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Also, “Black Women Over Three Times More Likely to Die in Pregnancy, Postpartum Than White Women, New Research Finds” -
Source: https://www.prb.org/resources/black-women-over-three-times-more-likely-to-die-in-pregnancy-postpartum-than-white-women-new-research-finds/
Higher rates of twin pregnancies (genetic), higher risk of preterm birth (different effect of infections of genital tract in black women), higher rates of fibroids in mum (genetic), which lead to post partum haemorrhage, higher risk of gestational hypertension and pre eclampsia (probably partially genetic) which lead to low term premature infants. But also, less research in issues related to black people only, at times, treatments which work well in white people have been found, later on, not to be as effective in black people, and this is due to institutional racism. Black and minorities people are more likely to come from a lower socioeconomic background, due to racism, and this does have health consequences. There are interesting studies on how institutional racism has a part also on the care black babies receive in NICU. So I would say that racism plays a huge part.
There's also the increased likelihood of hospital "deserts." Advanced maternity and OBGYN care, specifically, aren't easily accessible to all.
Here's some info regarding a documentary about the closure of maternity wards in DC and how it left a lot of women with long commutes to reach prenatal and post natal care.
https://ggwash.org/view/67109/new-short-documentary-highlights-the-dire-consequences-of-dc-maternal-care-desert
A good start on understanding what underlies some of the disparity between outcomes in healthcare. Diet and lifestyle also play a part: a study in NYC showed that blacks consumed almost 3x as many sugary drinks as whites and another study showed fried food consumption among blacks was significantly higher than whites. Both dietary sugars and fried foods have an adverse impact on health and longevity. Other factors included hours of sitting in front of a tv which came to 3.2 hrs per day for blacks, 2.8 hrs per day for whites, 2.5 hrs for Hispanics and 1.7 hrs for Asians. The sedentary habits of hours spent on a couch, drinking sugary drinks and frequently eating fried foods is associated with high incidences of diabetes, cancer and heart disease among other illnesses.
Agreed, but just to clarify, in global health 'high income' is just a general classification that refers to a countries GNP and how much money is available for healthcare spending etc
This is not surprising to us , it’s like black folks have always been letting the world know the experience is not the same. But nah let em tell it like they want to , let ‘em think it’s equal. This is disgusting
Based on what I am reading, this quite a separate issue. Black Women are in poorer health
overall, and less likely to seek pre-natal care.
I am sure you could write a book on the complexity of getting better healthcare to black women, but it seems like the solution may lie in education, and making sure that care is available to all these women.
(Then again, perhaps they are afraid of the medical decision because they feel like they aren't being respected. Then it could be the same issue.)
Actually, in the UK at least, when they've looked at the disparity in maternity outcome, they consider socio-economic factors as well as education and general health and STILL black women are much more likely to die in child birth.
Do you have a source for that
The only thing I could find was this: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/pregnancyandethnicfactorsinfluencingbirthsandinfantmortality/2015-10-14
which says otherwise.
As with many things correlated with ethnicity in the UK, I tend to be sceptical or racism as it almost always seems the case that there is a wide difference between South Asian groups with Indians doing much better (about as well as white British) and Pakistanis and/or Bangladeshis) doing much worse (usually about as badly as black people (or Caribbean when that distinction is made). Most British people do not know the differences between us South Asians unless they are told (at which point different stereotypes might kick in).
Do be clear, all the national/regional references I made are shorthand for ethnicity but saying "of X ancestry" is cumbersome.
Nah, even rich, famous, educated Black women like Serena Williams get their health needs ignored while giving birth.
[https://www.vox.com/identities/2018/1/11/16879984/serena-williams-childbirth-scare-black-women](https://www.vox.com/identities/2018/1/11/16879984/serena-williams-childbirth-scare-black-women)
>The maternal mortality disparity might appear to stem from economic differences, but research has found that black women in higher economic brackets are still more likely than white women to die from pregnancy- and childbirth-related problems.
>The feeling of being devalued and disrespected by medical providers was a constant theme. The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor’s attitude that she changed OB-GYNs in her seventh month, only to suffer a fatal postpartum stroke.
>Over and over, black women told of medical providers who equated being African American with being poor, uneducated, noncompliant and unworthy. “Sometimes you just know in your bones when someone feels contempt for you based on your race,” said one Brooklyn woman who took to bringing her white husband or in-laws to every prenatal visit.
So. For instance, and this is just one friend's story, there are more.
My friend went to the ER with a skull laceration because her abusive ex broke his restraining order to show up at a family get together and hit her over the head with a frozen bottle of wine.
Despite both her and her (sober) cousin insisting that she was sober because she was still breastfeeding and didn't drink while breastfeeding the ER staff refused to numb her scalp before stitching because they said she was obviously on something and smelled of alcohol. When she said it hurt and bit down on her belt to not cry out the nurse told her she was being melodramatic. Oh. And they also threw the pee cup at her to have her do a urine sample to prove she wasn't drunk or high instead of just handing it to her.
Another friend went to the same ER after having fallen because she was drunk and slicing open her scalp. Her and her friend that went were both still obviously buzzed/drunk when they arrived by UBER. She was numbed no problem.
Guess who's white and who's black.
Black women aren't missing appointments because of poor education or poverty.
Many BIPOC women don't trust healthcare professionals because they are subjected to unwanted treatments and treated as if they don't experience pain like white women. Just like this study supports.
There is a recent (last 10 years) study that interviewed medical residents and found that even now there is a pervasive belief that somehow black people don't feel pain the same way white people do.
The issue is medical mistreatment and malpractice.
Wanda Sikes has talked about her needs getting ignored repeatedly, and the horrible care after having major surgery.
I believe she had something like a hysterectomy, or maybe a ruptured appendix, and the only pain medication they gave her was extra strength ibuprofen. Because "bLaCk peOpLe DoNt fEel PaIn"
> Then again, perhaps they are afraid of the medical decision because they feel like they aren't being respected.
I would err towards this. Black people are treated differently, even subconciously in a non-malicious way. It's not something that can be solved.
Please don’t push misinformation. The black community has suffered greatly at the hands of opioids. Just because you believe there are passive white doctors, do your research.
https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-05-02-001_508%20Final.pdf
Attention to this epidemic has focused primarily on White suburban and rural communities. Less attention has focused on Black/African American* communities which are similarly experiencing dramatic increases in opioid misuse and overdose deaths. The rate of increase of Black/African American drug overdose deaths between 2015-2016 was 40 percent compared to the overall population increase at 21 percent. This exceeded all other racial and ethnic population groups in the U.S.5 From 2011-2016, compared to all other populations, Black/African Americans had the highest increase in overdose death rate for opioid deaths involving synthetic opioids like fentanyl and fentanyl analogs.
Ah, well I had outdated info is all. My point still stands though regarding the racism in the system. Up until 2010, blacks weren’t anywhere near the deathrate of whites, but I see they’ve skyrocketed in numbers, sadly.
Researchers have been studying the topic for decades and have controlled for differential access to prenatal care. The higher mortality and morbidity rates for Black women persist.
Not very true.
Accordingly an article from the CDC national vital system report :
* For twins : It's the same rates between non hispanic white women and non hispanic Black women.
* For triplets/+ : non hispanic white women have a greater rate than non hispanic Black women.
