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The Amsterdam News recently talked with Dr. Dawnette Lewis, MD, MPH, director of the Northwell Health Center for Maternal Health and Director of Maternal Fetal Medicine at North Shore University Hospital, about maternal health issues, birth complications for Black patients, and potential future solutions. This interview has been edited and condensed for clarity.
AmNews: Could you talk about the Maternal Outcomes Navigation Program?
DL: It’s a program that started during the pandemic, when patients were being discharged early from the hospital, and it started at three of our hospitals that had the highest COVID rates. It was designed to follow these patients to make sure that they were doing well. We didn’t know what the results were going to be with this program.
What we saw was that over 30 days after discharge, we were able to decrease the 30-day
readmission due to severe maternal morbidity by about 50% in the overall population. For our Black birthing patients, we were able to decrease the 30-day readmission rate due to severe maternal morbidity by 60%.
AmNews: Who is particularly at risk for birth complications?
DL: Our program initially focused on patients who are at highest risk—those who have comorbid conditions or pre-existing medical conditions: chronic hypertension, preeclampsia, Type-1 diabetes, renal disease, any autoimmune conditions, any cardiac abnormalities, or any cardiac complications that emerged during pregnancy. I know from the statistics that Black women are three times more likely to die than white women when giving birth.
AmNews: Why are Black women three times more likely to die than white women giving birth?
DL: I think there’s not only one reason why—I think it’s multiple reasons. Certainly, we know that the population having babies is getting older, [and] the older you are, the more likely you are to have a pre-existing medical condition, and that can contribute to maternal morbidity, maternal mortality. Where Black birthing patients are concerned, we know that the data shows that even if you’re a highly educated Black patient or healthy patient, your outcomes are worse than a white woman who has less than a high school education, so I don’t think it’s simply that patients have pre-existing medical conditions.
I think it’s also the way Black women are treated when they’re entered in the healthcare system. I also think that the support that you have in labor and delivery is important. I think your nurses in labor and delivery are important. There are multiple factors that contribute to poor outcomes.
AmNews: What can be done to help this situation?
DL: As simple as it seems, a lot of it is education. Any time a woman enters health care for whatever reason, whether they’re seeing their family physician or their primary care physician, I think it’s an opportunity to talk to patients about their plans—whether they’re planning a pregnancy soon or maybe in the next two or three years—to just talk about how patients can prepare to have a healthier pregnancy. I think if patients have existing medical conditions, like chronic hypertension, it’s important to optimize their blood pressure control before becoming pregnant.
It’s also important for patients to be on medications that aren’t contraindicated in pregnancy because some medications can cause anomalies in the baby. What often happens is someone who has chronic hypertension, [which are among medications that are contraindicated for someone who is pregnant], then [the medications should be] stopped. Then the patient has to wait until they present to an obstetrician or midwife or maternal fetal medicine specialists before they can get restarted on their medications to control blood pressure.
Those are opportunities where patients can be educated before delivery. We certainly continue to educate our patient population and our staff, our nurses, our physicians, about implicit bias training in the disparate outcomes for our Black birthing patients.
AmNews: What should new mothers be looking out for?
DL: Oftentimes, being a new mom—or even if you’re a second-time mom, it can be overwhelming. We encourage patients, anytime they’re having any feelings of being overwhelmed or feeling that they can’t manage what they’re doing, to reach out for support and not feel like it’s a weakness.
AmNews: Is there anything else you would like our readers to know?
DL: One of the things that is really inspiring and heartening is that when I started in obstetrics and maternal fetal medicine, no other specialty was interested in taking care of a pregnant patient, and now we’re seeing other medical disciplines who are very involved in publishing and talking about pregnancy complications. It’s exciting for me to know that there are other medical disciplines outside of OB/GYN that are paying attention to the maternal health crisis and who are willing to help.
