A Qualitative Examination of Factors that Influence Birthing Options for African American Women

Abstract

This article examines the factors that influenced the birthing decisions of a group of African American women from regions throughout the United States who selected to give birth at home. Using the Afrocentric and Africentric social science models developed by Asante and Akbar, respectively, 25 African American women were interviewed to discern why they chose to give birth at home and eschew traditional Western medical birthing practices. The women asserted that (1) a desire for control, (2) avoiding pharmacological pain relief, and (3) dissatisfaction with the medical aspects of intrapartum care were all central in their decision-making process. Finally, the participants also alluded to a desire to utilize indigenous African birthing methods and to reconnect with more indigenous African cultural practices.

Keywords

African Americans African American studies birthing options sociology women

Introduction

The knowledge of a new pregnancy should be a time of elation for expectant mothers, but often times entangled with that excitement are uncertainties regarding details about their delivery. There are numerous birthing options for mothers to choose from, all of which have pros and cons (Lothian, 2009b). Recent growth in ideas about alternative birthing options has seen an increase in the number of mothers choosing to pursue a natural birth (Longworth et al., 2001; Viisainen, 2001). With this increase in natural births comes an increased need for awareness about each option due to a general lack of support for such practices by the United States government (Boucher et al., 2009). A decreased knowledge about available options increases the anxiety of patients and in return decreases the ability to make a rational decision regarding a birthing avenue. Lothian (2009b) asserts that women need to know the history behind natural births, the evidence that supports the value of a natural birth, and the ways in which standard maternity care can increase risk of harm for mothers and their babies.

As modern technology concerning medical obstetrics grows, the number of births in the hospital setting also increases (Lothian, 2009a; Sears and Sears, 1994). In the United States, statistics report that in 1940, 40% of births to white women and 73% of births to nonwhite women took place in the home. A shift took place by 1950, as shown by reports of 88% of births occurring in hospital, followed by an increase to 99% in 1960 (Martin et al., 2007). This illustrates a drop in the number of home births in women of all ethnicities.

Many mothers believe that is it nearly impossible to complete the birthing process without drugs due to the heightened level of pain, despite the fact that such beliefs are not evidence-based (Shilling, 2009; Storton, 2007). Although medication serves to alleviate the pain, taking medication comes with numerous risks for both the mother and child (Storton, 2007). Complications often arise unexpectedly and may be associated with errors in judgment by health care staff, use of unsuitable drugs, or incorrect patient management (Nicholson and Ridolfo, 1989).

The location of the birth is an issue that surfaces along with the decision to medicate or not to medicate (Janssen et al., 2009). Some women choose to have a non-medicated birth in a hospital setting to gain the peace of mind of knowing that proper medical equipment is available in the event that complications occur during the labor process (Wax et al., 2010). Others however, gain satisfaction by naturally birthing their children at home (Ngomane and Mulaudzi, 2010). Women who choose the option of home birthing seek to have a non-medical assisted experience in comfortable and familiar surroundings wherein the mother maintains situational control (Wax et al., 2010).

Cultural beliefs play a vital role in most healthcare decisions, and childbirth is no different (Shaikh and Hatcher, 2005). As such, it is important to know what factors guide African American women and their attitudes towards the selection of child birthing options. Currently, there is a dearth of research available on the current factors that drive African American women’s choices regarding home childbirth options (Craven and Glatzel, 2010).

An Afrocentric/Africentric Sociological Approach

Asante (1998: 173), in articulating an Afrocentric or African-centered model, posits that ‘an Afrocentric method is concerned with establishing a worldview about the writing and speaking of oppressed people’. The aforementioned technique is grounded in three epistemological assumptions. First, a thematic presentation positioned in a resistance to subjugation, stereotypes, and a proactive, instead of reactive, action. Second, a dialogue and discourse that is culturally relevant. Third, a discourse that is a geared to a Black, non-Black, or mixed audience.

Akbar (1984) posits that African (Black) social scientists have failed to acknowledge that the Eurocentric modalities they have acquired in their western academic training have rendered them intellectually bankrupt when it comes to the purpose of economic, social, psychological, and political liberation of African people. Nobles (1978) contends that the western-trained African scholar is imprisoned by his training and adoption of European epistemologies and thus ill-prepared for an African-centered analysis of the dilemmas faced by African people. Moreover, Akbar (1984) insists that Africans need a technique of analysis that is reflective of our reality.

