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Midday Edition Special: Racism Fuels A Public Health Crisis In Black Maternal And Infant Health

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Above: Dr. Toluwalase Ajayi is pictured with her daughter in this undated photo.

In San Diego County, Black women are three times more likely to die due to pregnancy or delivery complications than white woman and Black infants are also 3 times more likely to die and 60% more likely to be born prematurely than white babies. In a special program on KPBS Midday Edition we hear personal stories from Black mothers about their birthing experience, explore why the problem exists and what is being done to address it.

Speaker 1: 00:00 A conversation about the black, maternal and infant health crisis here in San Diego.

Speaker 2: 00:05 I see pregnant women of color walking around here. I am fearful for them. I'm fearful for their lives, but I'm fearful for the life of their child.

Speaker 1: 00:12 Jade Hindman with Maureen Cavenaugh. This is KPBS midday edition. We look close at what's causing health disparities among black moms and their babies.

Speaker 2: 00:29 It's not, well, it's not education. It's not held. So none of those things really factor in it's it's pretty much race.

Speaker 1: 00:36 Then we hear from women impacted by the crisis and what's being done to fix it from medical school to the community programs. That's ahead on midday edition, We'll bring you a special about a public health crisis affecting black women and infants across the country. Right here in San Diego County, black women are three times more likely to die due to pregnancy or delivery complications. Black infants are also three times more likely to die and 60% more likely to be born prematurely. This is happening because of racism in healthcare, and it affects so many women, including me, my husband and I in every coup or chuckle from our 10 month old daughter, meet it with immense gratitude.

Speaker 3: 01:36 Oh

Speaker 1: 01:41 No. If we would ever hear that because during my pregnancy like many black women, there were complications concerns when ignored, there were delays in care. Triaged doctors seem to be more concerned with surgically sterilizing me than finding out why my pregnancy was ending early. They even suggested my husband consider a vasectomy. Our daughter was delivered by C-section prematurely weighing just two pounds. During her two months in the NICU nurses told me she's going to be fine. The black girls are the strongest as well-intentioned, as they may have been. It translated to them not being as attentive to her needs and delays in her care because black girls are the strongest. And so the cycle continued. Now what's being done to break it. We start our conversation with Dr. Wilma Wooten, who is the public health officer for San Diego County. She joins us to talk about how the County is working to fix racism and implicit bias within the healthcare system. Dr. Wooten. Welcome. Thank you for having me. We know the statistics. We know the disparities here in San Diego County. What do those statistics reveal to you? Well,

Speaker 2: 02:54 [inaudible] reveal that, uh, black women experienced long-term, uh, deterioration of their health,

Speaker 4: 03:00 Not because of the genetics education or economic status, but due to toxic stress in their environments and racial bias, uh, within the healthcare system is a contributing factor that can result in higher rates of infant and maternal complications. And so we've heard a lot about racism as a public health crisis, and it indeed is a racism as well as social and economic stressors play a major role in poor birth outcomes. Babies are born too early and too small, particularly for black women. And although the gap appears to be closing, there continues to be large disparities between African-American and white infant mortality and not just white after mortality, but all of the other racial and ethnic groups as well. If you look at the threshold or target that is identified that the nation should have African Americans has been above whatever that threshold has been, all of the other racial groups are below those targets. So this has been an ongoing problem.

Speaker 1: 04:11 And let me ask you this. What do you think is broken within the healthcare system that allows these disparities to continue to exist?

Speaker 4: 04:18 Obviously, we've been talking a lot about racism as a public health issue, and there's just a lot of information out there. Uh, we are working currently with our healthcare system partners to improve service delivery, uh, in the healthcare setting, through the counties, uh, Perry NATO equity initiative. And we are providing implicit bias training to our healthcare providers so that they are cognizant and aware of the issues that, uh, African-American women experience to help, uh, them have better birth outcomes.

Speaker 1: 04:52 Uh, the County, um, is connecting people with resources. Can you tell me about that?

Speaker 4: 04:57 The black infant health program is a major resource, the core elements focus on stress reduction, uh, social support and empowerment. Uh, but we also have other resources for women that are planning to become pregnant. So these are prenatal resources

Speaker 1: 05:15 As the County takes the lead in addressing these issues and the disparities. Um, why do you think there is no urgency within the healthcare system to address these issues? They have certainly been front and center for a while now.

