Patients were encouraged to advocate for themselves during a Tuesday panel on Black maternal health outcomes, which featured UPMC experts and was hosted at the Kingsley Center in the Larimer neighborhood of Pittsburgh.
Black Americans are 2.5 times more likely than whites to die in pregnancy, during childbirth, or six weeks postpartum.
Pregnancy is a particularly vulnerable time. And systemic racism, implicit bias and inequities can make it hard for someone to voice concerns or disagree with a provider as they might not want to seem difficult or dramatic.
“It’s better to be bossy than bitter,” said Chaunda Cunningham, director of clinical practice and home visiting for Healthy Start in Allegheny County.
Still, medical settings can be intimidating and are sometimes not respectful – or even unsafe – for Black patients. Courtney Powell, a social worker at UPMC Magee’s outpatient clinic, said it’s important to consider the repercussions of staying silent, “You’re going to realize that there’s a lot more pros if you say something.”
Powell added that some patients find self-advocacy is easier when a support person attends appointments with them. This can be a friend, family member or doula, which is a nonclinical provider who supports a pregnant person emotionally, physically and spiritually before, during and after childbirth.
Dr. Sharee Livingston, chair of obstetrics and gynecology at UPMC Lititz, encourages her patients to work with doulas. But she said medical professionals also need to confront systems of oppression when providing maternal care.
“What we can do is stop blaming the patient. We can look them in the eyes, and we can listen and become more empathic,” she said.
And long term, Livingston said health systems need to focus on dismantling racism by measuring outcomes and funding interventions.
Part of this is understanding the traumatic history of the medical specialty. The man many consider to be the father of modern gynecology experimented on enslaved women without their consent and without anesthetic.
This includes three women namedAnarcha, Lucy and Betsey, who lived on plantations near Montgomery, Alabama. Anarcha suffered through30 procedures and was only 17 at the time of the first operation.
“If we pretend that it’s not there, then we will inadvertently repeat the issue,” said Livingston.