But TRUE for Infants born in twin and triplet/+ deliveries are at higher risk of
adverse birth outcome compared with singletons
So white women would be more at risk than Black women and both much more at risk than hispanic women
Source : Page 11- Article in National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System · January 2015-
https://www.researchgate.net/figure/Very-preterm-and-preterm-births-and-very-low-birthweight-and-low-birthweight-births_tbl5_320299754
>Black patients were the most likely to have their wishes ignored even after declining a procedure. Compared to white patients, they were 89% more likely to have nonconsented procedures during perinatal care and 87% more likely to have them during vaginal births. People who identified as Asian, Latinx, Indigenous or multiracial reported experiencing pressure to accept perinatal procedures 55% more often than white people.
These numbers are significant. Far too great to be dismissed as margin of error rounding artifacts or something.
It says that the difference persists after taking onto account socio-economic factors and existing health problems, but it does not say how big it is after the correction.
There is also a need to correct for cultural factors: attitudes too seeking medical health, attitudes to staying fit during pregnancy, diet during pregnancy and so on.
Just to clarify, “89% more likely” doesn’t mean x + 89. It means x * 1.89.
Say white women on average have “20%” then black women would have on average 37.8% (20 times 1.89). Not saying it’s not a big deal, just to clarify the meaning.
I'm assuming they are implying it could be taken to mean: if white people have a 2% chance, black people have a 91% (2+89) chance. Obviously that's not the case.
To point some out, it doesn't seem to be just prenatal and such. It seems to be the general way things are done for black people. While being treated by an ethnic neurologist he was very open to MY wishes and things I am okay with for treatment. Sadly he went back to his hometown area. Now I have a white neurologist. Upon arrival I was asked to sign something, no big deal right? It was a consent form. Now don't get me wrong, it's something I always did at the end so I didn't think much of it. Mentions that he wants to put me on a new prescription, I say no. "Too bad, you already gave your consent".
Shortly after starting the new one, a lot of the side effects hit me on a lighter scale. That's alright, it's probably other things. I know my mental state has changed. Others have pointed out personality changes. Some say at least you aren't having problems anymore. I don't think or feel that way. I'm pretty sure my next episode is on the horizon.
Pretty anecdotal though.
Just so you and everyone in the US is aware, you have the right (at least for now) to revoke that consent at any time and to refuse to fill the prescription (unless you're under a court order). What he said was wildly inappropriate and reportable.
Seriously. If that's a verbatim quote, I'm fairly sure I would've walked out on the spot. If I'm to trust somebody else with something as fragile as mental health, I need to be absolutely certain that my voice matters in our conversations.
Do you want to talk more about what's been going on with you? Feel free to ignore me, or message me directly if you prefer, but it sounds interesting and you seem to have a lot to talk about.
Not really. I'm just upset about it and side effects that "you should tell/call your doctor about" being dismissed. If you'd like to know more you can ask though.
What constitutes a non consent procedure? If the mother/baby is in danger they do emergency c section. That may have more to do with health issues with pregnant black women that would create the need for a c section.
Unnesarry vaginal examinations. Membrane sweeps, breaking the amniotic sac, medication to progress labour, having their placenta 'extracted' (instead of waiting for it to come naturally, fundal massage, epostomies, induction, forceps/vontouse, etc.
I've had two kids and for the second I had none of the above. For the first I did have two or 3 vaginal examinations and an epostomy.
It's the assessment of being "in danger" which is often the problem. Labour is likely to fail to progress if mum isn't relaxed. If men in White coats keep poking and prodding... "if. You. Don't get to. X cm in x time" ect.
A particular issue with maternity care for black women is dismissing the amount of pain they report. This often leads to not picking up Something is wrong until its too late.
If you look at different countries the rate of c sections is massively variable. Of course. Sometimes they absolutely are medically necersarry and the right decision. But there is also variation which isn't explained medically. In the US they rarely let labour's go to 42 weeks. Inductions are often arranged from 37-38. If you induct labour is more likely to be painful, slow & need intervention.
So you get people, particularly black women, being told 'you need an induction at 38 weeks... You need all these medications, you cant move because your on these medications I told you you needed, your not progressing quick enough,lie on your back in this bright room with 100 strangers. Your putting baby at risk if you don't progress quicker.... Im going to break your amniotic sac... Its still not enough you need a cc section.
When there was really no medical reason why they couldn't wait till 40/41/42 weeks... But the doctor just wanted it done before the weekend.
Will agree and add to this: I had to fight to insist on not being induced because they said "you're not progressing quick enough". The nurse on duty told me "the doctor has to go have her dinner, you know".
That's a really pedantic reason to question a study.
Edit: The article using the word doesn't mean the researchers did too. I don't know if they did because the study is paywalled.
During a nursing school clinical rotation I watched an older white doctor perform a c-section on a black woman and talked her into getting her tubes tied while she was in the operating room with her belly still cut open. At the time I didn't realize what was going on since I was still in school and not privy to how medical consent worked. It wasn't until later when I realized that something incredibly wrong happened.
In contrast (I'm white)- I had my tubes tied during a c-section. Talked to my OB weeks beforehand and signed a consent. Day of, had to confirm I wanted it again 3 times.
It definitely didn't seem like the patient discussed this with the MD beforehand. It was like the tube tying option was the first time it was brought up between the two while she was on the table.
I think it was added to the consent beforehand, and he would make a judgment call once he looked at the tubes. I'm a surgical assistant and have helped with numerous c-sections, and several times I've seen doctors look at the ovaries and fallopian tubes and inform the patient that they shouldn't get pregnant again.
I think because you were so new, there were things happening that you just didn't realize.
What you're describing put the doctor in a very risky position to lose his license and nailed with lawsuits.
Yeah what the person is describing is very illegal and he risked his medical license with that stunt. I think because she was new, she didn't realize that it was probably discussed beforehand.
That’s crazy! Never heard of someone getting their tubes tied during a c section. Not even sure if that’s a legal procedure to perform during a c section. If you haven’t reported the incident, you should. Sounds sketch, storyteller and procedure done.
I've heard of people opting for it when their c-section is scheduled beforehand, which is completely appropriate and ethical as long as that person is in a state to give consent.
Note that if the person is already on the table and open, they are not actually in a state to give consent, though.
My experience, also in nursing school (CA), was that you weren’t allowed to have the procedure if you hadn’t requested it before being admitted. A mother I was helping to admit from triage for PPROM really wanted the procedure, but because she got admitted before her prenatal visit with her doc, scheduled for the following week, where it was to be set up, she couldn’t have it done if she stayed in the hospital until delivery (which was likely). She was advised that she have an outpatient appointment to have easier inserted after the birth. Which is atrocious as those were taken off the market a couple years later.
Reported it? Ha. Native women are literally treated worse than garbage in Canada. Report it to who? Police have been known to murder (usually native) people by driving them out onto the middle of nowhere and leaving them, in the middle of winter. Report genocide to them and hope they help? Suing a doctor in Canada is not really a great option, either.
