Chapter 1: Midwifery

This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice. More information

Author: Eileen Russell-Roberts

Aims and learning objectives

The Aim of this chapter is to introduce student midwives and midwives to the issues related to the provision of care for women and their families across different culturally diverse communities. The text aims to promote culturally safe practice which in turn will signpost good standards of health care practice.

By the end of this chapter students will have

Explored the challenges offered in the provision of maternity care in a multi-cultural/multi-ethnic society.
Discussed the strategies adopted to ensure the provision of equitable care in a midwifery setting.
Demonstrated awareness of the role of the midwife in the provision of an equitable service.

Whilst in the main the feminine pronoun has been used when designating the midwife, it is recognised that midwives may be male. When dealing with some cultures a male midwife may be unacceptable to both the woman and her family. This is a problem that has not been explored in this work although it is acknowledged that it is an important issue to consider.

Introduction

This chapter is intended for use in conjunction with other modules that have been developed for other health care disciplines. As one of a series it is not intended to replicate the contents of the other modules although, inevitably, there may be some overlap. This is a basic text to introduce the student to a complex phenomenon.

Childbirth is a life changing experience within all cultures and ethnic groups. It provokes a wide range of responses that are influenced by a complex interaction of religion, culture, education, social status, economy and the perceived position of women within the society. At the centre of all these powerful forces is a unique individual with her own personality, needs, hopes and fears.

Ethnic groups are a complex phenomenon, different from each other but also with considerable diversity within particular groups. Women hold varying status within differing cultures, and there are varying perceptions of the female role. Both the status and the perceptions of women are influenced by social class, education, religious beliefs and the degree to which the group has been exposed to different value systems.

The experience of immigration also varies for women. Many African and African-Caribbean women migrated to Britain for economic reasons, to seek work; and therefore were immediately exposed to the majority ethnic culture. Although some women of South Asian origin came as students, these were predominantly from the higher socio-economic classes and the majority came to Britain either as a member of a family unit, or to join family who had previously settled here. Those joining or re-joining a family were exposed to the majority culture initially through the perceptions of those relatives who had already experienced it. Frequently they had little, if any, ability to speak in English and were therefore further excluded from contact with the majority culture.

Recent women immigrants who have left countries torn by war or famine frequently have witnessed traumatic situations, and in some cases deaths of close family members. Often they have been separated from husbands, parents and children and, sometimes, they do not know if their relatives are still alive. It is almost impossible to comprehend their tragedy and their deep sadness. To experience childbirth in a foreign country without family support and, often, without adequate financial resources is an additional grief.

Since midwives have a professional duty to offer equitable care according to the client's need it follows that an understanding of the client's cultural background is a requisite. This involves gaining knowledge of the demography of the area in which the midwife practices, the patterns of settlement and the values of the differing communities as they impact upon client care.

Although on initial consideration this may appear an overwhelming demand, the pattern of settlement may include a valuable advantage for the health care professional. Ballard (1994:11) refers to South Asian settlement in the United Kingdom as being along 'increasingly well-worn paths of kinship and friendship'.

It can be argued that this pattern is not limited to South Asian settlement; it is a natural response for a minority ethnic group to settle close together for mutual support and protection. In addition employment prospects for immigrants tend to be in specific localities. The combination of settlement close to co-nationalists and/or co-religionists in areas of employment opportunities results in differing areas having differing ethnic groups. It is unlikely that any one maternity service will be called upon to work directly with women from every minority ethnic group which currently forms part of the population of the United Kingdom.

Whilst good will on the part of the health care professional is a pre-requisite for good care for the client, good will alone is not an adequate preparation to meet the challenges of midwifery in our current complex society; it is just the first step.