medical professionals to implement mandatory HIV testing in pregnant women.

It was a concept that would save the lives of newborn babies and improve the lives of the mothers. Many women in the health care system in Illinois did not know their HIV status.

When rapid HIV testing is implemented and the mother and baby are treated – even during labor and delivery – the transmission of HIV is dramatically reduced.

Borders and her colleagues thought that sounded like a no-brainer. And they didn’t think it was good enough just to implement HIV testing in one hospital, or even in the city of Chicago. They pushed for the whole state.

Today, at each of Illinois’ 132 birthing hospitals, state legislation requires that when a woman shows up in labor she will be offered a rapid HIV test. Borders and her team produced educational materials, provided 10 regional trainings, gave PowerPoint presentations, and trained 5,000 nurses in the state how to do rapid testing and how to counsel patients who tested positive.

The project has been applauded by the Centers for Disease Control and Prevention (CDC) and emulated by the World Health Organization. Today, 99.9 percent of moms and babies in Illinois go home from the hospital knowing their HIV status.

Borders quotes medical literature that says if you improve the health of women and their babies, you improve the health of the entire population.

She says people should go out and find a niche in some little corner of the world and make it better.
She says whenever she gets frustrated with the health care system and poverty in this country, she just remembers to focus on the women in her care and know that while she can’t solve all the problems of the world, she can help her patients have better lives and healthier pregnancies.

And sometimes she thinks about Tameka Jackson. Tameka gave birth to a healthy baby in Bloomington.
She has a job, and her children are in
a good school.

“She’s doing very well,” Borders says. And then she smiles.

*not her real name

Read on | Hiking toward change

About the Writer | Carole Gieseke is the editor of VISIONS magazine.