Our expert answers 3 Questions
I’m focusing on the downstream impact of adverse birth outcomes such as stillbirth and infant death. More babies die in the perinatal period (from the 20th week of pregnancy through the first month after birth) than all deaths from homicide or suicide, deaths from motor vehicle accidents, or gun deaths, but there is little research on this topic. In addition, virtually all bereavement research has focused on white, upper-middle class women, when actually African-American women face at least twice the risk of having a baby die. Much of my work focuses on health disparities and variations in care by race and ethnicity. I’m particularly interested in looking at mental health issues and also thinking about how physicians deal with death and how that impacts quality of psychosocial care for patients.
It is becoming clear that perinatal death has profound impacts on families, which affects them long after the death and into subsequent pregnancies and beyond. Until we can better characterize the risks which bereaved families face, it is difficult to know how best to intervene. I’m also attracted to this issue because so few investigators are looking at the racial and socioeconomic disparities and how to address them. Early research has suggested that existing mental health problems can lead to subsequent fetal and infant deaths—helping prevent complications from perinatal loss could actually improve future birth outcomes.
Much of my work is trying to quantify the direct and indirect costs of perinatal death—the economic impact, healthcare utilization, rate of chronic diseases and maternal hospitalizations, risks to subsequent pregnancies, impact on healthcare providers, and racial disparities. I think until we can better show that these losses are common, costly, and traumatic, it will be challenging to get better interventions in place for families and improve care of bereavement and mental health complications from loss.