Exploring the Experience of Life Stress Among Black Women with a History of Fetal or Infant Death: a Phenomenological Study

Abstract

Introduction

Disparate birth outcomes among Black women continue to be a major public health problem. Whereas prior research has investigated the influence of stress on Black women’s birth outcomes, few studies have explored how stress is experienced among Black women across the life course. The objectives of this study were to describe the experience of stress across the life course among Black women who reported a history of fetal or infant death and to identify stressful life events (SLE) that may not be represented in the widely used SLE inventory.

Methods

Using phenomenological, qualitative research design, in-depth interviews were conducted with six Black women in Kansas who experienced a fetal or infant death.

Results

Analyses revealed that participants experienced multiple, co-occurring stressors over the course of their lives and experienced a proliferation of stress emerging in early life and persisting into adulthood. Among the types of stressors cited by participants, history of sexual assault (trauma-related stressor) was a key stressful life event that is not currently reflected in the SLE inventory.

Conclusion

Our findings highlight the importance of using a life-course perspective to gain a contextual understanding of the experiences of stress among Black women, particularly those with a history of adverse birth outcomes. Further research investigating Black women’s experiences of stress and the mechanisms by which stress impacts their health could inform efforts to reduce disparities in birth outcomes. An additional focus on the experience and impact of trauma-related stress on Black women’s birth outcomes may also be warranted.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    MacDorman M, Hoyert D, Mathews T. Recent declines in infant mortality in the United States, 2005-2011. NCHS Data Brief. 2013;120:1–8.

    Google Scholar 

  2. 2.

    Hogue CJR, Parker CB, Willinger M, et al. A population-based case-control study of stillbirth: the relationship of significant life events to the racial disparity for African Americans. Am J Epidemiol. 2013;177(8):755–67. doi:10.1093/aje/kws381.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Hogue CJ, Silver RM. Racial and ethnic disparities in United States: stillbirth rates: trends, risk factors, and research needs. Semin Perinatol. 2011;35(4):221–33. doi:10.1053/j.semperi.2011.02.019.

    Article  Google Scholar 

  4. 4.

    Spong CY, Iams J, Goldenberg R, Hauck FR, Willinger M. Disparities in perinatal medicine: preterm birth, stillbirth, and infant mortality. Obstet Gynecol. 2011;117(4):948–55. doi:10.1097/AOG.0b013e318211726f.

    Article  PubMed  Google Scholar 

  5. 5.

    Mathews T, MacDorman MF. Infant mortality statistics from the 2010 period linked birth/infant death data set. Natl Vital Stat Rep. 2013;62(8):1–27.

    PubMed  Google Scholar 

  6. 6.

    Bell JF, Zimmerman FJ, Almgren GR, Mayer JD, Huebner CE. Birth outcomes among urban African-American women: a multilevel analysis of the role of racial residential segregation. Soc Sci Med 1982. 2006;63(12):3030–45. doi:10.1016/j.socscimed.2006.08.011.

    Google Scholar 

  7. 7.

    Buescher PA, Mittal M. Racial disparities in birth outcomes increase with maternal age: recent data from North Carolina. N C Med J. 2006;67(1):16–20.

    PubMed  Google Scholar 

  8. 8.

    Collins JW, Simon DM, Jackson TA, Drolet A. Advancing maternal age and infant birth weight among urban African Americans: the effect of neighborhood poverty. Ethn Dis. 2006;16(1):180–6.

    PubMed  Google Scholar 

  9. 9.

    Schempf AH, Branum AM, Lukacs SL, Schoendorf KC. Maternal age and parity-associated risks of preterm birth: differences by race/ethnicity. Paediatr Perinat Epidemiol. 2007;21(1):34–43.

    Article  PubMed  Google Scholar 

  10. 10.

    Collins JW, Butler AG. Racial differences in the prevalence of small-for-dates infants among college-educated women. Epidemiol Camb Mass. 1997;8(3):315–7.

    Article  Google Scholar 

  11. 11.

