Session 459: The Postpartum Conversation You Need to Hear

Episode Transcript
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Speaker 1 (00:10):
Welcome to the Therapy for Black Girls Podcast, a weekly
conversation about mental health, personal development, and all the small
decisions we can make to become the best possible versions
of ourselves. I'm your host, doctor joy hard and Bradford,
a licensed psychologist in Atlanta, Georgia. For more information or

(00:32):
to find a therapist in your area, visit our website
at Therapy for Blackgirls dot com. While I hope you
love listening to and learning from the podcast, it is
not meant to be a substitute for a relationship with
a licensed mental health professional. Hey, y'all, thanks so much

(00:57):
for joining me for session four fifty nine or the
Therapy for Black Girls Podcast. We'll get right into our
conversation after a worry from our sponsors. This week, I'm
once again joined by doctor Sharon Malone for an important

(01:18):
conversation in honor of Black Maternal Health Week. We're digging
into the realities of black maternal health, from the historical
roots of medical bias to the ways those patterns still
shape our experiences today. Doctor Malone and I talk about
why black women are so often left out of the
censor of maternal health conversations, what we need to know
about preoclansia and other cardiovascular risks, and why half of

(01:41):
maternal deaths happen after delivery. She also shares practical guidance
for advocating for yourself when something doesn't feel right, and
what to consider even years before pregnancy if you're planning
for a family, supporting someone who is, or simply wants
to better understand the landscape of black women's health. This
episode offers clarity, validation, and tools to help you feel

(02:01):
more informed and empowered. If something resonates with you while
enjoying our conversation, please share with us on social media
using the hashtag TPG in session, or join us over
in our Patreon so talk more about the episode. You
can join us at community dot Therapy from blackgirls dot com.
Here's our conversation. Well, thank you so much for joining

(02:26):
us again today, doctor Malone.

Speaker 2 (02:28):
Thank you for having me.

Speaker 1 (02:29):
Yeah, I'm very excited to chat with you again. Our
community loved your first time visiting us and lots of questions,
lots of follow up, and so we wanted to bring
you back. Especially we are observing Black Maternal Health Week
as we film this conversation, and we know that there
are so many things that happen and don't happen when
Black women are having babies going into labor. Why is

(02:51):
it important for us to frame this conversation as not
just a women's health conversation, but specifically around black women's health.

Speaker 2 (02:59):
Well, because I I think that we're never centered in
the conversation. I did a deep dive a couple of
weeks ago for a talk I was giving, and it
was just sort of the origins of our current medical practices,
how they started back and from the time of Aristotle
to today, and women were never centered in the conversation,

(03:20):
and Black women weren't even considered women. When you think
about how we talk about medicine, how conversations are framed,
you're at the bottom of the totem pole when it
comes to issues and things that should concern us. So
I think that refocusing the conversation, sort of changing the

(03:40):
lens a little bit such that we put black women
in the center. It helps two things. It helps them
be better advocates for themselves as patients, and it also
helps doctors understand where these sort of misconceptions and beliefs
came from. And it's historically based. It's not something that

(04:01):
we made up. It's something that we've been taught for
generation after generation after generation.

Speaker 1 (04:07):
I know you are well studied, but I'm curious, is
there anything in that research that jumped out to you
or that you were surprised by?

Speaker 3 (04:14):
Even as someone who's been in the field for so long.

Speaker 2 (04:17):
I think that the thing that surprised me most. And
let me just say, as an obgyn, I find it
just incredible that even the story about Jay Marion Simms,
the man who was considered the father of gynecology, how
he came to be and how that knowledge was acquired

(04:37):
was literally on the backs of black women, enslaved black
women that I never knew about. I never knew their
names until about ten years ago. I went to medical
school forty years ago. Never heard that story. You hear
only the positive things, and you never hear the negative things.
Everybody kind of knows the story a little bit about

(04:59):
Henrietta Las, everybody kind of knows the Tuskegee experiment, and
the reality is that those are not isolated events. You
could tell a story about the neglect of the black
body every generation, and the notion that the medical profession

(05:21):
was complicit. We weren't just complicit, I should say, we
were out there advocating that black women and black people
were inferior, and thus their health problems and their issues
were not because of anything we were doing or any
way that they were treated or not treated. It was
because there was some inherent weakness in the black body,

(05:43):
which is interesting to say for black people who toiled
in the fields from sun up to some down and
they're like, wait a minute, now, you're no. We have
to own that. We have to owned that history. We
have to make sure that people know it. And more importantly,
like I said, than just patients feel it, but doctors
need to know it. Doctors need to be educated about

(06:04):
where these myths and misconceptions really came from.

Speaker 1 (06:07):
Yeah, and often when we're talking about like our postpartum
kind of prepartum kinds of things, we're only talking about
the window between getting pregnant and delivery. What harm does
it cost for us to have such a narrow window
when we're talking about like black women's health there.

Speaker 2 (06:23):
Well, it's extremely harmful when the fact is that fifty
percent of maternal deaths occur out of the hospital. So
you're home thinking everything is fine, and I can say
this as a former obstetrician, when I have gotten a
patient through a pregnancy successfully, We've had a wonderful delivery,

(06:44):
everything is good, I'm home. I'm home in an hour
after you, after you have delivered that baby, and I
think everything is fine unless somebody tells me otherwise. And
there is this gap in the hospital whereas are being
monitored not by doctors but by skill nursing staff and

(07:05):
people who will listen and understand what patients may be
complaining of and not ignoring and dismissing those complaints and
passing them on appropriately. That's the first problem area that
we have with poor maternal outcomes. But when that patient
is discharged from the hospital, it is wholly insufficient for

(07:29):
me to say I'll see you in six weeks. And
that's what we did. We say see you in six weeks.
And it was a big deal when we said i'll
see you in two weeks because we started to understand
that things like postpartum depression sets in pre acclamsia, which
is also one of the conditions that is more prevalent

(07:50):
in the African American community. Sometimes it will not show
up until after delivery. So you have to know that
patients need to be discharged from the hospital with a
specific set of instructions. If you have this, call us
right away, and to also have the training on the
other side when someone calls and said, hey, I have

(08:13):
a headache, Hey my legs are swelling, not to say, oh, well,
of course that's normal. Those are red flags for conditions
that can be much more serious and at times fatal.
So that's why we have to look at the continuum.
It's not over once you've had a successful delivery. Your
care should extend for at least six weeks with touch

(08:36):
points in between, not just I'll see you in.

