We Are All Accountable Together: Black Maternal Health

By: Andrew Mulkerin and Ed Neuhaus

UPMC doctors share their thoughts on racial disparities in maternal health care and what providers, nurses, hospital staff and community members can do to reduce disparities and create more positive birth experiences — and more positive health outcomes — specifically for black women.

The issue is especially important with Maternal Health Awareness Day observed Monday and will be a point of discussion during Black Maternal Health Week in a few months (April 11 to April 17).

Dr. Rickel Tripp

Rickquel Tripp, MD, MPH, CDR USN, is an attending physician in emergency medicine at UPMC Magee-Womens Hospital and UPMC St. She is involved with UPMC Health Equity NOW, an organization-wide group of providers and staff whose goal is to reduce maternal morbidity and mortality in women of color, racially and ethnically diverse populations, and vulnerable communities in UPMC’s footprint.

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Tripp said there is a nationwide epidemic of black mothers dying. That’s why Black Maternal Health Week and other similar initiatives are underway, so providers can shine a light on this important issue.

“The Pittsburgh Equity Indicators report says that in Pittsburgh, we’re even worse than comparable cities when it comes to black maternal health. And that’s why we really started building UPMC Health Equity NOW,” Tripp said.

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

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

“It’s where we start to see the implicit bias between providers, check whether providers can not believe the concerns, especially Black mothers, or there may be mismanagement of care,” said Tripp. “Postpartum hemorrhage is the No. 1 cause of maternal death around the world, and especially for black mothers.”

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This is an issue that resonates with him personally.

“Especially me, as a black woman and a mother, when I get pregnant, I have to think: Will I survive this? Instead of thinking about how happy I will be to have this child, but ‘Will I live to see my child?’

The history of OB-GYN care in America includes experiments on black female slaves. The women did not receive anesthesia, knowingly and intentionally, and did not give their consent.

“When it’s established, you can’t really blame Black women for coming and not trusting the automatic providers,” Tripp said. “As a black woman, I say to the provider, ‘Hey, can I be trusted? Let me make sure what you’re saying is true. Do you really like me?'”

Action for Solution

Tripp recommends the following steps to address disparities in maternal care and to understand and reject implicit biases that may affect the way we treat others.

  • – Take the Implicit Association Test, created by Harvard University’s Implicit Project, to begin understanding implicit bias. “Knowing that I have a bias, especially for this particular group, helps me move forward and reduce my bias,” she said.
  • – Consider Upstander Training, an educational opportunity – used and offered throughout the country – that provides tools that can be implemented when witnessing bias, prejudice, discrimination or microaggressions.
  • – Ask questions and provide advice to patients and their loved ones who may be exposed to implicit bias in the healthcare setting.
  • – Advocate for doulas, aspects of the birth experience at UPMC hospital. “Doulas are advocates,” Tripp said.

Efforts to improve health outcomes for black women continue at UPMC, including educational opportunities that can help people identify and overcome unconscious bias.


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