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Better care for Black mothers and babies · 20-Minute Health Talk

0:08
Hello,
0:08
and welcome to 20-Minute Health
0:10
Talk. I'm Sandra Lindsay.
0:12
My guest today is Dr.
0:14
Dawnette Lewis,
0:15
the director of Northwell's
0:17
Center for Maternal Health,
0:19
which has put in a focus on
0:21
black maternal health.
0:23
For too long,
0:24
black women have had poorer
0:26
health outcomes due to
0:28
institutional bias.
0:30
Through their center, Dr.
0:32
Lewis is working to remove those
0:34
barriers to care while providing
0:37
support, advocacy,
0:38
and connection to needed
0:40
services before, during,
0:42
and after pregnancy. Dr.
0:45
Lewis has practiced for more
0:47
than 20 years in maternal fetal
0:49
medicine and as director of the
0:51
center for Maternal Health,
0:53
oversees all aspects of
0:56
Northwell's maternal health
0:58
program. Dr. Lewis,
1:00
thank you for being here.
1:02
Thank you for inviting me, Dr.
1:04
Lindsay.
1:04
And it's a pleasure to be here.
1:06
Unfortunately,
1:08
pregnancies and deliveries
1:10
are high risk these days.
1:13
The statistics around pregnancy
1:16
and black women are staggering.
1:20
Black women are three times more
1:22
likely to die from pregnancy
1:24
than their white peers.
1:26
I had the opportunity to speak
1:28
to Dr. Monique Rainford.
1:30
She has a book coming out on
1:32
April 11 titled Pregnant
1:35
While Black.
1:36
That podcast will be available
1:38
in the coming weeks.
1:40
In that book,
1:41
she mentioned that,
1:42
among other risk factors,
1:44
being black is a risk factor for
1:47
the staggering disparity. Dr.
1:49
Lewis, do you agree?
1:51
I have to agree with Dr.
1:52
Rainford.
1:53
And I know that there was an
1:55
article published recently in
1:56
The New York Times based on a
1:58
paper that was published
2:00
from California,
2:01
was published from the National
2:02
Bureau of Economic Research.
2:04
And they looked at maternal
2:06
and infant inequality,
2:08
and they looked along
2:09
economic lines,
2:10
but they also looked based
2:12
on race ethnicity.
2:13
And when they looked
2:14
at race ethnicity,
2:16
they found that disparity was
2:17
even greater than when
2:20
you looked at income.
2:21
And what they found was that no
2:23
matter what income category
2:25
a black woman is in,
2:26
that her birth outcomes are
2:28
worse. And as a matter of fact,
2:30
black maternal mortality rate
2:32
was the same for black high
2:35
income earners compared to white
2:37
income earners in the
2:38
lowest ventile.
2:40
And they talked about
2:42
different solutions.
2:43
And one of the things that they
2:45
highlighted was that any
2:46
policies that are directed to
2:49
help this should consider more
2:51
than economic lines,
2:53
because it's clear that there's
2:55
a difference in how black
2:56
patients are treated when
2:59
they're in the healthcare system.
3:00
One of the things that
3:02
come up frequently in
3:05
women who experience postpartum
3:08
complications is that I
3:11
went to my physician,
3:13
I complained of shortness of
3:16
breath or swelling in my legs
3:18
or pain in my legs,
3:19
and I was sent home.
3:22
I was dismissed.
3:24
My doctor wasn't
3:26
listening to me.
3:27
How do we empower women
3:28
to speak up more?
3:30
And on the other side of it,
3:33
physicians encourage physicians
3:36
to listen more attentively
3:39
to women.
3:41
I think it's important that
3:43
patients have someone with them,
3:46
whether it's a family
3:47
member or a friend,
3:48
that can be their advocate.
3:49
Because I know sometimes it's
3:50
hard for us to be our
3:51
own advocates,
3:53
and that's where a doula
3:55
might be coming handy.
3:56
The patient's partner,
3:59
their mom or sister or anyone
4:01
that's with them that they can
4:03
help to advocate for
4:05
the patient.
4:05
If they feel that the patient
4:07
is not being heard,
4:10
it is a problem.
4:11
And I can say when patients come
4:14
to us for their prenatal visits,
4:17
they want to know, am I safe?
