Meta-ethnography of the Experiences of Women of Color Who Survived Severe Maternal Morbidity or Birth Complications.

Abstract

Objective: To develop a deeper understanding of the health care experiences of women of color affected by severe maternal morbidity (SMM) or birth complications in the United States and opportunities to improve the delivery of maternal health care.

Data sources: PubMed, CINAHL, Embase, and Scopus.

Study selection: We included qualitative studies on the experiences of pregnancy or childbirth among women of color in the United States published within the past 10 years (to reflect recent societal events and obstetric practices) in which researchers examined women's experiences of SMM or birth complications.

Data extraction: Five reports of qualitative research studies met inclusion criteria. We assessed the methodological quality of each study using the JBI (Joanna Briggs Institute) critical appraisal checklist for qualitative research. We extracted the following data from the included studies: participants' demographic characteristics (i.e., race/ethnicity, age, experiences), methodological characteristics of the studies (i.e., sample size, research design, data collection, data analysis), and individual study metaphors (i.e., concepts, phrases, participant quotes) related to the overarching themes.

Data synthesis: We used the meta-ethnographic approach of Noblit and Hare (1988; Meta-ethnography: Synthesizing qualitative studies; Sage) to critically examine studies, translate the studies into one another, and synthesize reciprocal translations. Four overarching themes emerged from the meta-synthesis: Lack of Knowledge; Stigma, Discrimination, and/or Bias; Provider Communication Issues; and Barriers to Care and Services. Each overarching theme had complicating factors, which represented factors that exacerbated problems, and mitigating factors, which represented factors that alleviated some negative experiences. Complex layers of varying demographic characteristics and social determinants of health shaped women's individual experiences.

Conclusion: The experiences of women of color with SMM or complications during pregnancy and/or childbirth reveal shortcomings in the delivery of maternal health care. Findings suggest opportunities for improvement across various levels of the health care system. Further qualitative studies using high-quality methodology are needed on this topic given that the research is limited.