Black Women's Accounts of Clinician Interactions in the Context of High-Risk Pregnancies

Respectful maternity care practices are important to understand and support. Enhancing practice to promote positive experiences and optimal health among Black women experiencing a high-risk pregnancy is particularly urgent. Using principles of relationship-centered care through a critical race lens, our aims were to describe individuals' accounts of clinician interactions, including the role of racial concordance, and participant accounts of the short-term and potential long-term outcomes of these interactions.

We conducted a qualitative descriptive study (N = 14) between September 2022 and December 2024. For inclusion, participants had to self-identify as Black, have given birth at ≤6 months, and have had a diagnosis of gestational diabetes or a hypertensive disorder of pregnancy. We used directed content analysis with deductive codes and in vivo, inductive codes.

Positive interactions were characterized by clinicians being emotionally present, acknowledging patients' expertise, using shared decision making, establishing genuine relationships, and, in some cases, exceeding standard care. These interactions were described to lead to increased trust, satisfaction, and better health outcomes. Harmful interactions were often influenced by bias and stereotypes and included lack of empathy, disregarding patient's expertise of their body, and making unilateral decisions. Harmful interactions contributed to worse health outcomes, birth trauma, posttraumatic stress disorder-like symptoms, and frustration, while patients also displayed resilience. Racial concordance sometimes enhanced experiences but did not guarantee positive interactions.

The findings illuminate the impact clinician interactions have on Black women's mental and physical health outcomes and satisfaction with care. Relationship-centered care principles can be used to develop clinician-facing interventions that foster respectful care and reduce severe maternal morbidity and mortality.