Bridging the Divide: Addressing Racial Disparities in Maternal Health Through Nursing Education

This episode of Nursing EDge Unscripted explores the urgent Black maternal health crisis, highlighting stark disparities in outcomes and the systemic factors that contribute to them. Host Dr. Kellie Bryant is joined by Dr. Kandis McLean and Dr. Marie Wilson, who share their work in simulation, clinical practice, and community health to address inequities in maternal care. The conversation examines how bias, social determinants of health, and gaps in provider education impact the quality of care Black women receive. The guests emphasize the critical role of nursing education in preparing future clinicians to recognize disparities, provide culturally responsive care, and advocate for patients. Through practical strategies and real-world insights, the episode underscores how nurse educators can help drive meaningful change and improve maternal health outcomes.

Learn more about Black maternal disparities:

• Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). www.AWHONN.org
• National Association of Nurse Practitioners in Women’s Health (NPWH). www.NPWH.org

Dedicated to excellence in nursing, the National League for Nursing is the leading organization for nurse faculty and leaders in nursing education. Find past episodes of the NLN Nursing EDge podcast online. Get instant updates by following the NLN on LinkedIn, Facebook, Instagram, Bluesky, and YouTube. For more information, visit NLN.org.

Transcript

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Hello everyone. Welcome to another episode of the NLN podcast, Nursing EDge Unscripted. I am your host today, Dr. Kellie Bryant, and I am the director of the Center for Innovation and Education Excellence at the National League for Nursing. In this episode, we have a very, very important topic to talk about. We're going to be discussing black maternal health crisis because the statistics show that black women die at 3 to 4% higher rate than their counterparts. So, we need to talk about it. What are the reasons for that health disparity and what can we do as nurse educators to help educate our future nurses and health care practitioners on how we can reduce that gap? So, our guests today, I'm really excited about our guests. We have Dr. Kandis McLean. And we are also joined by Dr. Marie Wilson, who is the regional director of nursing for New York City Health and Hospitals Gotham Health. I want to give a warm welcome to our two wonderful guests. Thank you for joining us, Marie and Kandis. Thank you. Thank you for having us. Oh. So, I want to start just by if you can give us a little bit of background of some of the work that you're doing both at your where you work but also I know that you're also doing a lot of work in organizations. If you can just give us a brief overview of some of the wonderful work you're doing in this area and I'll start with you Marie. Okay. Hi everyone. So as you stated I'm regional director of nursing for New York City Health and Hospitals Do Health Manhattan. I oversee six ambulatory care sites. So my job is the largest FQHC in the United States. So it's amazing to sit in this role and to provide care and oversee operations and nursing leadership for you know communities for nurses but also for the communities that we serve. As far as work, I have been a long-term advocate for for black maternal health is my passion. I'm also a doctorally prepared woman's health nurse practitioner. So, this is my core passion at heart. I've worked everything from labor and delivery to outpatient, inpatient, I've seen a lot. So, you know, seeing the disparities ignited that passion like, hey, I have to do something about this. So, that's my day job. As far as my weekend in community service, I am literally doing community service almost every weekend and I am also the chair for greater New York City Black Nurses Association for the Women's Health Committee. We do a lot of work in the community. We serve New York City, all the five boroughs and put on a lot of community events, speaking engagements, forums where people can be educated, the communities could be educated so that they know how to advocate for themselves and to you know ultimately protect the themselves, their families, ensure that their families are thriving. In addition to that, I'm also part of the health committee for Alpha Kappa Alpha Sorority Incorporated and we do a lot as you guys know. If you may not know, Alpha Kappa Alpha is the first black Greek sorority over 118 years. And this is the core of our mission is providing care and education to humankind to everyone. So through volunteer and through a lot of work and other organizations I'm part of as well. But those are some of my core passion where I'm constantly giving back to the community. Again, I feel like as if, you know, having this education, also being able to be on platforms where I'm able to give back through education, through mentorship, through leadership, through, you know, through everything is important to me. So, I'm excited to be here. Thank you. Thank you. Thank you. And Kandis, tell us a little bit about your background. Yes. I just want to say thank you. It's a pleasure to be on this podcast and to deliver this knowledge regarding maternal disparities, right, that are plaguing us and are still at the height. This