[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.66,0:00:03.42,Default,,0000,0000,0000,,It was chaos as I got off the elevator.
Dialogue: 0,0:00:03.77,0:00:06.64,Default,,0000,0000,0000,,I was coming back on duty\Nas a resident physician
Dialogue: 0,0:00:06.66,0:00:08.86,Default,,0000,0000,0000,,to cover the labor and delivery unit.
Dialogue: 0,0:00:08.88,0:00:12.02,Default,,0000,0000,0000,,And all I could see was a swarm\Nof doctors and nurses
Dialogue: 0,0:00:12.05,0:00:14.48,Default,,0000,0000,0000,,hovering over a patient in the labor room.
Dialogue: 0,0:00:14.51,0:00:17.96,Default,,0000,0000,0000,,They were all desperately trying\Nto save a woman's life.
Dialogue: 0,0:00:17.99,0:00:19.75,Default,,0000,0000,0000,,The patient was in shock.
Dialogue: 0,0:00:19.77,0:00:24.68,Default,,0000,0000,0000,,She had delivered a healthy baby boy\Na few hours before I arrived.
Dialogue: 0,0:00:24.70,0:00:27.80,Default,,0000,0000,0000,,Suddenly, she collapsed,\Nbecame unresponsive,
Dialogue: 0,0:00:27.82,0:00:30.46,Default,,0000,0000,0000,,and had profuse uterine bleeding.
Dialogue: 0,0:00:30.48,0:00:32.20,Default,,0000,0000,0000,,By the time I got to the room,
Dialogue: 0,0:00:32.23,0:00:36.53,Default,,0000,0000,0000,,there were multiple doctors and nurses,\Nand the patient was lifeless.
Dialogue: 0,0:00:36.55,0:00:39.84,Default,,0000,0000,0000,,The resuscitation team\Ntried to bring her back to life,
Dialogue: 0,0:00:39.86,0:00:41.61,Default,,0000,0000,0000,,but despite everyone's best efforts,
Dialogue: 0,0:00:41.64,0:00:43.08,Default,,0000,0000,0000,,she died.
Dialogue: 0,0:00:43.11,0:00:47.28,Default,,0000,0000,0000,,What I remember most about that day\Nwas the father's piercing cry.
Dialogue: 0,0:00:47.30,0:00:50.95,Default,,0000,0000,0000,,It went through my heart\Nand the heart of everyone on that floor.
Dialogue: 0,0:00:50.98,0:00:53.79,Default,,0000,0000,0000,,This was supposed to be\Nthe happiest day of his life,
Dialogue: 0,0:00:53.81,0:00:56.62,Default,,0000,0000,0000,,but instead it turned out\Nto be the worst day.
Dialogue: 0,0:00:58.28,0:01:01.85,Default,,0000,0000,0000,,I wish I could say this tragedy\Nwas an isolated incident,
Dialogue: 0,0:01:01.87,0:01:04.11,Default,,0000,0000,0000,,but sadly, that's not the case.
Dialogue: 0,0:01:04.13,0:01:05.98,Default,,0000,0000,0000,,Every year in the United States,
Dialogue: 0,0:01:06.00,0:01:09.52,Default,,0000,0000,0000,,somewhere between 700 and 900 women die
Dialogue: 0,0:01:09.54,0:01:11.47,Default,,0000,0000,0000,,from a pregnancy-related cause.
Dialogue: 0,0:01:11.88,0:01:13.84,Default,,0000,0000,0000,,The shocking part of this story
Dialogue: 0,0:01:13.87,0:01:17.22,Default,,0000,0000,0000,,is that our maternal mortality rate\Nis actually higher
Dialogue: 0,0:01:17.24,0:01:19.66,Default,,0000,0000,0000,,than all other high-income countries,
Dialogue: 0,0:01:19.69,0:01:22.49,Default,,0000,0000,0000,,and our rates are far worse\Nfor women of color.
Dialogue: 0,0:01:23.19,0:01:28.18,Default,,0000,0000,0000,,Our rate of maternal mortality\Nactually increased over the last decade,
Dialogue: 0,0:01:28.21,0:01:30.88,Default,,0000,0000,0000,,while other countries reduced their rates.
Dialogue: 0,0:01:31.38,0:01:33.50,Default,,0000,0000,0000,,And the biggest paradox of all?
Dialogue: 0,0:01:33.52,0:01:37.70,Default,,0000,0000,0000,,We spend more on health care\Nthan any other country in the world.
Dialogue: 0,0:01:38.58,0:01:42.67,Default,,0000,0000,0000,,Well, around the same time in residency\Nthat this new mother lost her life,
Dialogue: 0,0:01:42.70,0:01:44.70,Default,,0000,0000,0000,,I became a mother myself.
Dialogue: 0,0:01:44.72,0:01:48.09,Default,,0000,0000,0000,,And even with all of my background\Nand training in the field,
Dialogue: 0,0:01:48.11,0:01:51.65,Default,,0000,0000,0000,,I was taken aback\Nby how little attention was paid
Dialogue: 0,0:01:51.68,0:01:54.62,Default,,0000,0000,0000,,to delivering high-quality\Nmaternal health care.
