Looking at these numbers, there are apparent disparities in the mortality rates and cesarean rates between races. One contributing factor in these disparities is scientifically inaccurate stereotype data used to create tools for clinical decision making and inaccurate racial characteristics. For example, it was previously believed that Black women had a higher pain tolerance, which affected the number of pain-relieving measures they were given. Race and ethnicity were included in the calculations to determine a woman's probability of a successful vaginal birth after a cesarean (Green et al., 2021). So, even following the latest evidence- based practice, the provider may offer different counsel to two women who are only different by skin tone with a prior cesarean, as a White woman has a 66.1% predicted chance of vaginal birth after cesarean (VBAC). In contrast, the Black woman has a 49.9% predicted chance of VBAC. These calculations for chance of VBAC from Green and colleagues (2021) are based on a woman who is 30 years old, who is 5 feet 6 inches tall, who weighs 200 pounds, who had a prior cesarean delivery for breech presentation. As you can see from Figure 2, there has been a steady increase in pregnancy-related mortality rates, with 2020 seeing an average of 23.8 deaths for every 100,000 births. Figure 2. Pregnancy-Related Mortality
High disparity rates in women's health are multifactorial. Provider-to-patient and patient-to-provider biases do play a role in care discrepancies. Patients may delay seeking prenatal care, typically due to personal experiences of bias and racism. Providers miss critical warning signs. There are many documented instances of women sharing feelings of being ignored and dismissed by their providers. Moreover, these disparities in women's health are seen consistently across all education levels (CDC, 2022). In 2020, the CDC began the Hear Her national campaign to raise awareness of how important it is to listen to women and look for the warning signs of potentially life-threatening complications during pregnancy and the first year after pregnancy. Further recommendations for decreasing disparities and increasing better outcomes are standardizations in protocols and ensuring previously and newly written protocols do not exacerbate disparities. Two examples are (1) a standardized labor induction protocol, which has decreased cesarean deliveries and neonatal morbidity, and (2) a standardized protocol for the prevention and care of hemorrhage, which has shown a noticeable reduction in maternal morbidity (Green et al., 2021). Hear Her Campaign: Why It Is Needed Serena Williams, who is well known for her tennis achievements, including being a 23-time Grand Slam Champion, shared her harrowing birth story with reporters. Her story started in 2010 when she was treated for blood clots in her lungs and abdomen. Because of this experience, she knew she was at risk for blood clots and took preventative medication daily. In 2017, while she was off the preventative medication, she began to lose feeling in her legs and noticed increased pain. No one seemed to take these symptoms seriously when she reported them to the hospital staff. She continued to advocate for proper testing until the provider agreed. The tests revealed she needed immediate intervention to prevent the clots from reaching her lungs. She required three surgeries and a cesarean before the harrowing ordeal was over (Gardner, 2022). Reflection Questions 1. If she had not been a famous athlete and continued to advocate for her life, would there have been a different outcome? 2. Why did her provider not initially consider her history and assess for warning signs of blood clots? and an education level bias depending on a known difference. Other areas where bias can be shown are how she dresses and even her hair color. An education level bias is sometimes seen in assessing her clothes (interpretation of modest or not modest) and hair color (blonde versus dark). These are also areas where women are affected by biases in their career progression. To help your colleague, the first step is to notice what is happening. If you were on the team, you would have contributed to the response through your affinity bias. However, in overcoming the bias, you do not want to make the situation uncomfortable or embarrassing for Maria. When you become aware of this situation, find a way to catch the group's attention that will allow her to share her input with the group. It may be speaking directly to Maria, such as stating, "Maria, what were you saying about the topic?” or "Maria, I think you have some excellent insight— could you share that with the team?"
Note: Adapted from https://www.cdc.gov/reproductivehealth/ maternal-mortality/pregnancy-mortality-surveillance-system.htm; https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/ e-stat-maternal-mortality-rates-2022.pdf
Case Study #1: Biases Maria is the only female on an innovative team whose purpose is to review the hospital’s hiring procedures for biases. Every time she attempts to express her viewpoint or ideas, she is ignored or interrupted by other team members. This continues to happen throughout an hour-long meeting. Questions 1. What bias(es) is/are probably at play in this scenario? 2. If you were a team member, how could you help Maria overcome the bias(es) in this scenario? Discussion 1. From the information provided, we can see there is an affinity bias that is related to gender. An affinity bias occurs when we gravitate toward others who remind us of ourselves. Because Maria is the only female on the team, the males in the group favor those who remind them of themselves, causing them to dismiss her unintentionally or intentionally. Because she is the only female, we also see this as a gender bias. 2. What is unknown but could also be at play is an age bias if she is younger or older than the rest of the team
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