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Hoang TMH, Lee BA, Hsieh WJ, Lukacena KM, Tabb KM. Experiences of racial Trauma among perinatal women of color in seeking healthcare services. Gen Hosp Psychiatry 2023; 84:60-66. [PMID: 37393649 DOI: 10.1016/j.genhosppsych.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To describe the experiences of perinatal Black, Indigenous, and other People of Color (BIPOC) women in healthcare interactions. METHODS We conducted eight virtual focus groups with perinatal BIPOC women across the USA from November 2021 to March 2022. A semi-structured interview protocol was used, and focus groups were audio recorded and transcribed verbatim. Our team used reflexive thematic analysis to analyze the qualitative data and describe our findings. RESULTS Three latent themes emerged related to racial trauma in healthcare interactions: (1) observations and experiences of anti-Black bias, (2) experiences of dismissal of pain and withholding of care, particularly among Black and Latinx patients, and (3) common race-based traumatic experiences across all BIPOC women, including a consistent lack of bodily autonomy and deferral to White people for decision-making. Recommendations from participants included more transparent communication and greater empathic care for all patients, with calls to specifically address anti-Black bias in healthcare treatment. CONCLUSION The study's findings suggest that perinatal healthcare needs to reduce mental stress and exposure to racial trauma for perinatal BIPOC women. This study offers a discussion of implications for future training for healthcare providers and implications for addressing systemic racial disparities in perinatal mental health.
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Affiliation(s)
- Tuyet-Mai H Hoang
- School of Social Work at the University of Illinois Urbana-Champaign, USA.
| | - B Andi Lee
- Department of Psychology at the University of Illinois Urbana-Champaign, USA
| | - Wan-Jung Hsieh
- Department of Social Work at the National, Taiwan University, USA
| | - Kaylee Marie Lukacena
- Center for Social and Behavioral Science at the University of Illinois Urbana-Champaign, USA
| | - Karen M Tabb
- School of Social Work at the University of Illinois Urbana-Champaign, USA
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Carvalho K, Kheyfets A, Lawrence B, Moky A, Harris L, Abouhala S, Amutah-Onukagha N. Examining the Role of Psychosocial Influences on Black Maternal Health During the COVID-19 Pandemic. Matern Child Health J 2021; 26:764-769. [PMID: 34417954 PMCID: PMC8379571 DOI: 10.1007/s10995-021-03181-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
Introduction Due to the disproportionate impact of COVID-19 on communities of color, racial disparities in maternal mortality and morbidity are likely to increase. However, neighborhood and social support factors have yet to be discussed as potential mechanisms by which COVID-19 can exacerbate racial disparities. Methods We examined literature on the role of neighborhood factors and social support on maternal health outcomes and provided analytical perspective on the potential impacts of COVID-19 on Black birthing people. Results Even prior to the pandemic, Black individuals were disproportionately impacted by psychosocial stress. However, the compounding effect of pre-existing and current pandemic psychosocial stressors may be a mechanism by which racial disparities are exacerbated and result in higher rates of maternal mortality and morbidity in Black women. Conclusion We recommend continued monitoring of data related to racial disparities in maternal mortality and morbidity throughout the pandemic. Given that Black women may be disproportionately impacted by psychosocial stress, it is necessary for leadership structures and communities to recognize the potential for worsening disparities and intervene.
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Affiliation(s)
- Keri Carvalho
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue MV 252, Boston, MA, 02111, USA.
| | - Anna Kheyfets
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue MV 252, Boston, MA, 02111, USA
| | - Blessing Lawrence
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue MV 252, Boston, MA, 02111, USA
| | - Alison Moky
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue MV 252, Boston, MA, 02111, USA
| | - Lauren Harris
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue MV 252, Boston, MA, 02111, USA
| | - Siwaar Abouhala
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue MV 252, Boston, MA, 02111, USA
| | - Ndidiamaka Amutah-Onukagha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue MV 252, Boston, MA, 02111, USA
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Liese KL, Davis-Floyd R, Stewart K, Cheyney M. Obstetric iatrogenesis in the United States: the spectrum of unintentional harm, disrespect, violence, and abuse. Anthropol Med 2021; 28:188-204. [PMID: 34196238 DOI: 10.1080/13648470.2021.1938510] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
'Medical iatrogenesis' was first defined by Illich as injuries 'done to patients by ineffective, unsafe, and erroneous treatments'. Following Lokumage's original usage of the term, this paper explores 'obstetric iatrogenesis' along a spectrum ranging from unintentional harm (UH) to overt disrespect, violence, and abuse (DVA), employing the acronym 'UHDVA' for this spectrum. This paper draws attention to the systemic maltreatment rooted in the technocratic model of birth, which includes UH normalized forms of mistreatment that childbearers and providers may not recognize as abusive. Equally, this paper assesses how obstetric iatrogenesis disproportionately impacts Black, Indigenous, and People of Color (BIPOC), contributing to worse perinatal outcomes for BIPOC childbearers. Much of the work on 'obstetric violence' that documents the most detrimental end of the UHDVA spectrum has focused on low-to-middle income countries in Latin America and the Caribbean. Based on a dataset of 62 interviews and on our personal observations, this paper shows that significant UHDVA also occurs in the high-income U.S., provide concrete examples, and suggest humanistic solutions.
