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