 And joining us now to talk about your health is Dr. Dewey Katesa, an obstetrician, gynecologist at the University of Maryland Medical Center and assistant professor of medicine at the University of Maryland School of Medicine. Doctor, thank you for joining us. Thank you for having me. Maternal mortality, tough topic, got a lot worse during the pandemic. Why was that? Yeah. So I think there's several factors. One is COVID-19. So just as we saw that many people in the United States were affected by COVID-19, pregnant women were not immune to that either. Part of the issue also why it was worse in pregnancy and exacerbated maternal mortality is just some of the changes that happen in pregnancy that make women more susceptible to having more severe disease and more likely to be hospitalized. And that contributed partially to the rate of maternal mortality increasing since the pandemic started. Apart from COVID, what are the top reasons that someone would die near or during a delivery? Yeah. So the kind of top reasons for maternal mortality in the United States, one is cardiovascular disease, namely high blood pressure or hypertension, severe infection or sepsis. And lastly, another major cause is hemorrhage or postpartum hemorrhage. In addition to that, I think we also have to talk about health disparities. Black women are almost three times more likely to die in pregnancy and around pregnancy in the United States. So that's a contributing factor as well. It is black maternal health week. What are the factors that go into that? I mean, that's an incredible disparity. It's not like it's 10% higher or 20%. It's a factor of 100% or 200% higher. Yeah. It's a significant disparity. And one is access to care, but that doesn't really answer really the full reasons for why. So access to care is an issue, but that doesn't explain it because even for black women who have a college degree or higher, their rate of maternal mortality is higher than white women with a high school degree. So other factors include structural racism, implicit bias among health care providers. So these are other factors that contribute to the disparity in maternal mortality. Implicit bias among health care providers meaning a lack of attentiveness, maybe. Somebody's exhibiting symptoms and the provider somehow isn't as tuned in. Right. So just by nature of being human beings, we all have implicit bias. But implicit bias impacts some groups more than others. And so for black people and black women in particular in this case, implicit bias is a major factor. And part of it has to do with stereotypes. Some of these stereotypes stem all the way back from slavery that stereotypes because black women during slavery were disproportionately forced into childbearing. They were forced into harsh conditions working in the fields. They had higher rates of pregnancy loss. They weren't able to take care of their children. And that kind of directly links to some of the stereotypes that exist of black women today, that they are hyperfertile, that they don't want to take care of their children, that they experience pain less than white women do. And all of these are contributing factors into implicit bias as to how black women are treated and their symptoms may not be listened to or heard or addressed sometimes. Within your practice. As you're training the next generation of doctors, how do you address those things? I think a big part of it is talking about it. So in my medical training, these weren't things that were discussed as much as they are now. And as you said, I teach at the School of Medicine. And there are sessions with students on health equity or health inequity. There are sessions to discuss these things. And that's something I think we need to continue in all of our medical training and our medical care when we're taking care of patients. When things come up, we need to talk about it. We need to reflect and think about what are our biases. And by starting to do that, then we can work to try and change things and overcome them. If I leap from that to thinking that if I'm a black woman delivering a baby, I want to see a black doctor on the other side. Am I wrong? Yes, that is true. And I've seen that even in my own practice, more black women coming to see me and seeking out black physicians to take care of them. And there is data that shows, not specifically in OB-GYN, but there's data for babies in the NICU that their mortality rates are for black babies. Their mortality rates are lower if they're taken care of by a black physician. There was an interesting study that just came out looking at primary care physicians in different counties in the United States, and that the counties where there were a greater proportion of black physicians. The disparity in life expectancy was less between black and white. And so these are all things that then I think extend probably to other specialties as well. The other thing is more diversity in the physician field, in the healthcare setting. Right now there are about 5% of physicians in the United States are black, whereas 12% of the population is black. And so bringing greater diversity into the pool of doctors in this country also brings more diversity of experience, brings these issues to the table more because they're bringing their lived experience also. So that's important I think as well. Yeah, we know Morgan State University about to open a medical school. And so you work in a highly regarded facility in an urban environment