Dialogue: 0,0:01:54.65,0:01:57.36,Default,,0000,0000,0000,,And I thought about what that meant,\Nnot just for myself
Dialogue: 0,0:01:57.38,0:01:59.36,Default,,0000,0000,0000,,but for so many other women.
Dialogue: 0,0:01:59.78,0:02:03.18,Default,,0000,0000,0000,,Maybe it's because my dad\Nwas a civil rights attorney
Dialogue: 0,0:02:03.21,0:02:05.46,Default,,0000,0000,0000,,and my parents were socially conscious
Dialogue: 0,0:02:05.49,0:02:08.29,Default,,0000,0000,0000,,and demanded that we stand up\Nfor what we believe in.
Dialogue: 0,0:02:08.31,0:02:10.79,Default,,0000,0000,0000,,Or the fact that my parents\Nwere born in Jamaica,
Dialogue: 0,0:02:10.82,0:02:12.22,Default,,0000,0000,0000,,came to the United States
Dialogue: 0,0:02:12.25,0:02:15.23,Default,,0000,0000,0000,,and were able to realize\Nthe American Dream.
Dialogue: 0,0:02:15.26,0:02:17.41,Default,,0000,0000,0000,,Or maybe it was my residency training,
Dialogue: 0,0:02:17.43,0:02:19.62,Default,,0000,0000,0000,,where I saw firsthand
Dialogue: 0,0:02:19.65,0:02:22.83,Default,,0000,0000,0000,,how poorly so many low-income\Nwomen of color were treated
Dialogue: 0,0:02:22.86,0:02:24.59,Default,,0000,0000,0000,,by our healthcare system.
Dialogue: 0,0:02:24.62,0:02:28.38,Default,,0000,0000,0000,,For whatever the reason,\NI felt a responsibility to stand up,
Dialogue: 0,0:02:28.40,0:02:29.86,Default,,0000,0000,0000,,not just for myself,
Dialogue: 0,0:02:29.88,0:02:31.15,Default,,0000,0000,0000,,but for all women,
Dialogue: 0,0:02:31.18,0:02:34.73,Default,,0000,0000,0000,,and especially those marginalized\Nby our healthcare system.
Dialogue: 0,0:02:34.76,0:02:39.26,Default,,0000,0000,0000,,And I decided to focus my career\Non improving maternal health care.
Dialogue: 0,0:02:40.73,0:02:42.63,Default,,0000,0000,0000,,So what's killing mothers?
Dialogue: 0,0:02:42.66,0:02:45.03,Default,,0000,0000,0000,,Cardiovascular disease, hemorrhage,
Dialogue: 0,0:02:45.06,0:02:48.04,Default,,0000,0000,0000,,high blood pressure\Ncausing seizures and strokes,
Dialogue: 0,0:02:48.07,0:02:49.50,Default,,0000,0000,0000,,blood clots and infection
Dialogue: 0,0:02:49.52,0:02:53.29,Default,,0000,0000,0000,,are some of the major causes\Nof maternal mortality in this country.
Dialogue: 0,0:02:53.80,0:02:57.33,Default,,0000,0000,0000,,But a maternal death\Nis only the tip of the iceberg.
Dialogue: 0,0:02:57.36,0:03:02.27,Default,,0000,0000,0000,,For every death, over a hundred women\Nsuffer a severe complication
Dialogue: 0,0:03:02.29,0:03:04.32,Default,,0000,0000,0000,,related to pregnancy and childbirth,
Dialogue: 0,0:03:04.34,0:03:09.06,Default,,0000,0000,0000,,resulting in over 60,000 women every year\Nhaving one of these events.
Dialogue: 0,0:03:09.51,0:03:12.48,Default,,0000,0000,0000,,These complications,\Ncalled severe maternal morbidity,
Dialogue: 0,0:03:12.50,0:03:16.34,Default,,0000,0000,0000,,are on the rise in the United States,\Nand they're life-altering.
Dialogue: 0,0:03:16.36,0:03:20.04,Default,,0000,0000,0000,,It's estimated that somewhere\Nbetween 1.5 and two percent
Dialogue: 0,0:03:20.06,0:03:23.78,Default,,0000,0000,0000,,of the four million deliveries\Nthat occur every year in this country
Dialogue: 0,0:03:23.81,0:03:25.99,Default,,0000,0000,0000,,are associated with one of these events.
Dialogue: 0,0:03:26.54,0:03:32.09,Default,,0000,0000,0000,,That is five or six women every hour\Nhaving a blood clot, a seizure, a stroke,
Dialogue: 0,0:03:32.12,0:03:33.94,Default,,0000,0000,0000,,receiving a blood transfusion,
Dialogue: 0,0:03:33.96,0:03:36.86,Default,,0000,0000,0000,,having end-organ damage\Nsuch as kidney failure,
Dialogue: 0,0:03:36.88,0:03:38.100,Default,,0000,0000,0000,,or some other tragic event.
Dialogue: 0,0:03:40.76,0:03:43.97,Default,,0000,0000,0000,,Now, the part of this story\Nthat's frankly unforgivable
Dialogue: 0,0:03:43.99,0:03:48.29,Default,,0000,0000,0000,,is the fact that 60 percent\Nof these deaths and severe complications
Dialogue: 0,0:03:48.32,0:03:50.28,Default,,0000,0000,0000,,are thought to be preventable.
