How African-American Nulliparous Women Construct Birth

Moore, Marianne Frances

Purpose/Aim

A focused ethnography was conducted to describe cognitive constructions about birth among nulliparous Black women in a Southwestern US urban area, and how these constructions are reconciled with the actual birth.

Significance/Background

African-American women suffer significant disparities in outcomes such as preterm birth, Cesarean section rates, maternal mortality and infant mortality, in the United States.

Methods

Women, 16 or older, 17 - 33 weeks carrying a singleton fetus without anomalies or medical problems and scheduled for an anatomy scan were recruited, and semi-structured interviews were conducted before and then after the birth. Eleven women participated: 17 to 30 years old, 11 to 22 years of education (2 college graduates) and 17+5 to 31+5 gestation. Three women were employed; all used Medicaid. Seven women received SNAP and/or WIC benefits. Three women had absent mothers. Post-delivery interviews (25-54 minutes) occurred 13 to 25 days postpartum. The researcher transcribed all interviews.

Findings

Women described views of birth that grew from ideas shared by their mothers. Themes included the predominant view “birth is painful”, followed by “birth damages you and/or the baby” Two women identified “birth changes you.” Ideas obtained from friends, family, the media and popular culture, as well as care providers were evaluated in light of these maternal ideas. Women also evaluated their own births using these maternal ideas. Beyond describing birth as their mothers had described it, women concluded that birth was essentially unknown to them, and they had limited expectations about what would happen during the birth.

Discussion

Further investigations into the expectations and birth experiences would help practitioners to provide more relevant care. Findings will expand what is known about how African-American women experience first deliveries. The role of the woman’s mother and extended family during her first birth presents another avenue for research, and for care.