Black Women's Perceptions of Race‐Concordant Midwifery Care and Home Birth: Liberation in Labor

Introduction Racial disparities in perinatal health continue to drive negative outcomes for Black women in the United States, often due to low‐quality perinatal care. Few studies examine patients’ perceptions of perinatal care. This study explored Black women's experiences of pregnancy and home birth with race‐concordant certified nurse‐midwives and their perceptions of care quality. Methods This qualitative study used semistructured interviews with Black women who received perinatal and home birth care from Black certified nurse‐midwives. Participants were recruited through referrals from midwives in California, Georgia, and New York. Eligible participants self‐identified as Black women, received home birth care from a Black nurse‐midwife, and provided informed consent. Interviews were conducted between August and November 2022, lasted approximately 60 minutes, and were audio‐recorded. Transcripts were analyzed using thematic analysis guided by the Donabedian model. Codes were organized around care structure, process, and outcomes, and then refined into overarching themes. Results Ten participants described pregnancy and home birth experiences with race‐concordant nurse‐midwives. Most had experienced prior hospital births, which informed their decision to seek midwifery care. Analysis produced 3 themes: (1) holistic healing, in which midwives addressed physical, emotional, spiritual, and cultural needs in supportive home environments; (2) liberation through care, in which participants experienced autonomy and empowerment in contrast to prior medicalized births; and (3) race‐concordant connections, in which shared racial identity fostered trust, comfort, and personalized relationships that participants perceived as high‐quality care. Discussion Black women in this study perceived race‐concordant home birth midwifery care as high quality, emphasizing holistic support, autonomy, and trust. These findings highlight the importance of culturally responsive, relationship‐centered care in addressing persistent perinatal inequities. Increasing racial diversity within the midwifery workforce and expanding access to race‐concordant care may improve Black women's perinatal experiences and outcomes.