Speaker 1 (08:39):
Six weeks and you said so it sounds like now
the maybe more customary idea is to meet with a
patient after two weeks after a delivery. Is this kind
of common or are some people still kind of doing
six weeks?

Speaker 2 (08:52):
It depends. It depends on the practice, and it may
not be an in person visit in two weeks, but
there should be a check in for someone to say, hey,
how you doing, how you're feeling, how's the nursing going.
Because I think that what has happened for us today
and I can say this, I grew up in the

(09:12):
South where everybody was. You had your family around you.
People tended to the birthing mother. I had my kids.
I'm here in Washington, d C. I'm not around family.
There's nobody in the house but me and my husband
and my baby. So having someone to really tend to you,

(09:33):
because a postpart a mother needs care, You need rest.
You're not ready to jump up and go back to
everything you've been doing, even though we think that that
is what's supposed to be normal. We need community. And
if you don't have the luxury and the good fortune
of having family around you, then this is where community

(09:55):
is important. This is where where we need nursing, you know,
this is where people to come in and check on
you to see how you're doing. These are touch points
that are really important because, like I said, people think that, oh,
when people die as a result of childbirth, we think
that there was some something that went wrong as far

(10:17):
as the delivery is concerned. And sometimes it's not. It's
just plainal miscommunication that had that information been known, all
of this could have been avoided. It's expected, you know,
they say about probably seventy to eighty percent of maternal
deaks could be avoided.

Speaker 1 (10:34):
And then fifty percent you mentioned happened post our, post delivery.

Speaker 2 (10:39):
Exactly exactly more than twenty four hours after you have delivered,
when all of the normal complications such as bleeding and
those kinds of things that you would see in the
hospital you're done with. You know, now that's not even
the issue. It's more sort of the cardiovascular issues. And
here's something that also I think was very troubling for

(11:01):
me was when you sort of look at the statistics
of what are the causes of maternal deaths, and so
it depends on where you draw the line, and they say,
we'll say pregnancy associated deaths. What's disturbing is that pregnancy
associated death So anytime you're death in a pregnancy, during pregnancy,

(11:23):
or after a year after, murder is high on that list.
Violence to pregnant women and young mothers is way higher
on the list than you would think. And this is
something that I think that we have we've got to address.
We've got to address mental health issues, because that's also

(11:46):
high on the list. For black women. I think the
number one cause is cardiovascular issues, but for all women,
mental health issues and that is something that I think
that doesn't get enough attention and are.

Speaker 1 (12:02):
You referring specifically to things like postpartum depression and anxiety
or other.

Speaker 2 (12:06):
Concerns postpartum depression, anxiety, suicides, I mean, all of that.
Anything that could lead to you ending your life can
happen during that time. And that is a big, big factor.
And I think that again in this country, birthing mothers
are really not well supported.

Speaker 1 (12:26):
So you mentioned cardiovascular concerns is kind of one of
the primary things, and I don't know that I've heard
that before. So what kinds of cardiovascular concerns happened post delivery?

Speaker 2 (12:36):
Well, for the biggest one is like pre eclampsia or
a clampsia, and this is the condition in pregnancy where
it will typically show up during the pregnancy, but sometimes,
as I said, it will show up after delivery. And
that is the combination of high blood pressure. There is
a function where women have swelling. They can also have headaches,

(13:01):
very severe headaches. And there is also where the severest
part of it is called the help syndrome, where you
will get your liver will be affected, your platelets will
be affected, so your ability to clot. That's why bleeding
is so much of an issue. If you don't get
it in time, and so it's blood issues, so it's bleeding,

(13:25):
its hypertension, it's headaches, it's low platelets and liver problems.
That's the most severe form of it. And if it
is not treated then it can lead to full on
a clampsia because notice I said preeclamsia and it clampsia
is all of that that leads to seizures, and the
seizures in the mom can lead to strokes and permanent

(13:47):
disability or death. And these conditions, preeclampsia and a clampsia
are more common in African American women.

Speaker 1 (13:56):
So doctor Malone is pre aclamsia and a clamsier. You know, sometimes,
like you said, there are signs kind of in the pregnancy,
but then sometimes it sounds like these conditions will just come.

Speaker 3 (14:07):
Up after pregnancy. Is it related to just.

Speaker 1 (14:10):
Like the strain that pregnancy and delivery put on so
many systems are what is the rationale for those.

Speaker 2 (14:16):
Well, you know, here's the thing that we don't really
know what causes it. We know what things sort of
increase your risk for it, but what exactly causes it.
And that's a problem because preclamsya has been around forever.
We don't study it enough, you know, we don't talk
about Okay, what are the types of things that we

(14:38):
can do? Are there earlier indications that we can sort
of intervene at other points. But here's something that I
think that every person can take home as a message.
Since high blood pressure is certainly one of the indicators
that you were having pre eclampsia A right, so we've
redefined what's considered high blood pressure. High blood pressure now

(15:01):
is not one forty over ninety, it's one twenty over eighty.
And if you go into a pregnancy with hypertension already,
your blood pressure really has to be aggressively managed because
if not, we know that that puts you at higher
risk for having preeclamsia. So monitoring blood pressure is simple.

(15:23):
Even when you go home from the hospital. We can
all get a blood pressure cuff, the electronic ones from CBS.
You need to monitor your blood pressure after you go home,
not just during the hospital. And if you have high
blood pressure coming into a pregnancy that needs to be
aggressively managed, don't tolerate oh okay, well, my blood pressure

(15:45):
is usually one ten over sixty. It's only one thirty
over eighty. Now, no, that's high and if anything, in pregnancy,
sometimes your blood pressure will go down in a normal pregnancy.
So if it's going up, that's red flag number one
for you need to be monitored more carefully. You need
to know what the escalating signs are. Oh, I have

(16:08):
vision changes, that's a red flag. I have a headache
that won't go away. Red flag. I have swelling, and
not just swelling in your feet. What we call worrisome
swelling is that when you start to swell above the waist,
your eyes are puffy, your face is puffy, your hands

(16:28):
are puffy, all of that. Those are again, much more
worrisome signs that we have to really be on it.
And again, as as long as you the patient know
what the signs and symptoms are, such that if you
have those things happening, you don't let someone tell you
when you call into a helpline or you call a
doctor's office and they say, well, oh that's fine, just

(16:51):
put your feet up. No, that's an escalate moment. And
the more you know, the better advocate you can be yourself.

