Season 3 Episode 9 – Maternal Health Crisis (Part 2)

Continuing our last discussion, the doctors share their personal histories regarding the Maternal Health Crisis after watching the Hulu Originals documentary, Aftershock.

Maternal Health Crisis (Part 2) Transcription

00;00;00;05 – 00;00;33;23 Unknown We hope that you all checked out our last episode where we gave you some brief discussion about maternity, health care and the maternity morbidity crisis here in this country. And recently, there was a documentary that was presented on Hulu entitled Aftershock, that has gotten a lot of critical acclaim, as well as continued some much needed discussion in this area of health care disparity and maternal mortality, especially as it relates to black and brown women. 00;00;33;57 – 00;00;55;10 Unknown So we wanted to continue the discussion and we’ll be utilizing that documentary and some of the information that was presented as a means of just discussion. Again, we want to continue to have open forum and communication and shine a light on those issues that we feel are important to us as physicians, but also to our community at large. 00;00;55;55 – 00;01;34;42 Unknown And when we were talking about this episode and thinking about the documentary and the information that was presented, I shared with my partners, it reminded me of when my mother had her first stroke. My mother is deceased now, but she had a stroke, massive stroke 25 plus years ago initially. And when she had her stroke, what really impacted me was the way that my mother was written off from the beginning. 00;01;35;49 – 00;02;04;57 Unknown So as soon as she was admitted to the hospital or evaluated in the emergency room and then admitted at the hospital, and it was determined that she had had this significant stroke, um, she was unable to speak, couldn’t really move much. Um, and so the health care team was just making a decision that we just need to find a nursing home, send her to. 00;02;05;28 – 00;03;01;54 Unknown Now, I was a physician practicing medicine at this time, and there was no consideration for anything else. And I realized that all they saw was an overweight, middle aged black woman. They had no concern for the fact that she was a mother, a wife. She herself had been a registered nurse for over 30 years of her working career, that she was a friend, a sister, a daughter in her own right, and had many children that were extended adopted children, as we do in our village. 00;03;01;54 – 00;03;32;59 Unknown You just everybody’s child is your job. So even though she only gave birth to one, that would be me. She was a mother to many, but that didn’t matter. There was never a consideration that anything else could be afforded to her in terms of her recovery. So I didn’t argue. I wasn’t trying to change any minds because it was clear to me that all the minds at that particular hospital had already been made up as it related to my mother. 00;03;34;30 – 00;04;19;41 Unknown So I went about the task of trying to get her out of the hospital and somewhere else where I could hopefully have a conversation with the health care team to let them know that, no, my mother was going home and she was going to go home as fully functional as possible or at least be given that opportunity. So thankfully, I was able to get her transferred to another hospital and just because of circumstances ended up contacting a cardiology colleague of mine, um, at 9:00 at night because it was time for the transfer and we had to have an attending. 00;04;20;36 – 00;05;14;34 Unknown And I asked this physician to please if he could just act as the admitting position for my mom tonight so I could get her transferred to this hospital tomorrow. I’ll figure everything else out and get her tapped into the resources and things she needed for stroke recovery. This was an African-American physician who brought his 14 of residents and medical students to the rehab facility at 10:00 at night to fully assess my mother medically. 00;05;15;01 – 00;06;03;23 Unknown And from that day, until the day that she passed, some 20 years later, he afforded my mother the best care and compassion and gave us 20 plus years with my mother who went home. It took four months in the rehab facility for her to get all of the resources that she needed for her rehabilitation that this cardiologist made sure happened because he saw the humanity in my mother. 00;06;06;54 – 00;06;58;46 Unknown He is my cardiologist to this day. And anyone who needs cardiology, I refer them to this physician that has informed my care of all women, but in particular women who were seen as marginalized and less than because of bias and health care disparity. So I wanted to share that as we move into this discussion of a very challenging and at times difficult to watch documentary that was recently streamed on Hulu entitled Aftershock. 00;07;00;24 – 00;07;16;22 Unknown So, Dr. GREENE, can you get us started just giving us your impression of the documentary overall and just anything that you wanted to share after viewing that powerful story and collection of stories? 