Community-Led Solutions to Build Safer, More Equitable Places to Birth: The Baltimore Patients as Partners Project

To describe a Patients as Partners maternity care quality improvement initiative. At the time the initiative was developed, the patient-provider relationship had emerged as a focal point in discussions of factors contributing to racial disparities in maternal health outcomes. The experiences of Black maternity patients have been the subject of many studies and have yielded consistent findings, particularly around patient-provider communication failures during childbirth. Baltimore Healthy Start partnered with the Preeclampsia Foundation to collect and curate the stories of Baltimore women who suffered maternal health complications. During 2020-2021, a total of 34 women participated in focus groups facilitated by the Preeclampsia Foundation in order to share and draw lessons from their recent birthing experiences. All of these women were Black. Six women presented their experiences and recommendations to improve care at three hospital forums in Baltimore, MD held at Mercy Medical Center, Johns Hopkins Hospital, and Sinai Hospital. Together, these three hospitals account for the majority of births in Baltimore. Combined, over 100 medical, nursing, and administrative staff attended the Patients as Partners in Maternity Care Forums. Women reported feeling not listened to regarding pain, their birth plan, or being excluded from discussions and decisions regarding their care. Many women reported a belief that women of color are perceived as uneducated, therefore their opinion is viewed as less relevant; some women reported they believed this perception and treatment is exacerbated by preconceptions held by providers in relation to the education and intelligence of women receiving Medicaid coverage. Women offered a number of recommendations to improve the quality of care. This article illustrates a mechanism to provide recognition of community members as co-equal partners in their health care, which requires a significant shift in perspective and practice for providers and health care institutions in order to acknowledge not only the broad societal power imbalances that lie at the root of health inequities but also how the manifestation of societal inequities at the practitioner-patient level and institution-community level perpetuate inequities in health.