looks like you and I think part of that is implicit bias and part cultural humility. Also, I’ve been there… so I’m going to take care of you like you are me and so there is research that shows that. The other thing we need to do is to get more of us in the workforce…It’s a community thing to be aware [of] and make sure we have the data and information. But in the meantime, we need to make our colleagues care…I want you to feel treated well to have a great birthing experience… and then also make sure that you live.
The report Dr. Perkins is referring to is a study conducted by the National Library of Medicine that shows that although Black Americans make up about 13% of the U.S. population, they comprise only 5.4% of the physician workforce, and of these, only 2.8% are Black women.
You also dealt with your own high-risk and difficult pregnancy. Could you share some insights into how you advocated for yourself during your pregnancy?
My daughter is now four and a half. During my pregnancy, I went to my first OBGYN… they didn’t pay attention to my age, and by the time the visit was over, we didn’t address the fact that I was over 35, which comes with higher risk and because of that; it was kind of ignored and kind of joked [about] – ‘Oh well you look really young.’ I immediately changed my physician because we can do that…you can change your doctor anytime. Do not let anyone tell you anything different….I made it a point to get a Black female physician. We communicated well – she understood me. If I had a question, there wasn’t as much pushback…And then my daughter changed position and I ended up having to be on bed rest and also have a C-section…But even when we decided that I had to go on bed rest, my specialist doctor listened to me. She was another woman of color and she made choices and gave me options because she wanted my baby to get here alive and healthy…It’s important when you have questions to ask them even if it seems annoying. My husband was also very supportive and he had questions… And then ultimately having to have a primary C-section delivery also done by my OBGYN, which I definitely advocated for because I could schedule it with my doctor. I was able to have the delivery that I wanted as close as I could get it and have a healthy child and heal appropriately. At each step – whether it was changing the doctor, not realizing my age, almost having a second-trimester miscarriage, and then my daughter switching to the breech position and having a C-section – each challenge my doctor’s ears were open to hear my concerns, which is why I’m alive and why my daughter is alive…I felt like let me get my affairs in order. Do I have my will together?… Because that’s kind of what you start thinking about when you’re a Black woman who is delivering in the U.S. It doesn’t matter your education or access to healthcare or socioeconomic status. If you’re Black in the U.S., you’re still going to be three times more likely to die in childbirth regardless… I don’t think that’s fair.
You highlighted some key points for women when they’re advocating for themselves as far as getting a second opinion and changing doctors if they’re dismissive. Is there any other advice you could offer to women who may be in a similar situation as you?
We tend to have all these other responsibilities that we are responsible for when we’re pregnant. Make sure you prioritize your pregnancy. The only person who can birth the child is you. Everything else can be done by someone else. Culturally, I believe we feel like we have to do everything, but just remember that everything else can be outsourced. Spend as much time as you can focusing on the growth of this human being that you’re going to bring into the world because that’s so important. Making sure we prioritize that in a way that’s meaningful – I think is what keeps empowering you to advocate for yourself to learn about each stage, to read up, to understand what’s going on with my body – let me go do some research, let me write some stuff down and take this into the doctor. Don’t just go to the doctor and check your box. Go in with your questions. It is our job to answer your question. If you go in and you have questions that are not getting answered, then you need to think about changing your doctor. Making sure that we keep that international knowledge also in our toolbox… those generational tools and cultural tools are equally as important.
You mentioned the importance of not just collecting data, but being able to have some action behind that. From your perspective, how do you think we can effectively use this data to get these policy changes into effect?
We’re going to need more data around why this is happening. We have a lot of data that is starting to show that this is happening. What we’re lacking is data about why this is happening and so we should use the data that we have that shows one in three women of color are mistreated to understand why is that and how do we fix it. We say implicit bias – we say cultural humility. But once they get to the hospital, we’re not asking not wanting to ask questions…We need to make sure you have the health literacy that you need you need to understand the why instead of just the cause…It’s time to dig into the why…so we can use the information we have now to back up our research projects to really dig into that and then fix that so that we could actually stop dying…I think we need to spend a lot of time funding those kinds of projects… We need assistance to put funding and support behind fixing this in training our clinicians… Now you’re aware you have biases, but what tools do you have to ensure that those biases don’t come into play when you’re making decisions for your patients? Making sure that health systems are funding programs to give clinicians tools to use to overcome, like coaching community issues, while we work on more understanding about why we’re actually dying.
You mentioned something important with physicians being able to understand the implicit bias and being able to overcome that. You’re in a unique position as a Black woman who has experienced these issues when giving birth and as a physician. Could you speak to some of the tools that physicians can take to overcome implicit bias?
Our system had a bias reduction training, which was really interesting. I was on the second floor and it made us aware. And then the second portion of it was to give us tools and figure out how we could overcome the bias. If you notice that you’re more biased towards me – if I’m more biased towards someone who doesn’t look like me when I speak to them – when I engage with them, trying to understand them as a patient. I like jazz, you like jazz… something that you have in common that we can talk about every time you come in… those kind of tools help you gradually get over any biases that you may have… Just get to know your patient and make sure your patient understands every step…based on their literacy level.
Lastly, you briefly mentioned some initiatives around finding out why so many Black women are dying. Are there any recent developments or initiatives that signal some progress toward achieving equity in healthcare for BIPOC individuals?
One initiative that I’m personally a part of is trying to develop a focus group of Black women who are past conception age but are pregnant and talking to them about things that stressed them out. What is your anxiety level on the day-to-day? What are things that cause you constant stress? I personally tend to believe that our lived experience and having to deal with racism or…the poverty gap of being the first generation to go to college – things like that are just a part of our normal day-to-day lives that could cause some level of stress that could help could cause some issues when you get pregnant… It’s basic things that I think we have in our lived experience – I think it’s connected. So I’m hoping that more research will focus on what is your life like that when you get pregnant you have a higher risk.