    Love C, David RJ, Rankin KM, Collins JW. Exploring weathering: effects of lifelong economic environment and maternal age on low birth weight, small for gestational age, and preterm birth in African-American and White women. Am J Epidemiol. 2010;172(2):127–34.

    Article  PubMed  Google Scholar 

  12. 12.

    Parker JD, Schoendorf KC, Kiely JL. Associations between measures of socioeconomic status and low birth weight, small for gestational age, and premature delivery in the United States. Ann Epidemiol. 1994;4(4):271–8.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Tong V, Dietz P, England L. Age and racial/ethnic disparities in prepregnancy smoking among women who delivered live births. 2015: 8.

  14. 14.

    Holland M, Kitzman H, Veazie P. The effects of stress on birth weight in low-income, unmarried Black women. Women’s Health Issues. 2009.

  15. 15.

    Mustillo S, Krieger N, Gunderson EP, Sidney S, McCreath H, Kiefe CI. Self-reported experiences of racial discrimination and Black-White differences in preterm and low-birthweight deliveries: the CARDIA study. Am J Public Health. 2004;94(12):2125–31.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Schetter C. Stress processes in pregnancy and preterm birth. Curr Dir Psychol Sci. 2009:1467–8721 SRC-GoogleScholar.

  17. 17.

    Duthie L, Reynolds RM. Changes in the maternal hypothalamic-pituitary-adrenal axis in pregnancy and postpartum: influences on maternal and fetal outcomes. Neuroendocrinology. 2013;98(2):106–15.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Giurgescu C, Engeland CG, Zenk SN, Kavanaugh K. Stress, inflammation and preterm birth in African American women. Newborn Infant Nurs Rev. 2013;4(13):171–7. doi:10.1053/j.nainr.2013.09.004.

    Article  Google Scholar 

  19. 19.

    Giurgescu C, Kavanaugh K, Norr KF, et al. Stressors, resources, and stress responses in pregnant African American women: a mixed-methods pilot study. J Perinat Neonatal Nurs. 2013;27(1):81–96.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Hatch SL, Dohrenwend BP. Distribution of traumatic and other stressful life events by race/ethnicity, gender, SES and age: a review of the research. Am J Community Psychol. 2007;40(3–4):313–32.

    Article  PubMed  Google Scholar 

  21. 21.

    Corwin EJ, Guo Y, Pajer K, et al. Immune dysregulation and glucocorticoid resistance in minority and low income pregnant women. Psychoneuroendocrinology. 2013;38(9):1786–96.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Christian LM, Glaser R, Porter K, Iams JD. Stress-induced inflammatory responses in women: effects of race and pregnancy. Psychosom Med. 2013;75(7):658–69.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Earnshaw V, Rosenthal L, Lewis J. Maternal experiences with everyday discrimination and infant birth weight: a test of mediators and moderators among young, urban women of color. Ann Behav Med. 2012:s12160-012 SRC-GoogleScholar.

  24. 24.

    Rosenthal L, Lobel M. Explaining racial disparities in adverse birth outcomes: unique sources of stress for Black American women. Soc Sci Med 1982. 2011;72(6):977–83.

    Google Scholar 

  25. 25.

    Cricco-Lizza R. Voices from the battlefield: reports of the daily experiences of urban Black mothers. Health Care Women Int. 2008;29(2):115–34.

    Article  PubMed  Google Scholar 

  26. 26.

    Giurgescu C, Zenk SN, Dancy BL, Park CG, Dieber W, Block R. Relationships among neighborhood environment, racial discrimination, psychological distress, and preterm birth in African American women. J Obstet Gynecol Neonatal Nurs JOGNN NAACOG. 2012;41(6):E51–61.

    Article  Google Scholar 

  27. 27.

    Lu MC, Chen B. Racial and ethnic disparities in preterm birth: the role of stressful life events. Am J Obstet Gynecol. 2004;191(3):691–9.

    Article  PubMed  Google Scholar 

  28. 28.

