Because of inequitable maternity care, I was afraid

OPINION – 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.

Nearly 7 in 10 Black Californians (69%) experienced negative interactions during healthcare visits, compared to 54% of Californians overall. And Black birthing people are four to six times more likely to die from complications related to pregnancy and childbirth. Although we represent only 5.5% of California’s birthing population, we account for 40% of the state’s maternal deaths.

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. Being a physician and the daughter of two physicians (a high-risk obstetrician and a pediatrician) could not save me. My education level could not save me. My income level could not save me. I had the knowledge. I had access. I could speak the language. But instead, I was completely dependent upon my health team, my doctors and the staff to check their bias at the door. I found a doctor, Angelyn Thomas, M.D., 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.

Bias in healthcare – whether on the part of individuals (i.e., unconscious bias) or structurally built into medical education, algorithms, treatment protocols and devices – is well-documented by researchers and is known to be a key contributor to adverse health outcomes. And while the identification of bias has moved policymakers to action in recent years, 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 assess these types of biases in medicine and extend far beyond current state mandates.

When I put on that hospital gown, I was another Black woman at high risk for a bad outcome in maternity care.

At Sutter Health, we’re taking a comprehensive, 360-degree approach to uncover and mitigate bias within health care, including its impact on maternal and infant health disparities within our system. Our Innovation Lab for Maternal and Birth Equity — part of Sutter’s Institute for Advancing Health Equity — is researching the influence of patient-, provider- and facility-level risk factors to help design solutions to promote health equity among our health system’s pregnant patients. This includes our recently launched pilot programs focused on improving perinatal mental health screening and breastfeeding support for at-risk patients, and another pilot on doula care services which will launch this fall. 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.

We know we can’t do it alone. That’s why in 2022, we partnered with the California Medical Association, Physicians for a Healthy California, the California Primary Care Association and others to host the state’s first unconscious bias symposium with the goal of developing a framework to help establish future unconscious bias mitigation strategies that can be leveraged by providers not only across California, but the nation. Stay tuned for a findings report to be released soon.

Achieving equitable outcomes to quality care for all pregnant patients in California should be our reality, not our aspiration. At Sutter, we’re leveraging the research, data and insights provided through our integrated health system to address disparities like these and design solutions that can be applied to care settings across the Sutter network and beyond. If we put in the effort to recognize and address our bias, we can empower our patients to achieve their best possible health outcomes. I encourage our state and nation to continue to put in the work required to achieve improved and equitable maternal health outcomes for every patient.

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, California.