Speaker 1 (17:01):
I'm glad you said that because I do think that
that is something I mean, it definitely is something when
I have my kids, right like, there was oh, just
put your feet up if there's a little swelling, right like,
I think that's common advice that you're given.

Speaker 3 (17:11):
What does it look like to escalate?

Speaker 1 (17:13):
Like if you've been in a practice with your obgui
in and the nursing staff and you call and say, hey,
this is happening, and they give you that feedback, what
does it look like to escalate?

Speaker 2 (17:22):
Then you say, can I talk to my doctor? Can
my doctor call me back? Here's the problem, here's the
logistical problem, is that it's hard to get your doctor
on the phone. The way we communicate now is very
different than the way we communicate it when I was
doing this thirty years ago. If a patient call, I
call them back unless it was something extraordinarily simple. But

(17:45):
the reality is is that now we got a lot
of layers in between. You're now maybe messaging through a portal,
and it's really hard to get a full picture through
a text message, you know how it is, just how
it's hard to imply tone and severity of something through text.
Sometimes you just need to have someone tell me if

(18:10):
you're not concerned, please tell me why I shouldn't be concerned.
Then if if it's not, maybe it's nothing. That is
a conversation that needs to be had. And like I said,
don't be afraid to take it to the next level
if you are not getting the response or the the
level of concern that you may have. And I think
that's that's a simple thing that we don't do enough of.

Speaker 1 (18:34):
More from our conversation after the break Dot Malone, you
mentioned that preoclamsia has not been studied as much kind
of as it relates to pregnancy. And I feel like
I heard a lot around preoclamsia, like when I was

(18:56):
giving birth. And I also know that there has been
a lot of studies that's like around like diabetes, right,
like there are all these.

Speaker 3 (19:02):
Glucose tests you got to take, you got to drink
this stuff.

Speaker 1 (19:04):
And so it feels like there's a lot of energy
around like certain things and like early intervention and recognition,
but not for preoclamsia.

Speaker 3 (19:12):
Do you have an understanding of why that is?

Speaker 2 (19:14):
We don't really have a better understanding of what causes
preaclamsia now than we did years ago. You know, yeah,
we know what to do about it when we get it.
But the evolution of medicine usually is we have a
better understanding, we have better medications, we come up with
new therapeutics for it. There's nothing new in the preclamsia world,

(19:36):
let me put it that way. And I think that
we've just accepted that as a well, you know, that's
a complication of pregnancy. What are you gonna do. That's
the attitude that we have about most things that affect women.
You know, it's like, well, you know, what are you
gonna do? Fibroids, cramps, whatever, and we let that go.

(19:56):
But I think that it matters who's doing this research.
It matters who's funding the research, because you can have
all the great ideas in the world, and if you're
a researcher and you can't get funding for your study
or a lot of the research that has done in
this country, we only have really two sources. You've got

(20:17):
nih which has its own issues. But then it's also
the pharmaceutical industry because their impetus is really to get
more therapeutics, not because they're concerned yet. I shouldn't say this,
but I'm gonna say it. They're concerned about something else
that a new drug that they can sell and make

(20:39):
money on. And sometimes the two can go together. All right, well, yeah,
we want somebody to find something new for this. But
this is why diversity is so important, because it matters
which questions are asked. It matters whether or not you're
able to get engagement in a community, because if you're

(21:04):
going to do a study, you've got to be able
to recruit people who trust you, who believe that this
is something I'm contributing to medical knowledge, that kind of thing,
and so it matters who asks you. But I have
to say that one of the big problems is that
we have low participation in clinical trials for a lot
of things in the African American community. And that's just

(21:26):
that's across all studies. But you would think the excuse
for why there's such low participation is because they said, well,
black people don't like to participate in studies, and oh
and it's Henrietta Lax and oh it's a Tuskegee experiment. Okay,
Well no, the number one reason why Black people don't

(21:46):
participate in clinical trials is because they're not asked. You're
not asked, and when you may qualify for a trial,
you have to make the trial and the clinical trial
accessible to that patient. If I've got to get in
the car and drive to the university center, that's an
hour and a half, whom I got to come in

(22:08):
and get blood and do all that kind of stuff.
You have to bring it to the patients where the
patients are that you want to participate, so don't make
it hard for them. So that's sort of been the
standard excuse for why we tolerate low participation in clinical trials.
But we know that when you have the right people

(22:29):
out there who are recruiting, we do fine. There are
a lot of people that haven't even heard of Tuskegee,
so we can't blame Tuskegee. I think that the mistrust
that comes from the medical profession is historic, just generally,
and it has nothing to do with any particular trial.
It has to do with how we have been treated

(22:53):
in that medical interaction, and that goes for it. If
you feel respected and seen and heard, your farm more
likely to be receptive than if that has not been
your experience.

Speaker 3 (23:07):
Doctor Malone.

Speaker 1 (23:07):
You know our audience is full of young women who
may just be starting to think about if kids are
a part of their picture, and we know that conversations
often start like at the moment of you finding out
your pregnancy. But we know it's important to think about,
like there's a lot leading up to even becoming pregnant
that can impact like the health of the pregnancy and
those kinds of things. What kinds of things should be
on the radar for people thinking about having babies in

(23:29):
the next five to ten years.