was very passionate to me as a mother of four and being part of New York State and having all my children here. I always talk about how I had three C-sections on my fourth child, I had a vaginal birth due to the failure of the hospital not listening to me. When I approached this institution and I walked in and I said, "Hey, I know I'm about to deliver. I've been vomiting all night, regurgitating." I was told that I'm not crying and have a seat in a chair. I told them I'm a nurse practitioner. I'm fully dilated. I checked myself at home and I was still placed in a waiting chair. I was then later 15 minutes after arriving at this premises, ushered into a room and placed on a fetal monitor. Didn't have an IV, but I kept feeling constant pressure and I was shaking and I still wasn't very verbal. So, I want to advocate for black women now for us to be heard and listened to when we go into these birthing spaces. Several nurses would keep telling me to wait. Nobody would check me. It took me to communicate with an African-American doctor in the triage who did not know me. And I said, I just need someone to listen to me and help me. And I end up delivering my fourth child via vaginal birth. And I bring awareness to this that black women do VBAC, right? But we need to also take care of us when we go into spaces and make sure that we're being heard. So using the New York City maternal mortality, I bring highlights to these injustices that we face when we go into triages and not being listened to and how it's a common theme. Also part of AWHONN, I like to bring awareness through simulation. That is my great work. I got introduced to this work and I cannot be on this podcast and not mention my great directors and leaders and vice presidents Michael Muga Chaden and Kimberly Campbell Taylor at New York City Health and Hospitals who introduced me into simulation. They helped me get certified but we did it in a special strategic way right we had a grant program that addressed maternal mortality growing across this 12 hospital system and just training through manikins so I still carry this journey now into AWHONN, the Association of Women's Wealth and Neonatal Care, in which I now take simulation internationally. I use it to train international midwives and nurse practitioners through simulation but using themes of disparities and constant scenarios that black women face such as assumptions that we are induced or inebriated when we have a placenta abruption. Placenta abruption is attributed to other causes beside cocaine. We may have preeclampsia and just be high risk. So these are what I incorporate in scenarios not to foster stereotype and stigmas but to bring awareness to these disparities that still plague us and constantly that we still face unfortunately. Oh goodness. Well, thank you both for the wonderful introduction and for the wonderful work that you're doing. And Kandis, thank you for sharing your personal story. Also, for those of you that don't know, everybody thinks of me being in simulation or nursing education, but my love and my background. I'm a women's health nurse practitioner. So, I spent my whole nursing career in women's health, labor, delivery, postpartum, and also as a woman's health nurse practitioner. So, this is an area that's near and dear to my heart also. and being someone who was in practice, I saw a lot of these health disparities play out right in front of my eyes. So, let's talk about it. And I also want to make a note that, you know, it's common for us to say pregnant women, but I do want to make a note. We're talking about birthing people. We want to be mindful, you know, not every person that has a child is identifies as a woman. So, just to make that statement here that birthing person, birthing people we're referring to when we have our discussion here. So first question I have for both of both of you or either one of you to answer. Why do we have this disparity? What are the most evidence consistent contributors to the fact that black birthing people have a three to four times higher risk of dying than than white women? Can you give us a little bit of the background of the as to the why? I mean that we can go back to history, right? We talk about the the godfather of gynecology. We speak about experiments on black women without anesthesia. So that whole notion of the strong black woman came about from that. They were do performing all type of type of experiments, medical experiments on black women without anesthesia. So that's one thing. So they feel as if we don't have the same pain. So things like when we do report, hey, I'm having pain, often dismissed or saying that we're drug seeking or we're being a little bit extra and say, oh, it's normal versus our white counterparts. I mean, everything stops and and like again, patients are coming up with PCA pumps versus black women coming out of L & D with PCA pumps, whether they can control their own anesthesia versus black women, this their third C-section, and they still have to take PO medication, Percocet, things like that. So, better control, things like that. But we're often dismissed, you know, delayed recognition of signs and things like that, kind of like waiting and seeing and things, you know, things of that nature. And again, some of the implicit biases that have been structurally ingrained in our health care systems, even in