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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 April 2023, 2958; DOI: https://doi.org/10.1370/afm.2958
Elle Lett
Birthing Cultural Rigor, LLC, Nashville, Tennessee
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
PhD
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Marie-Fatima Hyacinthe
Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut
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Dána-Ain Davis
Center 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
Birthing Cultural Rigor, LLC, Nashville, Tennessee
Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, San Francisco, California
Department of Humanities and Social Sciences, School of Medicine, University of California San Francisco, San Francisco, California
MD, MPH
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ABSTRACT

PURPOSE We undertook a study to assess whether presence of community support persons (CSPs), with no hospital affiliation or alignment, mitigates acts of obstetric racism during hospitalization for labor, birth, and immediate postpartum care.

METHODS We conducted a cross-sectional cohort study, measuring 3 domains of obstetric racism as defined for, by, and with Black birthing people: humanity (violation of safety and accountability, autonomy, communication and information exchange, and empathy); kinship (denial or disruption of community and familial bonds that support Black birthing people); and racism in the form of anti-Black racism and misogynoir (weaponization of societal stereotypes and scripts in service provision that reproduce gendered anti-Black racism in the hospital). We used a novel, validated instrument, the Patient-Reported Experience Measure of Obstetric Racism (the PREM-OB Scale suite), and linear regression analysis to determine the association between CSP presence during hospital births and obstetric racism.

RESULTS Analyses were based on 806 Black birthing people, 720 (89.3%) of whom had at least 1 CSP present throughout their labor, birth, and immediate postpartum care. The presence of CSPs was associated with fewer acts of obstetric racism across all 3 domains, with statistically significant reductions in scores in the CSP group of one-third to two-third SD units relative to the no-CSP group.

CONCLUSIONS Our findings suggest that CSPs may be an effective way to reduce obstetric racism as part of quality improvement initiatives, emphasizing the need for democratizing the birthing experience and birth space, and incorporating community members as a way to promote the safety of Black birthing people in hospital settings.

Annals “Online First” article

Key words:
  • 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
  • Received for publication August 25, 2022.
  • Revision received December 13, 2022.
  • Accepted for publication December 22, 2022.
  • © 2023 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 23 (2)
The Annals of Family Medicine: 23 (2)
Vol. 23, Issue 2
Mar/April 2025
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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 Apr 2023, 2958; 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 Apr 2023, 2958; DOI: 10.1370/afm.2958
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Subjects

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  • Methods:
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  • Core values of primary care:
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    • Racism
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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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