HJAR Mar/Apr 2024

Q&A 22 MAR / APR 2024 I  HEALTHCARE JOURNAL OF ARKANSAS   mentioned to me recently a community doula, and that really resonated with me. Doulas can be very valuable. I put them in with the community healthcare worker bucket, where I think they could help patients navigate the healthcare system in a way that they can't otherwise.They could help support them, especially in that postpartum period. I think there needs to be some sort of a gov- erning body. There needs to be a definition of what a doula is. There need to be some standardized policies and protocols to which they have to adhere. There needs to be scope of practice and educational training. There needs to be a database. Then I think there can be reimbursement of these services. Some of the push-comes-to-shove is people not knowing what they do, what that scope of practice is; and a regulatory body would make sure that we stay within that scope. You mentioned the three buckets, but within those three buckets, it seems like there are a couple of variables that are standing out. I remember an interview with a state secretary of health, pre-Black Lives Matter. She was an OB-GYN, and she said that racism was killing women, Black mothers, in her state. I remember we all just turned our head around and did a double take, "Racism is doing that?" But since that time, data has come out, and we're looking more closely at Black mothers versus White mothers versus Hispanic mothers. Do you think racism is actually playing a role? I do think racism is playing a role. I would be remiss to say that it's not. When you look at the statistics and see that, even when accounting for maternal healthcare con- ditions and comorbidities such as chronic hypertension and diabetes, Black women are having more poor outcomes than white women or Hispanic women, I think we all can agree there's something going on there and I think it's systemic. Do I think a Black woman comes through a provider's office and they say, "I'm not going to listen to you"? No, I do not think that's the case. But if we say that we're blinded to that, we'remissing the point. I think recognizing that when a Black woman comes to you, as a fact, as we've seen with the statistics, their health outcomes are poorer ... What do we have in place to make sure that we are listening to those concerns? That's a big part of what these AIM bun- dles are meant to do. It's supposed to take race, socioeconomic status, and some of the other social determinants of health off the table. You come in, and if you have this, you do this. If you have this, this, and this, you do X, Y, and Z. We need to level the playing field. I think there is structural racism, and I don't know what else to qualify or quantify that with, but I see the statistics that Black women are doing more poorly even when accounting for other comorbidities. Is it that they're not being heard? Is it that they don't know that these symptoms are significant? Is it that they don't have support systems in place to help them navigate this? Is it that they don't have access to a healthcare sys- tem that their counterparts do? Well, if you had a magic wand, how would you fix that problem? Gosh, there are so many … I would want to educate every mother in the same way — knowing that I can't, though — because peo- ple have very different lived experiences. Giving an educational spiel to one person, someone else is potentially hearing some- thing very differently. In a magic world, we all hear the same thing, we all understand it the same way, and there is a clear and direct way with which, if you feel as though you are not heard, you can elevate your care to the next level and know that you will be heard. But that is completely fictional. The second variable that we're seeing is age, and we all know that women are having births later. Arkansas ranks very high in teenage births but for the older women, what do we need to know and do better to look out for those patients? I think a lot of what is plaguing, as we call, advancedmaternal age of 35 years and older is the comorbidities. You've lived a longer life. You have an increased incidence of chronic hypertension. You have an increased inci- dence of type 2 diabetes, of obesity, of some of the healthcare consequences that even come with those with end-stage renal disease or renal impairment. What we see as the top three to four diagnoses of maternal mortal- ity are chronic hypertensive disease, cardio- myopathy … consequences of comorbidities. As we get older, those comorbidities become more apparent, and sometimes they have gone undiagnosed and are in a worse health condition when they're getting pregnant. Are you seeing differences in maternal mortality based on the number of children? Is someone having their first baby at more risk than maybe her third? It depends on age. If they're having their fourth C-section, that's very different than their fourth vaginal delivery as far as out- comes of care. It certainly depends. Did they have their children young and healthy ver- sus older and with more risk factors? I don't know that you can directly correlate one or the other where first pregnancies are harder or easier with regard to that. Vaginal deliveries are healthier for the mother, but they may not always be healthier for the baby. How do you balance this? Yes, C-sections have significantly more comorbidities, being an abdominal surgery. What we do know is there are certain health- care concerns where we then worry about the fetus staying in for longer. We work on a 40-week gestational age with your 40th week being your due date. There are certain healthcare concerns that can occur during