“Black Women Should Not Die Giving Life”: The lived experiences of Black women diagnosed with severe maternal morbidity in the United States
Georgetown University School of Medicine; MedStar Health Research Institute
How they used Delve
A research team at Georgetown University and MedStar Health used Delve to code 12 in-depth interviews with Black women who survived severe maternal morbidity and with mothers of women who died, coding independently and then reviewing each other's work to build a reflexive thematic account of obstetric racism.
“Employing grounded theory and thematic analysis principles, the research team used Delve qualitative coding software to scrutinize and categorize transcripts. The analysis focused on themes linked to the conceptual framework, encompassing racism forms (interpersonal, internalized, institutional, and structural), intrapersonal manifestations [...] and healthcare-related manifestations (communication breakdowns, provider stereotyping, differential treatment, resource/policy inadequacies, and medical errors).”
- Field
- Maternal health equity; obstetric racism as experienced by Black women who survived severe maternal morbidity in the US counties with the highest maternal mortality
- Data
- 12 in-depth interviews conducted August-December 2022: 10 with Black cisgender women aged 18-40 who had been diagnosed with severe maternal morbidity and lived in the US zip codes with the top-five highest maternal mortality rates, and 2 with mothers of women who had died. Mean age 31; most had graduate education and an average household income of $123,750.
- Approach
- A phenomenological study analysed with grounded theory and thematic analysis principles, guided by reflexive thematic analysis and aligned with Braun and Clarke. A codebook was built by the principal investigator and three study staff from a subset of three transcripts, mixing deductive codes drawn from the conceptual framework (forms of racism - interpersonal, internalized, institutional, structural; intrapersonal manifestations such as microaggressions and implicit bias; healthcare manifestations such as communication breakdowns, provider stereotyping, differential treatment and medical errors) with inductive codes from repeated transcript reviews. Definitions were refined through consensus discussion; each transcript was coded independently by one team member and then reviewed by a second, with discrepancies settled by consensus.
- Data types
- Interviews
Abstract
OBJECTIVE: We sought to understand the lived experiences of Black women diagnosed with severe maternal morbidity (SMM) in communities with high maternal mortality to inform practices that reduce obstetric racism and improve patient outcomes. METHODS: From August 2022 through December 2022, we conducted a phenomenological, qualitative study among Black women who experienced SMM. Participants were recruited via social media and met inclusion criteria if they self-identified as Black cisgender women, were 18-40 years old, had SMM diagnosed, and lived within zip codes in the United States that have the top-five highest maternal mortality rates. Family members participated on behalf of women who were deceased but otherwise met all other criteria. We conducted in-depth interviews (IDIs), and transcripts were analyzed using inductive and deductive methods to explore birth story experiences. RESULTS: Overall, 12 participants completed IDIs; 10 were women who experienced SMM and 2 were mothers of women who died due to SMM. The mean age for women who experienced SMM was 31 years (range 26-36 years) at the time of the IDI or death. Most participants had graduate-level education, and the average annual household income was 123,750 USD. Women were especially interested in study participation because of their high-income status as they did not fit the stereotypical profile of Black women who experience racial discrimination. The average time since SMM diagnosis was 2 years. Participants highlighted concrete examples of communication failures, stereotyping by providers, differential treatment, and medical errors which patients experienced as manifestations of racism. Medical personnel dismissing and ignoring concerns during emergent situations, even when raised through strong self-advocacy, was a key factor in racism experienced during childbirth. CONCLUSIONS: Future interventions to reduce racism and improve maternal health outcomes should center on the experiences of Black women and focus on improving patient-provider communication, as well as the quality and effectiveness of responses during emergent situations. Précis statement: This study underscores the need to center Black women’s experiences, enhance patient-provider communication, and address emergent concerns to mitigate obstetric racism and enhance maternal health outcomes.
Citation
Wendy Post, Angela Thomas, Karey M. Sutton (2024). “Black Women Should Not Die Giving Life”: The lived experiences of Black women diagnosed with severe maternal morbidity in the United States. Birth. https://doi.org/10.1111/birt.12820