We Are All Accountable Together: Black Maternal Health

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

These issues are top of mind 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. Rickquel Tripp

Rickquel Tripp, M.D., M.P.H., 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 who aim to decrease 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 nation with Black mothers dying. That’s why Black Maternal Health Week and other similar initiatives are being implemented, so that providers can put a spotlight on this important issue.

“The Pittsburgh Equity Indicators Report highlighted that in Pittsburgh, we’re even worse than comparable cities when it comes to Black maternal health. And so that really jumpstarted the creation of UPMC Health Equity NOW,” said Tripp.

At UPMC Magee’s annual Perinatal and Neonatal Health Care Conference last fall, the group showcased the movie “Aftershock,” which highlights stories of Black mothers who have died during postpartum care or while giving birth.

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

“That’s where we start to look at implicit bias among providers, examining whether a provider may not believe the concerns, especially of Black mothers, or there may be mismanagement of the care,” said Tripp. “Postpartum hemorrhage is the No. 1 cause of death of mothers all around, and specifically for Black mothers.”

This is an issue that resonates with her personally.

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

The history of OB-GYN care in America has included experimentation on Black female slaves. These women did not receive anesthesia, purposefully 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 trusting their providers automatically,” Tripp said. “As a Black woman, I’m saying to a provider, ‘Hey, can I trust you? Let me make sure the things you are saying are really true. Do you really have my best interest at heart?’”

Actions for a Solution

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

• – Take the Implicit Association Test, created by Harvard University’s Project Implicit, to begin to understand implicit biases. “Knowing that I may have a bias, especially for this particular group, helps me progress and mitigate my bias,” she said.
• – Consider Upstander Training, an educational opportunity – used and offered nationwide – that provides actionable tools to implement when witnessing bias, prejudice, discrimination or microaggressions.
• – Get comfortable asking questions and advocating for patients and loved ones who may be subject to implicit bias in the health care setting.
• – Advocate 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.