Speaker 4: 05:27 Urgency. I think that there is, uh, that we are taking the lead and making this issue a parent and calling it out to our healthcare providers so that they can become a partner in ensuring that these issues do not continue.

Speaker 1: 05:45 And you've, you've mentioned some of the resources that you all provide. Is there any legislation in the works that you're aware of that may help address some of these issues?

Speaker 4: 05:53 Well, actually, um, there was a legislation, uh, Senate bill, uh, SB four 64. It is called the California dignity and pregnancy and childbirth act. It requires a hospital that provides perinatal care and an alternate, uh, alternative a birth center or a primary, uh, clinic that provides services as an alternative birth center to implement an evidence-based implicit bias training for all the healthcare providers involved in perinatal care of patients, uh, within those facilities. So SB four 64 requires the healthcare provider to complete initial implicit bias training and a refresher course every two years.

Speaker 1: 06:40 Do you think there needs to be more legislation,

Speaker 4: 06:43 Quite honest with you? It would be nice if we didn't have to legislate our way into something like this, but with the additional training, providing training, not only this is a start with healthcare providers training of our entire public, and that's something that we think is very important training needs to occur at all levels so that anyone who engages with these women is aware of things that they might do that might, they might not see as, um, a bias, but, uh, in fact actually could be. So the more training that everyone gets, the better all of us are because this will mean that this particular group of women will no longer stand out and have a higher infant mortality rate. And when we bring, uh, everyone or achieve parity with all of these, uh, public health, uh, indicators and infant mortality is one of our most important public health indicators when there's parody and everyone, uh, has equity or health equity, the greater our society will be overall.

Speaker 1: 07:51 I've been speaking with San Diego County public health officer, Dr. Wilma Wooten, Dr. Wooten, thank you very much for joining us.

Speaker 4: 07:57 I see so much of Jade is a pleasure talking with you today.

Speaker 1: 08:05 Shallah Mason is a San Diego mom. She shares her traumatic birthing experience. The impact it's had on her son and how advocating may have saved his life. She joins us now shallow.

Speaker 2: 08:18 Hello, thank you. So how long

Speaker 1: 08:21 Ago was your traumatic birthing experience?

Speaker 2: 08:24 Nine months ago. And what happened? I basically, um, was having issues during my pregnancy. So, um, I was failing stress tests and they never took the time to check or to look into why I was felling, the stress test, which ended up being detrimental to my son. He, his care, his birth, he suffered a lot. He had a brain hemorrhage, his liver wasn't large kidneys were enlarged. His scrotum was enlarged. Thyroid was out of whack just to delay care. Um, cause all the problems that my son had at birth,

Speaker 1: 09:06 You finally did give birth. What did doctor say about your son?

Speaker 2: 09:11 They didn't say anything at first, at first, you know, it was me who drew attention to the doctors in the labor and delivery room. I had him via C-section and I was the one that pointed out that he looked pale. He didn't look right and that they needed to take him and they needed to check him out once they did. They had no idea in the beginning. What was going on with him? Why any of this was happening to him?

Speaker 1: 09:36 Delays in care when he was in your room? Uh, what type of, uh, side effects did that have? How did that impact your son

Speaker 2: 09:44 It's health? It impacts him greatly like he's delayed now, you know, and with his developmental milestones. Um, so he's nine months now and he's just now learning how to sit up and roll over and do the things that, you know, kids who are born at nine months, like my son, he, he did make it to 37 weeks. So I was nine months pregnant when I had him. But he's very delayed today. So that's the impact that it's had. That's all we know as of now.

Speaker 1: 10:16 And your son had to spend some time in the NICU. How long did he have to stay there? And what was his care like in there?

