A dual antibiotic infection prevention bundle achieved a 58% reduction in surgical site infections after hysterectomy, according to a retrospective study in the 

International Journal of Gynecological Cancer

The research was conducted at the Moffitt Cancer Center, which is located on the campus of the University of South Florida in Tampa.

First author Michelle Kuznicki, MD, was a resident in ob/gyn at the University of South Florida at the time of the study. “We performed a literature search and institutional assessment with the help of our Department of Infection Prevention to identify potential opportunities for quality improvement in surgical infections,” he said.

Based on the literature, a bundled intervention was created that included dual antibiotic prophylaxis (cefazolin and metronidazole) aimed at reducing surgical site infections for all patients undergoing hysterectomy. 

The bundle also importantly contained the antiseptic chlorhexidine gluconate (CHG) for vaginal preparation.

“Organ space infection is not comprised of vaginal cuff infection alone and due to the bundled nature of this intervention, we cannot determine which component most strongly contributed to this observed outcome,” Dr. Kuznicki said.

The study comprised 358 women (median age 58) undergoing hysterectomy for any indication, benign or malignant, at the surgically diversegynecologic oncology practice of Moffitt Cancer Center between January 2016 and January 2017. 

Indications for surgery varied widely and a mixed cohort of open and laparoscopic cases was included.

Patients were divided into two groups: those who had surgery during the 6 months prior to the intervention (pre-bundle) (n = 178) and those who had surgery during the 6 months following the intervention (post-bundle) (n = 180).

The post-bundle cohort attained a 58% reduction in rate of surgical site infection: 3.3% vs. 7.9% pre-bundle. This was mostly attributed to a reduction in organ space infection, including vaginal cuff abscesses: 0.6% vs. 4.5%, respectively.

“Although we expected to see some degree of infection reduction after hysterectomy with our bundled intervention, we were surprised at the significant 58% reduction in surgical site infection after bundle implementation,” Dr. Kuznicki told 

“The bundle was associated with a reduction specifically in organ space infection, a clinically important outcome which often requires hospital admission, IV antibiotics and/or procedural intervention for resolution.”

Not only were infections averted in open surgical cases with the infection prevention bundle, but there was a reduction in infection after laparoscopic hysterectomy as well.

The study also found that mean length of stay was shorter post-bundle than pre-bundle: 2.7% vs. 3.2%. The 30-day re-admission rate was also lower: 2.2% vs. 6.7%, respectively.

“By demonstrating safety with these interventions and the associated improved outcomes, they are reasonable to implement into clinical practice,” said Dr. Kuznicki, who is currently a gynecologic oncology fellow at Cleveland Clinic in Ohio. “Surgical site infection reduction after hysterectomy is an important endpoint for patients, caregivers, and payers.”

Given the bundled nature of the intervention, the investigators were unable to identify which components most heavily contributed to infection prevention. Furthermore, the study is subject to intrinsic bias because of the non-randomized and retrospective study design.

“Reflecting on this experience, a big challenge to long-term infection prevention is maintaining team compliance with infection prevention measures over time,” Dr. Kuznicki said. 

“Therefore, we encourage multidisciplinary involvement when instituting and maintaining such measures, along with interval re-education efforts. This can help to continually engage staff members and trainees who are integral to infection prevention.”

Additional data from prospective, randomized studies of dual antibiotic prophylaxis and vaginal preparation will allow clinicians to determine associated risk reduction and optimize the care of hysterectomy patients.

Dr. Kuznicki reports no relevant financial disclosures.

Kuznicki M, Mallen A, McClung EC. Dual antibiotic prevention bundle is associated with decreased surgical site infections. 

. Published online July 29, 2020. doi:10.1136/ijgc-2020-001515

Articles

Does dual antibiotic prevention and vaginal prep decrease surgical site infections?

 spoke with Drs. Vanessa Rogers and Shawna Nesbitt about racism and unconscious bias in ob/gyn for the August issue. 

Following the written piece, we sat down with Drs. Rogers and Nesbitt to get their additional insight and expertise on overcoming racism and unconscious bias in their practices, and what you can do to ensure a more inclusive environment for colleagues and patients.

