The Refugee Experience: Pregnancy, Labor, and Delivery

Pregnancy, labor, and delivery can be incredibly complex and unpredictable. Even the best pregnancy guide books can't provide an exact account of how it will all unfold. Instead, they offer tips and tricks for navigating healthcare systems, managing energy during labor, and dealing with the physical and emotional changes that come with pregnancy. Unfortunately, refugee mothers often lack easy access to this kind of help and advice. They face the challenge of learning a new language, navigating unfamiliar systems, and rebuilding their community after leaving their home country. As a result, their experiences of pregnancy and the postpartum period can be even more stressful, leading to poorer health outcomes for both the mother and the baby.

A study by Mosely et. al. compared US women’s and non-refugee immigrant women’s pregnancy experiences. They found that refugee women tend to begin prenatal care later and attend fewer prenatal care visits. This is due to various barriers they face, such as a lack of adequate translation resources, social stigma, and healthcare systems that lack the necessary cultural sensitivity to address pregnancy concerns in a respectful manner for refugee families. Unfortunately, these barriers contribute to higher rates of labor induction and cesarean delivery among refugee women. These procedures carry greater risks of postpartum hemorrhage, fetal stress, respiratory illness, preterm birth, low birth weight, and low rates of exclusive breastfeeding. All of these factors increase health concerns and infant mortality rates. These additional challenges place unnecessary burdens on families who are already struggling to navigate unfamiliar places, systems, and communities, often without access to the necessary resources.

Transportation barriers make it difficult for refugee women to attend appointments, while language barriers make it a nightmare to fill out necessary forms and communicate concerns or needs. However, there is good news. There are resources and programs available that aim to alleviate these barriers and make quality healthcare accessible to refugee women. Studies have identified gaps in healthcare systems that lead to inadequate care for refugee women, but they have also highlighted programs and strategies that mitigate these gaps and improve pregnancy outcomes. For example, a qualitative study conducted in Perth, Australia found that community-based prenatal services for refugee women led to improved social support, better continuity of care, easier access to transportation services and language resources, as well as increased confidence in asking questions. Additionally, culturally sensitive approaches have successfully addressed barriers, encouraged the use of perinatal health services, and improved pregnancy outcomes.

To implement culturally competent practices, it is crucial to utilize knowledge about cultural differences and backgrounds of refugees in newer models of care. A study focusing on Afghan refugee experiences with obstetrical care identified inadequate prenatal and postpartum care, insufficient information about the US healthcare system, and reduced social support among the study participants, which involved 10 Afghan women in the US. These women lacked private delivery rooms, there was no consent process, and they were unaware of the signs and symptoms that may lead to a cesarean delivery instead of a vaginal birth.

Refugee women have been uprooted from their previous social support systems and placed in a new country where they are expected to navigate language barriers while facing economic and cultural instability. During pregnancy, much of the information people rely on comes from their community. However, refugee women and their families often struggle to establish long-lasting communities due to housing instability or being moved from one refugee camp to another. Pregnancy and birth are deeply personal experiences, and without these community resources, refugee women face significant gaps in their knowledge about what to expect during pregnancy and how to advocate for their wants and needs in an American delivery room.

With the understanding that there are resources that can make a difference in the difficult situations refugee women encounter during pregnancy and birth, the final step is ensuring that women and their families have access to them. The work done by Knight Perinatal Advocacy - NB Doulas focuses on finding resources for refugee families and collaborating with community partners and volunteers to make them accessible.

Much of the work we do is aimed at building community amongst refugee families so they are able share resources and help each other access the resources we are able to provide. Bibimah Arabzada, our translator and trained doula, assists families at their doctors appointments and attends births as an advocate and emotional support professional to provide our clients with safe and equitable birthing experiences. The members of our wonderful community works tirelessly to make the transition into this country less overwhelming and make sure our families can access resources with dignity and in ways that uphold their cultural values.