Speaker 2 (23:31):
Well, I don't think that it's a stretch to say
that your health coming into a pregnancy is going to
influence greatly how you do during that pregnancy. So the
healthier you are, the lifestyle things that everybody should do,
you know, exercise, eat right, manage your weight, all the
things that people tell you to do, you should. Because

(23:54):
here's the other alarming statistic about young women. We are
having babies later. We used to think, and again this
was the conventional knowledge. When we get back to pre aclamsia.
We thought, oh, pre acclamsia, it's highest in young mothers
like teens, and it's higher in older women sort of

(24:15):
in there, you know, having your babies in their thirties
and forties. So those are the extremes. But we thought
that all the poor outcomes were being driven because say
two three generations ago, there was a higher rate of
teen pregnancy. So the thought was, if we can reduce
the rate of teen pregnancy, we're going to reduce the

(24:36):
pre acclamps here, We're going to reduce the rate of
preterm births because preterm deliveries are also higher in African
American unity. If we could just get this teen pregnancy
rates down, because they were pretty high. So guess what,
We got the teen pregnancy down and it's still not fixed.
Here's the rub. There's a constant what should I say

(24:58):
explanation for when outcomes are poor, and again this is
historically based. Whenever Black people do worse at any particular
medical outcome, you try to find a reason for what
Black people are doing wrong that's causing it, because that's
the notion where you brought this on yourself if you
had only if you would only stop doing this, stop

(25:20):
doing that, stop perming your hair, stop and name any
list of things, because if you blame the people rather
than the conditions that those people are in, you're off
the hook for trying to figure out because you're like,
you go fix that. So I say that to say,
that's an example of our preocclamcy of what we thought

(25:42):
it was due to teen pregnancy, not because teen pregnancy
is at its lowest point ever. But this is what
we do know. There's a social scientist at the University
of Michigan, doctor Arlen Geronymus, and she talks about this
concept of weathering and that the experience of being a

(26:04):
black person in America just from the chronic stress, from
the poor conditions, the things which we call the social
determinants of health. Where you live, whether or not you've
got clean water and air, whether you have access to
quality health care, whether you have health insurance. All of
those things are societal issues. They're not personal failure issues.

(26:30):
All of that to say, when we can't lead this
conversation without talking about obesity in the African American community.
Obesity is one of those things that, yes, it increases
your risk of diabetes, it increases your risk of hypertension,
which also, as I said, going into a pregnancy, increase
your risk for having complications during that pregnancy. But we

(26:52):
need to back it up because when we talk about
why are African American more prone to be overweight or
obese and see, and again that's a complicated issue. We
didn't used to be so it's not like we got
new genes in fifty years. And it's funny. I talk
about this in my book. I said, look at some
pictures of your grandparents. Just look at a view of

(27:14):
the march on Washington and you've got two hundred and
fifty thousand people out there, and look at what a
black person looked like in the fifties, in the forties
versus what we look like now. What happened Again, we
didn't get new genes. It's the food source. You know,
we've sort of gone from making food in the house,

(27:35):
to fast food, to more processed food, all of that.
And when you couple that with making that food cheaper
and more convenient than the way your grandparents ate, then
that's what people do. That's not rocket science. But it's
also the notion that it's not now just happening to

(27:59):
black people. Everybody in America is overweight. The numbers have
gone up tremendously, and so what happens. And I'm going
to say, I'm a right, I'm not going to sound
like conspiracy theories here, but when everybody gained weight, then
now we've got solutions for it. You can be on
a GOLP one you can do this, you can control

(28:19):
your weight all the wonderful Guess who can't get GOLP
ones if you don't have insurance, if you can't afford
to pay out a pocket if on and on and on.
The interesting thing is as the therapies get better, sometimes
the disparities will get worse because now all of these

(28:40):
obesity related chronic illnesses that we know are improving on
people who have access to GLP ones, Well, you can't
afford it, or you can't get it, or is denied
by your insurance. Those are again policy issues. These are
biological differences in how we are. But you have to

(29:01):
recognize that and you have to be willing to do
something about it because it's a much bigger issue than
personal just your personal behavior. But that being said, we
get back to before pregnancy. What can you do manage
your weight? Exercise, eat a healthy diet, start taking a

(29:23):
multi vitamin before you get pregnant. Those are things that
are going to be important that will minimize your risks,
not eliminate them, but it will certainly minimize them because
you're still going to be walking around in a world
that may stress you out from time to time. As
we all learn.

Speaker 1 (29:41):
You mentioned that you know women are also having babies
later kind of historically, and we know that there's this
thing called advanced maternal age.

Speaker 3 (29:49):
I think the age was thirty five, but I feel
like was there.

Speaker 1 (29:52):
Some conversation recently around changing that and where do we
stand with that? And what does it mean to be
advanced maternal age?

Speaker 2 (29:58):
Well, advanced maternal age, because again we're going to take
race completely out of it. The maternal mortality rate does
go up with age, Okay, So an eighteen year old
has far less chance of dying as a result of
pregnancy than a forty two year old does. Okay, just
because a forty two year old has lived longer, you're

(30:21):
more likely to have those chronic diseases that we talked
about going into a pregnancy than someone who's younger. Okay,
So there's that. But this is how we live now.
In my practice, I can count on one hand the
number of patients that I had who were pregnant voluntarily

(30:43):
at twenty or nineteen. We are doing things, we are busy,
we are going to graduate school, we're going to med school.
We're doing a lot of things and getting our careers
and sometimes just being economically, at a point, we get
to choose when we have our children, which our grandparents

(31:04):
did not. You had what you had right well, and
when we're choosing, we're doing this later. And that's happening
for everybody. And when you start late. This is the
double tax by being a Black woman in the sense that,
as I told you, pregnancy complications go up with age.
For everybody, maternal mortality rates are higher in your forties

(31:24):
than you are in their twenties. Here's the problem with
Black women. We accumulate stress. Our biologic age is older
than we really are. So if you're choosing to have
a baby in you're thirty, black women generally will have
a biologic age that's much older than that because again

(31:48):
you're coming into it with more pre existing conditions. So
that's why it's doubly problematic for Black women as they age,
and some of us are not getting pregnant into our forties.
And that's why we say advanced maternal age, which we
again which was something that came up before it was

(32:09):
we were even talking about the racial disparity. It was
because for women, the older you are, the more likely
you are to have complications. And it was certainly an
uncommon thing a couple of generations ago, for someone to
be having their first child at thirty five, thirty six, forty,
that wasn't a thing. By the time most women had

(32:32):
had you know, it started having their babies in their twenties.
And so when you start trying to compare Black women
to majority population, just know that that biologic aging, that
what it's also called an allostatic load, which is just
the wear and tear on your body is higher and

(32:55):
that's why we do worse later ages. But the AMA, Yeah,
the advanced maternal age, we used to call it, Thank goodness,
you would be surprised. But back when I started, if
someone had their first baby at thirty five years old
or older, they used to call them an elderly primigravita,
which means an elderly first pregnant. Okay, so we don't

(33:18):
say that anymore. So advanced maternal age, believe it or not,
is an upgrade from what we used to call them.

