Many individuals, particularly females in the Black community have a distrust in the existing healthcare system because of the chronic history of racial discrimination and prejudice in the political and healthcare systems.
This issue of implicit bias that exists in healthcare is especially worrisome in women’s gynecological and maternal health. If the patient feels that her OB/GYN displays bias, then she may feel that her physician is not worried about her health, the outcome of her pregnancy, or her baby’s survival. That female may not feel comfortable or be inclined to ask questions pertaining to how to ensure a healthy pregnancy and post-pregnancy care.
She may not be aware of the necessary follow up visits for ultrasounds, blood pressure and urinalysis checks, and blood sugar/ glucose testing. She may not be aware of the pregnancy and post-pregnancy complications that are disproportionately seen in the Black and minority communities.
It is alarming to know that Black women have the highest maternal mortality rates during pregnancy or within a year of pregnancy. Black females are more likely to suffer from pregnancy related complications like preeclampsia/eclampsia, postpartum hemorrhage from fibroids, nonelective C-sections or cardiomyopathy (enlarged heart).
What can women do to navigate implicit bias in healthcare?
Black individuals may also feel more empowered to take more control of their health through more education and about preventable diseases and commit to healthier lifestyles to mitigate risk for conditions such as pregnancy induced hypertension, Gestational Diabetes and Pre-eclampsia if they have a healthcare provider that looks like them that can possibly better understand the barriers, mistrust or suboptimal care that these female patients may have faced trying to achieve equality in their maternal healthcare experience.
They should ask their insurance companies for a list of minority OB/GYNs or do their own research online and through the hospital system websites to find culturally competent physicians. From personal experience, I have felt the excitement and joy from some Black patients when I walk into the room and introduce myself as “Doctor”. Their faces light up because they know that there is someone present who can better relate to them, empathize with their struggle and is willing to work harder to reduce the healthcare disparities that currently exist.
TIPS TO IMPROVE THE EXPERIENCE
Females should read and do their own research and self study about the trimesters of pregnancy and complications that may accompany this happy but stressful period.
They should write down questions about follow up visits for ultrasounds, weight gain and abdominal measurements, urinalysis, lab work, glucose testing and any other tests that need to be performed.
They may want to ask questions about nutrition and how to maintain a good weight gain so that high blood pressure, Diabetes and protein in the urine does not develop. They also need to know when to start folic acid and any other medications that are needed during pregnancy.
They need to be prepared and bring a list of the information pertaining to sexual, social and family history as well as a thorough medical history including any prior maternal complications like a prior C section or fibroids that they suffered in the past.
They need to discuss any mental health issues that they may have grappled with in the past and journal any feelings of anxiety, depression or “feeling blue” as the pregnancy progresses. Mental health and stress associated with pregnancy and the postpartum period must be addressed.
Other questions should focus on genetic testing, the amount of exercise and type of exercise that the patient may engage in and what are the signs of an emergency such as bleeding or discharge that the patient should contact her obstetrician for.
If the patient at any point feels that the physician is not adequately or appropriately responding to her questions or hearing her concerns or if the patient just feels like the physician-patient relationship is not a “good fit”, then the female should seek another opinion and find her obstetrical care elsewhere. She may also feel it is time for a second opinion if the physician is not taking her cultural beliefs into consideration when discussing therapeutic options for the patient concerning the birth plan.