4:19
And so I think it's up to us
4:21
to reassure the patients,
4:23
to let them know that they're
4:24
in good hands,
4:25
that we're going to take care of
4:27
them, that we're here for them,
4:29
whatever those needs are.
4:31
And I think it's very important
4:33
to establish that rapport and
4:35
that trust with patients.
4:38
That's so true because I
4:40
remember vividly when I went
4:44
in to deliver my son,
4:46
who thankfully was delivered
4:49
healthy.
4:49
And
4:51
looking back, I say to myself,
4:55
oh, my God,
4:56
I'm so happy that I had
4:57
a great outcome
5:00
when I felt like I was being
5:02
treated unfairly.
5:04
I remember this doctor who
5:07
leaned over, held my hand,
5:09
and that's what she said,
5:11
I'm going to take good care of
5:12
you. You're going to be safe.
5:14
And that made a world of
5:16
difference to me. Yeah.
5:17
And we also know that when
5:19
we see patients,
5:20
it's important that we take a
5:23
seat and talk to the patients
5:25
as opposed to standing,
5:27
because the impression that
5:29
patients get when you sit as
5:31
opposed to when you stand
5:32
is much different.
5:33
So just sit with the patient,
5:35
take our time,
5:37
and like you said,
5:37
just let them know that we're
5:39
here for them and that they're
5:41
in safe hands and we want to
5:43
take good care of them.
5:44
And ultimately,
5:46
like I said,
5:47
I think we have to treat
5:48
patients like how we want to
5:49
be treated. Absolutely.
5:51
I can still remember
5:52
the touch and yes,
5:54
you are absolutely correct.
5:56
Sit in,
5:58
demonstrates or illustrate.
6:00
Rates to the patient conveys the
6:01
message that, I have time,
6:04
I care. I see you.
6:06
I am going to take
6:07
good care of you.
6:08
So Northwell launched the center
6:11
for Maternal Health.
6:14
Can you tell us about the
6:15
center? Why was it opened,
6:17
and what is your role?
6:19
Sure. So, as you stated,
6:22
we know that for black patients,
6:24
they're more mortality rate is
6:25
three times higher from their
6:26
white counterparts.
6:28
And that's the same nationally
6:30
and in New York State.
6:31
And in New York City,
6:32
that number is that black
6:33
patients are eight times more
6:35
likely to die in childbirth
6:37
eight times more likely to die
6:39
in childbirth compared to their
6:40
white counterparts.
6:42
And recognizing this, Mr.
6:45
Dowling launched the center for
6:46
Maternal Health in hopes of
6:49
combating these inequities that
6:50
we see in birth outcomes.
6:53
Do we know why it's eight times
6:55
higher in New York compared
6:58
to other states?
7:00
I'm not sure that it's less
7:02
than other states,
7:03
but I think the answer
7:04
is it's very complex.
7:07
Sometimes it can be due to
7:08
preexisting health conditions.
7:11
Recently,
7:11
the Commonwealth Fund released
7:13
some data in December of 2022
7:16
looking at high income
7:17
countries.
7:18
And what they found was in the
7:19
United States and Canada that we
7:22
tended to have patients who had
7:25
two or more chronic medical
7:26
conditions.
7:27
So that explains some of it.
7:31
There's also access
7:32
issues to care.
7:34
There's also what I think is
7:37
systemic racism and bias that
7:39
does exist in the healthcare
7:41
system that makes black patients
7:44
not get the same treatment.
7:46
We know that black patients,
7:48
they have a higher rate of
7:50
early preterm delivery,
7:51
meaning delivery less
7:53
than 37 weeks.
7:55
We also know that the rate of
7:57
preclampsia is higher for our
8:00
black birthing patients compared
8:02
to other ethnicities.
8:03
We know that our NTSV,
8:06
our cesarean delivery rates are
8:09
higher for our black birthing
8:10
patients compared to
8:11
other ethnicities.
8:13
And that data is something that
8:14
we see nationally. So.
8:18
I think it's Northwell's.
8:20
We're hoping to narrow that gap
8:24
and to improve outcomes for our
8:26
black birthing patients.
8:28
So what is your role, Dr.
8:30
Lewis?
8:31
At the center for
8:32
Maternal Health?
