Page Leggett, Novant Health Healthy Headlines
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Dr. Tiffani Jones, who has been a physician with Novant Health Providence OB/GYN for 12 years, had two uncomplicated pregnancies and deliveries.
Not all Black moms have the easy pregnancies and deliveries Jones did.
Black maternal mortality has been much discussed in recent years in light of new research on the topic, which is captured at length in this New York Times story: Childbirth Is Deadlier for Black Families Even When They’re Rich, Expansive Study Finds.
“Not even the tennis dynamo Serena Williams is immune from the complications and challenges new mothers face during and after childbirth,” wrote the New York Times in another story that detailed Williams’ “agonizing postnatal experience, including an instance in which hospital employees did not act on her concern that she was experiencing a pulmonary embolism, a sudden blockage of an artery in the lung by a blood clot.”
Black women are three times more likely to die from a pregnancy-related cause than white women, according to the CDC. Jones has been aware of, and talking about, the issue for years. She said Novant Health has likewise been addressing the problem for a long time: “We’ve always desired to give great care to all women.”
“This has been a conundrum for years,” she continued. “Even when I was in training, we couldn’t figure out why preterm birth rates are so much higher for women of color. If you’re a woman of color and receive good prenatal care, you may still deliver earlier than your Caucasian counterparts – regardless of your socioeconomic status or level of education. We have never been able to figure out why that is. It could relate to rates of preeclampsia (high blood pressure during pregnancy), gestational diabetes or other medical conditions in pregnancy – or it may not.”
With the current disparity, something more maddening may be lurking. “There have been cases of women of color who told their doctors about unexplained pain but weren’t taken seriously,” Jones said.
“Women have had symptoms that could or should have led a physician to a certain diagnosis – yet they went undiagnosed. If a complaint is ignored and medical intervention is delayed, it could be life-threatening.” Jones is referring to implicit bias – something we all unwittingly carry around. Novant Health has an initiative underway now to educate physicians and other providers on implicit biases and to help them ensure they don’t creep into their diagnoses and treatment.
A doctor who looks like you
Jones chose OB-GYN as her field because it offers “a nice balance of obstetrics, primary care and surgery, all of which I enjoy.”
Besides, she knew she wanted to devote her career to women. “Women perpetuate knowledge,” she said. “If you tell a mother or sister or an aunt something, they’re frequently going to share that with their community or their village, if you will. I felt like I could do the most good for my community as an OB-GYN.”
She earned both her undergraduate degrees and medical degree at History Black Colleges and Universities (HBCUs) – Kentucky State University and Meharry Medical College in Nashville, Tennessee.
“I always tell people that physicians are benevolent by nature and want the best outcomes for their patients,” she said. Non-diverse doctors provide excellent care, Jones often says. But she adds that it’s perfectly reasonable for a person of color to want a physician who looks like them. For those patients, Jones is glad she can be there for them.
Jones also reminds patients they have a choice. “If you feel like you’re not getting what you deserve – if you feel like you’re not being heard or taken seriously – you have options,” she said. “Go for a second opinion.”
Aware, but not nervous
The most important part of prenatal care starts before you get pregnant, Jones said. She tells patients that the way they go into their pregnancy will generally determine how their pregnancy goes. “If you get your weight to a reasonable point, if you get your blood pressure where we like it to be, if you form good habits, are exercising and eating well before the pregnancy, it makes it so much easier once you’re pregnant.”
“After that, it’s a matter of setting realistic expectations,” she said. “Pregnancy looks different for every woman, every single time she’s pregnant. I can’t predict everything that might happen, but I can prepare you the best I possibly can for things that may occur.”
With every patient, she looks at and addresses risk factors, such as hypertension or any medical conditions they may have.
One of Jones’ clinical interests is obesity, a condition that may put women at risk for preeclampsia, gestational diabetes and the need for a Caesarean delivery.
“Obesity is something I like to discuss before my patients get pregnant,” she said. “But I’m careful to let them know nothing is absolute. While losing weight is something I encourage obese and overweight patients to do, it’s not the end of the world if it doesn’t happen. Obese women can still have successful pregnancies and vaginal deliveries. It’s just one less worry if we get it taken care of and managed before pregnancy.
There’s a balancing act involved in addressing risk factors with patients. “I don’t want my patients to be fearful,” she said. “I want women to enjoy their pregnancies. But I do speak candidly about the fact that being an African-American or Latina woman is going to put you at increased risk for certain things. We talk about it, but I don’t dwell on it.”
Even for healthy women with no risk factors, there can be less-than-ideal outcomes that are unexplained. “One of my best friends was fit and active; did everything she was ‘supposed to do,’ including yoga four times a week; was a normal weight – and still ended up with preeclampsia and delivered her children early as a result,” Jones said.
She helps mitigate what she can. For instance, it is now accepted that a daily aspirin can improve placental function and is safe to take during pregnancy. Many women feel more comfortable before and during delivery with a midwife – a healthcare professional trained to provide medical care during pregnancy, birth and postpartum. Others choose a doula – a professional who offers physical and emotional support before and during labor and postpartum. Jones considers either or both to be a great supplement to the care she offers.
In fact, her office has midwives on staff. “Our practice is fortunate to have a midwifery group,” she said. “We are one team and we take care of patients by each other’s sides. The doulas we work with on a regular basis are independently hired by the patient and can be a great complement to care.”
For Black women
Jones is gratified to see progress being made in addressing Black maternal health. “I’m happy to report that this year Novant Health will have a week-long set of activities geared toward Black maternal health for Black Maternal Health Week (April 11-17),” she said. “We’re trying to increase advocacy and awareness to – hopefully – improve outcomes.”
She said many of the poor outcomes for Black moms have “happened without malicious intent.”
“There are stereotypes that have been ingrained into our cultural norms,” she said. “We’re trying to dispel them by having conversations and doing things like publishing this story.” One myth worth dispelling: The sometimes-poor outcomes suffered by Black mothers aren’t always the result of a lack of access to good health care. But as a society, we need to get to the root causes of what is leading to these outcomes – and address them.
Jones is heavily involved at the institutional level now but used to be a frequent speaker at community forums and the like. “I was really involved before I had teenagers,” she said. “Now, we’re just trying to balance our busy lives as best we can.”
She’s also encouraged that Novant Health is training staff to recognize their own implicit biases. She said, “As a woman of color in this community, knowing that Novant Health is starting those conversations with providers makes a difference.”