A year into her role seeing patients with high-risk pregnancies at Allegheny Health Network, Carmen Proctor was reflecting on the patients she's had, the questions she's answered, and the babies born under her care.

She recalled one patient who delivered twins at 22 weeks gestation and one of the babies died during delivery. The surviving baby has been thriving in the neonatal intensive care unit for nearly 200 days.

Experiences like these motivate Proctor to be a compassionate and comprehensive provider — and she especially feels the responsibility of being one of the only Black maternal-fetal medicine physicians in Pittsburgh.

"I've pretty much been in school my whole life," she said in a recent interview, in a room filled with crimson poinsettias at Bloomfield's West Penn Hospital. "I put a lot of things on the back burner, but I do feel like I'm in my purpose."

It's not new that Black birthers face a maternal death rate higher than their white counterparts. In Allegheny County and Pennsylvania at-large, Black women die at a rate more than two times higher than white women, per county and state data.

Proctor, however, is trying to approach the problem in a new way.

Since the 36-year-old finished her medical fellowship at UPMC Magee-Womens and moved to work in maternal-fetal medicine with AHN, she's started using a ratio that helps predict a patient's risk of preeclampsia.

Preeclampsia, which is characterized by dangerously high blood pressure during pregnancy, impacts up to 8% of pregnancies worldwide and kills 46,000 mothers each year, per the World Health Organization.

It's a leading cause of pregnancy complications, and with symptoms such as high blood pressure, headaches, upper abdominal pain and nausea, some doctors say it can be hard to identify. Historically, it has not always been taken seriously.

In addition to being more likely to have their concerns brushed off by providers, Black women are also nearly twice as likely to have preeclampsia than white women, according to a Johns Hopkins University study from 2021.

The preeclampsia risk ratio

Shortly after arriving at AHN, Proctor read up on the sFlt-1 ratio, which measures certain proteins in a pregnant person's body that puts them at higher risk for developing preeclampsia. While use of the ratio is still fairly new, research going back to 2016 shows it can be effective at predicting preeclampsia two weeks later.

Proctor thinks she may be one of the only maternal-fetal medicine specialists in the region that uses the ratio to gather more information about a patient's risk for the condition.

She hopes technology can improve so doctors can get more real-time data about results, because it takes three or four days for results to come back — at which point, the patient may have already been discharged back home.

She estimates that around 20% to 25% of her patients have hypertension, and those with hypertension are 25% more likely to develop preeclampsia during pregnancy.

The solution to improving outcomes, though, lies beyond preeclampsia, said Proctor.

"I think there is a need to really listen about implicit bias and be open to patients who have a different cultural background and understanding how they feel, what their pain is like, and the way they verbalize those things," she said.

Coworkers have called Proctor a "wonderful" addition to the team with a knack for connecting with patients. It's integral for her patients to see a doctor who looks like them, she said.

"I think that's the biggest thing, is when you meet somebody and they say, 'I've never had a Black doctor before,' or 'I can't believe you're my OB-GYN,'" she said.

Proctor's ultimate goal is to increase trust among her Black patients and work to close the health gaps they face, driving down maternal complications while building rapport with the community.

Proctor's story

Early experiences shaped her desire to study medicine, although she had been dead set on becoming a professional dancer until college.

Her father, Stephen Proctor, is an OB-GYN who completed his medical residency at Allegheny General Hospital in 1985. She had an idea of what studying women's health would look like, watching him practice medicine and seeing the obstacles he faced as a Black doctor.

Then, when Proctor was in undergrad at Virginia Commonwealth University, her mom was diagnosed with Stage 3 hormone-receptor positive breast cancer. While she entered remission, her cancer eventually returned and she died a few years later in 2016 while Proctor was in medical school.

Both experiences primed Proctor for entering the subspecialty of maternal-fetal medicine.

"Women's health has always been in the forefront of my brain," she said.

She had naysayers throughout her schooling: some who told her she wouldn't get into medical school, others who discouraged her from specializing in obstetrics and gynecology or from trying for a fellowship in maternal-fetal medicine. She succeeded at all of the above.

Proctor tries to keep her focus on improving relations with her patients, many who might have longstanding distrust of the medical community or have never had a doctor sit for more than 15 minutes to listen to their concerns.

She remembers her mother complaining about not being taken seriously by doctors when she had cancer.

She recalled her mother saying "they didn't hear her out when she said things were hurting her when she was going through chemo or some of the side effects that she was dealing with."

That made her realize that "learning how to talk to patients is the biggest thing" and has informed the way she relates to her patients and their own experience of their symptoms.

"One of the things that I try to emphasize to my residents is telling people that things are normal," she said. "Because what may be normal for us as a physician — because we see it all the time — may not feel normal for somebody who is pregnant or postpartum."

'One of the best doctors'

Proctor has had supporters along her journey: Some Black doctors and other residents at Howard University, where she attended medical school, mentored and encouraged her.

D'Angela Pitts, her sorority sister, was a few years ahead of Proctor in medical school at Howard. Pitts, now a maternal-fetal medicine specialist at Henry Ford Health in Detroit, Mich., and Proctor text regularly and discuss questions they have about their practice or certain strategies. They try to meet in person whenever they can.

"Carmen is a phenomenal person," Pitts said. "She's one of the best maternal fetal medicine doctors ... I have known that if a patient is moving elsewhere, she will call to find the right doctor for them. So she is invested in the well-being for mom and baby."

Around 6% of OB-GYNs are Black women, and when they specialize in maternal-fetal medicine, that percentage drops, Pitts said. Knowing that outcomes for Black patients improve when they have a physician who looks like them, representation is not trivial — it could be lifesaving.

"She's uniquely positioned for addressing that," said Devon Ramaeker, division director of maternal-fetal medicine at AHN Women's Institute. "When you have a Black physician taking care of Black patients, there's a comfort level you can't replicate.

"It's really hard to overcome that distrust unless you have someone you can relate to," she added. "So it's a huge deal."

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