(969) Black birthing persons’ perspectives on factors leading to medical mistrust in obstetric settings

Objective: To examine factors leading to medical mistrust among Black birthing persons.

Study Design: In this prospective qualitative study, 30 Black birthing people participated in semi-structured interviews to elicit their perspectives on factors leading to medical mistrust during their obstetric care. Purposive sampling was used to ensure a cohort diverse in terms of obstetric experiences such as parity, current mode of delivery, and with or without doula support in current pregnancy. Interviews were recorded, transcribed, and coded twice by two different team members in MAXQDA2022. Data were analyzed using thematic analysis to identify patterns and develop and refine themes.

Results: The average age of participants was 28 (range 19-41 years of age); 13% were married, 27% had a high school diploma, 40% were unemployed, 40% had an income of $20-000-$40,000, 77% had public insurance, and 27% had used doula services for the most recent pregnancy. Majority of participants were multiparous (70%), delivered vaginally (53%) and interviewed within 6 weeks postpartum. Five themes contributing to medical mistrust were identified: 1) lack of sufficient education provided to birthing people around possible obstetric complications 2) not feeling heard by the medical team due to lack of time and feeling rushed at prenatal appointments, 3) overuse of the medical terminology and jargon by the medical team, 4) discrepancies in expectations regarding birthing experiences in the hospital, and 5) inadequate support and reassurance after traumatic pregnancy or birth experience.

Conclusion: Perspectives gathered in this analysis identify inadequate communication, and insufficient time and knowledge for shared decision making as key factors leading to medical mistrust among Black birthing persons.