00;07;19;02 – 00;07;44;33 Unknown So, Dr. Williams I had to watch it twice. Um, we were discussing earlier that once you read what it’s about and it talks about maternal mortality, specifically African-American maternal mortality, you know what’s going to happen. I didn’t even have to know who the people were. You just know. You just know which is sad and a whole nother story in and of itself. 00;07;45;39 – 00;08;07;02 Unknown So I knew what to expect. So I had to kind of brace myself to say, okay, I have some time. Let’s go ahead and watch it. So the first time I watched it, I watched it as a physician. Mm Which in watching it as a physician, it allowed me to kind of look at it from an obstetrician, you know, giving care. 00;08;07;15 – 00;08;34;09 Unknown Mm hmm. And so as I went through the movie, I thought to myself, you know, how did this happen? You know, why did this happen? And there’s several points in the movie that it it was kind of hard to separate the fact of being a physician and being a patient because, you know, I have two children. And my first child was born when I was 35 and 35, for whatever reason, is considered advanced maternal age. 00;08;35;01 – 00;08;56;54 Unknown I was a elderly Gravatt man and an elderly Gravatt is supposed to have other complications during their pregnancy because of the fact they were old and I was old. Family history of high blood pressure. And so going into a pregnancy, knowing that I’m a little older than most, I have a family history of high blood pressure. Things could happen. 00;08;58;06 – 00;09;24;23 Unknown And so when I’m watching the movie, I’m thinking, you know, trying to be that physician being objective and watching as to why I’m thinking that could easily have been me. Mm hmm. There’s one line where the mom says, when they brought her to this hospital, I knew this was not the place she should be. Mm hmm. And one of the reasons she said that was because they kept asking her the same questions. 00;09;24;45 – 00;09;50;26 Unknown Does she use any drugs? Does she use any drugs? And she says, I told you that she doesn’t use any drugs because the daughter’s brought in with a pulmonary embolism. And everyone is asking all these other questions, asking all these other questions, and not really listening or taking care of her. And she subsequently expires. And the reason it’s called aftershock is the shock to the families that this affects. 00;09;50;26 – 00;10;16;13 Unknown You know, you lose a pregnant mom, you know, after giving birth. And then the the people that are affected are the people that don’t have them in their lives, that don’t have the 20 years and that Dr. Williams mom was afforded, because they’re anticipating she said, I was anticipating, you know, growing old with my child, having conversations with my child, and now my child is gone. 00;10;16;13 – 00;10;38;27 Unknown And I have a grandson that has no mother. You know, here the husband is. He’s never lived in the home by himself because his wife was always there. And so when a mother dies in childbirth, it affects not only the family, it affects so many people. It’s so many people that are involved. And so when a person comes in seeing that whole person and seeing who they are is important. 00;10;40;43 – 00;10;57;25 Unknown And so the second time I watched it, you know, I watched it as a patient. And it affected me probably a little more as a patient, mainly because of the fact that, as I said, I was older and, you know, I kind of worried about my pregnancy. And I did. And I tried not to. I was like, I’m not going to doctor myself. 00;10;57;25 – 00;11;14;24 Unknown I’m just going to, you know, be the patient, you know, and and listen to my doctors and do what they tell me to do and try not to make decisions on my own. So, of course, first pregnancy I had spotting in the beginning, then I had extra fluid, you know, and so extra fluid could mean something bad. So I had all the different tests, right? 00;11;14;25 – 00;11;41;56 Unknown All those bad things. And it ended up being idiopathic. So there’s a lot of idiopathic meaning, meaning there’s a lot of reasons for it. But this is nothing serious. It’s probably just happened. So it just happened. Didn’t really sit right with me, but because of that, I got lots of ultrasounds, ultrasounds, a look at the baby, ultrasounds to look at my son, make sure his anatomy was okay and so I had to kind of calm myself off the ledge of all the possible things that they might find each time I had an ultrasound. 