The challenges of becoming a mother in an adopted land

The process of becoming a mother in an adopted land presents specific challenges for migrant mothers in first and second generation women. For migrant women, cultural displacement has an impact on the dilemmas of motherhood, for example, the intergenerational issues that arise with acculturation; changing conceptions of gender roles and of dependence/independence; conflicts between traditional and western cultural values and practices; and changing family structures and social networks (Tummala-Narra, 2004).

First and second-generation migrant mothers have a higher overall risk of contact with psychiatric services during both pregnancy and the postpartum period compared to other mothers in settlement societies (Munk-Olsen, Laursen, Mendelson & Pedersen, 2010). Understanding the impact of migration or of refugee resettlement is important in enabling health and mental health practitioners to assist mothers (O’Brien, 2014). Pre-migration stress is associated with an increased risk of postpartum depression. Refugee women who have been exposed to severely traumatic events during refugee flight and settlement in a new and alien society are at significant risk of psychological distress. (Tummala-Narra, 2004). For new mothers the stressors include: a lack of family and community support; loss of cultural belonging; social isolation; discrimination and harassment; financial hardship and difficulty navigating our complex health system. The dissonance between pre-migration fantasies and expectations of the new country and the reality of life in New Zealand impacts on mental health, particularly during vulnerable times of life such as pregnancy and new motherhood (Tummala-Narra, 2004).

Women are faced with navigating a complex and unfamiliar LMC and health system in New Zealand. Language barriers compound the level of disempowerment and distress, particularly when a migrant mother has a history of traumatic experiences, but is unable to express these to a health practitioner (BC Reproductive Mental Health Program, 2006; O’Brien 2014). It is well recognised that a traumatic birth, whether in a medically objective sense or in the women’s subjective experience, can trigger past traumatic events (Garthus-Niegel, von Soest, Vollrath & Eberhard-Gran, 2013). Halperin, Sarid and Cwikel (2013), examining the experience of ‘traumatic’ birth in Arab women, found that a subjectively traumatic birth experience not only increases the risk of postpartum depression and the re-activation of trauma in subsequent pregnancies and births, but also the quality of the mother-baby attachment.

For migrant women, the impact of giving birth post-migration can interact with intrapsychic and sociocultural issues, far beyond the immediate perinatal period (Tummala-Narra, 2004). As O’Brien (2014, p.2), states:

Becoming a mother can reactivate experiences of being mothered and the cultural values and traditions that accompanied this. Migration involves a physical and psychological separation from this previous identity, and mourning this loss can complicate the renegotiation of an identity in the new cultural context. The ultimate goal is to balance a reconnection with the culture of origin whilst opening oneself up to engagement with the new. However, this can be challenging in a new culture that espouses a different view of gender roles, particularly in the case of women. Different societal conceptions of attachment can also pose difficulties. Some societies favour the development of interdependence on the family and a collective societal identity, whereas … Western cultures tend to promote the individual identity. Failure to straddle this cultural divide can act as a stressor on both individual mental well-being and family dynamics.

While there is no single approach to perinatal mental health care, taking a family-centred approach and recognising the psychosocial, cultural and spiritual context of CALD women’s lives, may assist women to feel safe in healthcare interactions (beyondblue, 2011a; Nguyen, 2008). When LMC providers show an interest in and respect for migrant women’s journeys and cultural backgrounds, it helps to alleviate anxiety about coming into a health facility in a new country (Boerleider et al, 2013).