The Cycle to Respectful Care: A Qualitative Approach to the Creation of an Actionable Framework to Address Maternal Outcome Disparities

Abstract

Despite persistent disparities in maternity care outcomes, there are limited resources to guide clinical practice and clinician behavior to dismantle biased practices and beliefs, structural and institutional racism, and the policies that perpetuate racism. Focus groups and interviews were held in communities in the United States identified as having higher density of Black births. Focus group and interview themes and codes illuminated Black birthing individual’s experience with labor and delivery in the hospital setting. Using an iterative process to refine and incorporate qualitative themes, we created a framework in close collaboration with birth equity stakeholders. This is an actionable, cyclical framework for training on anti-racist maternity care. The Cycle to Respectful Care acknowledges the development and perpetuation of biased healthcare delivery, while providing a solution for dismantling healthcare providers’ socialization that results in biased and discriminatory care. The Cycle to Respectful Care is an actionable tool to liberate patients, by way of their healthcare providers, from biased practices and beliefs, structural and institutional racism, and the policies that perpetuate racism.

Refocusing the Conduct of Maternal Mortality Research in Black Pregnant Populations

“…The model outlines a systematic method of dismantling biased practices and beliefs that promote racism. 25 The core of the model is centered on key values including Blackness, equity, reproductive justice, holistic maternity care, humanity, and love. As individuals move through various phases of the cycle, the likelihood of providing respectful maternity care is more likely.…”

Postnatal Unit Care and Safe Transition Home

“…The Cycle of Respectful Care is a framework born out of the experiences of Black birthing individuals, their community partners, and Black Feminist scholars. It is designed to liberate patients and health care providers “from biased practices and beliefs, structural and institutional racism and the policies that perpetuate racism 32…”

“…(p.12) ” The framework was developed with an understanding that experiencing racism and disrespect during hospital-based care can negatively impact health. The framework calls for key steps that can improve Maya’s care, such as “establish[ing] bidirectional trust and transparency with patients, creat[ing] an environment where patients feel secure and supported in their cultural, spiritual and religious practices, incorporat[ing] patients’ social capital and network and mak[ing] medical recommendations responsive to patient’s birthing needs, values and priorities.”32 (p.7) Too often our vision of respectful care is limited to being polite and kind during interpersonal interactions. The Cycle of Respectful Care demonstrates that respectful care is about systems and interventions that tangibly impact the wellbeing of birthing people.…”

Innovations in Breastfeeding Support

“…In addition, RMC’s core structures serve as a basis for providing trauma informed care,40 which can be achieved by using RMC to provide care to patients with traumatic experiences. Some women with histories of childhood maltreatment describe breastfeeding as a retraumatizing experience, and these women were more likely to have difficulties with breastfeeding 44.…”