Speaker 2: 10:23 So he had to stay in a NICU almost two full weeks. The nursing staff in the NICU was amazing with those doctors. The doctors did not have bedside manner. They were literally preparing us to bury our child that were talking to me as if he was already dead. They were talking to me about planning, um, his autopsy and we're going to do it very respectfully. And mom, you know, he could go with any moment. And then once we took him off of the ventilator and he didn't pass and he was actually breathing on his own and opened up his eyes and doing what they thought he would not do. You know, they were like not trying to give him enough food to feed them. Well, mom, if we move towards comfort care, we'll just give them enough. Just we'll just make this a little bit of formula just enough, you know, because he's going to, he could still go at any moment. So

Speaker 1: 11:17 How did you respond to that? You have your child and you see that he's breathing he's his eyes are open. He is thriving. Uh, and then yet you have doctors who have decided, uh, otherwise

Speaker 2: 11:31 I felt like if I didn't get him out of there, that they were literally going to let my child die. They were going to start him to death and let him die. And I told my husband at that moment, I said, we have to go because one of the NICU nurses, basically he kept telling us, get him out of here, take him home and love him. You will be amazed at what love will do for little babies like this. So we just, I just decided that morning I woke up that it was time to go. We needed to leave the hospital. And that's what we did. I took them over. How was

Speaker 1: 12:02 That transition? Getting the baby home.

Speaker 2: 12:05 He was breathing on his own. He had a feeding tube in his nose, just in case if he couldn't, we couldn't get him enough milk and through the mouth, then we could put the rest of it through his feeding tube. They told me, um, basically that hospice care for babies was like home health care and not like hospice care for adults. So they were willing to do whatever I wanted them to do. So they were like, if you want him to live, you want him to thrive. Then by all means, feed him, you know, love him, take care of him. If you need anything, call us we're here. They came in twice a week just to check on him. And they were so impressed with his weight gain and how alert he was and just, you know, his progress, how he grew. And like today he doesn't even look like the same time. He's in the 90th percentile for both weight and height and he's thriving. He's doing well. And I think about like, what, what if I didn't listen to my gut? You know? And didn't bring him home when I did,

Speaker 1: 13:03 You know, you, you made that decision, um, and advocated for yourself and for the health of your baby. Um, what advice would you give to expectant parents, right?

Speaker 2: 13:14 Yeah. You need to advocate for yourself, forced them to pay more attention to you because I didn't do it. I was, you know, we're inclined to thinking, well, they're the medical professional. They have our best interests at heart, but sometimes they don't. I see pregnant women of color walking around here. I am fearful for them. I'm fearful for their lives or I'm fearful for the life of their child. And, and I think this interview and, you know, listening to other women tell their story and we getting the word out. I think this is what's going to, it's going to take all of this for things to change.

Speaker 1: 13:44 I've been speaking with shallow Mason, a San Diego mom, shallow. Thank you so much for sharing your story. And, uh, I'm so sorry for what you experienced, but I am so happy to hear that your son is doing well.

Speaker 2: 13:57 Thank you so much.

Speaker 1: 14:05 You're listening to KPBS midday edition. I'm Jade Hindman with Maureen Kavanaugh. Sharday Fonteneau is a doula with project concern, international her own traumatic birthing experience and the experiences of women in her family for generations back led her to the work she does. Now. Here's that interview? What was your own birthing experience?

Speaker 2: 14:27 There was discrimination at play. There were things that happened that were ignored. When I found out that I have preeclampsia, nobody told me nobody addressed it. Um, these are things that I know now that I didn't know, then that again, led me to doing this work. Um, and then with my second child, knowing that I had preeclampsia with the first, just knowing that they did nothing about how to prevent

Speaker 5: 14:52 That from happening with my second, that led to a very, very negative pregnancy experience. My birthing experience was I wouldn't say it was negative, but it wasn't positive.

Speaker 1: 15:02 How are your children now? They're

Speaker 5: 15:04 Great. They're doing great. Um, uh, for the most part, my youngest was born at four pounds. Um, but he's thriving and he's doing well. My was suffering from intrauterine growth restriction with him, and that was due to the high blood pressure, which was due to them, not even, you know, acknowledging that blood pressure, acknowledging that I was a black woman that had high blood pressure in a first pregnancy and probably would have it in the second. They did nothing about it. And then it led to all this string of events throughout my pregnancy that were negative and adverse and led to me having a premature delivery, which is another thing that we often see in the black maternal health crisis.

Speaker 1: 15:49 And as you got into this line of work, I'm sure you, you began to notice some similarities and the birthing experiences of other black women. Can you tell me about that?

