Cesarean Sections and Racial Birth Trauma: A Qualitative Analysis for Obstetric Racism among Black Women in the...

The United States has one of the highest cesarean section (c-sections) rates among high-income countries. Birthing people who self-report as Black women in the United States are not only are three to four times more likely to die from preventable prenatal challenges, but also are the most prevalent racial group to receive either planned or unplanned c-sections.

Our initial aim focused on the lived experiences of prenatal care and the variety of birth types among Black women that was analyzed for a prior publication. In this secondary analysis, we noticed there was a large portion of study participants who discussed their perceptions of cesarean births.

In this specific analysis and due to c-section prevalence among Black women, we solely focused on the perceptions of c-sections, whether of planned or unplanned mode of delivery.

We analyzed interviews from 25 women in the South Florida region of the United States who had at least one recent pregnancy and/or birth of a living child (<24 months) at the time of data collection. Data were thematically analyzed and coded using NVIVO 12 software by our research team.

Nineteen Black women had high-risk prenatal status, with n = 15 of the 25 Black women having c-sections. Regardless of whether c-sections were planned or unplanned, perceptions of c-sections were expressed as traumatizing and coercive. We also noticed how participants described their experiences with intergenerational trauma from the collective memory and triggers of their familial social groups who also had adverse experiences with c-sections. Participants who desired vaginal-births-after-cesarean sections or wanted to incorporate approaches with midwives or doulas further experienced constrained choices due to their high-risk prenatal diagnosis and limited insurance coverage. Based on our results, we designed a conceptual model to illustrate how our findings can be applied to better understand the overlap between medical racism and obstetric racism, which has implications for the perpetuation of unwarranted c-sections, high-risk pregnancies, negative mental health issues, and racial birth trauma.

Social factors, including medical racism, contribute to obstetric racism and racial birth trauma throughout postpartum and impact mental health.