Respect, clear communication can address ‘mismatch in care’ for postpartum Black women

Key takeaways:

• Postpartum Black women reported poor communication, disrespect, structural racism and care discrepancies.
• Clinicians should strive to improve communication with all patients.

To improve morbidity and mortality rates for postpartum Black women, clinicians must focus on patients’ lived experiences, communication needs and the consequences of structural racism, researchers reported in O&G Open.

“The disparities we’re seeing in reproductive health outcomes for Black women, including maternal mortality and morbidity, are tied to experiences of racism on individual and structural levels in health care systems,” Micki Burdick, PhD, MA, assistant professor of women and gender studies at the University of Delaware, told Healio. “These disparities are also tied to social determinants of health and the ways health care systems and society are set up that exacerbate those poor outcomes. We need to understand the underlying racism in health care systems, as well as the social support needed specifically for marginalized, pregnant patients, especially understanding that we all have biases in health care. Those are things that everyone needs to lean into and understand to improve outcomes for patients.”

Assessing patient experiences

Burdick and colleagues conducted semi-structured 30-to-60-minute interviews with 30 women of color asking about care and lived experience through delivery, discharge, coming home and postpartum ED visits or readmission. All participants were readmitted to hospital or had a perinatal ED visit within 30 days of delivery hospitalization from June 2021 to July 2022. Researchers identified themes surrounding barriers to and lack of quality postpartum care for this patient population.

Overall, 97% of women self-identified as Black and 3% as Hispanic. Researchers identified the following main themes after interviews:

• perceived lack of communication about postpartum complications;
• structural racism described through examples of not being heard or believed;
• perceived lack of respect for Black women’s bodies by health care workers linked to inappropriate verbal and nonverbal communication; and
• discrepancies in care provided and chart documentation vs. patients’ understanding of their health care needs.

In addition, 83.3% of participants also described experiencing discrimination in health care settings during their most recent perinatal period attributed to race/ethnicity. According to Burdick, one of the more surprising findings of this study was the concept of a “mismatch in care” between patient expectations and the care they received or what was noted in their chart.

“Not only did a patient feel like they weren’t being given the care they should,” Burdick said during an interview. “It seemed as if they weren’t getting the necessary information about their health that they needed.”

This care mismatch could be a stepping point for thinking about how patients and clinicians communicate through face-to-face and chart interactions, Burdick noted.

“Even if the doctor told a patient they had [a condition] but the patient either didn’t hear them or didn’t understand what they were saying, that lack of communication can be quite dangerous,” Burdick said.

Put patient voice first

The researchers also noted women of color in the postpartum period want more information on their specific complications and wish to become partners in decision-making. Burdick said researchers should do more to focus on patient stories when working to improve care.

“There’s been a lot of work done already, including a study on patient stories and narratives, but more needs to be done with these stories,” Burdick told Healio. “Instead of writing papers, disseminating these stories in different ways is helpful on community and patient advocacy levels. More research around charting and patient experiences and communicating that across health systems is a fruitful place to do more research.”

For more information:

Micki Burdick, PhD, MA, can be reached at mburdick@udel.edu; X (Twitter): @Mickianna.