In this video, Drs. Rogers and Nesbitt break down the differences between equality and equity. They are not interchangeable terms. In fact, they mean very different things. As Dr. Nesbitt put it, 

“Equality is when everyone gets the same. Equality is when everyone comes up to the same.”

Watch the full-length interview with Drs. Rogers and Nesbitt 

 for the full, peer-reviewed article from the August issue.

Videos

In this video, Drs. Rogers and Nesbitt break down the differences between equality and equity. 

Equality vs. Equity: What's the difference?

The Food and Drug Administration (FDA) continues its post-market evaluations of Essure devices and aims to keep information as updated as possible. Yesterday, on August 11, 2020, the FDA posted the first spreadsheet of adverse event reports.

The information was obtained via social media sources and, as such, may reference information already reported to the FDA. The information in the spreadsheet may not represent new adverse events.

In this spreadsheet, the FDA reviewed reportable events, with the nature and severity of the reports consistent with Medical Device Reports (MDRs) received for Essure since 2017.

The reports mentioned above were received from Bayer, manufacturer and seller of Essure until 2018. From now until April 2021, Bayer will continue to provide spreadsheets of reports and provide analysis reports detailing the information.

View the 522 post-market surveillance studies 

Yesterday, on August 11, 2020, the FDA posted the first spreadsheet of adverse event reports. 

FDA provides new information on Essure device

As we learned from Drs. Crissman and Stroumsa in 

Gynecologic care considerations for transmasculine people

, transgender and nonbinary people face disproportionate rates of stigma and discrimination in seeking healthcare—and may encounter additional unique barriers in attaining gynecologic and reproductive care.

Steps clinics can take to create a safe, supportive, and welcoming environment for transgender and nonbinary people include training frontline staff in cultural competency training such as pronouns and names used (“preferred”), ensuring intake forms avoid cisgender assumptions, having gender-neutral bathrooms, and posting lesbian-, gay-, bisexual-, transgender-, queer-positive friendly signage.

Thank you for participating in our poll. Stay tuned for more coverage on transmasculine care for the ob/gyn.

Poll

There are several steps clinics can take to create a safe, supportive, and welcoming environment for transgender and nonbinary people. Is your hospital and/or practice one of them? 

Poll: Training in transgender care

Women who reported more frequent and severe hot flashes had a smaller increase in the stress hormone cortisol after waking up, according to a prospective study in the journal 

“Research has observed a relationship between more severe hot flashes and an increased risk for cardiovascular disease, but the mechanisms underlying that relationship are unknown,” said principal investigator Jennifer Gordon, PhD, an associate professor of psychology at the University of Regina in Saskatchewan, Canada. 

“Alterations in the stress axis, or hypothalamic-pituitary-adrenal (HPA) axis, have been proposed to be an underlying mechanism. Thus, this study aimed to look at the connection between hot flashes and activation of the HPA axis.”

A total of 101 perimenopausal women, ages 45 to 55 years, from Regina, completed a 24-hour hot flash diary assessing frequency and severity of vasomotor symptoms (VMS), once a week for 12 weeks.

Participants also provided two saliva samples weekly for the measurement of the cortisol awakening response (CAR): immediately upon waking and 30 minutes postwaking. A urine sample was also collected weekly for the measurement of a urinary metabolite of estradiol and progesterone: estrone-3-glucuronide and pregnanediol glucuronide, respectively.

General linear models examined the between-subject relationship of mean VMS symptoms and mean CAR, whereas multilevel modeling was used to examine the relationship between within-person weekly changes on weekly CAR.

Although within-subject weekly change in VMS bother, frequency, and severity were not significantly related to weekly CAR, there were several significant changes in between-subject effects of VMS on the CAR. As a result, the total number of hot flashes, overall VMS severity and VMS bothersome were each significantly associated with a blunted CAR.

Outcomes remained significant, despite statistically adjusting for levels of estrone-3-glucuronide, pregnanediol glucuronide, and self-reported sleep quality.

