Intergenerational and interethnic marriage issues

Besides being aware of identifying cultural and religious practices, there is increasing interethnic marriage and relationships in New Zealand society. Rates of interethnic marriage are significantly higher in Asian populations in the 1.5 generation and among the New Zealand born than in the overseas born (Didham & Callister, 2014). The term 1.5 generation in this resource refers to people who were born overseas and relocated to New Zealand at a young age.

It is important to remember that maintaining ethnic belonging is central to the identity of many Asian, Middle Eastern and African women in interethnic marriages or relationships. Being in a cross-cultural marriage does not preclude the pressure from family and community to observe traditional birthing practices. New Zealand born and 1.5 generation women may be living with mothers or mothers-in-law who have an expectation that their daughter or daughter-in-law will follow their cultures’ birthing practices.

Traditional practices during pregnancy, birth and during the postnatal period are used worldwide in countries and regions such as China (Lau, 2009), Myanmar (Kokanovic, 2011; 2012), Korea (Kim, 2015), India (Goyal, 2006; Wells & Deitsch, 2014), the Middle East (Halperin et al, 2013; Kulwicki, 2003; Reitmonova & Gustafson, 2008), Africa (Staunton & Duressa, 2004) and beyond. What constitutes the appropriate management of pregnancy and birth varies cross-culturally, from mandatory behavioural changes and a long list of restrictions, to minor modifications to diet and activities (Lau, 2009). When families migrate, traditional pregnancy and birth practices are challenged by western models. Older family members in New Zealand are likely to maintain traditional beliefs and pregnant women and mothers may struggle with a lack of decision-making power (Lau & Wong, 2007).

For migrant women, there are big changes in the experience of pregnancy and birth moving from eastern to western societies. There are changes from traditional models of care to western models; from collective cultural support and obligations to a more nuclear family system and individual responsibility; and for some from medicalised birth to natural birth choices (DeSouza, 2005; 2006a; 2006b). For others a further change may be the need to negotiate cultural birth and postpartum practices in the context of an interethnic marriage or relationship.

Specific traditions differ by ethnicity, but they are all generally female-oriented with family-centric support networks aimed at ensuring the mother’s health. Typically, during the first month after birth the woman is under the care of her mother or mother-in-law who helps to restore her health and strength as quickly as possible after birth, for example, by providing her with good nutrition, taking care of the older children, and doing the housework.

The need to ensure the health of women during pregnancy and birth, and a healthy newborn are universal. Evidence suggests that following some traditional practices during pregnancy and birth may be therapeutic for women (Manyande & Grabowska, 2009), and women may be motivated to alter their social behaviours and to modify their diets in order to safeguard their unborn baby (Ip, 2009). Some women may wish to follow the advice of the older generation about traditional customs (whether they are New Zealand born, from the 1.5 generation or in an interethnic marriage) in spite of their scepticism about traditional customs (Guo, 2013).

Postnatally, the traditional practices of rest, abstaining from housework, having a good diet, and avoiding fatigue and stress are intended to support lactation. In traditional cultures, the first month is of fundamental importance to the survival of the new mother and her baby, therefore the postpartum period is as important as the pregnancy.

Cultural expectations and conflicts

In New Zealand, women are encouraged to take personal responsibility for their pregnancy and childbirth experience. However, for some cultures, it is expected that pregnant women will seek support and information from more experienced family members and trusted people such as mothers and mothers-in-law (Guo, 2013). Older family members’ expectations of what constitutes a safe pregnancy and healthy practices in the postnatal period may conflict with the advice women receive from their midwives. Recognise that there may be components of traditional practices that migrant women wish to follow or to adapt, and that these practices may be helpful for the woman and her baby.

Differences between traditional childbirth, cultural beliefs and practices and health practitioner’s views may cause conflict between the family and maternity care providers (Guo, 2013). Women may find themselves caught uncomfortably between western and eastern styles of pregnancy care. When pregnancy restrictions are imposed by older members of the family, intergenerational disputes can put women under stress (Lau, 2012). Mothers and mothers-in-law and other family members, who may be overseas, may be the main source of information for women settled in New Zealand. Older family members who support the woman often experience culture shock as their experiences of pregnancy, childbirth, postpartum and child rearing may not be understood by maternity service providers.

Midwives as cultural mediators

Maternity care providers may discuss the need to include extended family members when engaging with migrant women. Midwives can be proactive in anticipating the potential challenges to the pregnant woman’s ability to make her own decisions about her pregnancy and birth, and caring for her baby. Family harmony can be maintained by acknowledging the important role of older family members and the relationship between the woman and her extended family, and by including them in the woman’s care. Additionally, the midwife can act as a mediator between older family members and the expectant couple. The cultural practices that sound useful can be considered by the couple and can be modified to ensure that the older family members feel accommodated.

In Guo’s (2013, p.309) study of migrant Chinese mothers in New Zealand, a midwife successfully included older family members in providing the kind of support that was acceptable to the woman and her husband. During a postnatal home visit, the midwife asked the woman and her husband how the woman’s mother would help them during the postpartum period. The couple were worried that the woman’s mother would expect the woman to observe the practice of the ‘sitting month’, and that she would be making decisions about breastfeeding and how they should parent their baby.

To overcome the potential cross-cultural communication barriers between herself and older family members, and to avoid conflict between the woman’s parents and the couple, the midwife recommended that the couple interpret what was being discussed for both sets of parents:

I can actually sit here with you guys and baby and your mum and dad and you can translate for me. And sometimes when I have you translate for me they kind of like get to understand a bit more about how things are for you here. Okay? (Guo, 2013, p.310)
By doing this, the older family members felt included and they had an opportunity to understand the roles and practices of New Zealand maternity care and health care services. Most importantly, the older family members felt respected and involved in decision-making rather than being excluded from the communication between the midwife and the couple.

Networks of other women of the same ethnicity

When women are unfamiliar with the New Zealand maternity system, networking with other migrant women is helpful, in particular, when women have limited English language skills. Chinese communities often access online forums to share ideas and perspectives on pregnancy and childbirth. New mothers trust their friends in New Zealand to introduce them to a midwife who they recommend and to help them to book the first appointment (Guo, 2013). For first-time mothers, the role of maternity-care providers is critical in alleviating her and her family’s stress and uncertainty about how New Zealand maternity services work.

Some Plunket groups also offer ‘coffee groups’ for specific ethnic groups in order to encourage networking and support during the postnatal period.