Speaker 5: 15:59 They've been really, really early, similar to my own experience, talking about their preeclampsia stories, right? The same stories of being ignored or spoke down to biomedical staff, way too much lack of disregard for human life. And it's just, it's appalling to me that my grandmother's birth story is the same as my birth story. She's 82 and this is 2021 and it's not too much different from my birth story or my cousins or my, or my sisters and my clients. And my great-grandmother actually died of preeclampsia. And I also suffered from that preeclampsia. My grandma told me the story of when my great grandmother had her final twins before she passed away. She had twins and she was having babies at the house. And the doctor came to the house where she was giving birth. She said that the doctor just seemed disgusted and annoyed, and he just wanted her to hurry up and have the baby so he could leave.

Speaker 5: 17:09 And then he hurries up and leaves after the baby's born. And he didn't know or says he didn't know that she was having twins. And so he leaves in the second baby. She has on her own while my great, great grandpa was, you know, running out the house to go get the doctor and tell him to come back. She's sitting there hemorrhaging out and she passes away. And so my grandmother was able to share this story with me of how, you know, discrimination played a role in contributing to my great-grandma being a statistic of this black maternal health crisis. And it being in, and as I started to work more closely with marginalized communities in the birth world, that's when I began to realize like, this is not a coincidence. It's this is a public health crisis

Speaker 1: 18:04 Issues have persisted for a long time. Um, just as the disparities have. Why do you think there's no urgency to fix the problem?

Speaker 5: 18:13 You know, I feel like the medical community should care more about this collectively and realize that there is a there's distrust there due to the historical roots and how racism has been in the healthcare system. You know, it's just so deeply ingrained in our history that that sense of urgency was never there. And it's it's, we are creating that now by, by fighting, you know, for reproductive injustices and those reproductive injustices that are for white women's reproductive healthcare is all coming at the expense of black and Brown women's lives. They used to test birth control options on us, um, reproductive medical procedures on black slaves and black women are the very foundation of gynecology. And yet we still receive inequitable reproductive and maternal health care services.

Speaker 1: 19:14 And so where the health system falls short, there are resources available, like the ones you offer, what are some things and expecting moms should look for when seeking out those services.

Speaker 5: 19:25 One of the things we do at healthy start is we help navigate families through pregnancy and their parenting journey. And we do that from the time that they find out they're pregnant until the baby's 18 months old. We also provide the information to them about the County of San Diego and how the medical system works here. Um, hiring a doula could definitely help. That's something that we provide for free at the healthy start program.

Speaker 1: 19:54 Speaking with Chardonnay, bell Fanta, no, a doula and perinatal navigator with PCI has healthy start program. Sharday, thank you so much for sharing your story and for the work that you're doing. Thank you.

Speaker 6: 20:11 It may not be surprising that racism is a factor in adversely affecting the quality of care black women and their babies receive. As we've learned, racism is a factor in just about every aspect of black lives, but the medical profession has its own particular history of ignorance and abuse of African American healthcare. It's a system of explicit and implicit bias that begins in medical school. Now there's a new effort to recognize that bias and remove it. Joining me is Dr. Rodney hood he's precedent and chairman of the multicultural health. He is also a physician, an expert on health disparities, medical history, and racism in medical care. Dr. Hood. Welcome.

Speaker 7: 20:56 Thank you. Thank you for having me

Speaker 6: 20:59 Now, the medical profession has had a long and cruel history with black Americans from Tuskegee to Henrietta lacks. Can you remind us about those incidents and maybe others we're not familiar with?

Speaker 7: 21:13 Well, you know, we're dealing with the pandemic and one of the issues is the hesitancy of black folks and taking a vaccine. And when are the first things that arises is the issue that took place in Tuskegee, where there was a 400 of black men that were enrolled in a public health study. So it was a government study and these individuals were diagnosed with syphilis. At that time, they had identified a drug that could actually cure it, but for about 30 years, they followed these individuals so that they could determine the natural course of the disease without treating them. But it didn't begin there. Uh, the us has a, uh, I call it ethno historic legacy of inappropriate inhumane research with, uh, blacks going all the way back to slavery. We got Dr. J Marion Sims who was known as the father of women's health, who got his reputation by operating on 30 or 40, uh, slaves with no anesthesia developing his procedures. There were multiple experiments on, uh, African-Americans throughout the centuries.

Speaker 6: 22:26 I'm kind of biased. Did you experience when you were going to medical school?