Speaker 1 (33:23):
Yeah, I feel like geriatric pregnancy was like probably the
middle term. I think that's what it was called when
I had my second, like a geriatric regnancy.

Speaker 3 (33:32):
Yeah, so you know, with the advances in medicine.

Speaker 1 (33:35):
We know that it is kind of biologically and physically
possible for women who have babies later, But in your opinion,
is there an age at which a woman should be concerned? Like, hmmm,
this might not be like the best decision, Like is
that a conversation like somebody thinking at a certain age, Okay,
I might be too old.

Speaker 2 (33:54):
Well let me say this, and I say this as
someone My mother was almost forty five when OURT was born. Okay,
but I was not baby number one. I was baby
number eight. And I'm sure she was appalled with the prospect,
Like what because the next sibling to me was seven
years before I was born. So I don't think she

(34:14):
was exactly saying, ooh, eight, it's a good round number.
I don't think that was her thought process. But lo
and behold, I'm here, and I was born at home.
And again, I was born at home by choice, not
because it was just baby number eight and she couldn't
get to the hospital. We lived a block away from
the hospital. And I don't have my mother here to

(34:37):
ask her. But you know how, sometimes you put together
you're like, well, what could she have been thinking? Because
my sister, who's seven years older than me. My mother
had that baby at the hospital was a mobile general hospital,
the city hospital, and it was segregated. She was born
in nineteen fifty three, so segregated. I'm sure it was

(34:57):
awful and it was an experience that she didn't I
wish to repeat. So when g had me, I was
born at home. I was delivered by midwife. So that's
why I said, the personal experiences that you have drive
your behavior in how you seek care or choose not
to seek care. But all all that to say, all right,

(35:18):
can you have a successful pregnancy in your forties, Yes
you can. And again, but the healthier you are, the
better you will do. But remember, by the time you
get to your forties, a lot of us have accumulated
a lot of other things which increase our risk. And
it can be done. And we had many patients in
our practice. As I said, most of the patients in

(35:39):
our practice were in their thirties and mid thirties, late
thirties having children. It just requires a little bit more attention.
Got to have a little bit more touch spots on
women just to make sure that if they are venturing
and in the area that we should be concerned about.
If you get high blood pressure, you need to treat
that high bloo PRESSU. You don't watch it. You don't

(36:01):
say go home and lay in a bed. No, you
treat the high blood pressure aggressively. If you develop type
two diabetes, which there is also a condition called gestational diabetes,
which means you were not diabetic coming into the pregnancy,
but now you've developed diabetes in pregnancy, again needs to

(36:21):
be aggressively managed in getting those blood sugars down because
you end up with babies that are too big, that
increases your risk for ce sections all of that. So
it's just a matter of knowing what the things are
that you're looking for and being aggressive about managing them
throughout the pregnancy. And yes, most people do just find

(36:44):
because the one thing that I don't want women to
have is a fear, because I think that all of
the discussion about internal mortality is good. We should have it,
people should be aware, but I also want young women
to know that it's still rare. It's still rare. The
overwhelming majority of women who go in to have babies

(37:06):
do fine, and that's another stress during a pregnancy that
you probably don't need. So you do the things that
you're supposed to do, know what's supposed to be managed,
but don't walk into that thinking that, oh my god,
they're going to kill me. Because this leads to some
other things which are problematic, and that is I have

(37:27):
no problems with midwives, but if you were going to
be taken care of by midwife, no problem. There are
midwives who are affiliated with hospitals such that God forbid,
should something go wrong, you're there they can act on that.
And another thing that as we're sort of turning to
Midwiffrey and home births and birthing centers, just know this,

(37:52):
if you have any sort of pre existing condition high
blood pressure, diabetes, or any other health problem, I don't
even qualify to deliver in a birthing center, so it
is the lowest of the low risk patients that can
deliver that way. And home birth, let's just say I
have three children. I wouldn't try it at home, and

(38:13):
I know what I'm doing. I like to know that
if it doesn't go well, I don't have to call
nine to one one. I'm already there. But that's how
I look at it. You can be aware, but you
don't have to be fearful because I think that the
feeling out of control is where the fear comes from.
But if you say you look at these things and

(38:35):
you say, oh, I have high blood pressure, Okay, I
know that can be managed. I have these things that
can be managed. Here's another thing that I think a
lot of women don't realize that even if you have
we call pregnancy induced hypertension, which is like the first
stage before you get to preeclampsia. It means your blood
pressure just goes up during pregnancy. We treat that, hopefully

(38:56):
to ward off preeclampsia. If you have pregnant induced diabetes,
we treat that. Make sure that's done and managed well.
Even if those conditions resolve after pregnancy, because usually we do, say,
monitor your blood pressure, make sure if your blood pressure
goes back to normal after pregnancy, if your blood sugars

(39:20):
go back to normal after pregnancy, it's not over. Having
had those things during pregnancy increases your risk forgetting hypertension
or diabetes later in life, So you're not done. You
should always take that as a red flag to say, Okay,
now I know this is something I'm at risk for

(39:42):
and I need to manage this more aggressively. Don't act
like I don't need to go to doctor again or
I'll see you in two years. You need to be
monitored to make sure that those things don't happen, because
they do put you at risk. Another thing that puts
you at risk for developing these cardiovasc issues is that
if you've had a low birth weight baby, so you've

(40:04):
gotten to term. And our problem today is that babies
are too big. They're not too small, and if they're
too small, then that says something too about a vascular
problem that you may be having. So again, these are
people that need to be managed aggressively as you get
outside the pregnancy, not just while you're pregnant, because this

(40:27):
puts you at higher risk. And I think a lot
of people don't realize that, and so they go on
and realize that the next thing shouldn't be you're in
heart failure or you've had a stroke or something like that.
You just need to know. Again, knowledge is power, and
you know how to manage even when your doctor or

(40:48):
whoever you're seeing, your nurse practitioner may not be suggesting
these things. These are just things I want you to think.

