When the mother of one of her patient’s first saw board-certified OB-GYN Dr. Gillispie-Bell, she told her, “You look like someone who should have your own theme song when you enter the room.”
“I do,” laughed Gillispie-Bell. “It’s ‘Formation’ by Beyonce.”
In fact, Gillispie-Bell has been trying for many years on multiple fronts to get Louisiana “in formation” when it comes to improving women’s healthcare in the state.
It’s a big job; Louisiana consistently ranks in the five worst states when it comes to maternal mortality rates in the United States — which itself has higher rates of maternal death than any other high-income country in the world.
In addition to serving as associate professor for Ochsner Health in New Orleans, senior site lead and section head of obstetrics and gynecology at Ochsner Health Center —Kenner and director of quality for women’s services for the Ochsner Health System, Gillispie-Bell is also the medical director of the Louisiana Perinatal Quality Collaborative (LAPQC) and Pregnancy Associated Mortality Review (PAMR) for the Louisiana Department of Health.
The latter’s latest report — released in April — presents a detailed picture of maternal mortality in Louisiana throughout 2020. Findings show deaths are far more common in non-Hispanic Black women who, although they made up only 27% of births in the state, accounted for 62% of all pregnancy-related deaths.
The good news is that a vast majority of deaths are preventable. The same report noted 93% of pregnancy-related deaths and 81% of pregnancy-associated, but not related deaths were potentially preventable.
“Fortunately, we now are seeing more acknowledgement of the social drivers of health,” said Gillispie-Bell. “Eighty percent of clinical outcomes are due to social factors. For instance, if you have a single mom with no childcare, how is she expected to get to the doctor? How is someone supposed to afford food, housing, and medicines if they are living on a below poverty wage?”
While issues of childcare and wages require policy changes by the state, with others some headway is being made.
“One big issue is that about 26 percent of parishes in Louisiana are maternity care deserts, meaning the people who live in them have no access to an OB-GYN, a midwife or a birthing facility within a 30-minute drive,” said Gillispie-Bell. “So if an emergency happens, a woman is waiting to get help, which of course can impact outcomes.”
The issue is there are not enough OB-GYNs to go around, especially in the South, and the problem is expected to get worse.
“By 2030, it is estimated that we will be short be about 5,000 OB-GYNs nationwide, with a little over 2,000 of those just in the South,” she said. “And these numbers were estimated just after the pandemic in March 2021, so I do think it is an underestimation.”
Gillispie-Bell said burnout is a huge problem in her profession with existing physicians, less medical students in general are choosing OB-GYN, and those that do are becoming less likely to stay in the South.
Asked if recent state policy changes when it comes to abortion care have contributed to that in her opinion, she said, “Yes. That’s all I can say about it, unfortunately, but yes.”
Gillispie-Bell said she has been encouraged by the medical community’s move to embrace telehealth, including a program at Ochsner that aims to help diagnose issues with hypertension (high blood pressure) in pregnant women. Hypertension disorders in pregnancy are the leading cause of maternal deaths — accounting for 31.6 percent according to the Association of State and Territorial Health Officials.
“We introduced the Connected MOM program (maternity online monitoring),” she said. “We provide women with Bluetooth connected blood pressure cuffs that allow them and their physician to keep track of their blood pressure.”
According to Ochsner, Connected MOM program participants have shown to have 20 percent lower odds of delivering pre-term and the program is able to identify women with “masked high blood pressure,” where a woman’s blood pressure may be higher at home than when in a clinic. Connected MOMs have also been shown to complete a postpartum blood pressure check as they can easily do so from home.
Gillispie-Bell said the ability to meet with patients virtually has also been a positive move toward improving care.
“I saw patients that way during COVID, of course, and then during Hurricane Ida, when I evacuated, I was still able to see all of my patients through virtual visits,” she said. “But just in regular times it has been so great for so many women. I have plenty of patients who may not be able to take off work to come to the office but can take a 15-minute break at work and hop on for a virtual visit.”
In addition to thinking about more ways to bring care to patients, she said she’d also like to see midwives incorporated more for low-risk patients.
“We [physicians] need to be less territorial and work on collaborating together,” she said.
Another aspect of working to reduce maternal mortality rates, said Gillispie-Bell, is getting physicians to be aware of and address implicit bias in their work.
“We’re making some headway here,” she said. In my work with the Louisiana Perinatal Quality Collaborative we started doing trainings about bias in 2018 and requiring teams to look at their data in a disaggregated way so they could uncover any bias they may have. As a result, we’ve seen evidence of bias drop by about 20 percent. We’re seeing the gap get narrower. It’s not closed — especially when it comes to hypertension — but it is getting better. I am happy that we have been intentionally working with birthing facilities to improve equity. When we started talking about equity and racial bias, we would get a lot of defensiveness, even eye-rolling, but thankfully, times have been changing and people are much more willing to listen. It makes me hopeful.”
As medical director of LAPQC, Gillispie-Bell also oversees the organization’s work to improve care for pregnant women affected by opioid and substance use disorder. Launched in part due to findings from the Louisiana Pregnancy-Associated Mortality Review Report, for which she also serves as medical director, LAPQC launched a program in Sept. 2021 called the “Improving Care for the Substance-Exposed Dyad (ICSED) Initiative,” to address the fact that accidental overdose was found to be the leading cause of pregnancy-associated deaths in women in Louisiana. Thirty-four percent of all pregnancy-associated deaths were due to accidental overdose. The goal of ICSED is to achieve specific, measurable outcomes when it comes to identifying and treating those affected by substance use/misuse.
