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“After this experience, I'm just shook”: Using a Mixed Methods Approach to Explore Black Women’s Maternity Care Experiences Influence on Subsequent Pregnancy and Birthing Intentions

This mixed-methods study demonstrates that person-centered maternity care significantly influences Black women's subsequent pregnancy and birthing intentions, with those experiencing poor care reporting drastically higher odds of altering their future birth settings or avoiding childbirth due to mistreatment and a loss of trust in the health system.

Original authors: Dorian S. Odems, Patience A. Afulani, Kaila Comerie, Jessica Johnston, Lauren Everett, Lucia Palmarini, Taryn Hill, Josselyn Taylor, Dominique Walker, Meredith Smith, Blair A. Simon, Brittany D. Chamb

Published 2026-06-24

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Dorian S. Odems, Patience A. Afulani, Kaila Comerie, Jessica Johnston, Lauren Everett, Lucia Palmarini, Taryn Hill, Josselyn Taylor, Dominique Walker, Meredith Smith, Blair A. Simon, Brittany D. Chambers-Butcher

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine the healthcare system as a massive, high-stakes restaurant. For most people, dining there is a routine experience: you order, you eat, and you leave satisfied. But for Black women in the United States, this "restaurant" often serves a different kind of meal—one that can be cold, disrespectful, or even harmful.

This research paper, titled "After this experience, I'm just shook," investigates what happens to Black women after they leave this "restaurant" (the hospital) and how that experience changes their future plans. Specifically, the researchers wanted to know: Does a bad (or good) birth experience change whether a Black woman wants to have another baby, and if so, where she wants to have it?

Here is a breakdown of the study using simple language and analogies.

The Setup: The "Mama Certified" Project

The study took place in the Cincinnati area, a region with high rates of maternal health issues for Black women. The researchers worked with a community-led group called "Mama Certified." Think of this as a neighborhood watch group that decided to stop just complaining about the food and actually measure the taste to prove it to the chefs (the hospitals).

They asked two main questions:

The Numbers: Is there a statistical link between how a woman was treated and her plan for the next baby?
The Stories: How does that treatment change her mind?

Part 1: The Survey (The Menu Check)

The researchers surveyed 241 Black women who had recently given birth in local hospitals. They used a special "report card" called the PCMC-US Scale.

The Analogy: Imagine a report card that grades the hospital on three things: Dignity (were you treated like a human?), Communication (did they listen?), and Support (did they help you?).
The Score: The average score was decent (81.7 out of 100), meaning most women felt they got "Good" or "Optimal" care. However, about 26% of the women received "Fair" or "Poor" care.

The Big Finding:
The report card score was a crystal ball for the future.

Women who got Good/Optimal care mostly said, "I'll come back to this same hospital for my next baby."
Women who got Fair/Poor care had a completely different reaction. They were 11 times more likely to say, "I'm never coming back here," or "I'm going to try a home birth," or even, "I'm not having any more babies at all."

In short: If the hospital treats you poorly, you don't just get mad; you change your entire life plan.

Part 2: The Interviews (The Taste Test)

To understand why the numbers looked that way, the researchers interviewed 24 of the women. These conversations revealed three powerful themes, which the authors described as the "flavor" of the experience:

1. Seeking Autonomy (Taking the Wheel)

For many women, the hospital felt like a place where they were a passenger with no control over the steering wheel.

The Metaphor: One woman said, "I'm just shook." She felt like the doctors were driving her car off a cliff based on statistics rather than her actual needs.
The Result: Because they felt powerless in the hospital, many decided they wanted to drive their own car next time. They talked about wanting home births, midwives, or doulas (birth coaches) who would listen to them and let them make the decisions.

2. Hypervigilance (The Radar)

The bad experiences turned up the volume on their internal "danger radar."

The Metaphor: Even women who had a "good" birth said they were now constantly scanning the horizon for threats. They knew the statistics: Black women are at higher risk of dying in childbirth.
The Result: This fear made pregnancy feel scary. Some women said, "I'm on the fence about having another baby." They felt they needed to do extra research, hire a doula, or find a specific doctor just to feel safe enough to try again.

3. Reproductive Decisions Shaped by Mistreatment (The Broken Trust)

This was the most heartbreaking theme. For some, the mistreatment was so severe it broke their trust in the system entirely.

The Metaphor: Imagine a mechanic who fixes your car but leaves a wrench inside the engine. You don't just avoid that mechanic; you stop driving that car entirely.
The Result: Some women said they wanted to get sterilized (so they couldn't have more kids) just to avoid ever going back to a hospital. One woman said, "If something happened and I had to go to that hospital, I'd tell them to just leave me." The trauma was so deep that it made them decide, "I will not bring another child into this world if it means going through that again."

The Conclusion: Why This Matters

The paper concludes that person-centered care (care that respects the patient) isn't just a "nice-to-have" luxury; it is a critical safety factor.

The Takeaway: When Black women are treated with respect and dignity, they trust the system and return for care. When they are mistreated, they don't just leave the hospital; they leave the system entirely. They might choose home births, or they might choose not to have children at all.
The Goal: The researchers argue that to save lives and reduce harm, hospitals must stop treating Black women like statistics and start treating them like partners. The goal isn't just for Black women to "survive" childbirth, but to have a experience where they feel safe, respected, and free from harm.

In a nutshell: This study proves that a bad birth experience is a heavy weight that can change a woman's future. If the healthcare system wants Black women to keep coming back and having healthy families, it has to fix the "food" it is serving.

