Cheryl Martin (Host): According to the Centers for Disease Control and Prevention, or CDC, Black women here in the United States are three times more likely to die from a pregnancy related cause than white women, and most of the maternal deaths are preventable. This heightened risk spans all income and educational levels.

While multiple factors contribute to this disparity, the bottom line remains the same. We must act now to reduce this inequity. Every year, Black Maternal Health Week takes place April 11th through the 17th to bring awareness to this disparity and amplify the voices and experiences of Black mothers. Dr. Tashima Lambert Giles is an OBGYN at VCU Health and she's here to discuss the importance of Black maternal health and what the health system and its patients can do to improve outcomes. This is Healthy with VCU Health. I'm Cheryl Martin. Dr. Lambert Giles, welcome. So glad to have you on.

Tashima Lambert Giles, MD: Thank you so much for having me, Cheryl.

Host: I'd love for you to share some facts surrounding Black maternal health and the disparities.

Tashima Lambert Giles, MD: Yeah, I think that you hit the nail right on the head, Cheryl. Black maternal health is so important to not just Black women, it's really important to all of us. The statistics are staggering. Black women are three times more likely to die of pregnancy related causes than their white counterparts. But that statistic can be worse in certain zip codes.

That can be as high as six times more likely in certain areas. The leading cause of death in Black women are typically cardiovascular diseases and particularly preeclampsia. Preeclampsia is a special type of high blood pressure that happens mostly in the third trimester of pregnancy. And it's usually one of the things that have become really popular in our culture because of lots of celebrities that have been afflicted with preeclampsia.

So a lot of patients come in and want to know a lot about it. And our goal is really to make sure that we're educating our patients because it's something very common that they're being affected by.

Host: So, what are some of the specific concerns or questions that Black pregnant women ask you and how do you respond? You mentioned that they ask you about preeclampsia, but what are some of the other specific concerns?

Tashima Lambert Giles, MD: I'll definitely say the number one thing that patients come in with is asking whether or not they'll be one of the statistics. I think even before patients are pregnant, they come in with this overall fear of becoming pregnant. For a long time, people educated Black women might try to prevent pregnancy for years and then when they're at a place where they're ready to become pregnant.

I think the statistics that we have in our world right now have really settled in and made a lot of women fearful of the idea of pregnancy and fearful for their lives when it comes to pregnancy. So a really big concern that people come to our office with is whether or not they will be a Black woman that dies in pregnancy or dies postpartum.

 So I do think that that is one of the things that we constantly have to battle, with talking with patients and trying to educate patients on what these statistics are and how we can try to alleviate those statistics, what we're doing in our system to try to battle those things, educate them on ways that we can prevent those.

I think the second thing that they come in with is how can they prepare themselves for pregnancy, and be in the best health that they can before pregnancy and through pregnancy.

Host: And what do you say to them regarding that?

Tashima Lambert Giles, MD: With that, I definitely say preparation is key. We know that sometimes having the best outcomes in pregnancy is really when you're in the best health prior to pregnancy. And that's why Black maternal health is not necessarily just about Black women, and it's really about the overall health of our system, the overall health of our people, because the healthier communities we have, the healthier patients we're going to have.

 If women have less high blood pressure, if we have less diabetes, if we have less obesity, if we have less unintended pregnancies, we're going to have better outcomes in pregnancy. So one of the things that we always talk about is one, making sure that we are becoming pregnant when we actually plan to become pregnant.

 The second thing that we talk about is when we actually are planning to become pregnant, that we're making sure that our blood pressures are actually under control. We're making sure that we're on the right medications, that we should be on that are safe in pregnancy. We're making sure that our diabetes are under control if that's the case.

Maybe if pregnancy is not immediate in our future, if we could lose 25, 50 pounds in order to make our pregnancy a healthier one, that we're doing those things and being proactive in those manners so that our pregnancy can be a healthier journey.

