Addressing Medical Gaslighting to Improve Maternal Health—Together
We know talking about maternal mortality—the death of a person during pregnancy, at delivery, or soon after delivery¹—and the causes of these types of deaths is a sensitive topic. To make care safer for pregnant people, it is essential that everyone involved in their care contributes to creating an environment in which all patients and families feel comfortable expressing their health concerns, knowing they will be listened to by their healthcare providers.
Unfortunately, over 700 women die of pregnancy and delivery complications every year in the US, according to the Centers for Disease Control and Prevention (CDC)¹. Additionally, as many as 50,000 women experience severe, unexpected health problems because of pregnancy-related complications that may have long-term health consequences¹. In 2020, the CDC identified that Black women were three times more likely to die from pregnancy and delivery complications than White women, underscoring racial disparities that exist in the healthcare system based on multiple factors, namely implicit bias among healthcare providers and structural racism within the healthcare system². While every pregnancy-related death is tragic, it is especially tragic that two out of three of these deaths are preventable³.
A challenge that pregnant people may face when sharing concerns about their health, and that Black women and women of color may face in particular, is that when they share concerns with their healthcare provider, they are not always listened to. The term medical gaslighting has seen increased use in recent years, and refers to the experience of having one’s health concerns dismissed or minimized by a healthcare provider, causing one to question one’s memory or perception⁴ ̓ ⁵. The practice of gaslighting within healthcare has affected people’s health outcomes and lives for many decades, most often people of color and women⁴ ̓ ⁵.
A well-known example of pregnancy and delivery complications because of medical gaslighting is when tennis champion Serena Williams experienced a delay in care that led to an emergency surgery following the birth of her daughter in 2017. In a 2018 Vogue interview, Williams shares that she began experiencing shortness of breath following an emergency C-section and recognized the symptoms as that of pulmonary embolisms, based on a previous experience with blood clots. Despite her request for a CT scan and blood thinner, the healthcare staff initially dismissed her concerns and request. The delay in care she experienced ultimately led to an additional emergency surgery⁶. This is just one example of patient harm because of medical gaslighting, but it highlights an experience shared by many women across the US.
In an effort to improve communication between healthcare providers and patients, the CDC created the Hear Her campaign⁷. This initiative highlights the importance of engaging pregnant patients in conversation about their care and listening to their questions and concerns to ensure safe care for all pregnant patients. The goal of the campaign is “to encourage partners, friends, family, coworkers, and providers—anyone who supports pregnant and postpartum women—to really listen when she tells you something doesn’t feel right. Acting quickly could help save her life.” Similarly, the White House Blueprint for Addressing the Maternal Health Crisis has established a goal to “Ensure Those Giving Birth are Heard and are Decisionmakers in Accountable Systems of Care⁸.” The Healthy People 2030 initiative, which provides 10-year national health objectives, has also established the prevention of pregnancy complications and maternal deaths as one of its national goals⁹.
While there are steps individual patients and healthcare providers can take to help address medical gaslighting and reduce maternal mortality rates, this pressing issue requires that everyone involved in patient care take a collaborative approach to effectively and sustainably improving patient safety in a variety of healthcare settings.
What You Can Do
Your healthcare organization can invest in programs, policies, and initiatives that support efforts to improve health equity and maternal health outcomes. Specifically, your organization can identify and address structural racism within its own systems and any unconscious biases held by its staff members by using resources like Think Cultural Health, an initiative sponsored by the US Department of Human Service’s Office of Minority Health that is dedicated to advancing health equity at every point of contact.
Here are additional resources to help your organization learn more about advancing health equity to make care safer for all pregnant patients.
Resources
Think Cultural Health Maternal Health Care Resources
A free e-learning program designed by the US Department of Human Service’s Office of Minority Health to help healthcare providers and students seek information and resources related to cultural and linguistic competency with an aim to advance health equity at every point of contact.
Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them
A 2022 Kaiser Family Foundation brief that provides an overview of racial disparities for selected measures of maternal and infant health, discusses the factors that drive these disparities, and provides an overview of recent efforts to address them.
A 2022 BMJ Quality & Safety article on a quality improvement and patient safety initiative in Utah that demonstrates the importance of including race and ethnicity data in quality improvement projects. By disaggregating their data, they were able to identify racial disparities in severe maternal morbidity from hemorrhage and make targeted improvements.
Alliance for Innovation on Maternal Health
A quality improvement initiative to support best practices that make birth safer, improve maternal health outcomes, and save lives.
Communities in Action: Pathways to Health Equity
A 2017 report from the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, and Committee on Community-Based Solutions to Promote Health Equity in the United States.
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity
A 2021 consensus study that explores how nurses can work to reduce health disparities and promote equity, while keeping costs down, using technology, and maintaining patient and family-focused care into 2030.
References
Centers for Disease Control and Prevention. Maternal Mortality. CDC Reproductive Health. Published September 16, 2022. Accessed February 23, 2023. https://www.cdc.gov/reproductivehealth/maternal-mortality/index.html
Hoyert DL. Maternal Mortality Rates in the United States, 2020. National Center for Health Statistics Health E-Stats. Published November 7, 2022. Accessed February 28, 2023. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm
Centers for Disease Control and Prevention. Pregnancy-Related Deaths in the United States. HEAR HER Campaign. Published November 14, 2022. Accessed February 28, 2023. https://www.cdc.gov/hearher/pregnancy-related-deaths/index.html
Witvliet MG. How COVID-19 Brought Medical Gaslighting to the Forefront and Made Invisible Illness Visible: Lessons from the BIPOC Long COVID Study. In: Palermo S, Olivier B, eds. COVID-19 Pandemic, Mental Health and Neuroscience - New Scenarios for Understanding and Treatment [Working Title]. IntechOpen; 2022. doi:10.5772/intechopen.107936
Onque R. How to recognize “medical gaslighting” and better advocate for yourself at your next doctor’s appointment. CNBC. Published September 1, 2022. Accessed February 22, 2023. https://www.cnbc.com/2022/09/01/medical-gaslighting-warning-signs-and-how-to-advocate-for-yourself.html
Haskell R. Serena Williams on Motherhood, Marriage, and Making Her Comeback. Vogue. Published January 10, 2018. Accessed February 23, 2023. https://www.vogue.com/article/serena-williams-vogue-cover-interview-february-2018
Centers for Disease Control and Prevention. CDC’s Hear Her Campaign. Centers for Disease Control and Prevention. Published November 17, 2022. Accessed February 23, 2023. https://www.cdc.gov/hearher/index.html
White House Blueprint for Addressing the Maternal Health Crisis. The White House; 2022. Accessed February 23, 2023. https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf
US Department of Health & Human Services. Pregnancy and Childbirth. Healthy People 2030. Accessed February 28, 2023. https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth