By Andrew Mulkerin and Ed Neuhaus
A UPMC doctor shares her thoughts on racial disparities in maternal care and what providers, nurses, hospital staff and community members can do to help reduce inequalities and create a more positive birthing experience — and more health outcomes—especially for black women.
These issues were at the forefront of Maternal Health Awareness Day on Monday and will be the focus of Black Maternal Health Week (April 11-April 17) in a few months.
Dr. Rickquel Tripp
Rickquel Tripp, MD, MPH, CDR USN, is an attending physician in emergency medicine at UPMC Magee-Womens Hospital and UPMC St. Margaret, and serves as UPMC’s vice chair for diversity, equity and inclusion in medical education. She joins UPMC Health Equity NOW, an organization of providers and staff across the organization working to reduce maternal morbidity and mortality among women of color, racially and ethnically diverse populations, and disadvantaged communities within UPMC’s footprint.
There is an epidemic of black mother deaths across the country, Tripp said. That’s why Black Maternal Health Week and other similar initiatives are being implemented so providers can focus on this important issue.
“The Pittsburgh Equity Indicators report highlighted that in Pittsburgh, we were even worse than comparable cities in terms of Black maternal health. So that really kicked off the creation of UPMC Health Equity NOW,” Tripp said.
At UPMC Magee’s annual perinatal and newborn care conference last fall, the group screened the film “Aftershock,” which focuses on the stories of black mothers who die during postpartum care or delivery.
Tripp noted that most deaths among black mothers occur during childbirth and postpartum care.
“That’s where we started looking at implicit bias among providers, examining whether providers might not believe their concerns, especially those of black mothers, or there might be mismanagement of care,” Tripp said. “Postpartum hemorrhage is the number one cause of death for all mothers, especially black mothers.”
It’s a question that resonates with her personally.
“Especially me, as a black woman and a mother, if I get pregnant, I have to think: Will I survive? I’m not thinking how happy I am to have this baby, but ‘I can live See my baby?'”
The history of American obstetrical care includes experimentation with black female slaves. The women knowingly and intentionally did not receive anesthesia, nor did they give their consent.
“You can’t really blame black women for coming in and not automatically trusting their providers when that’s the foundation,” Tripp said. “As a black woman, I say to my provider, ‘Hey, can I trust you? Let me make sure you’re telling the truth. Do you really have my best interests at heart?'”
Actions for solutions
Tripp recommends the following steps to address disparities in maternal care and to understand and remove implicit biases that can affect how we treat others.
- – Take the Implicit Association Test, created by Harvard University’s Implicit Project, to begin understanding implicit bias. “Knowing that I might be biased, especially toward this particular group, has helped me progress and mitigate my biases,” she said.
- – Consider Upstander Training, an educational opportunity used and offered nationwide that provides actionable tools to implement when witnessing bigotry, bigotry, discrimination, or microaggressions.
- – Easily question and advocate for patients and loved ones who may experience implicit bias in healthcare settings.
- – Promoting playfulness, which is a growing aspect of the birthing experience at UPMC Hospitals. “The doula becomes that advocate,” Tripp points out.
UPMC continues its efforts to improve the health outcomes of Black women, including educational opportunities that can help people recognize and address unconscious bias.
