Becoming a mother: The meaning of childbirth for African–Canadian women
Josephine Bassey Etowa
Associate Professor of Nursing, University of Ottawa, Ottawa, ONT, Canada
Abstract
Increasingly, with globalization, various countries including Canada are becoming ethno-racially and culturally diverse. Health professionals face the challenge of working effectively across these ethno-racial and cultural boundaries. In acknowledgement of the need to generate knowledge that informs the development of effective health care policies, this paper discusses the findings of a qualitative study that examined the childbirth experiences of African Canadian women. The meaning of childbirth, which is the primary focus of this paper, includes: sense of responsibility, childbirth as a positive life event, the uniqueness of childbirth as a life experience, childbirth as a bitter-sweet paradox, and childbirth as a spiritual event. The paper will conclude with a discussion of study implications including the need to provide opportunity for nurses to learn about the client's values, beliefs, and practices. This is necessary for the attainment of desired health outcomes such as having a healthy mother and the safe birth of a healthy baby.
Keywords
meaning of childbirth; nursing care; cultural competence; black women
Article Text
Childbirth, the process of giving birth to a child, is one of the most significant life events for a woman and her family. It exerts a profound physical, mental, emotional and social impact on her. Halldorsdottir and Karldottir (1996) noted that no other event that involve such a diverse plethora of experiences that include pain, emotional stress, vulnerability, possible physical injury, permanent role changes and the assumption of new responsibilities. Similarly, although it is a universal and natural health transition, childbirth is not only colored by a pregnant woman's circumstances and expectations but it is also significantly influenced by the broader context of societal and cultural values (Callister, 2009; Amoros, Callister, & Sarkisyan, 2010; Corbett, Reed, Tomao, Thornton, 2010; Ito & Sharts-Hopko, 2002).. In many parts of the world, childbirth is viewed as a normal, healthy event in the life of a woman. Accordingly, it is supported by an informal network of caregivers, typically including family members and non-medical practitioners (Callister & Khalaf, 2009). As Etowa and Keddy, (2009) stated, there are more cultural rituals and practices found around childbearing than around other life events.
As a cultural phenomenon, human childbirth is a unique process involving highly systematized patterns of care and diverse perspectives so that members of one culture might not recognize care in another culture as care. Thus, if one cultural group confronts the practices of another, they may be left wondering how women even survive the childbirth process. Culture not only specifies the perinatal care available to the perinatal family, but it also socializes and educates thereby eliciting the desire for a particular style of care (Kartchner & Callister, 2003; Williamson & Harrison, 2010). The cultural dimensions of childbirth include methods of providing prenatal care, choice of caregivers, the birthing process, use of pain relief measures and diet (Callister & Khalaf 2010; Behruzi, Hatem, Fraser, Goulet & Misago, 2010; Selin, 2009). These dimensions of childbirth can range from the scientific medicine of the dominant cultures of Western societies such as Canada, to the indigenous childbearing traditions of the developing world (Etowa & Keddy, 2009).
The paper presents the meaning of childbirth; a major theme of a qualitative research that examined the childbirth experiences of Canadian women of African descent in one of Canada's Maritime Provinces. The overall research objective was to generate knowledge about childbirth that would enable health care providers to work more effectively with childbearing women of African descent. The specific objective was to build up research knowledge that will guide the development of health care policies to better serve an increasingly diverse ethno-cultural Canadian population with a particular emphasis on the experiences of women from the African Canadian communities.
References
American Heart Association (AHA). "Heart and Stroke Statistical Update". At http://www.americanheart.org/statistics/stroke.html.2003 Accessed April 26th 2007.
Amoros, Z.U., Callister, L.C. & Sarkisyan, K. Giving birth: the voices of Armenian women. International Nursing Review, 2010; 57, 135-141.
Baum, F., MacDougall, C., Smith, D. Participatory action research. Journal of Epidemiology and Community Health, 2006; 60, 854-857.
