ing or simply never having acknowledged
that privilege comes with assumptions and
biases that must be looked for consciously.
For example, blaming a pregnant woman for
gaining too much weight assumes that she
has access to affordable healthy foods, time
to prepare them and a safe place to exercise.
Black women who are working long hours for
low pay may barely be able to make it to the
appointment, and need support, not blame.
The insensitive, unaware type doctors might
launch into a lecture and then feel aggrieved
that patients “don’t listen” instead of seeing
everything, first and foremost, from the patient’s
reality - not their own. Research has
proven that pain is undertreated in Black
women compared to others. White doctors
have been known to order more tests on white
women than others. White doctors may speak
differently to Black women, as described by
the National Institutes of Health. These effects
of bias are not lost on the Black patient, who
recognizes the implicit bias and backs away
from care by the offending provider. That can
lead to failure to follow standard medical care
with the result being an increased potential
for medical injury. Nationally, the maternal
mortality rate for women of color is twice
that of white women.
Reviewing two women may put life into
these concepts. We may be treating patient
Cierra, a 25-year-old Black woman from a
largely non-white neighborhood. Even before
COVID-19 struck, she had difficulty getting
to a doctor in the suburbs and felt that the
closest clinic treated her as a number. Cierra
shares an apartment with her children, her parents and one other
sibling. She cannot find anyone to watch her own children when
she has to take two buses to get to her medical appointments, so
she misses many of them. She is suspicious that the doctor makes
money by just checking her in and is not really concerned with her
health. Cierra is not able to follow the recommendations on diet or
obtain prenatal vitamins—she has bigger issues to deal with in her
environment. So it is not surprising that she develops hypertension
in the pregnancy with renal injury. The obstetrician recommends
early delivery as she is becoming pre-eclamptic. Cierra delivers
prematurely at 31 weeks gestation; and because of her pre-eclampsia,
is at risk for future hypertension.
Kentucky has a large rural population. While only 8% of its population
is Black, the Commonwealth has a large white population
with a different set of problems. Nationally, women in rural areas
MOTHERS IN MEDICINE
Source: https://www.courier-journal.com/in-depth/news/investigations/2018/09/20/maternal-death-rate-state-medical-deadly-deliveries/1352054002/
(last accessed Aug. 9, 2020)
face greater issues with adequate access to proper prenatal care both
because of the distances to hospitals, and also because there are fewer
obstetricians or maternal-fetal medicine doctors in the rural areas.
The overall perinatal mortality rate is higher in the rural areas. All
of this makes for higher-risk patients during the COVID-19 crisis.
The impact on the rural areas is huge.
But for our rural patient, Casey, who had a traumatic injury several
years before her current pregnancy, she began taking Vicodin for
that injury and is now finding OxyContin either in doctors’ offices
or through friends. She has been unable to find work since her job
at the Dollar General Store was eliminated with the coronavirus
pandemic. She has trouble making her appointments because she is
either high or her boyfriend doesn’t have gas money. She develops
hypertension in pregnancy and has to have an early delivery. The
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