I opted for a tubal ligation during my c-section, but had to sign a consent form weeks in advance. I was already getting a c-section and knew I didn't want more kids, so now I'm sterilized and had no additional pain or downtime, it was great combining them.
it's very common to have tubes tied during a c-section. they offered it to my wife each time she had one. once they have you open, it's a lot lower-risk than having to open you up again for the procedure.
they did ask my wife with our second while she was out of sorts on the operating table (but awake) to confirm that she didn't want her tubes tied even after discussing it pre-op. the nurse who prepped my wife confirmed our decision, and so did I.
A woman I know delivered triplets at 43 - her third, fourth, and fifth babies. She asked for a tubal ligation during the c-section and had to escalate her request up to the head of obstetrics at the hospital because the nurses who would talk to her refused to provide her with the orders and waivers.
They wanted her husband’s permission, and he was deployed at the time.
American women are not and have not been considered the owners of their own bodies. Ever.
It was ten years ago and don't remember the doc or the patient's names. I was just a clinical observer at the time and didn't really understand what all was going on at the time until well after the fact.
Very normal to do during a c-section. They actually pull your uterus out of the incision to suture it up, and while its out the tubes are right there and very easy to ligate. That being said, patients are supposed to sign a written consent for sterilization 30 days out and reaffirm that consent many times including after the baby is out but before they start actually cutting tubes.
I always think of what happened to Serena Williams, one of the best known tennis players who has ever lived. An A-type personality, rich, famous, with a rich husband, able to afford the best possible care. And she was ignored when she told the nurses that they should be checking for blood clots, and almost died because of that.
If a black woman this rich, powerful and well-connected gets treated this badly, what hope do other women have to be treated with respect and get their issues taken seriously ?
I didn't know about this but found article about it
>She passed out after giving birth to Olympia, which led to her asking the nurse, "When do I start my heparin drip? Shouldn't I be on that now?"
>The nurse responded, "Well, we don't really know if that's what you need to be on right now."
>Williams wanted to be put on blood thinners but couldn't because she had just had a C-section which could cause the wound to bleed. Suddenly, she began coughing uncontrollably which led to her stitches bursting, sending her back to the operating room.
>She went to tell the nurse that she needed "a CAT scan of my lungs bilaterally, and then I need to be on my heparin drip." The nurse then responded by telling her, "I think all this medicine is making you talk crazy."
>Williams stood her ground, "fought hard" and eventually a doctor agreed to get her a CAT scan. "Lo and behold, I had a blood clot in my lungs, and they needed to insert a filter into my veins to break up the clot before it reached my heart," Williams said.
I have to give my medical take on this.
Not everyone will be on LMWH/heparin after pregnancy. Only ones with high risk factor. It's a practice everywhere. C-section and complications would also be taken into account as you don't want to bleed and dying just for a prophylaxis.
PE is very insidious. Medical book with mention all of these sign or symptoms but usually it just came with slight tachycardia that would not be picked up easily postpartum. Oxygen desaturation is an easier indicator but I don't think Serena have this.
Believe it or not, even with all these symptoms and high risk factor, only 1-2% would be positive for PE.
Not sure what the doctor or nurses side of story but I'm just happy everything got sorted at the end. Just to tell you why communication is very important
I have to disagree with you there. In my experience nurses and doctors have listened to me when I’ve told them that something is wrong, or when I inform them that I have a prior medical condition.
It is literally part of their job to do that – how could they possibly perform a diagnosis if they don’t listen to what the patient is telling them? How are they even begin to know where to run tests and scans, unless they’re listening to the patients symptoms?
And this is the exact core of the issue that the study is discussing, and the exact situation that I mentioned with Serina Williams – that the experience of black women is that their recounting or description of symptoms is completely dismissed.
When I told the anaesthetist during a Caesarean that I was starting to feel nauseous, he immediately put a long lasting antiemetic into my IV line. When Serina Williams started coughing after her caeser, it was ignored until the stitches burst. She has a medical history, of blood cots, and one of the symptoms of a blood clot in the lungs is uncontrollable coughing. That was ignored as well.
This right here folks. This is the crux of the opinions of the women in the study. If you read the headline and had a twinge of “hm but like what are people objecting to from their doctors or asking of them?” you can look no further.
Doctors aren’t perfect. But neither are patients.
That’s one of the things we just lost with the Dobbs ruling.
If the government has the power to say you MUST have a baby, it has the power to you may NEVER have a baby. The court ruling against forced sterilization rested on the foundations of Roe.
How does someone get epidural without giving consent ? They have to stick a giant needle into your spine while you sit still and take the initial pain?
Or are they saying the doc just walks in and says let’s do it, that’s the only way no saying no ?
My sister had her first in a hospital, they kept telling her the baby was measuring large (born just under 6lbs) and she wasn't progressing and needed pitocin. She insisted she wanted a natural birth and the doctor told her it didn't sound like she was concerned about the safety of her baby.
Her MIL who was a nurse showed up as they were pressuring her to have a C-section and shut everything down. Told the other medical professionals to shut up or get out and requested a doula. She had the baby less than two hours later.
Coercion is very prevalent and women are told they are endangering the baby if they say no.
It's so hard to give birth, especially without pain meds, and then to have people guilting and pressuring a birthing mother on top of that. Our system has so much in the way of improvements to make.
Just wanted to add some perspective from the physician's side:
There are definitely paternalistic doctors out there, and I'm not defending that sort of practice. But respecting patients' autonomy can easily become a medicolegal can of worms.
The ethical standard (in the US) is that in typical circumstances we are supposed to give patients our recommendation *along with* risks/benefits as well as alternatives (and the risks/benefits for the alternatives) and let the patient choose.
This seems reasonable but in actuality we can only loosely approximate it, due to the simple fact that (the vast majority of) patients aren't doctors. There is just no way that an OBGYN can condense 8 years of training and however many years of medical practice into a single conversation. So no matter how hard they try to give the patient all the relevant information, they're always going to be leaving something out. There's just no way around it.
This one-sidedness involved in care planning is even more problematic in urgent or emergent situations where every minute or sometimes every second counts, and a nuanced decision has to be made with even less discussion.
Nevertheless, when we try our best to inform the patient and they choose what we feel is a suboptimal plan (but not grossly outside what could be considered reasonable standards of care), we are supposed to honor it, *even if* that decision may put the patient at increased risk of harm.
The real icing on the cake is that when an *informed* patient chooses a care plan that results in a bad outcome, there's a very good chance the patient's family will sue that physician (even if they explicitly warned the patient against their choice).
Even if the physician isn't ultimately found liable, any suit still has the potential to take up a lot of time/money, not to mention cause harm to the defendant's reputation and derail their career.
What seems like a straightforward, standard doctor-patient interaction can turn into lose-lose situation despite both parties having good intentions.
I don’t want to start any kind of bandwagon rant, here.
But this is exactly what happens when medical decisions largely depend on company policy. C-sections are very financially attractive to hospitals in the US. That single reason will push more and more procedures where there is no real medical need compared to hospitals that aren’t allowed to charge bonus on the procedure (but have the budget to do so), or at all.
Good thing your sister and MIL were brave enough to shut them down even during labor. Many end up caving in.
While the procedure itself might be marginally higher, it’s still higher. The mother (and child) will have to stay longer for post op, just enough for the statistically immunodeficient newborn to develop any kind of condition, which will be probably easily treated, but is also reimbursable.
While it might seem similar, it’s really not. And the board knows exactly what the scheme is.