our education, we look at things like even the pulse oxometer where it's mostly recognized for our white counterparts versus black people. So, it's different. So, being able to pick up on those things. So that's kind of the the foundation of it. But oftentimes even though we've made a lot of advancements not only in our medical practices and technology and we've advanced in culture period as a race you often still see this. So again even when it comes to education where we think, okay, I'm educated, I might be exempt from this even then we're often dismissed. So even our education can't even save us. So, you know, some of the those are some of the, you know, core reasons why this is happening. Definitely, Dr. Marie Wilson, I have to agree with you about that and the historical data shows it. I just want to tap in if we ever read Linda Villarosa and also the story where they talk about the two twins who were 13 years old and sterilized. It's been historically inundated in us to be tested upon as black women. And even till this day, when there's a new trial for birth control, a new trial of a patch for menopause, look at the population that is tested upon. It is black women that are subjected to it. Right? So even historically, we need to change that moving forward. So black women do not feel safe to go into these spaces to seek care because we're we're fearful and mistrustful of it being delivered. One of the things I wanted to also highlight too about the disparities is just awareness for the population by ethnicity and race. there is significant differences. The leading cause for caucasian women according to the New York City maternal mortality was mental health. So we had a fruition of mental health programs development of ACT teams within these hospital systems but the leading cause of deaths were by African-American women due to ectopic pregnancies right or cardiovascular health. Another significant identifier that we found on the New York City maternal mortality was black women were dying from BMIs greater than 40 and attributed to cardiovascular health. But do you ride the subways and see advertisement for, hey, we need better cardiovascular health? When did you last get your blood pressure check? So, we need to have campaigns that are directly targeted for our race and in our communities that have access. Maybe we need to go into the hairdressers, the barber shops, the nail salons where we can reach our people and get out there and get this information. We need to also advocate when we're in this space. I want to share a story that I was doing simulation with and actually my student shared it with about her birth experience and she said she didn't go back and she wanted to say I was on my second child and I went in when I was 33 weeks bleeding and my name is Tata Fante you know and she gave it like that - giving an example, not the real name. But her name was different, unique, right. And they made fun of this name, right. So she didn't feel safe. You're there seeking care and she could hear by the nursing station them repeating this name. And then they're laughing. What kind of name is that? Who would say that? We serve different races populations. We need to be diverse. Right? So that was very concerning. And she said, I wouldn't go back there. So I didn't go until I had time to deliver my baby. And that's hurtful, right? These are disparities. But she's seeking care in her own community, but we're not advocating for the proper care or giving empathetic care and respectful care. So that's a big part of those disparities. Thank you. I think there's so many factors, but what I'm getting from the conversation is, you know, implicit bias plays a role in the care and getting subpar care, not getting treated. What I found is people not being heard, coming in stating that they're having this symptom and it's really not taken seriously and they're sent home and then you find out, you know, with these horrible stories we've been hearing on the news that they wind up coming back deathly ill, dying or not even making it back to the hospital. but yet they went in two, three, four times complaining of, you know, a headache or having a difficulty, a difficult time breathing or heavy bleeding and just not being heard. So, I thank you for sharing again your stories. So, let's turn it a little bit more into what can we do about it? And Kandis, you gave some examples, but when it comes to nursing education, how do we best prepare our new graduates? How do we let them know that this is going on? Because one of and Kandis, you mentioned this. I think a lot of people think that, you know, postpartum hemorrhage is the number one cause of death for women and it really I was very surprised to find mental health, whether that's substance use disorder or suicide is actually ranked even higher when we think look at it from a national perspective. So what can we do in nursing education to kind of open our our learners eyes, these future nurses to this disparity and how we can do things differently so that we can hopefully contribute to a reduction in the black maternal death rate. I believe Dr. Bryant that we can incorporate a nursing education scenarios that highlight these critical differences in our health disparities but while now defuting the stigmas, right? We don't have to make it that the black woman comes in and she