Speaker 7: 22:29 Cool. Um, well, um, I went to medical school about, uh, 50 years ago. I, I, I started, uh, 50 years ago. I was one of the first African-Americans to go to a UCF medical school. Um, during one of my classes and a medical school, there was a lecture in behavioral health on, um, uh, the, the theory that, uh, uh, intelligence was inherited. Um, and by using the, uh, Eurocentric, uh, IQ tests that blacks had a lower IQ than whites. Uh, this was actually being, uh, one of the lectures that I had to attend. And the danger of that is the ones who were postulating that were, um, uh, scientists at UC Berkeley, uh, behavioral health scientist. Uh, they had William Shockley who was a physicist who postulated this, that, um, if this is true, then educating blacks to, uh, higher education, uh, may not be helpful. They should be trained to be, um, less educated because their intelligence wasn't there. So here I am, as a young black man, uh, attacking my, uh, intellect,

Speaker 6: 23:46 Even up until this day, we talk about implicit bias in medical school training. What exactly does that mean

Speaker 7: 23:54 In the 20th and 21st century? I think the racism we're talking about what isn't as overt as it was during slavery and post-slavery, but it's gone underground into a subconscious level where people make decisions towards different groups, specifically blacks that do not benefit them therapeutically in the health field, as it would others, multiple studies point that out.

Speaker 6: 24:24 How would implicit bias manifest itself in medicine?

Speaker 7: 24:29 This has been shown in cardiovascular disease where, uh, there was a study in the new England journal of medicine in 1999. That's almost 20 years ago with a, uh, show that good physicians train well. They interviewed eight patients that were actually actors and ask them questions. And the questions led to them telling them they had cardiovascular disease. When it came time to say, making a decision as to what to do, the black patients were recommended the less appropriate therapy than the whites. And these physicians consciously felt that they were making the same decisions, but both black and white. And what we now know is if you have a negative implicit bias against a certain group, you tend to make less therapeutic recommendations

Speaker 6: 25:25 Are some solutions to this problem of bias and inadequate treatment that black women have been confronting for years and black people in general have been confronting.

Speaker 7: 25:37 Now, having this discussion, uh, about that it's real, uh, I know many, um, medical school training, nursing training, they're now including cultural competency training, uh, implicit bias training. I think that's critical, um, critical when they just do it once. I think that training needs to be done periodically and on ongoing basis. And I think it needs to be incorporated not just in one class, but throughout their, uh, uh, medical nursing or health education training.

Speaker 6: 26:15 I've been speaking with Dr. Rodney hood, he's president and chairman of the multicultural health foundation in San Diego. Dr. Hood. Thanks again.

Speaker 7: 26:24 You're welcome. Thank you,

Speaker 1: 26:30 Dr. Lucia jive is a San Diego pediatrician who is expecting, and though she's filled with joy, she is also filled with anxiety from experiences with racism and implicit bias, the healthcare she received during her previous pregnancy. Dr. Isiah joins us now to share her experience Dr. Shi welcome.

Speaker 8: 26:52 Thank you so much. Pleasure to be here

Speaker 1: 26:54 As a physician and researcher, you are acutely aware of the health disparities that affect pregnant black women and our babies. When you became pregnant with your first child, were you anxious about the health care you'd receive?

Speaker 8: 27:09 I was honestly, and it's kind of ironic to say, because as a physician, I do feel a little bit nervous engaging the healthcare system in general, but I was definitely aware of the maternal fetal mortalities. And that was a little bit nervous. Yes.

Speaker 1: 27:24 So what was your experience like with your OB GYN during your first pregnancy?

Speaker 8: 27:29 Well, I've had, um, when I first moved to San Diego, I had, um, just, uh, picked a random OB GYN that was this time per my, um, fellowship insurance. And he had been finally interacted with him once a year. And then as I was approaching it advanced maternal age, and because I had known fibroids, um, he had told me that it'd be difficult for me to get pregnant in the first place. And so when I did get pregnant, I guess I was expecting a little bit more attention to be paid to me or more information given to me during that process. And I was, I didn't receive that. And I was, felt really uncomfortable because I felt like I wasn't being listened to by him. And then I remember the first ultrasound that I had cause I was having, I think I actually had a little bit of bleeding early on and I didn't know what that was about. And so he referred me to an ultrasound for an ultrasound and the ultrasonographer was just very cold. And the fact that I wasn't married to my husband at that time of my first pregnancy, I was definitely treated like a stereotype. They did not know that I was a physician. And I remember just a very unwelcoming feeling and just feeling very disregarded. And, um, I switched to another OB GYN as soon as possible, very early in that pregnancy.

