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00:00Hi, I'm Victoria Womarogi, the lifestyle editor for Essence Magazine, welcomed to health disparities
00:13in the Black community and its effects on pregnancy, in partnership with Johnson & Johnson.
00:17I'm here with J&J's Senior Medical Director, Dr. Robin Jones.
00:21Hello, Dr. Jones.
00:22Hello.
00:23And I'm also here with YouTube star and mom, Rita Onyx.
00:27Hello, thank you for having me.
00:28Hello, hello.
00:30We're here to discuss the inequity facing the Black community when it comes to pregnancy.
00:34Now, Reeve's here to share her personal story, while Dr. Jones will give us some tips on how
00:38to advocate for ourselves, not only in the doctor's office, but beyond.
00:41I'm super excited to jump into this topic because it's very close to my heart as a new mom.
00:46So let's kick it off with some insights from Dr. Jones.
00:49Dr. Jones, thank you so much again for returning to Essence Festival this year to continue this
00:53very important conversation surrounding maternal mortality.
00:57Thank you for inviting me back.
00:58Yes, it's a pleasure.
01:00It's a pleasure.
01:01And so first question I have for you, Dr. Jones, what are some of the social determinants
01:05of health that can cause health disparities?
01:08Sure.
01:09So I think we probably need some definitions here.
01:14Yes.
01:14And let's talk about what health disparities are first.
01:18And we're specifically talking about health disparities in the Black community.
01:22And what health disparities are, they're a higher burden of illness, of injury, of disability,
01:30and of death.
01:31And so we know that health disparities are related to the social determinants of health.
01:37And what are the social determinants of health, you ask?
01:40Well, the social determinants of health are where we live, where we work, where we age,
01:48where we're born, and where we grow.
01:50So it's a number of variables.
01:52And all of those impact our health.
01:55Okay, nice.
01:56That's good to know, because I was like, all right, social determinants of health, it
01:59causes health disparities.
02:01That's a lot of jargon.
02:02I can give you some examples, if you'd like.
02:06This would be an opportunity to do that.
02:09So one of the most vivid examples is having continuous health insurance.
02:15Many of us in the Black community, we may have health insurance in a spotty way.
02:22So we may have it with one job and not the next.
02:25We may be unemployed, and maybe we're not eligible for the health insurance that comes
02:31from government assistance.
02:33So that means that our ability to have health insurance and pay, have medical bills paid
02:38for, is not continuous.
02:40That being the case, we don't have continuous care with the medical community.
02:46The other thing is inadequate access.
02:48And there's a lot of reasons for inadequate access.
02:50It's not just our ability to get to an appointment.
02:53And when I say that, I'm thinking right away of transportation.
02:56That's related.
02:57But it also may be the history of what I call medical apartheid in this country.
03:03In other words, how we as Black people have been treated in the medical health care system
03:08since we were brought here.
03:10And the legacy is that certainly during slavery, we were not treated at all unless we were needed
03:19to do work.
03:19And even then, the treatment was insufficient because remembering that supposedly we don't
03:25feel pain the same way, supposedly we don't care the same way, and supposedly we don't care
03:33for ourselves the same way.
03:35And I say supposedly because that's blaming the victim.
03:39You know, all of that's about the victim.
03:41The other thing to think about is underlying medical conditions.
03:44And there's a number of reasons for those.
03:46I'm not going to spend a lot of time on that, but that may also preclude our access.
03:51And then, of course, there's the systemic racism and the implicit and conscious biases
03:56that exist.
03:59It's very deep and very true.
04:01Very true.
04:02Dr. Jones, what is the risk of a Black woman dying related to pregnancy as compared to that
04:08of other racial and ethnic groups?
04:09And what are the main causes, you would say, of maternal mortality?
04:12So in the United States, Black women are three to four times more likely than white women
04:20to die because of a pregnancy.
04:22Let me say that again.
04:24Black women are three to four times more likely to die related to a pregnancy than white women
04:30in the United States.
04:31I think the other important thing to know that the United States is the only industrialized
04:36country that has an increasing maternal mortality rate, and we also have the highest maternal
04:42mortality rate in the developed world.
04:45That rate has increased 50% from 1990 to 2013.
04:52And 60% or approximately two out of three of those deaths are preventable.
04:57And according to the CDC, not only are we more likely to die related to pregnancy, but in
05:04general, our lifespan may be shortened because of a number of other reasons that impact our
05:09health.
