Season 3 Episode 8 – Maternal Health Crisis (Part 1)
With decades of experience as gynecologists and, previously, as obstetricians as well, the doctors of PTCOBGYN felt it necessary to join the conversation regarding the maternal health crisis in this country.
This is the first in a two part discussion regarding the Maternal Health Crisis and our next episode, episode 9, will return to discuss this topic in more detail.
Maternal Health Crisis (Part 1) Transcription
00;00;05;27 – 00;00;54;29
Welcome to take good care and endeavor of Peachtree City Obstetric and Gynecology. Our aim and mission is to serve as a source of vital information and discussion for women of all ages, races and walks in life. I’m Dr. Mironda Williams. I’m Dr. Deanna Guthrie, and I am Dr. Karen Greene. Welcome to our show. When we started doing this podcast, one of the driving forces, or I should say grounding forces with us doing the podcast is that we really wanted to broaden our platform in terms of education with our patients and just the general community at large.
00;00;54;59 – 00;01;26;46
All of us spent 25 plus years in the field of obstetrics taking care of women during their pregnancy and in their delivery. And for most people who do OB-GYN as a specialty, it’s really the obstetrics portion that really drives your passion in terms of why you go into the field. It’s a special time and a connection with the physician and their patient that is really, I don’t think, matched in any other field of medicine.
00;01;27;49 – 00;01;56;04
But we retired from obstetrics about six years ago and now or doing only practice. And while we only do GYN only at this time, we still very much have an affinity and a love for obstetrics as well as some of the challenges. And during this time, especially during COVID, a lot of health care disparities were unveiled. They were not new concerns or situations.
00;01;56;04 – 00;02;26;55
But I think because of everything that was going on, the spotlight on various different areas was really shined in the area of maternal health and some of the issues and concerns with that. So even though we don’t actively practice obstetrics at this time, we still feel it’s very much our calling and duty to continue to educate and shine a light on the field of obstetrics in those areas of maternal health where we can hopefully make an impact with this new platform that we have.
00;02;27;49 – 00;02;58;27
So one of the things that we also do frequently is to speak in the community on various different topics. And Dr. Greene actually gave a presentation, I think this was pre-COVID. I think it was right before COVID hit that talked about some of the issues that we’re going to be delving into with today’s episode. And because it it is such a broad topic and there’s been a lot of new things that have come about in the media, this may actually turn into two episodes, but we’ll start with just a general discussion.
00;02;58;50 – 00;03;30;56
And Dr. Greene is going to get us grounded and kind of give us a foundation of information with the presentation that she did. Thank you, Dr. Williams. The presentation was given just talking about maternal health. And so in the area of maternal health, of course, we had to talk about pregnancy and maternal mortality. So in doing my research, looking at the numbers, the group of women that I presented to, I just kind of wanted to let them know what the state was and and some of the numbers that aren’t great.
00;03;31;47 – 00;03;56;29
But as you’ll see in slide one, in general, the U.S. has done poorly on maternal mortality. There’s been a steady rise for the past two decades, resulting in the worse maternal death rate in the industrialized world. Other nations inch downward. But we keep going up. According to the CDC, 700 U.S. women die each year from pregnancy related complications and 60% of these are preventable.
00;03;57;01 – 00;04;25;39
Most of these happened within 42 days of women giving birth. And of course, as with most things, slide two indicates that maternal mortality is worse for black women. The death rates for black women are 3 to 4 times higher than white women. The CDC data indicates that pregnancy related deaths among black women are 43 per 100,000 live births versus 13 per 100,000 live births and white women.
00;04;26;40 – 00;04;52;19
Black babies also have a higher mortality that’s more than twice as high as for white infants. Other women of color have similar bad numbers. However, the black white gap is the starkest. Sadly, well-educated black women have a worse outcome than white women that have finished high school. So it’s not necessarily the color of their skin, not necessarily their education, but it’s probably related to the racial disparity.
00;04;53;15 – 00;05;27;50
Slide three African-American infants are more than 2.4 times likely to die in their first year of life. This disparity is rooted in racism. There’s structural racism in health care and social services, delivery. There’s denial of care for medical professionals and social services. This failure to be treated with dignity and respect. There’s undermining physical and mental health, and the psychological toll of racism leads to an increase in medical conditions that affect pregnancy and mental health conditions.
