Teaching Students and Nurses Evidence-based Recommendations of Culturally Sensitive Perinatal Care for Somali Immigrant Women

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1 Teaching Students and Nurses Evidence-based Recommendations of Culturally Sensitive Perinatal Care for Somali Immigrant Women Bernita Missal, PhD, RN Connie Clark. PhD, RN Bethel University

2 Objectives: 1. The learner will be able to examine the evidence related to culturally sensitive care for Somali immigrant new mothers. 2. The learner will be able to integrate recommendations for culturally sensitive care for Somali immigrant new mothers into nursing and patient education.

Clan warfare. Central government and infrastructure destroyed.

3 Somalia: History 1960: Somalia becomes independent from Britain and Italy. 1969: Dictatorial socialist state with persecution, torture, and jailing of opponents. 1991: Regime overthrown. Clan warfare. Central government and infrastructure destroyed. Metz, 1993; CIA The World Factbook, 2013; Encyclopedia Britannica, CIA The World Factbook. (n.d.). Retrieved from

Somalia: Refugees & Diaspora Est. 300,000 Somalis di

Somalia - 3 rd largest number of of refugees in the world (UNHCR, 2013). Al Jazeera.. (2013).

Oxfam International Blog.. (2011). Retrieved from http://blogs.oxfam.

4 Somalia: Refugees & Diaspora Est. 300,000 Somalis died during the war (United Nations (UN], n.d.) Over 1 million refugees (United Nations High Commissioner for Refugees [UNHCR], 2013). Somalia - 3 rd largest number of of refugees in the world (UNHCR, 2013). Al Jazeera.. (2013). Retrieved from Harrison, J. Oxfam International Blog.. (2011). Retrieved from 26-dadaab-diary-fleeing-famine CNN. (2009). Retrieved from

Cultural Care Diversity & Universality Theory Discover, document, know, and explain the interdependence of care and culture phenomena with differences and similarities between and among cultures

5 Cultural Care Diversity & Universality Theory Discover, document, know, and explain the interdependence of care and culture phenomena with differences and similarities between and among cultures (Leininger & McFarland, 2006, p.4). University of Washington School of Nursing. (2012). Retrieved from

6 Purpose of Study To explore Somali immigrant new mothers experience of childbirth in Minnesota Minnesota Public Radio. (2011). Retrieved from

7 Design Qualitative research Twelve female participants In-depth individual interviews Semi-structured open-ended questions BBC. (2013). Retrieved from

8 Data Collection Collaborated with Somali women community leaders Snowball sampling technique Interviews at varied locations Minnesota Historical Society. (2004). Retrieved from

Evidence for Culturally Sensitive Care to Somali Immigrant New Mothers 1) Family s & friends support 2) Cultural & religious practices 3) Relationships with nurses

9 Evidence for Culturally Sensitive Care to Somali Immigrant New Mothers 1) Family s & friends support 2) Cultural & religious practices 3) Relationships with nurses 4) Views on Cesarean section 5) Postpartum blues/depression USA_Mania-Job-Recruitment Ads. (n.d.). Retrieved from

10 Family Loss of mother s help & advice Loss of traditional family support Don t have a family here. Think about family and get sad. Retrieved from madaale.com

11 Husband s Support Different from Somalia: Husband s presence in the delivery room. Husband s extensive help with household tasks. Salon. (2002). Retrieved from Culturally, boys don t cook. He washed, cleaned the house, vacuumed.

Extended Family and Friends Support Any available family member or friend helped. Sister-in-law lived with me for two years. If you are Somali, you are friends.

12 Extended Family and Friends Support Any available family member or friend helped. Sister-in-law lived with me for two years. If you are Somali, you are friends. Minnesota Historical Society. (2004). Retrieved from

13 Cultural & Religious Practices Traditional foods 40-day postpartum period Prayer at the time of birth Somaliweyn. (2009). Retrieved from

Traditional Foods Food brought by family & friends to the hospital: oatmeal & tea for breast milk. The Phoenix of Somalia. (n.d.). Retrieved from http://thephoenixofsomalia.wordpress.

14 Traditional Foods Food brought by family & friends to the hospital: oatmeal & tea for breast milk. The Phoenix of Somalia. (n.d.). Retrieved from No, I am going to eat hospital food, and she [friend] was like: No, you are a new mother and you are going to get hungry in the middle of the night. And 4:00 in the morning came and I was so hungry and I had my porridge and I was so grateful. Traditionally Somali women eat during labor. She has no energy, how is she supposed to push the baby? My mom was really angry.

15 40-day Postpartum Period In Somalia: Mother stays at home and only cares for the baby Female relatives do all household work All that she does is feed the baby and sleep, that s it. In America nobody gets that time. When we got out, we went to Target. That is very strange. At the end of 40 days: Special celebration with the extended family & friends Special food and clothes

16 Prayer at Birth Father whispers prayer in baby s ear Prayer for help, for the mother and baby to have a happy face.

17 Relationships with Nurses Physical care Emotional support Teaching One nurse was the best. She was coming to visit me often. She taught me about the baby and to care for the baby. She was nice. She was talkative. Superscholar. (n.d.). Retrieved from

18 Views on Cesarean Section Family strongly disapproves Why is it necessary? Commercial interest of physicians Avoid going to the hospital Aversion towards C/S Punishment

19 Postpartum Blues/Depression Not common in Somalia Viewed as a weakness You re by yourself, you re so tired. You don t get to rest. My sister had a different experience because her mother-in-law always cooked. The food was not there [for me], that was a big challenge. [Husband says] What are you doing? My mom had 12 kids, never cried. You re weak.

Recommendations for Staff Nurses Husband Family & Friends Cultural Aspects Postpartum Depression/Blues Build Trusting Relationships Ask woman about his companionship during labor & delivery.

20 Recommendations for Staff Nurses Husband Family & Friends Cultural Aspects Postpartum Depression/Blues Build Trusting Relationships Ask woman about his companionship during labor & delivery. Include husband in pre- and postnatal teaching. Ask woman about preferred guests. Monitor traffic in the room. Be aware of loss of social support & 40-day period. Permit food. Be aware of its prevalence, denial, and stigma. Educate. Share personal experiences with children; allow time for questions, give rationale Retrieved from /who-is-your-primary-nurse/

21 Recommendation for Nurse Educators Teach students to be sensitive to the challenges of being in a second culture Teach students about importance of cultural and religious practices Teach importance of establishing trusting relationships Teach use of community resources

22 Recommendations for Administrators Establish policies that provide for cultural sensitivity Provide educational opportunities for interprofessional and ancillary groups Partner with community to understand health issues of the Somali community

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