How Clinician Interactions Affect Black Women During High-Risk Pregnancies

The Black maternal health crisis has been an ongoing issue in the United States. Research continues to show that Black women are more likely to experience pregnancy-related complications, such as hypertension, hemorrhage, cardiovascular disease, preterm birth, and death, than white women. These are all amplified during a high-risk pregnancy, underscoring the need for close medical monitoring.

A new study asked Black mothers who experienced high-risk pregnancies to describe their interactions with clinicians. Their insights highlight how much the patient-provider relationship and treatment can influence trust, stress levels, engagement in care, and, ultimately, health outcomes.

What Counts as a High-Risk Pregnancy?

A high-risk pregnancy is a pregnancy that involves medical conditions — before or during pregnancy — that can increase the risk of complications for the mother and baby, often requiring specialized care. High-risk pregnancies may cause complications like preeclampsia, gestational diabetes, premature labor, restricted fetal growth, and placental problems.

Major risk factors for a high-risk pregnancy include:

• Maternal age (under 17 or over 35)
• Pre-existing conditions (e.g., diabetes, hypertension, and obesity)
• Multiple gestations
• Lifestyle factors (e.g., alcohol, tobacco, or drug use)

High-risk pregnancies can require more proactive, specialized care to prevent complications during pregnancy and childbirth. Beyond typical prenatal care, mothers may work with a maternal-fetal medicine (MFM) specialist, receive more frequent monitoring, undergo specialized testing, and be given a customized delivery plan to ensure the best outcomes for her and her child.

About the Study

The qualitative descriptive study, published in Women’s Health Issues, interviewed 14 Black women between September 2022 and December 2024 who had experienced a high-risk pregnancy. Participants had to self-identify as Black, have given birth ≤ six months before the interview, and have been diagnosed with gestational diabetes or a hypertensive disorder of pregnancy to be considered for the study. 

Researchers asked participants about:

• Interactions with OB-GYNs, nurses, MFM specialists, and other clinicians
• If they felt heard or dismissed by medical staff
• How their race may have influenced treatment
• How their experience may have affected their health journey

In this study, qualitative research focused on patients’ lived experiences and voices, rather than solely on statistical data. With Black women having longstanding poorer maternal health outcomes, it’s time to look beyond the numbers and hear stories from the patients. Having a narrative can better explain what’s happening and shape how providers deliver care to Black women moving forward.

Positive Clinician Interactions Improved Care Experiences

There were four key themes the women described:

• Feeling heard: Clinicians who actively listened to their concerns and experiences, and took their pain, discomfort, and warning signs seriously.
• Respectful communication: Providers explained medical information in clear, plain language, didn’t rush or dismiss them, and treated them as partners in care.
• Shared decision-making: Providers involved them in the treatment plan and thoroughly discussed risks, options, and next steps.
• Compassion and emotional support: Clinicians recognized and acknowledged fear and anxiety throughout the pregnancy, and provided reassurance without minimizing their concerns.

These positive patient-provider interactions are crucial during the treatment journey, as they can make patients feel safer, increase trust in their clinician, and encourage follow-up care and treatment adherence.

Negative Experiences Created Harm

In contrast to the positive clinician interactions, researchers noted the following themes of negative experiences from the interviews:

• Dismissal of symptoms: Participants reported feeling ignored when describing pain, swelling, headaches, or complications.
• Poor communication: Clinicians didn’t fully explain the diagnosis or the changes to the treatment plan.
• Bias or stereotyping: Some participants felt their providers made assumptions about them based on their race or identity.
• Being talked at, not talked with: Providers made decisions without their involvement.

Ultimately, poor clinician interactions greatly affect care, potentially leading to consequences like:

• Increased anxiety and stress
• Delayed reporting of symptoms
• Increased distrust of the healthcare system
• Hesitation to seek future care
• Emotional trauma during pregnancy or childbirth

Why High-Risk Pregnancies Require Better Communication

High-risk pregnancies can often involve a larger team of specialists, more frequent monitoring, and treatment adjustments. The complexity of maternal care can be mentally and physically taxing for many patients, which is why a strong partnership between the patient and provider is critical. 

For Black women, who are already disproportionately burdened by maternal health disparities, poor communication may intensify fear and confusion, fragmenting trust and potentially causing worsened outcomes. 

Strong provider relationships can improve patient understanding, speed symptom reporting, and enhance continuity of care.

What Clinicians and Health Systems Can Learn

Maternal health providers can improve the care experience for Black women with these practical approaches:

• Be an active listener — especially when symptoms may indicate urgent complications.
• Practice awareness of bias through regular training on implicit bias and culturally sensitive maternity care.
• Improve shared decision-making by including patients in treatment planning whenever possible.
• Use clear, plain language to explain treatment recommendations.
• Be consistent and empathetic across visits to build trust.

Improving Black women’s care experiences doesn’t fall solely on providers — it requires a systems-level approach. Healthcare systems can do their part by collecting patient experience data by race, strengthening maternal equity initiatives, and improving postpartum follow-up for high-risk patients. 

The Takeaway

This study reveals that maternal health outcomes are not only shaped by diagnoses but also by the delivery of care. For patients with high-risk pregnancies, trust and strong communication can be essential, and, in some cases, lifesaving. 

Strengthening clinician interactions with Black women should not be seen as a “soft skill” issue. Instead, it should be a core component of delivering high-quality, compassionate maternal care. Continuing to listen to Black women’s experiences in healthcare remains critical to not only closing gaps in maternal health but across all specialties.

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