A Canary in the Coal Mine: Exploring African American Women's Lived Experience of Childbirth

Abstract
This purpose of this study was to better understand what contributes to high infant mortality rates (IMR) for African Americans living in Charlottesville, VA, a place with one of the highest IMR prevalence. The specific aim of this study was to examine the lived experience of the African American women living in neighborhoods with high infant mortality, looking for nursing implications that can inform targeted interventions for promoting maternal/child health. This study was a secondary analysis of data derived from a series of focus groups involving 60 women, with a subset of 42 African-American women. The thematic analysis approach was used to identify, analyze, and report patterns within data. A critical feminist lens, intersectionality and an ecological framework were used to underpin the analysis. In group interviews, women shared numerous and repeating experiences of the dissonance between what they sought for their care over the course of their pregnancy and what they actually experienced. Findings centered on a core experience, labeled seeking a health care home and finding an institution. Illustrations of this experience were found at every contextual point of contact for pregnant women, including family and community, health care providers of prenatal care in the clinic, the University of Virginia Medical Center, and local, State, and federal institutions and policies. Issues of trust and respect were thematic threads at every level of interaction. Women were using a new narrative to discuss a process not represented in the current literature, negotiating a perceived threat, to mitigate stressful encounters at each point of contact and ensure the best possible outcomes for themselves and their infants. These findings are understood in the context of important historical moments that continue to impact women’s perceptions of their care today. This study takes seriously the historical, social, and political figurations through which threats, occurring on multiple levels at multiple points in time, must be negotiated by African-American women. Implications for nursing include short term strategies to improve levels of trust and respect in provider-patient relationships and communication and long term structural changes to influence medical and nursing education and culturally tailored models of prenatal care that are meaningful to women.