Beagan B.L. & Etowa J,B. The Meanings and Functions of Occupations Related to Spirituality for African Nova Scotian Women. Journal of Occupational Science, 2011; 18(3), 277-290.
Berge, J.M., Mendenhall, T.J., Doherty, W.J. Using community-based participatory research (CBPR) to target health disparities in families. Family Relations, ,2009; 58, 475-488.
Behruzi, R., Hatem, M., Fraser, W., Goulet, L. Li, M. & Misago, C. Facilitators and barriers in the humanization of childbirth practice in Japan, BMC Pregnancy and Childbirth,(2010; 10 (25), 1471-2393. Open access at: http://www.biomedcentral.com/1471-2393/10/25
Bowen, S. Beyond self-assessment: Assessing organizational cultural responsiveness. Journal of Cultural Diversity, 2008; 15(1), 7-15.
Boyatzis, R. Transforming Qualitative Information Thematic Analysis and Code Development. Thousand Oaks: Sage Publications, 1998.
Brach, C. & Fraser, I. Reducing disparities through culturally competent health care: An analysis of the business case. Quality Management in Health Care2002; 10(4), 15-28.
Brathwaite, A. C., & Williams, C.C. Childbirth Experiences of Professional Chinese Canadian Women, Journal of Obstetric Gynaecologic and Neonatal Nurses (JOGNN)2004; 33(6), 748- 755.
Buka, S. L. Brennan, R. T., Rich-Edwards, J. W. Raudenbush, S. W. & Earls, F. Neighborhood Support and the Birth Weight of Urban Infants, American Journal of Epidemiology, 2003; 157 (pt 1), 1-8.
Callister, L.C., Corbett, C., Reed, S., Tomao, C. & Thornton, K. Giving Birth: The Voices of Ecuadorian Women. Journal of Perinatal Neonatal Nurses, 2010; 24 (2), 146-154.
Callister LC. Integrating cultural beliefs and practices in the care of women. In Simpson, KR & Crechan, PA (eds.) Perinatal Nursing, 3rd. Philadelphia: Williams & Wilkins,2008; 29-58.
Callister, L. C. & Khalaf, I. Spirituality in Childbearing Women. Journal of Perinatal Education,2010; 19(2), 16-24.
Callister, L.C. & Khalaf, I. Culturally diverse women giving birth, their birth stories. In H. Selin (Ed.)pp. 33-39. Childbirth across cultures. New York: Springer, 2009.
Callister, L.C. Mamawasi: Culturally sensitive birthing for Peruvian women. American Journal of Maternal Child Nursing, 2009; 34(1), 66.
Charlton, B.G. After science: Has the tradition been broken? Medical Hypotheses 2010; 74, 623-625.
Curtis, E., Dreachslin, J., & Sinioris, M. Diversity and cultural competence training in health care organizations: Hallmarks of success. Health Care Manager, 2007; 26(3), 255-262.
Callister, L.C., Semenic, S., & Foster, J.C. Cultural and Spiritual Meanings of Childbirth: Orthodox Jewish and Mormon Women. Journal of Holistic Nursing, 1999; 17, 280-295.
Callister, L.C. & Vega, R. Giving Birth: Guatemalan's Women's Voices. Journal of Obstetric Gynaecologic and Neonatal Nurses (JOGNN), 1998; 27(3), 289-295.
Cindoglu, D, Sayan-Cengiz, F. Medicalization discourse and modernity: contested meanings over childbirth in contemporary Turkey. Health Care for Women International. 2010; 31(3), 221-43.
Creswell, J.W. Standards of validation and evaluation. In J. W. Creswell (Ed.), Qualitative inquiry and research design. Choosing among five approaches (pp. 201-221). Thousand Oaks: Sage, 2007.
