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Black maternal health: How to have a healthy pregnancy

A Q&A with VCU Health’s Dr. Tashima Lambert Giles and Dr. Myrlene Jeudy.

Black pregnant woman with doctor Photo: Getty Images

According to the Centers for Disease Control and Prevention, Black women in the United States are three times more likely to die from a pregnancy-related cause than white women. While multiple factors contribute to this disparity, the bottom line remains the same — we must take action now to reduce this inequity.

This week is National Black Maternal Health Week, an observance that strives to bring awareness to this disparity and amplify the voices and experiences of Black pregnant individuals.

Dr. Tashima Lambert Giles and Dr. Myrlene Jeudy, OB/GYNs at VCU Health, discuss the importance of Black maternal health and what the health system — and its patients — can do to improve outcomes.

What advice do you have for people as they try to conceive? How can Black women best prepare for a healthy pregnancy?

Dr. Jeudy: Pregnancy care focuses on improving one’s health before getting pregnant. For Black women, it's important to find a health care team that understands the unique needs of Black women. This is also important for individuals who are not trying to get pregnant, because 50% of pregnancies are unplanned.

If you are trying to get pregnant, it’s important to share your medical background with your health care team, which can include your primary care provider, obstetrician and gynecologist, or midwife. You’ll want to share your family history, social history and any medications that you might take.

It’s also important for you to learn as much as you can about pregnancy and complications, such as preeclampsia, and other conditions that can affect Black women while they're pregnant.

What are some of the more common concerns or questions you get?

Dr. Lambert Giles: The No. 1 concern is whether or not they are going to die during pregnancy. It sounds morbid, but it is a very common question.

They see these statistics and news stories about Black maternal health outcomes and it is scary. They come with this fear and say, “Am I going to be OK?” This is followed by, “Are you going to be there when I deliver? Will you be my provider the entire time?”

I try to reassure our patients that we are working to ensure that our system is culturally competent, and that the health system is working to create an environment that is safe and supportive, regardless of the color of their skin.  

What are some complications that Black women experience during pregnancy that may play a role in poor outcomes?

Dr. Lambert Giles: Cardiovascular disease and preeclampsia (high blood pressure during pregnancy) are two of the most common conditions in our patient population. When we look at the risk factors for these conditions, we see that many of our patients also suffer from these conditions.

For example, at the beginning of a pregnancy, we look at the risk factors for preeclampsia. This includes being a first-time mom, being under the age of 20 or over the age of 35, being African American, having chronic hypertension or a history of hypertension in a prior pregnancy, being a mom with diabetes and being overweight. We don't know exactly what causes preeclampsia. But we do know that there are a lot of factors that create this syndrome, and Black women tend to have multiple risk factors. And I haven’t even touched on the social determinants of health yet, like socioeconomic status. These are additional risk factors.  

It goes back to what Dr. Jeudy said at the beginning: preparing for pregnancy and getting yourself in the best health that you can is extremely important. For example, if you are overweight, one thing that you can do is to lose some weight before pregnancy to remove that risk factor.

We can't change the fact that we're African American. We can't change the fact that our mom or our sister might have had a certain medical condition. But we can try to decrease any risk factors that we have some control over.

What is VCU Health doing to reduce health inequities, specifically in the OB/GYN department?

Dr. Jeudy: Our department is constantly looking at how care is being delivered and ways to improve maternal health outcomes. All team members have taken implicit bias training to help them understand that it exists and provide tools to reduce the likelihood that bias will impact their decisions. There’s also the development of our department’s diversity, equity and inclusion task force, which provides additional training and educational forums.

We also partner with local health departments and with community advocates to develop programs that help address social needs for patients, such as housing and transportation, and provide additional maternal support. One of the programs that is currently being developed is a community doula program, which offers free doula services from conception to six months after delivery to those on Medicaid. Offering services like this helps decrease inequities in maternal health outcomes.

We are making progress, but we recognize that much more needs to be done.

How has the pandemic impacted the prenatal and postpartum experience for women of color?

Dr. Jeudy: COVID-19 has exacerbated feelings of isolation arising from long periods at home and social distancing. The pandemic also limited the number of support people that could be present in the delivery room and after delivery.

In addition to the pandemic itself, there were other events around that time that contributed to Black people's decline in mental health, such as the killings of George Floyd and Brianna Taylor and the protests that followed. This, combined with the disparities that Black people already feel regarding the health care system, can put them at risk for perinatal and postnatal mood and anxiety disorders, such as depression, anxiety, OCD and post-traumatic stress disorder.

One in seven women experiences postpartum depression, with Black women being at greater risk. They are also more likely to receive suboptimal care. At VCU Health, we screen all patients for anxiety and depression at their prenatal and postpartum appointments. The value of screening is that it not only tells the health care provider whether that person is at risk, but it also educates the individuals and gives them permission to talk about what they are feeling.

Depending on your score, we may refer patients to our Peripartum Mental Health clinic. We are the only program in Richmond that integrates psychiatric care, social work and obstetrics care for expectant patients and new moms with mental health need. This is why it is so important for Black women to empower themselves by advocating for their mental health during their pregnancy.

 You can find more information and resources on vcumom.com.

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