Dialogue: 0,0:03:50.31,0:03:52.80,Default,,0000,0000,0000,,When I say 60 percent are preventable,
Dialogue: 0,0:03:52.83,0:03:56.07,Default,,0000,0000,0000,,I mean there are concrete steps\Nand standard procedures
Dialogue: 0,0:03:56.09,0:03:57.56,Default,,0000,0000,0000,,that we could implement
Dialogue: 0,0:03:57.58,0:04:00.13,Default,,0000,0000,0000,,that could prevent\Nthese bad outcomes from occurring
Dialogue: 0,0:04:00.16,0:04:01.73,Default,,0000,0000,0000,,and save women's lives.
Dialogue: 0,0:04:02.36,0:04:05.04,Default,,0000,0000,0000,,And it doesn't require\Nfancy new technology.
Dialogue: 0,0:04:05.06,0:04:07.17,Default,,0000,0000,0000,,We just have to apply what we know
Dialogue: 0,0:04:07.19,0:04:10.17,Default,,0000,0000,0000,,and ensure equal standards\Nbetween hospitals.
Dialogue: 0,0:04:11.26,0:04:15.44,Default,,0000,0000,0000,,For example, if a pregnant woman\Nin labor has really high blood pressure
Dialogue: 0,0:04:15.47,0:04:18.42,Default,,0000,0000,0000,,and we treat her with the right\Nantihypertensive medication
Dialogue: 0,0:04:18.45,0:04:20.03,Default,,0000,0000,0000,,in a timely fashion,
Dialogue: 0,0:04:20.05,0:04:21.54,Default,,0000,0000,0000,,we can prevent stroke.
Dialogue: 0,0:04:22.30,0:04:25.52,Default,,0000,0000,0000,,If we accurately track\Nblood loss during delivery,
Dialogue: 0,0:04:25.54,0:04:29.14,Default,,0000,0000,0000,,we can detect a hemorrhage sooner\Nand save a woman's life.
Dialogue: 0,0:04:29.70,0:04:34.22,Default,,0000,0000,0000,,We could actually lower the rates\Nof these catastrophic events tomorrow,
Dialogue: 0,0:04:34.25,0:04:37.02,Default,,0000,0000,0000,,but it requires that we value\Nthe quality of care
Dialogue: 0,0:04:37.05,0:04:38.90,Default,,0000,0000,0000,,we deliver to pregnant women
Dialogue: 0,0:04:38.92,0:04:42.03,Default,,0000,0000,0000,,before, during and after pregnancy.
Dialogue: 0,0:04:42.05,0:04:46.87,Default,,0000,0000,0000,,If we raise quality of care universally\Nto what is supposed to be the standard,
Dialogue: 0,0:04:46.90,0:04:50.70,Default,,0000,0000,0000,,we could bring the rates of these deaths\Nand severe complications way down.
Dialogue: 0,0:04:51.70,0:04:53.60,Default,,0000,0000,0000,,Well, there is some good news.
Dialogue: 0,0:04:54.40,0:04:56.27,Default,,0000,0000,0000,,There are some success stories.
Dialogue: 0,0:04:56.97,0:05:00.08,Default,,0000,0000,0000,,There are some places that have\Nactually adopted these standards,
Dialogue: 0,0:05:00.10,0:05:01.86,Default,,0000,0000,0000,,and it's really making a difference.
Dialogue: 0,0:05:01.88,0:05:06.21,Default,,0000,0000,0000,,A few years ago, the American College\Nof Obstetricians and Gynecologists
Dialogue: 0,0:05:06.24,0:05:09.00,Default,,0000,0000,0000,,joined forces with other\Nhealthcare organizations,
Dialogue: 0,0:05:09.03,0:05:12.34,Default,,0000,0000,0000,,researchers like myself\Nand community organizations.
Dialogue: 0,0:05:12.36,0:05:15.30,Default,,0000,0000,0000,,They wanted to implement\Nstandard care practices
Dialogue: 0,0:05:15.33,0:05:18.70,Default,,0000,0000,0000,,in hospitals and health systems\Nthroughout the country.
Dialogue: 0,0:05:18.73,0:05:21.06,Default,,0000,0000,0000,,And the vehicle they're using\Nis a program called
Dialogue: 0,0:05:21.08,0:05:25.32,Default,,0000,0000,0000,,the Alliance for Innovation\Nin Maternal Health, the AIM program.
Dialogue: 0,0:05:25.34,0:05:30.10,Default,,0000,0000,0000,,Their goal is to lower maternal mortality\Nand severe maternal morbidity rates
Dialogue: 0,0:05:30.13,0:05:33.33,Default,,0000,0000,0000,,through quality and safety initiatives\Nacross the country.
Dialogue: 0,0:05:33.96,0:05:36.92,Default,,0000,0000,0000,,The group has developed\Na number of safety bundles
Dialogue: 0,0:05:36.95,0:05:40.50,Default,,0000,0000,0000,,that target some of the most\Npreventable causes of a maternal death.
Dialogue: 0,0:05:41.15,0:05:44.18,Default,,0000,0000,0000,,The AIM program currently\Nhas the potential to reach
Dialogue: 0,0:05:44.20,0:05:46.52,Default,,0000,0000,0000,,over 50 percent of US births.
