I am a young, Black ob/gyn. Research has shown that Black women are at an increased risk of maternal mortality, and that Black babies face increased risk of sudden infant death syndrome (SIDS). Black women with higher educational backgrounds also have an increased risk of pregnancy-related maternal morbidity and mortality, as well as poor birth outcomes. Though it is unlikely that I will die during labor, I wonder about the “weathering” process that will take place during my pregnancy and how it will impact my health and that of my child. Maternal weathering has been associated with elevated prenatal delivery risk, including preterm labor. I worry that regardless of my educational background and how much I have learned, my knowledge will not be enough to save me or my baby from preterm labor and associated risks.
I wonder how my colleagues and care team will support me. Though I know that my partner, who carries weight and presence, will protect my interests and that of our child, I worry that his proximity to my Blackness will render him less worthy of being listened to. I wonder how my colleagues will show up for me, knowing that I am a physician. How will they treat me if I am unable to make decisions for myself? How will they treat my baby? Do I need to tell them that I am a physician in order for them to take me seriously? I wonder how they will support my partner if he loses me, or if we lose a child together. Despite increasing awareness of maternal mortality over the past several decades, the disparity in outcomes have remained stagnant. Without clear solutions, it is hard for me not to see pregnancy as a potentially life-threatening event for me. I worry that we will not move forward. I worry that our expertise in medicine will close us off to the voices of other experts who can make helpful recommendations on how to change the system for the better.
I hope these ongoing concerns prompt more than just a conversation about implicit bias. Implicit bias training is the diagnostic step we are all too familiar with. But we need action items and transformative work as well; we need the treatment step. This involves the utilization of radical acts and policies that create safety for Black and other historically marginalized folks. I don’t want to be afraid anymore. I desire to welcome, not fear pregnancy — for my family, for myself, and for my child. This is a basic human right. It is the responsibility of the medical community to make this happen. It is well past time we fix this.
As physicians, we commonly look for solutions to problems, believing that we can help address them. Several solutions I have considered include the following:
1) Listen to Black women. One of the common, yet poorly documented concerns Black women raise is that they are not appropriately listened to when they visit their doctor. This is well identified in “The Pain Gap” by Anushay Hossain, as well as by many other researchers who are concerned with the treatment disparities Black women experience in medical care. By listening to Black women patients when they express concern regarding their pregnancy or their health in general, we can initiate the proper work up that is required to give them the appropriate care. Their concerns should not be minimized or written off as anxiety or nervousness.
2) Invest time in learning about medical abuses. I am interested in learning more about medical abuses that Black women have experienced, including modern abuses in medicine, yet these abuses are rarely, if ever, discussed in medical school. Medical schools should invest time in educating students about historic medical abuses. Many physicians have graduated without being aware of these issues, and it will likely be a long time before most medical schools start discussing them. Thus, it should be a focus of physicians to learn about historic abuses that Black women have faced in order to understand the anxiety they experience as patients. When physicians come to the table better informed, it may make Black women more apt to present important health information and discuss their concerns.
3) Adjust your practice. It’s trying, but relatively simple, to start learning about the history of medical abuses that certain patient populations have experienced. However, it is more difficult to examine how we practice medicine and adapt our practice to prevent ongoing abuse. Is it possible that physicians might be explaining procedures or diagnoses in less detail to Black women compared with other patients. Is it possible that they might treat Black patients as if they experience less pain, even if unintentionally? It is important to ask ourselves such questions.
Do we take them less seriously? Perhaps we are unaware. Can you look at your patient reviews and see if there are differences based on race? Can you think of patients who you have seen before but no longer see? Is there a trend there? Even if you’re not guilty of these biased practices, it is highly likely your Black woman patient has had a doctor who is. Spend extra time with that patient. Be careful to make sure that she feels seen and heard. Find common ground. Make the relationship work before you dismiss her.
4) Recognize your power and privilege. Physicians wield an unearthly amount of power and privilege in society. My partner joked with me that, as a doctor, people believe we are also somehow experts in things beyond medicine, such as where road signs should be built and how to teach children. While the privilege of caring for patients is its own beast we must handle with caution, there are other, unearned privileges. When we recognize this power, we should think about how others view us, especially our patients. We must humble ourselves and consider how we wield this power. We can mention that we are also vulnerable and concerned about different things. We can be open about why we don’t want to prescribe something to them and accept their concerns when they challenge us. We can think critically about what we have been taught in medical school, residency, and how we have interpreted what we have learned in practice. This is the beginning of practicing better medicine.
How do you believe clinicians can help improve medical care for historically marginalized populations? Share your thoughts in the comment section.
Micaela Stevenson is a fourth-year medical student at the University of Michigan. She is planning to go into obstetrics and gynecology with a subspecialty in reproductive endocrinology and infertility. You can find her on instagram @babydocatyourcervix
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