(BPT) - By Wanda Barfield, MD, MPH, RADM USPHS
Director of the Division of Reproductive Health, Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention's (CDC) Hear Her campaign raises awareness of potentially life-threatening warning signs during and after pregnancy and encourages everyone supporting people who are pregnant or postpartum to really listen when they express concerns.
It is crucial that providers take time to really hear women’s concerns and are responsive to their needs to make sure any issues are adequately addressed. Valencia, one of the women featured in the campaign, talks about her experience with a pregnancy-related complication. During her first pregnancy, Valencia struggled with headaches and dizziness. When she reported worsening symptoms, she felt like no one took her seriously. “I didn’t know who to talk to and wasn’t sure how to speak up for myself,” she recalled. It was her primary care provider who finally helped her get the care she needed.
Valencia is one of the many people each year who face serious health complications during and after pregnancy. Many people who are pregnant or postpartum may feel ignored or dismissed when sharing their concerns, which may make them hesitant to ask questions or speak up. A 2023 survey found that nearly half (45%) of moms reported holding back from asking questions or discussing concerns with their provider during maternity care. Reasons included thinking what they were feeling was normal, not wanting to make a big deal about it or feeling embarrassed, or thinking their healthcare provider would think they’re being difficult. Open communication among healthcare providers and patients can build trust and contribute to better quality care.
Structural racism and implicit bias can play a role in the treatment that women receive from their providers. These biases, whether deliberate or unconscious, can put the health of pregnant and postpartum people at risk. For example, experiences of racial discrimination are associated with less than adequate prenatal care and not receiving a postpartum visit. In the same survey on mistreatment during pregnancy and delivery 30% of Black, 29% of Hispanic, and 27% of multiracial women reported mistreatment including receiving no response to requests for help, being shouted at or scolded, not having their physical privacy protected, and being threatened with withholding treatment or made to accept unwanted treatment.
Respectful and equal maternity care is an important component of strategies to reduce pregnancy-related deaths. Implementing quality improvement initiatives and provider training encourage a culture of respectful maternity care, creating an environment where patients can ask questions and share concerns knowing that they will be heard. Quality improvement initiatives can help ensure the right care in the right places at the right time. Perinatal Quality Collaboratives (PQCs) have implemented quality improvement initiatives to address birth equity and improve respectful care. These state and multistate networks of teams collaboratively provide infostructure to enhance the connections between hospitals, providers, nurses, patients, public health, and other partners creating opportunities critical to informing data-driven efforts to improve care and outcomes.
In the U.S., too many people die from pregnancy-related complications each year. Tragically, most of these deaths can be prevented. There are also considerable racial inequities when it comes to pregnancy-related deaths. Native Hawaiian, Pacific Islander, Black, American Indian, and Alaska Native people are disproportionately impacted by pregnancy-related deaths. A better understanding of why pregnancy-related deaths happen can help identify the approaches that will have the most impact. CDC supports the work of Maternal Mortality Review Committees around the country to get quality data about the circumstances surrounding a pregnancy-related death, including the documentation of bias, discrimination, and racism. These data are used by committees to make recommendations to prevent future pregnancy-related deaths and are also used by CDC to better understand maternal mortality across the nation.
The need for high-quality care doesn’t end at delivery — data shows that more than half of pregnancy-related deaths occur 7 days to one year postpartum. Recently pregnant women go through many changes and it is essential that during this time they can count on their community for support. Partners, friends, and family of postpartum women should listen when she expresses concerns, encourage her to seek help, if needed, and support her through follow-up care.
Everyone has a role to play in improving care and outcomes for mothers. Hear Her encourages partners, friends, family, and healthcare professionals to really listen when a woman says something doesn’t feel right. Acting quickly could save their life.
For more information, visit cdc.gov/HearHer.