Dialogue: 0,0:05:47.44,0:05:49.44,Default,,0000,0000,0000,,So what's in a safety bundle?
Dialogue: 0,0:05:49.46,0:05:52.21,Default,,0000,0000,0000,,Evidence-based practices,\Nprotocols, procedures,
Dialogue: 0,0:05:52.24,0:05:53.77,Default,,0000,0000,0000,,medications, equipment
Dialogue: 0,0:05:53.80,0:05:55.97,Default,,0000,0000,0000,,and other items targeting\Nthese conditions.
Dialogue: 0,0:05:56.54,0:05:59.14,Default,,0000,0000,0000,,Let's take the example\Nof a hemorrhage bundle.
Dialogue: 0,0:05:59.66,0:06:01.58,Default,,0000,0000,0000,,For a hemorrhage, you need a cart
Dialogue: 0,0:06:01.60,0:06:05.14,Default,,0000,0000,0000,,that has everything a doctor or nurse\Nmight need in an emergency:
Dialogue: 0,0:06:05.16,0:06:08.75,Default,,0000,0000,0000,,an IV line, an oxygen mask, medications,
Dialogue: 0,0:06:08.77,0:06:10.97,Default,,0000,0000,0000,,checklists, other equipment.
Dialogue: 0,0:06:10.100,0:06:13.16,Default,,0000,0000,0000,,Then you need something\Nto measure blood loss:
Dialogue: 0,0:06:13.18,0:06:14.72,Default,,0000,0000,0000,,sponges and pads.
Dialogue: 0,0:06:14.74,0:06:16.58,Default,,0000,0000,0000,,And instead of just eyeballing it,
Dialogue: 0,0:06:16.60,0:06:19.58,Default,,0000,0000,0000,,the doctors and nurses\Ncollect these sponges and pads
Dialogue: 0,0:06:19.61,0:06:21.20,Default,,0000,0000,0000,,and either weigh them
Dialogue: 0,0:06:21.22,0:06:25.56,Default,,0000,0000,0000,,or use newer technology to accurately\Nassess how much blood has been lost.
Dialogue: 0,0:06:27.32,0:06:32.53,Default,,0000,0000,0000,,The hemorrhage bundle also includes\Ncrises protocols for massive transfusions
Dialogue: 0,0:06:32.55,0:06:34.50,Default,,0000,0000,0000,,and regular trainings and drills.
Dialogue: 0,0:06:34.91,0:06:38.66,Default,,0000,0000,0000,,Now, California has been a leader\Nin the use of these types of bundles,
Dialogue: 0,0:06:38.68,0:06:42.44,Default,,0000,0000,0000,,and that's why California\Nsaw a 21 percent reduction
Dialogue: 0,0:06:42.47,0:06:44.12,Default,,0000,0000,0000,,in near death from hemorrhage
Dialogue: 0,0:06:44.15,0:06:47.57,Default,,0000,0000,0000,,among hospitals that implemented\Nthis bundle in the first year.
Dialogue: 0,0:06:48.28,0:06:52.68,Default,,0000,0000,0000,,Yet the use of these bundles\Nacross the country is spotty or missing.
Dialogue: 0,0:06:52.71,0:06:55.61,Default,,0000,0000,0000,,Just like the fact that the use\Nof evidence-based practices
Dialogue: 0,0:06:55.64,0:06:57.48,Default,,0000,0000,0000,,and the emphasis on safety
Dialogue: 0,0:06:57.51,0:07:00.17,Default,,0000,0000,0000,,differs from one hospital to the next,
Dialogue: 0,0:07:00.19,0:07:01.90,Default,,0000,0000,0000,,quality of care differs.
Dialogue: 0,0:07:02.36,0:07:06.62,Default,,0000,0000,0000,,And quality of care differs greatly\Nfor women of color in the United States.
Dialogue: 0,0:07:07.12,0:07:09.23,Default,,0000,0000,0000,,Black women who deliver in this country
Dialogue: 0,0:07:09.25,0:07:13.58,Default,,0000,0000,0000,,are three to four times more likely\Nto suffer a pregnancy-related death
Dialogue: 0,0:07:13.60,0:07:14.98,Default,,0000,0000,0000,,than are white women.
Dialogue: 0,0:07:15.65,0:07:19.70,Default,,0000,0000,0000,,This statistic is true for all black women\Nwho deliver in this country,
Dialogue: 0,0:07:19.73,0:07:21.86,Default,,0000,0000,0000,,whether they were born\Nin the United States
Dialogue: 0,0:07:21.88,0:07:23.24,Default,,0000,0000,0000,,or born in another country.
Dialogue: 0,0:07:23.82,0:07:27.51,Default,,0000,0000,0000,,Many want to think that income differences\Ndrive these disparities,
Dialogue: 0,0:07:27.54,0:07:29.42,Default,,0000,0000,0000,,but it goes beyond class.
Dialogue: 0,0:07:29.83,0:07:32.47,Default,,0000,0000,0000,,A black woman with a college education
Dialogue: 0,0:07:32.49,0:07:36.24,Default,,0000,0000,0000,,is nearly twice as likely to die\Nas compared to a white woman
Dialogue: 0,0:07:36.26,0:07:38.80,Default,,0000,0000,0000,,with less than a high school education.