“Because research examining the relationship between hot flashes and cortisol has been mixed so far—some found a relationship, some did not—I really did not know what to expect,” Dr. Gordon told 

. “Our study has the advantage of measuring hot flashes and cortisol a total of 12 times, which might have allowed us to see a relationship where other studies have not.”

The increase in cortisol that occurs when a person wakes up is considered adaptive, according to Dr. Gordon, noting that it is a healthy response and believed to be the body's way of preparing for the day. 

“But a smaller increase in cortisol has been linked to an increased risk for cardiovascular disease,” she said. “So the fact that women with more hot flashes have a smaller increase in cortisol in the morning supports the idea that dysregulation of the HPA axis may play a role in linking hot flashes with an increased risk for cardiovascular disease.”

Study results also indicate that treating hot flashes may have benefits for women's cardiovascular health.

However, because the study was observational, “more research is needed to determine whether hot flashes cause a change in the activation of the HPA axis or whether it is the other way around,” Dr. Gordon said.

Dr. Gordon reports no relevant financial disclosures.

Sauer T, Tottenham LS, Ethier A, et al. Perimenopausal vasomotor symptoms and the cortisol awakening response. 

. Published online June 22, 2020. doi:10.1097/GME.0000000000001588

Women who were in the top third of hot flash severity showed a 67% increase in cortisol, whereas those in the bottom third of hot flash severity showed only a 30% increase. 

Vasomotor symptoms, cortisol awakening response in perimenopause

It also may enable more patients to have primary surgery, reduce the burden on the surgical team to schedule more complex procedures, and help eliminate the need to involve other specialties in the procedures.

The findings are from a prospective United Kingdom study in the journal 

“The aim of surgery for patients with advanced ovarian cancer is to remove all visible disease in the pelvis and abdomen,” said co-author Nikos Akrivos, MD, PhD, a consultant gynecological oncologist and head of the 3rd Department of Gynecologic Oncology at Hygeia Hospital in Athens, Greece. 

“However, there is significant variation in surgical technique among gynecological oncologists. Also, marked differences in the presence of disease in the upper abdomen remain one of the main reasons for not achieving the desired surgical outcome.”

The aim of the study was to present the experience of Dr. Akrivos and his surgical colleagues in developing surgical skills required to resect metastatic ovarian cancer in the upper abdomen. 

The study comprised 126 patients undergoing cytoreductive surgery at Norfolk and Norwich University Hospital, United Kingdom, for stage IIIC and IV epithelial ovarian cancer that required at least one surgical procedure in the upper abdomen. At the time the research was done, Dr. Akrivos was a subspecialty fellow in gynecologic oncology at that hospital.

Patients were divided into three equal groups: Group 1, which underwent surgery between December 2012 and July 2014; Group 2, which had scheduled surgery between August 2014 and March 2016; and Group 3, which underwent surgery between April 2016 and March 2018.

The percentage of patients undergoing primary surgery in groups 1, 2 and 3 was 47.6%, 50.0% and 73.8%, respectively (

In comparison to groups 1 and 2, Group 3 had a significant increase in the percentage of patients undergoing cholecystectomy (

 = 0.02); resection of disease from porta hepatis (

 < 0.001); and celiac trunk lymphadenectomy (

But among the three groups, there was no difference in the percentage of patients undergoing splenectomy, diaphragmatic peritonectomy/resection and gastrectomy.

Complete cytoreduction was achieved in 54.8%, 35.7%, and 64.3% of patients in groups 1, 2 and 3, respectively (

There was also no significant difference in the occurrence of grades 3 to 5 complications among the three groups.

However, a liver surgeon was required in 9.1%, 5.6%, and 0% of cases in groups 1, 2 and 3, respectively.

“We found that aggressiveness of cytoreductive surgery increased with time, as reflected in the percentage of patients that had optimal surgical outcome,” Dr. Akrivos told 

“This is to be expected, as our knowledge and surgical skills improved during the study period. Interestingly, we observed no increase in the rate of complications, despite an increase in surgically complex cases. This likely is due to our multidisciplinary approach to perioperative care management,” Dr. Akrivos said.

The study underscores the need to train and educate gynecological oncologists in acquiring skills for performing surgery on the upper abdomen. 

