Negotiating Patient-Provider Power Dynamics in Distinct Childbirth Settings: Insights From Black American Mothers

Several studies have examined women's perceptions and experiences of out-of-hospital births. However, with only few exceptions, White women have been the subject of these investigations. Black women are underrepresented among mothers who have out-of-hospital births, yet provide an intriguing case for this birthing practice given their elevated maternal mortality rates and the general rise in home and birth-center births since 2005. This study utilized a split-sample design to compare the experiences of Black American women who had given birth in out-of-hospital and within-hospital settings in San Antonio, Texas. Texas made an excellent site for such an inquiry, as it is among the states with more relaxed laws governing midwifery practice, licensure and scope. Moreover, Black women in San Antonio are a decided racial minority in this Latino-dominated city and often face healthcare access challenges. Using insights from feminist theories of intersectionality and power, this study explored how patient-provider power asymmetries emerged and were negotiated by Black American mothers who have out-of-hospital births, in contrast to their hospital-birthing peers. In-depth interviews provided an ideal forum through which mothers could recount their birthing experiences and the negotiation of patient-provider power dynamics. Narratives revealed that patient-provider power relations and asymmetries existed both within and outside of hospital settings. Participants employed various forms of resistance to counter domination strategies, and the interviews revealed various recommendations made by Black American mothers to improve childbirth experiences and birth outcomes.