Dialogue: 0,0:07:38.82,0:07:44.35,Default,,0000,0000,0000,,And she is two to three times more likely\Nto suffer a severe pregnancy complication
Dialogue: 0,0:07:44.38,0:07:45.68,Default,,0000,0000,0000,,with her delivery.
Dialogue: 0,0:07:46.41,0:07:50.63,Default,,0000,0000,0000,,Now, I was always taught to think\Nthat education was our salvation,
Dialogue: 0,0:07:50.65,0:07:53.24,Default,,0000,0000,0000,,but in this case, it's simply not true.
Dialogue: 0,0:07:54.27,0:07:56.38,Default,,0000,0000,0000,,This black-white disparity
Dialogue: 0,0:07:56.40,0:07:58.14,Default,,0000,0000,0000,,is the largest disparity
Dialogue: 0,0:07:58.16,0:08:00.59,Default,,0000,0000,0000,,among all population\Nperinatal health measures,
Dialogue: 0,0:08:00.62,0:08:02.13,Default,,0000,0000,0000,,according to the CDC.
Dialogue: 0,0:08:02.99,0:08:05.21,Default,,0000,0000,0000,,And these disparities\Nare even more pronounced
Dialogue: 0,0:08:05.23,0:08:06.75,Default,,0000,0000,0000,,in some of our cities.
Dialogue: 0,0:08:06.78,0:08:08.93,Default,,0000,0000,0000,,For example, in New York City,
Dialogue: 0,0:08:08.95,0:08:12.36,Default,,0000,0000,0000,,a black woman is eight to 12 times\Nmore likely to die
Dialogue: 0,0:08:12.38,0:08:15.81,Default,,0000,0000,0000,,from a pregnancy-related cause\Nthan is a white woman.
Dialogue: 0,0:08:16.82,0:08:19.24,Default,,0000,0000,0000,,Now, I think many of you\Nare probably familiar with
Dialogue: 0,0:08:19.26,0:08:21.86,Default,,0000,0000,0000,,the heart-wrenching story\Nof Dr. Shalon Irving,
Dialogue: 0,0:08:21.88,0:08:25.87,Default,,0000,0000,0000,,a CDC epidemiologist\Nwho died following childbirth.
Dialogue: 0,0:08:25.89,0:08:29.48,Default,,0000,0000,0000,,Her story was reported\Nin ProPublica and NPR
Dialogue: 0,0:08:29.50,0:08:31.41,Default,,0000,0000,0000,,a little less than a year ago.
Dialogue: 0,0:08:31.43,0:08:33.11,Default,,0000,0000,0000,,Recently, I was at a conference
Dialogue: 0,0:08:33.13,0:08:35.77,Default,,0000,0000,0000,,and I had the privilege\Nof hearing her mother speak.
Dialogue: 0,0:08:35.80,0:08:38.34,Default,,0000,0000,0000,,She brought the entire audience to tears.
Dialogue: 0,0:08:38.91,0:08:41.16,Default,,0000,0000,0000,,Shalon was a brilliant epidemiologist,
Dialogue: 0,0:08:41.19,0:08:44.45,Default,,0000,0000,0000,,committed to studying\Nracial and ethnic disparities in health.
Dialogue: 0,0:08:44.47,0:08:47.62,Default,,0000,0000,0000,,She was 36 years old,\Nthis was her first baby,
Dialogue: 0,0:08:47.65,0:08:49.48,Default,,0000,0000,0000,,and she was African-American.
Dialogue: 0,0:08:50.07,0:08:53.10,Default,,0000,0000,0000,,Now, Shalon did have\Na complicated pregnancy,
Dialogue: 0,0:08:53.12,0:08:57.10,Default,,0000,0000,0000,,but she delivered a healthy baby girl\Nand was discharged from the hospital.
Dialogue: 0,0:08:57.71,0:09:02.09,Default,,0000,0000,0000,,Three weeks later, she died\Nfrom complications of high blood pressure.
Dialogue: 0,0:09:02.86,0:09:07.14,Default,,0000,0000,0000,,Shalon was seen four or five times\Nby healthcare professionals
Dialogue: 0,0:09:07.17,0:09:08.72,Default,,0000,0000,0000,,in those three weeks.
Dialogue: 0,0:09:08.74,0:09:10.39,Default,,0000,0000,0000,,She was not listened to,
Dialogue: 0,0:09:10.41,0:09:13.67,Default,,0000,0000,0000,,and the severity of her condition\Nwas not recognized.
Dialogue: 0,0:09:15.17,0:09:18.17,Default,,0000,0000,0000,,Now, Shalon's story\Nis just one of many stories
Dialogue: 0,0:09:18.19,0:09:21.61,Default,,0000,0000,0000,,about racial and ethnic disparities\Nin health and health care
Dialogue: 0,0:09:21.63,0:09:23.32,Default,,0000,0000,0000,,in the United States,
Dialogue: 0,0:09:23.34,0:09:27.71,Default,,0000,0000,0000,,and there's a growing recognition\Nthat the social determinants of health,
Dialogue: 0,0:09:27.74,0:09:32.04,Default,,0000,0000,0000,,such as racism, poverty, education,\Nsegregated housing,
Dialogue: 0,0:09:32.06,0:09:33.96,Default,,0000,0000,0000,,contribute to these disparities.