8:33
So I am the director
8:35
for the center,
8:36
but we work in collaboration
8:38
with other entities within the
8:41
Northwell health system.
8:42
So there are three different
8:44
work groups in the center
8:45
for Maternal Health.
8:46
There's the antipartum
8:48
work group,
8:48
which is community and
8:50
population health that's run by
8:52
Dr. Salas Lopez and Mitch Cor.
8:55
Net.
8:55
There's the Peripartum
8:56
work group,
8:57
which is the OBGYN service line.
9:00
Myself, Dr. Nimroff, Dr.
9:01
Adrian Combs and multiple other
9:04
talented physicians in the OBGYN
9:06
service line and also the
9:08
Postpartum Work Group,
9:09
which is under the
9:10
leadership of Dr.
9:12
Zena Brown and Health Solutions.
9:14
And they run a very successful
9:16
program called the Mom's
9:18
Navigation Program.
9:19
And let's talk more about that.
9:21
The Mom's Navigation Program
9:23
is already proven to have
9:25
significant impact based on the
9:27
results your team shared
9:29
last year.
9:30
Those are from a 20 month
9:31
pilot program.
9:33
Can you tell us more about the
9:34
program and those impressive
9:36
stats? Absolutely.
9:37
And it's one of the successes
9:40
of the Mom's Program,
9:41
and it's run by Health Solutions
9:43
under the leadership of Dr.
9:45
Zena Brown.
9:46
And during COVID which I know a
9:48
lot of conversation starts
9:49
with what COVID?
9:51
What we learned from COVID Our
9:53
patients were discharged early
9:54
from the hospital because we
9:57
needed those beds, right? Yeah,
9:59
we needed those beds.
10:00
And so this patient navigation
10:04
program was already in existence
10:06
in other service lines.
10:07
And so the thought was to
10:09
navigate patients who were at
10:12
high risk for complications
10:13
after delivery.
10:15
And so a pilot program was
10:17
started at three of the ten
10:18
birthing hospitals.
10:20
It was that Long Island
10:21
Jewish Medical Center,
10:23
south Shore Hospital and
10:25
Huntington Hospital,
10:26
and a total of 3600 patients
10:29
postpartum patients after
10:31
discharge from the hospital
10:32
were navigated.
10:33
And what they found was that
10:36
patients who were enrolled
10:38
overall,
10:39
there was a 40% decrease in
10:42
severe maternal morbidity in the
10:45
first 30 days after delivery.
10:48
And that was also higher
10:49
for our black patients.
10:50
There was a 66% decrease in
10:54
severe maternal morbidity.
10:55
And readmission in the patients
10:57
that were navigated,
10:58
which was we didn't expect it,
11:01
but it was certainly
11:02
a wonderful result.
11:04
And the plan is to expand the
11:07
program into the antipartum
11:10
period and also to expand the
11:11
program to our other
11:13
birthing hospitals.
11:16
So if you could just explain for
11:18
listeners what the navigation
11:21
process entails.
11:22
What do you mean by they
11:23
were navigated? Sure.
11:25
So with Health Solutions,
11:27
there are a number of nurses
11:30
that are available
11:32
for the patients
11:35
if they have any issues to
11:37
contact those patients.
11:39
And there's also a chat bot
11:41
that's available to the North
11:43
Health Physician Partners OBGYN
11:45
practices that patients can,
11:47
when they enroll for their
11:49
prenatal visit,
11:50
that they can enroll
11:52
in conversa,
11:53
which is this pregnancy chatbot
11:55
and that's also monitored by the
11:57
navigation team through
11:59
Health Solutions.
12:00
So patients can either initiate
12:02
a conversation or based on lab
12:05
results or any abnormalities
12:08
that are seen.
12:09
That conversation can also be
12:11
started by the navigation team.
12:14
You also mentioned expanding
12:16
this mom's navigation program
12:18
to the antipartum period,
12:20
which is the time before
12:22
childbirth.
12:23
How do you see that benefiting
12:26
these high risk moms to be?
12:28
Oftentimes when patients come
12:31
into the hospital to deliver,
12:33
there's not very limited
12:36
resources that we can do to
12:39
intervene if patients
12:40
come to us sick.
