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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
Elle Lett
1Birthing Cultural Rigor, LLC, Nashville, Tennessee
2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
PhD
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Marie-Fatima Hyacinthe
3Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut
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Dána-Ain Davis
4Center for the Study of Women and Society, The Graduate Center, City University of New York, New York, New York
MPH, PhD
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Karen A. Scott
1Birthing Cultural Rigor, LLC, Nashville, Tennessee
5Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, San Francisco, California
6Department of Humanities and Social Sciences, School of Medicine, University of California San Francisco, San Francisco, California
MD, MPH
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  • For correspondence: scotty@birthingculturalrigor.org
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    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.

    • View popup
    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).

    • View popup
    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.

    • View popup
    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.

Additional Files

  • Tables
  • SUPPLEMENTAL APPENDIX IN PDF FILE BELOW

    • LettSupplementalAppendix.pdf -

      PDF file

  • SUPPLEMENTAL MATERIALS IN PDF FILE BELOW

    • LettSupplementalAppendix.pdf -

      PDF file

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Community Support Persons and Mitigating Obstetric Racism During Childbirth
Elle Lett, Marie-Fatima Hyacinthe, Dána-Ain Davis, Karen A. Scott
The Annals of Family Medicine May 2023, 21 (3) 227-233; DOI: 10.1370/afm.2958

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Community Support Persons and Mitigating Obstetric Racism During Childbirth
Elle Lett, Marie-Fatima Hyacinthe, Dána-Ain Davis, Karen A. Scott
The Annals of Family Medicine May 2023, 21 (3) 227-233; DOI: 10.1370/afm.2958
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Subjects

  • Person groups:
    • Women's health
    • Vulnerable populations
  • Methods:
    • Quantitative methods
  • Other research types:
    • Health services
    • Professional practice
  • Core values of primary care:
    • Access
  • Other topics:
    • Racism
    • Organizational / practice change
    • Social / cultural context
    • Disparities in health and health care

Keywords

  • childbirth
  • labor, obstetric
  • maternal health services
  • obstetric racism
  • medical racism
  • health care disparities
  • misogynoir
  • Black maternal health
  • health inequities
  • community support person
  • labor coach
  • vulnerable populations

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