Dear Dr. Vero, 

I am 5 months pregnant and I am scared because I keep seeing stories on Facebook of Black women dying during or soon after childbirth.  What is going on?

Scared Mom

Dear Scared Mom,

These stories of mothers dying during and after childbirth are scary to read, especially when you are expecting a baby.  Pregnancy is supposed to be a joyful time, but it can also be stressful.  Reading these stories of moms dying from pregnancy-related problems will likely increase your stress level and prevent you from enjoying your pregnancy.  But, these stories can also be an opportunity to learn some facts and empower yourself to advocate for the excellent care you and your baby deserve.  

About 700 women in the United States die per year from complications from childbirth.  Compared to other similar countries, the U.S. has the worst rate of moms dying from pregnancy-related complications, despite the fact that it spends the most amount of money on healthcare. Mothers die in the U.S. at a rate more than six times higher than Italy and almost three times higher than Portugal.  However, the maternal mortality rate is not the same in all states.  Thankfully, Massachusetts and Connecticut have some of the lowest rates of maternal death in the U.S. Meanwhile, other states with lower populations of Cabo Verdeans, such as Louisiana, have as high of maternal death rate as Cabo Verde.  Yet, Cabo Verde’s maternal death rate has significantly decreased over the years.

It is true that Black women in the United States die from childbirth three times more often than white women and this disparity is present throughout different states. Why are there such great disparities in maternal mortality in the U.S.? Is it education? Is it age?  Data from the Centers for Disease Control and Prevention (CDC) clearly shows that it is not due to either of these factors.  In fact, when it  comes to pregnancy-related death, a college-educated Black woman is almost twice as likely to die than a white woman without a high school degree and a 20-year old Black woman is 2.3 times more likely to die than a 30-year old white woman.  So, what is the root cause then? The answer is complex.

Strokes, heart disease and high blood pressure are major causes of pregnancy-related death and Black women are at higher risk for these problems.  Still, about two-thirds of these deaths are preventable.  Racial disparities in maternal death cannot be explained by genetic differences as many still believe. Poor housing, food instability, unequal access to healthcare, biases encountered in the health system and stress from years of facing daily acts of racism lead to poor health outcomes.  Racism is a significant cause of the disparity in maternal death in the U.S. This country was founded on idealistic views, which did not translate into practice for all people.  We have been dealing with systemic and institutionalized racism that continues to negatively impact the quality of care that patients, including pregnant women, receive.

To solve a problem, we first have to name it.  Then, we find its source and have partners willing to work for a solution.  We know the problem. We know its causes and an increasingly greater number of us are actively working at different levels—through research, education, clinical care and advocacy—to help close the racial gap in maternal death. In the past few years, some politicians have noticed the problem and introduced bills to help improve the health of mothers and decrease their mortality.  Notably, members of the Black Maternal Caucus, including Senator Kamala Harris, introduced the Black Maternal Health Momnibus to help end preventable maternal mortality and close the health disparities in the U.S.

What can you do?

  • Educate yourself about how to stay healthy during your pregnancy and postpartum.
  • Find a trusted partner— a spouse, a sister, a friend or a doula—to be your healthcare advocate.
  • Find a healthcare team—including physicians, nurses and other staff members—as well as a clinic or hospital that treat you with respect and dignity, and thus earn your trust.
  • Attend your prenatal visits and follow the advice of your trusted obstetrical team.
  • If you have medical problems, make sure you are under great care of a physician team and that your medical problems are under control.
  • Pregnancy can worsen pre-existing medical conditions, so you may need extra medical care and more medication in order to be well and have a healthy baby.
  • Don’t be afraid to seek care when you feel unwell or you are concerned about your baby’s well-being.
  • Protect yourself from getting sick from bacterial and viral infections, such as COVID-19.
  • Write letters to your representatives or call them to support bills that address maternal mortality and racial disparities.

Stay healthy, educate yourself and enjoy your pregnancy.

Be well,

Dr. Vero

This article was originally published at http://cvnetworktv.com/i-am-pregnant-i-see-posts-about-black-women-dying-from-childbirth-and-i-am-scared/ on July 18, 2020.

How to support Black Lives Matter and still protect yourself from COVID-19

We have been doing a lot of research in public health and medicine to understand how racism is negatively impacting the care of our patients.  Racism is a major public health problem.  Doctors across the United States, including myself, have joined in the protests and are speaking out against police brutality and killings of Black people.  These protests and open conversations about the impact of racism and need for social justice have already led to some positive changes.

