Fear of discrimination and dying during pregnancy and childbirth may lead pregnant Black women to prefer seeing a Black obstetrician, a small study suggests.
Researchers at the University of North Carolina at Chapel Hill conducted a series of interviews and focus groups with 32 Black women ages 27 to 34 about their past experiences with obstetric care, along with their perspectives about having a Black obstetrician. The study’s findings were presented Wednesday at the Society for Maternal-Fetal Medicine’s annual meeting in National Harbor, Maryland.
Women who spoke to the researchers brought up their fear that their pregnancies may kill them.
“I was so scared because I’m like, I might die with this pregnancy. Like that was the first thought in my head. I could very well die just from simply getting pregnant and because I decided to have a child,” one woman said in a focus group during the study.
Black women’s fear of dying during pregnancy and childbirth is a reflection of real-life risks. The maternal mortality rate of Black women in 2021 was 2.6 times higher than the rate of white women, according to data from the Centers for Disease Control and Prevention. A 2022 report by the Pew Research Center also found that 71% of Black women ages 18 to 49 reported having at least one negative experience with health care providers in the past.
The discussions also revealed stark instances of racial stereotyping.
One woman said in an interview with the researchers that she was told “abortion is an option, especially if you don’t know the dad.” She told the provider she did, in fact, know who her child’s father is. “I’m sorry, am I meant to be a single mother?” she told the interviewers.
Another woman said that a nurse kept asking if she needed a social worker or government assistance. “What in my profile is making you ask these questions, are these normal questions? Or are you asking me this because I’m Black?” the woman recalled saying.
The women in the study showed a clear preference for Black obstetricians, but noted how difficult this was to find, the researchers wrote in the study abstract. The findings have not yet been published in a peer-reviewed journal.
“So because I was terrified, and this was my fourth C-section, I told my doctors because my doctor is a white woman and I told her I really would like a Black woman in there. Because you know, I’m just afraid,” one woman said in a focus group.
The idea that having a Black obstetrician might make Black patients feel safer during pregnancy care and childbirth has not been rigorously studied, said lead study author Dr. Nicole Teal, a maternal-fetal medicine subspecialist at UC San Diego Health.
Teal, who is white, said that many of the Black patients she’s interacted with have shared being uncomfortable with their prenatal care and have asked her what she’s doing to dismantle the maternal mortality crisis for Black women, which “pushed me in this direction,” she said of her research.
“Racial concordance between providers and patients has shown to improve outcomes in primary care, like with diabetes management, hypertension management and patient trust and satisfaction,” said Teal, who did the study when she was a maternal-fetal medicine fellow at UNC Chapel Hill, adding that she and her co-authors thought there might be a similar pattern for obstetric patients.
Dr. J’Leise Sosa, an OB-GYN based in Buffalo, New York, said the results from the study are “not surprising at all.” Many of the Black women under her care have expressed feelings of relief because of their shared identities, she said.
Sosa, who is Black, also has conversations with her patients about their previous experiences and fears, along with what they’re looking forward to in their pregnancies to see “where I could meet them that’s still medically safe to do,” she said, while still helping them feel comfortable.
“I am often met with this same phrase for my patients who are telling me, ‘I chose you because I trust you, because you’re an African American doctor,’” Sosa said. “‘I am afraid of the statistics I’m hearing about pregnant people and I want to be in a place where I feel safe and heard, and this is why I sought you out.’”
Feelings of relief are also evident in the patients of Dr. Joy Cooper, an OB-GYN and the CEO and co-founder of Culture Care, a telemedicine startup company that connects Black women with Black doctors. While previously working in clinics, Cooper said, she called patients’ reaction “the waiting to exhale,” a pun on the 1995 Black film, from the real-time reactions of patients discovering their OB-GYN is Black.
“Their shoulders relax, they sit back and it’s like ‘I’m going to be heard,’” Cooper said. “They just feel it as a feeling. It’s sometimes hard to describe.”
Not being heard was another major theme revealed in the study.
“I did not feel heard. I didn’t feel like they were taking me seriously,” one woman said.
Another spoke of talking to a white provider about her concerns “but I felt like she wasn’t listening to them, and she was just kind of brushing them off as in not taking me seriously.”
Sosa said there are very “literal and real effects” of not paying attention to pregnant Black patients and not investigating their concerns, including death and severe illness, which can cause long-term hospitalization resulting in physical and emotional trauma. Characteristics of racism are still embedded in the medical curriculum, she added, in methods such as the vaginal birth after cesarean calculator, which helps doctors determine the chances of a woman who previously had a cesarean section having a successful vaginal birth.
“There’s no evidence out there that says a Black person, a Latina person, a Native American person is somehow physiologically genetically at increased risk of C-sections,” she said. Yet, race is still embedded as a factor in the calculator.
Sosa said that hospitals also need to include patients’ experiences of discrimination in quality measures that help address patient satisfaction and community needs.
Both Teal and Cooper agree that recruiting and retaining more Black OB-GYNs is also crucial.
Many institutions cannot retain Black doctors because they’re hostile to Black people, Cooper said,“whether you work for the system, whether you’re getting your care for the system — and that is really the problem of racism in medicine.”
“That’s the part that no one wants to address,” she added.
Teal said she hopes the data from the study will push institutions to prioritize diversifying the workforce, adding that it’s clear many Black patients would prefer to have an obstetrician of the same race.
“So, as a field, we need to work to increase the number of Black OB providers, and that includes physicians, but also midwives,” she said.
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