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Affiliation(s)
- Kylea L Liese
- Department of Human Development Nursing Science, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Karie Stewart
- Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Melissa Cheyney
- School of Language Culture and Society, Oregon State University College of Liberal Arts, Corvallis, OR, USA
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Collins CC, Rice H, Bai R, Brown PL, Bronson C, Farmer C. "I felt like it would've been perfect, if they hadn't been rushing": Black women's childbirth experiences with medical providers when accompanied by perinatal support professionals. J Adv Nurs 2021; 77:4131-4141. [PMID: 34137066 DOI: 10.1111/jan.14941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/01/2022]
Abstract
AIMS This study examined the nature and characteristics of Black women's interactions with medical providers during childbirth when accompanied by a perinatal support professional (PSP; similar to a doula). DESIGN The design was qualitative, and a phenomenological approach was employed to examine the meaning of women's experiences. METHODS We conducted in-depth interviews with 25 Black women enrolled in a perinatal support program in Cleveland, Ohio, in late 2017 and early 2018, exploring their interactions with medical providers, the meaning of their experiences, and the roles their PSPs played. RESULTS Clients broadly categorized experiences as positive or negative. When medical providers respected them, their birth plans and/or collaborated with PSPs, women reported more positive experiences. They associated negative experiences with providers having their own timelines and agendas, and women perceiving their needs were unheard and/or disrespected. CONCLUSION The findings emphasize the need for medical providers to be patient-centred, set aside assumptions, treat their patients as experts, value women's knowledge and voice, and treat patients and their supports as part of the team. IMPACT Findings support the importance of having a knowledgeable but non-medical support person present during birth. We discuss implications for how empowerment may be a tool to achieving better birth outcomes.
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Affiliation(s)
- Cyleste C Collins
- School of Social Work, Cleveland State University, Cleveland, OH, USA
| | - Heather Rice
- School of Nursing, Cleveland State University, Cleveland, OH, USA
| | - Rong Bai
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
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Altman MR, McLemore MR, Oseguera T, Lyndon A, Franck LS. Listening to Women: Recommendations from Women of Color to Improve Experiences in Pregnancy and Birth Care. J Midwifery Womens Health 2020; 65:466-473. [PMID: 32558179 DOI: 10.1111/jmwh.13102] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Women of color are at increased risk for poor birth outcomes, often driven by upstream social determinants and socially structured systems. Given the increasing rate of maternal mortality in the United States, particularly for women of color, there is a pressing need to find solutions to improving care quality and access for racially marginalized communities. This study aims to describe and thematically analyze the recommendations to improve pregnancy and birth care made by women of color with lived experience of perinatal health care. METHODS Twenty-two women of color living in the San Francisco Bay Area and receiving support services from a community-based nonprofit organization participated in semistructured interviews about their experiences receiving health care during pregnancy and birth. Interviews were audio-recorded and transcribed, and transcripts were analyzed using thematic analysis to highlight recommendations for improving perinatal care experiences. RESULTS Participants shared experiences and provided recommendations for improving care at the individual health care provider level, including spending quality time, relationship building and making meaningful connections, individualized person-centered care, and partnership in decision making. At the health systems level, recommendations included continuity of care, racial concordance with providers, supportive health care system structures to meet the needs of women of color, and implicit bias trainings and education to reduce judgment, stereotyping, and discrimination. DISCUSSION Participants in this study shared practical ways that health care providers and systems can improve pregnancy and birth care experiences for women of color. In addition to the actions needed to address the recommendations, health care providers and systems need to listen more closely to women of color as experts on their experiences in order to create effective change. Community-centered research, driven by and for women of color, is essential to improve health disparities during pregnancy and birth.
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Affiliation(s)
- Molly R Altman
- University of Washington School of Nursing, Seattle, Washington.,Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Monica R McLemore
- Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,University of California, San Francisco School of Nursing, San Francisco, California
| | - Talita Oseguera
- University of California, San Francisco School of Nursing, San Francisco, California
| | - Audrey Lyndon
- New York University Rory Meyers College of Nursing, New York, New York
| | - Linda S Franck
- Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,University of California, San Francisco School of Nursing, San Francisco, California
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Negotiating Patient-Provider Power Dynamics in Distinct Childbirth Settings: Insights from Black American Mothers. SOCIETIES 2019. [DOI: 10.3390/soc9020045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several studies have examined women’s perceptions and experiences of out-of-hospital births, that is, births that take place at home or in birthing centers overseen by midwives. However, White women have primarily been the subject of these investigations. Black women are underrepresented among mothers who have out-of-hospital births, yet they provide an intriguing case for this birthing practice, given their elevated maternal mortality rates and the general rise in home and birth-center births since 2005. This study utilizes a split-sample design to compare the experiences of Black American women who gave birth in out-of-hospital and within-hospital settings in San Antonio, Texas. San Antonio is an excellent site for such an inquiry, as Black women are a decided racial minority in this Latino-dominated city, and often face healthcare access challenges. Drawing on insights from theories of intersectionality and power, this study uses in-depth interviews to explore how patient-provider power asymmetries emerge and are negotiated by Black American mothers who have out-of-hospital births, in contrast to their hospital-birthing peers. Narratives reveal that patient-provider power relations and asymmetries exist both within and outside of hospital settings, but are distinctly manifested in each setting. Out-of-hospital births are more mother-centered, but power machinations are more covert in such settings. Participants employ various forms of resistance to negotiate asymmetrical relationships with providers.
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Margaret MC, Patricia MK, Mutinta M, Concepta K, Victoria KM, Musenge E, Odland JO, Stray-Pedersen B. Women’s Experience with Socio-Economic Factors Associated with Perinatal Morbidity and Mortality in Lusaka and Mumbwa Districts of Zambia. Health (London) 2019. [DOI: 10.4236/health.2019.116061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wren Serbin J, Donnelly E. The Impact of Racism and Midwifery's Lack of Racial Diversity: A Literature Review. J Midwifery Womens Health 2016; 61:694-706. [DOI: 10.1111/jmwh.12572] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/25/2016] [Accepted: 09/12/2016] [Indexed: 11/28/2022]
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