00;05;27;54 – 00;05;54;25
Thank you, Dr. Greene. Those numbers and tell us when you actually gave that presentation initially because it was a few years ago. Yeah, it had to be 2018. It was for the hundred black men have a female group behind hundred black women. And so that’s why I did the presentation for and I’m pretty sure was probably 2018. You know, it’s interesting, 2019 is a blur because it was into 2020 and then 2021, and here we are in 2022.
00;05;54;38 – 00;06;17;28
So although I think this was a recent presentation, I know it probably was at least three or four years ago. Right. And as you’ve said, the numbers that you presented have been longstanding for decades. Yes. And despite all the other advances that we’ve made in many areas of health care and medicine, this seems to be something that we just cannot get a handle on.
00;06;17;41 – 00;06;41;25
You know, and we cannot get a handle in. And I guess sometimes being cynical, I wonder, do we even want to get a handle on it? Because when you see the numbers and the documented we’re going to talk about presented those numbers and the graphs of how other company, other countries, what their maternal Black maternal mortality rates are and how they just keep going higher and higher and higher and higher, you know, you know, you just kind of wonder, but why?
00;06;41;49 – 00;07;03;38
You know, why is this and why don’t we do something about it? Mm hmm. Dr. Guthrie. What do you think about all of this? Well, like you said, I think it’s a sad state that here we are, one of the richest, most advanced countries in the world. And our numbers are the poorest in this. And in fact, the numbers have been gone up even more.
00;07;03;38 – 00;07;36;34
And it’s still going up for both white and black equally. But it is increasing. I think the latest statistics are that it’s there were 800 over 800 women who died in the United States in 2020, which is giving a death rate of 23.8 per 100,000. Georgia is number one in the country, and here we are. And for black women, the maternal mortality rate is 47 per 100,000.
00;07;36;34 – 00;08;06;19
And for white women, it’s 14.3. And I think you had given the numbers it was 45 and 13. So as you can see, every year that they add the statistics, it’s still going up and it’s going up equally. So there’s not an improvement for black women. So also Hispanic women, like you said, it’s not just African-Americans, but all women of color are Hispanic women, even though their mortality rate is less, though they have seen the biggest increase in maternal mortality.
00;08;06;20 – 00;08;30;48
It was a 44% increase in the past year. Wow. So, you know, again, why this is happening, of course, the differences in races, it is not systemic racism, but why is the country when we have the most advancements, why? You know, one of the things that was mentioned in the video that we’re going to talk about is that we do more C-sections than, you know, the rest of the world.
00;08;30;48 – 00;09;03;39
And even though that’s an intervention that’s supposed to help, you know, correct issues during a delivery, you know, it’s often done in a lifesaving slash interventional manner. It is because a lot of times for a lot of these complications that then add to the maternal mortality. So and again, when we and again, we practice obstetrics for 25 plus years, each of us individually before we decided to stop doing the obstetrics part of our practice.
00;09;03;39 – 00;09;39;48
And it was a it was a difficult decision because as a group of primarily African-American physicians at the time, but also just as a group of female physicians, I think that we were able to provide a level of sensitivity and awareness for our patients and some of the nuances that women may be going through as a part of their health journey during pregnancy.
00;09;40;27 – 00;10;16;16
That isn’t always seen with other physicians because I think it is a sensitivity issue. In previous seasons we’ve done shows about bias, you know, unrecognized bias, things that you’re just not even aware that you’re doing and that unfortunately can have a negative impact on someone’s health outcome. So it was a struggle for us because we still have patients and staff, you know, other nurses who mentioned that they really hate that we’re no longer delivering babies.
00;10;16;16 – 00;10;49;05
And I think that that is a testament to the fact that we really consciously try to make sure that every woman who came into our practice for obstetric care was seen, was heard and was taken seriously. Whatever the question may have been that they presented with or concern or they just didn’t understand, you know, what was going on with them.
