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, that is, births that take place at home or in birthing centers overseen by midwives. However, White women have primarily been the subject of these investigations. Black women are underrepresented among mothers who have out-of-hospital births, yet they 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 utilizes a split-sample design to compare the experiences of Black American women who gave birth in out-of-hospital and within-hospital settings in San Antonio, Texas. San Antonio is an excellent site for such an inquiry, as Black women are a decided racial minority in this Latino-dominated city, and often face healthcare access challenges. Drawing on insights from theories of intersectionality and power, this study uses in-depth interviews to explore how patient-provider power asymmetries emerge and are negotiated by Black American mothers who have out-of-hospital births, in contrast to their hospital-birthing peers. Narratives reveal that patient-provider power relations and asymmetries exist both within and outside of hospital settings, but are distinctly manifested in each setting. Out-of-hospital births are more mother-centered, but power machinations are more covert in such settings. Participants employ various forms of resistance to negotiate asymmetrical relationships with providers.