Having a provider you trust throughout your pregnancy and postpartum journey is crucial for both your health and your baby’s. Unfortunately, many moms, particularly women of color, don't always feel fully understood during this vulnerable and pivotal time in their lives.
To help spread awareness and advice ahead of #BumpDay on July 24, What to Expect creator Heidi Murkoff and Veronica Gilespie-Bell, M.D., an OB/GYN and maternal health champion in Louisiana, sat down for a conversation about maternal health care in this country. Below are some of the highlights from the conversation.
Why is it so important you find a provider who is respectful and responsive?
An attentive provider can help ensure you have a healthy pregnancy and postpartum experience. Not to mention, they can advocate for you throughout your journey. "Pregnancy is such a vulnerable time," says Dr. Gillispie-Bell. "Your baby is growing inside of you and there is a lot of uncertainty. You have to have a provider you trust."
You need a provider that is knowledgeable of course, but you also need someone who you can talk to, that you can bring your questions to and a provider that never makes you feel dismissed, she adds. "Having that level of trust is so important."
Many women feel dismissed when discussing their symptoms with their doctor. This can happen to any mom, but does it happen more often for moms of color?
It absolutely does, says Dr. Gillispie-Bell. "Just speaking as a Black woman myself and from doing the research on this from a health equity standpoint, women throughout time have been characterized and put into different stereotypes, especially Black women." This leads to inadequate care for expectant mothers who are Black. "Then as Black women, because we don't want to fulfill the stereotype, we often don't speak up," she adds.
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As a Black woman, are you more likely to get empathetic care from a Black doctor?
The short answer is yes. "The literature shows if the race of the physician and the patient are the same, that we do have better outcomes, not just for mom, but for their babies as well," says Dr. Gillispie-Bell. "There is a level of trust that is established just when you see somebody that looks like you," she emphasizes.
"Sometimes as health care providers, we forget that when patients come into the health care space, they lose all of their power. They're coming in because they need help and we're speaking a language that they don't understand."
Dr. Gillispie-Bell also says that she understands that when you walk into a room and see someone that looks like you, you can immediately drop your shoulders and exhale because you know you at least have culturally shared experiences. "That doesn't mean that a provider of a different race cannot establish that same level of trust, but it may take a little bit more time and effort."
If you're low-risk, should you seek out care from a midwife?
Many women seek regular care from midwives, or medical professionals who can provide care during pregnancy, birth and even care for newborns – and Dr. Gillispie-Bell says that's a good thing. "We should absolutely be incorporating midwives into the obstetric practice." She says that by the year 2030 in the United States, we will be short 5,000 OB/GYNs and we do not have more medical students choosing to go into obstetrics and gynecology. That means that if midwives can help fill this large gap, she's all for it. "We need to be thinking about leveraging the experience of midwives to provide care for our low-risk patients so that we as physicians can provide care for the higher-risk patients."
And Murkoff agrees, saying that around the world, there are far more midwives than there used to be and that midwifery care works really well for many low-risk patients. "It's critical that we get more midwives out to communities where they're most needed, especially in rural communities where there isn't an OB/GYN for many miles."
To find an accredited and trained midwife near you, the American College of Nurse-Midwives has an easy-to-use tool to help.
What about doulas? Can they help you during pregnancy and postpartum?
Absolutely, say both Dr. Gillispie-Bell and Murkoff. "Doulas can also help advocate for you and support you through the process," says Murkoff. And while they don't give medical advice or deliver your baby, they can answer questions and act as your support system — and that's invaluable, she adds. In fact, data shows, says Dr. Gillispie-Bell, that when doulas are involved in care during pregnancy, birth and postpartum, we have better breastfeeding initiation rates and lower C-section rates.
Postpartum doulas are especially important, Dr. Gillispie-Bell adds. "If you think about the way the health care system is designed in the United States, patients deliver their baby, they go home, and then they don't actually come back into the health care space until six weeks postpartum — and clearly there's a lot of things that are happening during that time." Postpartum doulas can come into your home and help with things like breastfeeding, physical recovery after birth, housekeeping, baby soothing and taking care of any other children at home, too.
DONA International, the largest doula organization in the world, has an online tool to help you find a certified doula that's right for you.
How do you advocate for yourself and interact with your physician as a woman of color?
Finding a physician that you trust before you get pregnant is the first step, says Dr. Gillispie-Bell. "During the time that you're even thinking about getting pregnant, seek out a care provider, spend time with that care provider and talk to your friends to find one that's right for you." She also says to never feel guilty for seeking out a second opinion if you feel like you need one.
"I am loud, I talk a lot and I like to educate, but I'm never gonna tell you what to do. We're gonna make a decision together. That's not everybody's cup of tea. So it's okay if we're not a good fit," she explains. "It's really important preconceptually to figure out if you have the right doctor for you."
Here's how to find the right doctor for you.
If you have a high-risk pregnancy, how do you find a specialist and prepare for appointments?
The first thing to do, says Dr. Gillispie-Bell, is to ask your OB/GYN how soon during pregnancy you should see a maternal-fetal medicine doctor (MFM). "There are so many conditions that can increase your risk for a maternal or fetal complication."
So start off your pregnancy by discussing how often — and when — it's appropriate to see a specialist. "We do have guidance from The American College of Obstetricians and Gynecologists as far as when extra testing is needed," she explains, "but because all patients are beautiful and complex, it's really important to have that MFM perspective to take all the things that don't fit into a box into perspective, and come up with a treatment plan that's right for them."
What role does your partner have during pregnancy and postpartum?
Your partner is a super-important part of your pregnancy journey, from the very beginning through the postpartum period, says Dr. Gillispie-Bell. "Partners need to be engaged, especially during the first prenatal visit, because a lot of counseling happens at that time." And later on in the third trimester, there are a lot of things changing as you get closer to labor, too, so if your partner can attend prenatal visits, that's ideal.
Partners need to be aware of serious warning signs of conditions like preeclampsia and postpartum depression, and be able to take action or get help if they notice something is off. But our country also needs to provide more support for partners and parents in general, says Dr. Gillispie-Bell. "In addition to not having guaranteed parental leave for our moms, we really don't have parental leave for our fathers," says Dr. Gillispie-Bell. "There's a lot we need to do in the clinical space and in the public policy space to help support families during these critical times."
You deserve respect during pregnancy and postpartum
The biggest thing Dr. Gillispie-Bell wants you to know is that you deserve the proper care and respect during these life stages. "There is no reason you shouldn't receive it," she says. If you aren't, or you're in an area with a shortage of health care providers, getting a doula or midwife can really be beneficial, acting as a buffer between you and your provider."
If you need help finding the right provider, here are some tips on what to look for.
Join What to Expect on July 24 for #BumpDayto show your support for safe pregnancies for every mom, everywhere. Post a baby bump pic — yours or one you love, past or present — or simply share a message of solidarity with the hashtag #BumpDay.
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