Tach.S.339560.PrenatalEducation

8/11/2019 Tach.S.339560.PrenatalEducation

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Running head: PRENATAL EDUCATION AMONG IMMIGRANTS 1

The Importance of Prenatal Education:

Related to Infant Morbidity among Immigrants

By

TidSureyah Tach

Langley, British Columbia

Submitted in Partial Fulfillment of Course Requirements for

Nursing 252

Professor Catherine Hoe Eriksen

Trinity Western University

April 2nd

, 2013

(THE FINAL COPY)

Author Note

Special thanks to: My peer reviewer, the Writing Center, and a few other editors who

have relentlessly given me feedback to make this paper a learning experience as I presented a

clinical topic that is of a personal interest.


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PRENATAL EDUCATION AMONG IMMIGRANTS 2

Abstract

Background: During my 9 weeks of clinical experience, each clinical day there was at least 2

South Asians out of 5 patients who came into Abbotsford Regional Hospital to deliver their

babies. As part of the assessment, I encountered a number of cases where newborns ended up in

the Neonatal Intensive Care Unit (NICU) due to preterm birth and/or low birth weight. Out of

curiosity and concern, I followed up on two to three cases by way of the mothers health record.

According to each chart, there was a similar theme because either the prenatal education or care

was not accessed. This clinical situation paper will discuss the needs of prenatal education among

immigrants regarding to prenatal care, risk factors, and mothers health; some barriers such as

language in-proficiency, family value, and differences in cultural background relating to accessing

the education; some consequences such as preterm and low birthweight, babys poor adaptation to

feeding or bonding, and in need of NICU care which prolong hospitalization; and nursing

considerations proposing an initiation of prenatal teaching/care program such as home visitation

among immigrant women who are most at risk, learning materials in an immigrant mother tongue,

and a nursing focus encouraging teaching participation from the whole family. Due to the length

of the paper and prenatal education being a huge topic, there will not be discussion of what is

included in Prenatal Education classes or individual education.

Keywords:prenatal education, immigrant pregnant woman, family values, preterm and low

birth weight, language barriers, & cultural expectations.


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The Importance of Prenatal Education: Related to Infant Morbidity among Immigrants

Migration into a new country designates determination. Beginning a new life in a foreign

land likewise invites a series of adaptations. Yet, every choice to conform to the new social

standard may present potential conflicts with original cultural expectations. In the healthcare

setting, there are many cases in the maternal ward where a lack of prenatal education among

immigrant, pregnant women signals health concerns for both the mother and the baby. Often, the

knowledge of pregnancy that the immigrants obtain is based on cultural values and customs

without any scientific basis. Although pregnancy and childbirth are a natural process, prenatal

teaching equips pregnant women with knowledge concerning fetal development, risk factors, and

suggestions for a healthier pregnancy, which reduces the rate of morbidity among the immigrant

population. This essay dialogues on the importance of prenatal education, its issues and barriers,

its consequences, and proposes solutions to a better assessment of it (Clinical experience: key

informants, observations and interviews, 2013).

Prenatal Health Education

Prenatal education plays a vital role in the reduction of maternal and fetal complications.

Comprehensive prenatal education includes pre-conception, perinatal, and postpartum care.

According to Public Health Agency of Canada, the majority of prenatal care in Canada is

provided by physicians or midwives in one-on-one visits, but approximately one-third of pregnant

women in Canada choose to supplement this care by attending prenatal education classes

(Bendediktsson, McDonald, Vekved, McNeil, Dolan, & Tough (2013, p. 2). Through recognition

of risk factors and identification of key topics concerning health during pregnancy, transitional

stages of fetal development can be optimized. The scope of teaching relates to both the mother and

the fetus. The topics may include prenatal care, dietary information, maternal nutrition,

supplements and vitamins, harmful drug usage, just to name a few (Calleja-Agius, 2009).


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male counterparts (p. e2). Angus, Lombardo, Lowndes, Cechetto, Ahmad, & Bierman (2013)

also stated that linguistic or cultural constraints cause hesitation in immigrants to reach out to

Canadian health services, especially when discussing female private sensitive issues. Cultural

beliefs and expectations not being met by health care providers have created additional barriers.

Despite the willingness to acquire a better health status, the immigrant women face complications

due to family function, and inadequate support inhibiting any female immigrant the option for a

different decision (Angus, & et al., 2013).

Results of Inadequate Prenatal Education

Attributable to the lack of uninformed prenatal education and care, the chance of low birth

weight in newborns is significant (Benediktsson, & et al., 2013). During my clinical experience, I

observed approximately three cases where newborns were admitted to the NICU due to preterm

and low birth weight. Not surprisingly, the records of these newborns resulted from mothers who

had not received prenatal education, prenatal care, or both. During postpartum care of three

mothers and their preterm and low birth weight newborns, I observed that the newborn was not

interactive or responsive with the mothers which created a challenge to the mothers and the

babys bonding.

