Midwives' Communication Practices About Risk and Racism With Black Women During Pregnancy: "We've Got to Find a Way"

A growing body of literature suggests that patient-provider communication in perinatal care is a key factor in addressing inequities in pregnancy outcomes. The purpose of this study was to explore how a sample of midwives who provide perinatal care perceive their communication practices about racism-related risks with Black women who are pregnant during clinical encounters.

Fourteen midwives from a national mixed-methods study completed semistructured interviews about communication practices regarding pregnancy risks during prenatal care. Interviews were analyzed using thematic analysis.

Three themes developed. Evolving Communication describes the multitude of ways participants engaged in patient-centered communication over time, tailored to the needs of individual patients and circumstances. Tension describes the internal conflict midwives experience when they want to address racism in conversations but fear causing offense, harm, or misunderstanding. Room for Growth was defined as the lack of formal training and the desire to learn more about incorporating discussions about structural racism into communication with Black women when discussing risks or complications during pregnancy.

Midwives in this study deployed adaptive communication strategies while experiencing tension between wanting to convey accurate information effectively and being considerate of how their communication might be received. Education and training in best practices for communicating with patients who are diverse may help reduce clinicians' reticence to raise potentially charged topics and support open, frank dialogue. Midwives have a clear commitment to ensuring Black patients are seen, heard, and receive excellent care, and there is a need for midwifery education to include training on communicating about how structural racism and contextual factors drive health care.