Emma investigates the dilemmas faced by Asian mothers living on the Gold Coast
Asian mothers living on the Gold Coast want to be part of the Australian community and healthcare, but when they are unable to follow cultural practices during labour and after birth they can be left feeling sad, anxious and helpless.
Faye is a young Chinese mother, whose baby was born at the GCUH. Faye says she was not happy and she suffered anxiety, although she admits she was provided with a very professional medical service.
Faye said it was a painful process of waiting for the baby to be born made worse because staff were not aware of the different cultural health practices. “During that time, the nurse constantly brings ice water to me and urges me again and again to drink the water.” However, Faye said she could not drink the water, because she thought that drinking the water with ice will increase the pain. In addition, she said, the nurse also gave her cold water after giving birth and emphasized that drinking water would assist in milk production, which made her feel very anxious.
In fact, Faye cannot accept the cold water due to her own culture. “Since my childhood I was told that if I am in poor health condition I cannot drink cold water at all, especially after a woman just giving birth.” Although Faye was very upset at that time, she drank the ice water because she did not know how to say no.
In addition, there is another thing that made her feel disappointed. She said, “My son has to wear a special clothes with eyes design at the first time after he birth, which was prepared by her grandma, but I failed to fulfil this custom in Australia.” Faye did not dare to mention this with her family.
To wear clothes with the eye pattern is a very important practice for newborns, which represents the auspicious life and newborn babies will have a bright future. However, because there is no timely communication with the nurse this led to her baby failing to fulfil this important custom, which made her very upset.
Annie, another Chinese mother living on the Gold Coast, whose baby was born late last year, had decided to make the trip back to her hometown to give birth, because she felt that it would be better than giving birth in Australia. She took a more than ten hours’ flight back to China, when she was almost eight months pregnant. Annie said that she and her husband felt overwhelmed with facing the new baby’s birth, and they also was concerned about how to provide a good postnatal care for the new mother in Australia.
In non-western cultures, there are many health practices, especially in terms of postnatal care, and some rules need to be strictly abided by. That is why Faye cared about the temperature of the water and why Annie was so worried about the complex rules for the postnatal care and went back to China to give birth.
In Western cultures, once the baby is born, the all focus is on the baby rather than the mother. The common practice is to celebrate the baby with baby showers and visits from friends and family who come bring gifts all for the baby. However, Non-Western cultures place great attention on the health and recovery of the new mother. There are many different beliefs and practices in non-cultures and two common belief of which play significant roles.
One common belief is to maintain balance between hot and cold within body and environment, especially in the period of postpartum care. According to Karen’s blog, the concepts of hot-cold balance in healthcare area have a long history in the traditional cultures of Latin America, Asia, and Africa, which also called humoral theories. Karen writes that because the blood is considered hot and after women give birth the body condition is considered cold, to keep warm and avoid touch cold stuff is very important in order to recover humoral balance. Therefore, it is easy to understand why Faye was so concerned about the cold water that the nurse gave her.
Dana, a Korean new mother, whose baby was born in the GCUH, says in Korean culture new mothers are not allowed to eat cold or hard foods, nor can they be exposed to cold weather and cannot take showers. However, in Australian hospital the air-conditioner is open all the time and nurse always urged her to take shower that made she felt so cold and anxious after she give birth.
The second common practice is to encourage rest and confinement up to 40 days after birth to regain energy and strength, and during postpartum period women’s internal organs and tissues will be recovered. In Karen’s blog, there are many different postpartum care experience related to many countries, such as Korea, China, Indonesia and Vietnam. She said some rituals, behavioral restrictions and proscription of the postnatal care aim to make sure that the new mother can restore energy to focus on caring for her baby and herself.
Dana said, in Korean, they call the postpartum care samchilil, in which period there are so many behavioral restrictions and special diet for milk production. Miyuk-kuk is the traditional soup and is prepared for new mothers to eat at least 2-3 times a day during samchilil. “The meal in the hospital don’t suitable for me and to prepare miyuk-kuk and deliver it to hospital is too much trouble, so I went back home from the hospital as soon as possible.”
