Document Type



Doctor of Philosophy



Date of Defense


Graduate Advisor

Julie Bertram, PhD, RN


Julie Bertram, PhD, RN

Anne Fish, PhD, RN, FAHA, FAAN

Roxanne Vandermause, PhD, RN

Kimberly Werner, PhD


Previous research has shown that postpartum women with untreated mental health conditions are more likely to fail to manage their own health, have inadequate nutrition, abuse substances, experience abuse, be less responsive to their baby’s needs, have fewer positive interactions with their baby, experience difficulties breastfeeding, and question their abilities as a mother. Rural culture plays a complex role in the transition to motherhood, influencing whether mothers seek out and use resources. While more is known about location and access issues, less is known about how rural culture and, more specifically, how empowerment and social support impact postpartum experience. The frameworks of Empowerment Theory, Zauszniewski’s Mid-range Theory of Resourcefulness and Quality of Life, and the Hage Framework guided the study through the concepts of support, cultural context, and empowerment. The study used a focused ethnography lens to give cultural context, and grounded theory analysis was used to understand the experiences of rural low-income mothers in Missouri. Data sources included observations of rural communities and semi-structured interviews with eighteen low-income women, the majority of whom identified as Black. Questions focused on support, wellbeing, and empowerment. From the analysis, five categories were developed: 1) “cultural context” (2) “social supports” (3) “perinatal mood” (4) “agency” and (5) “future oriented notions of contented mothering.” The mothering journey included the distinct lens through which mothers perceived experiences (cultural context), aspects of support (social supports), and the volatile landscape of the perinatal mood. Mothers discussed some degree of empowerment in the context of resourcefulness (social supports and agency), and achievement (future oriented notions of contented mothering). The new model was called Empowerment Framework for a Subculture of Rural Low-income Missouri Mothers. Future research is suggested to a) expand the understandings of immigrant postpartum mothers and their experiences in rural America and b) explore the identity journey in order to build trusting relationships and interventions post-birth.