12:42
So what we're hoping is that
12:43
with moving the navigation
12:46
program to the antipartum
12:47
period,
12:48
that if we can identify patients
12:50
who have, say,
12:52
chronic hypertension and they
12:54
need to see cardiology or
12:56
someone who has diabetes and
12:58
they need to be in our diabetes
13:00
and pregnancy program that those
13:02
patients can be identified
13:03
earlier and be referred to any
13:07
of the medical subspecialists
13:08
that they need in order to
13:10
improve their pregnancy outcome
13:12
and to control their medical
13:15
conditions before coming to
13:17
the hospital to deliver.
13:19
That is awesome.
13:21
So you mentioned our president
13:23
and CEO, Mr.
13:25
Michael Dowling before and his
13:26
commitment to improving the
13:32
lives for black women
13:35
and their children.
13:37
He's quoted as saying the risks
13:40
Black women face during and
13:42
after pregnancy and childbirth
13:44
are a shameful illustration of
13:47
the disparities that continue to
13:49
diminish the well being
13:50
of our nation.
13:52
What are some of the risks that
13:55
women face before, during,
13:57
and after childbirth?
13:59
Sure,
14:00
I think those risks are related
14:02
to if they have a chronic
14:03
medical condition or preexisting
14:06
medical condition.
14:07
And I think it's important that
14:09
those conditions are addressed.
14:11
So, for instance,
14:13
we know that cardiac disease is
14:15
a big contributor to maternal
14:18
morbidity and mortality.
14:19
So if we can identify patients
14:21
who have any cardiac
14:23
abnormalities or cardiac
14:25
conditions northwell has a
14:27
cardio Obstetrics program that's
14:30
run by cardiology and
14:33
also by Obstetrics.
14:35
And so if the patient
14:36
has an issue,
14:37
they can be referred to the
14:38
cardiob program so that they can
14:40
be monitored throughout the
14:42
pregnancy for any complications.
14:44
And also what happens is when we
14:47
identify patients prenatally who
14:50
have any chronic medical
14:51
conditions,
14:52
oftentimes we have what's called
14:54
a multidisciplinary preliminary
14:55
meeting with whatever the
14:57
subspecialties are.
14:59
That the pay.
15:00
Patient needs during the
15:01
pregnancy and throughout
15:03
the pregnancy,
15:04
we have meetings to talk about,
15:06
to plan their delivery if this
15:09
happens in the hospital so that
15:11
everyone is aware that this
15:13
patient is coming
15:14
to the hospital.
15:15
And so it allows us to be
15:16
prepared in case there are any
15:18
complications once they arrive
15:21
at labor and delivery.
15:23
Some women may think that once
15:26
they deliver and go home,
15:28
that's it.
15:30
So we know from data that was
15:32
published from New York State,
15:35
they released their monograph
15:38
about pregnancy related
15:40
mortality.
15:42
And what they showed was that
15:44
that mortality can occur across
15:46
all trimesters in pregnancy,
15:48
and a significant amount can
15:50
also occur postpartum.
15:52
So when patients are discharged
15:54
from the hospital,
15:55
they're given what's called
15:57
post birth warning signs.
15:59
If they have a temperature over
16:01
104 if they have any signs and
16:05
symptoms of preclampsia
16:06
such as headache,
16:07
unrelieved with tylenol or rest.
16:10
If they have any abdominal pain,
16:12
high blood pressure.
16:13
If they have heavy
16:14
vaginal bleeding,
16:15
then those are some things to
16:17
monitor after the delivery and
16:19
to speak to your physician or to
16:22
call your physician to
16:23
get help right away.
16:24
And we know that the first
16:27
year after delivery,
16:29
it can be pretty challenging.
16:30
And I think typically once
16:32
moms are discharged,
16:34
then we think that everything
16:36
is okay.
16:36
And I think we're looking at
16:38
different ways to provide
16:39
support for our moms
16:41
after delivery.
16:42
The Mom's Navigation program
16:45
follows patients up to 30
16:46
days after delivery.
16:48
And so we're looking to partner
16:50
with community based
16:51
organizations that have
16:54
community health workers that
16:56
can assist moms much longer than
16:59
that 30 day postpartum period.