    Glover DA, Loeb TB, Carmona JV, et al. Childhood sexual abuse severity and disclosure predict posttraumatic stress symptoms and biomarkers in ethnic minority women. J Trauma Dissociation Off J Int Soc Study Dissociation ISSD. 2010;11(2):152–73.

    Article  Google Scholar 

  29. 29.

    Dailey DE, Humphreys JC, Rankin SH, Lee KA. An exploration of lifetime trauma exposure in pregnant low-income African American women. Matern Child Health J. 2011;15(3):410–8.

    Article  PubMed  Google Scholar 

  30. 30.

    West CM, Williams LM, Siegel JA. Adult sexual revictimization among Black women sexually abused in childhood: a prospective examination of serious consequences of abuse. Child Maltreat. 2000;5(1):49–57.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Jackson FM, Phillips MT, Hogue CJR, Curry-Owens TY. Examining the burdens of gendered racism: implications for pregnancy outcomes among college-educated African American women. Matern Child Health J. 2001;5(2):95–107. doi:10.1023/A:1011349115711.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Jackson FM, Hogue CR, Phillips MT. The development of a race and gender-specific stress measure for African-American women: Jackson, Hogue, Phillips contextualized stress measure. Ethn Dis. 2005;15(4):594–600.

    PubMed  Google Scholar 

  33. 33.

    Jackson FM, Rowley DL, Curry OT. Contextualized stress, global stress, and depression in well-educated, pregnant, African-American women. Womens Health Issues Off Publ Jacobs Inst Womens Health. 2012;22(3):e329–36. doi:10.1016/j.whi.2012.01.003.

    Article  Google Scholar 

  34. 34.

    Curry Owens T, Jackson FM. Examining life-course socioeconomic position, contextualized stress, and depression among well-educated African-American pregnant women. Womens Health Issues. 2015;25(4):382–9. doi:10.1016/j.whi.2015.05.001.

    Article  PubMed  Google Scholar 

  35. 35.

    Moradi B, Subich LM. A concomitant examination of the relations of perceived racist and sexist events to psychological distress for African American women. Couns Psychol. 2003;31(4):451–69. doi:10.1177/0011000003031004007.

    Article  Google Scholar 

  36. 36.

    Woods-Giscombé CL, Lobel M. Race and gender matter: a multidimensional approach to conceptualizing and measuring stress in African American women. Cult Divers Ethn Minor Psychol. 2008;14(3):173–82. doi:10.1037/1099-9809.14.3.173.

    Article  Google Scholar 

  37. 37.

    Zhao Y, Kershaw T, Ettinger A, et al. Association between life event stressors and low birth weight in African American and White populations: Findings from the and Los Angeles Mommy and Baby (LAMB) Surveys. Matern Child. 2015:s10995–015. doi: 10.1007/−1734-x. SRC-GoogleScholar.

  38. 38.

    Braveman P, Barclay C. Health disparities beginning in childhood: a life-course perspective. Pediatrics. 2009;124(Suppl 3):S163–75.

    Article  PubMed  Google Scholar 

  39. 39.

    Halfon N, Larson K, Lu M, Tullis E, Russ S. Lifecourse health development: past, present and future. Matern Child Health J. 2013;18(2):344–65. doi:10.1007/s10995-013-1346-2.

    Article  PubMed Central  Google Scholar 

  40. 40.

    Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Matern Child Health J. 2003;7(1):13–30. doi:10.1023/A:1022537516969.

    Article  PubMed  Google Scholar 

  41. 41.

    Geronimus A,J. Understanding and eliminating racial inequalities in women’s health in the United States: the role of the weathering conceptual framework. Med Womens Assoc. 2000;56(4 SRC-GoogleScholar):133–6.

    Google Scholar 

  42. 42.

    Geronimus AT, Hicken MT, Pearson JA, Seashols SJ, Brown KL, Cruz TD. Do US Black women experience stress-related accelerated biological aging?: a novel theory and first population-based test of Black-White differences in telomere length. Hum Nat Hawthorne N. 2010;21(1):19–38.

    Article  Google Scholar 

  43. 43.