The impact of late access to prenatal care can lead to fetal damage and various

complications. According to Lu, Kotelchuck, Hogan, Johnson, & Reyes (2010), organogenesis

begins early in pregnancy; therefore, it is important for women to recognize the essential steps and

various concerns to be addressed in their lifestyles before becoming pregnant. Lacking the

essential knowledge concerning a healthy pregnancy leads to various potential complications as

evidenced by gestational diabetes, preterm labor, immature fetus, newborn defects, and many

others. The result of these issues is due to a knowledge deficit related to a lack of recognizing


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potential hazardous products or dietary consumption (such as alcohol or smoking) before, during,

and after pregnancy.

Premature newborns display observable characteristics such as failure to thrive, poor

adaptation to breastfeeding, and congenital anomalies due to substances abuse. According to

Brandon, Tully, Silva, Malcolm, Murtha, Turner, & HolditchDavis (2011), preterm infants, who

suffer medical complications, are in greater need for neonatal intensive care and require a longer

hospitalization.

Therefore, it is crucial to teach essential knowledge to immigrant pregnant women in order

to prevent uninformed decision making regarding their pregnancy.

Prenatal Education Proposal among Immigrants

To cut back the effect of premature and low birth weight of newborns as well as

knowledge deficits of new mothers, prenatal education should be encouraged and addressed in

communities where the pregnant mothers are most at risk. According to Lu, & et al. (2010), the

effectiveness of prenatal care is established through home visitation programs, comprehensive

care programs, and preterm prevention programs. These programs are facilitated by trained nurses

who understand an individuals culture and are willing to passionately work with immigrants. In

addition, prenatal education should be a familys focus rather than a pregnant womans alone.

When, and if, the immigrants family realizes the importance of prenatal education, this creates an

environment that supports wellbeing of both the mother and the fetus or baby.

Inadequate language proficiency can be resolved by facilitating communication through

the translation of educational materials into the immigrant familys mother tongue in both speech

and writing. Accessing learning materials in a foreign language is hard and time consuming.

Moreover, there should be an encouragement among non-native nurses to reach out to the


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immigrant community so that a relationship of trust and concern for womens wellbeing becomes

a priority.

Accessibility of prenatal education should be made readily available and be cost effective.

Since 1995 Health Council of Canada suggests a program called CenteringPregnancy where

both prenatal care and education is combined. In addition, this program is offered in locations

where there are a higher proportion of immigrants. The program also provides group prenatal care

where the focus is to develop relationships among women, their families, and health care

professionals. Usually, women who attend prenatal education classes need to pay a fee; however,

for low income family a fee waiver is available (Benediktsson, & et al., 2013).

Summary

Prenatal education provides maternal support as well as identifying risk factors in order to

promote optimal health in pregnancy. Although there are various barriers such as cultural belief,

family issues, and language proficiency, the knowledge concerning wellbeing for pregnant women

is essential among immigrants. Nurses can address the above issues by establishing early,

culturally, and language friendly accessible prenatal education via home visitation programs,

comprehensive programs, and preterm prevention programs. As nurses it is important to address

the importance of prenatal knowledge even when family values or various barriers conflict with

health promotion of mothers. Holistic care can be addressed by providing alternative care plans to

immigrant mothers and their families thereby providing for the babys best chance.


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References:

Angus, J. E., Lombardo, A. P., Lowndes, R. H., Cechetto, N., Ahmad, F., & Bierman, A. S. (2013).

Beyond Barriers in Studying Disparities in Womens Access to Health Services in Ontario,

Canada A Qualitative Metasynthesis. Qualitative health research, 23(4), 476- 494. doi:

10.1177/1049732312469464

Benediktsson, I., McDonald, S., Vekved, M., McNeil, D. A., Dolan, S. M., & Tough, S. C. (2013).

Comparing CenteringPregnancy to standard prenatal care plus prenatal education.BMC

Pregnancy & Childbirth, 13(Suppl 1), 1-10. doi:10.1186/1471-2393-13-S1-S5

Brandon, D. H., Tully, K. P., Silva, S. G., Malcolm, W. F., Murtha, A. P., Turner, B. S., &

HolditchDavis, D. (2011). Emotional responses of mothers of latepreterm and term

infants.Journal Of Obstetric, Gynecologic, & Neonatal Nursing: Clinical Scholarship

For The Care Of Women, Childbearing Families, & Newborns, 40(6), 719-731.

doi:10.1111/j.1552-6909.2011.01290.x

Calleja-Agius, J. (2009). Pre-conception care: essential advice for women.British Journal of

Midwifery, 17(1), 38.

Grewal, S., Bottorff, J. L., & Hilton, B. (2005). The influence of family on immigrant South Asian

womens health.Journal of Family Nursing, 11(3), 242-263. doi: 10.1177/1074840705278622

Kim, I. H., Carrasco, C., Muntaner, C., McKenzie, K., & Noh, S. (2013). Ethnicity and

Postmigration Health Trajectory in New Immigrants to Canada.American journal of public

health, 103(4), e96-e104.

Lu, M. C., Kotelchuck, M., Hogan, V. K., Johnson, K., & Reyes, C. (2010). Innovative strategies

to reduce disparities in the quality of prenatal care in under-resourced settings.Medical

Care Research and Review, 67(5 suppl), 198S-230S. doi: 10.1177/1077558710374324

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Tach.S.339560.PrenatalEducation