Leading with Health Equity

By By: Terri L. Major-Kincade, MD, MPH, FAAP

In honor of Black Maternal Health Week [1], I would like to issue a call to action to some of my most important allies at the bedside, Neonatal Therapists. Black women in the United States are two times more likely to experience preterm birth and three to four times more likely to experience adverse maternal outcomes before, during and after pregnancy. [2] These are statistics I refer to weekly, if not daily, and the recent COVID pandemic has magnified these differences and brought this issue squarely to the forefront. [3]

The reasons for persistent disparities in preterm birth and maternal mortality in the United States are multifactorial. A recent systematic review of racial and ethnic disparities in the neonatal intensive care unit (NICU) summarized the reasons into three categories related to structure, process and outcomes.

Structure refers to factors like geographic location of hospital, patient mix, and nursing ratios. Process refers to the way the way in which patients and families are made aware of and receive certain services or therapies including lactation consultants, high risk follow-up clinic, kangaroo care, and shared medical decision-making. Outcome refers to disparities in outcomes like intraventricular hemorrhage (IVH), mortality and morbidity.[4]

Addressing disparities in neonatal outcomes with regard to process is especially well suited to the unique skill sets of neonatal therapists. The special relationship between neonatal therapists, patients and families provides five key areas for advancing health equity, all rooted in the therapeutic alliance that focuses on what the patient or parent can do rather than what they cannot do.

These five areas include: 1) consistency as a care provider for parents and for babies with access to infants in a way that physicians and nurses do not have, 2) a hands on approach utilizing evidence-based therapies, 3) the ability to teach parents feeding, range of motion and massage techniques, 4) the ability to empower parents in a different way than physicians and nurses do, as their relationship is often defined by illness, and 5) as a central role of a parent advocate.

So how does a neonatal therapist maximize their unique skill set to lead with equity?

· Affirm families at the bedside. Often, you may be the only one to do so.

· Continue to take the time to explain what you are doing, why you are doing it and invite them to participate. Studies show that patients of color are less included in medical conversation, have less opportunity to participate in decision making and are more likely to feel talked at rather than talked to.

· Ask mothers about breastfeeding, their interest in breastfeeding and if they would like to meet the lactation specialists. There are voids and gaps for mothers of color with respect to referral to lactation specialists and ongoing conversations with respect to interest in breastfeeding. This is particularly important given breastmilk is associated with improved outcomes for preterm infants and Black infants have worse neonatal outcomes.

· Ask families if they’ve been able to participate in kangaroo care, and if not, encourage them to do so as kangaroo care improves neonatal outcomes and Black infants have decreased rates of kangaroo care time.

· Affirm families when there are questions about visitation schedule or ability to begin discharge teaching. Your perspective, free of bias or possible judgement, is hugely important to the experience of all families in the NICU.

These may seem like small things, but the sum of these small acts of acknowledgement are huge with respect to empowering families you interact with, particularly if the experience and interaction with the neonatal therapist has been the only validating experience for the parent over days, weeks and even months.

Let’s begin with I see you. I value you. I know that you are important to your child. I am here to help you be the best parent you can be. Teach me about your child – I know you are the expert on your child – and I’ll teach you what I know about your child.

Lead with equity. One baby, one family at a time. Thank you for your ever important presence as an infant and parent advocate.

– Dr. Terri

[1] https://blackmamasmatter.org/bmhw/

[2] https://www.nytimes.com/2018/04/11/magazine/black-mothers-babies-death-maternal-mortality.html

[3] https://www.ucsf.edu/news/2021/08/421181/covid-19-during-pregnancy-associated-preterm-birth

[4] https://www.publications.aap.org/pediatrics/article-split/144/2/e20183114/76884/Racial-Ethnic-Disparities-in-Neonatal-Intensive

Learn more from Dr. Terri and earn free CE credit by watching this NANT special topic course, Addressing Neonatal/Perinatal Health Disparities from the Bedside, Achieving Health Equity Through Neonatal Therapists, presented in partnership with Pampers Professional.

Visit Pampers Professional for free patient and professional downloadable resources related to Black maternal health curated by Dr. Terri.

Terri L. Major-Kincade, MD, MPH, FAAP is a double board-certified Neonatologist and Pediatrician; National Board Member for Pregnancy Loss and Infant Death Alliance-Chair Diversity, Equity, Inclusion Committee; National Thought Leader Perinatal Health Disparities; CEO and Founder DrTerriMD.

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