    Duru OK, Harawa NT, Kermah D, Norris KC. Allostatic load burden and racial disparities in mortality. J Natl Med Assoc. 2012;104(1–2):89–95.

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Seeman T, Epel E, Gruenewald T, Karlamangla A, McEwen BS. Socio-economic differentials in peripheral biology: cumulative allostatic load. Ann N Y Acad Sci. 2010;1186:223–39.

    Article  PubMed  Google Scholar 

  45. 45.

    Wallace M, Harville E, Theall K, Webber L, Chen W, Berenson G. Neighborhood poverty, allostatic load, and birth outcomes in African American and White women: findings from the Bogalusa heart study. Health Place. 2013;24:260–6.

    Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Wallace M, Harville E, Theall K, Webber L, Chen W, Berenson G. Preconception biomarkers of allostatic load and racial disparities in adverse birth outcomes: the Bogalusa heart study. Paediatr Perinat Epidemiol. 2013;27(6):587–97. doi:10.1111/ppe.12091.

    Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Braveman P, Marchi K, Egerter S, et al. Poverty, near-poverty, and hardship around the time of pregnancy. Matern Child Health J. 2010;14(1):20–35.

    Article  PubMed  Google Scholar 

  48. 48.

    Brown SJ, Yelland JS, Sutherland GA, Baghurst PA, Robinson JS. Stressful life events, social health issues and low birthweight in an Australian population-based birth cohort: challenges and opportunities in antenatal care. BMC Public Health. 2011;11:196.

    Article  PubMed  PubMed Central  Google Scholar 

  49. 49.

    Kingston D, Heaman M, Urquia M, et al. Correlates of abuse around the time of pregnancy: results from a National Survey of Canadian women. Matern Child Health J. 2016;20(4):778–89.

    Article  PubMed  Google Scholar 

  50. 50.

    Kingston D, Heaman M, Fell D, Chalmers B. Maternity experiences study Group of the Canadian Perinatal Surveillance System PHA of C. Comparison of adolescent, young adult, and adult women’s maternity experiences and practices. Pediatrics. 2012;129(5):e1228–37.

    Article  PubMed  Google Scholar 

  51. 51.

    Heaman M, Kingston D, Chalmers B, Sauve R, Lee L, Young D. Risk factors for preterm birth and small-for-gestational-age births among Canadian women. Paediatr Perinat Epidemiol. 2013;27(1):54–61. doi:10.1111/ppe.12016.

    Article  PubMed  Google Scholar 

  52. 52.

    Strutz KL, Richardson LJ, Hussey JM. Selected preconception health indicators and birth weight disparities in a National Study. Womens Health Issues. 2014;24(1):e89–97. doi:10.1016/j.whi.2013.10.001.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Burns ER, Farr SL, Howards PP. Centers for disease control and prevention (CDC). Stressful life events experienced by women in the year before their infants’ births--United States, 2000-2010. MMWR Morb Mortal Wkly Rep. 2015;64(9):247–51.

    PubMed  Google Scholar 

  54. 54.

    Witt WP, Cheng ER, Wisk LE, et al. Maternal stressful life events prior to conception and the impact on infant birth weight in the United States. Am J Public Health. 2013;104(S1):S81–9. doi:10.2105/AJPH.2013.301544.

    Article  PubMed  Google Scholar 

  55. 55.

    Witt WP, Park H, Wisk LE, et al. Neighborhood disadvantage, preconception stressful life events, and infant birth weight. Am J Public Health. 2015;105(5):1044–52.

    Article  PubMed  PubMed Central  Google Scholar 

  56. 56.

    Cheng ER, Park H, Wisk LE, et al. Examining the link between women’s exposure to stressful life events prior to conception and infant and toddler health: the role of birth weight. J Epidemiol Community Health. doi:10.1136/jech-2015-205848.

  57. 57.

    Witt WP, Litzelman K, Cheng ER, Wakeel F, Barker ES. Measuring stress before and during pregnancy: a review of population-based studies of obstetric outcomes. Matern Child Health J. 2014;18(1):52–63.

