Addressing Cultural Bias in L&D

It is important for healthcare providers to understand the issues of gaps in healthcare caused by cultural biases, and to understand the practices contributed to the care and to know what can be done to curve bias, especially in labor and delivery.

Dr. Alissa Erogbogbo, Medical Director of Operations at OB Hospitality Group, addresses the cultural bias in labor and delivery.
Addressing Cultural Bias in L&D
Featured Speaker:
Alissa Erogbogbo, MD
Alissa Erogbogbo, MD, is an experienced obstetric hospitalist and medical director who leads programs in central and northern California for Ob Hospitalist Group. She earned a BS in chemical engineering from the Illinois Institute of Technology and her medical doctorate from Rosalind Franklin University of Medicine and Science in Chicago; she completed her ob/gyn residency with Summa Health System. She is a fellow in the American College of Obstetricians and Gynecologists.
Addressing Cultural Bias in L&D

Prakash Chandran: The issues of gaps in healthcare are caused by cultural bias is an unfortunate reality. Healthcare providers need to understand the practices that contribute to bias care and know what can be done to curb instances of cultural bias, especially in labor and delivery. We're going to learn about it today with Dr. Alissa Erogbogbo, the Medical Director of Operations with OB Hospitalist Group. This is The Obstetrics Podcast from OB Hospitalist Group. I'm Prakash Chandran. So Dr. Erogbogbo. Thanks for joining us here today. I'm curious as to some examples of clinical cultural bias that you have seen in your line of work.

Dr. Alissa Erogbogbo: Well, for us as OB hospitalists, we encounter all patients and we generally want to be able to put patient care first. At times there are issues that may arise for a patient that may not necessarily fit in the middle of that community. For instance, I had a patient who presented, needed help as far as prenatal care, very shy, very nervous to really give the information that she needed to give, did not necessarily feel comfortable with, I guess I should say the nursing staff at the time, and felt that she would be judged, for whatever reason that was for her at that time. And it took a few coaching moments with her and me kind of relaxing her and letting her understand that she can trust me, for her to be able to just to give me some true background information in making sure that I can deliver on that care. And the first thing she says is I really felt that I was going to be judged by the nursing staff, by the physicians, and it brought on a different spin of how we as clinicians welcome patients and talk with patients. And she felt more comfortable after it was explained that I will not judge you. I'm here to take care of you. If there's anything that needs to be done, let's walk through it together.

Host: Yeah, I really liked that philosophy, but I'd like to spend some time unpacking that a little bit. When she said that she felt like she was going to be judged, are you able to go into any more detail because I'm sure people that are listening to this might feel that way for a number of different reasons. So maybe talk specifically about what she might've been feeling.

Dr. Erogbogbo: Sure. She's Vietnamese American, had no insurance and she was in an environment that was primarily Caucasian, and really did not understand with me talking with her, that I wasn't going to then dig deep into why she would do such a thing? Or why she was there? Why wouldn't you go to your own hospital? Why are you coming here? What made you choose here? So she really didn't understand that from my perspective, I wouldn't care where she came from because I don't have to worry about that. I'm not thinking of that. We're here just to take care of you.

Host: That's wonderful. And I think it's something that all healthcare clinicians and providers can learn from is that direct line communication and just reassurance to someone regardless of their cultural background that really you're there to take care of them, right. No matter what circumstance or situation they're in. And really just taking the time to sit down and do that. And that's something that you did and clearly it made her feel better about the care, isn't that right?

Dr. Erogbogbo: It did. And I have another example of an African American female who presented to the hospital who just carrying twins, and really wasn't sure where she should be. Had questions, wasn't sure, realize it was the right hospital that she needed to be. She received the care that she needed. But in the middle of her receiving care, certain things were asked of her and the person that asked those questions didn't realize that she actually had her own insurance. But she actually could also be able to pay for her care with cash. And they really, it was more of, well, why would you come to this facility? Well, we can't take you because we don't take that insurance. And it wasn't that the woman couldn't afford or couldn't do what she need to do to take care of herself. But her bill was being paid by a third party and the individual didn't realize that. And for her to have said something like that, well you can't stay here for any person that presents at any hospital. It kind of leaves a bad taste. And for the patient after things cleared, she was fine. She understood, she was okay. But those are the types of things as well where it's the prejudgment, and not knowing the whole backstory before you make a comment. So those are some just things that we as clinicians, as caregivers, we always need to take a step back, ask the questions first before we proceed with any type of judgment or course of action for that patient.

Host: And somewhat related, you know there is a large demographic of African American women here in this country and I imagine that their care experience during and after pregnancy is likely to be pretty different than that of a Caucasian woman. So maybe can you talk to some of those differences?