00;10;50;03 – 00;11;22;27
I think all of us in our practice over the years have really made the effort to educate patients and their families, to try to explain things to them in terms that they could understand and to hear them. Now, many of us can give many stories of getting, you know, this 3:00 in the morning phone call of something that necessarily didn’t seem that it was that urgent to us, but it was urgent to the patient.
00;11;24;04 – 00;11;50;17
It was important to them. And, you know, we did not not take them seriously, even though with our medical knowledge, we may have said, oh, this could have waited or this may not be that serious. It was serious for them. Mm hmm. And I think as physicians, you know, we have started to, I think, really understand that the patient does know their body.
00;11;50;21 – 00;12;12;43
Mm hmm. You know, and if they say something doesn’t feel right or is something I just don’t. Something’s just not normal. Even though they are unable to articulate what that may be in clinical terms, you know, that we can understand. It is our job to figure out what it is as a medical professional or figure out what it is.
00;12;13;12 – 00;12;35;55
Do you guys have any other comments about that? Well, yeah, like you said, the key is the patient feeling that they are heard and listened to. So even though it could be something like you said, that medically could be minor, instead of just brushing them off and telling you, don’t tell the patient that it’s minor or that’s nothing to worry about.
00;12;36;22 – 00;13;01;52
If you, you know, act like you listen and you hear what they say and then give them an answer to what they are feeling or questioning, then that goes a long way and in care. I think that it’s it’s not just what the problem is. And what the answer is, is that the fact that you listened and gave the information to the patient that may made them feel taken care of.
00;13;02;12 – 00;13;16;24
And I just want to piggyback on what you said, Dr. Guthrie. The other thing, too, that I think and we talk about this a lot, not just with obstetric care, but just with women in general who come in and they may have a complaint. And we know nine times out of ten it’s not going to be anything major.
00;13;16;41 – 00;13;52;11
But it is our job as a medical professional to work that situation up, to do what we know, to do for best clinical practice, to evaluate what that complaint or that symptom may be, to confirm that it is not something because there are cases and not to get your driving wrong, you may want to talk about some of the situations where something was discovered and you know, that required a higher level of attention and care or even, like you said, your even just a callback.
00;13;52;11 – 00;14;14;05
I think it’s just simple things. If you just answered a question or did something, it may have. Yes. Helped you pay attention to something or, like you said, reassure the patient so that something bad wouldn’t happen. It’s a fact that one step could take you either way, but that would be moving forward and helping the patient instead of not taking a step at all.
00;14;14;05 – 00;14;31;17
So, like you said, not returning a phone call, not at answering a question, that sort of thing. I think, or bringing the patient into the brain to like I said, it’s just like, you know, something very simple, evaluate, evaluated and the patient remembers that. I mean, they really they really remember that, you know, as patients always remember did that delivery.
00;14;31;35 – 00;14;52;50
I had a patient just recently and her children at 26 and 28 years old. Goodness. And she said that degree I remember you labored with me all night and then that adjusted to deliver your which is so wonderful, so much better than my previous practice and that you know, we appreciate that as a compliment. But I truly believe that the reason she said that was because we listened.
00;14;53;11 – 00;15;10;18
And I have no doubt in my mind, you know, even that was 26 years ago because that part hasn’t changed. And, you know, that whatever the problem was, we listened because a patient just wanted wants to be heard. And when you’re pregnant and worried and trying to figure out what’s going on with this other human being inside of you, you worry.
00;15;10;40 – 00;15;35;05
You really worry. And it may be little, but you just want to say, I know this might be nothing, but and if we say, okay, what is it? You know, then that’s all they need, right? Is sometimes it’s just that little bit of extra time spent listening. Right. Or another thing too is if they feel brushed off for something that could be simple, when it is something made major, they won’t feel comfortable to ask.
00;15;35;05 – 00;16;14;13
And then that’s when things are made. Things happen bad things can happen. And when I think about, you know, again, to your point, Dr. Greene, that you asked earlier about why why are we not seeing an improvement in this country? And is it because we don’t care? I hate to think that that may be a part of the answer to that question, but unfortunately, I think we have seen in many instances, unless it is something that isn’t affecting the individual directly, it’s not seen as important.