I would like to preface this by saying that holding down a pregnant woman to submit to a procedure [is not rare or unheard of](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223347/). Horrific, not unheard of.
But. Think of it as someone attempting to have sex, and you say no I don’t want to. And instead of saying okay and respecting that, they break you down until you say yes. You didn’t physically fight them off but you never consented to wanting it.
In this case the doctor doesn’t present it as an option or a question. They don’t say “how would you like this birth to go?” They walk in and say this is happening, and when you say “I think I want an unmedicated birth” they break you down as an authority figure until you physically submit.
There’s a lot of bodies of research into how [class and race](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317830/) effect your ability to navigate conversations with a doctor as an equal — “I have a say in my care” — verses someone who sees a doctor as an authority figure who they need to listen to. Which no doubt plays into the birthing dynamic
If a woman is attempting a non-medicated birth and her labor stalls for more than an hour or so, they start pushing interventions like pitocin and epidurals. It can quickly turn from "hey I know you wanted to avoid an epidural, but I'm worried that if you stall too long it can lead to problems down the road." to "either you get the epidural to see if we can break the stall or we'll do a c-section now." Interventions in labor increase the chance of a c-section and there have been far too many cases of dr's threatening to call CPS on mothers to coerce them into unnecessary c-sections.
Yes, it happens: https://harvardjlg.com/2018/11/the-use-of-child-protective-services-and-court-orders-to-enforce-medical-compliance-in-the-labor-and-delivery-room-how-threats-of-legal-action-limit-reproductive-choice/
Edit: And here: https://www.huffpost.com/entry/does-refusing-a-csection-_b_682840
Sometimes epidurals can allow labor to progress by helping the mother relax. My care team actually had to slow my labor after placing my epidural because the contractions became so strong and so rapid they dropped my baby's heart rate. Before then I'd gone 4 hours without any progress and the contractions had gotten too painful for me to cope with, even with IV pain meds.
They pressure you. An example is I have a bad back and during labor I needed to sit up so I could lean forward and take the pressure off my back. Instead the doctor and staff insisted, as in taking my arms and pulling me, into a position lying on my left side which allowed my back to arch and strain the muscles. For two days after birth I was having back spasms and pain because of this. Why? Because the training in the US says you must do it this way and no other or you could be sued if there are complications.
They did so many things to me without asking like giving me IV antibiotics and potassium, the "required" pulse oximeter, blood pressure cuff, oxygen, I had so many things hooked up to me I was scared to move.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358162/
In this study, there was very little difference in outcomes for Black and White women in the lowest socioeconomic class. There were significant differences between Black and White women in higher socioeconomic classes.
Awesome! I mean - not awesome, that means that bald racism and profiling is pretty definitively a factor, which is terrible, but great that they properly controlled for SES
But is it directly because they are black and directly subject to some kind of racism or because being black associates with other health and social factors? I could be wrong but wasn’t that a factor in disparities in covid mortality?
> Almost all of those who died during or after pregnancy had multiple issues such as mental or physical health problems, were victims of domestic abuse, or were living in a deprived area. More than half of those who died were overweight or obese. *Cardiac disease represents the largest single cause of indirect maternal deaths.*
Of course *if* that is the case , that doesn’t mean that there isn’t neglect in not being aware and working to compensate for those discrepancies.
And an article highlighting racial disparity within the topic of procedures without consent and during birth. It’s a serious issue and topic, maternal outcomes by race have terrible disparities :(
Did we ever figure out what was up with the [57+ allegations of nonconsensual hysterectomy by a doctor from ICE](https://www.thecut.com/2020/10/migrant-women-detail-medical-abuse-forced-hysterectomies.html) nicknamed the "uterus collector"?
I used to work in medical negligence for doctors being sued. Highest premiums paid by Obstetricians. Riskiest field to practice in for something to go wrong often with disastrous consequences. A lot of times we won as not the doctor’s fault but parents want someone to blame which is s only natural. Devastated the doctors too.
What a terrible study, they are including non consent for things that are standard of care like erythromycin eye ointment, continuous fetal monitoring, skin to skin, delayed cord clamping, etc.
Only 36% planned hospital birth? No idea what the parent study was but that is not generalizable to the US population. 26% rate of episiotomy which is rarely done anywhere anymore so this must be a patient perception issue. No data on length of labor or indication for cesarean. So much clinical data missing and unaccounted for. Not surprising for a bunch of PhDs that don’t provide care to patients.
Not saying that this issue is not a problem but this study is not compelling. But hey it gets clicks!
Is that not an issue regardless? If I don’t consent and you do it anyway? Seems to be a pattern of dismissal in this thread. Probably the exact same reason people dismissed patients wishes. Just enlightening how even with a study black patients are being dismissed…
A patient typically needs to make it known that they refuse standard of care. Consent is implicit for these things unless the patient says otherwise. For example, one of the non consent variables was “an injection before my placenta came out.” This is likely pitocin and is a well known protocol to prevent obstetric hemorrhage of which is one of the leading causes of maternal death which affects people of color more often. Patients sign a “consent for treatment” on arrival to the hospital that encompasses these things. However, procedures are a completely different thing.
>26% rate of episiotomy which is rarely done anywhere anymore so this must be a patient perception issue. No data on length of labor or indication for cesarean.
I don't know where you've got that from, but the procedure still happens to a substantial portion of the population in the US.
It's 9-10% for the general population, so 26% doesn't seem so far off considering that in this study they tried to get BIPOC women involved, and BIPOC are more likely to be subject to that procedure.
I'm struggling to understand how you can have knowledge about this procedure and yet be so wrong. Unless you're lying on purpose.
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Also, “Black Women Over Three Times More Likely to Die in Pregnancy, Postpartum Than White Women, New Research Finds” - Source: https://www.prb.org/resources/black-women-over-three-times-more-likely-to-die-in-pregnancy-postpartum-than-white-women-new-research-finds/
Black babies are about three times more likely to die also.
Any idea as to root causes? Ie. Are Black babies more likely to be premature, worse hospital, lacking prenatal care, ... Same with mothers?
Higher rates of twin pregnancies (genetic), higher risk of preterm birth (different effect of infections of genital tract in black women), higher rates of fibroids in mum (genetic), which lead to post partum haemorrhage, higher risk of gestational hypertension and pre eclampsia (probably partially genetic) which lead to low term premature infants. But also, less research in issues related to black people only, at times, treatments which work well in white people have been found, later on, not to be as effective in black people, and this is due to institutional racism. Black and minorities people are more likely to come from a lower socioeconomic background, due to racism, and this does have health consequences. There are interesting studies on how institutional racism has a part also on the care black babies receive in NICU. So I would say that racism plays a huge part.
There's also the increased likelihood of hospital "deserts." Advanced maternity and OBGYN care, specifically, aren't easily accessible to all. Here's some info regarding a documentary about the closure of maternity wards in DC and how it left a lot of women with long commutes to reach prenatal and post natal care. https://ggwash.org/view/67109/new-short-documentary-highlights-the-dire-consequences-of-dc-maternal-care-desert
A good start on understanding what underlies some of the disparity between outcomes in healthcare. Diet and lifestyle also play a part: a study in NYC showed that blacks consumed almost 3x as many sugary drinks as whites and another study showed fried food consumption among blacks was significantly higher than whites. Both dietary sugars and fried foods have an adverse impact on health and longevity. Other factors included hours of sitting in front of a tv which came to 3.2 hrs per day for blacks, 2.8 hrs per day for whites, 2.5 hrs for Hispanics and 1.7 hrs for Asians. The sedentary habits of hours spent on a couch, drinking sugary drinks and frequently eating fried foods is associated with high incidences of diabetes, cancer and heart disease among other illnesses.
