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Culturally tailored health care in obstetrics

Aisha Anderson, an African-American female in her early 20's, makes an appointment to see her primary care doctor to find out more about getting her high blood pressure under control. Aisha experienced problems during a recent pregnancy due to her high blood pressure, and she reveals during the appointment that she is pregnant again. When Aisha seems reluctant to acknowledge the effect of her high blood pressure on her health, Dr. Felicia Roberts discusses with her the importance of controlling her blood pressure and some steps she can take to begin doing so.

0:00 The primary care doctor (Felicia Roberts) and the patient (Aisha Anderson) are in the exam room. This is the first time the doctor has seen the patient since she gave birth to her first child.

01:07 [Felicia Roberts] Good morning, Ms. Anderson. It's good to see you again.

01:09 [Aisha Anderson] Hello.

1:10 [Felicia Roberts] The last time you were here, you just learned you were pregnant. How was the rest of your pregnancy?

1:16 [Aisha Anderson] Not so good. I started getting headaches and then I felt nauseous, and then I was told that I had high blood pressure. Then, my son came early – after my 6th month. And then he had to stay in the hospital for 12 weeks after that.

1:33 [Felicia Roberts] How is your son now?

1:35 [Aisha Anderson] He's okay now. I have a therapist that comes to the house to help me take care of him once a week.

1:38 [Felicia Roberts] That's good to hear. I'm glad you have some support. I'm sure this has been a difficult experience. Now, what can I do for you today?

1:46 [Aisha Anderson] Well, my OB/GYN says that my blood pressure is still too high and that I should see my primary care doctor on advice on how to get it down. I think I probably already had high blood pressure before I got pregnant, and didn't know about it.. I think that's why my son was born early.

2:02 [Felicia Roberts] Well, your high blood pressure certainly could have been the reason for your son's premature birth - high blood pressure or hypertension negatively affects pregnancy, both for the mother and the growing baby if it is not treated.

2:13 [Aisha Anderson] Yeah, and now I'm starting to feel the same way I felt when I was pregnant and getting headaches and having to sit down all the time because I was dizzy.

2:24 [Felicia Roberts] It's good you came to see me today. Let's start by checking your blood pressure and then we can discuss your options for keeping it under control.

2:34 [Felicia Roberts] The first thing we need to talk about is how to keep your blood pressure under control.

2:37 [Aisha Anderson] There's a lot of people in my family that have high blood pressure, and there's a group at my church, but I'm too young.

2:45 [Felicia Roberts] Too young?

2:46 [Aisha Anderson] It's not something I need to worry about at my age.

2:49 [Felicia Roberts] High blood pressure can strike a person at any age, and it's very common for African Americans like your self. Blood pressure is a measure of how the heart contracts. Diseases like kidney failure, congestive heart failure, and strokes all begin with high blood pressure. And as you know, high blood pressure may affect your children as well. That's why keeping it under control is really important.

3:12 [Aisha Anderson] Okay, but I don't have money for medications and stuff like that.

3:15 [Felicia Roberts] That's ok. I encourage you to check out the group at your church, and I know that Applewood Clinic around the corner offers a low cost program, too. I can get you additional information about those programs if you're interested.

3:27 [Aisha Anderson] Yeah, I'll check it out.

3:29 [Felicia Roberts] That's good to hear. I think that you will really benefit from these programs because they will inform you about healthy living choices aimed at controlling your blood pressure..Now I want to go back to what we were talking about before with your pregnancy and labor experience. Are you planning on having more children in the future?

3:44 [Aisha Anderson] I know I need to take care of myself and my son. But I think I might be pregnant again.

3:52 [Felicia Roberts] Do you use contraceptives?

3:53 [Aisha Anderson] I'm not on the pill. My doctor said the pill was a bad idea for someone with have high blood pressure.

3:58 [Felicia Roberts] That is true. How about condoms, do you use them?

4:01 [Aisha Anderson] No. My boyfriend doesn't like to use them.

4:04 [Felicia Roberts] Thanks for sharing this with me. It's important I get a complete picture. Let's start by having you take a pregnancy test, and once we figure out if you are pregnant, we can discuss some options for safe blood pressure control throughout your pregnancy. We can also discuss ways to prevent unplanned pregnancy in the future that won't affect your blood pressure. Are you interested in learning about these treatment options?

4:25 [Aisha Anderson] Yes, thank you.

4:27 Aisha and Felicia acknowledge each other with a smile.