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Podcast Recap | The Short Coat Podcast: Mothers deserve better

October 19, 2023

In this episode of The Short Coat Podcast, physician assistants and medical students from the University of Iowa's Carver College of Medicine discuss the impact of implicit bias and clinician shortages on maternal mortality rates in the United States.

Podcast Length: 59 minutes

5 Key Takeaways

1. The maternal mortality rate in the U.S. continues to increase to alarming levels, especially among people of color.

In 2018, U.S. maternal mortality rates were about 17.4 per 100,000 live births. Just two years later, the rates increased to about 32.9 per 100,000. With higher rates among Black and Native American women, over 80% of maternal deaths are preventable, but the rates among women of color are significantly higher for several reasons. Many women of color are of lower socioeconomic status and don't have health insurance. As a result, they are often less likely to afford to see a clinician.

2. While clinicians are generally highly respected, patients still have difficulty communicating with and trusting medical professionals.

In a CDC survey, 1 in 5 women reported mistreatment in medicine during pregnancy, with higher rates reported by women of color. Common issues were lack of response to requests for help, being shouted at or scolded by providers, privacy violations, and threats to withhold treatment.

About 45% of women reported not sharing concerns about their pregnancy with their doctor because they believed their issues were normal or they didn't want to complain.

Gender preference may be another reason that patients do not bring up concerns to clinicians. For example, women may have a hard time discussing their concerns with male OB/Gyn clinicians because they don't feel like there's the same level of understanding that they would have when speaking to a female OB/Gyn.

Finally, general shame or a patient's hesitancy to talk about bodily concerns is a problem in medicine that isn't limited to the specialty of obstetrics/gynecology.

3. Bias isn't just a patient obstacle; clinicians also have a level of bias they must face to curb maternal mortality rates.

There are many different ways that clinicians may demonstrate biases against patients. Sometimes the knowledge that a patient doesn't have insurance may mean that the patient doesn't receive the same level of care as an insured patient. This is particularly true with the expiration of COVID relief, which has greatly increased the rate of uninsured individuals. Cost and profit may affect the level of care, sometimes with an unspoken bias of "you get what you pay for."

Pregnancy is an especially vulnerable time for mothers and everyone's experience of motherhood isn't always positive. Depending on a variety of factors, mothers-to-be can "both celebrated and judged" in this culture. Being sensitive to this reality can help clinicians improve their communication and lessen the bias they may hold, knowingly or unknowingly.

To improve communication, clinicians should, first, be aware of their implicit biases toward pregnancy in general, as well as towards the specific patient before them. Clinicians can aim to discuss concerns with each person, regardless of background, and encourage them to speak up and advocate for themselves.

4. Hospitals in the U.S. are heavily profit-based, negatively impacting patient ratios and outcomes.

Hospitals in the U.S. follow a profit-margin model or a "just-in-time" inventory model whereby hospitals are staffed as minimally as possible to avoid overspending. Despite the U.S. being technologically advanced with the best equipment and best hospitals, the maternal mortality rate continues to increase.

In comparison, countries such as Canada or Germany, which also have private hospitals, follow either a single-payer structure or have highly regulated forms of insurance. In countries where health care systems are not designed for profit, maternal mortality rates are lower when compared to the U.S.

One area of concern in profit-based hospitals throughout the U.S. is the ongoing staffing shortage, affecting all care areas. Insufficient hospital staffing isn't safe and can contribute to maternal mortality rates. With increased patient loads, clinicians are under higher stress to see more patients, limiting the time they can spend with each patient. Patients may be less likely to communicate needs or concerns in such a situation because they view their doctor as too busy or distant to care about their problems. Yet patients' concerns and information about their own health can be as valuable as test results, and not capturing that information can adversely affect patients' care.

5. Due to restrictive reproductive health rights, some states have even fewer clinicians specializing in maternal medicine.

Since the Supreme Court overturned Roe vs. Wade, many states now have abortion laws impacting how a clinician can practice, laws that don't support or allow for the termination of pregnancy after a certain period. Because of such laws and potential repercussions, OB/Gyn clinicians may opt to practice in other states or completely change their specialty, which impacts general maternal care in those states.

With clinicians leaving states with strict abortion laws, the number of doctors available to care for pregnant patients in these states, especially in rural communities, is low. For example, half of the counties in Iowa lack even one OB/Gyn provider while clinics that do may already be at capacity. In such a scenario, with staff already stretched to the limit and clinics perhaps not having the funding they need, it's understandable that "patients could fall through the cracks."

For the overall health of local communities, the U.S. will need more OB/Gyns. Medical schools like University of Iowa Carver College of Medicine are creating awareness of this need throughout the U.S. The hope is that more students will become trained in obstetrics, ultimately increasing the availability of OB/Gyn clinicians who can work to decrease maternal mortality rates.

Any views, thoughts, and opinions expressed in this podcast recap are solely that of the host and guests and do not reflect the views, opinions, policies, or position of epocrates and athenahealth.

Source:

Etler, D. (Executive Producer). (2023, September 21). Mothers Deserve Better [Audio podcast episode]. In The Short Coat Podcast. University of Iowa Carver College of Medicine. https://theshortcoat.com/mothers-deserve-better/