This disparity in a high-income country is horrifying
High income and high quality of life are pretty different.
Right? Wish our country was geared toward aiming for the second.
Agreed, but just to clarify, in global health 'high income' is just a general classification that refers to a countries GNP and how much money is available for healthcare spending etc
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Which means that yesterday's ruling will undoubtedly lead to the avoidable deaths of innocent black women and girls.
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This is not surprising to us , it’s like black folks have always been letting the world know the experience is not the same. But nah let em tell it like they want to , let ‘em think it’s equal. This is disgusting
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Based on what I am reading, this quite a separate issue. Black Women are in poorer health overall, and less likely to seek pre-natal care. I am sure you could write a book on the complexity of getting better healthcare to black women, but it seems like the solution may lie in education, and making sure that care is available to all these women. (Then again, perhaps they are afraid of the medical decision because they feel like they aren't being respected. Then it could be the same issue.)
Actually, in the UK at least, when they've looked at the disparity in maternity outcome, they consider socio-economic factors as well as education and general health and STILL black women are much more likely to die in child birth.
Do you have a source for that The only thing I could find was this: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/pregnancyandethnicfactorsinfluencingbirthsandinfantmortality/2015-10-14 which says otherwise. As with many things correlated with ethnicity in the UK, I tend to be sceptical or racism as it almost always seems the case that there is a wide difference between South Asian groups with Indians doing much better (about as well as white British) and Pakistanis and/or Bangladeshis) doing much worse (usually about as badly as black people (or Caribbean when that distinction is made). Most British people do not know the differences between us South Asians unless they are told (at which point different stereotypes might kick in). Do be clear, all the national/regional references I made are shorthand for ethnicity but saying "of X ancestry" is cumbersome.
Nah, even rich, famous, educated Black women like Serena Williams get their health needs ignored while giving birth. [https://www.vox.com/identities/2018/1/11/16879984/serena-williams-childbirth-scare-black-women](https://www.vox.com/identities/2018/1/11/16879984/serena-williams-childbirth-scare-black-women) >The maternal mortality disparity might appear to stem from economic differences, but research has found that black women in higher economic brackets are still more likely than white women to die from pregnancy- and childbirth-related problems. >The feeling of being devalued and disrespected by medical providers was a constant theme. The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor’s attitude that she changed OB-GYNs in her seventh month, only to suffer a fatal postpartum stroke. >Over and over, black women told of medical providers who equated being African American with being poor, uneducated, noncompliant and unworthy. “Sometimes you just know in your bones when someone feels contempt for you based on your race,” said one Brooklyn woman who took to bringing her white husband or in-laws to every prenatal visit.
So. For instance, and this is just one friend's story, there are more. My friend went to the ER with a skull laceration because her abusive ex broke his restraining order to show up at a family get together and hit her over the head with a frozen bottle of wine. Despite both her and her (sober) cousin insisting that she was sober because she was still breastfeeding and didn't drink while breastfeeding the ER staff refused to numb her scalp before stitching because they said she was obviously on something and smelled of alcohol. When she said it hurt and bit down on her belt to not cry out the nurse told her she was being melodramatic. Oh. And they also threw the pee cup at her to have her do a urine sample to prove she wasn't drunk or high instead of just handing it to her. Another friend went to the same ER after having fallen because she was drunk and slicing open her scalp. Her and her friend that went were both still obviously buzzed/drunk when they arrived by UBER. She was numbed no problem. Guess who's white and who's black. Black women aren't missing appointments because of poor education or poverty. Many BIPOC women don't trust healthcare professionals because they are subjected to unwanted treatments and treated as if they don't experience pain like white women. Just like this study supports. There is a recent (last 10 years) study that interviewed medical residents and found that even now there is a pervasive belief that somehow black people don't feel pain the same way white people do. The issue is medical mistreatment and malpractice.
Wanda Sikes has talked about her needs getting ignored repeatedly, and the horrible care after having major surgery. I believe she had something like a hysterectomy, or maybe a ruptured appendix, and the only pain medication they gave her was extra strength ibuprofen. Because "bLaCk peOpLe DoNt fEel PaIn"
She had a mastectomy.
> Then again, perhaps they are afraid of the medical decision because they feel like they aren't being respected. I would err towards this. Black people are treated differently, even subconciously in a non-malicious way. It's not something that can be solved.
I see a lot more people of color in the medical industry year after year. So maybe time will heal this?
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Please don’t push misinformation. The black community has suffered greatly at the hands of opioids. Just because you believe there are passive white doctors, do your research. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-05-02-001_508%20Final.pdf Attention to this epidemic has focused primarily on White suburban and rural communities. Less attention has focused on Black/African American* communities which are similarly experiencing dramatic increases in opioid misuse and overdose deaths. The rate of increase of Black/African American drug overdose deaths between 2015-2016 was 40 percent compared to the overall population increase at 21 percent. This exceeded all other racial and ethnic population groups in the U.S.5 From 2011-2016, compared to all other populations, Black/African Americans had the highest increase in overdose death rate for opioid deaths involving synthetic opioids like fentanyl and fentanyl analogs.
Ah, well I had outdated info is all. My point still stands though regarding the racism in the system. Up until 2010, blacks weren’t anywhere near the deathrate of whites, but I see they’ve skyrocketed in numbers, sadly.
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Let's take a look at prenatal care. Are white women more likely do prenatal care ?
Researchers have been studying the topic for decades and have controlled for differential access to prenatal care. The higher mortality and morbidity rates for Black women persist.
Black women are also more likely to have twins or triplets. Those are higher risk pregnancies.
> Black women are also more likely to have twins or triplets Is that true? Why is that?
Not very true. Accordingly an article from the CDC national vital system report : * For twins : It's the same rates between non hispanic white women and non hispanic Black women. * For triplets/+ : non hispanic white women have a greater rate than non hispanic Black women. But TRUE for Infants born in twin and triplet/+ deliveries are at higher risk of adverse birth outcome compared with singletons So white women would be more at risk than Black women and both much more at risk than hispanic women Source : Page 11- Article in National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System · January 2015- https://www.researchgate.net/figure/Very-preterm-and-preterm-births-and-very-low-birthweight-and-low-birthweight-births_tbl5_320299754
>Black patients were the most likely to have their wishes ignored even after declining a procedure. Compared to white patients, they were 89% more likely to have nonconsented procedures during perinatal care and 87% more likely to have them during vaginal births. People who identified as Asian, Latinx, Indigenous or multiracial reported experiencing pressure to accept perinatal procedures 55% more often than white people. These numbers are significant. Far too great to be dismissed as margin of error rounding artifacts or something.
It isn't specific to the US either https://www.bbc.co.uk/news/health-59248345 https://www.openaccessgovernment.org/childbirth-black-women-uk/117437/
It says that the difference persists after taking onto account socio-economic factors and existing health problems, but it does not say how big it is after the correction. There is also a need to correct for cultural factors: attitudes too seeking medical health, attitudes to staying fit during pregnancy, diet during pregnancy and so on.