In addition, Zubida is an Iraqi mother, had her the second baby in Australia. She said, she stayed in door for 40 days after giving birth. In her culture, people believe that because of lochia, the normal discharge from the uterus after childbirth, women after birth are believed to be susceptible to evil spirits, so they do not leave their homes, and are not allowed to cook or clean for the first 40 days. Zubida said, after she gave birth, her parents came to Australia and dedicated to take care of her for the postnatal care. She said, “If there was no relatives come for help, I would really feel very helpless, also cannot cope with such a long time to take care of myself.”
Australia is a multicultural country, Queensland government pays attention to the cultural dimensions of pregnancy, birth and post-natal care. On Queensland Government’s website, there are many multicultural clinical support resource.The profiles present health and socio-cultural information which focuses on the pregnancy, birth and post-natal care practices of 11 multicultural communities in Queensland, as well as general information about each community. It encourages healthcare providers to actively explore cultural issues with patients and cautions against stereotyping.
In addition, the GCUH also actively deals with the cultural differences that exist in the hospital, and constantly develop and perfect their medical services. Julie works in the GCUH as an obstetric nurse. She told me in email that as a nurse, it requires cultural knowledge and ability to provide multicultural services. Moreover, the GCUH is providing interpreters, group supports and other resources according to clients’ requirement. “Health workers are given continuous education through lectures online and face-to-face encounters about multicultural problems and their corresponding solutions.” The GCUH are also distributing pamphlets, T-shirts and video materials advocating the solutions about cultural difference in health care system.
In the interview with Julie, I asked why these dilemmas still exist. Julie said that Faye’s experience was a vivid example of failure in rendering a holistic nursing care and management. “As a nurse, it is a part of our professional ethics to consider and respect the rights of our patients and their families. Nurses should know their patients beyond their presenting problems but also their religion, beliefs, race, traditions and customs in order to give a better nursing care base on the nursing standards. However, not all Asian women are bound to follow their native cultures and traditions. Some of them are already exposed to more westernized way of living. So it always safe and advisable to treat each client individually.” Therefore, in these bad experiences, such as the cold water, the eye design clothes, and the shower and air-conditioner matters, she thinks the main problem is lack of an effective communication.
In terms of how to improve the effectiveness of communication, she said “I have a Chinese patient that can only speak Mandarin and few English words. She cannot understand our instructions and queries. This is an example of language barrier that can affect in the rendition of our care to her. ” In this situation, an interpreter should be arranged in order to have a better communication and to uplift a better nursing care and management. Furthermore, she said “nurses should not give up on one of the many barriers that we encounter on a daily basis. Instead, we should be encouraged to find ways to remove any hindrances that can affect the standard of our care.”
The problem that some Asian women feel helpless when they face to their own postnatal care and the confinement, Julie mentioned that currently the GCUH has upgraded the postpartum tracking service. A family doctor will visit to new mothers’ home after they leave the hospital and doctors will assist in their health and give some effective rehabilitation guidance. The family doctor will visit the new mothers every day during the first week, and the number and frequency of visit will gradually decrease with the degree of rehabilitation and needs. The GCUH wants to provide good healthcare for each new mother when they back home from the hospital. Although it cannot help them with household chores, family doctor will try to give them support and help.
At the end of the interview between Faye and I, Faye said, in Chinese cultural saying ”no” to the person who gives you help is very impolite, which means she cannot to refuse others offers to help. She also believes that the reasons causing her bad experiences are lack of initiative to communicate with the nurse. In the future, she said, if she wants to integrate into Australian community and becomes apart of them, it is important to conduct effective communication.
Culture plays a significant role in the way a woman perceives and prepares for her birthing experience. As Julie said, everyone knows that each culture has their own values, beliefs and practices related to pregnancy and birth. Not all Asian women are bound to follow their native cultures and traditions, and some of them are already exposed to more westernized way of living. However, there are other women who still consider that to follow their own traditional pregnancy and birth practices is very important. Queensland government believe that “if health care providers are familiar with different ideas, rituals and behavioural restrictions and proscriptions, and communicate with the women for whom they care, then women from different backgrounds will have more choices.”
At the end, Julie said, some Asian women still have the problems of multicultural service and face to some dilemmas, which is an inspiration for them to be more assertive and to ask preferences depending on their culture. For instance, “if a mother will ask for a glass of water, it is always advisable to ask her what she preferred: hot, warm, lukewarm, or cold water.”