Speaker 1: 28:47 Hm. How did that experience affect you emotionally?

Speaker 8: 28:51 It never gets easier, right? So you deal with it as a black physician, by your patients who are surprised that you are actually their doctor. And then to encounter that as a patient, number one, it makes you think of all your interactions with your patients. And number two emotionally just makes you feel gutted. It makes you feel kind of demoralized and a little bit cast aside.

Speaker 1: 29:14 Hm. And you mentioned that your experience was so bad that you decided to change doctors. Um, what did you notice most about your care and your experience with your new doctor?

Speaker 8: 29:26 Oh, from the moment I stepped in, it was just night and day. First of all, the office was very welcoming. They had a diverse staff, it was like a rainbow of women in the firm and the front office staff. So there was diversity within their staff and I felt comfortable, um, having other women to interact with in that like front office visit, it was just a very welcoming, congratulations. You're pregnant. This is going to be amazing. And then my particular OB GYN, her nurse at the time was also a black, a black woman. And so it just made me like, you can just take that breath of fresh air and it's like, Oh, I'm going to be seen, I'm going to be listened to this is, this is going to be great.

Speaker 1: 30:06 You know? And you still experienced a lot of pain during that pregnancy and it sent you to the emergency room. What was that experience like?

Speaker 8: 30:14 The first person I interacted with was not particularly a client or warm. Um, then the nurse who took my vital signs and saw that I was, you know, truly in physical pain, helped me sit down was, was kinder to me. And then when I went and was waiting to be seen by the physician, of course it took a little bit. And once again, it was a male ultrasonographer that saw me in the emergency room and the way that he was pressing on my abdomen with the ultrasound, despite the fact that at this point I was actually crying. And, you know, it was saying like, this hurts, this hurts was not heard, was not listened to. And he was like, it's okay. This is, you know, this is part of the process. It's, it's gonna help. And like, just didn't let up, even though I was crying and in pain, it didn't matter.

Speaker 1: 31:00 It's such a vulnerable position to be in because you don't want him to start making demands, um, while you need, you know, want to make sure that you make it through the birthing process, um, unscathed, you want to make sure that your child is okay and that you're okay. Um, so as a physician, what would you tell doctors about how they treat patients, especially expecting black moms and, and our infants.

Speaker 8: 31:26 It starts with not just you, but also your nurses and the staff around you, right? By the time your patient meets you, they've already interacted probably two to three layers of staff that they've interacted with. So being aware, not just of your own implicit bias, but also that of your staff and how you do that training. Even though the words that we say to patients may be the same across all races. There was this great study that showed that the nonverbal communication that white physicians had with their black or other ethnic, um, patients was completely different. So the words that were perceived, um, were different between the different ethnicities. So just, it's not just the words that you say, but how you engage with your patient in general.

Speaker 1: 32:10 I've been speaking with Dr. [inaudible], Dr. Jaya, thank you so much for sharing your story and for the work that you do. Absolutely. Thank you so much.

Speaker 3: 32:26 Yeah.

Speaker 1: 32:27 You're listening to KPBS midday edition. I'm Jade Hindman Chinasa Campo. Verde is now expecting, but Thanksgiving day, 2019, her previous pregnancy took a tragic turn just a week earlier. She noticed something during an anatomy scan that she says when ignored by doctors here's that interview.

Speaker 5: 32:47 So that week prior I had actually went in for my anatomy scan and they noted that my cervix was, was shorter than it had previously been. I asked about several interventions, but I was told that I should just go home and take it easy. And a week later I went into labor and they couldn't stop my son's labor. So, um, I ended up having him at, at almost 21 weeks gestation. So, um, he didn't survive too long after birth.

Speaker 1: 33:19 I'm sorry that you experienced that you all held him in the hospital for awhile. I mean, did doctors suspect that he would be alive when he was born or?

Speaker 5: 33:29 Um, they, they, they actually thought that he wouldn't be alive when he was born, but he actually started moving and, um, he started moving in my arms. So that's how we found out that he was alive and yeah. Um, my family was there, so my husband got to hold them, my brother, my sister, my dad. Um, and we actually had him baptized, um, by, uh, by the hospital, chaplain B before he passed away. So

Speaker 1: 33:54 Where do you think doctors went wrong in your care and even the care of your newborn?

