Centering Birthing Experiences of Women of Color: Protocol for a Qualitative Maternal Near Miss Study (Preprint)

BACKGROUND In the US, Black women are 3–4 times more likely to experience maternal near miss (MNM) or severe maternal morbidity (SMM) than non-Hispanic White women [1]. However, there is limited narrative-based investigation into Black and other marginalized women’s maternal near miss experiences. Additionally, limited extant research on the impact of MNM and SMM on birthing women’s family/support persons and healthcare providers precludes development of multilevel, patient-centered methods to eliminate these racial/ethnic disparities. OBJECTIVE This paper presents the protocol for a study that aims to draw insights from the experiences of racially and socioeconomically diverse mothers with maternal near miss and/or severe maternal morbidity, their family/support persons (e.g., partners), and healthcare providers to inform legislation, clinical practice, and infrastructure for optimal social support. METHODS Morehouse School of Medicine (MSM) will partner with health services and community-based organizations to promote inclusive participant recruitment for this multiphase study. In phase 1, we will conduct qualitative interviews will be conducted with birthing women (n ≤ 120) who have experience MNM and/or SMM. In phase 2, we will conduct qualitative interviews with the following groups: birthing women’s partners/support persons (n ≤ 50); healthcare providers serving birthing women (n ≤ 50); and adults who lost their mothers to pregnancy related complications (n ≤ 50). In each phase, the total number of participants interviewed will be based on theoretical saturation, i.e., the point in iterative data collection and analysis when all important insights have been exhausted from the data already available. RESULTS Recruitment for Phase 1 started in July 2021. As of March 2024, we have recruited 92 racially and socioeconomically diverse birthing women. Of those, 75% self-identified as Black or African American, 19% as Hispanic or Latina, and 9% as Native American or Alaska Native. Severe preeclampsia accounted for 46% of participants’ pregnancy-related adverse experiences. Qualitative interviews grounded in narrative-based medicine are ongoing. Recruitment for Phase 2 will occur between July 2023 and July 2024. Study results will be published in peer-reviewed scientific journals. CONCLUSIONS The findings from this research will deepen understanding of how severe obstetric complications: (1) are experienced by birthing women; (2) perceived by their partners, support persons, health providers; and (3) impact the lives of bereaved family and community members.