We are all accountable together: Black Maternal Health

By: Andrew Mulkerin and Ed Neuhaus

A UPMC doctor shares her thoughts on racial disparities in maternal health care and what providers, nurses, hospital staff and community members can do to help reduce disparities and create more positive birth experiences — and more positive health outcomes — for black women in particular.

These issues are top of mind with Maternal Health Awareness Day being observed on Monday and will be a point of discussion during Black Maternal Health Week in a few months (April 11 to April 17).

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Dr. Rickel Tripp

Rickquel Tripp, MD, MPH, CDR USN, is an attending physician in emergency medicine at UPMC Magee-Womens Hospital and UPMC St. Margaret and holds the title of Vice Chair of Diversity, Equity and Inclusion for UPMC Medical Education. She participates in UPMC Health Equity NOW, a group of providers and staff across the organization that aims to reduce maternal morbidity and mortality in women of color, racially and ethnically diverse populations, and vulnerable communities across UPMC’s footprint.

Tripp says there is an epidemic across the country of black mothers dying. That’s why Black Maternal Health Week and other similar initiatives are being implemented so providers can shine a spotlight on this important issue.

“The Pittsburgh Equity Indicators Report highlighted that we in Pittsburgh are even worse than comparable cities when it comes to black maternal health. And so that truly began the creation of UPMC Health Equity NOW,” Tripp said.

At UPMC Magee’s annual Perinatal and Neonatal Health Care Conference last fall, the group screened the movie “Aftershock,” which highlights stories of black mothers who died during postpartum care or during childbirth.

Most deaths among Black mothers occur during labor and delivery and postpartum care, Tripp noted.

“This is where we start looking at implicit bias among providers, to investigate whether a provider might not believe the concerns, especially of black mothers, or there might be mismanagement of care,” Tripp said. “Postpartum hemorrhage is the No. 1 cause of maternal death around, and specifically for black mothers.”

It is an issue that resonates with her personally.

“Especially me, being a Black woman and a mother, when I’m pregnant, I have to think: Am I going to survive this? Instead of me thinking about how lucky I am to have this child, it’s ‘Am I going to live to see my child?'”

The history of OB-GYN care in America included experimentation on black female slaves. These women did not receive anesthesia, deliberately and intentionally, and they did not give their consent.

“When that’s the foundation, you can’t really blame black women for coming in and not automatically trusting their providers,” Tripp said. “As a black woman, I say to a provider, ‘Hey, can I trust you? Let me make sure that the things you say are really true. Do you really have my best interest at heart?’”

Actions for a solution

Tripp recommended the following steps to address inequities in maternal care and understand and debunk implicit biases that can impact how we treat others.

  • – Take the Implicit Association Test, created by Harvard University’s Project Implicit, to begin understanding implicit biases. “Knowing that I may have a bias, especially for this particular group, helps me to progress and mitigate my bias,” she said.
  • – Consider Upstander Training, an educational event – ​​used and offered nationwide – that provides actionable tools to implement when bias, prejudice, discrimination or microaggressions are witnessed.
  • – Become comfortable asking questions and advocating for patients and loved ones who may be subject to implicit bias in the healthcare environment.
  • – Advocacy for doulas, a growing facet of the birth experience at UPMC hospitals. “Doulas are there to be that advocate,” Tripp noted.

Efforts to improve health outcomes for black women continue across UPMC, including educational opportunities that can help people recognize and address unconscious bias.

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