You can support this movement for social justice in many ways besides going outside to protest.  If you choose to go to a protest, please wear a mask.

  • Donate to organizations committed to justice and equity, such us Black Lives Matter and the NAACP.
  • Support Black-owned, including Cape Verdean-owned businesses.
  • Volunteer your time and energy, for example at a soup kitchen, translating documents about the protests or health disparity to other languages, and mentoring young Black and Brown people.
  • Educate yourself about the history of racism and racial injustice in America.
    • Read a book, such us How to be an Anti-Racist by Ibram X. Kendi and Why Are All The Black Kids Sitting Together in The Cafeteria? And Other Conversations About Race by Beverly Daniel Tatum.
    • Watch a movie such us 13th by Director Ava DuVernay and I Am Not Your Negro.
    • Listen to postcasts such as 1619 from the New York Times and Throughline from NPR.

We need to keep the conversation and pressure going for our sake and the sake of our family and community.  

If you have questions about the coronavirus, women’s health, sexuality, or social activism that you would like Dr. Pimentel to answer, email your question to VeroMD.net@gmail.com

Original interview published by Cabo Verde Network and can be found at http://cvnetworktv.com/dr-pimentel-covid-19-black-lives-matter-the-cabo-verdean-community/

Don’t let your guards down. COVID-19 is still a danger to Cabo Verdeans in the northeast of USA

What are the dangers of Covid-19 in the Cabo Verdean communities and surrounding areas in general? 

The number of people diagnosed and hospitalized with the coronavirus in the northeast states is decreasing.  Research has shown that social distancing is working and has saved thousands of lives.  Still, we must be vigilant and continue to protect ourselves from this potentially deadly virus.  The best way to protect ourselves and our families from COVID-19 is to stay away from those who have the virus.  The problem is that not everyone shows symptoms of COVID-19 infection and yet, they can still be contagious and give it to someone else.  Thus, continue to practice social distancing.  Stay at home as much as possible and avoid large gathering.  If you cannot stay home, please wear a face mask properly.  Make sure it covers your nose and mouth. 

There are rumors that face masks are not safe. Is it true?

The use of face masks have become a hot political issue when it is a good public health measure that protects all of us.  Contrary to much false information out there, face masks are safe to use.  They filter air with oxygen in and air with carbon dioxide out.  At the same time, they keep droplets with possible viruses from spreading between people.   I have been wearing masks for long hours at a time since medical school, especially in the operating room and have never gotten sick from wearing one.   

When should I go to a hospital if I think I have COVID-19?

Many people who become infected with COVID have very mild symptoms and do not need to go to a hospital.  However, if you are having trouble breathing, please seek medical care immediately.  People with fever and cough should also go to the hospital.

Why is COVID-19 affecting Black and Brown people more than whites?

COVID infection and the consequences of this infection are affecting Black and Brown people disproportionately.  We are quickly learning that this disparity in health and outcome has to do with systemic racism that has created a system in which Black people face many barriers to accessing high-quality health care that could keep us healthy and safe.

Original interview published by Cabo Verde Network and can be found at http://cvnetworktv.com/dr-pimentel-covid-19-black-lives-matter-the-cabo-verdean-community/

Low-Dose Aspirin Can Prevent Preeclampsia and Preterm Birth

Preeclampsia is a serious health condition that occurs during pregnancy and/or up to 6 weeks after delivery. Preeclampsia involves a rise in blood pressure after 20 weeks of pregnancy and possibly large amounts of protein in the urine. Preeclampsia affects 3.4% of pregnancies in the United States.

How does preeclampsia affect my baby and me? Preeclampsia can cause the mom to have bleeding, seizures, stroke, kidney damage, liver damage, pulmonary edema (fluid in the lungs), and die. For babies, preeclampsia can cause preterm birth (before 37 weeks), intrauterine growth restriction (very small size), and death.

