Antenatal Care

It is helpful for health practitioners to explain to women who are new to New Zealand that antenatal screening includes ultrasound scans and blood tests and that the ultrasound scan is to monitor the growth and general wellbeing of the fetus and as well to detect severe abnormalities.

Some women may want to know if there is an abnormality so that they can prepare for the birth of the baby. Other women may choose not to have an ultrasound because they know that they would not terminate their pregnancies if an abnormality is detected. Some women may not want a recommended test based on their cultural beliefs. For example, some women may object to glucose tolerance tests while fasting (Queensland Health, 2009).

Cultural Perspectives
(Adapted from Queensland Health Multicultural Services, 2009)

Power-Distance between the health professional and the woman

In countries such as China, Korea and India, women expect health practitioner’s to be in charge of their maternity care. Women may lack autonomy to make decisions regarding antenatal tests and modes of birth (Carbines, Lim & Mortensen, 2015).

Consumer choice

Many migrant and refugee women will have no experience of informed consent and of making choices about their care and the mode of birth (Wikberg & Bondas, 2010).

Adherence to cultural and religious practices

Western medical models and terminology may be alien for some CALD women. Women may be used to trusting their religion rather than technology during birth (Wikberg & Bondas, 2010).

Number of antenatal health checks

Women from developing nations such as Somalia may perceive pregnancy as a normal state and may not understand the need for antenatal care. Others may find frequent antenatal checks repetitive and unnecessary (Boerleider, 2013).

Gestational age at the time of the initial antenatal visit

In New Zealand, pregnant women may self-refer to antenatal care immediately after confirmation of pregnancy. In other countries; women may attend antenatal care at the end of the first trimester or later.

Range of maternity services

In many developing countries there is an absence of pregnancy and parenting information, postnatal support groups, lactation consultancy, and other support services.

Pregnancy and Parenting information

Pregnancy and Parenting information may be perceived of as not being necessary for women who have already given birth or attended classes previously.

Range of antenatal investigations

In some developing countries there is an absence of genetic testing, amniocentesis and ultrasound scans.

Frequency of antenatal investigations

In some provinces of China and in South Korea, there is an overuse of ultrasound during pregnancy. In India, it is illegal to determine the sex of the fetus.

Preference for hospital births

Some migrant Chinese and Korean women prefer to give birth in a hospital setting rather than in a community based birth centre due to concerns about safety (Guo, 2013; WDHB, 2016)

Paternal involvement

In many African, Asian and Arabic countries, men are required, and often prefer, to stay out of the labour ward.

Birthing positions and mobility during labour

In New Zealand, active labour is widely practiced and women are encouraged to stay out of bed. In many other countries, mobility during labour is not common.

Labour pain management

In Japan, and in other countries, childbirth is considered a natural event and is usually drug-free. Women may be conflicted when offered pain relief (Doering et al., 2013).

Hygiene requirements

In many Asian countries, showering and washing hair after birth is prohibited until after seven days (or up to a month).

Duration of hospital stay

After a normal birth Chinese, Korean and Japanese women expect to stay in hospital for 7 days compared to the 48 hour stay in a New Zealand birth centre.

Postnatal checkups

These do exist, but are often attended by a small proportion of women, predominantly due to complications after birth (eg in Sudan).

Postpartum support

In Korea, there are private postnatal care centres available.

Elective/emergency caesarean section

In most developing countries, caesarean sections are performed only as an emergency procedure.

Dealing with female genital mutilation

In New Zealand, re-infibulation after birth is against the law. Somali women are not traditionally re-infibulated after birth.

Contraception

In some developing countries (eg Ethiopia, Eritrea, Sudan), on discharge the maternity department may provide women with contraceptive advice and at least a one-month supply of contraceptives as part of maternity care. However, this is not the case in New Zealand. It is important on discharge, to refer women to a female GP or to a Family Planning clinic for contraceptive advice.

Placing of the newborn child

In some maternity hospitals (eg Korea), all babies are separated from their mothers and placed in a neonatal ward. Babies are brought to their mothers at feeding times. New mothers would not expect to be “rooming in” with their baby.

Nappies

Disposable nappies are not available in many developing countries.

Pelvic floor exercises, healthy eating and early physical activity in a postnatal period

This may vary according to cultural traditions, for example, cold food items are avoided by some Chinese and Korean cultures. Early physical activity is not recommended in countries where a period of postnatal rest is usually observed (eg the Philippines, China, South Korea).

What to take to the hospital

This varies across countries and hospitals. In many countries, nothing is required for admission to maternity departments (eg Ethiopia and other Horn of Africa countries).

There are many important cultural aspects to consider when caring for women from cultural backgrounds different to your own. This checklist is a guide and can be modified according to the woman’s health and culture-specific needs; and the policies and practices of the DHB or agency. Discussing these aspects is optional depending on the health practitioner’s cultural knowledge and experience, the circumstances of the woman, and her pregnancy and postnatal outcomes. Women from CALD backgrounds may be late to engage with antenatal care services and many do not enrol in pregnancy and parenting education classes because they:

• Are unfamiliar with the Lead Maternity Carer (LMC) and maternity services available.
• Are uncertain about their eligibility to access these services.
• Have poor English language skills and interpreting services are not used.
• Are unaware of the availability of pregnancy and parenting education classes.
• Are uncomfortable with the participation of men in pregnancy and parenting education sessions.
• Feel stigma and shame related to mental health issues and maternal mental health services.

Support seeking: practical advice
(Adapted from Queensland Health Multicultural Services, 2009)

• Inform women about LMC and maternity services and their eligibility for these services.
• Emphasise that these services are free.
• Discuss the purpose of referral for antenatal care.
• Discuss the benefits of attending pregnancy and parenting education classes and where to attend these.
• Inform women when, where and how they can seek emergency care; specialist examination; etc.
• Ask if the woman requires assistance with booking appointments.
• Try to elicit any potential reasons for declining to use some services.