Introduction: Freestanding and in-hospital (alongside midwifery units AMUs) birth centers are evidence-based innovations for low-risk pregnancies that promote positive maternal and infant outcomes. However, racial and income inequities in birth center access exist. This study aims to describe the preferences and self-reported needs of Black pregnant people related to the implementation and adoption of a planned AMU within a safety-net hospital where participants were receiving prenatal care. Methods: In-depth qualitative interviews were conducted with a convenience sample of low-risk pregnant people who identified as Black and were receiving prenatal care in a safety-net hospital. A semi-structured questionnaire based on the Health Equity Implementation Framework (HEIF) was used to understand participant priorities and preferences for implementation of an AMU. Rapid qualitative analysis was employed. Results: Interviews with 15 participants were conducted. Themes were identified within each of the HEIF patient-level domains. Cross-cutting themes include autonomy in decision-making about birth setting, the need for comprehensive, unbiased birth center information, strong relationships with staff, high-quality communication, and recommended adaptations to AMU infrastructure. Discussion: Results contribute new information about the multidimensional aspects of patient autonomy and perceptions of safety related to maternity care services overall for Black birthing people. Patient recommendations for operational practices, physical infrastructure, and information sharing about AMU birth setting options can promote implementation success and increase access to choice in birth settings. Health Equity Implications: Findings can promote health equity across care settings by demonstrating the importance of relationship-based care, patient autonomy, and strong provider communication skills. For birth center care models, both freestanding and AMUs, this study contributes information about practices that can diversify access and adapt care models to serve all birthing people.
Mottl-Santiago et al. (Thu,) studied this question.