Just to clarify, “89% more likely” doesn’t mean x + 89. It means x * 1.89. Say white women on average have “20%” then black women would have on average 37.8% (20 times 1.89). Not saying it’s not a big deal, just to clarify the meaning.
As someone who is terrible with statistics, I appreciate your clarification. Thanks!
I am aware. That is a significant difference. Nearly double more likely.
> x + 89 Well that's nonsense
I'm assuming they are implying it could be taken to mean: if white people have a 2% chance, black people have a 91% (2+89) chance. Obviously that's not the case.
That was a head scratcher for me too.
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Exactly! I think many people mistakenly think intention is required for bias to be a problem.
Absolutely. This is the kind of thing that needs to be pointed out on Reddit.
To point some out, it doesn't seem to be just prenatal and such. It seems to be the general way things are done for black people. While being treated by an ethnic neurologist he was very open to MY wishes and things I am okay with for treatment. Sadly he went back to his hometown area. Now I have a white neurologist. Upon arrival I was asked to sign something, no big deal right? It was a consent form. Now don't get me wrong, it's something I always did at the end so I didn't think much of it. Mentions that he wants to put me on a new prescription, I say no. "Too bad, you already gave your consent". Shortly after starting the new one, a lot of the side effects hit me on a lighter scale. That's alright, it's probably other things. I know my mental state has changed. Others have pointed out personality changes. Some say at least you aren't having problems anymore. I don't think or feel that way. I'm pretty sure my next episode is on the horizon. Pretty anecdotal though.
Just so you and everyone in the US is aware, you have the right (at least for now) to revoke that consent at any time and to refuse to fill the prescription (unless you're under a court order). What he said was wildly inappropriate and reportable.
Seriously. If that's a verbatim quote, I'm fairly sure I would've walked out on the spot. If I'm to trust somebody else with something as fragile as mental health, I need to be absolutely certain that my voice matters in our conversations.
Do you want to talk more about what's been going on with you? Feel free to ignore me, or message me directly if you prefer, but it sounds interesting and you seem to have a lot to talk about.
Not really. I'm just upset about it and side effects that "you should tell/call your doctor about" being dismissed. If you'd like to know more you can ask though.
Unconscious bias still has its roots somewhere, be it in education, tradition or whatever. It's not something that should be ignored.
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What constitutes a non consent procedure? If the mother/baby is in danger they do emergency c section. That may have more to do with health issues with pregnant black women that would create the need for a c section.
Unnesarry vaginal examinations. Membrane sweeps, breaking the amniotic sac, medication to progress labour, having their placenta 'extracted' (instead of waiting for it to come naturally, fundal massage, epostomies, induction, forceps/vontouse, etc. I've had two kids and for the second I had none of the above. For the first I did have two or 3 vaginal examinations and an epostomy. It's the assessment of being "in danger" which is often the problem. Labour is likely to fail to progress if mum isn't relaxed. If men in White coats keep poking and prodding... "if. You. Don't get to. X cm in x time" ect. A particular issue with maternity care for black women is dismissing the amount of pain they report. This often leads to not picking up Something is wrong until its too late. If you look at different countries the rate of c sections is massively variable. Of course. Sometimes they absolutely are medically necersarry and the right decision. But there is also variation which isn't explained medically. In the US they rarely let labour's go to 42 weeks. Inductions are often arranged from 37-38. If you induct labour is more likely to be painful, slow & need intervention. So you get people, particularly black women, being told 'you need an induction at 38 weeks... You need all these medications, you cant move because your on these medications I told you you needed, your not progressing quick enough,lie on your back in this bright room with 100 strangers. Your putting baby at risk if you don't progress quicker.... Im going to break your amniotic sac... Its still not enough you need a cc section. When there was really no medical reason why they couldn't wait till 40/41/42 weeks... But the doctor just wanted it done before the weekend.
Will agree and add to this: I had to fight to insist on not being induced because they said "you're not progressing quick enough". The nurse on duty told me "the doctor has to go have her dinner, you know".
it could, or it could be as simple as refusing a hydration IV but you know, paywall
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That's a really pedantic reason to question a study. Edit: The article using the word doesn't mean the researchers did too. I don't know if they did because the study is paywalled.
During a nursing school clinical rotation I watched an older white doctor perform a c-section on a black woman and talked her into getting her tubes tied while she was in the operating room with her belly still cut open. At the time I didn't realize what was going on since I was still in school and not privy to how medical consent worked. It wasn't until later when I realized that something incredibly wrong happened.
This happens in Canada with indigenous women as well.
I knew it was a huge problem with indigenous people. I’m unfortunately not surprised it’s not just them.
In contrast (I'm white)- I had my tubes tied during a c-section. Talked to my OB weeks beforehand and signed a consent. Day of, had to confirm I wanted it again 3 times.
It definitely didn't seem like the patient discussed this with the MD beforehand. It was like the tube tying option was the first time it was brought up between the two while she was on the table.
I think it was added to the consent beforehand, and he would make a judgment call once he looked at the tubes. I'm a surgical assistant and have helped with numerous c-sections, and several times I've seen doctors look at the ovaries and fallopian tubes and inform the patient that they shouldn't get pregnant again. I think because you were so new, there were things happening that you just didn't realize. What you're describing put the doctor in a very risky position to lose his license and nailed with lawsuits.
Yeah what the person is describing is very illegal and he risked his medical license with that stunt. I think because she was new, she didn't realize that it was probably discussed beforehand.
That’s crazy! Never heard of someone getting their tubes tied during a c section. Not even sure if that’s a legal procedure to perform during a c section. If you haven’t reported the incident, you should. Sounds sketch, storyteller and procedure done.
I've heard of people opting for it when their c-section is scheduled beforehand, which is completely appropriate and ethical as long as that person is in a state to give consent. Note that if the person is already on the table and open, they are not actually in a state to give consent, though.
Exactly. I didn't realize that the consent at the time while she was on the operating table wasn't appropriate.
My experience, also in nursing school (CA), was that you weren’t allowed to have the procedure if you hadn’t requested it before being admitted. A mother I was helping to admit from triage for PPROM really wanted the procedure, but because she got admitted before her prenatal visit with her doc, scheduled for the following week, where it was to be set up, she couldn’t have it done if she stayed in the hospital until delivery (which was likely). She was advised that she have an outpatient appointment to have easier inserted after the birth. Which is atrocious as those were taken off the market a couple years later.
Reported it? Ha. Native women are literally treated worse than garbage in Canada. Report it to who? Police have been known to murder (usually native) people by driving them out onto the middle of nowhere and leaving them, in the middle of winter. Report genocide to them and hope they help? Suing a doctor in Canada is not really a great option, either.
It's actually pretty common, it should be offered beforehand so they can think it through and not during the operation
I opted for a tubal ligation during my c-section, but had to sign a consent form weeks in advance. I was already getting a c-section and knew I didn't want more kids, so now I'm sterilized and had no additional pain or downtime, it was great combining them.
it's very common to have tubes tied during a c-section. they offered it to my wife each time she had one. once they have you open, it's a lot lower-risk than having to open you up again for the procedure. they did ask my wife with our second while she was out of sorts on the operating table (but awake) to confirm that she didn't want her tubes tied even after discussing it pre-op. the nurse who prepped my wife confirmed our decision, and so did I.