17:01
We know two of the leading
17:03
causes of death postpartum are
17:06
behavioral health issues,
17:08
including suicide and substance
17:10
use disorders,
17:11
and especially for black women,
17:14
cardiac and coronary conditions.
17:18
What are we doing about issues
17:21
with blood pressure?
17:22
Any cardiac issues?
17:23
What are we doing about that?
17:25
I think one of the most
17:27
important things that
17:28
we could do,
17:29
I think every pregnant patient
17:31
should have a blood pressure
17:32
cuff or blood pressure
17:33
machine at home.
17:34
And I think all insurance
17:36
companies should cover that so
17:38
that a patient can monitor their
17:39
blood pressure during the
17:41
pregnancy and bring those
17:42
readings to us when they come
17:44
for their prenatal visit.
17:45
I think that will go a long way
17:48
in preventing a lot of the
17:49
complications related to
17:51
cardiovascular disease,
17:52
preeclampsia and hypertension.
17:56
Any other things that
17:57
we can do to.
18:00
Help with preterm delivery and
18:02
preclampsia for preclampsia.
18:05
One of the things that we know
18:07
helps with decreasing the risk
18:09
of preterm preeclampsia
18:10
is low dose aspirin.
18:12
So that's something
18:13
that we recommend.
18:14
Patients who are high risk for
18:16
developing preeclampsia,
18:17
patients who have a family
18:19
history of preeclampsia,
18:21
patients who are older than 35,
18:23
patients who have a BM
18:25
migrated than 30,
18:26
patients who have a history of
18:27
chronic hypertension, diabetes,
18:29
or any other chronic
18:30
medical conditions.
18:32
We offer low dose aspirin after
18:34
between twelve and 16 weeks.
18:36
We know that's when it's most
18:37
effective with preterm labor.
18:41
We're now trying to look at our
18:43
perinatal data center to
18:45
understand why are black
18:48
patients delivering preterm?
18:50
Because it could be
18:51
many reasons.
18:52
It could be an indicated
18:53
delivery because of a chronic
18:55
medical condition.
18:56
It could be because the patient
18:58
goes into spontaneous
19:00
labor early,
19:02
that their cervix starts to
19:04
dilate and they go into labor,
19:05
or they may rupture their
19:07
membranes and go into labor.
19:09
So that information we're still
19:11
trying to understand.
19:13
So we can focus our efforts in
19:15
terms of decrease in the rate of
19:17
preterm birth for our black
19:18
birthing patients.
19:20
That's great.
19:21
So what are some of your
19:23
goals for 2023,
19:25
for the center for Maternal
19:27
Health? Well,
19:28
for 2023 and beyond.
19:32
So I think this is generational
19:36
work,
19:36
and I think it's work that's
19:37
going to take time because
19:40
it affects behaviors.
19:42
So with our nulliprous term
19:45
cesarean delivery rate,
19:46
we're hoping our five year goal
19:48
is to decrease that Caesarean
19:50
delivery rate by 2%,
19:52
and we're hoping to
19:54
build on that.
19:55
We want to increase the use
19:57
of low dose aspirin
19:59
in our population.
20:01
We want to increase implicit
20:03
bias training.
20:04
We want to increase screening
20:05
for perinatal mood disorders.
20:08
And so we're implementing that
20:11
where patients are screened when
20:12
they enter prenatal care between
20:16
24 28 weeks in pregnancy and
20:19
also in the postpartum period to
20:20
find out what patients
20:22
are concerned about,
20:24
what do they have,
20:25
are anxious about,
20:26
what are they worried about.
20:28
So that's also something that's
20:30
now being added to the screening
20:33
that we will do going forward
20:35
for our pregnant patients. Well,
20:37
Dr. Lewis,
20:38
this has been an amazing
20:40
conversation.
20:41
Congratulations on your
20:44
improvements in the center
20:46
for Maternal Health,
20:48
and we just look forward to see
20:50
all the amazing things that
20:52
you'll do moving forward.
20:54
So glad to be here with you, Dr.
20:55
Lindsay,
20:56
discussing this very important
20:57
issue and the wonderful.
21:00
Work that's being done here
21:01
at Northwow. Thanks again.
21:03
And to our listeners,
21:04
thank you for tuning in.
21:06
I'm sandra lindsay.
21:07
Until next time.
21:13
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