always has preeclampsia but maybe she had a history of chronic hypertension prior that evolved. Sometimes we tend to make it very stereotyped. So we really need to be dismissive of that as nurse educators. I find even in the books we used to have textbooks that say we feel less pain. So we need to educate the students that that these things are not true. Your assessment may look different for your different races and your populations of patients. But they need to also be aware that there is a starking difference in the maternal health disparities. I open my class up with Kira Johnson's video by her husband to highlight of what happened. She was a educated black woman in a very popular hospital but still died and it failed due to assessment delay in intervention. Even when they were advocating for her to get this CT scan, it was still a delay because she was not prioritized. So I think we need to bring as nurse educators in the scenario one having like manikins that look like the students that we are being training right we just now started incorporating over the last 5 years brown and black manikins. All we used to train upon were task trainers. I remember myself being an educator, as a simulationist, and I had a beige pelvis. So it was really it didn't fit the scenario. So it's important that we have access to all different modalities we have the capability now using vSim simulation manikins, task trainers to make sure we have manikins and tools and resources that look like us for the students that we train. I think I want to encourage institutions also, especially in New York, to have a truly diverse population of nurse educators. I sit here with two masters of nursing education, a masters as an FNP and my DNP. And I'm almost hurtful to say I did not have a professor that looked like me, right? So, a lot of the cases, but I had immense support. I do not deny that through my education. But it's just important that we now incorporate that we have a rightful, respectful, racially concordinate nursing faculty to serve these populations of a students out there so that we can just have more relatability. There's an article out there unfortunately that shows that we are very low in percentage as nursing faculty. So we need government programs to heighten that. Definitely. I agree with you 100% Dr. McLean. Thank you for really spelling that out for everyone. On the clinical side, I can say that especially being a nurse leader on labor and delivery postpartum, especially postpartum where we think people are out of the clear where emergencies do happen like hemorrhage. I'm also proud to say, and I didn't say this earlier, I'm also a consultant for a National League for Nursing simulation where we're creating simulations for nursing students and I'm focusing on hemorrhage. The hemorrhage, preeclampsia, some of the common crises that may occur that they're able to kind of curve that knowledge gap especially during the Covid pandemic where a lot of nurses weren't afforded to go to the hospitals to do their clinicals as they as part of their curriculum. So there is that knowledge gap even with the new nurses that are coming out there or if you are transitioning from specialty. Oftentimes when there are emergencies you find the labor and delivery nurses are running up to postpartum and they sometimes consider postpartum as low acuity, which is not the case. However there is a knowledge gap there. So being able to recognize early signs. It's important to do simulations regularly with our nurse educators, with our providers, and to provide real drills. Just as if we do a fire drill or a active shooter drill, we need to do postpartum drills. Different topics such as hemorrhage, sepsis, preeclampsia, and even amniotic. Thank you. Thank you for that. Amniotic embolus which is very rare but I've seen that once in my 18 years career and it's very rare and I've seen it once and it's and those are things we're not really well trained on. So it's important that we do this regularly and also we have to you know utilize MUSE we have to also utilize the SBAR and we're making sure that nurses are able to escalate remember SBAR really SBAR really protects us as far as when like al alerting us when to escalate, but also uses has also allowed nurses to know when what they recognize at early intervention. So when we see vitals, what do we do? We just document it or are we escalating? Are they feeling empowered to escalate this? Because this can be life or death for a lot of people. So having those regular drills and also establishing cohesive teamwork between labor and delivery between even the antenatal space as well because those those nurses are spending most of the time with those patients versus labor and delivery postpartum. It's acute. It's two to three days and it's like, see you, have a good life. So we've developed a rapport with people in the in the ambulatory care setting. It's important that they all are connected and saying, hey, is there a connection and a bridge and communication like, hey, this is a patient. She's due to deliver on this at this date they're coming this day. This is what we need to be alert of. There's that communication gap there so I think that with drills with escalation they that knowledge gap will be reduced significantly. Great. You both had really, really great suggestions for our nurse educators out