Dialogue: 0,0:09:34.42,0:09:38.50,Default,,0000,0000,0000,,But Shalon's story highlights\Nan additional underlying cause:
Dialogue: 0,0:09:38.53,0:09:40.00,Default,,0000,0000,0000,,quality of care.
Dialogue: 0,0:09:40.03,0:09:43.04,Default,,0000,0000,0000,,Lack of standards in postpartum care.
Dialogue: 0,0:09:43.07,0:09:46.36,Default,,0000,0000,0000,,Shalon was seen multiple times\Nby clinicians in those three weeks,
Dialogue: 0,0:09:46.38,0:09:48.28,Default,,0000,0000,0000,,and she still died.
Dialogue: 0,0:09:48.30,0:09:51.00,Default,,0000,0000,0000,,Quality of care\Nin the setting of childbirth
Dialogue: 0,0:09:51.02,0:09:54.27,Default,,0000,0000,0000,,is an underlying cause\Nof racial and ethnic disparities
Dialogue: 0,0:09:54.29,0:09:57.11,Default,,0000,0000,0000,,in maternal mortality\Nand severe maternal morbidity
Dialogue: 0,0:09:57.13,0:09:58.31,Default,,0000,0000,0000,,in the United States,
Dialogue: 0,0:09:58.33,0:10:00.61,Default,,0000,0000,0000,,and it's something we can address now.
Dialogue: 0,0:10:02.07,0:10:04.22,Default,,0000,0000,0000,,Research by our team and others
Dialogue: 0,0:10:04.24,0:10:06.78,Default,,0000,0000,0000,,has documented that,\Nfor a variety of reasons,
Dialogue: 0,0:10:06.80,0:10:10.27,Default,,0000,0000,0000,,black women tend to deliver\Nin a specific set of hospitals,
Dialogue: 0,0:10:10.30,0:10:14.45,Default,,0000,0000,0000,,and those hospitals often have worse\Noutcomes for both black and white women,
Dialogue: 0,0:10:14.48,0:10:16.93,Default,,0000,0000,0000,,regardless of patient risk factors.
Dialogue: 0,0:10:17.38,0:10:19.94,Default,,0000,0000,0000,,This is true overall in the United States,
Dialogue: 0,0:10:19.96,0:10:22.20,Default,,0000,0000,0000,,where about three quarters\Nof all black women
Dialogue: 0,0:10:22.23,0:10:24.52,Default,,0000,0000,0000,,deliver in a specific set of hospitals,
Dialogue: 0,0:10:24.54,0:10:28.32,Default,,0000,0000,0000,,while less than one-fifth of white women\Ndeliver in those same hospitals.
Dialogue: 0,0:10:28.85,0:10:32.91,Default,,0000,0000,0000,,In New York City, a woman's risk\Nof having a life-threatening complication
Dialogue: 0,0:10:32.93,0:10:34.09,Default,,0000,0000,0000,,during delivery
Dialogue: 0,0:10:34.12,0:10:37.82,Default,,0000,0000,0000,,can be six times higher\Nin one hospital than another.
Dialogue: 0,0:10:37.85,0:10:41.92,Default,,0000,0000,0000,,Not surprisingly, black women\Nare more likely to deliver
Dialogue: 0,0:10:41.94,0:10:43.55,Default,,0000,0000,0000,,in hospitals with worse outcomes.
Dialogue: 0,0:10:43.57,0:10:45.64,Default,,0000,0000,0000,,In fact, differences in delivery hospital
Dialogue: 0,0:10:45.67,0:10:48.60,Default,,0000,0000,0000,,explain nearly one-half\Nof the black-white disparity.
Dialogue: 0,0:10:49.76,0:10:52.40,Default,,0000,0000,0000,,While we must address\Nsocial determinants of health
Dialogue: 0,0:10:52.43,0:10:56.34,Default,,0000,0000,0000,,if we're ever going to truly have\Nequitable health care in this country,
Dialogue: 0,0:10:56.37,0:11:00.10,Default,,0000,0000,0000,,many of these are deep-seated\Nand they will take some time to resolve.
Dialogue: 0,0:11:00.13,0:11:03.00,Default,,0000,0000,0000,,In the meantime,\Nwe can tackle quality of care.
Dialogue: 0,0:11:03.37,0:11:07.38,Default,,0000,0000,0000,,Providing high-quality care\Nacross the care continuum
Dialogue: 0,0:11:07.41,0:11:10.93,Default,,0000,0000,0000,,means providing access to safe\Nand reliable contraception
Dialogue: 0,0:11:10.95,0:11:13.39,Default,,0000,0000,0000,,throughout women's reproductive lives.
Dialogue: 0,0:11:13.80,0:11:18.53,Default,,0000,0000,0000,,Before pregnancy, it means\Nproviding preconception care,
Dialogue: 0,0:11:18.55,0:11:21.71,Default,,0000,0000,0000,,so we can manage chronic illness\Nand optimize health.
