Case studies

The following are three cases for readers to reflect on. One case presents the issues of different cultural values and expectations of maternal health services during pregnancy. The second case presents the issues of language barriers and health literacy during pregnancy. The third is about a CALD woman’s expectations during birth and communication issues.

Case Study 2: Different health systems and cultural values (Korean)
Adapted from (DeSouza, 2014, p. 4).

I felt something was lacking, as I couldn’t help comparing NZ system with the one in Korea. For example, in Korea the mother-to-be don’t feel anxious because all kinds of tests such as ultrasound, a test for the deformation etc. are offered to them, whereas NZ [maternity related medical staff] keeps telling you that “You are healthy... don’t need to worry... the family history is clean... etc.” This sounds like lip service... I wanted to see the evidence that everything was all right, and not just from the comforting words. I knew that I could have some additional ultrasounds if I am willing to pay, but didn’t do it as my midwife did not recommend it... not just because the cost matters. (Ji-Eun).

Ji-Eun compares the New Zealand maternity care system unfavourably with that available in Korea because she expects the greater repertoire of tests that are universally available in Korea such as repeated ultrasound tests and blood tests (De Souza, 2014). However, as she is from a collective culture which values high power-distance, she positions the midwife as more powerful than herself. Ji-Eun follows her midwife’s instructions that everything is alright, in spite of her anxiety and uncertainty about the health of the baby. She does not request further ultrasounds or tests.

Case Study 3: Language barrier and health literacy (Burmese)
(Singleton & Krause, 2009)

Mya Aye and her husband Naing are Burmese Karen refugees, who have recently arrived in New Zealand. Naing has limited English language skills and is not literate in English, and Mya has no English language or literacy. The couple are expecting their first child. The fetal medicine specialist Mya was referred to had told the couple that the baby’s heart rate was dangerously irregular and that the baby had an abnormally large valve in his heart. Without using an interpreter, a cardiology nurse shows the couple a picture of the heart with its chambers and valves to explain what was happening to the baby. She explained that:

“The human heart is like a busy factory with two strong pumps: the ventricles and two ‘receiving docks’ called the atria. These chambers work together to ensure that oxygen-rich blood moves out into the body, and that de-oxygenated blood comes back to the heart and lungs in return. Just like any other factory, however, the heart’s essential functions can be seriously disrupted if just one piece of machinery is compromised.”

Naing is astonished; stating that he couldn’t believe the heart had different parts inside it. The fetal medicine specialist proposes giving Mya a beta-blocker to slow the baby’s heart rate. Mya is new to western medicine and doesn’t know what to think about the treatment being proposed. She is concerned about what a beta-blocker might do to her and her baby.

Mya and Naing have had limited access to doctors in Myanmar and in the Thai border camps where they have been living in for the last 5 years.

Case Study 4: Expectations of birth (Korean)

“In Korea, it is said that you report the progress of your contraction to the doctor every several minutes... It could even be done over the phone. Here, I did it with my midwife but it was not very satisfactory. I said to her the gap between each contraction was several minutes so I felt the birth would be very soon, but was only told it would be long time later like tomorrow or the day after tomorrow. Even so, I wanted to go to the birthing unit and wait there but was refused being told that we would do nothing but wait. Clever me, I insisted to go to the birthing unit and she had to let me go to the birthing unit. I arrived at the birthing unit about 12am to have my first child and my midwife was on her way to go home but changed her trip to the birthing unit as she felt like something might be happening. It (the birth canal) opened by 5cm as soon as a test was done. Even to know this I had to ask. I had to keep asking to have an idea of the progress. In Korea, we are kept informed about the progress of the opening” (Jung-Ja).

Jung-Ja’s desire to come to the birthing unit early is in accordance with her expectations of the maternity services offered in Korea. However, because of the timing of her contractions, the LMC considers that she was too early for admission.