Because of Inequitable Maternity Care, I Was Afraid
Apr 11, 2023
Sutter Health
Black mother holding sleeping baby son

By Stephanie Brown, M.D., MPH

Dr. Brown shares this first-person narrative as we observe Black Maternal Health Week, April 11-17, 2023. 

When I delivered my children in 2016 and 2018, I was afraid. I was there as a patient, but as a physician, I knew the data.

I knew that I was three to four times more likely to die from preventable or treatable pregnancy-related complications than my white counterparts and that my education level could not save me. My income level could not save me. Being a physician and the daughter of two physicians (a high-risk obstetrician and a pediatrician) could not save me.

I had the knowledge. I had access. I could speak the language. But when I put on that hospital gown, I was another Black woman at high risk for a bad outcome in maternity care, and that was very scary.

I was completely dependent upon my health team, my doctors and the staff to check their bias at the door. I found a doctor, Dr. Angelyn Thomas, who looked like me, who understands and is committed to closing the disparities that Black birthing people face in this country and who was able to see me and hear my concerns. We could talk frankly about the issues and my risk, and I felt safe as a patient.

Black female physician with hair in bun with lab coat posing outdoors in park

Stephanie Brown, M.D., MPH

Doctors, nurses and other clinical care team members have an opportunity to better serve our patients. As a group, we must increase awareness of unconscious bias, which affects how we care for different groups of patients, and advocate for evidence-based standards and mitigation strategies to systematically assess these types of biases in medicine. Our collective expertise and insights are vital to ensure this important research can be directly applied to clinical settings.

While the need to address unconscious bias in healthcare is clear, there is little evidence on how to measure its impact and how to define success. As more health systems and provider groups look to expand their unconscious bias training, it is imperative that we get this right. We must move beyond checking the box. If policies are implemented without criteria for intervention selection, guidance on measuring impact or assuring accountability, we will miss an opportunity to truly effect change.

Sutter’s Innovation Lab for Maternal Health Equity—part of Sutter’s Institute for Advancing Health Equity—is exploring some approaches that are focused on change. The Lab will soon launch three pilot programs focused on improving perinatal mental health screening, breastfeeding and doula care services for Black mothers, among others. Additionally, Sutter’s Alta Bates Summit Medical Center is one of four hospitals in California piloting a comprehensive initiative, led by the California Maternal Quality Care Collaborative, that ultimately will develop a birth equity quality improvement toolkit for use in hospitals statewide.

Another larger scale health equity effort stems from Sutter Health’s Institute for Advancing Health Equity collaboration with the California Medical Association, Physicians for a Healthy California and the California Primary Care Association during its Unconscious Bias in Healthcare Symposium in the Fall of 2022. There, numerous leaders from across the state gathered to discuss existing hurdles and help inform new recommendations to mitigate bias in healthcare. Stay tuned for a findings report to be released later in 2023.

If we can do the work to provide the resources and care to check our bias, we can empower our patients to achieve their best possible health outcomes.

Dr. Brown is the clinical lead for Sutter Health’s Institute for Advancing Health Equity and an emergency medicine physician at Sutter’s Alta Bates Summit Medical Center in Oakland, Calif.

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