An Africentric social science/sociology can be surmised as inclusive of the following tenets according to Akbar (1984). First, the ‘self’ is viewed as ‘collective’ as opposed to ‘individualistic’ in the western frame. In other words, an African sociological approach identifies the ‘collective consciousness as the appropriate arena for human observation’ (Akbar, 1984: 407). Second, the Africentric sociological model asserts that the human is spiritual by nature and is inclusive of the physical, mental, and metaphysical dimensions of the person. The aforementioned is imperative because spirituality is not a component of western methodology. Third is the fundamental goodness of humans. Thus, in the Africentric approach, morality is endemic to the conception of man and synonymous with spirituality. Finally, the epistemological assumptions of an Africentric approach affirms that both symbols and affect are determinants of human endeavor, i.e. activity.

In this work, as advocated by Chipungu et al. (2000) and Gilbert et al. (2009), the terms Africentric/Afrocentric will be used interchangeably when describing an African-centered practice of why women chose home births. Further, both Asante’s (1998) Afrocentric social science model and Akbar’s (1984) Africentric social science model are both amenable for our analysis. Each technique is sociological in its emphasis on human nature/agency, indigenous culture as a determinant of behavior, and a desire to overcome the shortcomings of western modalities when attempting to explain African behavior. Finally, in the opinions of the authors, both methods recognize and are consistent with the sociological dictum advanced by Staples (1976). Staples (1976) argues that if White sociology, i.e. western-framed sociology, is the science of oppression, then Black, i.e. Afrocentric/Africentric, sociology must be the science of liberation.

The purpose of this study is to investigate and analyze factors that influenced the choices of African American women seeking a home birth using an Afrocentric/Africentric model. The need for the Afrocentric sociological method for the study of birth options selected by Black women is important because of the subjugation of African Americans by western society (Benkert et al., 2009). This suppression facilitated a lack of trust of European physicians (Washington, 2008). For instance, Ngomane and Mulaudzi (2010) found that most African women did not seek professional help during birth, which can be attributed to the decreased ability to voice their opinions and professionals using their authority to suppress the patient. As a result of this distrust most African Americans are seeking the spiritual and cultural rituals of the African culture (Ngomane and Mulaudzi, 2010). Finally, in our study, the most pertinent factors identified by African American women who desired a home birth were the desire to have control, avoiding pharmacological pain relief, and dissatisfaction with the medical aspects of intrapartum care (Wax et al., 2010; Ngomane and Mulaudzi, 2010; Draper, 2002). The aforementioned are the focus of our literature review.

Review of Literature

The review of literature provides a brief history of African birthing practices and examines factors that influence a mother’s choice of home birth. Upon examination of the literature, three main factors emerge as relevant to the present study since they influence birth options among African American women: (1) desire for control; (2) avoiding pharmacological relief of pain; and (3) dissatisfaction with the medical aspects of intrapartum care (Draper, 2002; Ngomane and Mulaudzi, 2010; Wax et al., 2010).

African Birthing Practices: A Brief Overview

Indigenous beliefs and practices are shaped by cultural traits that have been passed down from generation to generation (Ngomane and Mulaudzi, 2010). These rituals fomented a belief that women must follow their cultural rituals in order to deliver a healthy child. These cultural directives include telling the ancestors about the pregnancy, which is designed to obtain divine protection throughout childbirth (Nukunya, 1969). Sacrificing an animal (mhamba) to the ancestors is an act done to gain safe motherhood. Herbs like Ritlangi are given to a woman to preserve the pregnancy and Mpundulo, another herb, is given to strengthen the pregnancy. Davis-Floyd (2000) acknowledges that African women view herbs as healthy, nutritious, and conducive to a safe environment for the mother and the fetus (Ngomane and Mulaudzi, 2010). Other rituals include prohibiting sex during pregnancy, because of the belief that sperm could contaminate the child, and prohibiting drinking water while standing, to prevent hydramnios (excessive fluid) during delivery. Furthermore, there are also remedies midwives provide if complications occur when it is time to deliver the baby. These may include giving boiled Xiveve, an indigenous oxytocin, to accelerate the delivery or roots of Xirhakahani to relieve labor pains. If the placenta is retained after delivery, Dinda is boiled and given to the mother to drink to induce contractions and deliver the placenta or the midwife will use two river canes, Rihlanga, to pull the placenta out manually (Ngomane and Mulaudzi, 2010).

