A hospital can be a terrifying and intimidating environment, particularly for refugee womenwho may be experiencing childbirth in a Western health care setting for the first time. A tour of the Labor & Delivery unit should be encouraged in advance of labor to decrease a woman’s anxiety, alleviate fears, and prepare her for what to expect.

Frequent pelvic examinations, intravenous lines, fetal monitoring straps, and blood pressure cuffs may be considered invasive, along with labor induction and augmentation, epidural placement, and cesarean delivery procedures. Among Somali refugee women in particular, a growing body of evidence shows their profound fear of cesarean delivery.[1] There is also a common misconception that epidurals will cause paralysis or chronic back pain. Efforts should be made to ease a woman’s fears, provide anticipatory guidance, education, counseling, and appropriate language interpretation, while empowering a refugee woman to incorporate any traditional health behaviors and/or practices (i.e. walking during labor) as long as it is deemed safe for both the mother and fetus.

In addition, education should be provided on the standard of care for labor management. For instance, a woman with a breech presentation should be counseled on the safety concerns of delivering vaginally with a fetal malpresentation. Available options within the standard of care should be discussed such as offering either an attempt to physically maneuver the fetus to the head-down presentation (external cephalic version) or an elective cesarean delivery.

Additional Tips for Labor and Delivery:

• For women with extremely low literacy, verbal informed consent for procedures in lieu of written consent should be allowed in the presence of a trained medical interpreter for those patients who may not be literate in English or in their native language.
• The presence of family and social support should be encouraged. Evidence also suggests that the support of labor coaches or doulas may be beneficial to a woman’s positive attitude and experience with labor while decreasing the likelihood of obstetrical interventions.
• Special attention should be paid to the role of men as it may or may not be culturally appropriate for men to be present during delivery. Efforts should be made to engage men as partners/spouses in decision-making processes.

Other Pregnancy Topics:

• Pregnancy and Prenatal Care
• Postpartum Care
• Pregnancy and Neonatal Outcomes

Contributed by Crista Johnson-Agbakwu, M.D., M.Sc., F.A.C.O.G.