Theses Doctoral

Investigating Factors Related To Black Severe Maternal Morbidity Via Retrospective Recall Of A Prior Birth With A Life-threatening Complication: Comparing Pre- And During-pandemic Eras And Predicting Quality Of Patient-provider Relationships

Scarlett, Charmaine Nakia

This study addressed the long-standing crisis of Black severe maternal morbidity in the U.S., while the COVID-19 pandemic led to even worse outcomes. The purpose of the study was to identify significant predictors of the quality of patient-provider relationships during a birth hospitalization. The sample of Black women (N=182) gave moderate ratings for quality of patient provider relationships, and for level of trust, rapport, and communication with providers.

Providers were rated as having a fair level of cultural sensitivity, competence, and humility—while 30.2% rated them as poor. For experiences of racism, discrimination and inequities in service delivery, combining categories of a “few times” and “many times,” 53.3% felt racially stereotyped or treated like a racial stereotype, 52.5% were treated with less respect than a White woman would have been, 39.7% were verbally abused or yelled at, 43.8% were scolded, ridiculed, mocked, and shamed, 47.2% felt belittled and put down, 42.7% felt threatened, coerced, lied to, and manipulated, and 46% felt their pain was not managed the same way as for a White woman.

Women entered the hospital with risk factors of cardiovascular disease (20.3%), hypertension (23.6%), obesity (18.1%), and diabetes (13.7%). Further, 74.2% had COVID-19 in the past two years, 25.8% had long COVID-19, 34.1% had COVID-19 during their pregnancy, and 34.1% had COVID-19 at delivery. Medical events during their delivery hospitalization included hemorrhage (40.7%), blood clot (25.3%), and a hypertensive disorder of pregnancy (25.3%). Women had high rates (over 75%) of past year depression, anxiety, and trauma—with 68.1% receiving counseling; and higher rates (over 85%) the year post-partum—with 76.9% receiving counseling.

Noteworthy significant predictors of a higher quality of patient-provider relationships were higher education, higher trust/ rapport/ communication with providers, and lower global racism/ discrimination/ inequities during service delivery—while entering the hospital with lower risk factors for pregnancy-related complications (69.8% of variance predicted). The study contributes to literature on the crisis of severe maternal morbidity for Black women in the U.S, as well as factors that need to be addressed to reduce it, while offering a cache of culturally appropriate measures for ongoing research.

Geographic Areas


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More About This Work

Academic Units
Health and Behavior Studies
Thesis Advisors
Wallace, Barbara C.
Ed.D., Teachers College, Columbia University
Published Here
October 25, 2023