By: Lenise Freeman, health policy analyst, MHA
Over the past year, I supported the Birth Experience Project, a mixed-methods study examining how Black women across Michigan experience pregnancy, labor and delivery, and postpartum care. As part of this effort, I assisted in analyzing and coding more than 50 hours of interview and focus group data to better understand the patterns, experiences and needs that emerged across regions. This fall, I presented our findings at the 2025 American Public Health Association (APHA) Annual Meeting in Washington, D.C., where the work informed meaningful conversations about how hospitals can more effectively center the voices of Black women in maternal health improvement efforts.
The project engaged four focus groups and 37 individual interviews with women from the Midwest region, Southeast Michigan and Mid-Michigan. In partnership with the Michigan Council for Maternal and Child Health and Michigan State University’s Pediatric Public Health Initiative, our team aimed to capture mothers’ lived experiences directly and translate them into actionable insights for health systems.
Through coding and analysis, several themes surfaced consistently across all geographic areas. Women shared both positive and challenging care experiences that shaped their perceptions of safety, trust and autonomy. Many described moments when their concerns or pain were dismissed, minimized, or not addressed in a timely manner, which negatively impacted their ability to feel heard. Others emphasized how attentive listening, compassionate care and clear communication led to safer and more supportive hospital experiences.
Birth plans were another key theme. While some mothers shared that their preferences were honored, many experienced changes without adequate explanation or felt pressured into medical interventions that differed from their original plans. Across one participating region, only three of the 14 women who developed birth plans said their plans were thoroughly followed, with others noting limited options or confusion about what support the hospital could provide.
Hospital experiences varied widely. Mothers described moments of compassionate and responsive care, as well as instances where care felt rushed or impersonal due to staffing turnover, student rotations or limited coordination among providers. Some waited extended periods for updates, while others reported feeling like “just another patient,” rather than an individual with unique needs. These inconsistencies shaped how they felt supported or respected during their care.
Postpartum support was consistently identified as a gap in care. Many women reported minimal follow-up contact, limited mental health screening or unclear guidance about symptoms to monitor once they returned home. Several stated they “didn’t know what symptoms to look for,” highlighting the need for earlier, more proactive postpartum engagement.
Notably, the women in our study offered straightforward, realistic suggestions for improvement, recommendations that mirror ongoing maternal health efforts across the state. They emphasized the need for stronger communication and transparency, including more precise explanations of procedures and changes in care. They wanted birth plans reviewed and communicated across shifts—not forgotten or overridden. Many highlighted the importance of culturally responsive care and noted that they felt more comfortable advocating for themselves when staff reflected their identity or demonstrated cultural awareness. Doulas and midwives were described as critical sources of support, helping women feel heard when providers were limited or communication fell short. Women also expressed a need for more robust postpartum support, earlier follow-up visits, improved mental health screening, and accessible lactation and community-based resources.
Presenting this research at APHA reaffirmed the importance of hospitals in elevating patient voices within maternal care quality work. The themes that emerged through coding reveal both opportunities and strengths across Michigan hospitals. They also make clear the steps we can take to improve communication, strengthen autonomy and support mothers through the full continuum of care.
As Michigan continues implementing Maternal Levels of Care, advancing AIM bundles and supporting community-based maternal health initiatives, this research offers direction grounded in lived experience. I remain committed to ensuring that the insights shared through this project drive meaningful change, strengthening communication, honoring autonomy and supporting patient-centered care for every birthing person across Michigan.