A Mother’s Burden: The Interactive Effects of Racism-Related Stress and Disrespect and Abuse by Care Providers During the Perinatal Period on Black Women’s Postpartum PTSD Symptoms Open Access

Karra, Sriya (Spring 2023)

Permanent URL: https://etd.library.emory.edu/concern/etds/7d278v29r?locale=en


Posttraumatic stress disorder (PTSD) is a debilitating mental health condition that disproportionately affects postpartum Black persons. Racism-related stress may contribute to this inequity, exacerbating PTSD in both pregnant and non-pregnant individuals. Black pregnant persons are at increased likelihood of disrespect and abuse (D&A) by care providers during prenatal care, though it is unclear how this impacts postpartum PTSD (PP-PTSD) symptoms. Thus, the present study of Black women (6-10 weeks postpartum, N=47), seeking care from the OB-Gyn Clinic at Grady Memorial Hospital, a publicly funded hospital primarily serving minoritized individuals with few economic resources in Atlanta, GA, assessed for the main and interactive effects of racism-related stress and D&A by care providers on overall PP-PTSD symptoms. The Index of Race-Related Stress (IRRS), which captures experiences of racism that may not be linked to prenatal care, evaluated racism-related stress. The City Birth Trauma Scale (CiBTS) assessed overall PP-PTSD symptoms, birth-related symptoms of PP-PTSD, and general symptoms of PP-PTSD. The Mistreatment By Care Providers In Childbirth (MCPC) Indicators assessed D&A by health care providers during pregnancy and childbirth. A simple moderation analysis significantly predicted overall PP-PTSD symptoms with a main effect of racism-related stress (B=3.22, p=.03) and D&A by care providers (B=13.45, p=.04), whereby more D&A and greater racism-related stress predicted higher overall PP-PTSD symptoms. There was a significant interaction between D&A and racism-related stress (B=-3.69, SE=1.83, p=.05), where the effect of D&A on overall PP-PTSD symptoms was present only for individuals with less racism-related stress. Though models were not significant, D&A and racism-related stress had significant main effects on birth-related symptoms, and general symptoms of PP-PTSD, respectively. Findings suggest that Black individuals who have experienced higher amounts of either D&A during prenatal care or increased racism-related stress have greater overall PP-PTSD symptoms. Interestingly, D&A only impacted overall PTSD symptoms in the context of low racism-related stress. Overall symptoms may provide a more comprehensive understanding of the impact of racism-related stress and D&A on PP-PTSD, than birth-related and general symptoms of PP-PTSD alone. Results highlight the need for prenatal care providers to actively be anti-racist, culturally aware, and respectful to mitigate PP-PTSD symptoms. 

Table of Contents

1 Introduction…1

1.1 Overview of Postpartum PTSD Symptoms…1

1.2 Disrespect and Abuse by Care Providers…7

1.3 Racism-Related Stress…16

1.4 Vulnerability of Black Pregnant Persons to Postpartum PTSD symptoms…20

1.5 The Current Study…22

2 Methods…24

2.1 Participants…24

2.2 Clinical Assessments…24

2.2.1 Index of Race-Related Stress (IRRS)…24

2.2.2 Mistreatment by Care Providers in Childbirth Indicators (MCPC)…25

2.2.3 City Birth Trauma Scale (CiBTS)…25

2.3 Statistical Analyses…26

3 Results…27

3.1 Participant Characteristics…27

3.2 Correlational Analyses…27

3.3 Moderation Analysis of Racism-Related Stress and D&A on Postpartum PTSD Symptom Severity…28

3.3.1 Overall Postpartum PTSD Symptom Severity…28

3.3.2 Birth-Related Postpartum PTSD Symptoms…30

3.3.3 General Postpartum PTSD Symptoms…30

4 Discussion…30

4.1 Discussion of Results…30

4.2 Legal, Clinical, and Policy Implications…32

4.3 Limitations and Future Directions…33

5 Conclusion…35

6 Figures…36

Figure 1. Such normalized behaviors provide the foundation for and perpetuate disrespect and abuse by care providers. Adapted from 11thprincipleconsent.org/consent-propaganda/rape-culture-pyramid and BirthMonopoly.com…36

Figure 2. Racism’s context and its manifestations in each. Adapted from Harrell (2000)’s framework…37

Figure 3. A graphical depiction of the moderating effects of racism-related stress on the association between D&A by care providers and postpartum PTSD symptom severity across various levels of racism-related stress…38

7 Tables…39

Table 1. Documentation of Disrespect and Abuse…39

Table 2. Six Types of Racism-Related Stress…42

Table 3. Documentation of Health Outcomes Associated with Racism-Related Stress…44

Table 4. Demographics and Disrespect and Abuse, reported by select indicators…45

Table 5. Disrespect and Abuse Responses, by typology…48

Table 6. Means, Standard Deviations, and Correlations among Main Study Variables…48

Table 7. Hypothesis Regression Results and Moderator-Level Conditional Effects…49

8 References…52


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