Speaker 1 (40:53):
About more from our conversation after the break. So another
layer that has been added to this conversation around having
babies later in life is that people are also having
conversations around like freezing eggs and IVF. When are you

(41:15):
introducing conversations around like maybe freezing your eggs is a
good idea if you don't think maybe you want to
have babies in soil later, Like is that something we
should be thinking.

Speaker 3 (41:23):
About at around age twenty five? Like when do we
start thinking about that?

Speaker 2 (41:28):
Okay, well, here's the rub. The younger you are, the
better yield you're gonna get from your eggs. But the
younger you are when you freeze your eggs, the less
likely you are to need them. Because the other part
of it is that we haven't been doing egg freezing
for that long. There are a lot of eggs that
are still in the freezer because people never came back

(41:50):
for them because they didn't need them. You know, because
I would still say if you froze your eggs when
you were twenty eight years old and now you're thirty six,
I wouldn't say go get your eggs left, go unfreeze those.
I'd say, try to get pregnant. And if you get pregnant,
once you get pregnant twice, you will never go back
for those eggs. Okay, so that's one the decision to

(42:14):
freeze eggs or not freeze eggs, I would say I
probably wouldn't freeze eggs for somebody in there mid to
early twenties. There's just too much life, and you don't
want to wait and free them till you're forty either,
because now your fertility does go down with age. So
I would say, sweet spot, if you were going to

(42:35):
freeze eggs, if you were thirty years old and you're saying,
oh my god, I'm getting ready to start my residency
or I'm getting ready to start graduate school or law school,
and I'm not going to be done. I know I
don't want to have a baby until I'm thirty eight.
Let's just say then that might be the time to
consider it. But I think of freezing eggs the same

(42:58):
way I think you should think of having fire insurance
for your house. Flood insurance. Well, let's say we don't
live in a floodplain. Let's just say we just fire insurance.
Most people never need it, but if your house burns down,
you need it, And how are you gonna know until
you get to that point. So it's a big expense.

(43:21):
Each egg freezing costs maybe anywhere from about fifteen to
twenty thousand dollars because you have to go through the
same process as if you were going through IVF and
then they harvest the eggs. If you're younger, you're likely
to get your number of eggs, maybe in one go.
Sometimes you need to do two. So now instead of

(43:43):
fifteen to twenty, is thirty to forty thousand dollars. Then
you got to freeze them. Then you have to pay
storage on those free frozen eggs for every year they're
in storage, maybe five hundred to one thousand dollars a
year for storage. So I say it adds up some
people that have this as a benefit of their jobs.
A lot of tech companies are now offering this for

(44:05):
young women. If that's the case, I it wouldn't hurt.
But here's the other thing. If you are thirty years
old and you're thinking about, oh my god, I gotta
do I'm getting ready to do neurosurgery and I'm not
going to be able to have a baby. If you
have a partner, it is far easier, and we have
more data and success with frozen embryos than frozen eggs.

(44:35):
So if you already know who your partner is and
you're going to have a baby with this person, we
have more experience with that. You can come back and
unfreeze those embryos. Because remember you freeze eggs, they still
have to be fertilized, so there's another step that had.
You got to unfreezen, fertilize all that kind of stuff.
So it's more complicated than you think. But I don't

(44:55):
want anyone to leave this conversation and think, well, oh, okay,
I'm just going to go freez that's my eggs and
then I'll have a baby at forty maybe, because you
still have all those other steps to go through. And
even the best places will say, oh, we have a
forty fifty percent pregnancy rate successful pregnancy, But that's a

(45:18):
lot of conditions on that thirty to forty percent. You
have to have frozen your eggs before age thirty eight.
You have to have at least twenty eggs, okay, so
if you only harvest at five, then your chances are
not in the high range. So this is why I
said a little bit of homework and understanding where the
place is. If you're going to a place where they're

(45:39):
giving you cut rate, egg freezing and all this kind
of stuff. Do your homework. What is their success rate?
Now what they tell you, they usually have to report
what their pregnancy success rate is on that. So, again
long answer to a short question, It depends. It depends
on what you can afford, It depends on where you

(46:01):
are in life. And remember that at this point when
I wrote my book, I did a section on this
in talking about perimenopause and winter freeze eggs, and at
that time, I think less than ten percent of the
people who had frozen eggs, So the women who had
frozen eggs had actually come back for them. So just

(46:24):
know that those numbers are based on a very small
subset because again and it's not because it necessarily didn't work,
it's just that people didn't need them.

Speaker 1 (46:32):
Right, You have framed a lot of this conversation around
it's important for us as patients to know this, but
also really important for a providers to know this or
that it informs their practice.

Speaker 3 (46:42):
What kinds of tips are.

Speaker 1 (46:43):
Things can you offer in terms of what it looks
like to have like a healthy, trusting relationship with your
provider and how can we better advocate for ourselves.

