Indy Lane, MD, is a force in the field of obstetrics and gynecology. As the leader of The Mother Baby Center, a partnership between Allina Health and Children’s Minnesota, Dr. Lane has dedicated her career to improving women’s health and addressing disparities in Black maternal care.
She says, “When we have healthy mothers and babies, the communities we serve thrive and we thrive as a nation. Everyone wins.” It seems so simple. But Black women are still three times more likely to die in pregnancy than white women.
Dr. Lane is working hard to change that. Keep reading to learn why she chose to become an OB-GYN and her candid thoughts on what equity actions must be taken to help Black moms thrive.
Please tell us about yourself and what drew you to your profession.
Indy Lane: I was drawn to obstetrics and gynecology in medical school because it offered continuity of care along with the opportunity to participate in the birth of a baby and gynecologic surgery. Caring for women throughout their lifespan is what I found to be the most rewarding aspect of women’s health. In my opinion, the most important part of taking care of a patient is understanding them as a person and what is most important to them from a health care perspective.
Becoming an OB-GYN allowed me to really get to know my patients beyond one medical condition or one stage of their life. As their OB-GYN I had the privilege of participating in some of the most exciting stages in a woman’s life like starting college, getting married, and/or starting a family. I would see them through times of great turmoil or loss whether it was a difficult pregnancy, a divorce, or the loss of a job or a loved one. All of life’s events and the environment in which we live can impact an individual’s health and the capacity to do what is needed to be healthy. Over the years my patients and I developed mutual trust, understanding and accountability.
Why do you feel there should be more focus on Black maternal health and what actions are you taking to strengthen it?
Indy Lane: Despite advancements in health care technology and resources in this country, it is a tragedy that Black women are dying at a rate that is three times higher than other racial groups. We are seeing improvement in pregnancy outcomes in other racial groups which is outstanding, but the persistent gap in Black maternal health strongly suggests there is a problem that must be addressed. But it is a very complex issue which is why we are struggling to fix it.
Despite the rates, I believe most providers want the best outcomes for their patients. Unfortunately, as providers we are often not given the tools in our medical training to recognize our blind spots and how they negatively impact care.
Before we will see notable change, we have to acknowledge the role systemic racism and implicit bias has played in health care delivery. These forces have not only contributed to poorer health outcomes but an overall distrust of the health care system. There is a genuine fear among Black women regarding their ability to get safe and equitable care in hospitals because of historical events and modern-day stories of young Black women dying during childbirth or in the postpartum period.
We need to do a better job of just listening to patients. As health care providers, we have a tendency to communicate what is most important to us as the provider for their care rather than seeking to understand what the patient feels is most important. Because providers are faced with less time to spend with patients, we often walk into the exam room with a plan based on a review of the patient’s medical record. With this approach the patient does not feel safe or that her concerns matter. For instance, I can tell the patient how important taking an iron supplement is for the treatment of anemia but if I do not get a sense of why she isn’t taking it, I cannot improve her ability to be consistent. Another example is cultural or religious norms that may go against medical recommendations. Now we are encouraging more of a shared decision-making model where patients can actively participate in the management decisions for their care, instead of providers dictating care to patients.
We have a better understanding of how barriers such as language, transportation, housing insecurity, food insecurity, mental illness and substance use disorders impact outcomes for patients. Now processes have been developed to connect patients with resources to address social determinate of health barriers or referrals to mental health consultants. We are improving our approach to substance use disorder with care pathways that provide nonjudgemental, trauma informed care to patients. Since so many patients struggle with getting to the provider’s office for an in person visit, we must leverage technology with remote patient monitoring or virtual visits to limit the burden on patients. To rebuild trust and make positive changes in maternal and neonatal outcomes we need more resources to identify patients early and connect them to care.
Finally, increasingly we are recognizing the need to go into the communities we serve to listen and seek to understand what their concerns or fears are regarding health care. We must rely on members of the religious community and community advocacy groups to help health care leaders disseminate education about the importance of seeking care early in pregnancy. Through these forums we also need to create more awareness of chronic diseases that are impacting pregnancy outcomes and the overall health in communities of color. The increasingly sedentary lifestyles of Americans and the surge in the availability of ultra processed foods are really accelerating the rise of chronic diseases such as obesity, hypertension and diabetes in Black and Brown communities. All of these factors make the Black maternal health crisis worse in America.
Where have you seen progress?
Indy Lane: Today, health care systems are looking at clinical outcomes among various racial groups which was not typical when I was in medical school or residency training. This helps us recognize where disparities exist so we can work to improve them.
The implementation of standardized protocols enables providers to treat conditions like hypertension based on the best evidence. Since the protocol is standardized and is initiated based on the patient meeting certain criteria, it eliminates bias in care. There is a focus on cultural competence and implicit bias training in health care so we can understand some of our blind spots when caring for patients of color.
There is the recognition of the importance of having a health care advocate during a woman’s prenatal care, birth and postpartum period. Doulas and community health advocates are being leveraged by some health systems to ensure women are supported by someone they trust and who empowers them to advocate for their care. I am a big supporter of midwifery care for appropriate patients or in collaboration with a physician for patients with high-risk conditions. Traditionally, cultural competence, shared decision making and patient advocacy are ingrained in midwifery education which helps patients feel respected and heard.
Finally, we know that maternal outcomes are better when we have diverse provider teams. We must be intentional about recruiting care team members that reflect the communities we serve. Diverse care team members help to hold each other accountable for providing culturally competent care. It also helps patients feel safe seeing team members they feel can relate to them.
What are the biggest challenges?
Indy Lane: In this country we still struggle with the difference between equality and equity. We must acknowledge that everyone does not have the luxury of the same opportunities for a quality education, career advancement and health outcomes based on historical perceptions and implicit biases. Health equity is not about taking from one group to give to another. Instead, it requires providing the resources necessary to ensure everyone has the same opportunity for the best outcomes possible. The issues we are seeing go beyond what happens within the walls of the hospital. There must be notable changes in the community to help support better opportunities for all in order to improve health outcomes. When we have healthy mothers and babies, the communities we serve thrive and we thrive as a nation. Everyone wins.
What actions should health care professionals take to positively impact Black maternal health?
Indy Lane: While closing the gap in the disparities in birth outcomes is an extremely complex issue, I am of the mindset that the first step is simply listening and seeking to understand the individual patient. As health care providers, we can overlook the person and focus our attention on our desired outcome for the patient. Maya Angelou said, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” We need to start by making Black women feel heard, understood and safe.
Are there actions individuals outside of health care can take to positively impact Black maternal health?
Indy Lane: Black maternal and neonatal health outcomes are also a reflection of the overall health and well-being in the Black community. Black communities are challenged with rising rates of chronic diseases such as obesity, high blood pressure and diabetes. Helping the community shift cultural norms around traditional foods that are unhealthy, increasing access to healthier yet affordable food options, and increasing physical activity will be critical to moving the needle on maternal and neonatal outcomes. We need continued funding from the government for public health programs around healthy pregnancy education, the importance of early prenatal care and signs and symptoms of life-threatening complications of pregnancy.
With technology and social media, we can convey public health messages about maternal health and reach millions of people. The key will be doing it in a way that captures the attention of people much like the public service announcements for smoking.
Thank you, Dr. Lane, for thoroughly laying out why we see stubborn disparities in Black maternal health and the action needed to address them. Thank you also for your deep commitment to the health of all women. We can’t have a healthy community without healthy moms and babies. We are lucky to have you here in Minnesota.
