title: Racial disparities in birth care: Exploring the perceived role of African-American women providing midwifery care and birth support in the United States.
abstract: BACKGROUND
  Midwifery care has been linked to positive birth outcomes. Despite the broad racial disparities in maternal and infant outcomes in the United States (US), little is known about the role of minority women in either providing or receiving this type of care. A vibrant community of minority women, who self-identify as providing these services, exists online. In this exploratory study we ask how they describe their role; view their practice; and position themselves in the broader discussions of racial health disparities in the US.
  
  
  METHODS
  Using an internet mediated qualitative design we analyse online narratives from self-described African-American nurse-midwives, lay midwives and birth assistants; we found 28 unique websites. We collected and analysed narrative material from each site. We used a thematic analysis approach to identify recurrent and emergent themes in relation to the study question.
  
  
  RESULTS
  Narratives identified a strong link to the past, as providers viewed their practice in a historical perspective linking African roots, to the diaspora, and to current African-American struggles. Providers engaged both in direct clinical work, and in activist roles. Advocacy efforts sought to expand numbers of minority birth care workers and to extend the benefits of woman-centred birth care to underserved communities.
  
  
  CONCLUSIONS
  Results demonstrate the continued existence and important role of diverse types of African-American birth care providers in minority communities in the US. Recognition, support, and increasing the number of midwives of colour is important in tackling racial inequalities in health. Further research should explore minority access to woman-centred care.
authors.affiliation: Department of Applied Health Science, School of Public Health - Indiana University Bloomington, 1025 East 7th Street, Suite 116, Bloomington 47405, USA. Electronic address: luguerra@indiana.edu.
authors.forename: Lucia
authors.initials: L
authors.lastname: Guerra-Reyes
authors.affiliation: Department of Applied Health Science, School of Public Health - Indiana University Bloomington, 1025 East 7th Street, Suite 116, Bloomington 47405, USA.
authors.forename: Lydia J
authors.initials: LJ
authors.lastname: Hamilton
mesh_terms: D000328:Adult; D001741:Black or African American; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D020407:Internet; D008880:Midwifery; D009721:Nurse Midwives; D036801:Parturition / Q000208:ethnology*; D011247:Pregnancy; D036301:Qualitative Research; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014481:United States; D000078329:Workforce
keywords: African-American; Birth-care; Health disparities; Midwifery; Woman-centred