The Ethics of Perinatal Care for Black Women

Abstract

Perinatal and neonatal nurses have a critical role to play in effectively addressing the disproportionate prevalence of adverse pregnancy outcomes experienced by black childbearing families. Upstream inequities in maternal health must be better understood and addressed to achieve this goal. The importance of maternal health before, during, and after pregnancy is illustrated with the growing and inequitable prevalence of 2 common illnesses, pregestational diabetes and chronic hypertension, and 2 common conditions during and after pregnancy, gestational diabetes and preterm birth. New care models are needed and must be structured on appropriate ethical principles for serving black families in partnership with nurses. The overarching purpose of this article is to describe the ethics of perinatal care for black women; to discuss how social determinants of health, health disparities, and health inequities affecting women contribute to poor outcomes among their children; and to provide tools to dismantle structural racism specific to “mother blame” narratives.” Finally, strategies are presented to enhance the provision of ethical perinatal care for black women by nurses.

Naming Silence and Inadequate Obstetric Care as Obstetric Violence is a Necessary Step for Change

“…Describing structural “violence” against patients in the maternity care system does not take away patient agency but rather has the potential to illuminate and interrogate the power dynamics inherent, implicit, and in some cases, explicit, within the health care system. In particular, naming structural violence throws into relief the whole system, and moves away from blaming individual perpetrators to building accountability for the violence embedded within systems, hierarchies, and institutionalized practices (Scott et al, 2019).…”

“…The authors apply the feminist ethics of care paradigm, which focuses on the relational context of actions rather than right/wrong binaries, moving away from conceptualizations of “perpetrators” and “victims” and resisting the tendency to label actors as “good” or “bad”—or to blame patients. From our perspective, applying this paradigm argues in favor of naming the structural violence, as does black feminist theory, because both patients and clinicians are potentially harmed by the silent yet harried environment on the ward (Crenshaw, 1991; Scott et al, 2019). Thus, clinicians also experience the negative effects of structural violence within maternity care systems, and they too can benefit from adequate naming and examination of that violence.…”

‘Essential and undervalued: health disparities of African American women in the COVID-19 era’

“…An examination of the social determinants of health (conditions which people have that affects health) reveals that African American women are more likely to experience maternal mortality or pregnancy related mortality. Scott, Britton, and McLemore (2019) reveal that African American women are disadvantaged across every health indicator. For instance, they are more likely to die from complications related to venous thrombosis, preeclampsia, cardiomyopathy and hemorrhage than white women (Amankwaa et al 2018;Tangel et al 2019).…”

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

“…Development of the facilitator guide was informed by an extensive review of literature; feedback from Birthing Justice and Birth Equity activists and researchers, health services researchers, the Institute for Women and Ethnic Studies, and health care providers (e.g., midwives, OB/Gyn physicians, doulas, lactation consultants, nurses, etc. ); and Dr. Karen Scott’s Sacred Birth research [ 14 ]. All focus groups were co-facilitated by leaders of CBOs serving local communities of Black families.…”