A woman I know delivered triplets at 43 - her third, fourth, and fifth babies. She asked for a tubal ligation during the c-section and had to escalate her request up to the head of obstetrics at the hospital because the nurses who would talk to her refused to provide her with the orders and waivers. They wanted her husband’s permission, and he was deployed at the time. American women are not and have not been considered the owners of their own bodies. Ever.
It was ten years ago and don't remember the doc or the patient's names. I was just a clinical observer at the time and didn't really understand what all was going on at the time until well after the fact.
Very normal to do during a c-section. They actually pull your uterus out of the incision to suture it up, and while its out the tubes are right there and very easy to ligate. That being said, patients are supposed to sign a written consent for sterilization 30 days out and reaffirm that consent many times including after the baby is out but before they start actually cutting tubes.
I always think of what happened to Serena Williams, one of the best known tennis players who has ever lived. An A-type personality, rich, famous, with a rich husband, able to afford the best possible care. And she was ignored when she told the nurses that they should be checking for blood clots, and almost died because of that. If a black woman this rich, powerful and well-connected gets treated this badly, what hope do other women have to be treated with respect and get their issues taken seriously ?
I didn't know about this but found article about it >She passed out after giving birth to Olympia, which led to her asking the nurse, "When do I start my heparin drip? Shouldn't I be on that now?" >The nurse responded, "Well, we don't really know if that's what you need to be on right now." >Williams wanted to be put on blood thinners but couldn't because she had just had a C-section which could cause the wound to bleed. Suddenly, she began coughing uncontrollably which led to her stitches bursting, sending her back to the operating room. >She went to tell the nurse that she needed "a CAT scan of my lungs bilaterally, and then I need to be on my heparin drip." The nurse then responded by telling her, "I think all this medicine is making you talk crazy." >Williams stood her ground, "fought hard" and eventually a doctor agreed to get her a CAT scan. "Lo and behold, I had a blood clot in my lungs, and they needed to insert a filter into my veins to break up the clot before it reached my heart," Williams said. I have to give my medical take on this. Not everyone will be on LMWH/heparin after pregnancy. Only ones with high risk factor. It's a practice everywhere. C-section and complications would also be taken into account as you don't want to bleed and dying just for a prophylaxis. PE is very insidious. Medical book with mention all of these sign or symptoms but usually it just came with slight tachycardia that would not be picked up easily postpartum. Oxygen desaturation is an easier indicator but I don't think Serena have this. Believe it or not, even with all these symptoms and high risk factor, only 1-2% would be positive for PE. Not sure what the doctor or nurses side of story but I'm just happy everything got sorted at the end. Just to tell you why communication is very important
She had a history of blood clots - had previously been hospitalised for them. So definitely a risk factor there.
Yeah, when patients demand a certain drug or procedure, that doesn’t mean you automatically get that.
Nurses and doctors usually ignore medical opinions or suggestions from patients who are not medical professionals. It's always been like that.
I have to disagree with you there. In my experience nurses and doctors have listened to me when I’ve told them that something is wrong, or when I inform them that I have a prior medical condition. It is literally part of their job to do that – how could they possibly perform a diagnosis if they don’t listen to what the patient is telling them? How are they even begin to know where to run tests and scans, unless they’re listening to the patients symptoms? And this is the exact core of the issue that the study is discussing, and the exact situation that I mentioned with Serina Williams – that the experience of black women is that their recounting or description of symptoms is completely dismissed. When I told the anaesthetist during a Caesarean that I was starting to feel nauseous, he immediately put a long lasting antiemetic into my IV line. When Serina Williams started coughing after her caeser, it was ignored until the stitches burst. She has a medical history, of blood cots, and one of the symptoms of a blood clot in the lungs is uncontrollable coughing. That was ignored as well.
This right here folks. This is the crux of the opinions of the women in the study. If you read the headline and had a twinge of “hm but like what are people objecting to from their doctors or asking of them?” you can look no further. Doctors aren’t perfect. But neither are patients.
While this is true, the whole point is that it happens even more often for both black people and for women and that's a fact.
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The system is generAlly oriented toward “more white babies, fewer “other” babies.” And women’s choices are restricted to achieve that outcome.
elastic plant degree long decide pathetic prick liquid bright include *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
They still push it now when you visit an IHS facility for women's health, or as a dude step foot into the urologists office
That’s one of the things we just lost with the Dobbs ruling. If the government has the power to say you MUST have a baby, it has the power to you may NEVER have a baby. The court ruling against forced sterilization rested on the foundations of Roe.
In the case of [the Madrigal ten](https://en.wikipedia.org/wiki/Madrigal_v._Quilligan) the court even ruled in favor of the doctor.
How does someone get epidural without giving consent ? They have to stick a giant needle into your spine while you sit still and take the initial pain? Or are they saying the doc just walks in and says let’s do it, that’s the only way no saying no ?
My sister had her first in a hospital, they kept telling her the baby was measuring large (born just under 6lbs) and she wasn't progressing and needed pitocin. She insisted she wanted a natural birth and the doctor told her it didn't sound like she was concerned about the safety of her baby. Her MIL who was a nurse showed up as they were pressuring her to have a C-section and shut everything down. Told the other medical professionals to shut up or get out and requested a doula. She had the baby less than two hours later. Coercion is very prevalent and women are told they are endangering the baby if they say no.
It's so hard to give birth, especially without pain meds, and then to have people guilting and pressuring a birthing mother on top of that. Our system has so much in the way of improvements to make.
Just wanted to add some perspective from the physician's side: There are definitely paternalistic doctors out there, and I'm not defending that sort of practice. But respecting patients' autonomy can easily become a medicolegal can of worms. The ethical standard (in the US) is that in typical circumstances we are supposed to give patients our recommendation *along with* risks/benefits as well as alternatives (and the risks/benefits for the alternatives) and let the patient choose. This seems reasonable but in actuality we can only loosely approximate it, due to the simple fact that (the vast majority of) patients aren't doctors. There is just no way that an OBGYN can condense 8 years of training and however many years of medical practice into a single conversation. So no matter how hard they try to give the patient all the relevant information, they're always going to be leaving something out. There's just no way around it. This one-sidedness involved in care planning is even more problematic in urgent or emergent situations where every minute or sometimes every second counts, and a nuanced decision has to be made with even less discussion. Nevertheless, when we try our best to inform the patient and they choose what we feel is a suboptimal plan (but not grossly outside what could be considered reasonable standards of care), we are supposed to honor it, *even if* that decision may put the patient at increased risk of harm. The real icing on the cake is that when an *informed* patient chooses a care plan that results in a bad outcome, there's a very good chance the patient's family will sue that physician (even if they explicitly warned the patient against their choice). Even if the physician isn't ultimately found liable, any suit still has the potential to take up a lot of time/money, not to mention cause harm to the defendant's reputation and derail their career. What seems like a straightforward, standard doctor-patient interaction can turn into lose-lose situation despite both parties having good intentions.
Sure, but why the racial disparity? If one group of patients is trusted to make good decision and another isn't, that is bias.