Speaker 2 (46:52):
That is entirely why I wrote my book, because I
spent a lot of time in menopause world. I do
a lot of menopause. I do perimenopause because it's the
same sort of disparity issues that happen for Black women
im perimenopause and menopause. We have symptoms that start earlier,
last longer, they're more severe, and yet we are least

(47:12):
likely to complain of those issues and to go to
our doctors because you think, oh, well, that's just you
know how it's supposed to be, or you don't recognize
the symptoms as being menopause, and we just sort of
accept not feeling well for a decade or more. So.
It's that is having you understand. It's also the other

(47:36):
piece of it is trying to get doctors to understand,
because remember, we got a generation of doctors that don't
know how to treat menopause. They don't know how to
do a lot of these things. And here's the rub
all of the things that I want you to do
to kind of advocate for yourself and to explain to
you what's changed in our medical relationships now. It's even

(47:59):
more important that you really advocate for yourself, because it
would be great to have a wonderful relationship with a
doctor where you can go in they know you. That's
not likely to happen in today's world. I practiced in
one place for almost thirty years. I have been practicing

(48:19):
in DC for thirty five years, so one place generations.
I had patients that I took care of their mothers,
I've delivered your children. I had a lot of context
around who you are. That's not going to be the
lived experience for most people entering medicine now. So it's
hard to form a relationship if you enter in an

(48:41):
insurance based practice because your doctor's got fifteen minutes, I
don't know. Your doctor's not likely to stay in the
same place. You might see somebody this time, somebody else
the next time. So it's hard. And I say that
because now it changes the locus of power. Now the

(49:02):
power is yours, because nobody's going to know you better
than you. So this is why I said preparing for
a doctor's visit having really clear objectives about why you there.
Am I just there for it because I need to
check up and I need to make sure you know
these things are done, or am I there because I

(49:24):
have a problem and these and articulate very clearly what
your problem is, because remember, you may have to explain
this to three different people. So when you are clear
before you walk out of that doctor's office. This is
sort of how I craft conversations. I said, look, all right,

(49:48):
you don't leave there with it's nothing or you're fine okay.
If it's not fine, what do I escalate for? Or
you say, if I'm not better in X amount of time,
when do I come back. Don't ever just walk out
with the open ended oh, it's nothing, okay, and then
you walk out thinking it's nothing but it's still going on,

(50:09):
and you've still got that in your mind. Well my
doctor said it was nothing, but your symptoms are still there.
You see what I mean. It's sort of being very
intentional about the limited amount of time that you're going
to have with this person in front of you. Now,
good news and bad news. The good news is that
AI is going to be a big part of our

(50:31):
interactions going forward because we don't have enough doctors and
the doctors don't have enough time. That's the reality. You
may live in an area where you may have access
to different kind of doctors. So AI can be a
really important tool. But the AI is only going to

(50:52):
be as good as the people who create that large
language model for you if we continue this. This is
why I said I also in addition to trying to
educate patients, I want to educate doctors because I want
them to understand Dan what the limitations were and our
misconceptions and misperceptions about black people, and don't build that

(51:16):
into your AI model. If you take those things out,
you take those all the things that we take as normal,
Like this is what I was told. Black women don't
have menopausal symptoms as much as white women do. Black
women don't really get into metriosis. Black women don't get
and name blah blah blah whatever those kind of things.

(51:39):
Just know that they aren't based on fact. Somebody just
said it and it gets repeated over and over again.
And regardless of the race of your doctor, we're all
taught the same thing. And so this is a huge
opportunity if the people who are building these models moving forward,

(52:04):
it can make doctors efficient, it can make patience to
be able to interact a little bit better. It'll make
a lot of things more understandable for you. But you've
got to make sure that those models, and that's my
job is to make sure that doctors are aware so
you don't recreate the same biases that we've lived with
for the past one hundred and fifty years.

Speaker 1 (52:28):
You know, so much of what you've shared really is
about like listening to our bodies, knowing our symptoms, being
very aware. But I think that there are a lot
of people who really struggle feeling connected to their bodies right,
and like don't necessarily trust.

Speaker 3 (52:40):
What they're feeling.

Speaker 1 (52:41):
What would you say to someone who does have that
disconnect about how to rebuild trust with their own bodies?

Speaker 2 (52:47):
And I do talk about this in my book. We
all know about our five senses, site, hearing, tastes, whatever.
You have another sense called interception. An interception, we all
know what it is, even if you don't know what
to call it. And that sense is knowing what your
body feels like. When you feel normal, I'm not aware

(53:09):
of what's going on with my ankle, I'm not awareing
of what's going on in my head. You feel completely normal,
balanced walking around in your life. Let me tell you
what happens when you are in pain. When you accept things.
Pain is a very potent indicator that something is amiss somewhere.

(53:30):
You may not know what it is, but what happens
is for so many of us, we accept not feeling
normal as normal. So when you live with chronic pain,
when you live with chronic fatigue, when you live with
all of these things and you sort of it dampens

(53:53):
that sense of what you have, you don't even know
what to complain of because you think that that's that's normal.
And what I try to tell women is like, chronic
pain is not normal. Being fatigued is not normal. If
you can't get out of bed in the morning and
you're moving around and you're slow and you're sluggish, not normal.

(54:15):
Not normal. So I think that too many of us
have ignored what our bodies are trying to tell us
for too long, and so we really don't have a
sense of when to go with this. And that is
what I'd say women do and black women do times too,

(54:35):
is that we live diminished lives in terms of not
feeling like ourselves. And I can give you an example.
I would see patients. I would say to women, I
was like, people accept cramps, okay, so cramps are one thing. Okay,
oh yeah, cramps. Yeah, I can take a tie on
our motrin and I'm going on with my day. If

(54:56):
you're debilitated by cramps, if you can't leave your house
because you are bleeding so heavily that you can't be
more than ten feet away from a bathroom, not normal.
Do you know how many people walk around like that
every single month? And I always go and I look

(55:19):
at them. I'm like, that is not that's not normal,
But we don't talk about it. See, normal is what's
normal for you. And if you say, well, that's how
my periods have always been, and I'm like, well they
shouldn't have been, or somebody, we have things. We have
a lot of things that we can do to fix that.
Because if you are going along your day and you're

(55:41):
bleeding ten days out of the month, or soaking through paths,
or you can't travel during your period, you eventually get anemic.
I mean anemic to sometimes needing the point of a transfusion.
And I would see patients sometime and I'd say, so what,
because I get all in your business. I'll say, well, okay,

(56:01):
you can't say how'd you period? It's fine, it's regular. Well,
we're going to get into that, and I'll say, well,
how often and how many times do you have any
of these things? And then you get a blood count,
and their blood count they will be walking around every
day with half their normal blood volume. Do you know

(56:22):
what you feel like when you walk around with half
your blood volume? You don't feel good? And people have
felt this way for years. And I have had women
and let me just say this is not a oh,
uneducated women. I've had smart women who are out there
doing everything you know that they're supposed to be doing,

