Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.
Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
Womens Health Issues. 2021 Jan-Feb;31(1):75-81. doi: 10.1016/j.whi.2020.09.002. Epub 2020 Oct 14.
Racial and ethnic disparities in rates of maternal morbidity and mortality in the United States are striking and persistent. Despite evidence that variation in the quality of care contributes substantially to these disparities, we do not sufficiently understand how experiences of perinatal care differ by race and ethnicity among women with severe maternal morbidity.
We conducted focus groups with women who experienced a severe maternal morbidity event in a New York City hospital during their most recent pregnancy (n = 20). We organized three focus groups by self-identified race/ethnicity ([1] Black, [2] Latina, and [3] White or Asian) to detect any within- and between-group differences. Discussions were audiotaped and transcribed. The research team coded the transcripts and used content analysis to identify key themes and to compare findings across racial and ethnic groups.
Participants reported distressing experiences and lasting emotional consequences after having a severe childbirth complication. Many women appreciated the life-saving care they received. However, poor continuity of care, communication gaps, and a perceived lack of attentiveness to participants' physical and emotional needs led to substantial concern and disappointment in care. Black and Latina women in particular emphasized these themes.
This study highlights missed opportunities for improved clinician communication and continuity of care to address emotional trauma when severe obstetric complications occur, particularly for Black and Latina women. Enhancing communication to ensure that women feel heard and informed throughout the birth process and addressing implicit bias, as a part of the more systemic issue of institutionalized racism, could both decrease disparities in obstetric care quality and improve the patient experience for women of all races and ethnicities.
美国产妇发病率和死亡率的种族和民族差异显著且持续存在。尽管有证据表明，护理质量的差异在很大程度上导致了这些差异，但我们并不充分了解在严重产妇发病率的女性中，种族和民族差异如何影响围产期护理体验。
我们对在纽约市一家医院最近一次怀孕时经历严重产妇发病率事件的女性进行了焦点小组讨论（n=20）。我们按自我认同的种族/族裔（[1]黑人，[2]拉丁裔，和[3]白人和亚裔）组织了三个焦点小组，以检测任何组内和组间的差异。讨论内容进行了录音和转录。研究小组对转录本进行了编码，并使用内容分析来确定关键主题，并比较不同种族和族裔群体的发现。
参与者报告说，在经历严重分娩并发症后，他们经历了令人痛苦的经历和持久的情绪后果。许多女性对她们所接受的救命护理表示赞赏。然而，护理连续性差、沟通差距以及对参与者身体和情感需求的感知缺乏关注，导致对护理的严重关注和失望。黑人女性和拉丁裔女性尤其强调了这些主题。
这项研究强调了在严重产科并发症发生时，改善临床医生沟通和护理连续性以解决情绪创伤的机会错失，特别是对黑人女性和拉丁裔女性而言。加强沟通以确保女性在整个分娩过程中感到被倾听和知情，并解决隐性偏见，作为机构性种族主义更系统问题的一部分，都可以减少产科护理质量的差异，并改善所有种族和族裔女性的患者体验。
