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Hospitals, health plans, and quality organizations generally define safety as the absence of a preventable harm and subsequently interpret decreasing trends in adverse physical outcomes as indicators of reducing harm and improving quality. Karen Antoinette Scott situates the contemporary provision of obstetric care and evaluation of obstetric quality in a broader historical context to illuminate a culture of neutral apathy and detached concern towards the lives of Black women, men, and children, dating back to antebellum era ideologies and practices of anti-Black racism and anti-Black misogyny.

Scott challenges conventional obstetric quality ethics, leadership, theories, measures, and methodologies that primarily focus on adverse outcomes, effectively excluding patient experiences and community wisdom. SACKRED Birth argues the need for a more culturally and scientifically responsive, relevant, and rigorous obstetric quality paradigm defined, valued, and shaped for, by, and with Black mothers and birthing people. Using community-based focus groups and consensus dialogue, Scott establishes new obstetric quality norms and methodologies to guide scholars, professionals, and advocates in understanding, investigating, and interpreting clinical practice, decision-making, and care delivery during childbirth in a manner that affirms the humanity, power, and potential, not pathology, of Blackness, Black reproducing bodies, and Black births in hospital settings.