there. But my next question is so where do they get the resources? Let's say that they want to implement simulation and practice some of these scenarios that you discussed. Do you have any sites, any advice or recommendations for where they can get research resources if they want to implement more of these examples you've discussed into their programs? So definitely I would love to just recommend and not because it's the organization I've been with since I was 19 years old when I became a nurse but AWHONN - Association of Women's Health and Neonatal Nursing. We have a full DEI page. It's a big mission. The AWHONN OPS, Obstetric Patient Safety course, has multiple scenarios and escape rooms that I strategically worked with with educators across the United States. And one of the things that drive my passion to really represent with them is we have black women in rural Indiana, right, that are facing different disparities than what we face in New York State. I had the privilege of going out there and almost being petrified because I traveled 90 miles on a transport carrier because we were 90 miles from a hospital. And I said,"Are we going to birth in this ambulance?" That is a totally different scenario than what we face out here in New York State where almost every 15 miles we have a hospital, right? So you know it was very good to see this in AWHONN them going out there to make this course that can be internationally and in the United States integrated about DEI. So it has scenarios about preeclampsia, amniotic fluid embolism, but also with the background of, hey, we know there's disparities. There's a special component in it about mental health, especially about black women, but we added actually added a twist from feedback about Asian ethnicity because it's highlighted that also too that help mental health was not accepted in this culture. A lot of times as a Caribbean person, we weren't able to say, "Hey, we have a mental health problem." If you take antipsychotics, you're frowned upon by your family. So there's a component within the course about that and especially different cultures and how that's actually interpreted amongst your family. I think this is important conversations that we need to have because yes, as clinicians, we feel safe to talk about mental health disparities, but it's still a very hard thing for families and culturally very biased. Thank you, Marie. Do you have any resources for our listeners? Yes. Dr. McLean said it great. I think AWHONN has a great it's really centered focused around nurses as well to for their education. I think that's great. Definitely even in the National League of Nursing. Also NPWH, which is an organization for women's health nurse practitioners. They have a robust amount of information and simulations at conferences so they can be trained and also to sit in conferences to keep abreast to what's current because as you know healthcare is evolving every single day. But again if again when you look at the clinical side it's important to feel empowered to share things. I know myself like we have a huddle morning huddle every morning and I empower all nurses to take a take an opportunity to bring up articles of what's going on that they don't know about because you know we get so laser focused on our task our assignment but what else is going on we constantly need to be educating ourselves and taking that initiative and not be forced to oh I have to do my mandatory training versus you know doing it for ourselves because you bring that to the forefront that they weren't aware of you know speaking in terms bringing knowledge that is evident based that's best practice to keep that breast and then also getting involved in things like professional governance in your hospital, where we are literally governing as nurses what we do our practice. And we can change policies. Se go to Albany and to Washington DC to speak with lawmakers. We have so much power that we don't know. So it's beyond the bedside, it's beyond the hospitals, beyond the clinic. It's literally changing policy, changing laws in place to advocate for us what it looks for us. And speaking not only from my own personal experience but also what we've experienced as professionals and how we really have more power than just a nurse or bedside nurse. So it's really important so much things that you can do to really bring forth change in the communities that we serve. And having people that look like us can speak and advocate for us. Oh boy, I can't believe we have run out of time. I want to thank you and what a way to end, you know, to talk about advocacy because if you want to make the biggest change, it's really, like you said, talking to our politicians and making those changes when it comes to laws and where funding goes and money is spent to help reduce this black maternal mortality rate. So, I want to take the time out right now to say thank you to both of you. You shared a wealth of knowledge for our listeners and so many different strategies and even starting small you know even you know I'm we're pro-simulation so even simulation incorporating that into your nursing program can make a significant change. So again thank you for sharing your insight and we appreciate your support and we look forward to all of you joining us on our next episode. Thank you so much Kandis and Marie. Thank you so much. Thank you.