Paige Long Sharps, M.D., an ob/gyn, talks about teaching at Pace University
Mark Vergari, firstname.lastname@example.org
The New York metropolitan area has some of the best hospitals and top doctors in the world.
Yet New Jersey has the fifth-highest maternal mortality rate in the nation and New York ranks 25th in the number of women who die during or after childbirth in the U.S., according to a USA Today investigation.
The United States, which has the highest maternal death rate among developed countries, is one of only three nations — the others are Afghanistan and Sudan — where the maternal mortality rate is rising, according to the Alliance for Innovation on Maternal Health.
And the overwhelming majority of women who die or suffer catastrophic injury in birth or post-delivery are black women.
New Jersey Assemblywoman Shavonda Sumter said state Health Commissioner Shereef Elnahal “hit the nail on the head” when he said, “It’s implicit bias.”
Studies show that race, more than poverty or education, presents the most significant risk for maternal mortality. For example, New York City’s Department of Health and Mental Hygiene found the maternal morbidity rate of black women with at least a college degree was higher than for any other racial or ethnic group of women who lacked a high school diploma or GED.
Dr. Paige Long Sharps said the cause is “multi-factorial,” but bias by health-care providers cannot be discounted.
She said she’s seen colleagues treat women of color, especially women who are obese or poor, differently. And, Sharps said, she’s had doctors be curt and dismissive with her when she’s sought medical care — until they ask what she does and she tells them that she’s a doctor.
Sharps decided to go into teaching after serving as medical director of Montefiore Medical Center’s Department of Obstetrics & Gynecology and Women’s Health in part because of the bias she witnessed.
“If can instruct in clinicals, I can eradicate the biases in how residents and nurses are treating patients in the hospital,” said Sharps, who is an adjunct faculty member for Pace University’s Physician Assistant program at the Pleasantville campus.
New York and New Jersey are taking action: Both have formed task forces to define the issues and develop ways to address health disparities; both states’ legislatures have put forth bills to address the issues; both governors have included money in state budgets to act on recommendations.
‘It shouldn’t be a factory’
New York’s budget set aside $8 million to implement recommendations made by the Taskforce on Maternal Mortality and Disparate Racial Outcomes, which issued its first report in March.
New Jersey earmarked $4.7 million for Department of Health initiatives to improve health and birth outcomes; $1 million will help provide doula services for women on Medicaid. Sumter said those efforts included a pilot program that supported training and recruiting Camden-area doulas — often described as birth coaches, although they support women after birth as well. Sumter said the program has shown success, and there are plans to expand it throughout the state.
New York’s Department of Health launched a pilot program in March to cover doulas for Medicaid recipients in Erie County and will soon include Brooklyn. The two counties have among the highest maternal and infant mortality rates and largest number of Medicaid births in New York. Health officials say early reports show women taking advantage of the doula care in Erie.
New York’s efforts include scholarships for midwife training and increased Medicaid reimbursement rates for midwives, efforts Sharps supports.
“I was taught by a midwife,” Sharps said“They want to take their time. Now, it’s about numbers. There’s no time for holistic treatment of patients, you have to see 40 patients a day.”
Sharps supports more women of color in jobs that support women in labor and delivery, and hopes that’s part of shifting care back to the patient.
“This is one of the most important events of their life,” Sharps said. “It shouldn’t be a factory.”
New Jersey’s Health Department has also established a maternal health data center that focuses on reducing surgical births. Cesarean deliveries are sometimes needed, though they add risks. New Jersey’s c-section rates are among the highest in the nation, ranking fourth in 2016.
“We have the data but it’s how we use that data,” Sumter, an administrator at Hackensack Meridian Health, said. “We’re working on a reduction 25 percent or below … public education is a part of it, but there’s also a financial component.”
Sumter said efforts like this are possible because state agencies are working together. That cooperation, she said, can be credited to New Jersey First Lady Tammy Murphy’s involvement.
Quality of basic care varies, health officials have said. For example, there’s no medical facility that performs deliveries in Trenton, New Jersey’s capital where half the population is black. “When it comes to access, we’re not there yet,” Sumter said.
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Standard of care also shifts from hospital to hospital. New York’s Legislature passed a bill that would mandate obstetric hemorrhage protocols at hospitals, including such low-tech practice as weighing sanitary pads to track how much blood volume a patient is losing.
Getting the word out
Sharps was a panelist during a screening last month of the documentary “Death by Delivery,” which focuses on women and their families in Georgia and Brooklyn. Westchester County’s Women’s Advisory Board and Planned Parenthood Hudson Peconic sponsored a screening, which drew about 40 people, mostly women of color, to the Yonkers Riverfront Library.
While the discussion afterward was interesting, Sharps said, “the audience was like preaching to the choir.” She hopes the documentary, and the subject, could be discussed with a more “diverse” audience — by that, she means women who may not be informed about the country’s dire statistics on maternal mortality and morbidity. “We need to bring it to the people,” she said.
Providers need to hear these statistics, too, Sharps said. That’s why she integrates these discussions into her teaching, because she wants to “make students aware of their unconscious bias before they ever start administering care.”
Nancy Cutler covers People & Policy for the USA Today Network Northeast. Reach her at email@example.com. Twitter: @nancyrockland
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