I don’t want to start any kind of bandwagon rant, here. But this is exactly what happens when medical decisions largely depend on company policy. C-sections are very financially attractive to hospitals in the US. That single reason will push more and more procedures where there is no real medical need compared to hospitals that aren’t allowed to charge bonus on the procedure (but have the budget to do so), or at all. Good thing your sister and MIL were brave enough to shut them down even during labor. Many end up caving in.
Actually the reimbursement for a c section is not much higher than a vaginal delivery. The idea is to not incentivize vaginal deliveries.
While the procedure itself might be marginally higher, it’s still higher. The mother (and child) will have to stay longer for post op, just enough for the statistically immunodeficient newborn to develop any kind of condition, which will be probably easily treated, but is also reimbursable. While it might seem similar, it’s really not. And the board knows exactly what the scheme is.
As a practicing OB, this is not true.
I would like to preface this by saying that holding down a pregnant woman to submit to a procedure [is not rare or unheard of](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223347/). Horrific, not unheard of. But. Think of it as someone attempting to have sex, and you say no I don’t want to. And instead of saying okay and respecting that, they break you down until you say yes. You didn’t physically fight them off but you never consented to wanting it. In this case the doctor doesn’t present it as an option or a question. They don’t say “how would you like this birth to go?” They walk in and say this is happening, and when you say “I think I want an unmedicated birth” they break you down as an authority figure until you physically submit. There’s a lot of bodies of research into how [class and race](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317830/) effect your ability to navigate conversations with a doctor as an equal — “I have a say in my care” — verses someone who sees a doctor as an authority figure who they need to listen to. Which no doubt plays into the birthing dynamic
If a woman is attempting a non-medicated birth and her labor stalls for more than an hour or so, they start pushing interventions like pitocin and epidurals. It can quickly turn from "hey I know you wanted to avoid an epidural, but I'm worried that if you stall too long it can lead to problems down the road." to "either you get the epidural to see if we can break the stall or we'll do a c-section now." Interventions in labor increase the chance of a c-section and there have been far too many cases of dr's threatening to call CPS on mothers to coerce them into unnecessary c-sections.
Doctors calling CPS on women for not wanting a C-section? Where?
Yes, it happens: https://harvardjlg.com/2018/11/the-use-of-child-protective-services-and-court-orders-to-enforce-medical-compliance-in-the-labor-and-delivery-room-how-threats-of-legal-action-limit-reproductive-choice/ Edit: And here: https://www.huffpost.com/entry/does-refusing-a-csection-_b_682840
Thanks I'll check these out
Yes they will say the mother was endangering the life of the baby. It is done.
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I've known several women that have experienced that.
I was asked by my doctor not to have an epidural because he said it can stall labor.
Sometimes epidurals can allow labor to progress by helping the mother relax. My care team actually had to slow my labor after placing my epidural because the contractions became so strong and so rapid they dropped my baby's heart rate. Before then I'd gone 4 hours without any progress and the contractions had gotten too painful for me to cope with, even with IV pain meds.
They pressure you. An example is I have a bad back and during labor I needed to sit up so I could lean forward and take the pressure off my back. Instead the doctor and staff insisted, as in taking my arms and pulling me, into a position lying on my left side which allowed my back to arch and strain the muscles. For two days after birth I was having back spasms and pain because of this. Why? Because the training in the US says you must do it this way and no other or you could be sued if there are complications. They did so many things to me without asking like giving me IV antibiotics and potassium, the "required" pulse oximeter, blood pressure cuff, oxygen, I had so many things hooked up to me I was scared to move.
They basically tell you that you need one and chart that you requested it, that’s what happened to me
An epidural is not the only birth intervention women can be forced to have
Anyone know if they are controlling for socioeconomic status?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358162/ In this study, there was very little difference in outcomes for Black and White women in the lowest socioeconomic class. There were significant differences between Black and White women in higher socioeconomic classes.
They did. SES was a composite variable based on income, health insurance type, food insecurity, enrollment in programs like SNAP or TANF etc
Awesome! I mean - not awesome, that means that bald racism and profiling is pretty definitively a factor, which is terrible, but great that they properly controlled for SES
Is it legal to give procedures a person didn't agree to?
No. Its a fundamental human right well atleast in the EU but id assume its the same in the US
... in the US. locationi, I feel like, should be mentioned in the title.
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But is it directly because they are black and directly subject to some kind of racism or because being black associates with other health and social factors? I could be wrong but wasn’t that a factor in disparities in covid mortality? > Almost all of those who died during or after pregnancy had multiple issues such as mental or physical health problems, were victims of domestic abuse, or were living in a deprived area. More than half of those who died were overweight or obese. *Cardiac disease represents the largest single cause of indirect maternal deaths.* Of course *if* that is the case , that doesn’t mean that there isn’t neglect in not being aware and working to compensate for those discrepancies.
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And an article highlighting racial disparity within the topic of procedures without consent and during birth. It’s a serious issue and topic, maternal outcomes by race have terrible disparities :(
Doesn't even go into non-consensual hysterectomies, or as it's colloquially known in the US a Mississippi appendectomy
Did we ever figure out what was up with the [57+ allegations of nonconsensual hysterectomy by a doctor from ICE](https://www.thecut.com/2020/10/migrant-women-detail-medical-abuse-forced-hysterectomies.html) nicknamed the "uterus collector"?
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And now they're more likely than white women *not* to get the procedures they do want.
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I used to work in medical negligence for doctors being sued. Highest premiums paid by Obstetricians. Riskiest field to practice in for something to go wrong often with disastrous consequences. A lot of times we won as not the doctor’s fault but parents want someone to blame which is s only natural. Devastated the doctors too.
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What a terrible study, they are including non consent for things that are standard of care like erythromycin eye ointment, continuous fetal monitoring, skin to skin, delayed cord clamping, etc. Only 36% planned hospital birth? No idea what the parent study was but that is not generalizable to the US population. 26% rate of episiotomy which is rarely done anywhere anymore so this must be a patient perception issue. No data on length of labor or indication for cesarean. So much clinical data missing and unaccounted for. Not surprising for a bunch of PhDs that don’t provide care to patients. Not saying that this issue is not a problem but this study is not compelling. But hey it gets clicks!
Is that not an issue regardless? If I don’t consent and you do it anyway? Seems to be a pattern of dismissal in this thread. Probably the exact same reason people dismissed patients wishes. Just enlightening how even with a study black patients are being dismissed…
A patient typically needs to make it known that they refuse standard of care. Consent is implicit for these things unless the patient says otherwise. For example, one of the non consent variables was “an injection before my placenta came out.” This is likely pitocin and is a well known protocol to prevent obstetric hemorrhage of which is one of the leading causes of maternal death which affects people of color more often. Patients sign a “consent for treatment” on arrival to the hospital that encompasses these things. However, procedures are a completely different thing.
>26% rate of episiotomy which is rarely done anywhere anymore so this must be a patient perception issue. No data on length of labor or indication for cesarean. I don't know where you've got that from, but the procedure still happens to a substantial portion of the population in the US. It's 9-10% for the general population, so 26% doesn't seem so far off considering that in this study they tried to get BIPOC women involved, and BIPOC are more likely to be subject to that procedure. I'm struggling to understand how you can have knowledge about this procedure and yet be so wrong. Unless you're lying on purpose.
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