Abstract
OBJECTIVE: To explore the contribution of psychosocial factors, perceived barriers to care, structural racism, and experiences of care to disparities in postpartum outcomes for Black patients, as measured by emergency department (ED) visits and postpartum readmissions. METHODS: We conducted semi-structured interviews with women of color who were readmitted or had an ED visit related to perinatal outcomes within 30 days of delivery hospitalization. We created an interview guide based on patient, community, and health system factors, asking questions about care and lived experience through delivery, discharge, coming home, and ED visits or readmission during the postpartum period. Patients were identified through the electronic medical record system. Interviews ranged from 30 to 60 minutes and were transcribed, and medical charts were reviewed for delivery and postpartum outcomes. We coded interviews through deductive engagement with the interview guide, which was validated through double-comparative coding between researchers, and used content analysis to delineate themes surrounding barriers to and lack of quality postpartum care for birthing people of color. RESULTS: Principal themes that emerged from the interviews with participants were: perceived lack of communication about the complications they experienced; structural racism described through examples of not being listened to or believed; a perceived lack of respect for Black women's bodies by doctors and nurses, which became embedded in inappropriate verbal and nonverbal communication practices by clinicians and staff; and mismatches in care for participants were noted from the care provided and chart documentation compared with what patients understood to be happening with their health. CONCLUSION: To counter the increasing rates of morbidity and mortality among postpartum Black patients, stronger efforts are required to address the needs of Black patients during the postpartum period through documenting and acknowledging patients' lived experiences, addressing communication needs, and understanding the consequences of structural racism.