On the gynecological side of her practice, Gillispie-Bell has yet another passion — treating fibroids.
“July is actually fibroid awareness month, so it’s a great time to talk about it,” she said. “Fibroids are tumors that can develop in or around the uterus. They are very common — by the age of 50, about 80 percent of Black women will experience them and about 70 percent of white women. Black women tend to present with symptoms five years younger, and generally have more and worse symptoms. Those symptoms can include things like heavy bleeding, longer or heavier periods and pelvic pain.”
Gillispie-Bell said her interest in this particular female problem came via a personal connection.
“I was a junior in college when my mom told me she had to have a hysterectomy because of fibroids,” she said. “At the time, I knew I wanted to go into medicine. I hadn’t heard of fibroids before, so I started reading. That was in 1999, and the only treatment for fibroids was a hysterectomy. That was an epiphany moment for me. I decided I was going to find a cure for fibroids.”
While she acknowledges that a cure may not be found within her lifetime, Gillispie-Bell was a principal investigator for a drug called Oriahnn® that was approved in 2020 to treat heavy bleeding associated with fibroids. She also serves as the medical director of the Ochsner Center for the Minimally Invasive Treatment of Uterine Fibroids, which treats women from Louisiana and Mississippi for growths that can be as “small as a seed or as large as a grapefruit.”
“I can’t tell you how much it means to me when I see the relief on women’s faces when they learn that a hysterectomy is not their only option — that they have choices,” she said. “They come to see me, and they can be so clenched up with anxiety and fear. Some may have delayed care, maybe out of concern for their fertility, so much that they’ve become anemic from heavy periods. But then we start talking, and I can see the change in them. They leave feeling better, more secure, knowing their options.”
Gillispie-Bell credits her decision to become an OB-GYN with the fact that another physician helped her better get to know her career options.
It is just so amazing to be there with patients when they’re giving birth. I really just enjoy the process, even during pushing. I think we have so much fun. I also just enjoy being in clinic andgetting to know my patients. I
understand that my role as an OB-GYN goes beyond the clinical sometimes, to sharing life experiences. Women don’t just come in with just a cervix, they come to see me as a whole person and I treat them as such.
“I was home in Meridian, Mississippi for Christmas break from Xavier University, where I was an undergrad,” she explained. “I went for a regular checkup with my pediatrician, Dr. Purvis, and he was asking me what I was going to do. I told him I wanted to be a pediatrician because I love kids. He said, ‘But do you love kids when they’re vomiting and crying?’ and pointed out that I had never seen any other doctor. Then he asked me if I’d ever seen a C-section. I hadn’t, so he let me see one. It was incredible. For the two-and-a-half weeks I was home he treated me like a third-year med student. During that time, I realized I loved medicine but also doing surgery and the opportunity to be focused on women’s health.”
Gillispie-Bell went on to earn her medical degree from Meharry Medical College School of Medicine in Nashville, Tennessee and completed her residency training at Ochsner Health System. She also has a Master of Applied Science degree in health care quality and patient safety from the Johns Hopkins Bloomberg School of Public Health.
Gillispie-Bell said that after years of practice, she still thrills in her job.
“It is just so amazing to be there with patients when they’re giving birth,” she said. “I really just enjoy the process, even during pushing. I think we have so much fun. I remember one patient where we listened to the entire Isley Brothers soundtrack while she was pushing…But I also just enjoy being in clinic and getting to know my patients. I understand that my role as an OB-GYN goes beyond the clinical sometimes, to sharing life experiences. Women don’t come in with just a cervix, they come to see me as a whole person and I treat them as such.”
All of the roles she has taken on outside of her main practice have helped Gillispie-Bell become recognized as an authority on women’s medical care. In addition to publishing opinion pieces on Nola.com and “The New York Times,” she brought her experiences as a public health professional, a physician and a Black mother with her when she testified before the U.S. Congress in March of 2020 about healthcare disparities and systemic racism. She also spoke at the White House’s Maternal Health Day of Action in 2021, where she noted the importance of investing in historically Black Colleges and universities (HBCUs) to diversify the physician population.
“Only about 5 percent of OB-GYNs are black and 6 percent are Hispanic,” she said, noting her excitement for the upcoming opening of the Xavier Ochsner College of Medicine in New Orleans, for which she serves as a member of the board.
“I feel so blessed to have been given a platform around these issues,” she said. “I feel like people are starting to understand where we are now in terms of health outcomes. I feel hopeful that people are listening.”
She said she also hopes to inspire those who may be looking to become physicians who don’t fit what has so long been the dominant profile.
“When Dr. Purvis, a Black man, took me under his wings, I saw him achieving things and it gave me hope that I could too,” she said. “I want to be that for someone who may see me and say, ‘I look like her,’ or ‘I come from a small town like her,’ and be inspired that they can accomplish whatever they want to.”
Deaths are far more common in non-Hispanic Black women who, although they made up only 27% of births in the state, accounted for 62% of all pregnancy-related deaths.
A vast majority of deaths are preventable; 93% of pregnancy-related deaths and 81% of pregnancy-associated, but not related deaths were potentially preventable.
Source: Pregnancy Associated Mortality Review (PAMR) for the Louisiana Department of Health, April 2023 report
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More than 2.2 million women of childbearing age live in so-called maternity care deserts with no hospitals offering obstetric care, obstetric providers or birthing centers.
Source: March of Dimes
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From 1999 to 2019, the U.S.’s national maternal mortality rate more than doubled, going from 9.65 to 32.2 deaths per 100,000.
Source: Journal of American Medicine