“Collaboration with colleagues from other disciplines such as hepatobiliary or upper gastrointestinal tract surgeons is required to develop or improve surgical skills,” Dr. Akrivos said. “Cadaveric training is also necessary to improve understanding of the relevant surgical anatomy.”

Furthermore, collaborating with multiple gynecological oncology surgeons in complex upper abdominal procedures can facilitate learning, according to Dr. Akrivos, whereas monitoring of surgical morbidity is of greatest importance.

“In short, surgical management of metastatic ovarian cancer can be safely assigned to gynecological oncologist surgeons,” Dr. Akrivos said.

Dr. Akrivos reports no relevant financial disclosures.

La Russa M, Liakou CG, Akrivos N, et al. 

. Learning curve for gynecological oncologists in performing upper abdominal surgery. Published on July 17, 2020. doi:10.23736/S0026-4784.20.04605-5

Training gynecologic oncologists to perform cytoreduction for advanced ovarian cancer can result in better outcomes for patients, according to results of a new study

Better outcomes when gyn oncs are trained to perform upper abdominal surgeries

“Medicare has long undervalued office visit services provided by internal medicine and other cognitive and primary care physicians, and CMS’s decision to move forward with higher payments for E/M services is a major step toward recognizing the importance of these services to our patients,” Jacqueline W. Fincher, MD, MACP, president of ACP, says in a recent news release.

The new payment rates are part of the proposed Medicare Physician Fee Schedule for 2021, which will take effect on Jan 1.

“The improvements that CMS has included in the proposed fee schedule for 2021 will go a long way to help physician practices next year and in the future. However, more still needs to be done to support physician practices, particularly primary care practices, to weather the COVID-19 pandemic,” Fincher says.

For more information on the proposed fee schedule, visit 

The American College of Physicians (ACP) expressed support for the Centers for Medicare and Medicaid Services’ (CMS) changes to the Medicare fee schedule. 

ACP supports new Medicare fee schedule

 recruited 173 women aged 45 to 72 (mean age 57.8 years) with good oral hygiene and a mean of 23 functional teeth from the Departments of Rheumatology and Endocrinology at Jaen General Hospital in southern Spain between 2016 and 2018.

Of the 173 women, 70 were healthy with normal BMD, whereas the remaining 103 women had decreased BMD (61 with osteoporosis and 42 with osteopenia). In addition, 22 women reported smoking between 1 and 20 cigarettes per day, of whom 12 had osteoporosis/osteopenia.

More than 90% of women with osteoporosis/osteopenia were postmenopausal, which was the most frequent cause of low BMD.

Moderate or severe periodontitis was present in 52.6% of the study population. This prevalence is comparable to that in oral health surveys conducted in Spain.

“Theoretically, the general bone loss derived from osteoporosis would also involve jawbones, favoring the bone loss observed in periodontitis and increasing the risk of tooth loss,” wrote the authors.

The authors also noted that osteoporosis and periodontitis have common risk factors, including age, genetics, hormonal changes, smoking habits, corticosteroid treatment, and low serum calcium and vitamin D levels.

To assess the severity of periodontal disease, the percentage of sites with a clinical attachment level (CAL) ≥ 4 mm and ≥ 6 mm was recorded.

Age was a modifiable variable for the association between osteoporosis and periodontitis: women older than 58 years with low BMD had a higher mean percentage of sites with CAL ≥ 4 mm, as well as more severe cases (CAL ≥ 6 mm), compared with controls. These findings were independent of tobacco consumption, oral hygiene or serum levels of 25-OH vitamin D or calcium.

For CAL ≥ 4 mm, the probability of having osteopenia/osteoporosis was 27.40% more likely (95% confidence interval [CI]: 12.19 to 42.61) for each unit of increase (mm) in clinical attachment loss.

In cases of CAL ≥ 6 mm, the probability increased by 13.62% (CI 95%: 1.49 to 25.75) for each unit of increase.

These associations were detected when osteoporosis and osteopenia were analyzed independently, although a significant connection was not seen between osteopenia and severe cases of periodontitis.

