Dissertations & Theses (Open Access)

Date of Award


Degree Name

Doctor of Philosophy in Nursing (PhD)


Joan C. Engebretson, DrPH, RN, AHN-BC, Dissertation Chair

Second Advisor

Linda Bergstrom, PhD, RN, CNM, Member

Third Advisor

Robbie E. Davis-Floyd, PhD, Member

Fourth Advisor

Cathy L. Rozmus, PhD, RN


A focused ethnography was conducted to determine the cognitive constructions about birth described by nulliparous Black women in an urban area of the Southwestern US; also, during postpartum, how do these women reconcile expectations with the actual birth? Semi-structured interviews were conducted before birth and after birth.

Women, 16 or older, 17 - 33 weeks carrying a singleton fetus and without anomalies or problems like pre-gestational diabetes, NYHA Cardiac Class III/IV, cancer, renal failure, or sickle cell anemia that eliminated vaginal birth were sequentially recruited and sampled in an affiliated ultrasound clinic. Women scheduled for an anatomy scan were approached.

Eleven women enrolled. Participants were 17 to 30 years old, with 11 to 22 years of schooling. Gestational age at enrollment was 17+5 to 31+5 weeks. Two women were college graduates. Four women were employed, and all used Medicaid to pay for care. Seven women received SNAP and/or WIC benefits. Three of the 4 employed women received this assistance. Three women did not have their mother in their lives. The sample was purposefully analyzed for age, education and maternal presence, and a natural spread of ages and situations was found, making purposeful sampling unnecessary.

Initial interviews lasted 12.5 to 41 minutes. Post-delivery interviews lasted 24 to 54 minutes, and occurred 13 to 25 days postpartum. The researcher transcribed all interviews, and used Atlas.ti to assist in analysis and organization.

Women described views of birth that grew from ideas shared with them by their own mothers. Themes included “birth is painful” which was the predominant view, followed by “birth damages you and/or the baby” Two women identified, “birth changes you.” Ideas obtained from friends, other family members, the media and the popular culture, as well as their 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 did, women concluded that birth was essentially unknown to them, and they had limited expectations about what would happen during the birth.



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