and I'm certain with a with a very diverse staff. Are these things that as a group, you and members of your team have to be conscious of in the practice of medicine? Yes, it's really important to be conscious of these things and to talk about these things. And myself, I'm the director of our department's program on diversity, inclusion and women's empowerment. So it's a big part of what I and my team and the department under our chair work on as well. This week, as you mentioned, is Black Maternal Health Week. And one of the things we did was have a town hall discussion about the state of Black Maternal Health here in Maryland, in Baltimore and in our department to try and have these conversations on a regular basis and address these issues. Anything surprise you in that conversation? Any any points brought up that you might not have expected? I think the point that I think was really that made me feel good was people express how much they were happy that we had that discussion and that they wanted to have more discussions like that. And that was really that was really I was really glad to see that. How much is access to care a factor in pregnancies going going badly? I think about a couple of things. I mean, we hear about food deserts. You can live in a section of town where there just aren't good grocery stores. Maybe there's not good primary care either. And also when somebody winds up maybe without a lot of advanced care in labor and you wind up in a situation where maybe you don't have insurance and maybe as a group or those people discriminated against as well. Yeah, I look at access to care in different ways. One is access to like insurance or access to be able to get to a hospital, which here in Baltimore, we have a lot of hospitals physically like structures in other parts of the country that's not necessarily the case. And in many places, hospitals are closing due to lack of resources funding. I mean, Indian reservations prime example. Absolutely. And in many rural areas in the south, but access to care, you can think about in other ways, too. You mentioned food deserts. But part of it is are people working jobs that don't allow them to take time off of work to go to doctor's appointments? Do people are people having issues with transportation? And that makes it difficult for them to make it to doctor's appointments. I think often patients, people want to get care and they want to have good health. But there are lots of other factors related to socioeconomic status that can negatively impact that. I bet if you if you ask the next 10 people you see on the street, how how does the United States do compared to other countries in the safety of labor and delivery of maternal mortality? Everybody would think we're at the top or darn close to it. And that's not true either. Yes, sadly, that's not true. And the United States has the highest rates of maternal mortality when you compare to other high income countries. So sadly, that's not the case here. Similar factors to the national problem that we have. Yes, I think that is similar factors to the national problem that we have. You know, in other countries, the health care system and health care is supported by there's universal health care. So and it's structured in a way that primary care is emphasized. And that's not as much how our system is emphasized. There's probably there's a lot of factors, but that's just one. And the disparities that we're talking about when it comes to maternal care aren't limited to maternal care. I mean, this happens in plenty of other fields as a as a medical profession, which is getting more diverse. Is there anything else we could be doing? You think about the standard of care in medicine, you want the standard of care. Why do we fall short in in some cases within your field and beyond? I think a big part of it is, you know, we're having not as many physicians going into primary care. And if you look at other countries, there's a very much a bigger emphasis on primary care here. It's not reimbursed as much. It's not paid as well. So people are less likely to go into it. But a strong primary care system is really what helps in preventing disease complications. Lastly, anybody's watching who is fortunate to be expecting a baby, maybe expecting a grandparent, what should they know? Within the black community and beyond about doing all the right things to give the young mother and the young baby the best chance. Yeah, I think if you're thinking of becoming pregnant, going to see your OBGYN even before you start to try to get pregnant to make sure if you have any medical problems that those are well controlled. If you are pregnant, seeking care early is really important to mitigate any sort of complications that might happen. Still getting vaccinated for COVID-19 is still really important. As I said, pregnant women are more likely to have severe illness and hospitalization and other complications. And then I think particularly for black women and all women, but particularly black women, because of the disparity, it's important to seek out a provider that you feel comfortable with, that you feel like is listening to your concerns, is answering your questions and is making you feel comfortable and positive about the experience that you're having. You can find Dr. Doe Katesa and her team at the University of Maryland Medical Center. Dr. Thank you so much for being here. Thank you so much for having me. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.