Dialogue: 0,0:11:22.08,0:11:26.24,Default,,0000,0000,0000,,During pregnancy, it includes\Nhigh-quality prenatal and delivery care
Dialogue: 0,0:11:26.26,0:11:29.10,Default,,0000,0000,0000,,so we can produce healthy moms and babies.
Dialogue: 0,0:11:29.12,0:11:34.45,Default,,0000,0000,0000,,And finally, after pregnancy, it includes\Npostpartum and inter-pregnancy care
Dialogue: 0,0:11:34.47,0:11:37.81,Default,,0000,0000,0000,,so we can set moms up\Nto have a healthy next baby
Dialogue: 0,0:11:37.83,0:11:39.32,Default,,0000,0000,0000,,and a healthy life.
Dialogue: 0,0:11:39.35,0:11:42.47,Default,,0000,0000,0000,,And it can literally spell the difference\Nbetween life and death,
Dialogue: 0,0:11:42.49,0:11:44.46,Default,,0000,0000,0000,,as it did in the case of Maria,
Dialogue: 0,0:11:44.48,0:11:47.79,Default,,0000,0000,0000,,who checked into the hospital\Nafter having an elevated blood pressure
Dialogue: 0,0:11:47.81,0:11:49.63,Default,,0000,0000,0000,,during a prenatal visit.
Dialogue: 0,0:11:49.65,0:11:52.47,Default,,0000,0000,0000,,Maria was 40, and this\Nwas her second pregnancy.
Dialogue: 0,0:11:53.04,0:11:56.62,Default,,0000,0000,0000,,During Maria's first pregnancy\Nthat had happened two years earlier,
Dialogue: 0,0:11:56.64,0:12:00.03,Default,,0000,0000,0000,,she also didn't feel so well\Nin the last few weeks of her pregnancy,
Dialogue: 0,0:12:00.06,0:12:02.43,Default,,0000,0000,0000,,and she had a few\Nelevated blood pressures,
Dialogue: 0,0:12:02.45,0:12:04.77,Default,,0000,0000,0000,,but nobody seemed to pay attention.
Dialogue: 0,0:12:04.80,0:12:07.26,Default,,0000,0000,0000,,They just said, "Maria,\Ndon't worry, you'll be fine.
Dialogue: 0,0:12:07.29,0:12:09.98,Default,,0000,0000,0000,,This is your first pregnancy.\NYou're a little nervous."
Dialogue: 0,0:12:10.01,0:12:12.44,Default,,0000,0000,0000,,But it did not end well\Nfor Maria last time.
Dialogue: 0,0:12:12.47,0:12:14.38,Default,,0000,0000,0000,,She seized during labor.
Dialogue: 0,0:12:14.91,0:12:17.34,Default,,0000,0000,0000,,Well, this time her team really listened.
Dialogue: 0,0:12:17.37,0:12:19.78,Default,,0000,0000,0000,,They asked smart and probing questions.
Dialogue: 0,0:12:19.81,0:12:23.71,Default,,0000,0000,0000,,Her doctor counseled her about\Nthe signs and symptoms of preeclampsia
Dialogue: 0,0:12:23.74,0:12:25.97,Default,,0000,0000,0000,,and explained that\Nif she was not feeling well,
Dialogue: 0,0:12:25.100,0:12:27.72,Default,,0000,0000,0000,,she needed to come in and be seen.
Dialogue: 0,0:12:28.06,0:12:30.06,Default,,0000,0000,0000,,And this time Maria came in,
Dialogue: 0,0:12:30.08,0:12:32.70,Default,,0000,0000,0000,,and her doctor immediately\Nsent her to the hospital.
Dialogue: 0,0:12:33.42,0:12:37.36,Default,,0000,0000,0000,,At the hospital, her doctor\Nordered urgent lab tests.
Dialogue: 0,0:12:37.38,0:12:39.82,Default,,0000,0000,0000,,They hooked her up\Nto multiple different monitors
Dialogue: 0,0:12:39.84,0:12:42.13,Default,,0000,0000,0000,,and paid special attention\Nto her blood pressure,
Dialogue: 0,0:12:42.16,0:12:43.80,Default,,0000,0000,0000,,the fetal heart rate tracing
Dialogue: 0,0:12:43.82,0:12:47.01,Default,,0000,0000,0000,,and gave her IV medication\Nto prevent a seizure.
Dialogue: 0,0:12:47.04,0:12:51.02,Default,,0000,0000,0000,,And when Maria's blood pressure got\Nso high it put her at risk for a stroke,
Dialogue: 0,0:12:51.04,0:12:53.60,Default,,0000,0000,0000,,her doctors and nurses jumped into action.
Dialogue: 0,0:12:53.62,0:12:55.80,Default,,0000,0000,0000,,They repeated her\Nblood pressure in 15 minutes
Dialogue: 0,0:12:55.82,0:12:57.98,Default,,0000,0000,0000,,and declared a hypertensive emergency.
Dialogue: 0,0:12:58.00,0:13:02.20,Default,,0000,0000,0000,,They gave her the right IV medication\Naccording to the latest correct protocol.