Nukunya (1969) states that in Ghana the childbirth experience included the entire village. Mostly, this was attributable to having few hospitals, which were usually out of reach. Although hospitals were built, African villages still relied on their traditions of midwifery. Even today it is only in a difficult pregnancy that a woman from a village will deliver in a hospital. Nukunya (1969) also stated that the cries of the laboring mother were the alert to other neighbors to come to the house and wait for the delivery of the child. While the woman is in labor, the other women pray for good delivery.

Fraser (1995) asserted that midwifery was an African American tradition, with most midwives being black, along with their clients. Interestingly, white women also turned to African American midwives to help in delivery and postpartum care (Fraser, 1995). There are reports that 90% of African American births were attended by midwives in the southern states in the first decade of the twentieth century (Craven and Glatzel, 2010). This percentage declined by the 1940s but varied depending on location. Virginia and Kentucky fell under 20% while Mississippi and Alabama continued to have about 75% of births attended by midwives (Midwifery in Virginia, 1951; Litoff, 1978; Robinson, 1984). In the 1950s, the role of African American midwives in the reproductive healthcare system was shrinking (Fraser, 1995). This decrease was due to the transition of black women in the rural community from depending on midwives to giving birth in the presence of medical professionals (Logan, 1989; Susie, 1988). The prevailing school of thought that painted the medicalization of childbirth as a positive was expected when evaluating the history of segregated hospitals and inferior healthcare that blacks in the South endured (Beardsley, 1990).

Desire for Control

Birth can be stressful, and encouragement during labor is important for the expectant mother (Lothian, 2009a). Mothers who choose to have continuous support during labor have fewer cesareans, are less likely to use the drug Pitocin during the labor process, and are more satisfied with their birth experience (Hodnett et al., 2007; Leslie and Storton, 2007). Hospital policies limit the number of people that can be present during birth, but the option of having a child at home eliminates this problem. In a study carried out in Sweden, twelve women reported that giving birth at home conserved their authority and autonomy by having faith in their own ability to give birth along with the power to choose their support (Sjoblom et al., 2006). Having a sound system of support has proven to be influential in the birthing process.

Not only is it vital to have the power to choose who is present at the birth but it is also valuable to have control over the environment in which the child is born. According to Morison et al. (1998), the relevance of control is reflected in the ability of the mother to manipulate lighting, ventilation, and temperature during the birth process. Janssen et al. (2009) also contend that many mothers felt that the home environment enhanced relaxation and the ability to concentrate. Additionally, Borquez and Wiegers (2006) concluded that the choice of home birth was due to a desire to have influence over relaxation and comfort.

In the hospital, standard care for a laboring mother includes intravenous lines, continuous electronic monitoring, epidurals, and restrictions on eating and drinking and movement (Declercqet al., 2006). These hospital routines are viewed as both bothersome and stressful for a mother and child. In a home setting, mothers have control over positioning, eating, and drinking as desired. Evidence shows that the routine use of technology throughout labor without a clear medical indication has contributed to an increased cesarean rate and other complications concerning both mother and baby (Goer et al., 2007).

Not only do invasive procedures complicate the labor process but it also has been shown that directed pushing during labor has an association with an increased risk for pelvic floor dysfunction (Schaffer et al., 2006). The desire for a home birthing experience is based on wanting the baby to enter the world with the least stress and with the fewest possible interventions in the first few hours after birth (Viisainen, 2001). With the option of a home birth, modern technology is eliminated and birth is capable of naturally unfolding, therefore eliminating second-hand complications. Some may argue that giving birth in a hospital with a doctor is safer than at home with a midwife, but no evidence supports the view that moving a birth to a hospital or having an obstetrician present makes birth safer for healthy women with an absence of pre-existing medical conditions (Enkinet al., 2000).