Dixon-Woods, M. Agarwal, S., Jones, D., Young, B. & Sutton, A. Synthesizing Qualitative and Quantitative Evidence: A Review of Possible Methods. Journal of Health Services Research and Policy, 2005; 10(1), 47-56.
Dreachslin J. Diversity leadership and organizational transformation for health Services Organizations. Journal of Health Care Management 2007; 44(6), 427-439.
Enang (Etowa), J.E., Wojnar, D., & Harper, F.D. Childbearing among diverse populations. Association of Obstetric, Gynaecologic, and Neonatal Nursing (AWHONN) Lifelines, 2002; 6(2), 153-157.
Etowa, J. & Adongo, L. Cultural Competence: Beyond Culturally Sensitive Care for Childbearing Black Women. Journal of the Association for Research on Mothering,(2007; 9 (2), 73-85.
Etowa, J. & Keddy, B. Racism in Health Care: Experiences of Childbearing women of African descent. International Journal of Diversity in Organization, Communities and Nations, 2009; 9(2), 17-34.
Etowa, J. Vukic, A. & Jesty, C. (in press). Indigenous Nurses' Stories: Perspectives on the cultural context of health care for Aboriginal peoples. Canadian Journal of Native Studies.2011; 37(2)
Frisby, W., Maguire, P. & Reid, C. The 'f' word has everything to do with it: How feminist theories inform action research. Action Research (AR), 2009; 7(1), 13-29.
Fraser, D.M. & Hughes, A. J. Perceptions of motherhood: The effect of experience and knowledge on midwifery students Midwifery 2009; 25, 307-316.
Freeman, E.M. and Logan, S.L. Reconceptualizing the Strengths and Common Heritage of Black Families: Practice, Research and Policy Issues. Illinois: Charles C Thomas, 2004.
Galabuzi, G.E. Social exclusion. In D. Raphael (Ed.), Social determinants of health: Canadian perspectives (pp. 235-252). Toronto, ON: Canadian Scholar's Press Inc, 2004.
Halldorsdottir, S., & Karlsdottir, S. Journeying Through Labour and Delivery: Perceptions of Women Who Have Given Birth. Midwifery, 1996; 12, 48-61.
Health Canada. Canada's Health Care System. Ottawa: Author, 2005.
Herbig, B, Bussing, A. & Ewert, T. The role of tacit knowledge in the work context of nursing. Journal of Advanced Nursing 2001; 34(5), 687-695
Ito, M. & Sharts-Hopko, N. C. Japanese Women's Experience of Childbirth in the United States Health Care for Women International, 2002; 23(6/7).
James, Carl E., Este, David, Bernard, Wanda Thomas, Benjamin, Akua, Lloyd, Bethan, Turner, Tana. Race and well-being: The lives, hopes and activism of African-Canadians. Halifax, NS: Fernwood Publishing, 2010.
Kartchner, R. & Callister L.C. Giving birth: Voices of Chinese women. Journal of Holistic Nursing, 2003; 21(2), 100-116.
Kemmis, S., & McTaggart, R. Participatory action research: Communicative action and public sphere. In: Denzin NK, Lincoln YS (eds.), Handbook of qualitative research (3rd ed., pp. 559-603). Thousand Oaks, CA: Sage, 2005.
Kington, R.S., Tisnado, D. & Carlisle, D.M. Increasing Racial and ethnic diversity among physicians: An intervention to address health disparities? In B.D. Smedley, A.Y. Stith, L. Colburn & C.H. Evans (eds.) The right thing to do, the smart thing to do: Enhancing diversity in the Health Professions. Washington D.C: National Academy Press, 2001; 57-75.
Krieger N. Proximal, distal, and the politics of causation: what's level got to do with it? American Journal of Public Health, 2008; 98, 221-230.
Kroelinger, C.D. & Gladders, B. Using scientific evidence to shape research, intervention programs, and policy in a statewide effort to reduce infant mortality, 2004-2009. Delaware Medical Journal, 2010; 82(8), 273-8.
