Maternal mortality disparities [PODCAST]

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We are joined by Bayo Curry-Winchell, a family physician, as we delve into the alarming maternal mortality crisis among Black women in the U.S. Join us as we discuss the complex factors contributing to this issue, the role of unconscious biases in health care, personal stories, and actionable steps to address this critical public health concern.

Bayo Curry-Winchell is a family physician and can be reached at Dr. BCW and on TikTok, Instagram, LinkedIn, and Twitter @DR_BCW. Dr. Bayo Curry-Winchell holds the esteemed position of medical director of community engagement and health equity, where she spearheads diversity, equity, inclusion, and belonging initiatives. Additionally, she serves as the medical director of urgent care clinics at Saint Mary’s Regional Medical Center, Reno, NV, and is the visionary founder of Beyond Clinical Walls.

She discusses the KevinMD article, “I’m a doctor, and I almost died during childbirth.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast to get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Bayo Curry-Winchell. She’s a family physician, and today’s KevinMD article is titled “I’m a doctor, and I almost died during childbirth.” Bayo, welcome back to the show.

Bayo Curry-Winchell: Thank you for having me, Kevin. I’m so excited to be here.

Kevin Pho: Now, for those who want to listen to Bayo’s story, go to KevinMD.com/podcast. In the upper right-hand corner there’s a search bar; search for her last episode to hear her story. But today, let’s jump right into your most recent KevinMD article. It’s titled “I’m a doctor, and I almost died during childbirth.” How did your article come together?

Bayo Curry-Winchell: It was rooted in my lived experience. We have often heard about Black women dying at the highest rates, either during pregnancy or shortly after, and so often what’s socialized is that it’s about access and socioeconomics. I wanted to highlight that it goes beyond that. It is about systemic racism. It’s about systemic practices that are impacting women of color and Black lives every day. So by sharing my story as a physician, how I almost died, my hope was to really spark new conversation around this topic and dig deeper into all of the elements that are part of this really huge crisis.

Kevin Pho: Now, before you share your story, let’s give a little more context. Do you have any data or numbers that can really illustrate that disparity?

Bayo Curry-Winchell: Yes. At this time, and it’s been the same number for quite a while, Black women are dying at the highest rate, three times more than white women. When you look at that data, and you look at how robust our health care system is, you have to ask yourself why. The current climate, or the current go-to, is, “Oh, we need to really improve access,” or “It’s a socioeconomic issue.” Well, there’s more study and more data now, including a recent article that shared that Black women of higher socioeconomic status were dying in this category. Those two points really reflect that it is much more than an access or socioeconomic problem. We have to think about why this continues to happen.

I think the other part that is often not talked about is that we know that the color of my skin, my race, is not biological. So there’s no biological reason why I, as a Black woman, have a higher risk of dying. It involves so many different areas. So that’s a little bit of the data to support what I’m saying.

Kevin Pho: So please share your story with us.

Bayo Curry-Winchell: I had just given birth to my second child. I had come out of the OR after a C-section, and I knew that I didn’t feel the way I did after my first one. I was having a hard time concentrating, and I was tired. I know people are like, “Well, of course you were tired; that’s normal,” but it just didn’t feel the same. So I reached out to my nurse and said, “Something doesn’t feel right. Can you call my doctor?” And she said, “Bayo, everything looks OK. Your vital signs look fine. What you are feeling is normal.”

So I sat with that for a little longer, and then it started to get worse, to where I was having a hard time even speaking and concentrating. I asked for my nurse to come back, and I said the same thing: “This is getting worse. Please call my doctor.” And she again said, “Nope, everything you’re experiencing is normal,” and I remember her saying, “You look fine.” She left the room, and I told my husband, “Please call my doctor.” Of course, physician to physician, as most of us do, we have each other’s phone numbers, so my husband reached out to my doctor on my phone and said, “Something’s wrong with Bayo. Can you come back?” And he did. Within minutes, I remember him really taking in who I am. Most people who know me know I’m quite energetic all the time, even in different environments and situations, and he knew that I wasn’t myself. So he took me back to the OR. I was bleeding internally. I was transfused multiple units of blood, and I was hospitalized for two weeks.

As you know, Kevin, my love and passion is health equity and health literacy; that has been a part of my fabric. So to experience this, knowing the data and knowing my risk factors, and for this to happen to me as a physician, I just knew I was like any other Black woman trying to give birth, and it almost happened to me. My hope is that by sharing my story, I can help save other people, and that we can look at this issue in a broader way, instead of focusing on just one or two issues that are part of the problem but definitely not the entire issue.

Kevin Pho: Now, as you reflected on this story and episode, did you have conversations with your physician and the medical team about what had happened?

Bayo Curry-Winchell: I did, after all of this evolved, because I’m someone who leans into curiosity and asking questions. I think it’s really important to be able to talk about an issue or something that happens. When I was asking the nurse, and this is an important piece, it wasn’t malice. It wasn’t ill intent. She just couldn’t see that what I was showing, or what I was stating, was pain. I think that’s an important piece we forget, and that’s unconscious bias. It’s something we all have, based on what we think about how people look, behave and talk, and it’s not a bad thing in itself. However, when it impacts the care that is delivered, we have to take note, find ways to acknowledge it and then find ways to change it, so we don’t impact lives. That was really the starting point, and I think leaning into curiosity and sharing that part helped me build this into something, in hopes of sharing this story with as many people as I possibly can.

Kevin Pho: When you share the story, and other health care professionals are listening to you, either on the TEDx stage or on this podcast, tell us what should have happened in an ideal world. If this situation were to present itself again, what should the ideal response have been?