00;11;42;08 – 00;12;07;44 Unknown But instead I have lovely pictures to go in the baby. You know, and I had a wonderful, you know, delivery. Second child, no problems, wonderful delivery. And I can honestly say that although I watched Aftershock and thought that could be me, I realize why it probably wouldn’t have been me because I’m a physician, you know, and I kind of know what’s going on. 00;12;08;11 – 00;12;26;57 Unknown I went to a hospital where my colleague and I trained together. She’s a physician. And so they knew coming in that this is a physician. But I thought after watching the movie the second time, suppose I went into labor and I had to go to a hospital that wasn’t my hospital. I didn’t deliver at the hospital I worked at because I just didn’t want to, not because I didn’t think well of it. 00;12;26;57 – 00;12;48;55 Unknown I wanted to just deliver somewhere else. But suppose I went into labor in the middle of the night and I didn’t make it to my hospital of choice. I had to stop and go to any hospital. How would they see me? You know, they would see me as a pregnant lady, a pregnant unmarried lady, because I don’t wear my ring because I’m afraid I’m going to lose it at work and my puffy hands in pregnancy. 00;12;48;55 – 00;13;09;16 Unknown The ring certainly wasn’t going to go on it. So they would see me as an unmarried, pregnant black girl. I am sure of that. And it is distressing that I knew that within my bones that that’s exactly how they would see me if I were to go somewhere else. And that should not be the case. No, that should never be the case that we should not be seen. 00;13;11;02 – 00;13;30;49 Unknown So the movie itself talks about those particular situations where, you know, the moms are lost, but it also talks about what can be done. And I think for me, that was the hopeful part of watching it, that, you know, there are ways to let patients be seen. There are ways we can fix this. But you have to want to do it. 00;13;31;13 – 00;13;51;57 Unknown You have to want to give them that space to go to a place, understand that these people are going to take care of me and I’m going to have a good outcome. There’s a story at the end of the movie that the couple realizes where they live has one of the worst maternal mortality in the country. And so that particular hospital wasn’t in their mind a good hospital. 00;13;51;57 – 00;14;19;12 Unknown So they were looking at, you know, other options. And so their other option was, you know, a birthing center, not me personally. I don’t think I want a birthing center because I want all the anesthesia you can give me. But I think that people should have the option. And I also think that I say should be more affordable and safe so that you can make that decision not based, just on finances, because they were lucky that they were able to afford that particular option. 00;14;19;12 – 00;14;45;54 Unknown But for a lot of people, that’s not a choice for them because this birthing center was safe. They did all the right things, they had all the right tools. They knew when to, you know, change paths if something was going to go wrong. And they allowed the patient to be involved in their delivery. And so when that baby came out and I’m watching it on TV, I was just as excited as if I had to live with the baby because she had an option, she had a safe delivery and she was happy and she felt good about her labor and delivery because she knew they really cared about her. 00;14;45;54 – 00;15;03;39 Unknown And that’s all as an obstetrician you ever want, and that’s always a patient you ever want. And so, you know, by the end of the movie, although it started off kind of rough at the beginning, every time the two times I saw it, I, you know, I felt good. And the ruff good. Talk a little bit more about why you said it was rough. 00;15;03;39 – 00;15;38;00 Unknown The it was rough because the signs were there when the lady had a problem in pregnancy. She said she didn’t feel good. She says something was wrong and nobody listened, you know. And not only did they not listen, they did the appropriate bloodwork to show that our platelets were dropping and they still didn’t do anything. And by the time they realized that it was you, no time to deliver the baby emotionally. 00;15;39;03 – 00;15;58;55 Unknown And the dad says it. If they had intervened earlier, my my partner wouldn’t have died. And that’s true, because if your platelets are 44 and low normal is 150. Right. You’re not going clap real well no matter what you do. And they had to do a C-section. And he was told that, you know, the her blood was like water because it was. 00;15;59;20 – 00;16;20;52 Unknown And so he has a healthy baby, but he lost his wife. And so that part was rough because looking at the laboratory results and then and then looking at the response from the hospital that their only thing to say was this hospital has a mortality rate of. And they gave a number. I don’t even remember what the number was because the number didn’t mean anything. 00;16;21;37 – 00;16;36;36 Unknown It’s like, okay, so you gave me the data. You gave me the statistics, but what about the fact that I have no wife? What about the fact that my mother in law has no daughter? What about her friends? What about all these people who are missing her? That was rough. Yeah, you know, because that could have been prevented. 