    Article  PubMed  Google Scholar 

  58. 58.

    Newton RW, Hunt LP. Psychosocial stress in pregnancy and its relation to low birth weight. Br Med J (Clin Res Ed). 1984;288(6425):1191–4.

    CAS  Article  Google Scholar 

  59. 59.

    Husserl E. The Crisis of European Sciences and Transcendental Phenomenology. 1970.

  60. 60.

    Cresswell J. Qualitative Inquiry and Research Design: Choosing among Five Approaches. 2007.

  61. 61.

    Moustakas C. Phenomenological research methods. Thousand Oaks CA Sage Publ Inc. 1994.

  62. 62.

    US Census Bureau. State and County QuickFacts:Kansas. Bureau website. http://quickfacts.census.gov/gfd/states/2000.html. Published 2015. Accessed December 15, 2015.

  63. 63.

    Kansas Department of Health and Environment. Infant mortality Sedgwick County special report. Topeka, Kansas: Kansas Department of Health and Environment; 2015.

    Google Scholar 

  64. 64.

    Kansas Department of Health and Environment. Infant Mortality-Sedgwick County. A presentation to maternal and infant health coalition. Topeka, Kansas: Kansas Department of Health and Environment; 2015; 2014.

    Google Scholar 

  65. 65.

    Barfield WD. Standard terminology for fetal, infant, and perinatal deaths. Pediatrics. 2011;128(1):177–81. doi:10.1542/peds.2011-1037.

    Article  PubMed  Google Scholar 

  66. 66.

    Kuzel A, Crabtree B, Miller W. Sampling in Qualitative Inquiry.; 1999.

    Google Scholar 

  67. 67.

    Castle K, Imms C, Howie L. Being in pain: a phenomenological study of young people with cerebral palsy. Dev Med Child Neurol. 2007;49(6):445–9.

    Article  PubMed  Google Scholar 

  68. 68.

    Maccallum F, Bryant RA. Impaired autobiographical memory in complicated grief. Behav Res Ther. 2010;48(4):328–34.

    Article  PubMed  Google Scholar 

  69. 69.

    Hung C. Revalidation of the postpartum stress scale. J Clin Nurs. 2006;15(6):718–725, 8p. doi:10.1111/j.1365-2702.2006.01350.x.

    Article  PubMed  Google Scholar 

  70. 70.

    Chen MJ, Grobman WA, Gollan JK, Borders AEB. The use of psychosocial stress scales in preterm birth research. Am J Obstet Gynecol. 2011;205(5):402–34. doi:10.1016/j.ajog.2011.05.003.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We acknowledge the contributions of the Kansas Infant Death and SIDS Network, Inc. and Dr. Michael Birzer for his methodological advice. We also recognize the dedicated work of Alaina Hanzlicek, Anikae Brown, Alissa Bey, and Thoi McNair. We also extend gratitude to the strong and courageous women who participated in this study.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kyrah K. Brown.

Ethics declarations

All authors contributed to the work presented in this paper. K.K.B. coordinated the project activities. K.K.B and E.B. conducted qualitative interviews. Analysis of data was performed by K.K.B., E.B., J.M., and J.L. All authors contributed to the interpretation of the data and the review and development of this article.

Funding

This study was not supported by grant funding. The cost of gift cards was covered through donation.

Conflict of Interest

The authors Kyrah K. Brown, Rhonda K. Lewis, Elizabeth Baumgartner, Christy Schunn, J’Vonnah Maryman, and Jamie LoCurto declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Participants were given a US$20 gift card for participating in this study. No identifying information is included in the manuscript. This article does not contain any studies with animals performed by any of the authors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Brown, K.K., Lewis, R.K., Baumgartner, E. et al. Exploring the Experience of Life Stress Among Black Women with a History of Fetal or Infant Death: a Phenomenological Study. J. Racial and Ethnic Health Disparities 4, 484–496 (2017). https://doi.org/10.1007/s40615-016-0250-z

Download citation

Keywords

  • Stress
  • Qualitative research
  • Infant death
  • Black women
  • Life course