Research ArticleOriginal Research

Community Support Persons and Mitigating Obstetric Racism During Childbirth

Elle Lett, Marie-Fatima Hyacinthe, Dána-Ain Davis and Karen A. Scott
The Annals of Family Medicine May 2023, 21 (3) 227-233; DOI: https://doi.org/10.1370/afm.2958

Article Figures & Data

Tables

  • Table 1.

    Sample of the PREM-OB Scale Suite

    ScaleNumber of ItemsSubdomainSample Themes
    Humanity31Safety
    Autonomy
    Empathy
    Communication    		Health care delay, denial, neglect, or dismissiveness
    Health care exclusion or erasure in medical decision making
    Health care inquiry and elicitation of attitudes, feelings, and daily life
    Health care information, comprehension, transparency, and relevance in eliciting informed consent
    Kinship9NonapplicableHealth care team or system affirmation, disruption, or denial of biological or social relationship between Black birthing person and their newborn, partner, parent, or doula
    Racism12NonapplicableHealth care practice of biologic determinism and racial stereotyping in medical counseling and decision making

    • PREM-OB = Patient-Reported Experience Measure of Obstetric Racism.

    • Note: The PREM-OB Scale suite is proprietary and owned exclusively by Birthing Cultural Rigor, LLC. Please contact the authors for more information.

  • Table 2.

    Characteristics of Participants, Overall and According to Whether a CSP Was Present During Birth

    CharacteristicAll
    (N = 806)    		No CSP
    (n = 86)    		CSP
    (n = 720)
    Age, mean (SD), y30.2 (5.9)30.1 (6.7)30.2 (5.8)
    Gender, No. (%)
        Woman799 (99.1)84 (97.7)715 (99.3)
        Gender nonconforming/nonbinary1 (0.1)0 (0.0)1 (0.1)
        Genderqueer2 (0.2)1 (1.2)1 (0.1)
        Transgender malea1 (0.1)0 (0.0)1 (0.1)
        Unknown1 (0.1)0 (0.0)1 (0.1)
        Missing2 (0.2)1 (1.2)1 (0.1)
    Race, No. (%)
        Black or African American806 (100.0)86 (100.0)720 (100.0)
        White24 (3.0)0 (0.0)24 (3.3)
        American Indian or Alaska Native16 (2.0)2 (2.3)14 (1.9)
        Asian10 (1.2)0 (0.0)10 (1.4)
        Native Hawaiian or Pacific Islander11 (1.4)0 (0.0)11 (1.5)
    Ethnicity, No. (%)
        Not Latine766 (95.0)81 (94.2)685 (95.1)
        Latine35 (4.3)4 (4.7)31 (4.3)
        Missing5 (0.6)1 (1.2)4 (0.6)
    Education, No. (%)
        Less than high school31 (3.8)5 (5.8)26 (3.6)
        High school graduate/GED141 (17.5)19 (22.1)122 (16.9)
        Some college218 (27.0)29 (33.7)189 (26.2)
        Associate’s/bachelor’s degree251 (31.1)23 (26.7)228 (31.7)
        Master’s/doctoral degree162 (20.1)9 (10.5)153 (21.2)
        Missing3 (0.4)1 (1.2)2 (0.3)
    Household income, No. (%)
        $0-$24,999256 (31.8)39 (45.3)217 (30.1)
        $25,000-$49,999212 (26.3)31 (36.0)181 (25.1)
        $50,000-$74,999108 (13.4)6 (7.0)102 (14.2)
        $75,000-$99,99958 (7.2)3 (3.5)55 (7.6)
        ≥$100,000122 (15.1)4 (4.7)118 (16.4)
        Missing50 (6.2)3 (3.5)47 (6.5)
    Relationship status, No. (%)
        Partnered/married and cohabiting434 (53.8)26 (30.2)408 (56.7)
        Single212 (26.3)27 (31.4)185 (25.7)
        Partnered/married and living separately95 (11.8)19 (22.1)76 (10.6)
        Cohabiting with biologic parent, not partnered62 (7.7)14 (16.3)48 (6.7)
        Missing3 (0.4)0 (0.0)3 (0.4)
    Household size, mean (SD) number of people3.4 (1.6)3.7 (1.5)3.3 (1.6)
    Census region, No. (%)
        Midwest107 (13.3)15 (17.4)92 (12.8)
        Northeast83 (10.3)7 (8.1)76 (10.6)
        South207 (25.7)31 (36.0)176 (24.4)
        West404 (50.1)32 (37.2)372 (51.7)
        Missing5 (0.6)1 (1.2)4 (0.6)

    • CSP = community support person; GED = general equivalency diploma.

    • ↵a Trans man/female-to-male (FTM).

  • Table 3.

    Scores for Obstetric Racism According to Whether a CSP Was Present During Birth

    ScaleaNo CSP
    (n = 86)    		CSP
    (n = 720)
    Humanity score, mean (SD)0.30 (0.97)−0.01 (0.93)
    Kinship score mean (SD)0.50 (1.05)−0.04 (0.88)
    Racism score, mean (SD)0.36 (1.01)−0.04 (0.90)

    • CSP = community support person; PREM-OB = Patient-Reported Experience Measure of Obstetric Racism.

    • ↵a PREM-OB scores are item response theory (IRT) scaled scores.

  • Table 4.

    Association of CSP Presence vs Absence During Birth With Obstetric Racism

    ScaleaCSP Present vs Absent
    Unadjusted AnalysisAdjustedb AnalysisAdjustedb and Standardizedc Analysis
    Humanity score, coefficient (95% CI)−0.31 (−0.52 to −0.10)−0.33 (−0.58 to −0.09)−0.36 (−0.61 to −0.10)
    Kinship score, coefficient (95% CI)−0.53 (−0.74 to −0.33)−0.57 (−0.81 to −0.33)−0.62 (−0.88 to −0.36)
    Racism score, coefficient (95% CI)−0.40 (−0.60 to −0.19)−0.43 (−0.67 to −0.18)−0.46 (−0.73 to −0.20)

    • CSP = community support person; PREM-OB = Patient-Reported Experience Measure of Obstetric Racism.

    • ↵a PREM-OB Scale scores item response theory (IRT) scaled scores.

    • ↵b Adjusted for relationship status, age, household size, annual household income, education, and Census region.

    • ↵c Scale was standardized to a mean of zero and unit variance was applied before model fitting.

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