Expectations from antenatal care

Many refugee women will have had minimal exposure to formal antenatal care. Previous births may have taken place at home, often with the assistance of a traditional birthing assistant (Foundation House, 2007). Members of the extended family may have played a pivotal role in the postnatal care of mother and baby.

Additionally, many refugee women will not be familiar with the options for antenatal care and birth available in New Zealand. It is important that women are offered an LMC for continuity of care throughout pregnancy, birth and the postnatal period. It is best to establish, in some detail, a pregnant woman’s past obstetric history and to assess her for general and specific risk factors. Women from refugee backgrounds may have higher-risk pregnancies for some of the following reasons:

• Previous multiple, spontaneous or elective abortions.
• Previous stillbirth.
• Previous neonatal death.
• Multigravida.
• Rhesus disease.
• Pre-eclampsia (higher prevalence of risk factors).
• Short spacing between pregnancies.
• Recurrent urinary tract infections possibly associated with FGM.
• Pelvic infections (endemic, seldom treated or resulting from sexual assaults or complications of FGM).
• Aged above 35 years or below 18 years.
• Pregnancy weight less than 45kg.
• Short stature.
• Cephalopelvic disproportion (a higher incidence among women from Africa).
• Sickle cell disease, thalassaemia, anaemia below 10g/dh.
• Vitamin D deficiency.
• Exposure to STIs or HIV.
• Rheumatic heart disease.
• Higher risk of TB causing ‘common’ problems of pregnancy, eg back pain and headaches.
• FGM.