Dr. Erogbogbo: Sure. In preparing for this, I did do some research and looking through then of course own personal experiences and seeing things, but just in looking at some of the research that's being done, and looking at these comparisons between African American women and Caucasian women and what it's like pre pregnancy, pregnancy, and post-pregnancy. There are some disparities that they have come through in some of the research just as recent as 2015 and looking at is there a difference and clearly there is a difference that has been recognized in a quite a few articles. Drilling down to what is it that seems to be the difference. Is it the level of understanding? Is it the level of communication? Is it the level of just being able to see this person for who they are and not necessarily having cultural or antidotal information creep into the care of that patient. So clearly there is some disparity. We see it. We don't know necessarily how it seems to level itself out, but we see it, we hear it. It's been researched, it's been proven.

And as early as in 2015 well, a lot of things started kind of coming through. A personal one for me is just for a lot of the patients in what we take care of as OB Hospitalists, the prejudgment of the non-insured African American woman or the fact that maybe she has more than two, three or four kids, the misnomer that she's doing this or she wants this, that is not necessarily the case. You know, the fact that maybe she is going through depression and not understanding what type of tone of voice she's using and being able to slow the conversation down and talk with this woman, talk with her, ask her what she needs. Even as simple as really understanding does she need pain medication after she delivers, not being able to communicate with any woman on that level, really can cause a miscommunication or error in judgment or a lot of African American women, which doesn't necessarily fold over for your Caucasian population. And in one example I have just for the Hispanic perspective, maybe she doesn't speak English and we have many modalities to really figure out what's going on with a patient. It's not cumbersome. Not going to cause a more workflow or add a system issue to you talking to that patient. And sometimes that's not done. You see a patient postpartum, you talk to her nurse and she, you asked she, okay, how's her pain? Some will be able to answer that question, some may not because they didn't necessarily use a language line or use whatever modality it is to understand what's going on with that patient.

Host: Yeah, that's really surprising to me. And it kind of reminds me that even though we're care providers, we're human beings at the end of the day and we have to treat each other with dignity and respect no matter what background we come from. You know, I'm curious as to how OBs can take steps to recognize and address potentially their own unconscious bias. You know, maybe there are things that they aren't even aware of that they're either saying or doing or not saying or doing, that really need to be looked at. So what recommendations might you have for them?

Dr. Erogbogbo: So for a lot of us, we as physicians, we are always working towards, you know, making sure we're looking at the health of the patient, we're doing things. But we also, like I say, we all have these biases and how to decrease that is usually looking at different platforms that allow a retooling or reteaching or even maybe making more awareness as to your tone of voice, what you should be asking, what you're looking at, understanding that this person is a person just as well as anyone else. And really being able to speak to that. Many different platforms offer a lot of implicit bias training, a lot of inclusivity so that you can really be able to talk to these patients, African American, non Hispanic, Hispanic, whomever they are, and not allow other things to creep into your mind because now you've made yourself more aware. You've done some teaching, you've understood underlining biases that are there and how you can at least address it for yourself and remove that from the conversation of taking care of your patient.

Host: We touched on this a little bit earlier, but one thing that I've read is that, you know, this cultural bias is actually contributing to maternal mortality rates in the US, so I'd love for you to talk about that a little bit.

Dr. Erogbogbo: Sure. Just like I was saying for a lot of the research that's being done right now and being able to drill down in, say for instance, just a postpartum hemorrhage, and really being able to recognize that for a Hispanic or African American woman versus a Caucasian woman. And you know, something as simple as well that seems to run in that culture, they seem to have this in that culture or things of that nature. Yes, that could be the case, but we also have to look at the bigger picture. If this is a woman that needs something, then we should treat it. And so that is where also education, understanding and really being able to take care of the patient early on and really look at what's going on with that patient, and be able to treat that patient appropriately.

Host: So besides the education around unconscious bias that you mentioned, what are some other actions that healthcare systems should be taking to ensure equitable care for all of their patients?

Dr. Erogbogbo: I think for a lot of our health systems is just looking at your community and having some outreach to your community. Whether that's making things available, whether it's being able to have some talking conversations. Maybe you have a town hall and talking about the services that you have at your hospital and you wanting to make sure that your community is well-informed and well aware of what we have available. Maybe that's the way we could go for a lot of our hospitals. The other thing is really pairing up with the clinics that we have in the area for the hospitals and, and understanding what's the dynamic or what's the demographics of the hospital community around you. And really being able to understand what the services that may be necessary around this community that will allow a lot of these people to understand and see that the hospital's really working towards making sure that everyone is taken care of and that we're really looking at what can be done in that community for each and every one of them and no one's going to be left behind.

Host: Yeah, that's really great advice. Just staying very connected with your community. Thank you so much for your time today, Dr. Erogbogbo. That's Dr. Alissa Erogbogbo, the Medical Director of Operations with OB Hospitalist Group. Thanks for checking out this episode of The Obstetrics Podcast. Visit the This email address is being protected from spambots. You need JavaScript enabled to view it. to learn more from Dr. Erogbogbo and other OB GYN influencers. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.