IN THIS ISSUE

Co-create a Better Future

When the MetroDoctors editorial board decided that Black birthing would be the theme of the Spring 2021 issue, I immediately asked Dr. Lisa Saul, President of the Mother Baby Clinical Service Line for Allina Health, to be my co-editor. Lucky me. She said, “Yes.” Read more about her amazing life’s journey in our Colleague Interview. We are fortunate to have her leadership. This issue is full of experts talking about Black maternal health and describing the exceptionally poor outcomes that Black families experience before, during and after birthing, why this happens, and what the community is doing to improve the situation. You’ll miss the Luminary. After a decade of serving as a physician editor, writing 60 Luminary vignettes, our colleague, Dr. Marvin S. Segal, has retired. We thank him heartily and wish him well. In its place we welcome a medical student column. When you finish reading this issue of MetroDoctors, I have four books I want you to read: Daniel Kahneman’s, Thinking, Fast and Slow; Isabel Wilkerson’s, Caste; Ibram X. Kendi’s, How to Be an Antiracist; and Robin DiAngelo’s, White Fragility. These books provide meaningful context to contributory factors of societal disparities—unconscious bias and racism—and present the “how” of antiracism, a solution to remedy these disparities. In his book, Kahneman describes the evidence for system 1 and system 2 thinking. System 1 is our intuitive brain that is always running in the background and, because it equates difference with potential danger, it tends to generate racist thinking. System 2, our forebrain, is lazy and tends to accept without question the signals it gets from System 1. The take-home is that we need to consciously and consistently challenge our System 1 thoughts if we are to avoid racist thoughts and racist acts. If your reaction to Caste is the same as mine, it will be, “OMG! This is terrible. They never told me this in high school history class.” Just one example: Wilkerson documents that the Nazis, when looking to set up their anti-Semitic regime, turned to Jim Crow laws as their model. Even more shocking, they initially concluded that they could never get away with Jim Crow in Germany. Unfortunately, they did and much worse. I’ll bet you never learned that in history class, either. In the third book, How to Be an Antiracist, Kendi describes his journey from growing up racist in Brooklyn (yes, Blacks can be racists, too) to his current position as Director of the Center for Antiracist Research at Boston University. Concluding his book, he tells the reader that there is no neutral ground. There is racism and there is antiracism; sustaining antiracism requires policy change—education and awareness will never be enough. I think he’s right. A few weeks ago, as I was reading a National Academies of Sciences publication, I came across a study (https://bit. ly/SAGEjournal) of more than 3 million Swedish infants. Adjusted for covariates, preconception stress of the mother increased the risk of infant mortality by 53%, preterm birth by 19% and small for gestational age by 14%. As I imagine the experience of Black women and the daily microaggressions and microtraumas that they experience, I conclude that, in addition to improving obstetrical care, all of us—OBs or not—have an opportunity to improve birth outcomes by improving the experience of Black daily life. In the fourth book, White Fragility, Robin DiAngelo suggests we do it by becoming allies. So, seek out your opportunities and ask, “How would you like me to help you?” In doing so, you will be co-creating a better future for everyone.

By Thomas E. Kottke, MD Member, MetroDoctors Editorial Board