Khalaf, I., & Callister, L.C. Cultural Meanings of Childbirth: Muslim women living in Jordan. Journal of Holistic Nursing, (1997) 15(4), 308, 380.
Lê Cook, B., McGuire, T. & Zuvekas, S. Measuring Trends in Racial/Ethnic Health Care Disparities. Medical Care Research and Review, 2009; 66(1), 23-48.
Liamputtong, P. The journey of becoming a mother amongst women in Northern Thailand. Lenham, MD: Lexington Books, 2007.
Liamputtong, P. Motherhood and moral career: Discourses of good. London: Sage Publications, 2006.
Logan, S.L. and Freeman, E.M. Eds. Health Care in the Black community: Empowerment Knowledge Skills and Collectivism. The Haworth Press Inc. New York, 2000.
Lundberg, P.C. Cultural Care of Thai Immigrants in Uppsala: A Study of Transcultural Nursing in Sweden. Journal of Transcultural Nursing, 2000; 11(4), 274-280.
Maddalena, V. Cultural competence and holistic practice: Implication for nursing education, practice and research: Holistic Nursing Practice, 2009; 23(3), 153-157
Maguire, P. Uneven Ground: Feminisms and Action Research. In Reason P, Bradbury H (eds.), Handbook of Action Research: Participative Inquiry and Practice 2001; 59-69.
Maputle, M.S. & Jali, M.N. Dealing with diversity: incorporating cultural sensitivity into midwifery practice in the tertiary hospital of Capricorn District, Limpopo Province. Curationis, 2006; 29(4), 61-9.
May, K.A. & Mahlmeister, L.R. Comprehensive Maternity Nursing. 2nd Ed. Philadelphia, PA: Lippincott, 1990, pp. 240-245.
McAdoo, H.P. Black Families. 3rd edition. Sage Publications, 2006.
McMahon, M. Engendering motherhood: identity and Self-transformation in women's lives. New York: The Guildford Press, 1995.
Meleis A.I. Culturally competent scholarship: Substance and rigor. Advanced Nursing Science, 1996 19, 1-16.
Miller, M.A. Culture, Spirituality, and Women's Health. Journal of Obstetric Gynaecologic and Neonatal Nurses (JOGNN), 1995; 24, 257-263.
Morse, J.M. Strategies for sampling. In J.M. Morse (Ed.), Qualitative Nursing Research. A contemporary dialogue (pp. 127-145). Newbury Park, CA: Sage, 1991.
Namey, E.E. & Lyerly, A.D. The meaning of "control" for childbearing women in the US. Social Science & Medicine, 2010; 71, 769-776
Nichols, F.H. The Meaning of Childbirth Experience. The Journal of Perinatal Education, 1996; 5(4), 71-77.
Nilsson, C., Bondas, T. & Lundgren, I. Previous Birth Experience in Women with Intense Fear of Childbirth. Journal of Obstetric Gynaecologic and Neonatal Nurses (JOGNN), 2010; 39, 298-309
Oxley, G., & Weekes, D. Meanings, perception, appraisal and coping: A pregnant African-American adolescent's perspective. Journal of Family Nursing, 1997; 3(2), 167-188.
Page, R.L., Ellison, C.G., & Lee, J. Does religiosity affect health risk behaviour in pregnant and postpartum women? Maternal Child Health Journal. 2009; 13, 621-632
Pasco, A.C. Y., Morse, J. M., & Olson, J.K. . Cross-Cultural Relationships Between Nurses and Filipino Canadian Patients, Journal of Nursing Scholarship,2004; 36 (3), 237-246.