Avoiding Pharmacological Pain Relief

The shift from home to hospital birth encouraged a new mode of thought surrounding the birthing process. Women have an innate perception of how their own body works and should have confidence in their own capability to give birth (Lothian, 2009b). Traditional ways of solving issues concerning comfort were deserted and replaced with pharmacological pain relief (Goer et al., 2007). This decreases the mother’s desire to rely on her own abilities. Hospital restrictions often place time limits on a woman’s inner ability to find comfort without the use of medications (Lothian, 2001).

Routine interventions set the platform for an effluence of other interventions, which interrupt the physiological labor and birth process (Lothian, 2009a). Women place their trust in medications and health care workers, which may yield negative results (Romano and Lothian, 2008). The use of epidurals, a commonly used medication for pain, has been associated with longer labors, increased possibility of using instruments during delivery, more malpositioned babies, more vaginal tearing to the mother, and increased cesarean risk, especially if the drug is given too early in labor (Goer et al., 2007; Lieberman and O’Donoghue, 2002). Complications often arise unexpectedly and may be associated with errors in judgment by health care staff and the use of unsuitable drugs or incorrect patient management (Nicholson and Ridolfo, 1989).

In the view those who support home birth, women perceive pain as a stepping stone to birth that should be overcome instead of relieved (Ng and Sinclair, 2002). A woman’s body is physically prepared and capable for labor and birth. Finding comfort naturally with contractions stimulates the release of oxytocin and endorphins which are natural hormones needed in labor. Endorphins moderate pain and result in women working with their labor (Cunningham et al., 2001). A woman’s body responds to the released endorphins and her perception of pain decreases. This leads to her becoming more aware of how to move and act in response to her motherly instincts (Lothian, 2009a).

Dissatisfaction with the Medical Aspects of Intrapartum Care

Although there are compassionate doctors and nurses in practice, there are also staff members that perform their duties in an unprofessional manner (Washington, 2008). This treatment by health care workers may often be overlooked but lead to a mistrust of the health care system as a whole. Hodges (2009) states that this non-professional patient care could be viewed as abusive. Actions that can be seen as abuse may include lack of obtaining informed consent before conducting medical procedures, overriding a mother’s choice of a treatment, and misrepresentation of medical situations and the need for intervention (Hodges, 2009).

Healthy women have the safest births when care is based on evidence-based practice (Lothian, 2009a). Mothers deserve to give birth in a location that is medically sound, but also where safety is paramount and privacy is given. Health care providers should also value the natural process of the birth and only intervene when necessary. Women have the right to know that hospital and obstetrician care may not be the best way to accomplish a healthy birth and that planned home or free-standing birthing centers are also safe options for healthy women (Enkin et al., 2000; Leslie and Romano, 2007). Although along with the issue of home birth comes a recommendation of midwives, evidence shows that women valued the ability to choose birth at home independent of their response to midwifery care (Janssen et al., 2009).

Methods

This study examines factors that influenced African American women choosing to have a home birth, based on interviews with 22 women who have had home births. In-depth interviews were used in the study to identify factors, as outlined in Wax et al. (2010), Ngomane and Mulaudzi (2010), and Draper (2002), that were most relevant to women who have had home births. Qualitative interviews were necessary to analyze the rich contextual meanings of the mother’s answers, according to the interview analysis schemata outlined in Berg (2007).

Qualitative Methodology

Respondents were selected via convenience/snowball sampling. This sampling method was used due to monetary and time restraints and followed the content analysis format provided in Berg (2007). Berg’s (2007) method of interview analysis was employed to tap into the rich contextual meaning of the subjects’ responses. Our initial method of soliciting participants involved attending a traditional childbearing organizational conference and asking attendees if they would be interested in participating. Interviewees ranged in age from late twenties to early sixties and lived throughout the United States as well as coming from different socioeconomic backgrounds. The interviews were conducted between May and July 2011. Pseudonyms were used to protect the identities of the participants. The women responded to a list of open-ended questions that centered around three emergent factors in the literature (e.g. Draper, 2002; Ngomane and Mulaudzi, 2010; Wax et al., 2010) that influenced the choice to have a home birth. Responses from the interviews were analyzed through the lines of sight provided by Asante’s (1998) African-centered social science model and Akbar’s (1984) Africentric model. Both models were utilized because they can be considered sociological in nature via their emphasis on non-western cultural frames, human agency, and liberating discourses.

