Intersections of Gendered Racial Trauma and Childbirth Trauma: Clinical Interventions for Black Women

• Published in: Psychotherapy (Chicago, Ill.) Ill.), 2023-03, Vol.60 (1), p.27-38
• Main Authors: Markin, Rayna D., Coleman, M. Nicole
• Format: Article
• Language: English
• Subjects: Birth Rate; Birth Trauma; Black People; Female; Human; Humans; Intervention; Posttraumatic Stress; Pregnancy; Psychotherapy; Racial Trauma; Racism
• ISSN: 0033-3204; 1939-1536
• DOI: 10.1037/pst0000403

Studies suggest that racism affects the type and quality of health care that patients who are Black receive, perhaps in part because poorer patient-provider communication and less provider encouragement of patient involvement have been consistently reported for patients of color. In particular, Black women are 3-4 times more likely to experience dangerous and even life-threatening complications, and more likely to report mistreatment and neglect from medical providers and staff, during childbirth. Experiences with gendered racism during childbirth, which in itself is a vulnerable, intense, and potentially traumatic experience when proper support is absent, may lead to posttraumatic stress reactions. Psychotherapy can help affected clients to process gendered racial and childbirth traumas through: (a) the establishment of a safe, trusting, and collaborative therapeutic relationship, in which careful attention is paid to repairing alliance ruptures caused by cultural misunderstandings or gendered racial microaggressions, and (b) framing experiences and "symptoms" as understandable reactions to gendered race-based traumatic stress during childbirth. In addition to direct therapeutic intervention, therapists should collaborate with doulas and/or medical providers on patient care, and, separately, advocate for systemic-level change, supporting clients' lived experiences outside of the therapy room. Clinical Impact Statement Question: What are specific traumatic experiences that Black women are more likely to experience during childbirth, what are the psychological consequences, and how can psychotherapy help? Findings: Clinicians can hopefully use this paper to help clients who are Black women and have experienced gendered racial and childbirth traumas to process the emotions and experiences associated with the traumatic event within a safe and trusting therapeutic relationship. Meaning: Prior studies find that Black women are more likely to experience gendered racism during childbirth, leading to potentially traumatic events and even dangerous or life-threatening complications. Yet, this form of trauma is rarely discussed, and clinical interventions are lacking. Next Steps: The authors suggest that clinicians focus on maintaining a safe and trusting therapeutic alliance and pay careful attention to how cultural factors are impacting the alliance, frame client "symptoms" as understandable reactions to gendered race-based traumatic stress during childbirth, and