Dr. Warner Huh (Host): Hello, everyone again. This is Dr. Warner Huh, the Chair of Obstetrics and Gynecology at the University of Alabama at Birmingham. And I'm excited about this monthly episode of Women's Health with Dr. Huh. Today, we're going to talk about black maternal health in Alabama, and this is a highly relevant podcast because from April 11th to the 17th is Black Maternal Health Week. This podcast will highlight why this particular topic is important for women who live in the state of Alabama, particularly Black women.

So, with me today are Dr. Audra Williams, who's an Associate Professor in the Department of OB-GYN here at UAB and is also our Residency Program Director for the last couple years. And also with me today is Jasmine Maye, who's one of our awesome obstetrical nurse navigators. And we're just going to have a conversation about Black maternal health in Alabama. So, Dr. Williams and Dr. Ms. Maye, welcome to the podcast.

Dr. Audra Williams: Thanks for having us.

Jasmine Maye: Thank you. I'm excited.

Host: All right. So, let's just dive into it. You know, as I mentioned, we have a Black Maternal Health Week in April, so obviously this is on the forefront of a lot of people's minds, certainly on our minds within the Department of OB-GYN here at UAB, but I thought maybe one of you could comment on what you think are the biggest challenges black women face in maternal healthcare in the state of Alabama.

Dr. Audra Williams: Absolutely. I think the biggest maternal health crisis that many people are now aware of is the big disparity in maternal mortality when it comes to black women, particularly in the state of Alabama. We know that in the U.S., our maternal mortality rates are relatively high compared to other comparable nations. And unfortunately, here in the state of Alabama, we actually have the third highest maternal mortality rate. Among Black women, that rate is actually three times higher compared to their white counterparts. So, this is something that is really at the forefront of anybody that cares about women's health, particularly in the state of Alabama.

Another crisis that I think is facing all women and particularly, Black women in the state of Alabama, is decreasing access to maternal care. In the state of Alabama, about a third of our counties are considered maternity deserts where there's not adequate access to maternity healthcare. And about 27% of women in the state of Alabama don't have a birthing hospital within 30 minutes of where they live. So, this poses significant barriers to women being able to access timely and adequate prenatal care, which in turn increases maternal mortality risk, increases infant mortality risk, and is really something that is on all of our minds here in the state of Alabama.

Host: And to be clear, Dr. Williams, obviously, we're talking about what's going on in the state of Alabama, but the issues related to black maternal health obviously expand to the entire United States. Is that correct?

Dr. Audra Williams: Yeah, absolutely. So, looking at rates of maternal mortality for Black women across the country, those rates are two to three times higher.

Host: So, I thought maybe one of you could just comment on what are some of the pregnancy-related complications in black women and what women in this state particular experience, in light of the comment that you made about the markedly increased maternal mortality in Black women, and then also if you could just comment on how we're addressing that specifically.

Dr. Audra Williams: Absolutely. So, I think one of the biggest contributors to maternal health issues in our state is chronic health conditions. So, about 45% of women in Alabama already have a preexisting condition coming into pregnancy, whether that's high blood pressure or diabetes. And this puts those women at particularly high risk of having complications during pregnancy, increases their mortality rates. And unfortunately, those rates of chronic disease are even higher among Black women in our state.

Other things that have been shown to be attributed to maternal death, particularly in Alabama, are substance abuse and mental health disorders as well. Fortunately, we have a lot of great people in the state and particularly here at UAB, that are kind of taking on this problem and encountering it head on. So, the Alabama Perinatal Quality Collaborative has really done a lot of work to improve a lot of these areas in our state. It's a collaboration among physicians here at UAB, along with community organizations.

And one of the biggest things that they've really been attacking is treatment of hypertension. And so, they've created a toolkit that is available to any healthcare provider across the state that really gives them an outline of how to best screen women for hypertensive disorders in pregnancy, how to get them immediate treatment, and then ultimately get them referral to an obstetric specialist or a primary care physician to manage those disorders. They're also looking at issues like postpartum hemorrhage, postpartum depression, and really kind of creating a safety net across the state to address a lot of these issues that our pregnant mothers face.