Significant differences in study results were not found in women under age 58 years.

“Findings such as ours imply that postmenopausal women, facing estrogen-related loss of bone density, may challenge clinicians to properly diagnose and correctly assess the risk for periodontitis,” wrote the authors. 

“It is of vital importance that physicians and nurses caring for women with decreased BMD refer their patients to dentists for appropriate diagnosis and treatment. This multidisciplinary approach will further unite the medical and dental efforts to achieve overall patient wellness.”

The authors said longitudinal studies, larger sample sizes, and trials evaluating the effect of medication for osteoporosis on CAL would lend scientific credence to the findings of the current study.

Gil-Montoya JA, Garrido-Martinez M, Barrios-Rodriguez R, et al. Association between low bone mineral density and periodontitis in generally healthy perimenopausal women. 

. Published online July 27, 2020. doi:10.1002/JPER.20-0029]

A prospective study of generally healthy perimenopausal women has concluded that low bone mineral density (BMD) is significantly linked with periodontal disease in women over 58 years old, and independent of tobacco consumption or oral hygiene.

Low BMD linked to periodontitis in perimenopausal women

Little is known about whether maternal vaccinations during pregnancy impact early childhood health outcomes in children. A literature review in 

sought to understand more about the possible impacts.

Of 3647 records, 9 met the inclusion criteria and all had a study period between 1980 and 2012. In these few studies, researchers found that in-utero exposure to an influenza vaccine was not linked to adverse outcomes in early childhood but emphasize the need for further research.

For details on this literature review, visit 

A literature review in Pediatrics sought to understand more about the possible impacts. 

Can maternal flu shots during pregnancy negatively impact early childhood health outcomes? 

: Like many Americans, I watched the video of the killing of George Floyd with horror. In the days that followed, I found myself thinking, '

What can I do to improve the problem of racism in America?' 

Racism is so prevalent that we as individuals cannot wait for someone else to solve the problem. We must each set out to do our part starting in our own community, specifically our own clinical space. 

is Professor, Department of Obstetrics and Gynecology Chief, Division of Education and Faculty Development, and Norman F. Gant, Jr., M.D. Chair in Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas.

is Professor, Department of Internal Medicine, Division of Cardiology, Hypertension Section, and Associate Dean for Student Affairs, Office of Student Diversity and Inclusion, UT Southwestern Medical Center Dallas, TX

I reached out to a physician I greatly admire, Dr. Nesbitt. As the Associate Dean of Student Diversity and Inclusion, she has provided me mentorship on racism and bias in medical education before. 

I sat down with Dr. Nesbitt to discuss what obstetricians and gynecologists can do to reduce racism and unconscious bias in their practice.

I want my Black patients to feel understood, cared for, and safe. Are there practical ways I can send that message to my patients?

: It is important for all patients to feel heard and seen by their health care provider. Because of life experiences, Black patients will see a White physician with some degree of distrust. Therefore, physicians must train themselves to see their patients differently.

That may mean setting aside longer appointment times so there can be better communication. It is also helpful to have staff in the office that reflect the patient population you see so patients feel more comfortable. 

The importance of the office staff cannot be understated. A patient’s first experience with the physician is through the staff. If the staff does not make the patient feel comfortable, it will affect how the patient interacts with the physician.

What is the role of positive imagery? Certainly, when people are exposed to positive ideas related to a minority group, it will affect how they see that group as a whole. What do you think about having materials in the office that celebrate the contributions and achievements of Black people and other underrepresented groups in America?

: Positive imagery is very important. Physicians should look at the materials they are handing out in the office to make sure that those materials reflect the patient receiving them. Perception is critical, and positive imagery can increase patient trust.

There are well-documented racial disparities in pain management. The myth that Black people are resistant to injury and pain has been carried through medical history. False beliefs are still present today, and contemporary studies have shown that it causes health care providers to undertreat the pain experienced by Black patients.

As ob/gyns, pain management is an important part of what we do. There has been a great deal of attention given to following a standard multimodal approach to pain management.

 How do we recognize and prevent racial bias while remaining mindful of opiate misuse?

