Ensuring appropriate pre-pregnancy through postnatal care is critical for optimal health of mother and child.
Derek van Amerongen, MD, MS: Let’s change topics slightly and talk about something that’s gotten increasingly important in the last few years: health disparities related to morbidity and mortality and maternal health areas. In many parts of the country, the maternal mortality rate is significantly higher than in places in Central America. The United States overall has a higher maternal mortality rate than any other industrialized country. How do racial disparities tie into this? Let’s start with you, Dr Hawkins.
Soyini Hawkins, MD, MPH, FACOG: There are disparities across the board when it comes to maternal wellness and care. Some of those disparities come from the things we’ve already mentioned, like disparities in access to care. Are they getting to their visits earlier in their pregnancy? In doing so, are they getting the basic preventive treatments that are reflective of their outcomes for childbearing and their actual time in pregnancy? That’s going to be extremely important [in determining] what their results are, how they carry themselves to term, and whether they’re going to be screened for things like cervical shortening. If they’re not coming in early, we can’t know if they need additional treatments and management. Some of the disparities are in the front end, but there are disparities all the way through, unfortunately. With the way we’re monitoring their labs, it can be as simple as that. With the way they present to the hospital if they have pain, elevated blood pressure, or swelling, how is that interpreted across the board? Is it evenly interpreted no matter what their race or culture is? Because all of those are going to affect outcomes when it comes to maternal health.
Of course, the biggest discussion we’ve had in recent years is unconscious bias. Is there a place for us to make improvements in the way we’re partnering with our patients? If they have a birth plan, what does that look like? How can we help them execute in the way that is safe and feels comfortable for them? As providers, we need to be safe in the way that we’re caring for them beyond a birth plan when they get there. They might say something as simple as, “I have chest pain.” [We need to make sure that’s] not brushed off or excused as melodramatic in patient populations that have been sidelined during their disease or symptomatic states? That translates into outcomes. The disparities are extremely important at the front end of how women are being treated when they’re trying to get pregnant. From their planning stages, to getting them to their obstetricians early in their pregnancies, to making sure they receive the best baseline care all the way to the day of delivery.
Transcript edited for clarity.
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