05:10So, Dr. Jones, what are the most common causes, you would say, of morbidity and mortality outside
05:15of those related to hemorrhage after delivery?
05:18So outside of hemorrhage, that's a good way to frame it.
05:20Because hemorrhage is responsible, outside the United States, postpartum hemorrhage is
05:26responsible for most maternal mortality.
05:29But here in the United States, it's responsible for about a quarter or 25% of maternal mortality.
05:36And I'm referencing bleeding that occurs after a delivery.
05:41So what are the other causes?
05:43Number one is cardiovascular conditions, including cardiomyopathy, all of which are related to
05:49conditions of the heart.
05:50Next would be preeclampsia.
05:53And some of us may know that by an older term called toxemia of pregnancy, but it has to
05:59do, starts out with elevated blood pressure and then has a sequela of different signs and
06:04symptoms and laboratory values that occur with it.
06:08In addition, there is, and I'll talk about morbidity now, up to 20% of women suffer from
06:16postpartum depression.
06:17And in that number, there's a significant amount of suicides that take place that's related to
06:23mortality as well.
06:25And Rita, I'm going to bring you in because I know you had quite the heroine experience while
06:30trying to, attempting and after the fact, giving birth to your fourth child.
06:33Can you share your story about your pregnancy?
06:35Yes, during my fourth pregnancy, I had two life-threatening conditions, placenta previa and the most severe
06:44form of placenta accreta.
06:46These conditions put you at risk for hemorrhage and even needing surgery on the organs.
06:52So for me, my placenta grew into my bladder.
06:57So during the surgery, not only did I need five bags of blood, I needed extensive bladder
07:01reconstruction surgery.
07:03After the surgery, I was wheeled to the recovery room where I was given my son to hold for the
07:08first time.
07:09And unlike with my other three kids, I passed out.
07:13Luckily, my husband was there to grab my son.
07:16And when I woke up, I knew something was very wrong.
07:19I alerted the staff, the nursing staff, and I told them that, you know, I do not feel right.
07:23My heart is racing.
07:24I'm short of breath and I feel extremely weak.
07:27They brushed off my concerns and told me that I needed to just get up and walk.
07:31I said, I need to see the doctor.
07:33They brought in a resident and the resident also brushed off my concerns and told me I needed
07:38to just get up and walk.
07:40Now, because I was in the recovery room right next to the operating room, I wasn't even close
07:45to where the nursery was.
07:47And unlike with my other three kids, I wanted, I was unable to breastfeed my son without assistance.
07:55So instead of giving me the assistance that I needed because I was so weak, they decided
07:59without my consent to just keep him on the nursery and feed him the formula.
08:05After this went on for a couple of days, my specialist came in to follow up and he immediately
08:12saw me, saw my chart, saw my lab work, and immediately ordered four more bags of blood.
08:17So in total, I got nine bags of blood and he reprimanded the staff for ignoring my concerns,
08:23for ignoring even the clinical signs and symptoms.
08:26And it left me traumatized because I was treated with a lack of professionalism, empathy, and
08:32respect.
08:32And I know you mentioned that, you know, you, you initially, when you were given your
08:38son, you passed out.
08:39And then when you were in the recovery, you were very weak.
08:41Are those the moments that you started to realize that something didn't feel right?
08:45Or was there something else that kind of triggered you to know that something was going wrong?
08:49Well, yes.
08:50I mean, I have never hemorrhaged.
08:53I had four.
08:53That was my fourth C-section.
08:55Right.
08:55So my husband was telling me while during my fourth C-section, he was trying not to alarm
09:00me, but he was saying, Rita, there's a lot of blood on the floor.
09:03And by that point I was so weak and I, I, I could feel that my life was, was, was draining
09:09out of me.
09:09So I knew that something was wrong in the surgery, but I assumed that after everything would
09:13work out, but, um, passing out, I have never passed out before in my life.
09:18I'm not before that and not even after that.
09:20So that was a very, um, bizarre and very alarming situation.
09:25And yes, from there I knew, okay, this is not right.
09:27But again, trying to be optimistic when I woke up, I thought, okay, maybe I'll feel better.
09:32But again, I was feeling even worse and to be told, you know, just get up and walk.
09:36And at the time I was almost done with my, um, RN degree.
09:40So I knew that there, I knew immediately that, okay, with my training, you know, you get, um,
09:45a vision of, okay, this is what's wrong with, you know, and complications.