00;16;37;03 – 00;16;55;41 Unknown The other lady, she went home and she kept saying, I am not breathing. Right. You know, I’m not feeling good. And she would call and they say, oh, you know, it’s just pregnancy. You know that, you know, something that happens in pregnancy sometime you just don’t feel like you can breathe. And she kept saying that. She kept saying it until the ambulance had to take her. 00;16;55;52 – 00;17;20;43 Unknown They bring her in. The family’s gathered and all they’re told is she’s gone. You know, that was rough because I remember one night I’m breastfeeding, I looked at my feet and they’re so swollen. So another talking off the ledge moment and I pre-eclampsia I postpartum now I don’t my blood pressure’s fine I don’t have a problem. But if it was a problem, I know that I could have called my physician and she would have addressed it. 00;17;20;43 – 00;17;43;30 Unknown She would have helped me talk myself off the ledge, or she would have had me come in. She wouldn’t have blown me off because it deserved evaluation. It did. It deserved evaluation. And that ladies did not Simone did not get it evaluated. That’s the character in an aftershock. And she’s a real person that’s no longer here. And these are young ladies, young, vibrant ladies that had their entire life ahead of them. 00;17;43;48 – 00;18;12;55 Unknown And Aftershock demonstrates two examples, but they’re not the only ones. And so that that part was rough. That that part was rough, not gathering. What are your impressions? So this documentary we could get 15 topics from this from this back and really may I just highlighted a lot of things for me like you, Dr. Williams I had a situation of my father having a stroke. 00;18;12;56 – 00;18;36;16 Unknown My father had a stroke when he was 83, which you’re thinking, okay, older person, not, you know, not unexpected. But the what happened was my mom called me to tell me that my dad had passed out and I flew from my house. It took me like 10 minutes to get there. And I got there right when the ambulance was getting there and they were upstairs getting ready to take my, you know, take my dad, me. 00;18;36;17 – 00;19;00;54 Unknown But they weren’t asking any questions. They weren’t trying to evaluate him. They just walked in and saw elderly man thinking, Oh, this is just the old people dwindling type. And so if I wasn’t there, what what they didn’t realize was that this 83 year old man had worked a 12 hour day, which he normally did at his place of business, that he was fully functioning. 00;19;01;35 – 00;19;18;49 Unknown And, you know, and so when they walked in and saw this person who wasn’t talking, wasn’t, you know, I walked in, I knew immediately what it was. And I kept trying to tell them. And they kept looking at me like, yeah, you know? And I was like, No, you don’t finally have to stop him. Said he worked a 12 hour day and business today. 00;19;19;00 – 00;19;47;33 Unknown This is not normal for him. So like you said, it’s just the the preconceptions that come in when when when they see a person that can affect medical care. So that’s number one, which of course flows into this film. Um, I, I only watched it once. That was enough. I watched it once and I was trying to toggle between and just, you know, being a patient. 00;19;47;33 – 00;20;04;13 Unknown And I never had a baby, but just being a patient thinking, what would I do in that situation? And then seeing all that could have been done as a physician. So it wasn’t so much that it was just I was like, Oh, every time they said something else, I was like, Oh, oh. I was like, Are you kidding me? 00;20;04;35 – 00;20;25;24 Unknown You know? And and it could have been something as simple as I said, even if the first time she somani if she the first time she called with a complaint. Okay, I could even see trying to reassure the patient, drink some more water, lay down, do whatever. But if somebody called you three and four times with the same complaint, just take a look. 00;20;25;24 – 00;20;56;38 Unknown Just. I didn’t hear anything. It doesn’t have any waiting. That’s that. That was that was hard for me to watch as a physician. It just, you know, I was kind of hopeful at the end to but it also brought up other issues for me that, like I said, you know, how how do we work with how as obstetricians, it even got into the history of how we got to, you know, how we became obstetrician gynecologist till tell a little bit yeah so you know which was you know and I hadn’t thought about it that way. 00;20;56;56 – 00;21;18;42 Unknown So in ancient times, women having babies, that’s nothing new that’s been happening from the dawn of time. That’s why we are here today. But all throughout history it’s been women taking care of women having babies, right? So there was always the one woman in the village or wherever she was that when somebody was having a baby would take care of the woman and it got a name. 00;21;18;42 – 00;21;49;18 Unknown It was called a midwife. Still all through ancient times. Well, what started happening was they all of a sudden there was a man who wanted to take