Dialogue: 0,0:13:02.22,0:13:05.18,Default,,0000,0000,0000,,They worked smoothly together\Nas a coordinated team
Dialogue: 0,0:13:05.20,0:13:07.68,Default,,0000,0000,0000,,and successfully\Nlowered her blood pressure.
Dialogue: 0,0:13:09.25,0:13:12.98,Default,,0000,0000,0000,,As a result, what could have been\Na tragedy became a success story.
Dialogue: 0,0:13:13.00,0:13:15.24,Default,,0000,0000,0000,,Maria's dangerous symptoms\Nwere controlled,
Dialogue: 0,0:13:15.26,0:13:17.85,Default,,0000,0000,0000,,and she delivered a healthy baby girl.
Dialogue: 0,0:13:18.49,0:13:21.02,Default,,0000,0000,0000,,And before Maria was discharged\Nfrom the hospital,
Dialogue: 0,0:13:21.04,0:13:24.94,Default,,0000,0000,0000,,her doctor counseled her again about\Nthe signs and symptoms of preeclampsia,
Dialogue: 0,0:13:24.96,0:13:27.63,Default,,0000,0000,0000,,the importance of having\Nher blood pressure checked,
Dialogue: 0,0:13:27.65,0:13:29.85,Default,,0000,0000,0000,,especially in this first week postpartum
Dialogue: 0,0:13:29.87,0:13:34.19,Default,,0000,0000,0000,,and gave her education about\Npostpartum health and what to expect.
Dialogue: 0,0:13:34.21,0:13:36.29,Default,,0000,0000,0000,,And in the weeks and months that followed,
Dialogue: 0,0:13:36.31,0:13:39.10,Default,,0000,0000,0000,,naturally, Maria had follow-up visits\Nwith her pediatrician
Dialogue: 0,0:13:39.13,0:13:41.36,Default,,0000,0000,0000,,to check in on her baby's health.
Dialogue: 0,0:13:41.38,0:13:42.69,Default,,0000,0000,0000,,But just as important,
Dialogue: 0,0:13:42.71,0:13:45.38,Default,,0000,0000,0000,,she had follow-up visits with her ob-gyn
Dialogue: 0,0:13:45.41,0:13:47.83,Default,,0000,0000,0000,,to check in on her health,\Nher blood pressure,
Dialogue: 0,0:13:47.85,0:13:50.86,Default,,0000,0000,0000,,and her cares and concerns\Nas a new mother.
Dialogue: 0,0:13:50.88,0:13:54.72,Default,,0000,0000,0000,,This is what high-quality care\Nacross the care continuum looks like,
Dialogue: 0,0:13:54.74,0:13:56.65,Default,,0000,0000,0000,,and this is how it can look.
Dialogue: 0,0:13:56.67,0:13:59.25,Default,,0000,0000,0000,,If every pregnant woman in every community
Dialogue: 0,0:13:59.27,0:14:02.45,Default,,0000,0000,0000,,received this kind of high-quality care
Dialogue: 0,0:14:02.47,0:14:06.10,Default,,0000,0000,0000,,and delivered at facilities that utilized\Nstandard care practices,
Dialogue: 0,0:14:06.12,0:14:10.32,Default,,0000,0000,0000,,our maternal mortality and severe\Nmaternal morbidity rates would plummet.
Dialogue: 0,0:14:10.35,0:14:13.91,Default,,0000,0000,0000,,Our international ranking\Nwould no longer be an embarrassment.
Dialogue: 0,0:14:13.94,0:14:18.76,Default,,0000,0000,0000,,But the truth is, we've had decades\Nof unacceptably high rates
Dialogue: 0,0:14:18.78,0:14:23.53,Default,,0000,0000,0000,,of maternal death and life-threatening\Ncomplications during delivery
Dialogue: 0,0:14:23.55,0:14:28.67,Default,,0000,0000,0000,,and decades of devastating consequences\Nfor moms, babies and families,
Dialogue: 0,0:14:28.69,0:14:30.83,Default,,0000,0000,0000,,and we have not been moved to action.
Dialogue: 0,0:14:31.34,0:14:35.17,Default,,0000,0000,0000,,The recent media attention on\Nour poor performance on maternal mortality
Dialogue: 0,0:14:35.20,0:14:37.53,Default,,0000,0000,0000,,has helped the public to understand:
Dialogue: 0,0:14:37.56,0:14:40.56,Default,,0000,0000,0000,,high-quality maternal health care\Nis within reach.
Dialogue: 0,0:14:40.58,0:14:41.79,Default,,0000,0000,0000,,The question is:
Dialogue: 0,0:14:41.81,0:14:47.02,Default,,0000,0000,0000,,Are we as a society ready to value\Npregnant women from every community?
Dialogue: 0,0:14:47.04,0:14:51.71,Default,,0000,0000,0000,,For my part, I'm doing everything I can\Nto ensure that when we do,
Dialogue: 0,0:14:51.74,0:14:54.83,Default,,0000,0000,0000,,we have the tools and evidence base ready
Dialogue: 0,0:14:54.85,0:14:56.22,Default,,0000,0000,0000,,to move forward.
Dialogue: 0,0:14:57.00,0:14:58.18,Default,,0000,0000,0000,,Thank you.
Dialogue: 0,0:14:58.21,0:15:03.21,Default,,0000,0000,0000,,(Applause)