Implicit Bias and institutional racism in the healthcare system contribute significantly to pregnancy-related deaths of Black women. According to the Center for Disease and Control and Prevention (CDC), African American women “are two to three times more likely to die from pregnancy-related causes than white women.”
Furthermore, the risk increases with age for Black women. Therefore, as studies and data collection are ongoing regarding Black-related pregnancy deaths, Black women must continue advocating and improving their care throughout their pregnancy.
In a 2020 study published in the Proceedings of the National Academy of Sciences, the death of Black newborns significantly reduced to half when Black physicians completed care and delivery.
In addition, there was no significant difference in infant death rates when Black physicians administered delivery.
A board certified-family physician-obstetrician, Dr. Kristin Reavis serves as the Maternal Child Health Director for the University of Maryland Department of Family and Community Medicine and is the Director of Student Diversity and Inclusion for the University of Maryland School of Medicine. She is also a Cook Ross certified unconscious bias trainer.
Dr. Reavis recognizes there are improved health outcomes for Black women who share the same racial, ethnic background as their doctor.
In 2018 however, the Association of American Colleges (AAMC) reported that only five percent of physicians in the United States identify as African American, and less than three percent identify as African American women.
Dr. Reavis shares, “what’s more important than finding a physician who is also Black, is finding a physician that understands the impact that race and racism may have on the outcomes of that patient and is working to address some of the health disparities.”
Dr. Reavis also expresses that a continuity relationship is one way Black expecting mothers can screen for cultural competency and implicit Bias in an OB clinician. A continuity relationship is one where a physician often treats a patient over time, and in some cases from childhood to adulthood.
“Having prior relationships and prior knowledge is one of the best ways to screen because you know what the physician’s outlook is and how they treat or don’t treat people based on their race,” said Dr. Reavis.
Dr. Reavis encourages Black, expecting mothers to:
Envision What You Want for Your Ideal Delivery— Delivery can look like a medicated birth, labor in the tub, or frequent availability of an OB clinician. Black expecting mothers should envision their ideal delivery and seek a practice and clinician that reflects and supports their ideal delivery.
Utilize your social network— Reach out to friends and your primary care physician to ask for recommendations for culturally competent obstetric clinicians.
Listen to your gut— If you feel like you’re not being listened to or that your concerns are being brushed off or you are being treated a certain way because of your race or socioeconomic status, listen to your gut.
Dr. Henrietta Akintoye is a Morehouse School of Medicine Alumna and practicing OB-GYN in Baltimore, Maryland. Dr. Akintoye notes improved health outcomes for Black pregnant women who share the same race as their OB-GYN. She says this is likely due to Black and Brown OB-GYNs having added experience, knowledge and training for risk factors that Black women face before and during pregnancy.
In cases where there are limited numbers of Black OB-GYN’s, Dr. Akintoye says that Black women can look at patient profiles of hospital and hospital settings to get an idea of where Black expecting mothers are treated.
Dr. Akintoye also encourages Black women to:
Schedule a Well Women’s Visit— Black women should try to choose an OB-GYN before becoming pregnant. Scheduling a wellness check allows Black women to see whether they feel comfortable and relate with a specific OB-GYN.
Search for OBGYN’s Affiliated with Your Local Hospitals— On their website, hospitals will list physicians that are affiliated with them. Black expecting mothers can scroll through the list of healthcare providers and individually research physicians that fit their interests.
Tour the Hospital and Neonatal Intensive Care Unit— When you visit the NICU, you can ask questions about their protocols for management of preterm delivery. See if the hospital is associated with a high-level NICU. See whether or not the NICU has a system in place for the parents of newborns to ask questions.
Blatantly Ask Your OB-GYN. Black expecting mothers should feel free to openly ask their provider about their thoughts and awareness of the high death rates and complications associated with pregnancy for Blackwomen.
Meeting Your OB-GYN &Progressing to Your Delivery Date
Pay Attention to the Atmosphere & OB-GYN— When meeting your OB-GYN for the first time, Black women should take account of the atmosphere of the practice and the diversity of the images and staff. In addition, Black women should take note of if their OB- GYN is asking them questions and listening to their responses.
Communicate with Your OB-GYN—Black expecting mothers are encouraged “to address their concerns before you deciding to move on. Many times when [OBGYN] patients don’t feel comfortable there may be a lack of communication between the patient and provider. Often times this can be circumvented by saying, “I didn’t feel comfortable by something that you said. I don’t feel like my questions or issues are being addressed.”
Seek Alternate Care. In a case when a Black pregnant woman feels as if her OB-GYN continues to minimize and overlooks her concerns, she should not be afraid to seek out alternative care. A lot of what underlies health disparities is that women of color are not being listened to and their concerns and complaints are not being heard or are being minimized.
Have Someone with You. Due toCOVID-19, many practices may still limit visitors. However, Black expecting mothers are encouraged to have someone on the phone or facetime during visits. Dr. Reavis shares, “it’s difficult sometimes to intake all the information that you are given.” Having someone with you can be beneficial as that person can listen, take notes, and catch information that you might miss, especially when you are given news that might be challenging.
Advocate for Yourself. If at any point during pregnancy, you notice that your concerns are not being taken seriously, Black expecting mothers are advised to vocalize their concerns, which can include: contacting the on-all,
overnight OB-GYN if you have any questions; asking for earlier appointments; or requesting same-day appointments. If a same-day appointment is unavailable, Black expecting mothers should walk into the labor and delivery and request an assessment.
And, if you find yourself in a position where you feel that your concerns might not be taken seriously, Black expecting mothers should continue to advocate for themselves—ask someone else or ask to speak to a nurse manager. Black expecting mothers can also request to talk to the liaison of risk management, patient advocate, or a patient experience representative.
On “delivery day,” both Dr. Akintoye and Dr. Reavis share the same sentiment regarding the things that Black women can do if they feel healthcare professionals dismiss their concerns during delivery. In healthcare systems both in and out of the hospital, there is definitely a chain of command. If you feel that your health concerns are not being addressed or that you are being brushed off, ask to move up the chain of command.
“If you are feeling like you are being brushed off, if you are feeling like your concerns are not being addressed, ask to speak to the nurse manager; ask to speak to the head physician in the hospital; ask to speak to them immediately; ask for a face-to-face conversation about your concerns.”
“If someone is not answering the questions to your satisfaction, you [should] always escalate, escalate, escalate!” Dr. Akintoye said.
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