A Mixed Methods Study Assessing the Impact of a Black Maternal Experience Discussion-Based Module
Chantay Young, 1Donald
1 BA
and Martine Hackett,
2 PhD
and Barbara Zucker School of Medicine at Hofstra/Northwell 2Hofstra University, Department of Population Health
Background During the 2015-2017 period, New York’s maternal mortality rate hovers at 18.9 deaths per 100,000 live births with Black women are still three times more likely to die in childbirth than White women1. Structural racism in large part has fueled these statistics2. Many Black women recall being neglected and stereotyped as uninformed, unemployed, and unmarried when receiving care3. Researchers have turned to implementing respectful care and storytelling to address this disparity. Respectful care aims to provide empower women and allow them to maintain ”their dignity, privacy and confidentiality” when giving birth4. Storytelling is being used in health promotion, education, and social advocacy5. Hearing Black women’s birthing experience has been designated as one of the measures to improve outcomes.
Results
Table 1. Participant Demographics Module Participants (n=15) n Occupation Physician 4 Student 1 Registered Nurse 8 Administrator 1 Clinical Program Manager 1
%
Common themes included: need for patient education, different perspectives, lack of empathy, empowerment, and ineffective communication. Select quotes are below:
26 7 53 7 7
v “[It] sounds like she didn’t have a champion (nurse, nursing student, med student, resident, attending) [or] anybody including fam members to help absorb the information and explain it.”
Objectives
Quantitative Analysis • Providers were evaluated a using pre-test assessing their prior knowledge and a post-test following the discussion. • The results were analyzed using the Wilcoxon Signed Rank Test. Qualitative Analysis • Field notes from the discussions were coded and organized into a code book. • Common themes and relevant quotes were extrapolated to support the quantitative data. • Coding was performed using HyperRESEARCH 4.5.2 (Researchware, Massachusetts, USA).
Based on the current literature and recommendations, we crafted a module to further understand Black women’s perspectives. Our objectives are:
Results
• Analyze how anticipatory guidance during the prenatal and postpartum period are communicated within the patient and healthcare provider relationship • Understand the significance of utilizing respectful care in interactions with patients and their families
Methods Black Maternal Experience Module • Providers watched videos of three Black women’s birthing testimonies. • This was a facilitated discussion in which providers were asked questions relating to informed care, anticipatory guidance, and communication. They were also asked to reflect on similar situations they may have encountered in their career. • This module was conducted as a quality improvement pilot for the Northwell’s NYS Birth Equity Improvement Project (BEIP) steering committee. BEIP aims to work with hospitals across the state to improve maternal outcomes. • Providers were affiliated with Northwell Health and The Visiting Nurse Services of New York.
Table 2. Average Pre and Post Test Responses Questions I am aware of the common adverse maternal and child health outcomes that affect the Black community. I am aware that Black women may experience racism during their pregnancy, delivery, and post-partum period. I am aware of how experiencing racism can affect maternal and child health outcomes. During the pre-partum period, I routinely talk to patients about risk factors that predispose them to adverse maternal and child outcomes. I routinely talk to patients regarding symptoms of potentially serious medical events during the pre and postpartum periods. I am aware of the term "respectful maternity care." I am aware of the importance of utilizing "respectful maternity care." I routinely use respectful maternity care in all patient encounters/interactions. When able, I routinely involve and communicate with the patient's support system (i.e. spouse, family member)
Pre-Test Post-Test D Average Average
P
4.00
4.45
0.45 0.14
4.60
4.60
0.00 0.84
4.33
4.40
0.07 1.00
4.10
4.60
0.50 0.23
4.10 3.60
4.50 4.40
0.40 0.19 0.80 0.03
4.00
4.53
0.53 0.11
4.00
4.40
0.40 0.41
4.14
4.45
0.31 0.18
v “The root cause is not time; it’s interest in best utilizing resources an creating protocols to address patient care.” v “[These modules] should be disseminated to others. Just seeing and hearing their narratives[s] are important for others to see.”
Conclusions Providers who participated in the module developed an awareness of ”respectful maternity care.” These individuals who elected to participate were amenable to engaging in the discussion and sharing their perspectives. Their ability to grasp this concept may stem from their prior understanding of current climate surrounding Black maternal mortality. While other modules have focused on widely available statistics, Black birthing stories are not centered. This module offers a crucial first step in exposing providers to and reinforcing habits that promote respectful maternity care.
Future Direction This data will be presented to the NYS BEIP steering committee. Recommendations will include increasing the minimum number of participants may generate more perspectives. Complementing this module with stories from Black providers may offer a balanced discussion and represent both the patient and provider perspective. Further modules can be developed to share the perspectives of other birthing people.
References 1. New York State Maternal Mortality Review Report: A Comprehensive Review of the 2014 Cohort. 2019. 2. Julian Z, Robles D, Whetstone S, et al. Community-informed models of perinatal and reproductive health services provision: A justicecentered paradigm toward equity among Black birthing communities. Semin Perinatol. 2020;44(5):1-20. doi:10.1016/j.semperi.2020.151267 3. Davis DA. Obstetric Racism: The Racial Politics of Pregnancy, Labor, and Birthing. Med Anthropol Cross Cult Stud Heal Illn. 2019;38(7):560-573. doi:10.1080/01459740.2018.1549389 4. Shakibazadeh E, Namadian M, Bohren MA, et al. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. BJOG An Int J Obstet Gynaecol. 2018;125(8):932-942. doi:10.1111/1471-0528.15015 5. Mojtahedzadeh R, Mohammadi A, Emami AH, Zarei A. How digital storytelling applied in health profession education: A systematized review. J Adv Med Educ Prof. 2021;9(2):63-78. doi:10.30476/JAMP.2021.87856.1326