NEW YORK, NY (January 23, 2025) -- Language that conveys stigma is common in clinicians’ notes on laboring and birthing people, Columbia University School of Nursing researchers report this month in the Journal of Obstetric, Gynecologic & Neonatal Nursing (JOGNN).
The study appears in a January 2025 special issue of JOGNN, “Women’s Mental Health Across the Life Course.” Veronica Barcelona, PhD, an assistant professor at Columbia Nursing, will participate in an accompanying webinar on Tuesday, January 28, 2025, at 2 p.m. Central Time.
Studies show Black patients’ medical records are more likely to contain biased language than white patients’ records, which could contribute to worse health care, Barcelona and her colleagues note in the report. While implicit bias and racism are known contributors to worse perinatal outcomes among Black people, they add, to date most research on clinicians’ use of stigmatizing language has been in non-maternity settings.
To better understand bias in medical records for birthing patients, Barcelona and her colleagues analyzed 1,771 clinical and labor birthing notes from 2017 for two large hospitals, identifying 10 categories of stigmatizing and non-stigmatizing language.
The most common category of stigmatizing language directed against patients were unjustified descriptions of social and behavioral risks, for example referring to suspected or actual substance use, domestic violence, or teen pregnancy, identified in 22.4% of the notes. Patients were called difficult in 7.2% of notes, while 5.2% of the notes included power or privilege language, for example mentioning a patient’s husband’s job at a prominent financial institution.
Other stigmatizing categories occurring less frequently included language indicating unilateral, authoritarian decision making (4%), questioning patient credibility (2.9%), and clinician disapproval (1.1%).
The authors defined two categories of non-stigmatizing language: positive or preferred language, for example using words like “endorses” or “reports” to convey a patient’s point of view, identified in 10.8% of the notes; and language indicating patients exercising autonomy for birth, seen in 0.8%.
“Implications of this work extend beyond the research context,” Barcelona and her colleagues write. “We aim to improve clinical documentation that reflects each person’s autonomy, is patient-centered, and demonstrates respect to achieve the ultimate goal of developing more inclusive and equitable health care practices for all in the perinatal period.”
Barcelona’s Columbia Nursing co-authors include postdoctoral associate Jihye Scroggins, PhD; doctoral students Danielle Scharp, MS, and Sarah Harkins, BS; and Associate Professor Maxim Topaz, PhD.
The study was funded with a grant from the Columbia University Data Science Institute Seed Funds Program and a grant from the Gordon and Betty Moore Foundation.
About Columbia University School of Nursing
Columbia University School of Nursing is advancing nursing education, research, and practice to advance health for all. As one of the top nursing schools in the country, we offer direct-entry master’s degrees, advanced nursing, and doctoral programs with the goal of shaping and setting standards for nursing everywhere. And, as a top recipient of NIH research funding, we address health disparities for under-resourced populations and advance equitable health policy and delivery.
Through our expansive network of clinical collaborations in New York City and around the world —including our dedicated faculty practice, the ColumbiaDoctors Nurse Practitioner Group — we cultivate a culture of innovation and diversity and champion a community-centered approach to care. Across the Columbia Nursing community, we encourage active listening, big thinking, and bold action, so that, together, we’re moving health forward.
Columbia University School of Nursing is part of Columbia University Irving Medical Center, which also includes the Columbia University Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, and the College of Dental Medicine.
Journal
Journal of Obstetric Gynecologic & Neonatal Nursing