She didn't want to be a statistic. Now she's raising awareness of the Black maternal health crisis

The Shift: Taking note of a changing healthcare profession

Anitra MacVeety’s pregnancy was anything but textbook.

Over the course of 37 weeks, she faced a rare autoimmune condition that left painful blisters in her mouth, a short cervix that put her at risk for preterm birth, and life-threatening atrial fibrillation 24 hours after delivering her daughter.

She knew the statistics were particularly dire for someone like her, a Black woman in America, who statistically is 2.6x more likely to die from giving birth compared with non-Hispanic White women. Those numbers have been getting worse in recent years, not better.

MacVeety and her doctor, Dr. Rashmi Rao, a maternal-fetal medicine (MFM) specialist at UCLA Health, are now sharing her story to highlight the role clinicians can play in addressing the Black maternal health crisis.

MacVeety’s case is a study in how the healthcare system can be confusing and frustrating to navigate, putting the most vulnerable patients at a significant disadvantage. Black patients also are more likely to see their concerns minimized and face bias from healthcare professionals.

A 2022 study in Health Affairs, for example, looked at 40,000 notes and found that Black patients were 2.5x more likely than White patients to have a negative descriptor (like “resistant” or “noncompliant”) written in their medical record. 

“We all have to take responsibility for the system that we work in, and the system that we live in, and the history that comes before us,” Rao said. “My biggest message to my colleagues is that we all have work to do when it comes to this.”

MacVeety, by her own admission, is not afraid to advocate for herself, something that proved to be critical time and time again. 

First, there was the autoimmune diagnosis — or lack thereof. By her count, she saw more than two-dozen doctors — including a number who insisted she had herpes, even though she never tested positive for it — before a dental surgeon correctly identified pemphigus vulgaris, the rare blistering condition that left her unable to eat. 

After her diagnosis, she wanted to transfer to an MFM at the University of California, Los Angeles. But UCLA, she said, gave her the runaround, first wanting her to establish care with one of its own obstetrician-gynecologists, and then when she persisted, offering an MFM appointment several weeks out.

“All you read in the media, all you see, is that there’s a big disparity of Black women dying in childbirth,” she said. “I always had this uneasy feeling of am I going to be another statistic because they missed something?”

It was at her 19-week anatomy scan when she also learned that her cervix was shortening earlier than it should have been. And while she was initially told she didn’t need to worry, she and her husband decided to go to the emergency department later that night after she felt an increasing number of cramps. 

That’s when she finally met Rao, who would continue on as her OB for the rest of her pregnancy.

Standardizing protocols could help mitigate some of the disparities in outcomes that patients face, Rao said. But doctors still need to take into account social factors, like whether someone is facing housing, transportation or food insecurity. 

And sometimes, like in MacVeety’s case, it might mean more appointments, more reassurance and even just acknowledgement that the medical team understands the statistics and they’re paying close attention. 

MacVeety’s ordeal didn’t end with her delivery. Exactly 24 hours after giving birth, her heartbeat suddenly became fast and irregular. She knew enough to press for an EKG. After that, things happened quickly. A crash team raced to MacVeety’s room as her heart rate climbed as high as 287 beats per minute.

“You have to make the right call and do the right thing, which thankfully we did,” Rao said. “But these are also the same exact stories you hear from other places where [where the patient] was saying that I felt like I was dying, but I was ignored.”

Nearly two months later, MacVeety is off her heart medication and she and her daughter are doing well. She encourages other women to always ask questions (“never be afraid to ask them over and over.”) But she emphasizes she never wanted to be her own doctor. “The urgency isn’t quite there,” she said, “and that’s why you need to advocate for yourself.”

Are you a clinician with a story to share for Path to Recovery? Send me an InMail or leave a comment below.

The Payer Mix: Talking money in healthcare

Taking a new job can be a major headache for healthcare professionals. The credentialing process can take weeks, if not months, and requires reams of documents on education, licenses, board certifications, certificates of insurance and more. My husband, a neurologist, saw this first-hand when he received the job offer that took us out to California; getting his medical license took nearly six months back in 2015.

The process isn’t only a pain for clinicians, but also for their employers. At the peak of the COVID-19 pandemic, many states faced backlogs that severely limited their ability to bring on additional healthcare professionals at a time when they were desperately needed. And as more doctors, nurses and therapists eschew full-time employment in favor of contract work — something we’ve seen in LinkedIn data — the credentialing red tape is having significant impacts on their livelihoods, potentially driving them to quit practicing altogether.

Dr. Edwin Leap wants to restore sanity to the process. Read his op-ed for MedPage Today and join the conversation below:

Charting: What the numbers show

This year’s Match Day — when fourth-year medical students find out where they’ll be doing their residency — had a record high number of applicants. International medical graduates as well as osteopathy students largely drove the increase, according to the National Resident Matching Program® (NRMP®), which organizes the process. Even with the increase, the match rate remained the same — although the number of DOs being accepted into residency programs has been steadily increasing since 2019.

This is the first Match Day since the American Medical Association took aim at the process last year, vowing to “study alternatives ... which would be less restrictive on free market competition for applicants.” It also comes after a wave of unionization efforts from residents fed up with poor working conditions.

Here are some takeaways across specialties:

• Pediatrics filled only 92% of its positions, down from 97.1% last year, and dragged down the numbers for primary care overall. American Academy of Family Physicians, meanwhile, said family medicine is welcoming its largest class of residents, or 4,600 trainees. The specialty added 124 positions and filled 86.4% of its total residency spots. 

• Emergency medicine is making a comeback after being battered during the pandemic. The specialty used to be highly coveted, filling at least 98% of its spots each year. That changed as emergency rooms got walloped with COVID-19 cases; by 2023, the fill-rate had plunged 17.9 percentage points. This year, however, emergency medicine is once again attracting interest, filling as many as 95.5% of its positions.  

• Medical students still want to go into obstetrics and gynecology, despite the upheaval in women’s health that’s changing the way doctors are practicing medicine, particularly in states that have enacted abortion bans following the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization. The specialty filled 99.6% of its residency spots.