Host: I'd love for you to talk about some of the initiatives here at VCU Health to reduce these health inequalities and specifically in the OBGYN department.

Tashima Lambert Giles, MD: Yeah, I think that this is multifactorial. We know that this journey to having a healthier Black maternal health and a healthier department is not just in the OBGYN department. I think it's in our VCU health system in general. Our number one priority is truly the health and safety of our patients and of their babies.

The first thing that our goal is to do is to ensure that everyone has true access to quality care and quality care that is equitable, regardless of their race, regardless of their socioeconomic status. And I think that we're doing that in many different ways. The first thing that we're doing is looking very closely at the care that we are providing.

We are utilizing research in order to figure out if we are differing our care by the populations that we're serving. We will never know if we are offering different care based on race or based on gender or gender identity or based on insurance, unless we actually ask those hard questions. And I think that one of the biggest things that we're doing here is asking the hard questions of whether or not our care differs based on the different populations that we're caring for.

So that is the one of the biggest things that I think we're doing as a health system. We're really interrogating our system to find out if the care that we are providing is equitable care. And if it's not, what are we doing in order to make sure that all of our patients are getting quality, equitable care.

 I think that we are also instituting implicit bias training because we know that a large part of Black maternal health has to do with structural racism. And structural racism, one way to combat that is by all of us as providers, as nurses, as people in the health system that are interacting with patients; recognizing that we bring bias to every situation, but most importantly, learning ways that we can reduce the bias that we bring to a situation so that it doesn't impact the care that we are providing.

Host: How important is it to hire more diverse doctors and midwives and nurses as part of dealing with inequities?

Tashima Lambert Giles, MD: Oh, it's incredibly important. There is a lot of research that supports race concordant care, particularly when it comes to the health outcomes in obstetrics and in neonatal care. A lot of research supports that we have better outcomes in those sectors, particularly. Our patients feel more comfortable. They have a better relationship with their providers. They feel a better sense of trust, but most importantly, because they feel that better sense of trust, they're more willing to actually accept recommendations. And in those situations, you're able to have a better impact in those communities.

Because of that, it's really important that our workforce reflects the patients that we're caring for, and because of that, one of the things that we're doing in our system is paying attention to the workforce that we have caring for the women of Richmond, and we want to do a better job in recruiting physicians, nurses, medical assistants, that it is actually reflecting the women that we are caring for in our system, so that our patients feel comfortable coming to us for care.

Host: One in five women experience postpartum depression with Black women being at greater risk. What's being done to help in that area?

Tashima Lambert Giles, MD: I think a big part of what we're doing here is really utilizing our community partners. In the Black community, the word depression was really a taboo word. We don't really always recognize depression as something that we wanted to acknowledge. And I think that it's something that we, almost lived with as just part of who we are and we just accept it and the reason why depression now is being thought of something that's even higher in the Black population is because of years of structural racism and why Black women are thought to be at higher risk for postpartum depression, is because they have so much more societal risk factors that are put in them in a place where they don't have as much support in the postpartum period.

That puts a lot more burden on them. And in those situations, we want to make sure that we're utilizing our community partners. We use Urban Baby Beginnings, which is a community partnership that we have that might be addressing social needs for these patients, such as housing, transportation, helping maternal support with doulas. Postpartum doulas in particular, a lot of our patients have found really helpful. We partner with other doula programs as well in order to help these patients have the support that they need in pregnancy and after pregnancy to maneuver the feelings that they're feeling and recognize that these things are normal but also recognize how they can move forward from these feelings, if that might be through talk therapy, if that might be through a support group, if that might be by using medications and a psychiatrist.

We want them to know that they're not the only person that experiences that, and we want them to know that there is other ways that they can actually get through this. So I think that this is the best way of using community partners to really help our patients through the depression that is a real thing.

In particular right now, it is a research interest of my own. Right now we are getting approval to begin a postpartum depression research project that is geared towards minorities to see whether or not the screening systems that we use for postpartum depression actually recognizes and identifies depression well in women of color, because we don't always sometimes identify the same words as depression. We might use words a little bit differently and say things a little bit differently, but don't identify that those things that we're doing and saying and those feelings that we're feeling are actually feelings of depression.

 And maybe if we started to screen our patients in a different way, we would recognize the depression that women of color might actually be experiencing, but instead we're describing it as something different.

Host: Very, Very, good. Dr. Lambert Giles, so for a Black woman, and you've been hitting on this throughout our conversation, but for a Black woman who's pregnant, any other things she can do to ensure that she receives optimal care?

Tashima Lambert Giles, MD: Yeah, I definitely want to make sure that our patients recognize that they don't have to have things happen to them. I want them to make sure that they know they can be in complete control. They can be their best advocate, that they should never let anyone make them feel like they're asking too many questions.

 And if a provider or a nurse, or a system makes you feel like you're asking too many questions, then you're not at the right provider, system, or nurse. And you need to make sure that you feel safe in the system that you're in. You want to make sure that you feel comfortable with the care that you're receiving.

And if you're not at that place where you feel comfortable, then you want to make sure that you are moving on and asking the questions that you need to ask in order to feel comfortable with that care. And I never want anyone to understand or expect them to understand to the level that we understand.

 Ultimately, it took us 12 years of education to become obstetricians. But at the same time, our job is to make sure that all of our patients have a clear understanding of what is happening to them and in their bodies. And if we can't do that as providers, then we're not doing our job. And I want each and every patient to feel empowered. And to feel like they're their best advocate in getting the care that they need. So really to take control of their own health before pregnancy, throughout pregnancy and after pregnancy, and know that there are providers out there that want to help them do that as well.

Host: I'm so glad that you mentioned that they are in control, so does that mean then that it's okay during a meeting with the physician to come in with a set of questions and to not hesitate to inquire if something isn't understood.

Tashima Lambert Giles, MD: Absolutely. Absolutely. I always encourage them. Please write them down beforehand. Make sure that you have your list of questions, because you should never leave with these things unanswered. We never want you to leave unclear of what our recommendations are. We never want you to leave with this hovering uncertainty because that should never be the way that a patient feels.

When you come here, you should feel educated. You should feel empowered. You should know what the next step is. It should never be a feeling of doom. And I think that a lot of patients sometimes feel like pregnancy, a lot of Black women feel like pregnancy is this feeling of doom, just waiting for the next shoe to drop.

 We want to reclaim the feeling of joy. They're feeling that pregnancy should be one of joy, bringing life into the world should be a joyful experience. And despite the statistics and despite the disparities that are occurring, this is still a really joyful time. And we want to bring that back. So never feel like any question is too much.

So write them down, make sure that they're all answered. And if they're not, somebody can definitely get them answered for you.

Host: That's some great advice. And just one last thing, Doctor, any final thoughts on just this whole area that we didn't cover on Black maternal health or any other advice for Black women to best prepare for a healthy and safe pregnancy in closing?

Tashima Lambert Giles, MD: Yeah, I think Black maternal health, like I said, is a super important topic, but it doesn't stop just in pregnancy. Black maternal health is something that starts before pregnancy. It is something that continues after you're pregnant. We want to make sure that you're reclaiming your health throughout each postpartum period.

Once we have delivered, that you're getting back to health, that we're getting back to pre pregnancy weight, that you're keeping yourself healthy in between pregnancies, because once we're actually a healthy person, we can actually continue on to be a healthy community. And I think that that's why we need to remember that Black maternal health doesn't just affect the Black woman.

It doesn't just affect our Black community because healthier Black women and a healthier Black community really impacts our entire community.

Host: Dr. Tashima Lambert Giles, thank you so much for enlightening us on this health crisis.

Tashima Lambert Giles, MD: Thank you for having me.  

Host: For more information and resources, visit vcumom.com. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the entire podcast library for other topics of interest to you.

This is Healthy with VCU Health. Thanks for listening.