In recent years, the U.S. has experienced an unfortunate increase in the rate of maternal mortality with a strong racial bias. Multiple studies have shown wide gaps in care for women of color.
According to a report released in March by the National Center for Health Statistics at the Centers for Disease Control, maternal death rates increased by nearly 40% during the second year of the pandemic, widening disparities as Black women again faced alarmingly high, disproportionate rates.
Ob Hospitalist Group’s mission is to ensure that all women entering the labor and delivery unit or obstetric emergency department receive consistent and timely care.
We asked our OB hospitalists to share advice they have for other health care providers to address Black maternal health inequities.
“Listening to our BIPOC (Black, Indigenous, and People of Color) patients is so very important. I openly talk to my BIPOC patients and discuss that the color of their skin is a risk factor for them and encourage them to be advocates for their own health and medical care. I think it is also so very important to have BIPOC physicians available to care for patients- because representation matters and the studies show that black mothers have better obstetrical outcomes when cared for by black doctors. I know I am trying to do all I can to eliminate disparities in my own care and trying to help affect change at my local level. If we all do this, we can make strides at a greater level.” – Dr. Cathleen Brown, OBHG Site Director, Pennslyvania
“Having a welcoming and supportive attitude in our OBED for our patients will help them become more confident in our services and care. They are educated by posters regarding warning signs of pregnancy dangers in my hospital. We also encourage them to return as they leave and by written information regarding their high-risk condition. A welcoming attitude is important for them to hear.” – Dr. Gary Person, OBHG Clinician, Florida
“When I was in private practice, I would see Black patients that had never seen a Black OB/GYN physician. Sometimes they would question why I was doing a breast exam during their yearly exam, why I was doing a rectal exam on an over 50-year-old woman, why I was measuring their uterus, etc. I would state that I am practicing the standard of care. I never had a white patient question my practice of performing the standard of care. It is interesting that one of the solutions to reducing Black maternal morbidity and mortality is to develop and follow protocols to manage causes of maternal deaths such as hypertension, hemorrhage, sepsis, etc. This is to ensure that regardless of the color of the patient’s skin the medical problem should be managed the same. This should help reduce the number of deaths, but not the prejudice, unconscious biases, poor communication, lack of respect, etc.” – Dr. Lydia Sims, OBHG Clinician, Texas
“We need clinics willing to start prenatal care when Medicaid is pending in patients that you know are going to qualify. Often care is delayed when waiting on Medicaid approval. Also realizing that detailed explanations are needed when implementing management and accepting and acknowledging cultural differences. Being less judgmental.” – Dr. Patricia Elliott, OBHG Clinician, Florida
“You’re correct. I previously worked at an FQHC clinic and that (starting prenatal care) was the first thing I addressed. When patients came in, I was able to get the Medicaid proof of pregnancy form filled out and sent them directly over to the Medicaid office or set up an appointment with our outreach coordinator. Medicaid approval if all went well took 30-45 days. We were able to retroactively bill. In the meantime, high-risk factors were identified, and the patient had an appointment with the usage of diagnosis code amenorrhea.” – Dr. AnnMarie Ledley, OBHG Site Director, Texas
“I believe one of the first steps is acknowledging this as a problem and spreading awareness globally. Many people aren’t even aware that this is an issue. Many others do not realize the impact that this issue has on not only our local communities but across the globe. If we start making people aware of this issue it might also spark interest globally.” – Dr. Robin Whatley, OBHG Site Director, Illinois
“Awareness is necessary on both sides, clinician, and patients. Patients sometimes do not like to acknowledge that they are at risk for increased morbidity and mortality simply by virtue of the color of their skin. This increased risk does not resolve with increased education. Simply explaining it and why you are being so thorough as a clinician may eventually help gain trust although even as a black woman OB/GYN I often find patients not particularly ready to embrace this information. I have found patients often distrust health care providers at least initially. There are valid reasons for this both historically and often in the personal experiences African American patients have in hospitals and healthcare settings. I believe one of my colleagues said it best. All patients need care. When you continuously approach patients with an “I clearly care about what is best for you and your baby” disposition, most patients will eventually come around. Explain why you ordered the test, why the result tells you the patient and baby are ok or why you have further concerns. Meet people where they are. If they missed a few visits or didn’t comply with a physician’s recommendation, reiterate how this problem remains and how you will approach treatment now. Sometimes patients have huge challenges in complying with care. Covid has become a very common reason for no prenatal care in our community. It is true physicians have been unable to accept patients for care for extended periods of time and then have been unwilling to accept patients at an advanced gestational age. There is blame on both sides of this issue, but we must meet patients where they are. Consistent reinforcement of clear and genuine concern about you and your pregnancy helps to build trust.” – Dr. Roslyn Banks-Jackson, OBHG Clinician, Georgia