The PREM-OB Scale®

Obstetric racism, as defined by Dr. Dána-Ain Davis, MPH, PhD , sits at the intersection of obstetric violence, a form of gender based violence during the provision of obstetrics care to women and gender expansive individuals seeking ANY pregnancy related care by any health professional or system, and medical racism, a form race based discrimination enacted against Black people, Indigenous people, and People of color by ANY health professional or system that manifests as inappropriate or inadequate screening, diagnosis, and therapies.

Obstetric racism describes the particular types of harms enacted against Black women and people seeking health care for ANY pregnancy-related concern or condition by anyone in the health care profession, any health team, or any health or hospital systems that tracks along histories of anti-Black racism and eugenics.

According to Dr Davis, obstetric racism manifests as six manifestations:

• Diagnostic lapses

• Neglect, dismissiveness, and disrespect

• Medical abuse

• Coercion

• Ceremonies of degradation

• Intentionally causing pain

Obstetric racism is anthropological theory and event that characterizes various harms enacted against Black women and people by any personnel in a hospital or health system.

Dr Scott and team translated obstetric racism into a set of obstetric quality domains based on individual interviews with patient, community, and content experts. Data were collected in 2018 across California with the state perinatal quality collaborative. Then Dr Scott and her team continued to revise the obstetric quality and equity domain names to better reflect patient expectations and experiences of obstetric care during pregnancy, labor, childbirth, and postpartum.

Then in 2019, Dr Scott and her team partnered with two Black women led community-based organizations to develop an interview guide and methodology for curating the space and experience to learn about pregnancy and birth expectations and experiences. We conducted a total of 4 focus groups with Black mothers and Black community leaders based on the principles and practices of Black feminism, reproductive justice, and research justice.

The theorized domains of the PREM-OB Scale were identified based on the lived experiences of childbirth hospitalization of 37 Black mothers in Oakland and Los Angeles:

• Safety & Accountability

• Autonomy

• Communication and Information Exchange

• Kinship

• Racism (anti-Black racism and anti-Black misogyny, called misogynoir)

• Empathy and Humanity

• Dignity in Blackness and Holistic Care

After designing and validating the survey items with participation of 806 Black mothers and birthing people across 348 hospital and 34 states including Washington DC, the validated quality domains identified by Black people include:

• Humanity, 31 items that examine hospital language and/or behavior that affirms or violates safety and accountability, autonomy, communication and information exchange, empathy, and humanity

• Racism, 9 items that examine hospital language and/or behavior that affirms or mitigates anti-Black racism and misogynoir

• Kinship, 12 items that examine hospital language and/or behavior

Based on the science and evidence of the theory of obstetric racism and the methodologies used in survey design and validation, the PREM-OB Scale®️ is best used with the highest accuracy and precision among Black women and gender expansive individuals aged 18 years or older, who read, write, and speak English.

There is no science or evidence to support use of the PREM-OB Scale®️ in any language outside of English or among non-Black identifying groups.

With the inclusion of Indigenous communities or other birthing communities of color, we would obtain permission from Dr Dána-Ain Davis, MPH, PhD to elaborate upon the current definition of obstetric racism. Additionally, our team would seek additional consultation with patient, community, and content experts from the impacted community and apply a lens of settler colonialism or other forms of imperialism, colonialism, or oppression that reflect the lived experiences of the impacted structurally marginalized or minoritized communities. Likewise, we may need to use a different quality instrument and/or adapt the existing PREM-OB Scale® to reflect the lived experiences of birthing in hospital settings as an Indigenous woman or gender expansive individual or woman/person of color.

Below Dr Scott and her team invite new or return clients to review and consider completing the proposed four steps to curate an optimal experience for the client and BCR.

First, click here to complete the BCR Client Intake Form.
Second, search your emails for a follow-up email from the BCR Team to review and return

forms to facilitate an optimal experience for the client and BCR.

Third, we invite the client to review the following three forms:

• your client intake summary (to be shared with your team)

• FAQs for 2024 new or return clients

• mutual non-disclosure agreement (NDA) to be signed and returned by your

  institutional representative prior to our meeting

  • Please note that each respective institutional or organization representative

    must sign and submit their own NDA

Fourth, we welcome the client to explore a list of four things to uniquely prepare and support your and your team to co-developing talking points for exploratory meeting, based on the proposed agenda:

• your most pressing issues and highest levels of impact

• proposed budget

• review of desired services you are seeking from BCR

• proposed strategies or scope of work that is feasible based on system's needs, budget,

  timeline, capacity, readiness, and resources

The proposed agenda for the 40 min exploratory meeting follows the format below:

• 5 min Introductions and Review of Hospital/Health System

0. o welcome and introduction of BCR and Dr Scott
   o popcorn introduction and check-ins from your team

   ▪ Consider adding names, credentials, and roles in the chat • 15 min big picture system and community overview

   o Potential client's team provides ONE brief, clear, concise sentence description of the perinatal quality and patient safety challenges

   o identification of impacted birthing communities
   o review of desired services and QI pain points
   o identification of local, state, or national Black community partners and their role

   • 15 min budget, timeline, resources, and feasibility
   o proposed budget vs actual availability of funds
   o proposed strategies or scope of work that is feasible based on system's needs, budget,

   timeline, capacity, readiness, and resources
   o timeline and duration with and/or without the grant
   o Does starting ANY work depend on grant approval?

   • 5 min closing and next steps
   o meeting reflections, comments, concerns, or questions o next steps: 2 options

   ▪ BCR moves forward with drafting a scope of work based on the organization’s timeline, actual budget, and appropriate services/activities

   ▪ The potential client chooses to pause, until your team desires to follow-up at a future date