PROJECT SUMMARY Background: Severe maternal morbidity (SMM) is a significant public health problem in the United States (U.S.). Rates of SMM in the U.S. increased 200% from 1993 to 2014. Black birthing people endured 70% more risk of SMM during the antepartum period, 40% more during the intrapartum period, and 18% more risk in the postpartum period when compared to their White counterparts. In the U.S., minority patients report experiencing higher rates of both chronic racial discrimination (day-to-day occurrences of interpersonal racial discrimination occurring outside the medical setting) and acute racial discrimination in medical settings (discrimination experienced inside the medical setting, perpetuated by nurses, midwives, and obstetricians) and disrespectful care. Moreover, previous studies have primarily focused on discrimination perpetrated by physicians rather than nurses and midwives, who typically interact more frequently with hospitalized patients. While research shows a relationship between racial discrimination and adverse health outcomes, no studies have measured the relationship between experiences of discrimination (acute and chronic) and disrespectful maternity care perpetuated by all provider types and SMM outcomes. Purpose: This study aims to conduct a case-control study with a nested qualitative study collecting quantitative and qualitative data on 100 self-identified Black birthing people who gave birth in a U.S. hospital within six months of enrollment. Methods: The case-control design will compare 50 cases (birthing people who experienced an SMM outcome) and 50 controls (birthing people who didn't experience SMM outcomes). Participants will complete five surveys, including a demographic survey and scales assessing racial discrimination from providers while seeking antepartum, intrapartum, and postpartum care, respectful maternity care from all providers, and racial discrimination in their daily lives. The study is comprised of three parts: (1) measure the association between experiencing an SMM outcome and experiences of discrimination and respectful care; (2) analyze survey data and purposively recruit a sample for qualitative interviews; (3) conduct 15-20 interviews of birthing people identified by low scores on the respect scale (indicating low respect) and high scores on the discrimination scale (indicating a high level of discrimination). Implications: This study, for the first time, will provide information on both acute and chronic interpersonal racial discrimination and maternal disrespect in Black birthing people experiencing SMM outcomes, a population at high risk for health inequities. Importantly, we will measure discrimination and disrespectful care received from all provider types, including midwives and nurses, the latter of who has been omitted from previous health inequities research. The findings of this study have the potential to impact practice in many ways, including the revision of standardized care...