Qualitative study of pregnancy and childbirth experiences in Somalian women resident in Sweden

Abstract

Objective To explore the attitudes, strategies and habits of Somalian immigrant women related to pregnancy and childbirth, in order to gain an understanding as to how cultural factors might affect perinatal outcome.Interpreter assisted qualitative in depth interviews around topics such as attitudes and strategies regarding childbirth.Fifteen women from the Somalian community in a city in Sweden, between the ages of 20 and 55 years with delivery experience in Somalia and Sweden.The interviews describe how the women themselves perceived their experiences of childbirth in the migrant situation. Many voluntarily decreased food intake in order to have a smaller fetus, an easier delivery and to avoid caesarean section. The participants considered a safe delivery to be the same as a normal vaginal delivery They reduced food intake in order to diminish the growth of the fetus, thereby avoiding caesarean section and mortality. The practice of food intake reduction, while rational for the participants when in Somalia, was found less rational in Sweden and may lead to suboptimal obstetric surveillance.Somalian women have childbirth strategies that differ from those of Swedish women. These strategies should be seen as 'survival behaviours' related to their background in an environment with high maternal mortality. The hypothesis generated is that there is a relationship between the strategies during pregnancy and adverse perinatal outcome among Somalian immigrants. Considering the strong association of the habits to safe birth, it seems doubtful whether the women will change their habits as long as health care providers are unaware of their motives. We suggest a more culturally sensitive perinatal surveillance. Methods Participants Results Conclusions

No association between female circumcision and prolonged labour: a case control study of immigrant women giving birth in Sweden

“…Among immigrants from low-income countries it is known that some of them, in order to avoid having a large fetus and the complications it might bring during labour, many women eat less during pregnancy [25]. However, control of birthweight deviation did not change the results ( Table 2).…”

Factors affecting the acceptability and consumption of Corn Soya Blend Plus as a prenatal dietary supplement among pregnant women in rural Cambodia

“…Similar concerns and purposive reductions in food intake during pregnancy have been identified in other settings, including Bangladesh and Indonesia (24,25) . A study among Somali immigrants in Sweden identified negative attitudes towards 'abnormal' caesarean delivery and decreased food intake to avoid the procedure (26) . Our findings suggest women's views towards weight gain in pregnancy can considerably influence acceptance of a food supplement and should be considered when introducing interventions that promote energy, weight gain and increased birth size.…”

Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services?

“…3 One hypothesis put forward to explain this observation is that culturally determined strategies of handling pregnancy and childbirth by this particular ethnic group affect perinatal outcomes. 4 In order to gain an increased understanding of these phenomena, a medical and anthropological study was undertaken. It was determined from Somali women residing in Sweden that they had particular pregnancy strategies in seeking to achieve a safe birth.…”

“…The notion among these ESE women seems to be that caesarean section causes death, rather than viewing the procedure as an attempt to avoid a fatal outcome. 4 The Swedish antenatal care programme has, heretofore, lacked appropriate measures to meet the pregnancy strategies of this immigrant group. As a matter of public policy, it would appear to be important that ESE women in Sweden be informed about perinatal health issues, be encouraged to book antenatal care early, attend clinical sessions regularly, and be trained to seek immediate health care when certain symptoms appear.…”