What is my risk for developing preeclampsia? Women are at higher risk for developing preeclampsia if they have or had any of the following: Preeclampsia or high blood pressure in previous pregnancy, Chronic high blood pressure, Diabetes (Type 1 or Type 2), Kidney disease, Autoimmune Diseases (i.e. Lupus, RA), First time pregnant or it has been more than 10 years since you had a baby, Pregnant with twins, Obesity, Older than 35 years of age, You are African-American or Black, Became pregnant via in-vitro fertilization (IVF), Sickle cell disease

What steps can I take to help reduce my risk for developing preeclampsia in pregnancy? If your doctor thinks that you are at higher risk of developing preeclampsia, he/she will ask you to take a low-dose (81mg) aspirin every day starting at 12 weeks of pregnancy (and preferably before 16 weeks of pregnancy). You will continue the aspirin until 36 to 37 weeks of pregnancy. Adopt a healthy lifestyle, including healthy eating, quitting smoking, and exercise, such as walking.

Are there risks to taking aspirin during my pregnancy if I am at increased risk of developing preeclampsia? The risk of taking low-dose aspirin during pregnancy is small. Aspirin is not known to cause any birth defects in the baby. In general, aspirin affects your platelets (blood cells that work to form blood clots when you get injured). Thus, there is a small risk of bleeding. It is also possible to be allergic to aspirin. The benefits of maintaining a healthy pregnancy and carrying a healthy baby to term are greater than any small risks linked to taking low-dose aspirin every day.

More Resources: Preeclampsia Foundation – www.preeclampsia.org,  The American College of Obstetricians and Gynecologists – www.acog.org,  U.S. Preventative Services Task Force – www.uspreventiveservicestaskforce.org.

“What is the matter with the flu this year?” you asked.

Perhaps you have heard the story of a young 21-year-old bodybuilder who recently died from apparent influenza (flu) complications. Maybe you heard the many news reports about how bad the flu season already is.  We are facing one of the worst flu seasons in years.  Many of you have asked me questions about the flu.  I decided to answer them below. 


Why is this flu season so bad?

The virus responsible for most of this year’s flu is the H3N2 influenza A.  According to the Centers for Disease Control and Prevention (CDC), in the past, this virus caused more people ages 65 and older and young children to be hospitalized and die when compared to other age groups.  Unfortunately, the vaccine does not do a great job of protecting against this strain of the flu virus. 


What does hurricane Maria have to do with the flu?

Part of the treatment of a patient who is hospitalized with the flu is intravenous (IV) fluid hydration.  To make matters worse, there is a shortage of IV fluid after the devastation caused by hurricane Maria in Puerto Rico.     


I am young and health.  Can I still get the flu and have complications from it?

People who have an immature or a poor immune system are at higher risk of developing complications from the flu.  This means that young children, adults over the age of 65, people suffering from chronic diseases, such as cancer, and those who are obese and pregnant can get very sick and possibly die from a flu infection.  Still, young and health people can get the flu and get very sick and possibly die.      


How do I know if I have the flu?

If you experience some combination of the following symptoms, cough, fever, sore throat, body ache, body weakness, tiredness, and headache, you should contact your doctor as soon as possible.  Your doctor will examine you and run tests to check if it is the flu.  If you have those symptoms, please wear a mask and avoid exposing other people to possible flu.


Why doesn’t my doctor give me antibiotics for the flu?  Wouldn’t antibiotics make me feel better faster?

The flu is caused by viruses and not bacteria.  Antibiotics are medications that are used to kills bacteria.  Instead, the treatment for viruses are called antivirals.  In the case of influenza, your doctor may prescribe you an antiviral called Tamiflu (oseltamivir).  This medication works on both influenza A and B.  It should help you feel better and recover from the flu sooner. 


What can I do to protect myself (and others)?

·       You can still get the flu vaccine.  Although the vaccine is not great at preventing this year’s flu infection, some protection is better than no protection. 

·       Be religious about washing your hands.

·       Don’t be in close contact with people who are sick.

·       Sleep well.

·       Drink a lot of fluid.

·       Stay home if you are sick, except to seek medical care.

·       Wear a mask if you are sick, especially if you are coughing or sneezing.

·       Call your doctor if you think you were exposed to the flu.  In certain cases, antiviral drugs can be given to prevent influenza. 


You can find more information about the flu at www.CDC.gov.  You should always contact your own physician if you any health-related questions. 


Stay informed.  Stay Healthy.   Be joyful!


Disclaimer:  The information displayed in this blog are for informational purposes only.  It should not be used to substitute for your physician’s (or qualified health care provider’s) medical advice, diagnosis or treatment.  Always seek the advice of your physician (or qualified health care provider) regarding a medical condition or treatment and before undertaking a new health care regimen, and never delay in seeking their care and advice because of something you read on this blog.