care of women, so they called it a male midwife. They said then it then men did not. They were saying it’s understandable that men would not have the empathy. He couldn’t. He’s never going to have a baby as far as taking care of women, also the tradition of women having babies, it was always the men were over here, the women were over here. 00;21;49;36 – 00;22;08;49 Unknown So all the things that went on in a delivery that were kind of secret and unknown and not that they had to be a secret, but that things men didn’t have to worry about. But the women having baby now men were seeing that and in a my a man they almost said it like in a mind, a man’s mind of how do I fix this? 00;22;08;51 – 00;22;30;42 Unknown You know, you’re going to scream when you’re in labor, get over it, it’s going to hurt. But in a man’s mind, it’s like, how can we make it make it better, right? So if we hook her up and if we do this. So then they started educating men and doing this, and then it became obstetrician gynecologist. And then what was so surprising to me was that they were even talked about in slavery times. 00;22;30;42 – 00;22;56;45 Unknown It was the black midwives who were taking care of the white women having babies. Well, when they started to see that this could be an enterprise, all of a sudden white women were becoming midwives and they started to outlaw black women being midwives. Yes. And so and then everything was moved to the hospital. And so that was just that just caught me by surprise as to. 00;22;56;46 – 00;23;20;59 Unknown But when you think about it, it makes perfect sense. So again, here is something that was totally natural, taken care of by women that has now become a very and I’m a physician, don’t get me wrong. I appreciate science and advancements, but just the whole history of how it changed was very surprising to me. But I was also hope. 00;23;21;01 – 00;23;52;06 Unknown Also the whole question of doulas and working with doulas as a ob gyn, recognizing that there’s some issues there. But, you know, it should be a collaborative thing. It should not be adversarial. Dr. GREENE mentioned that. And in one place there was a birth center. But even in the place where in New York, where the other two main characters were having babies, they were looking to build a birth center in the Bronx. 00;23;52;06 – 00;24;16;09 Unknown And so it’s just again, it’s going to take collaboration. It’s going to take, you know, putting our minds to, you know, what’s the what’s the goal? Keep in mind, what is the goal? The goal is not that I get to do what I want. It’s for a healthy baby, a healthy family, everybody going home, everybody going home. You know, so those are some of the things that kind of got me. 00;24;16;09 – 00;24;55;35 Unknown They even got into the history of Simms, this famous obstetrician who’s supposed to be the father of gynecology, and how he experimented on women. I mean, there was just so much in this in this doc. It’s a lot to unpack. Yeah, definitely a lot to unpack. And I think, again, as you said, this is not something that can be handled in one brief podcast episode, but something that we need to continue discussing and evaluating solutions and, you know, one of the things that you guys have highlighted is that sometimes our interventions, no matter how well-meaning, you know, all the good intentions don’t get to the desired goal. 00;24;56;34 – 00;25;26;24 Unknown You know, the intervention may have been a good intervention, but did it get to the desired goal, which is everybody going home healthy? And, you know, that’s one thing I would say to patients, you know, as we were taking care of them in labor, you know, I see the goal is everybody goes home. We may do plan A, it may be plan B, sometimes there’s even a plan C, but we do what we have to do so that everybody goes home healthy. 00;25;27;36 – 00;26;02;11 Unknown And for me, I think, you know, the only thing I really want to highlight or add from what the other ladies have mentioned about this documentary is, again, looking at it from a physician’s eyes and saying, gosh, if they had just acted. And again, I understand in the hustle and bustle of modern medicine, especially in obstetric unit, it can get very busy and it can be a lot happening. 00;26;02;11 – 00;26;36;59 Unknown But we never should lose sight of the fact, as you said, Dr. Guthrie, if someone has continued to say that something is wrong or have a concern, even if nine times out of ten it’s probably nothing, is that 10th time when it is. And I never wanted it to be said that I didn’t look. It may have been a little aggravating at 230 in the morning to have to get up and do that evaluation. 00;26;36;59 – 00;27;22;22 Unknown But that’s my job. That’s why we’re here, is to do the tough stuff and to make decisions and to help advocate for our patients and collaborate. Midwife Do you know all of us have the same goal and so we should all nursing, respiratory therapists, anesthesiologists, we should all be working together to come up with the desired outcome of a healthy mother and a healthy baby and a family that gets to go home and enjoy years, years of enjoyment with that child or children. 