The data were obtained through in-depth interviews. The interview questions centered on factors previously identified with women who have had a home birth. The data were obtained by asking the following open-ended questions:

What influenced your decision to have a home birth?

What type of research did you do before making this decision?

Did your economic status play a role in choosing this method?

How did your culture play a part in the choice?

Describe the relationship between you and your midwife.

How did this relationship differ from relationships with other health care professionals that you have encountered?

Tell me about your home birth experience.

What were the most important elements for you to have during the birth?

Was a desire to have control important to you?

Did you feel in control during your home birth?

Did you feel that you had a voice?

Tell me how you handled pain during labor.

Who was present during the birth?

How important was it to have those people in the room?

Would you recommend a home birth to other women?

Findings

The findings in the research study corresponded to and differed from the existing literature on factors affecting home birth. The data were organized based on the best representation of pertinent themes in the subjects’ responses associated with the primary factors in the literature: desire for control, avoiding pharmacological pain relief, and dissatisfaction with medical aspects of intrapartum care. In other words, the analyzed responses were those the authors believed best captured the importance of the factors correlated with a successful home birth. Respondents answered questions and statements focusing on succinct predictors of women who seek home births as identified in the literature (Wax et al., 2010; Ngomane and Mulaudzi, 2010; Draper, 2002).

Desire for Control

A strong emphasis has been placed on the ability to manipulate lighting, ventilation, and temperature during the labor process (Morison et al., 1998). These variables suggest that women who chose to have a home birth desire a voice in controlling their surrounding environment. The most direct subject response on the idea that women who choose to have a home birth want to control their environment come from Susan, a 31-year-old mother:

It was intimate, four people maximum, very comfortable and very easy. I could move around and be comfortable. I knew where things were and if I wanted something I knew where to get it. I also didn’t have to worry about anyone (healthcare workers) getting anything past me.

Susan, the first respondent, was asked to describe the most important factor during her birthing process. Susan’s response, when examined through the lens of an African-centered model, revealed a degree of solace on her part. This solace can be presumed to be related to the mother’s affirmative voice in her child’s home birth. Akbar’s (1984) Africentric construct posits that the distress experienced by Susan could be presumed to have emerged from a lack of control over her child’s birth. This lack of control over her own body would be a psychosocial trauma which is connected to a history of European oppression (Washington, 2008). European oppression, particularly during the enslavement and colonization of peoples of African descent, allowed for Africans to have relatively little input in most facets of their lives, including, but not limited to, control over their bodies (Anderson, 1995; Karenga, 2010).

In a cultural sense, the control that the mother is afforded via a home birth would enable her to integrate usage of traditional African herbs during the birthing process (Ngomane and Mulaudzi, 2010). Using these herbs is believed to provide a calming effect and a safer environment for the uterus (Davis-Floyd, 2000). The factor of control identified from the mother’s response is corroborated in the literature, but her desire to control the milieu was not to alter lighting, ventilation, or temperature as suggested in the literature. The reasoning behind wanting control was so that the mother could relax in her own environment. Rather than altering her own environment she kept elements the same and aligned them with her usual routine.

The following response from an African American woman could be seen as an accurate portrayal of why women choose to have their children at home:

The desire to have control was the most important factor because I had a strong desire to do what I needed to do. I got the freedom to move as I wanted. (Jackie, 35 years old)

Jackie asserted that to be in command of the birthing process equated with a more satisfying childbirth. The control–satisfaction nexus is corroborated in the literature (Hodnett et al., 2007). Further, the available research offerings indicate that the control retained by a mother giving birth at home increases relaxation and concentration during the birthing process (Borquez and Wiegers, 2006).

The Afrocentric method would propose that Jackie’s response has importance because it illustrates the relevance of intellectual and cultural agency in the birthing process. Black women, especially when it comes to medical procedures, present a dilemma reaching back to the tragic case of Sarah Baartman, who had her genitals on display in a museum for over 100 years after her death (Washington, 2008).

