Overview

This Maternal Health resource for health providers who work with women from culturally and linguistically diverse (CALD) backgrounds is the first of its kind in New Zealand. The resource has been developed to increase health practitioners’ understanding of the influence of culture on women’s experiences of pregnancy, birth and the postnatal period. Every culture has its own cultural and religious values, beliefs and practices related to pregnancy and birth.

As New Zealand society becomes increasingly ethnically diverse, we need to ensure that we work towards maternity services that are responsive to women from diverse cultural and religious backgrounds. Understanding traditional pregnancy, birth and postnatal practices enables appropriate assessment, interventions and support for women and their families.

Culture plays a major role in the way a woman perceives and prepares for her birthing experience. If health care providers are familiar with different cultural ideas, rituals and behavioural restrictions and are able to communicate about these, they are able to increase women’s choices. Health practitioners are not expected to know about the cultural practices of all the communities living in New Zealand. Using an open communication style and having an interest in women’s cultural practices will be useful in cross-cultural interactions with women and their families.

The purpose of this resource is to support services and individual practitioners working with women during pregnancy, birth and the postnatal period develop the knowledge, skills and attitudes needed to provide culturally appropriate maternal health care to CALD women and their families.

Who this resource is for

This resource is intended for all health providers who contribute to the care of women during pregnancy, birth and the postnatal period including: Lead Maternity Carers (LMC), hospital midwives, general practitioners (GPs), obstetricians, neonatologists, paediatricians, Well Child/Tamariki Ora (WCTO) nurses, public health nurses, practice nurses, allied health professionals, psychiatrists, mental health nurses and other mental health practitioners. The way in which different health providers or health practitioners use these resources will vary depending on their knowledge, skills and role, as well as the setting in which care is provided.

This resource complements the CALD Cultural Competency Training Programme. It is expected that readers of this resource will:

1. Have completed CALD 1: Culture and Cultural Competency.
2. Additionally, it is highly recommended that the readers of this resource will:
   • Have completed CALD 2: Working with Migrants (Asian) Patients course.
   • Have completed CALD 3: Working with Refugee Patients course.
   • Have completed CALD 4: Working with Interpreters course.
   • Have completed CALD 5: Working with Asian Mental Health Clients course.
   • Have completed CALD 9: Working in a Mental Health Context with CALD Clients course.

Additional valuable information on working in a culturally competent way with migrants, refugees and interpreters can be found in the following courses and supplementary resources:

• CALD 7: Working with religious diversity.
• CALD supplementary resources:
  • Working with Asian Mental Health Clients.
  • Working with Middle Eastern and African Mental Health Clients.
  • CALD Family Violence Resource for Health Practitioners: Working with Asian, Middle Eastern and African Clients.

Visit www.eCALD.com for more information about these face-to-face and online courses and resources.

What this resource aims to do

This resource aims to:

• Promote culturally appropriate services and support for CALD women transitioning from pregnancy and birth to parenthood.
• Promote best practice in maternity care for CALD women.
• Improve care for CALD women and their babies in birthing units and community settings through health provider’s understanding of:
  • The cultural beliefs, health practices and perspectives of CALD women towards pregnancy, birth, postnatal care, parenting education and nutrition.
  • Culturally appropriate approaches to addressing emotional distress and perinatal depression in migrant and refugee-background mothers.
• Improve perinatal mental health care and support for CALD women through health providers understanding of the:
  • Transition period to new parenthood and the social, cultural and religious factors which shape emotional responses to parenthood for CALD women and their families.
  • Culturally appropriate approaches to addressing emotional distress and perinatal depression in migrant and refugee-background mothers.
  • Cultural factors’ that impact on postpartum depressive symptomatology.
• Provide culturally appropriate assessment and screening tools for health providers to improve maternal health outcomes for CALD women and their families

What this resource does not include

While the approach taken in the resource includes consideration of the mother-baby interaction in CALD families, the resource does not cover neonatal health specifically. In addition, the resource does not cover screening for partner abuse in CALD women as this is covered in the CALD Family Violence Resource for Health Practitioners.

How this resource is organised

The resource is organised and written in the following manner to enable readers to read specific section(s) of interest. Some information is repeated in various sections to ensure that readers who are not reading the full resource will not miss key points. It is recommended that readers who are interested in reading, for example, the antenatal care section also read about the traditional practices which pertain to antenatal care, in the cultural profiles section.

Welcome: A summary of the purpose, aims and scope of this resource and who it is intended for.

Introduction: This section provides an introduction to the impact and influence of culture, migration, the refugee experience, settlement in a new society and barriers that women experience in accessing maternity care. CALD womens’ expectations of New Zealand maternity services are included.

Cultural Perspectives: This section provides an overview of traditional practices in pregnancy, birth and the postnatal period common to CALD women from Asian, Middle Eastern and African backgrounds. It also discusses intergenerational and interethnic marriage issues and culturally appropriate approaches.

Maternity Services: This section provides tools for cultural assessment for health providers to assess CALD women throughout the pregnancy, birth and postnatal journey. It also provides information about the differences between services provided in home countries and in New Zealand. Additionally, advice is provided on how to discuss family planning with CALD women who may not have had access to using western family planning services.

Complications of Pregnancy and Birth: This section discusses the risk of genetic conditions in specific ethnic groups and provides advice on screening and counselling. It also includes: the cultural considerations to be taken into account when imparting bad news; discussing the complications of pregnancy and birth; and when giving women choices regarding the mode and place of birth.

Female Genital Mutilation: This section explains female genital mutilation (FGM) and provides cultural considerations about how to prepare women with FGM for pregnancy, labour and birth. It also explains what to expect when providing postnatal care and family planning services with women with FGM. A list of FGM resources for health practitioners is provided.

Pregnancy and Parenting Education: This section discusses access to birth and parenting education and support groups for CALD women/parents. Cultural considerations are outlined to increase CALD women’s/parents participation.

Postnatal care: This section presents case studies to illustrate the differences between CALD women’s cultural and maternity service expectations; and what is provided during postnatal care in birthing units, homes and communities in New Zealand.

Perinatal Mental Health: This section examines maternal experiences and understandings of perinatal mental health in women from CALD backgrounds, as well as the impact of culture on the perinatal period. It describes antenatal and postnatal depression in CALD women, risk factors, diagnosis, cultural variations and issues, cross-cultural understandings of depression, mental health stressors and possible psychological reactions, reproductive loss and grief, managing the communication of bad news, and of end-of-life decisions in neonatal intensive care. It provides cultural assessment tools and considerations.

Reproductive Loss and Grief: This section provides information about reproductive loss, including miscarriages, fetal deaths in utero and stillbirths, and termination of pregnancy in some cases.

Neonatal Intensive Care: This section examines the stress migrant parents may experience when their babies are in the neonatal intensive care unit.

Cultural Profiles: This section examines the spiritual and traditional practices, traditional family values, health beliefs and the various cultural understandings of pregnancy, birth, care of the babyand perinatal depression in Chinese, Indian, Korean, Filipino, Japanese, Vietnamese, Myanmarese, Muslim and Sikh women.

Additional Guidelines: This section contains guidelines for developing trust and rapport, improving communication and how to work with interpreters.

Terms Used and Glossary: This section contains commonly used terms.

How to use this resource

To be rewritten

Icons to help you navigate through the resource:

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