Childbearing in Geographically Isolated Communities: The Smith Island Experience

Objective: The objective of this study is to explore the childbearing beliefs and to describe the perspectives of pregnancy in women living on Smith Island, a geographically isolated community that lacks on-site obstetrical care services. Design: A qualitative exploratory, longitudinal focus group model consisting of two focus groups, conducted 6 years apart, that included 12 female participants was used. The focus group used open-ended questions regarding their childbirth experiences and the impact of geographic isolation and lack of healthcare access impacted them during the childbearing period. During the initial focus group, 60%multiparous and participated in a 70 minute interview. The second focus group contained only multiparous women and lasted 110 minutes. The timing interval represented the interval when another group of women had given birth. The study included 100% of women who were pregnant and subsequently gave birth who were living on the Island during the study period. Data collection and analysis were performed simultaneously and included: audio recordings with verbatim transcription, and subsequent coding using direct quotes from the participants. Findings: The majority of women identified acceptance of pregnancy as a safe, normal biological process and identified strong religious beliefs as the underlining factor for their perceptions. All women identified themselves as Methodist religion and “to be religious”. All of the women also identified anxiety, separation strain, and financial strain as normal components associated with pregnancy and childbearing in this remote island community. Of the women who had never given birth, all of them, and the majority of the multiparous women feared their family members, especially their husbands, would miss the actual birth due to geographic separation and feared being alone in labor and at the time of birth. Conclusions: The strong religious presence provided a foundation of acceptance of normalcy of childbearing. Women perceived their religious beliefs as a source of protection. They viewed childbirth as a rite of passage, but reported spending a great deal of time and financial resources on obtaining prenatal care. Separation strain occurred when the women were forced to be away from family and friends at the end of the pregnancy. Multiparous women with older children expressed a greater degree of stress in being separated from children and having to manage childcare and school issues. All of the women in the study had a fear that their husbands, working watermen, would missthe birth itself and that they would be alone at the time of birth.