00;16;14;17 – 00;16;42;52
Right. It’s very concerning to me, which is why I think we’ve heard a lot as well in recent conversation and in the media and just an emphasis on health equity, not just health care disparities and trying to delve into why there are these disparities. But again, one of the solutions is improving health equity, which is the access of to care to everyone.
00;16;42;52 – 00;17;38;31
And equally, you know, and objectively and by having a diverse pool of health care providers who can culturally communicate and identify with patients so that things aren’t brushed off because there may be a cultural difference that I may not understand, you know, with Indian patients or Asian patients or Hispanic patients that having a full variety of providers in the health care team, not just physicians, nurses, you know, techs that everyone that’s involved this patients care having a broad team of individuals that have a broad experience and across many cultural spheres I think really does help to improve the patient’s care overall.
00;17;39;00 – 00;18;09;07
And as it relates to maternal death rates and, you know, co-morbidities, I do think that there is definite bias, whether it’s recognizing us or not, that negatively impacts the health care system to really recognize, address and evaluate issues that are brought up by black and brown women. Because, again, you said it’s not an education thing. These women are getting care, right?
00;18;09;27 – 00;18;48;39
These are not women who did not get prenatal care throughout their pregnancy. They did what they were supposed to do. They came in and they saw prenatal care and follow the advice of their health care team. And poor outcomes, unfortunately, happen and in some cases a maternal death. You know, it’s interesting. I think, you know, as a nation in general, as we get more advanced, we think, well, if we can just, you know, make a process that is very electronic, it’s going to speed up efficiency and it’s going to make things better because we can just put everybody in a little slot, you know, and manage them based on, you know, this protocol of this
00;18;48;39 – 00;19;21;58
algorithm, you know, and algorithms are good when it comes probably to financial things and maybe even work processes. But when it comes to people, because people are different, the algorithm may be wrong because the person who made the algorithm didn’t have all the variables. Right, the research behind it. Exactly. And so that when you’re looking at different things on how to actively, in the case of women, manage labor, you know, maybe that’s not the best way to do it, you know, because we’re looking at a person objectively and not subjectively.
00;19;21;58 – 00;19;42;05
We’re not really looking at them as people. And so the reason for the increase in C-section probably has more to do with that than actually seeing the person. And, you know, why they came in. And what they’re here for is to actually have a baby, not to, you know, fall into this little category and, you know, deliver in certain amount of time, you know, and change, you know.
00;19;42;05 – 00;20;04;51
I mean, I think about our training in general that as doctors were trained to do things certain ways and a lot of computers and a lot of trying to be efficient really doesn’t. It takes away from the person themselves. They become a you know, a 76 year old grabbed one pair, too. That’s all they are, you know, and best practices, you know, and algorithms definitely have their place.
00;20;04;51 – 00;20;44;10
And I do think that they help to avoid some some subjectivity that can happen in health care. But I know Dr. Greene and Dr. Guthrie and myself, whenever we have students or interns, anyone in the office and while we fully support the use of best practices and algorithms in certain cases, we always try to emphasize it doesn’t take the place of your clinical acumen and your standing at the bedside or in the patient room, evaluating that patient directly, speaking to that patient directly and listening to that patient is both.
00;20;44;10 – 00;21;06;28
And it’s not either or. And I think that that’s, you know, where we have to be very careful in in terms of how we utilize all the advances that technology, you know, Lord knows I love my gadgets, you know, the things that technology brings for us, but we cannot lose the importance of the human element that just makes all of that work better.
00;21;06;46 – 00;21;41;20
And again, you know, when we talk about health equity, it’s not just in the in product of the health care team, but the research that goes into developing these algorithms and best practices. For instance, it was just noted that in the care of some COVID patients that they are discovering that the pulse oximeter doesn’t read accurately in people with melanin because it wasn’t studied in people with melanin when the pulse oximeter was this was was developed and tested.
00;21;42;14 – 00;22;06;27
Those trials did not include large numbers of people with melanin. So therefore the pulse oximeter readings can’t always be reliable, reliable and I’m sure that it was a person with melanin that came up with this, because we’re the only people that would think about that, you know? I mean, I think that someone with color might think, well, maybe there’s a difference.
