"Bearing in Mind That I Am a Black Mother": Black Women's Anticipation of Poor Perinatal Care and Related Coping Strategies.

BACKGROUND: Black women in the United States continue to experience disproportionate rates of severe maternal morbidity and mortality and frequently report disrespectful perinatal care. Although prior research has documented discriminatory encounters within perinatal care, less is known about how Black women anticipate and prepare for potential poor treatment before and during pregnancy. We aimed to better understand how Black women's anticipation of racism shapes their engagement with care during the perinatal period. METHODS: This qualitative secondary analysis draws on in-depth interviews with 93 Black, English-speaking women across four urban areas of New Jersey who gave birth within the previous 24 months. Data analysis utilized a thematic analysis approach within a community-based participatory research framework. RESULTS: Two major themes were identified: 1) fear of negative outcomes, including acute awareness of the Black maternal health crisis, and resulting vigilance and anxiety, and 2) fear of poor treatment by health care providers, characterized by expectations of being labeled, ignored, or dismissed, which led to anticipatory self-regulation. CONCLUSIONS: These findings bring attention to the phenomenon where some Black women in our study entered perinatal care expecting harm, a reality that creates a profound psychological burden and may undermine the patient-provider relationship before it even begins. This reality also places Black women in a double-bind, wherein they balance the vigilance needed to protect themselves with modifying their behavior to avoid stereotypes. Efforts to improve perinatal health must address clinical disparities in outcomes and the systemic conditions that make anticipatory fear a rational and necessary coping strategy.