Bayo Curry-Winchell: First, listening to me, instead of thinking, “I know what pain looks like,” or “I know what she’s feeling,” or “She doesn’t look like someone who needs help, or like something’s wrong.” I think as clinicians, we have to take the time for some introspection and think about what we feel or think pain should look like on different people. I think that is the jumping-off point, the starting point, for us as clinicians. So what should have happened is that when I said, “I don’t feel right,” it shouldn’t have just been, “Well, she doesn’t look like something’s wrong. Her vital signs look fine.” It should have been, “Let me find out why she’s saying that, and what is concerning to her. Even though I don’t see it and I don’t understand it, let me go a little bit further and acknowledge it.” I think that could have changed the entire trajectory. Calling my doctor: Even if the first time you wanted to wait, you could have called and said, “Bayo just stated that she wasn’t feeling right. I just want to make you aware.” That could have made a huge difference.

Kevin Pho: One of the ways you mentioned that we can address implicit bias is that we in health care need to reflect on ourselves and ask ourselves sometimes hard and difficult questions. How can we do that? What kinds of questions should we ask ourselves in order to combat implicit bias, because by definition it’s not something we may even be aware of?

Bayo Curry-Winchell: First, think about different people, different experiences and the things that we’ve learned as clinicians, and take a step back and ask: Is this really about the individual? Is this really about the disease process? Because we all know there are different labels associated with how people look, the color of their skin, and identifiers such as drug seekers, pain seekers and so forth. Think about how we get back to what we all love, which is delivering health care based on the individual and then using all the amazing tools and skills that we have as doctors to help people. So the first part is acknowledging that it exists and being OK with that, and then every day taking time to make sure that in your delivery, in whatever you’re going to put forward for that patient, you can remove those pieces of bias that may be happening. If you think, “Is this patient really in pain?” then ask yourself, “Why did I think that? What made me think they must not be in pain?”

And I have to give applause and recognition to my physician, who recognized, “This is not Bayo,” and took it forward. I truly believe he just thought to himself, “This is not her. This is not who she is. I need to find out what’s going on. I may not know what it is, but I need to find out why this is happening.” I think that’s something each and every one of us can do: lean into curiosity, think about what’s in front of us and make sure that we’re not allowing our own thoughts to drive that care.

Kevin Pho: When you share this story, and I’m sure many people have heard it, tell us some of the reactions you’ve received after people have heard it.

Bayo Curry-Winchell: There was a new perspective. People are often thinking, and I don’t mean to say always, but there was a new perspective that this goes beyond access, because I’ve been in many conversations where people will say, “Yes, we need to expand access and have more centers.” That is true; we definitely need more birthing centers and so forth. But if those centers are still delivering care that is rooted in biases or race-based practices, we can’t move the needle.

The other piece that is often part of the conversation, when I bring this up and people hear my story, is that they’ll say, “Well, I’m working on increasing access to Medicaid.” That’s important, and I mention it because I’m sure everybody listening has heard that comment before about certain disease processes. And then I go back again, Kevin, to that unconscious bias, that labeling and association, that somebody must have a certain income status to experience this disparity and inequity. Yes, that’s a part of it, but when you hear my story, how I had the most access in the world and the privilege of being a physician, and I almost died, you need to think about it through a new lens. That has allowed me to really bring forward a new thought process.

And last but not least, we talk about doulas and midwives and all of the important pieces that are part of delivering a baby, and all of those things have to happen. But one powerful question that is asked over and over, and I love giving this answer, is, “Are midwives the answer? Are doulas the answer?” I say they’re a part of it, but if the clinician isn’t listening to the patient, what makes you think they’re going to listen to the doula or midwife? That is all rooted, again, in unconscious bias.

Kevin Pho: Let me ask you from the patient perspective, because in your story, fortunately, you were able to call your physician directly, but not every patient can do that. If patients don’t feel like their health care team is listening to them, what kind of advice can you share with patients about what they can do in that situation?

Bayo Curry-Winchell: The first thing, and it sounds a little different, a different thought process, is to share with the team and state, “I don’t feel like you’re listening to me.” Because, again, the team may not have ill intent; they just didn’t know that you didn’t feel heard. I think just sharing how you feel can really make a difference. Say, “I don’t feel like anyone’s acknowledging what’s happening to me. I don’t feel like anyone is really taking into consideration what I’m asking or how I’m feeling.” If that request is still dismissed after you’ve leaned into curiosity, then take it a step further: Find an advocacy team within that system, reach out to them, and try to get a new team or help delivering your concerns. But the first step, I think, is telling them, “I don’t feel like you’re hearing me,” because that can allow the team to take a step back and say, “I’m so sorry. I didn’t know you felt that way.” So those are two pieces that can really help you advocate for the best care.

Kevin Pho: We’re talking to Bayo Curry-Winchell. She’s a family physician, and her KevinMD article is titled “I’m a doctor, and I almost died during childbirth.” Bayo, let’s end with some take-home messages that you want to share with the KevinMD audience.

Bayo Curry-Winchell: We are often privileged with all of this wonderful information, so think about how you can use it in new ways. Think of anything you’ve been doing for a long time in health care delivery, and take a step back to make sure it is the right way to do it, that it is still rooted in delivering individual care, not care based on associations and labels. And involve yourself in uncomfortable conversations, because when that happens, your ability to really help people in new ways can grow, and you can really do what you love to do. I encourage everyone to take a look at my new TEDx talk, titled “Do no harm.” It shares those uncomfortable conversations, those pieces that we as a health care team can really put forward in order to do what we love, which is care.

Kevin Pho: Bayo, thank you so much for sharing your story, time, and insight, and thanks again for coming back on the show.

Bayo Curry-Winchell: Thank you for having me.

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