09:50Like placenta previa, you're told what to look for, but when it's happening in real life
09:55and the staff is not even me stepping up to their training, you feel like, okay, you're,
10:02you're being told that what you're experiencing, you're not really experiencing and your, your,
10:07your concerns are being ignored.
10:08Your clinical symptoms are being ignored.
10:10And even if I had, even though I had the education, it didn't matter at that point.
10:14It just shows me that education, fame, wealth, it does not matter.
10:18Um, it just, you're just treated this way because I feel, because I was black.
10:24Hmm.
10:25Yeah, that's, it's just a terrible experience.
10:28Um, and, you know, you very much advocated for yourself from what I heard from your story
10:32and told, you know, the staff, what you were going through, um, because you were also knowledgeable
10:37and because you're just, you could feel, you know, what you were going through physically.
10:40Um, so based on the things that you did ask and the things that you told the staff, you
10:45would say, or would you not say that you felt a conscious or unconscious bias in your medical
10:49team during your, uh, during your term or your birth?
10:52Oh, yes.
10:53Because if you see, and my lab work showed that I was severely anemic and not just anemic in
11:01the way that people think is anemic.
11:02This is from literal lack of blood.
11:04And, you know, if my heart is going at 150 beats per minute, um, and I, and my, all of
11:10my skin was pale everywhere and I was gray, you would think that they would say, okay, this
11:16is what's happening.
11:17I think it was funny because I have another, um, thing I'm writing about when it comes to
11:22this particular experience.
11:23And one of the questions was, do you think you were educated?
11:26And I was educated, but I think the staff needed to have been more educated so that they
11:31knew what to look for.
11:32And because it should not be on me, it should be on them because they were the ones that
11:36were supposed to be taking care of me and treating me with professionalism.
11:40Yeah.
11:41Treating with respect.
11:42Um, and what are some warning signs, Rita, from your experience, um, that women should
11:47look out for and what would you say that they can do?
11:50You know, if they're not being listened to again, you try to speak up as much as possible
11:54and you didn't really, you didn't really get the help until your doctor came.
11:57Um, but with your nursing background, um, what kind of advice would you give?
12:01And did you feel that helped at all when you did try to advocate for yourself?
12:06I think, especially for women who have had a baby before, there's something dramatically
12:10different and they know that they don't feel right.
12:13I know that a lot of people feel like that's very vague, but a lot of people know that when
12:17there's something wrong, they can't quite put their foot on it there.
12:20Um, you know, they just know that there's something wrong.
12:22I think, listen to your body, advocate, don't ever stop advocating.
12:27Um, when they decided to keep my son up there, I got on the phone and I told them if I have
12:32to crawl to the elevator on all four, uh, on my knees and my hand, on my hands and knees
12:37and go up there and try to breastfeed my son, I will do it.
12:40And I was getting very emotional.
12:42They decided, okay, okay, let's bring him down.
12:44But it shouldn't, it shouldn't come to that where I feel like I have to, you know, threaten
12:49to embarrass them by crawling out of my room.
12:52Really, I just think that women need to listen to their body, continue to advocate.
12:57Don't worry about being embarrassed or being a pain.
12:59You know, that saying, the squeaky oil, the squeaky wheel gets the oil.
13:02Just keep being that squeaky wheel until you're, until you're actually listened to.
13:08Yes.
13:08And Dr. Jones, how can one take the steps necessary to advocate for themselves during pregnancy?
13:15So I just have to say, listening to Rita's story is, is disappointing, discouraging,
13:21depressing, okay?
13:23To think that she had this medical background, was in a healthcare facility that was supposed
13:29to be equipped fully for labor and delivery and the complications that have to happen after
13:34delivery, whether it's a cesarean section or a vaginal birth, was known to have blood loss,
13:40had been given nine units of blood, had had previous C-sections.
13:47I mean, when I'm telling her story, I can't make it make sense.
13:51Yeah.
13:52There, there is potentially, and I'll, you know, I'll say one thing that could have happened
13:57just when at the bedside diagnosis is that if you're not culturally competent, you don't
14:02know what it looks like for a brown skin person to be anemic.
14:05So you probably didn't look pale to them at all.
14:08Right.
14:09And there's, you know, specific places they have to look at that for that.
14:12They have to look at the palms of your hands, the soles of your feet, your gums, there's
14:17specific areas and that you look for in a black person to look for anemia, but they had lab
14:23work.
14:23I mean, I'm angry.
14:25I'm just so angry that that happened to you.
14:28And you certainly were advocating for yourself.
