(439) Birth experiences of discrimination on labor and delivery

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Bridget C. Huysman, MD, MPH (she/her/hers)

Fellow
Washington University in St. Louis
St. Louis, Missouri, United States

Coauthor(s)

PW

Paige Wilder, BA

Washington University in St. Louis
St. Louis, Missouri, United States
MB

Maya Bussey

Medical student
Washington University in St. Louis/Barnes-Jewish Hospital
St. Louis, Missouri, United States
LA

Lori Atwood, BA

Washington University in St. Louis
St. Louis, Missouri, United States
MM

Mia Malcolm

Washington University in St. Louis/Barnes-Jewish Hospital
St. Louis, Missouri, United States
MG

Monique Gill

Washington University in St. Louis/Barnes-Jewish Hospital
St. Louis, Missouri, United States
RW

Rachel Witt

University of Minnesota
Minneapolis, Minnesota, United States
Ebony B. Carter, MD (she/her/hers)

Associate Professor; Director, Division of Maternal Fetal Medicine
University of North Carolina
Chapel Hill, North Carolina, United States
EC

Eve Colson

Washington University in St. Louis/Barnes-Jewish Hospital
St. Louis, Missouri, United States
CW

Candice Woolfolk, MPH, PhD

Research Statistician
Washington University School of Medicine in Saint Louis
St. Louis, Missouri, United States

Objective: Discrimination and racism impact obstetric care and approximately 1 in 5 birthing people will report mistreatment during maternity care. We sought to assess perceived discrimination experienced by birthing persons at the time of their delivery admission.

Study Design: This is a prospective survey of 129 birth people presenting for delivery from 03/2024 to 05/2024 using the Discrimination in Medical Settings Scale (DMSS) administered prior to discharge. Birthing people admitted for an indication not related to delivery, who delivered off L&D or precipitously, or unable to speak English were excluded. DMSS scores were compared between people of color (BIPOC) and White and assessed by reports of any discrimination, and DMSS scores >75^th percentile (score 8) and ≥90^th percentile (score 11). Survey responses were compared between groups using the Mann Whitney U test and multivariable logistic regression was used to estimate adjusted odds ratios(aOR) and 95% confidence intervals (CI) after adjusting for relevant confounders.

Results: Prior to discharge, 176 birthing people were approached to complete the survey and 47 declined to participate. Over 60% of the cohort identified as a person of color. Comparing by race, BIPOC and White birthing people differed by highest educational level achieved and insurance and employment status. In bivariate analysis, there was a statistically significant difference in reported DMSS scores ≥90^th percentile between BIPOC and White birthing people with 5 times higher likelihood of reporting discrimination (14 (17%) vs. 2 (4%), p=0.03, OR 5.42 [95% CI 1.18, 25.00])(Table 1). There was a statistically significant difference in security calls while in medical care between Black and White birthing people, respectively (13 (20%) vs. 5 (7%), p=0.04)(Table 2).

Conclusion: Discrimination is experienced more by people of color on labor and delivery. Calls made to security calls by staff were more commonly experienced by Black birthing people. Future work is needed to explore how experiences of discrimination contribute to obstetric outcomes and care seeking.