Traversing Traditions: Prenatal Care and Birthing Practice Preferences Among Black Women in North Florida

Abstract

Objectives: Our goal was to explore prenatal practices and birthing experiences among Black women living in an urban North Florida community.Design: Non-random qualitative study.Setting: Private spaces at a convenient loca­tion selected by the participant.Participants: Eleven Black women, aged 25-36 years, who were either pregnant or had given birth at least once in the past five years in North Florida.Methods: Semi-structured interviews were completed in July 2017, followed by the­matic analysis of interview transcripts.Results: Four main themes emerged: a) decision-making strategies for employ­ing alternative childbirth preparation (ie, midwives, birthing centers, and doulas); b) having access to formal community re­sources to support their desired approaches to perinatal care; c) seeking advice from women with similar perspectives on birthing and parenting; and d) being confident in one’s decisions. Despite seeking to incorpo­rate “alternative” methods into their birth­ing plans, the majority of our participants ultimately delivered in-hospital.Conclusions: Preliminary results suggest that culturally relevant and patient-centered decision-making might enhance Black women’s perinatal experience although further research is needed to see if these findings are generalizable to a heterogenous US Black population. Implications for child­birth educators and health care profession­als include: 1) recognizing the importance of racially and professionally diverse staffing in obstetric care practices; 2) empowering patients to communicate and achieve their childbirth desires; 3) ensuring an environ­ment that is not only free of discrimination and disrespect, but that embodies respect (as perceived by patients of varied racial backgrounds) and cultural competence; and, 4) providing access to education and care outside of traditional work hours.Ethn Dis. 2021;31(2):227-234; doi:10.18865/ed.31.2.227

Factors influencing birth setting decision making in the United States: An integrative review

“…Thirteen (54.5%) of the 22 studies included self‐reported data on participant racial and ethnic identity. Two studies reported binary race/ethnicity categories among 194 participants: White or “Ethnic/Minority.” 40,42 The remaining 11 studies reported more specific race/ethnicity details among 952 participants 38,43–47,49–52,56 . Among these participants, 539 (56.6%) participants identified as White or Caucasian, 287 (30.1%) identified as Black or African American, 54 (5.7%) identified as Asian, 16 (1.7%) as Hispanic or Latinx, 9 (1.0%) as American Indian or Alaskan Native, 4 (0.4%) as Native Hawaiian or Pacific Islander, and 2 (0.2%) as Middle‐Eastern.…”

“…One study mentioned all three options; however, the author’s reference to birth centers referred specifically to in‐hospital birth centers 41 . A total of eight studies dichotomized choices between home and hospital births 41–48 . Seven studies focused solely on home birth 37,49–54 .…”

“…In 18 studies, participants discussed perceptions of the relative safety versus risk of birth setting options 17,37–39,41,43–52,55–57 . For participants who chose a home birth or desired a home birth option, they cited fear of unnecessary medical intervention at hospitals as a driver of decision making 37,39,43,47,49,51,52,55 .…”

“…In 18 studies, participants discussed perceptions of the relative safety versus risk of birth setting options 17,37–39,41,43–52,55–57 . For participants who chose a home birth or desired a home birth option, they cited fear of unnecessary medical intervention at hospitals as a driver of decision making 37,39,43,47,49,51,52,55 . They expressed concern about being pressured to accept unwanted interventions, such as medical labor inductions, epidurals for pain relief, and cesarean births.…”

“…Across 16 studies, external influences on participants' awareness of birth setting options and decision making most commonly included references to media exposure and birth narratives of friends and family 37,38,40,42–45,47–55 . Resources such as the book Spiritual Midwifery by Ina May Gaskin and the film The Business of Being Born were cited as key resources informing specific interest in home birth and midwifery care 50,52,54 .…”