14:30And just as you were saying, you can never stop advocating for yourself.
14:35And when you have that person with you, you know, during labor and delivery and that time
14:42in the hospital during recovery for either a vaginal delivery or a C-section, you need
14:48to have discussions with them before the birth even happens about, you know, these are the
14:53things you may be hearing me say after I deliver and I need your support.
14:57Unfortunately, there's still going to be stories like yours, Rita, but I think more and more
15:01of us need to speak up and advocate and educate ourselves before we get there so that we can
15:08really be forceful, unremitting about our story and getting the attention that we need while
15:15we're hospitalized.
15:17And even afterwards, because certainly there are stories when women have gone home after delivery
15:21and then have died because no one heard them.
15:25Absolutely.
15:26Yes.
15:26And Dr. Jones, you know, how can a birthing team help?
15:29And can you kind of tell us what a birthing team is?
15:32So a birthing team is something you assemble yourself.
15:35It includes the person who's actually going to be the medical or healthcare professional that's
15:41actually doing the delivery.
15:42It may be a physician.
15:44It may be a midwife.
15:45But both of them are the leaders of your team, you know, depending who's in that position,
15:51managing your care during the pregnancy, during labor and during delivery.
15:56In addition, there may be a family member or friend that is there to support you.
16:01And then, of course, you might have a doula as part of your team.
16:05Now, the nursing staff is also part of your team, but you can't usually pre-select who they
16:10are.
16:11They come with the hospital package.
16:15So it is, you know, it is, I'd say, dependent on you to look at the hospital where you want
16:22to deliver, get some knowledge about the births that happened there.
16:28What are the rates of morbidity and mortality for that institution?
16:32Are they used to seeing people that look like you at that institution?
16:35And for your healthcare professional, the midwife, the physician, are they used to caring for
16:42people that look like you?
16:44Are they comfortable with, you know, who else, the others that you want on your team?
16:49That's all part of what a birth team is.
16:52And then there's the whole process of building your birth team.
16:56So, Dr. Jones, what steps are being taken to address the type of, you know, health disparities
17:00within our community that we've been discussing today?
17:02So, Johnson & Johnson is committed to our Race to Health Equity, where we have put aside
17:11or committed $100 million over the next five years.
17:15And externally, the plans for that funding are for medical school scholarships through the
17:20National Medical Fellowship, and also for training of clinicians to lead clinical trials.
17:27And that is also through the National Medical Fellowship.
17:31And the National Medical Fellowship Program is not a new one.
17:34We've had an ongoing partnership with them for years.
17:37The other thing that we're doing that is related to the community is that we have the Equitable
17:43Maternal Health Coalition.
17:45And that coalition was founded by Johnson & Johnson, but is led by the March of Dimes.
17:51And it is truly a coalition of professional organizations, such as the American College
17:57of OBGYN, advocacy organizations, and individuals, all committed to helping to change policy as
18:05relates to maternal health.
18:07There's just one more thing I want to add, and it has to do with our Maternal Health Equity
18:13Project in Georgia.
18:14And through that project, we are partnered with other businesses, as well as we are doing
18:21research to have a better understanding.
18:24Two of the foci for the research is understanding how Black moms feel when they enter the health
18:29care system, and how the health care providers feel about those Black moms.
18:34And one of the things that we've learned is they don't agree.
18:37You know, there's a mismatch there in the perception of the understanding of what health care should
18:42be expected, and what health care should be provided.
18:47And that's huge for us.
18:48And then we're also looking into telehealth as part of our research.
18:52And all of these things are all directed at changing health equity, and making it possible
18:58so that there aren't inequities, and reducing the public health crisis as it relates to maternal
19:04health today.
19:06Yes, thank you.
19:07Thank you so much, Dr. Jones and Rita, for spending your time with us today.
19:11And to our friends at Johnson & Johnson for sponsoring this very important segment, we
19:16thank you for being so forthcoming and sharing your story with us so that we can learn from
19:19your experiences, because, I mean, it was such a hearing experience you went through, and
19:23we're so glad that you're here and being able to help others.
19:27And Dr. Jones, I learned so much about the disparities facing our community and how we can all advocate
19:32for ourselves in the doctor's office and beyond.
19:34So, thank you so much, ladies, for all the insights shared, and for just being wonderful
19:40Black mothers.
19:40We, we, we, we, you gotta look out for it.
19:44So, thank you.
19:46Awesome.
19:46And thank you guys for watching.
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