: Knowing that such bias exists is the first step. A self-audit of your own practice may also be very helpful.

 Looking at how you prescribe pain medication to patients of different races can make you aware of what you may be doing unconsciously so you can correct it. 

Specifically, reviewing trends in both inpatient and outpatient prescribing, dosages given in relation to pain scores, patient functionality, and patient education regarding pain expectations can help the physician ensure that all patients are receiving the highest quality care. 

There are studies documenting bias in contraception.

 Contraceptive choices are complex, influenced by cultural and societal values as well as access. 

There is a risk that we could allow our unconscious bias to influence our contraception counseling. Trust is a huge factor in all patient encounters, no less so in family planning. However, in a country where Black Americans have been victimized in medicine, how do ob/gyns build that trust?

t: The experiences of Black people in medicine has been seen as its own topic when really it is an integral part of American history. So it’s not taught the same way, and people are therefore largely unaware. There are subtle ways for physicians to acknowledge this history. 

Action is, of course, more important than words. It is not for the physician to provide a history lesson. Rather, it is for the physician to demonstrate an appreciation for how their patients may feel.

The rate of maternal mortality is 3 to 4 times higher in Black women than in White women. This holds true for severe morbidity as well.

 It is a complicated issue with many contributing factors. We need to address this, and it must be a priority. 

The Black Maternal Health Caucus has introduced legislation that will do just that. Patient-centered care and increased access to services helps, but what can general ob/gyns do in their offices to improve the experience for pregnant Black patients?

: Each ob/gyn needs to ask themselves the question, “How is systemic racism manifested in this office?” Systemic racism is a difficult concept to understand. It is not a problem with an individual. 

It is embedded in processes that affect one group disproportionately. So physicians can look at their practices and see how the system in place affects certain patients in a negative way.

Difficulties with childcare and transportation disproportionately affect minority patients.

That might be something that the practice can address by partnering with a childcare service, for example.

Another area that every ob/gyn must be aware of and address is the impact of race on gynecologic cancers. When you control for how many patients have undergone a hysterectomy, endometrial and cervical cancer are of significantly higher incidence in Black women. 

Poverty, a lack of insurance, loss to follow-up, and other health comorbidities are all issues. In addition, a number of studies have shown that Black women do not get the same level of surgical treatment as White women.

What is the role of the ob/gyn in fostering health equity in the context of cancer? Is it patient-centered navigation?

: Patient navigators are very helpful. The navigators should reflect the ethnicity and culture of the patients. They do not have to be health care providers, although one can transition someone in the office into this role. 

They could be someone from the community. Physicians should look at their own office outcomes to define what the best approach would be. You cannot do everything, but you can focus on a few of the biggest barriers to care that you find. 

Giving a questionnaire to the patients, either in person or by phone, can also provide important information.

Howard Ross talks about power and micro-inequities in an organizational group.

 I have received reports before from residents and faculty of instances when they experienced negative interactions that were small but incredibly hurtful. 

How do we eliminate them in the office setting? How do I address my colleague who I witness in the act of micro-inequity?

: Micro-inequities are not easy. Addressing them requires some degree of risk, which is why they have probably lasted so long. Physicians may witness them but they do not feel comfortable taking the risk of addressing it because they do not see a benefit to doing so. 

However, physicians owe it to their staffs, when they see something to say something. If the leader of the practice won’t do it, the rest of the practice won’t either. The leader must also make it clear to the staff that taking the risk of saying something will not result in them losing their job. It must come from the top so everyone feels comfortable expressing their concerns.

It is hard for one physician to give that feedback to another physician. We don’t like to confront our peers. You want to say it in a congenial way, and you have to accept that you may get a negative response. However, you offend more people by not saying anything.I think what you can say to that colleague is, “

You may not be aware, but people had a negative response to what you said

Recent world events have highlighted racism in America. It is on the news and social media constantly. When the White staff in the workplace do not acknowledge what is happening in the world to Black people, the Black staff are going to feel like the White staff don’t care. 

With this in mind, how do ob/gyns address recent events, like the killing of George Floyd, with their coworkers?