Technical Summary: "After this experience, I'm just shook": Using a Mixed Methods Approach to Explore Black Women's Maternity Care Experiences Influence on Subsequent Pregnancy and Birthing Intentions

Problem Statement
Black women in the United States face disproportionately high rates of maternal morbidity and mortality, often exacerbated by persistent mistreatment and obstetric racism within perinatal care systems. While prior research has documented these negative experiences and their impact on patient satisfaction and postpartum care utilization, there is a significant gap in understanding how these specific care experiences shape Black women's subsequent pregnancy and birthing intentions. Existing literature has not sufficiently explored whether negative hospital-based care experiences deter Black women from future pregnancies, lead them to seek alternative birth settings (e.g., home births), or cause them to switch providers. Furthermore, previous studies utilizing the Person-Centered Maternity Care Scale–U.S. (PCMC-US) have often been limited to samples with privileged socioeconomic factors, lacking representation from broader Black populations in regions with high maternal mortality rates, such as Ohio.

Methodology
The study employed an explanatory sequential mixed-methods design to investigate the relationship between hospital-based maternity care experiences and future reproductive intentions among Black women in the greater Cincinnati area.

Study Population: The quantitative phase recruited 241 Black women (≥18 years) who delivered at five Cincinnati-area hospitals between April 2023 and September 2024. Recruitment utilized social media, community health workers, and hospital discharge materials. Eligibility required verification of racial identity via photo ID.
Quantitative Measures: Participants completed a self-administered survey via REDCap. The primary independent variable was the Person-Centered Maternity Care Scale–U.S. (PCMC-US), a 35-item instrument measuring Dignity and Respect, Communication and Autonomy, and Responsive and Supportive Care. Scores were standardized (0–100) and categorized into Optimal/Good (75–100) and Fair/Poor (0–74). The dependent variable was subsequent pregnancy and birthing setting intentions, assessed via a single-item question regarding whether participants would return to the same hospital, choose a different hospital, opt for a home birth, or decline future births based on their recent experience.
Quantitative Analysis: Researchers conducted descriptive, bivariate (Pearson chi-square), and binary logistic regression analyses to determine associations between PCMC-US levels and birthing intentions, controlling for covariates such as age, insurance status, provider type, and birth type.
Qualitative Phase: A subsample of 24 participants was selected for semi-structured virtual interviews. The interview guide was co-designed with a community advisory board of Black women and focused on PCMC-US components. Data were analyzed using reflexive thematic analysis to contextualize quantitative findings.

Key Results

Quantitative Findings:
- The mean PCMC-US score for the sample was 81.7 (SD=16.3). While 73.9% reported Optimal/Good care, 26.1% reported Fair/Poor care.
- 66% of participants indicated they would return to the same hospital. However, 24.5% indicated a care-related change in future intentions (switching hospitals, choosing home birth, or declining future births).
- A statistically significant association was found between PCMC-US levels and birthing intentions ( $p < 0.001$ ). Participants with Fair/Poor care scores had significantly lower mean scores than those intending to return to the same hospital.
- Regression Analysis: Women who received Fair/Poor person-centered care had 11 times higher odds (OR=11.36; 95% CI: 5.76–22.43) of reporting a care-related change in future pregnancy or birth setting intentions compared to those who received Optimal/Good care.
Qualitative Findings:
Three primary themes emerged regarding how care experiences influenced decision-making:
1. Seeking Autonomy in Birth: Participants with negative experiences expressed a strong desire to bypass hospital systems entirely, seeking home births, midwifery care, or doula support to regain control and avoid judgment.
2. Hypervigilance or Fear of Subsequent Pregnancy: Even among those with "Good" scores, the awareness of maternal health inequities and previous negative encounters fostered heightened anxiety and a need for self-protection strategies (e.g., extensive research, hiring doulas) for future pregnancies.
3. Reproductive Decisions Shaped by Mistreatment: Direct experiences of dehumanization, ignored pain, and lack of trust led some participants to consider sterilization, decline future pregnancies entirely, or refuse to return to specific hospital systems. One participant noted that mistreatment led to a decision to have only one child, while another described avoiding sterilization due to distrust of providers, resulting in an unplanned subsequent pregnancy.

Key Contributions

Empirical Link to Reproductive Intentions: This study provides quantitative evidence that person-centered care is a critical determinant of Black women's future reproductive choices, specifically linking Fair/Poor care scores to an 11-fold increase in the likelihood of altering birth settings or declining future births.
Contextual Depth: By integrating qualitative data, the study elucidates the mechanisms behind the statistics, revealing that "hypervigilance" and "distrust" are direct consequences of obstetric racism and mistreatment, driving women toward alternative care models or reproductive cessation.
Geographic and Demographic Expansion: Unlike previous PCMC-US studies concentrated in California, this research focuses on the greater Cincinnati area, a region with stark maternal mortality rates and a history of anti-Black racism, thereby broadening the applicability of findings to other high-risk U.S. regions.
Methodological Integration: It represents one of the first studies to integrate validated quantitative scales with community-led qualitative narratives to explore the downstream effects of maternity care on reproductive decision-making.

Significance and Claims
The paper claims that person-centered maternity care is not merely a metric of satisfaction but a fundamental factor in ensuring Black women's safety and willingness to engage with the healthcare system. The authors argue that the "downstream consequences" of poor care extend beyond immediate morbidity to long-term reproductive autonomy, where mistreatment actively shapes decisions to avoid hospitals or cease reproduction.

The study concludes that advancing patient-centered approaches is essential to reducing preventable maternal morbidity and mortality. It emphasizes that for Black women to not only survive childbirth but thrive, the healthcare system must address the specific harms of obstetric racism that erode trust and alter reproductive trajectories. The authors position their work as a call to move beyond documenting harm to integrating these narratives into actionable policy and practice reforms that ensure care is free of harm and respectful of autonomy.