(56:44):
going to work every day and come home and can't
take their head off the pillow. This is why I'm
talking about reconnect. Know what your body feels like when
you feel good and normal, and that should be the
goal that we're all trying to get to. Anything less
than that, we need some answers and you need to

(57:07):
bring it up and stop thinking that that's just the
way you're supposed to feel, in particular as we get older,
because as we get older, we just think that those
are things are just part of you know, well, you know,
let's getting old. I see my mother and she's moving
slow about the house. We are trying to create a
different path forward. I don't want women to think that

(57:32):
just getting old, being fifty, being sixty is something that
means that you're leading a diminished life. I'm I don't
mind telling me. I'm sixty seven years old and I
have a brother who's ninety, and I think of it
this way. I was like, I'm going to be the
best sixty seven year old I can be. I'm not

(57:54):
twenty seven. I know that too, but there is a
standard that I want to be at. And this is
where I want people to aim a little bit higher
about how you want to age. When we can't stop
the clock. Nobody's trying to do that, but we at
least want to make the best of how we navigate lives.
And I think that as women, that's where we give

(58:17):
up sometimes. And here's the other little misconception. I want
black women from getting away from saying stuff like this,
you know, because we like to say, oh black women,
black don't crack. Okay, all right, well it's cracking on
the inside. You may not look a certain way, but
trust me, you're aging faster than someone else and a

(58:41):
different ethnicity because of the lives that you lead. And
so you've got to really be intentional and take steps
to make sure that you are constantly restoring that balance.
And yes, it does involve some self care. It does
involve so trying to figure out how to eliminate the
stress in your life that you can control. You can

(59:04):
control all of it, but it's a lot of it
that you can keep that mindset. And if you go
into aging that way, if you go into pregnancy that way,
if you go into any phase of your life where
there's a major change and you think of it that
way and actually take the concrete steps, because thinking about

(59:24):
it is not enough. You actually got to do something.
But if you do it, then I think that we
can feel better about aging. It's not all decrepitude. That'll
get there soon enough, but not early.

Speaker 1 (59:41):
So in addition to your book, Doctor Malone, you have
your amazing podcast. Let us know where we can find
all of the resources that you have created for people,
your website and where we can stay connected with you
on social media.

Speaker 2 (59:52):
Yes, you can go to my website, doctor Sharon Malone
dot com. And I have my book Grown Woman Talk,
which really is everything. It's like soup to nuts. What
are the kinds of things that you should prepare and
know what is coming if you plan to live beyond forty.
So it's all of that. It's not just perimenopause and menopause.

(01:00:14):
It's like all the things that you need to do
to how to show up, how to advocate for yourself,
and even the things at the end. There will be
things that may not be relevant to you right now,
but there are things that you can use for your
parents because many of us, if you are so fortunate
to have parents, you will end up being caregivers for
those parents. So you need to know again not necessarily

(01:00:38):
just how to advocate for yourself, but how to advocate
for your parents as well. That's the book. My podcast
is called The Second Opinion. As a matter of fact,
we just finished I think the last episode of this
season comes out today, and they've got, you know, lots
of topics. You know, if anybody wants to wants to

(01:00:58):
listen to any of them, you can go to The
Second Opinion. You can get them wherever you can get YouTube, Spotify,
Apple podcasts. And I do a lot of stuff about
things in midlife, so I talk about that, and I
am really at a crossroads right now because I'm trying
to decide whether or not I'm going to retool the

(01:01:19):
podcast and come back, and I tell you what I
want to do. And you know, sometimes you're trying to
find your voice in your footing, and I really do
want to do something that is specifically for Black women
in the health and menopause and midlife phase, not just
all menopause. But I really would like to hear from

(01:01:43):
your listeners and from other people just to tell me
what do you want to hear, Because, like I said,
if I'm out here and I'm helpful, I'm all for it.
But if you're like, h, I do need know that,
then that's okay too. But I am very interested in
moving forward with what you and your listeners would like

(01:02:03):
to hear and the kinds of things that, particularly in
the health and the medical feel that you feel are
not being addressed. And those are the kinds of things
I want to talk about.

Speaker 1 (01:02:13):
Is there a place for the community to offer you
that feedback on your website or somewhere.

Speaker 2 (01:02:17):
Yes, you can go to my website doctor Sharon Malone
dot com and you can put in comments, and you
can also just go if you listen to the podcast,
put in feedback. Tell me you liked it, you didn't
like it? What you want to see or hear more
of absolutely, And I'm on instagram s Malone MD on
Instagram and you can leave me messages DM me because

(01:02:39):
I again my point is I want to be helpful
and useful.

Speaker 3 (01:02:44):
Got it.

Speaker 1 (01:02:44):
We will be sure to include all of that in
our show notes. Thank you so much for spending some
time with us again today, Doctor Malone.

Speaker 2 (01:02:50):
You are so welcome.

Speaker 3 (01:02:51):
Thank you.

Speaker 1 (01:02:55):
I'm so glad doctor Malone was able to join us
again today to share her expertise, more about her and
to check out her work. Be sure to visit the
show notes at Therapy for Blackgirls dot com slash Session
five four nine, And don't forget to text this episode
to two of your girls right now and tell them
to check it out. Did you know that you could
leave us a voicemail with your questions and suggestions for

(01:03:15):
the podcast.

Speaker 3 (01:03:17):
Drop us a.

Speaker 1 (01:03:17):
Message at mimmo dot fm slash Therapy for Black Girls
and let us know what's on your mind. You just
might feature it on the podcast. If you're looking for
a therapists in your area, visit our therapist directory at
Therapy for Blackgirls dot com slash directory don't forget to
follow us over on Instagram at Therapy for Black Girls
and join us in our Patreon community for exclusive updates,

(01:03:39):
behind the scenes content, and much more. You can join
us at community dot Therapy for Blackgirls dot com. This
episode was produced by Eleas Ellis, Indechubu and Tyree Rush.
Editing was done by Dennis and Bradford. Thank y'all so
much for joining me again this week. I look forward
to continuing this conversation with you all real soon. Take

(01:03:59):
good care.

Speaker 3 (01:04:03):
The best place the PO

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Dr. Joy Harden Bradford

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