The mothers expressed strong feelings towards a desire to personalize their environment. Western medicine in hospitals is viewed as a mill mentality. Birthing plans and environments are created and tailored to each specific mother, but in the end monitoring is not carried out to make sure that the mother’s original birthing plan is followed. Healthcare workers want to get the baby delivered, by any method they see fit, and discharge mother and baby as soon as possible. For example, the response given by Susan suggests that being in control of the environment around her gave her comfort. Eating and drinking, two things done during her labor, are not permitted in the hospital. Depriving the body of food and water does not place the mother at the optimum strength to deliver a baby (Leslie and Storton, 2007). If a woman is hungry and dehydrated she is unprepared to go through the process of birthing a baby. When questioned about who was present at the birth, Susan also stated that her birth was intimate, comfortable, and easy. The desire to control who is present at the birth lines up with the study carried out in Sweden where it was reported that giving birth at home conserved their (mothers) authority and autonomy by having faith in their own ability to give birth along with the power to choose their support (Sjoblom et al., 2006).

Avoiding Pharmacological Pain Relief

Ng and Sinclair (2002) state that women who choose home births perceive pain as a stepping stone to birth that should be overcome instead of relieved by medication. Women’s bodies are naturally equipped to give birth; this includes finding ways to minimize the intensity of labor pains without the help of pharmacological interventions (Goer et al., 2007). Debra (32 years old) elaborated on the myth that most women think that pain is unbearable.

It’s a misconception that women can’t do it by themselves and I always try to refute that myth.

The comment by Debra concerning the issue of pharmacological pain relief is very instructive. Viewed through an Afrocentric lens, her statement can be perceived as supportive of the literature suggesting that an African-centered medical action program is averse to the use of epidurals (Chipungu et al., 2000; Ngomane and Mulaudzi, 2010). In particular, Chipungu et al. (2000) stress the importance of Africentric values such as spirituality and resiliency, and the ability to mitigate risk factors. These variables, i.e. spirituality and resiliency, can be presumed to have been drawn upon in order for the mother to summon the intestinal fortitude to eschew traditional western medical practices and their corresponding methods of pain relief. Moreover, the cultural relevance of rejecting western/European medical pain relief methods is strengthened by the fact that the use of epidurals has been associated with numerous medical problems (Goer et al., 2007).

The views expressed by Jackie (35 years old) assert that pain, pre and post birth, is something to be overcome and in return makes some women feel empowered.

I took my instructors advice and didn’t use the word pain. I used the term uncomfortable. The pain was a totally different type of pain. I didn’t think it was going to kill me or anything. The pain was intense but after you have the baby you feel overwhelmed with shock and pride.

Jackie’s response to the pain which accompanies child birth is reflective of the third postulate of Chipungu et al.’s (2000) Africentric medical treatment program. The aforementioned postulate places primacy on the development of a positive sense of self which can serve the role of reducing the significance of pain. Equally important, home births in some African societies, in which African cultural practices/residuals are utilized by the participants, view pain as a mere stepping stone to a successful childbirth that can be overcome naturally instead of feared (Ngomane and Mulaudzi, 2010).

The viewpoints of the selected respondents touched the following areas: (1) Mental preparation to overcome pain; (2) Naturally creating ways to alleviate the intensity of labor pain. The previous statements made during the interviews reverberate throughout literature on home birthing (Goeret al, 2007; Lothian, 2010; Ngomane and Mulaudzi, 2010).

Dissatisfaction with the Medical Aspects of Intrapartum Care

Hodges (2009) explains that unethical services provided by health care workers often go unnoticed but lead to the mistrust of health care workers. This unethical treatment could be interpreted as abuse towards pregnant women. The superseding of a mother’s choice of treatment, falsification of medical situations, and the need for interventions are presenting factors found in the literature and re-emerged during the interviewing process.

Many women who were interviewed share this same view, including Janice (69 years old) who states:

I was put in a room all by myself with no consultation about how I wanted to give birth. I was given gas over my face and left there. The doctor stayed downstairs and the nurse did all of the work. No relationship with them. The next time I was pregnant I was shaven and given an enema and an episiotomy without telling me what they were doing or explaining.

