The Consideration of Environment in Black Midwifery Care Practices

Black midwives today and in the past have indicated their motivation to provide physically and emotionally safe perinatal care that includes building meaningful relationships, equitably sharing information, spending more time with clients, and providing racially concordant care. An unexplored element within the literature the consideration of a patient's environment. This work seeks to understand the importance of this element in a patient's care and reproductive experience.

Semistructured interviews (60-75 minutes) of 5 Black midwives across the continental United States were conducted to answer the research question How do considerations of the environment shape Black midwives' care praxis? Participants held a variety of licensing designations; 3 were certified nurse-midwives, 1 was a certified midwife, and 1 was originally unlicensed but later became a certified professional midwife. Abductive analysis was used, and multiple rounds of coding were conducted to produce themes.

Three general categorizations of environment emerged: (1) natural or climatic environment, (2) social environment, and (3) caregiving environment. Environmental consideration informs anticipatory guidance, or experiences witnessed and participated in that inform how midwives will advise a future patient. This anticipatory guidance demonstrates how Black midwives draw on their embodied knowledge of past experiences to inform and personalize their care for current and future patients.

Black midwives consider the environment in a multiplicity of ways to inform their care and how it may impact a pregnancy. Awareness of both the natural and social environment of a patient informs the midwives on relevant aspects of the patient's history and steers the Black midwives' anticipatory guidance, which can go beyond just one patient. Overall, the consideration of the environment for Black midwives does not necessarily change the quality or type of care they administer, but instead informs how to approach care so that they can provide a more personalized experience for patients.