Reiger, K.M. Knights" or "knaves"? Public policy, professional power, and reforming maternity services. Health Care for Women International, 2011; 32(1), 2-22
Rolf, B. The theory of tacit and implicit knowledge. 2011;. Accessed on Feb 24, 2011 at: http://www.nt.fh-koeln.de/philosophyandinformatics/AutumnMeeting2004/sois/SOI_Rolf.pdf
Rothman, B.K. Women, Providers, and Control, Journal of Obstetric Gynaecologic and Neonatal Nurses (JOGNN), Clinical Issues, 1996; 25(3), 252-257.
Savage, J.S. Postmodern implications of modern childbirth. International Journal of Childbirth Education, 2002; 17(4), 56-68.
Selin, H. Childbirth across cultures. New York: Springer, 2009.
Simkin, P. Just Another Day in a Woman's Life? Part II: Women's Long Term Memories of Their First birth Experiences. Birth, 1992; 18(4), 203-210.
Simkin, P. Supportive Care During Labor: A Guide for Busy Nurses, Journal of Obstetric Gynaecologic and Neonatal Nurses (JOGNN), Clinical Issues, (2002) 31(6), 721-732.
Smith, D. B. Racial and ethnic health disparities and the unfinished civil rights agenda. Health Affairs, 2005; 24(2), 317-325.
Smythe, E. Safety is an interpretive act: A hermeneutic analysis of care in childbirth. International Journal of Nursing Studies, 2010; 47, 1474-1482.
Srivastava, R. The healthcare professional's guide to clinical cultural competence. Toronto, Canada: Mosby, 2007.
Srivastava, R. & Craig, D. Embracing cultural diversity in health care: Developing cultural competence. Toronto, ON: Registered Nurses Association of Ontario (RNAO), 2007.
Sturmberg, J. P. & Martin, C. M. Knowing - in Medicine. Journal of Evaluation in Clinical Practice, 2008; 14(5), 767-770.
Sullivan Commission on Diversity in the Healthcare Workforce (2004).Missing persons: Minorities in the health professions. Retrieved on April 8, 2011 from: http://www.jointcenter.org/healthpolicy/docs/SullivanExecutiveSummary.pdf
Ted, H & Whitley, E.A. What is meant by tacit knowledge? Towards a better understanding of the shape of actions 2000;. Accessed on July 13, 2011 from http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.126.5730
Tiedje, L. B., Price, E. & You, M. Childbirth is changing: What now? MCN: American Journal of Maternal Child Nursing, 2008; 33(3), 144-150.
van den Brink, , Y. "Diversity in Care Values and Expressions Among Turkish Family Caregivers and Cutch Community Nurses in the Netherlands." Journal of Transcultural Nursing. 2003; 14(2), 146-154.
VandeVusse, L. Decision Making in Analyses of Women's Birth Stories, Birth, 1999; 26 (1), 43-50
Vargens O.M, Progianti J.M, & da Silveira A.C .The meaning of unmedicalization of childbirth attendance in hospitals: an analysis of the obstetric nurses' conception. Revista da Escola de Enfermagem da USP , 2008: . 42 (2), 339-46.
Wilkinson S.E, & Callister L.C. Giving birth: the voices of Ghanaian women. Health Care for Women International, 2010; 31(3), 201-20.
Willard-Williams, C. Black teenage mothers, pregnancy and child rearing from their perspective. Lexington, MA: D.C. Heath, 1991.
Williams, D.R. Race, SES, and health: The added effects of racism and discrimination. In Adler, N.E., Marmot, M., McEwen, B.S. & Stewart, J. (Eds.) Socioeconomic Status and Health in Industrial Nations: Social, Psychological and Biological Pathways. Annals of the New York Academy of Science 1999; 896.
Williams, D. R. Race and health: Trends and policy implications. In: Auerbach JA& Krimgold, BK. (eds.) Income, socioeconomic status, and health: Exploring the relationships. Washington, D.C., National Policy Association, 2001.
Williamson, M. & Harrison, L. Providing culturally appropriate care: A literature review. International Journal of Nursing Studies 2010; 47, 761-769.
eContent Home
