Black Birthing People's Perspectives on Racial Concordance With Obstetricians and Midwives

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OBJECTIVE: To explore Black birthing people's perspectives on racial concordance with obstetricians and midwives and understand how their lived experiences with racism, discrimination, and contextualized stress influence those perspectives. METHODS: This study used a qualitative descriptive approach to conduct 1-on-1 semistructured interviews and focus groups in a sample of individuals who self-identified as Black or African American, were aged 18 years or older, were English-speaking, and gave birth within a large university health system between 2019 and 2021. Potentially eligible individuals were identified using electronic health record data and then were recruited and provided consent electronically. Interview and focus group guides were cocreated by the research team and were used to elicit discussion regarding lifetime experiences with racism and discrimination, experiences with the health care system during pregnancy, and perspectives on racial concordance with obstetricians and midwives. Interviews and focus groups were conducted by experienced researchers who identify as Black women. The interviews were audio recorded and transcribed, and data were deidentified for analysis. Thematic analysis was used to group codes into larger themes. RESULTS: Researchers conducted a total of 16 individual semistructured interviews and five focus groups of two to four participants each. The final sample included 32 individuals who all identified as non-Hispanic Black women. The median age was 32 years, 62.5% were married, and 71.9% had a bachelor's degree or higher. Six themes arose: 1) fear of dying deeply embedded within the Black perinatal experience; 2) obstetricians, midwives, and nurses not listening as an invalidating experience; 3) stereotyping toward Black birthing people; 4) desire for racial concordance with obstetricians, midwives, and nurses as a way of harm reduction; 5) difficulty finding racially concordant obstetricians and midwives as a resigned reality; and 6) self-advocacy and seeking continuity with one obstetrician or midwife as strategies for obtaining quality care. CONCLUSION: Black birthing people in this study shared a clear preference for racially concordant obstetricians and midwives, specifically citing fear of dying and experiences of racism and discrimination both in their lives generally and in obstetric care as major reasons why, and they lamented how difficult it is to find this. Increasing opportunities for racially concordant obstetric care may be one strategy for achieving equitable obstetric care for Black birthing people.

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