00;22;06;27 – 00;22;34;07
You know, let’s at least look at and let’s look at it. At least look at could it could it be could it be possible? Right. And so while we encourage this is not intended to discourage anyone from seeking medical care, no matter your race, because I think in today’s world, with the attention that’s being brought upon it, there’s been a lot of advancement and there are a lot of good things happening.
00;22;34;53 – 00;23;09;06
But what we do advocate for always is for the patient to be their advocate. And if you are seeking health care with any provider and you don’t feel that you have been seen and heard or that you just don’t understand what was explained to you, you can always ask the question and if you’re not getting the answers to your level of understanding, then go get another opinion.
00;23;10;16 – 00;23;37;27
And I think that’s one of the things that we really want to encourage our own patients and those who may be listening to this podcast is that yes, in this episode we’re highlighting some numbers and some issues as it relates to maternal care in this country and maternal mortality rates, specifically as it relates to black and brown individuals and how we still unfortunately have a very long way to go in reversing that trend.
00;23;37;59 – 00;24;13;07
It doesn’t mean that the health care system as a whole is bad. We have to continue to participate and to engage and to push the system to change and evolve in a way that takes care of everyone optimally participating in health care trials, encouraging young people to go into health care fields of all genders, all races, and to ask questions of your providers so that we can make sure that we are helping you achieve the best health possible in this scenario.
00;24;13;07 – 00;24;43;47
So while we don’t currently practice obstetrics and it’s highly unlikely that we ever will, we do love the field of obstetrics. And it was for me the reason I went into OB-GYN primarily as a specialty coming out of medical school. So we still continue to advocate and support education around maternal issues, trying to do all the we can on whatever platforms we have to continue to shine the light on the disparity.
00;24;43;47 – 00;25;06;39
Again, not to dissuade people from participating in the process, but to encourage us all to continue to work toward the end. That makes this a thing of the past. Any other thoughts before we close? Now, again, just want to piggyback to what you said that, you know, we encourage people, you know, seek care, don’t let this keep you away from accessing care.
00;25;06;39 – 00;25;42;06
And, you know, I gave a talk a month ago and I said the same thing. If if you’re a physician, if you feel your physician is getting slighted or by your asking questions or or seeking a second opinion, that that’s not the right physician probably for you. Me as a physician, I can say if anybody were to say they’re going to get a second opinion, I would be happy for that because hopefully it’s going to validate what I said, meaning, you know, that it’s going to be postponed or or even if there’s a different perspective, there’s, you know, different ways to.
00;25;42;06 – 00;26;02;06
So, like I said, it’s it’s being your own advocate and making sure that you’re getting the answers that you have questions for. Yeah. Yeah. I guess all I can add is just the being your own advocates probably care. You know, we all have bad dates. You know, sometimes you may not feel like you’re getting answered the questions. You might not feel like you’re getting heard.
00;26;02;49 – 00;26;33;18
But it’s okay to keep asking and it’s okay to keep asking because as we started off with, most women do know, most people do know when something is just not quite right. And so you want to feel seen. You want to feel heard, you want to feel listened to. Absolutely. So we hope you all have enjoyed just this beginning discussion that we wanted to put forward today, just to kind of be timely with some of the things that you may be hearing in the media, different things that are being presented in terms of documentaries.
00;26;33;40 – 00;26;58;59
And we’re actually going to continue this discussion in another episode of Take Care podcast where we will review a recent documentary that was presented and talk about it a little bit more in detail in terms of our reaction to some of the things that were present in this documentary and then just continue this discussion because again, you can’t fix an issue if you don’t understand the problem.
00;26;58;59 – 00;27;27;13
So we want to continue to sometimes look at things that may be a little bit more difficult and challenging, but yet are important for us to discuss. So please continue to share this podcast with your friends. You can find us on any of the platforms where you get your podcast. You can also check us out on our website at PTCOBGYN.com and we hope that you continue to share this with all of your friends and family until we see you again with the next episode.
00;27;27;28 – 00;27;33;20
I’m Dr. Mironda Williams. I’m Dr. Deanna Guthrie. And I’m Dr. Karen Greene. Take good care.
