Exploring Structural Factors that Influence Black Maternal Morbidity: A Case Study of Illinois Hospitals

<p dir="ltr">The United States is the only industrialized country whose maternal mortality rates are increasing at an alarming pace (Ollove, 2018). These deaths are often precipitated by co-morbidities, pregnancy complications, or missed opportunities as it relates to accessing care, quality, and level of care, a missed or delayed diagnosis, or not recognizing warning signs (CDC, 2019). Severe maternal morbidities (SMM) such as preeclampsia, hypertension and hemorrhage represent some of the leading causes of maternal death and significantly disproportionately affect Black women (Howell, 2018). Since evidence suggests that up to half of all maternal deaths may be preventable (CDC, 2019) and 98% of births take place in a hospital, exploring the type of care delivered to patients is a critical element of getting to the root cause of SMM (MacDorman & Declercq, 2019). Research has shown that Black women are significantly more likely to have a severe maternal mortality and morbidity event during delivery (Howell & Zeitlin, 2018). Therefore, it is equally critical to acknowledge and explore this country’s inequitable and fragmented health care system steeped in systemic racism as a root cause of the stark maternal health disparities.</p><p dir="ltr">The quality of maternal care delivered by hospitals as well as racism, bias, and discrimination experienced along with that care, are significant drivers of high Black maternal morbidity rates (Howell & Zeitlin, 2018). To reduce pregnancy related complications and deaths among Black women, maternal health experts have proposed hospitals transform how they deliver care by ensuring protocols, policies as well as practices that are safe, respectful, and equitable are in place (Howell, et al & Collier and Molina). Furthermore, public health and medical experts have found that organizational factors such as leadership and communication, play a significant role in hospital culture and the delivery of care. Therefore, exploring the intersectionality of these factors with the quality of healthcare, and health disparities and inequities, may provide rich insight into the influence they have on maternal care and pregnancy outcomes, particularly among Black women.</p><p dir="ltr">This explanatory, multiple methods case study approach focused on Black maternal morbidity occurrences in Illinois and aim to describe: 1) how organizational factors influence the delivery of maternal care within Illinois hospitals, and 2) how hospital labor and delivery practices impact patient safety, and 3) the extent to which Black pregnant and postpartum women receive poor quality hospital-based care and how that care contributes to health disparities in maternal morbidity occurrences. Phase 1 of the study consisted of 8 semi-structured, in-depth individual interviews individuals representing 6 hospitals participating in the Illinois Perinatal Quality Collaborative’s (ILPQC) Birth Equity Initiative. These interviews provided diverse experiences, perspectives, and insights from hospital staff leading the quality improvement (QI) work to improve maternal health outcomes among Black women as well as all patients of color. Phase 2 of the study consisted of facilitated reflective conversations with team leads from ILPQC and national perinatal health experts to validate findings and inform implications for practice and recommendations for future work.</p><p dir="ltr">Study findings revealed 6 primary themes when exploring structural and organizational factors influencing adverse Black maternal health outcomes and their relationship to these outcomes: <b>adequate and informed staff;</b><b> </b><b>communication, collaboration and teamwork;</b><b> </b><b>biases and microaggressions; patient voice; SDOH screenings, and leadership buy-in and commitment.</b> The findings from this case study are applicable to other Illinois birthing hospitals participating in the ILPQC Birth Equity Initiative, and possibly applicable to hospitals partnering with the other 49 PQCs across the country working to improve maternal and infant outcomes and aiming to provide high quality, respectful, and equitable care.</p>