: Black people often feel unheard. Acknowledgment is really important. It says that you hear them and see them. But that is just the first step. It should be followed by action. Asking the staff what the office can do to make changes is also important. 

This is not a political issue. If it is, it will never be fixed because the political parties will never agree. Conversely, by it not being a political issue, we are free to talk about it in a meaningful way.

Racism is a continuingd problem in health care.

Physicians must acknowledge their role and commit to working for equality.

There are racial disparities in pain management, cancer treatment, and maternal mortality.

If you witness micro-inequities in the office, they should be addressed.

The office staff are representatives of the physician; if they do not make a Black patient feel welcome, it can negatively affect the patient’s relationship with the physician.

Communication is an important first step in addressing race relations in the United States, but how does one do that in the workplace? 

Physicians may fear that they do not know enough about the topic to address it properly. They may not understand that the discomfort they are feeling over this topic is but the smallest window into how their Black colleagues feel every day as they try to “fit in” at work.

: Black people have been socialized to live two lives. They do feel like they are expected to make White people feel more comfortable so they will be accepted. It is an interesting topic because it was not really addressed before now despite it being discussed among Black people frequently. 

Even among Black people who have the benefits of education and resources, it is not easy. Discrimination still exists. It comes back to acknowledgment. To do that, you have to break down the barriers to communication. Asking questions is a good way to start. 

Allowing Black people to become more comfortable increases the dialogue about what their lives are like, their customs, and homelife. This can help normalize the conversations.

We have a long way to go in America. Racism is not a new concept. Its origins date back to the dawn of America. By acknowledging the issue, understanding what our role is, seeking insight into our own influences, and building communication with our colleagues and patients, we can do our part to create a community based in equality.

Watch the full, extended video interview with Drs. Rogers and Nesbitt

Hoffman KM, Trawalter S, Axt JR, Oliver MN. racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between Blacks and Whites. 

Badreldin N, Grobman WA, Yee LM. Racial Disparities in postpartum pain management. 

Lee P, Le Saux M, Siegel R, Goyal M, Chen C, Ma Y, et al. Racial and ethnic disparities in the management of acute pain in us emergency departments: meta-analysis and systematic review. 

Lian X, Adsumelli R, Girffin TR, Gan TJ. Clinical updates in women’s health care summary: perioperative pain management: primary and preventative care review. 

Pulver LK, Oliver K, Tett SE. Innovation in hospital quality improvement activities—acute postoperative pain management (APOP) self-help toolkit audits as an example. 

Higgins JA, Kramer RD, Ryder KM. Provider bias in long-acting reversible contraception (LARC) promotion and removal: perceptions of young adult women. 

Dehlendorf C, et al. Disparities in family planning. 

Kramer RD, Higgins JA, Godecker AL, Ehrenthal DB. Racial and ethnic differences in patterns of long-acting reversible contraceptive use in the United States, 2011-2015. 

Diangelo R. White Fragility. Boston, Massachusetts: Beacon Press; 2018.

Howell EA. Reducing disparities in severe maternal morbidity and mortality. 

Black Maternal Health Caucus. About the Black Maternal Health Momnibus Act of 2020. 

https://Blackmaternalhealthcaucus-underwood.house.gov/Momnibus

Roman LA, Raffo JE, Dertz K, Agee B, Evans D, Penninga K, et al. Understanding perspectives of african american medicaid-insured women on the process of perinatal care: an opportunity for systems improvement. 

Heaman MI, Moffatt M, Elliott L, Sword W, Helewa ME, Morris H, et al. Barriers, motivators and facilitators related to prenatal care utilization among inner-city women in Winnipeg, Canada: a case-control study. 

Temkin SM, Rimel BJ, Bruegl AS, Gunderson CC, Beavis AL, Doll KM. A contemporary framework of health equity applied to gynecologic cancer care: A Society of Gynecologic Oncology evidenced-based review. 

Ross HJ. Everyday Bias. Lanham, Maryland: Rowman & Littlefied; 2014.

Drs. Rogers and Nesbitt discuss what obstetricians and gynecologists can do to reduce racism and unconscious bias in their practice.