The sentiments expressed by Janice are very compelling. She views the birthing process in the traditional, i.e. typical medical setting, as one in which she was not given a voice. Also, she did not perceive the doctor and nurse as being concerned with working together as team to provide her with the best treatment possible nor did she believe that she was ever given adequate information regarding what was taking place.

Kendra (31 years old) also depicts her view of hospitals. She describes how mothers have no control once they enter the hospital.

When you go to a hospital you are in their domain. No one is going to let you stay there for a long period of time. They have their customers.

According to Asante (1998), a genuine Afrocentric rhetoric is opposed to negation and concentrates on human’s relationships to their own being. Therefore, an African-centered analysis would be more culturally focused on the humanity of the individual. In other words, the prime focus would have been on enabling the mother to know what was transpiring in all phases, i.e. steps, of the home birthing process.

Hodges (2009) maintains that women often view health care professionals as abusive. Such an analysis is especially salient among Black women who have a mistrustful view of western medical practices as the culmination of a torrid history of mistreatment (Washington, 2008). Consequently, the view of Kendra communicates a feeling of being just another ‘number’ as opposed to an important ‘person’ when giving birth in a traditional hospital setting. Basically, the birth process was a business than mandated shuffling women ‘in’ and ‘out’ as quickly as possible. When assessing the viewpoint articulated by Kendra from an Afrocentric approach, the feeling of being synonymous to just another ‘cog’ in an assembly line would have been mitigated by an emphasis on her importance as an individual in need of excellent medical care. Moreover, Asante (1998) underscores the Afrocentric model as a strength-based perspective. It is based on embracing the woman undergoing the birthing process in a positive way. Thus, Kendra’s example is indicative of the type of treatment associated with a western based ideology that is the antithesis of an African-centered approach to treatment (Ani, 1994). Finally, Janssen et al. (2009) assert that women value being informed of different birthing options, particularly that a traditional birth in a hospital may not be the most suitable alternative.

Throughout the interviews there was a continuous theme of healthcare workers not taking the time to explain the procedures that they were conducting. This is very important because African Americans have consistently reported that non-African American healthcare workers use a condescending communication style with them. Such a communication was perceived as verbally dominant and indicative of a parent–child relationship (Washington, 2008).

The above responses express the sentiment towards health care professionals, specifically gynecologists used in a previous pregnancy, before making the alternative choice to pursue a home birth. Davis-Floyd (2000) states that biomedicine is an inappropriate model for birth in any culture. Using a traditional midwife to birth at home is a critical decision that women make after weighing the risks and benefits of other available alternatives. Because of unprofessional behavior, women seek other options and turn away from traditional healthcare services. The use of scare tactics is aimed to gain the trust of the doctor but instead breaks the bridge of trust between a patient and the professional.

Conclusion

This research study was conducted to allow African American women who chose to have home births describe why they did so using not completely developed African-centered sociological models. Therefore, as a result of the use of a ‘convenience/snowball’ sampling method to select participants, no generalizations could be made to the larger population of African American women from this study. Contrarily, we sought to understand why African American women chose to have home births relative to limited research offerings in this area. It is hoped that this study can serve to highlight the need for future research into this phenomenon.

Although the factors were the same, the reasoning behind the factors was different and personal to each mother. Second, an Africentric Sociological approach served as a lens for the analysis of interview responses and analysis of the cultural referents to the mothers’ decisions to have a home birth. Further, the Africentric Sociological approach (which is still in its infancy to some degree) was correct in highlighting the desire of Black women to re-connect with their African ancestral methods of giving birth. Moreover, the mothers used the aforementioned to empower themselves while giving birth in a home setting. Not surprisingly, despite the increase in hospital births, there is now a slow and steady increase in women selecting to give birth at home that can no longer be ignored. Finally, African American mothers are trying to move away from the popular hospital birth process and are actually moving with the larger society in the burgeoning home birth movement.

Consequently, this effort represented a glimpse into the feelings and concerns which can be used to facilitate future studies. Major limitations were the small sample size, a lack of a hospital birth comparison group, the use of a non-generalizable sampling method, and the utilization of two models, i.e. Asante’s (1998) Afrocentric and Akbar’s (1984) Africentric model, that are not purely sociological and have not been used in a study of this nature as of this writing.

Footnotes

Funding

No funding of any kind was used in this project.

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