OB-GYN, PTBi Postdoctoral Research Fellow
I was definitely one of those kids who always knew I wanted to be a doctor even when I was really small. I come from a big family, I’m the eldest of five. But my parents are the eldest of seven and nine respectively. So, there were and continue to be lots of announcements of pregnancies and births and I really valued that family unit and initially wanted to go into pediatrics. It was during medical school that I shifted into obstetrics and gynecology because I realized that there were a lot of really important foundations for that family unit that start before birth, that allow individuals and communities to have the outcomes we all want to see realized.
Also, I really liked surgery and I found pregnancy to be really fascinating. It’s incredible how our patients are able to bring life into this world. Then in residency, I gravitated towards high-risk pregnancies because I recognized that while pregnancy can be a very joyous experience when there are additional risks, it can quickly shift into something else. So to be able to help patients negotiate and feel empowered through those challenges felt invaluable.
For my Black patients, the challenge is racism and feeling like their voice is not being heard in their prenatal care. It could be concerns about the timing of the intervention you are or are not being offered, or your interactions with your provider or even the front desk staff. It’s always heartbreaking to hear.
Patients shouldn’t have to necessarily advocate for themselves to get the care that they deserve. Even with medical training or having a higher education level, we know that those things are not necessarily protective against the adverse outcomes we see for Black women. While I’ve been disheartened, I’m also appreciative to hear those experiences from other black female professionals because that helps me really advocate for a change in our clinical settings.
Aspirin has been studied in pregnancies, I think dating back to the 60s and it’s been found to decrease the risk of preeclampsia significantly. Preeclampsia is a pregnancy disease that results in high blood pressure and other potentially life-threatening consequences for both the mother and baby. It alsohas been found to decrease the risk of preterm birth, it seems to also decrease the risk of stillbirth in neonatal death.
Some academic centers have already moved to offer aspirin to all their prenatal care patients because of the thought that it’s fairly low risk, it’s inexpensive, and even decreases risk in low-risk patients. At the same time, there are others who feel hesitant to recommend an intervention to all pregnancies, because any time you give something to more people, there’s a higher chance of side effects that you didn’t expect coming up. Not to mention, I think there’s a very important conversation happening around the medicalization of pregnancy rather than recognizing that pregnancy and birth is a natural process that is not always complicated and is not inherently a disease state.
This process of pregnancy is not a disease state. And so really wanting to be respectful to that process and recognizing that we’ll never be able to bring the risk of the pregnancy down to zero, is it really necessary to provide every single intervention that you can? So, while we’re having these conversations in our professional healthcare settings, I don’t see a lot of engagement of patients and communities on their thoughts. I think a lot of patients don’t always have the information to know to even ask about Aspirin and that’s even in patients who have very clear risk factors for whom there’s very little debate that aspirin would be very beneficial.
There are now guidelines that suggest that providers recommend aspirin, around 81mg, to patients based on risk factors starting at 12 weeks gestation and continuing onward. And one of those risk factors that’s listed is being Black or African-American race.
But how does this comes across to patients, the fact that they are being recommended Asprin because of their race? Does it make Aspirin seem more acceptable or less acceptable? I am interested in really unpacking that with Black patients. In addition, I’m really interested to understand if prenatal care providers are even doing this. Are they prescribing Aspirin more frequently to their African-American and Black pregnant patients? If they are, how are they having these conversations with patients? Are they talking with them about the patient’s increased risk? And if they’re not, what also informs that decision? Because we do know that there is an increased risk of complications from these hypertensivedisorders in the Black community.
So that is why I am leading the Pregnancy, Race, and Aspirin – eXploration of Individuals’ Stances (PRAXIS) Study. It’s important to think about how to use this intervention, but how to use it equitably and in a way that’s respectful of patients’; priorities. I’m hoping that this study will help us understand how Black women and birthing people want their race to be integrated into their healthcare and what role they think it should play and how providers should address it in conversations and make sure that however we do it, we’re not decreasing their confidence in an intervention that has a lot of evidence to support its benefit.