Host: Yeah. So just an observation and a comment, I think you and I were just talking about this kind of briefly the other day about chronic diseases. What we've noticed, particularly on our Labor and Delivery Unit, which sees really all different types of pregnancies, very high-risk pregnancies to low-risk pregnancies, is that the overall state of health of pregnant women coming onto that unit is very different than it was five, 10, 15 years ago. And it's created some challenges, let's just say that we have patients who are just frankly just sicker than they've ever been. And it's kind of created sort of a unique environment that I don't think we've ever seen before. I don't know if you have additional thoughts beyond that, but I thought for our listeners they might be interested to know that the obstetrical population, at least we serve at UAB, is very different and changing.

Dr. Audra Williams: Yeah, absolutely. You know, I think being a safety net hospital really here at UAB, we are taking care of patients that may not have had any care for their chronic conditions coming in. And so, I think, a lot of times you see people that are at a more advanced disease state because they may have never been treated for their blood pressure or for their heart failure.

I think also with differential access to contraception and preconception counseling, these are women that may have not intended to get pregnant or may not have known they were pregnant until later on. And a lot of that is just due to lack of access to care, lack of access to primary care where they haven't been optimized before they even get pregnant.

Host: Kind of a light bulb went off. I mean, for a lot of these women, this is sometimes their first real legitimate foray into medicine. And so, it uncovers some of these issues that they may not have been aware of and privy to.

So, the question I have for you, Dr. Williams, is that, you know, we talked about chronic diseases, hypertension, other cardiovascular disorders in black women. But I think the one thing that I think has really kind of woken us to maternal care is after-delivery care or what we call the postpartum period. I just thought maybe you want to spend just a couple moments by why that period is particularly important in terms of maternal health outcome.

Dr. Audra Williams: Yeah, absolutely. I think one of the striking things is that the majority of maternal deaths actually happen in the postpartum period, and we kind of include up to a year after the delivery in that period. So as we mentioned before, for a lot of women, their pregnancy, their prenatal care is really their only time to be plugged into the healthcare system. And unfortunately, a lot of them will lose insurance, lose access after they deliver. But that is a crucial time to really make sure they're continuing to get care because women that have these complications during pregnancy are at higher risk of having long-term complications outside of pregnancy.

So, one of the actual great things that's happened in Alabama is that Medicaid coverage for pregnancy has been extended to cover up to a year. So, that's really allowed us the opportunity to be able to get more women plugged into postpartum care where they can transition from being cared for by the obstetrician to our primary care physician to continue to get the care they need for their hypertension or diabetes.

Host: Yeah. And my understanding is, like you said, to that point, is that there's actually a fair amount of morbidity and even mortality in that time period. So, I think, improving our situational awareness such as not just as providers. But for our patients and our families, I think is probably critical during that time period. I'm sure you agree with that.

Dr. Audra Williams: Yeah, absolutely.

Host: So, Ms. Mayes, let me ask you, how can Black mothers, particularly in the state of Alabama, advocate for themselves during pregnancy and childbirth? Obviously, this has been, I think, a big topic in everyone's minds, not just for the providers here at UAB and in the state, but obviously for our patients and their families. I'm sure that you have thoughts on this, but I'd love for you to be able to share that with the broader audience.

Jasmine Maye: Absolutely. Yeah. There are too many women, particularly first-time moms who are Black women that describe their birthing experience as traumatic, and that's why I stress to patients that you are your biggest advocate, but it's my responsibility to make sure they're informed. And as a perinatal nurse navigator, we have the opportunity to speak with patients and discuss their birth preferences and offer them the support to assure they have that personalized care. We also prioritize making sure each of our patients are aware that UAB Obstetrics and Gynecology offers various prenatal classes, not only for expecting parents, but also for extended family, including siblings, grandparents. It's often said, you know, it takes a village and that support does not end once the baby arrives. We were just speaking as far as postpartum care going out to a year. And so, that hands-on learning is always the most effective. And, you know, these classes are taught by registered nurses, so it's a great opportunity to discuss expectations, along with a patient's rights in a hospital setting. And so, we want our patients informed well before they have to come to that challenging decision to make with their healthcare team.

Host: And I thought maybe if one of you just comment on what community-based programs or organizations you feel are making a substantial difference in Black maternal health in either Birmingham or the state of Alabama?

Jasmine Maye: Yeah, it's important to highlight the organizations that are committed to closing the health equity gap. And March of Dimes is one that UAB partners with and the work that they do in preventing maternal health risk, reducing preterm births and tackling infant mortality is vital for ensuring healthier futures for families.

