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WE ARE ALL ACCOUNTABLE TOGETHER: BLACK MATERNAL HEALTH



January 24, 2023

By: Andrew Mulkerin and Ed Neuhaus



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.


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