00;27;23;48 – 00;27;57;31 Unknown So it was disturbing and unnerving. And again, when we stopped practicing obstetrics, I think that was one of the things that was of concern because we knew how much we took care of patients, all the high risk patients, you know, the ones that nobody else wanted to take care of because of whatever we all felt that they deserved good obstetric care. 00;27;58;18 – 00;28;45;04 Unknown So it didn’t matter. Their background didn’t matter, their ability to pay or not. Even those moms who showed up with no prenatal care, as many of them did, they still deserved the same treatment and level of attention to their concerns as issues as anyone else. So if nothing else, I hope that documentaries such as Hulu, the research that is going on, Hulu’s aftershock, the research that is going on, health equity, trying to be more inclusive with research populations as well as with health care teams. 00;28;45;04 – 00;29;17;10 Unknown All of it should never lose sight of the humanity of the individual. These are people, their daughters, their wives, their sisters, their mothers and their families should not have to go through aftershock. Right. And and this brings up term that was that was used and after that was reproductive justice. Yes. And and that’s the it’s going to it’s the big topic of the day with the recent Supreme Court rulings. 00;29;17;48 – 00;29;47;08 Unknown But I looked up the definition of reproductive justice, and it says the human right to maintain personal bodily autonomy have children, not have children and parent children. We have in a safe and sustainable community. And going back to what you were saying, Dr. GREENE, that the reason why you knew that you had a better outcome possibly was because you were a physician and you were and you knew the questions to ask and things to look for. 00;29;47;39 – 00;30;17;06 Unknown But even in that documentary, Simon, his mother was worked in the field and she was saying to yourself, here it is. I’m looking at these situations. I never thought it would happen to us. But right there it was, you know, right. So it’s it’s it’s just being vigilant, um, again, being your own advocate and then hoping that we get to a place of reproductive justice in this country for everyone all, no matter who you are. 00;30;17;06 – 00;30;34;37 Unknown Right. Right. There’s a I think there was a doctor in the movie was talking about, you know, how you can change it. And the one thing he said that kind of stuck out in my mind the second time I watched it, affirming a person’s dignity and making them seen is the way that you make them safe is not a luxury. 00;30;35;04 – 00;31;00;29 Unknown Say that again. Affirming a person’s dignity and making them seen is the way that you make them safe. It’s not a luxury. And I think that’s what we all talk about, that we want to make people feel seen. And that’s why we took all comers when we delivered babies, because somebody had to take care of them and we felt like, well, we should because we want them to feel seen. 00;31;00;29 – 00;31;25;32 Unknown We want these people, no matter when they came in, in their pregnancy, to have good care, you know, and if they get good care, then our job is done. That’s really all that matters. So again, we just wanted to take an opportunity to highlight this very timely topic, as well as to also highlight the extraordinary three documentary on Hulu Aftershock. 00;31;25;32 – 00;31;53;12 Unknown And if you haven’t seen it, we encourage you to watch it, to watch it very mindfully, very thoughtfully, and perhaps, you know, see what ways that you can advocate for yourself or for a loved one, knowing the information that is presented. And again, we we want to present information, but we want to always leave you with the sense of hope. 00;31;53;37 – 00;32;23;25 Unknown You that’s why we do what we do. If we didn’t think that things could change and get better, then I wouldn’t be a member of this very same health care system as a gynecologist now, but also still as an advocate for women’s health, which includes their reproductive justice, their maternity and gynecology, gynecological issues. And so please continue to listen to us share this episode or all episodes of our previous two seasons. 00;32;23;48 – 00;32;45;05 Unknown You can find us anywhere that you get your podcast episodes and also check us out on our website at PTC OBGYN dot com. We look forward to seeing you soon in more episodes down the line and we’re going to sign off. But I’m going to ask Dr. Green before she signs off to read that last statement one more time. 00;32;45;26 – 00;33;04;20 Unknown Again, I’m Dr. Miranda Williams. I’m Dr. Diana Guthrie. And I’m Dr. Karen Green. Affirming a person’s dignity and making them seen is the way that you make them safe. It’s not a luxury. Take good care.

Aug 24, 2022 | Podcast Episodes