Speaker 5: 34:00 I think where they went wrong was not listening to me, um, at that anatomy scan where, where they noted that change in my cervix, I asked for several interventions, both previously from my own knowledge and having a friend that had went through a similar situation. I asked for several interventions and my OB just looked at me and said, Oh, what does it go home? And take it easy. You're like, as if, um, I didn't know my own body or I'm as if I didn't know what I was talking about. So when, when, when my OB made that choice not to intervene, that's when his death notice was signed off on. Mm.

Speaker 1: 34:35 Are you getting the care you need now? You are 19 weeks.

Speaker 5: 34:38 Yes. I, uh, changed practices. I'm going to a much better practice now that is very responsive to me, treats me as the subject matter expert on my own body. And when, when my doctor does something, we collaboratively do it. It's not just her telling me something. And then I go back and do it. We discuss everything that's happening with my pregnancy and just discuss the best way forward for me and my family. So that's been a really huge change from my previous experience.

Speaker 1: 35:09 And are you working with a doula or anyone like that in addition to,

Speaker 5: 35:13 Yes, I am. I'm, I'm, I'm actually a client of project concern international, uh, shout out to my perinatal navigator, Sharnay, Fontenot. I've been working with them. And so they're really helping me with that advocacy piece being seen by them for, uh, for both doula care and midwifery care because they've acknowledged. And they understand that, that there is a, a pandemic other than COVID going on amongst black mothers and black infants. So they've done an amazing job with me and just helping me through this process and just through my trauma and everything else.

Speaker 6: 35:46 And what advice would you give to expectant parents right now?

Speaker 5: 35:50 You are the subject matter expert on your own body. No one is in your body, but you, so, so you need to advocate for yourself and say, Nope, this is not right. And something that I'll actually told by one of the other navigators with PCI was that if a doctor is refusing to treat, ask them to document that in your medical record. So something that I would have done differently is as when my doctor kept on saying, go home and take it easy, I would have said to her, well, can you document this in my medical record that you're refusing to treat sometimes that makes them have that second thought of wait a minute, is this the best way to proceed forward with this patient versus, okay, well, you know, it doesn't matter because it's not documented. So, um, I, I think that's something that's really important for patients to know is to, if, if your doctor isn't treating, you ask them to document that refusal, to treat

Speaker 6: 36:47 The misconceptions about these negative birth outcomes.

Speaker 5: 36:51 Some of the misconceptions about these negative birth outcomes is that they're linked to socioeconomic factors that they're linked to education factors, that they're linked to health factors, that the mother was already unhealthy. And therefore her pregnancy was unhealthy with my son's pregnancy. I was in perfect health. After my education background, I have a master's degree from my socioeconomic level. My husband is, and I have to do these senior enlisted in the military. I'm a Navy veteran. So we're doing very, very well for ourselves, but all these things still happened during our pregnancy. And if that single unifying factor has been my race and, and it's, it's just an, every, it's like at every level, you know, when you have Serena Williams, who is probably one of the greatest athletes of our time who had a very adverse perinatal experience herself, you know, a top 1% wealth still had this type of experience. So it's not, well, it's not, education has not helped. So none of those things really factor in it's, it's pretty much race. Race is the primary factor and, and all of these adverse outcomes.

Speaker 6: 37:59 And speaking with Chinasa camper Verde, she knows, thank you so much for sharing your story. Uh, we're sorry, you had that experience, but congratulations to you and we wish you the very best.

Speaker 5: 38:12 Thank you so much for having me. Thank you,

Speaker 6: 38:24 Tragedies, like the loss of a child or a death of a mother and childbirth are not only family sorrows. They affect whole communities. And when those deaths are the end result of racist attitudes, the whole society needs to take notice. And more attention is beginning to be paid. A new center for anti-racism research for health equity has just been established at the university of Minnesota. One of several efforts around the country to get to the root of the implicit racial attitudes in healthcare that have led to such unequal and often deadly outcomes for black Americans. Johnnie Mae is Dr. Rachel Hardiman, founding director of the new anti-racism research center. Dr. Hardiman, congratulations on your new appointment.

Speaker 9: 39:09 Thank you so much.

Speaker 6: 39:11 Can you tell us why you believe a center for anti-racism research in health care is needed?

