Black pregnant women are showing up to doctors’ offices filled with anxiety — and for good reason. Mothers who look like them are dying or barely escaping death in hospitals due to medical bias and neglect.
While lawmakers respond to the crisis that’s taking mothers from their children or leaving the moms in poor health after giving birth, some medical professionals are saying it’s time to empower Black moms before they enter the medical system.
We sat down with Dr. Rachel Bond, a cardiologist, and Dr. Alison Cowan, an OB/GYN and head of medical affairs at Mirvie, to discuss strategies Black expectant mothers can use to take the lead in their care experience.
Word In Black: What tips can you all offer to expectant mothers to be empowered in their experience with providers while navigating pregnancy?
Dr. Rachel Bond: Patient self-advocacy is such an important aspect. I do think it’s relevant to highlight that is not the only solution, but it’s definitely a big part of the solution. And for us, at least in the cardiovascular sector, we feel that we need to do this across all conditions, not just pertaining to maternal health. So, we have a lot of wonderful patient-centered resources.
I can speak on ones that I’ve helped to develop through the Association of Black Cardiologists. Our goal with these resources was really to make sure that the patient had all of the tools and, more importantly, understood all the questions that they should be asking their clinicians at each stage of the maternal health continuum.
We know that many conditions that occur during pregnancy lead to a longstanding risk to their cardiovascular outcomes, such as pre-eclampsia and gestational diabetes and hypertension, and premature labor. All of that could actually impact one’s cardiac health up to 40 or 50 years later.
So, we give them tools to better understand what are the questions they should be asking when they go to the clinician in the event the clinicians are not asking those questions.
And also what they can do to make sure that they’re living a well-balanced heart-healthy lifestyle. A lot of that includes being aware of the foods that we’re eating, being aware of exercising, but also being aware of the psychosocial stressors in our life.
We talk a lot about that, particularly in our community, the Black community, because we know that the lived experiences of many of these women really do set the stage at all of those areas in their maternal health continuum — preconception, all the way to postpartum and post-childbearing.
So, we’re really thoughtful about that. And one thing that I can at least speak on with the tool that we’ve created, it talks a lot about ways to help overcome those lived experiences or those psychosocial stressors that we get from those lived experiences. And one way is incorporating the faith-based community.
Alison Cowan: I think it’s really important to seek out a care provider that you feel like you have a trusting relationship with, and you feel that intuitive, collaborative, positive feeling when you enter the room with them. And if you don’t feel that right away, you should feel empowered to seek someone else because, so often, people may not feel that they have other options, but it’s okay to interview different providers, and it’s okay not to stick with the first one that you meet.
And then the other, I encourage all of my patients to engage with their providers about their birth preferences ahead of time, because that can help to regain that sense of control over the process.
Finally, I encourage patients, if they’re feeling uncomfortable, to speak up using some keywords. So, some of the keywords that we encourage patients to use or to say are “I’m concerned,” “I’m uncomfortable,” or “I don’t feel that I’m safe.” And so if you say those things to your care team, that should be a flag for them to stop what they’re doing and to reassess the situation.
Those are all tools that patients can use. But I think, as Dr. Bond pointed out, the burden shouldn’t always just fall on the patients to advocate for themselves. We in the medical community need to be actioning specific things to try to improve these unacceptably disparate outcomes for Black women.
WIB: So, as providers, what do you all believe the medical community can do to help end the Black maternal health crisis?
AC: Certainly, the March of Dimes has done a lot of work on implicit bias training and bringing that to more medical centers. Every clinician can work on bringing implicit bias training to their institution if they haven’t already done so. And really being a champion for it because we know that initiatives are great, but if you actually have some physician champions that are leading the commitment to it, that takes it much further.
And then I think another thing we can do is really to — at our state maternal morbidity and mortality committee level — formally track these outcomes. The 2021 data recently came out showing that Black women are dying at 2.6 times the rate of white women, but it’s not mandatory to track disparities and outcomes at the state levels.
RB: I think it’s important to highlight that it is challenging, from a system perspective, to have these changes that we’re obviously encouraged by. That doesn’t imply that it won’t happen. It’s just taking longer than we anticipated. And I think it’s important to address the reasons why: the system, of course, was built on this structure of oppression.
And unfortunately, because of that, this is why we’re seeing these still glaring discrimination and disparities in care. With that being said, one thing that we definitely need to address to really help improve these outcomes is also diversifying the perinatal workforce, but really just the healthcare workforce in general.
I mean, I can speak on even cardiology as a whole. As a Black female cardiologist, I only make 2% of the population, which is extremely low, of course. But the community that I serve looks more like me than less when it comes to cardiovascular disease. And we know that there’s so much data that shows when you have that racial concordance or cultural concordance where a patient identifies with the healthcare provider that’s taking care of them, the outcomes are better. And we also know that there’s so much data that shows that when you have a diversified workforce, outcomes are better.
So one thing that’s extremely important and absolutely something that I’m encouraged by is that there are so many medical societies right now that are really trying to increase the pipeline.