And while it's unfortunate right now that birth doulas aren't covered by health insurance or Medicaid in Alabama, I want to stress the benefits of continuous labor support from doulas. It's wonderful to know that there are local doulas who offer low-cost or even no-cost services, especially for families with limited resources. There are platforms like DONA International, DoulaMatch.com and Birth Well Partners, Community Doula Project, are fantastic resources for finding qualified doulas in your area. These organizations help connect families with certified doulas who are experienced in providing emotional, physical, and informational support throughout pregnancy labor, and once again, that postpartum experience.

Host: Yeah. And what we'll do is we'll make sure that those resources are put in the show notes for this podcast so our listeners can click and basically view them at their leisure basically. And it goes without saying, Ms. Mayes, I mean, I just want you to know for me that I'm very deeply appreciative of the work that you do as a navigator, kind of a shout out to our chair's office, particularly Jennifer Kelly, for creating that navigation program. I think it's been a game-changer and having individuals like you that advocate for patients and their families, I very much feel like the future of surgical care, not just here, but nationally as well. I think it's important. So, thank you for all that you do.

Jasmine Maye: Thank you so much. It's been a great opportunity. And within the state of Alabama and the limited resources, it's been great to be a part of it for sure.

Host: Yeah. Watching it grow and flourish has been really cool. It's been deeply gratifying to watch it grow, so thank you for being a huge component of that. You know, on the topic of just March of Dimes in our relationship with that, I just want to spend just a couple moments for our listeners about the issues related to implicit bias. I think as a department, it's been a growing experience, understanding the statistics related to different outcomes, particularly in black women.

But paying attention to that and being cognizant of those differences, but also how we relate to our patients and their families. I think it's been kind of a transformative exercise. So, I also want to give a big shout out to the March of Dimes with assisting with their modules and their education. I think it's definitely changed our perspective on this topic immensely.

So, I don't know if you guys have any other closing comments again in light of Maternal Health Awareness Week. I just wanted to make sure that you guys had the opportunity to kind of get anything out there that you thought was important for our listeners.

Dr. Audra Williams: Yeah, I think that it's just important for people to be aware of the issues and of the problem, because you can't do anything about it if you don't know about it. So, I just hope that people will continue to stay engaged with the news, with their community, and help out all of these community resources. There are people doing amazing work to address these disparities and improve maternal health for all women and Black women in the state of Alabama. There's still a lot of work to do, but we have amazing resources here at UAB and organizations across the state that are really working to make things better.

Jasmine Maye: Absolutely. And yeah, the beautiful part about our department's team approach to obstetric care is that, as a patient, you can ask the providers their thoughts and opinions on the plan of care that's been laid out for you. Our obstetric teams, both inpatient and outpatient, provide great collaborative care where there is open dialogue for patients to be in true partnership with their healthcare providers. So, I think that's important to know that you are one of the biggest important and vital people amongst your team.

Host: Yeah. And in fact, I want to expand on that a little bit and the listeners just can't see my hands, but like I have my hands enjoined because, you know, I think medicine overall has been a very top-down profession. And I think one of the things that's really important is that it's meant to be collaborative and shared between the provider doesn't have to be a physician all the time. It could be even nurse midwife, a nurse practitioner, PA, and the patient and their family.

And so, what I would love to see is this podcast serve as a nidus for everyone listening to understand that it's a two-way conversation. Part of this conversation that we're having today is to make our Black patients aware that these are important topics, but they're not like hands-off topics. They very much should bring that up and we want to make sure that they have the best outcome possible. I think we have a long way to go, but this is one step of many trying to get people to understand that this is meant to be collaborative and two-way and a partnership like you mentioned.

Jasmine Maye: Absolutely.

Host: Yeah. All right. Well, thank you so much to both of you. Again, I'd like to Thank Dr. Williams and Ms. Maye for sharing their thoughts on the paternal health and Black women. And again, April 11th to the 17th, this Black maternal health week in the state of Alabama. And as always, please rate this podcast and we welcome any comments, particularly in topics that you're interested in.

For more information on women's health services, including our obstetrical services that UAB provides, please check out uabmedicine.org. And until next time, thank you. Have a great day. Looking forward to the spring, and peace out. Bye-bye.