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Improving Black maternal survival and the birthing experience

March 17, 2023 | Carol A. Major, MD
Expectant Black mother talks with her Black physician.
UCI Health obstetrician Carol A. Major, MD, believes that unconscious biases and different cultural backgrounds may contribute to maternal health inequities faced by Black women.

U.S. maternal mortality rates, already the highest in the developed world, spiked in 2021 to an alarming rate of nearly 33 deaths per 100,000 live births, a jump of 40% from the previous year, according to the U.S. Centers for Disease Control and Prevention (CDC).

But for Black women, who already were three times more likely to die from pregnancy-related complications than non-hispanic white women, maternal deaths reached crisis proportions of nearly 70 deaths per 100,000 live births in 2021, the CDC reported.

It's a problem UCI Health high-risk pregnancy specialist Dr. Carol A. Major has thought deeply about, and one she is working to address in her role as the UCI School of Medicine's chief of maternal-fetal medicine and founding director of its program to advance medical education for Black students.

Major shared her thoughts with UCI Health:

Caring for patients requires constantly balancing empathy and understanding with clinical expertise, using knowledge of emotions as well as the human body. This is especially true during pregnancy and the birthing experience, one of the most emotionally complex journeys many patients will ever take. As medical professionals who seek to provide the best possible maternity care, facing our own human limitations can improve outcomes for these patients.

We have increasingly come to understand that individual life experiences — including our own cultures, behaviors and unconscious biases — can materially shape the way we care for patients. Unfortunately this may also contribute significantly to health inequities, especially for Black women.

At UCI Health and the UCI School of Medicine, we believe it is imperative to redress this inequity, to develop a new paradigm using creative approaches to help medical professionals recognize, avoid and overcome gaps in care, with a special focus on meeting the unique needs of Black obstetric patients and their infants.

Cultivating awareness and empathy

Obstetrician Carol A. Major, MD, leads the UCI Health high-risk pregnancy program and is a professor and chief of the UCI School of Medicine's Division of Maternal-Fetal Medicine.   .
"Without trust, it's impossible to provide good healthcare," says Dr. Carol A. Major. Photo by Michael Der for UCI Health

Two of the most important steps are developing awareness of our individual shortcomings and cultivating empathy for our patients. Empathy is rooted in understanding, but gaining insight into the experiences of Black patients is not an easy process.

To help achieve this, medical students in our Leadership in Education to Advance Diversity for African, Black and Caribbean (LEAD-ABC) communities program have sought to document the experiences of Black patients, physicians and other healthcare professionals.

Their findings illuminate the potential for adverse patient experiences when there is a perceived — and sometimes alarmingly real — lack of understanding on the part of medical professionals caring for them, particularly in California, where only 3% of physicians are Black despite having the fifth largest African American population of any state, according to a report from the California Health Care Foundation.

One patient interviewed described her obstetrician "writing off" her request for help in dealing with postpartum depression. Another woman with significant health concerns recounted bringing a trove of records to her appointments to prevent being dismissed or labeled a "difficult" patient. A marriage and family counselor told of Black patients who needed treatment for pain being dismissed by their healthcare providers as drug seekers.

UCI Health gynecologist Dr. Nkiruka Chuba said one pregnant patient sought her out as a Black physician and requested that other members of her care team also be Black to improve her odds of a good outcome. In a particularly heartbreaking segment, a patient who was experiencing a traumatic ongoing miscarriage says her obstetrician told her to go home, leaving her feeling that the doctor simply didn't care.

Persistent challenges

Individually, these stories are touching and eye-opening. Taken together, they reveal the persistent challenges faced by Black women before, during and after the birthing process. With this documentary, we hope to drive important conversations around medical racism and the diversity of birthing experiences across cultures.

A lot of times Black women just get a lower level of care. I know because I have been a patient myself, a patient who was very sick. I wasn't listened to. That is frustrating and really scary.

The students' findings also touched on the benefit of cultural diversity on medical provider teams. As the School of Medicine's division director for maternal-fetal medicine and chief of high-rlsk pregnancy services at UCI Health, I have seen first-hand the value of having physicians who represent the populations they serve.

Empathy is vital when we as healthcare providers treat and serve all patients. Expectations about how patients from different cultural backgrounds should advocate for themselves, ask questions, express pain and discomfort can lead to misunderstandings and create a disconnect that destroys trust and affect outcomes.

In my many years of practice, I have seen that without trust, it’s impossible to provide good healthcare. If your patient can't trust you or you can't trust your patient, you have nothing to build on.

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