Speaker 9: 39:17 I believe the center for anti-racism research for health equity is needed. When we look at health outcomes, whether it's black, maternal health to COVID-19, we have a lot of work to do to ensure that everyone in our communities have the opportunity to be healthy and live a healthy life.

Speaker 6: 39:34 Now, a study that you co-authored was profiled in the Washington post earlier this year, it found that when black doctors care for black babies after birth, the mortality rate for those infants is cut in half. That is a dramatic statistic. And I'm wondering what questions does a finding like that open up to you?

Speaker 9: 39:56 Well, I think it opens up a lot of different questions for, and I think it also depends on who's asking them, right? So, you know, we certainly got a lot of feedback from clinicians who were concerned that we were suggesting that they themselves, as individual clinicians are biased or racist, and that's not the case at all. That's not what these findings suggest. What they suggest is that clinicians are working within a system that has not grappled with the impact of racism, um, both throughout our society, but also within our healthcare delivery institutions. So there's a long history of how racial inequity has manifested itself. Um, in health care delivery from, you know, James Marion Sims, the father of modern gynecology who use black enslaved women to perfect his surgical techniques, um, to the Tuskegee, syphilis experiment, and many others in between. And so when we think about the failure of our healthcare systems to really grapple with this history, we have to understand that we have work to do, to both train our clinicians and our providers, to understand the history and understand how it shows up within the way that they're interacting with patients from black and Brown communities.

Speaker 9: 41:08 Now

Speaker 6: 41:08 It's been known for many years that the mortality rate for African-American mothers was much higher than for white mothers. Do you think the reason that has not been seriously addressed is because society tends to blame black women for the problem?

Speaker 9: 41:23 Absolutely. So what we've seen when it comes to black maternal mortality is this victim blaming narrative where we say, well, black moms are having at older ages. They're, um, they're fatter, you know, they're overweight, they don't have good diet, they're not accessing prenatal care. And we use these narratives to, to create sort of this idea that, um, black moms are to blame for their health outcomes, but in reality, what we're seeing, um, and what we see in the data is that when you control for all of those things, like high-risk behavior like tobacco use, or when we control in our models for, um, access to prenatal care, and also for socioeconomic status, we see that these inequities persist. So regardless of if a black woman has, um, has the highest degree she could possibly earn. And as a physician too, I'm a black woman who, um, has a high school diploma. They're still at greater risk than a white woman who has not graduated from high school.

Speaker 6: 42:24 Now, your research finds that disparities for black mothers, don't start with the first prenatal doctor visit, but rather with a lifetime of stressors.

Speaker 9: 42:33 Sure. So the stressors are everything from, you know, implicit bias. So those unconscious or automatic biases and microaggressions that, um, black people and black women are experiencing in their day-to-day interactions, whether it's at work at their children's school or whatever it may be. And then there's also the structural racism factors. So, you know, we see a history of red lining, which has dictated where many black people, um, can live right, and where they can afford to buy a home. It certainly has impacted interdis, intergenerational wealth or the inability to accumulate wealth. Um, and then we also see that it's showing up in healthcare delivery. Um, you know, black birthing people are reporting, not being heard when they're talking to their physician or not feeling respected during those clinical encounters. Another angle that my research has looked at is policing and, um, the impact of police violence, or even just being, living in a community that's overpoliced and that presence is associated with a greater risk of preterm birth.

Speaker 6: 43:34 It seems from what you're saying that the medical professional loan can't address these structural and systemic racial disparities. So what kind of approach is it going to take?

Speaker 9: 43:45 So that's an excellent question. And I completely agree. I think that, um, you know, this isn't the healthcare system problem alone. Uh, we have to beat what we know is that health optimal health requires, um, that all of the social context for someone's life is addressed in the work that I do as an anti-racist researcher is really understanding, um, and allowing for, and making space for the voice of those who are most impacted by these disparities and these inequities to be the loudest voice in, um, in the decision-making process.

Speaker 6: 44:18 I've been speaking with Dr. Rachel Hardiman. She is founding director of the new center for anti-racism research for health equity at the university of Minnesota and Dr. Hardiman. Thank you very much.

Speaker 9: 44:29 Thank you. It's been my pleasure.

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KPBS Midday Edition

KPBS Midday Edition is a daily talk show hosted by Maureen Cavanaugh and Jade Hindmon, keeping San Diegans in the know on everything from politics to the arts.