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 2
nd
, 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.
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.





PRENATAL EDUCATION AMONG IMMIGRANTS 3
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).
PRENATAL EDUCATION AMONG IMMIGRANTS 4
Pre-conception care identifies responsibilities and essential knowledge for a future mother
to consider as she plans for a healthy pregnancy. The weight of a mother plays an important role
in the wellbeing of her fetus. If her body mass index (BMI) is high, she can face severe
complications during pregnancy such as gestational diabetes, shoulder dystocia, and other
morbidities. For satisfactory fetal growth and maternal health, it is important that she has adequate
nutritional intake and that she takes quality prenatal multivitamins such as folic acid, which lowers
the risk of anencephaly, spina bifida, and encephalocele (Calleja-Agius, 2009). Women need to
consider their immunization history because of the fetal impact from many preventable diseases.
Furthermore, it is essential that pregnant women receive regular prenatal care.
During my clinical experience the mothers who had received prenatal education were more
confident and comfortable in providing care to their newborns.
Barriers to Prenatal Education
Despite acknowledging the benefits of prenatal education, immigrant women are less
likely to access it because of cultural issues and language barriers. According to Grewal, Bottorff,
& Hilton (2005), the health determinant of any female immigrant is predominantly affected by her
relationship to her family. The desire to access care is linked to cultural beliefs and the families
personal values. If the relatives, especially the husband, believe that it is nonessential to access
healthcare for any reason, an immigrant woman will submit to that decision. Moreover,
[unemployment], low income, poor language proficiency, and experience of discrimination were
significant risk factors for poor health among female immigrants (Kim, Carrasco, Muntaner,
McKenzie, & Noh (2013, p. e.6).
Within the cultural norms and the adaptation to a new standard of living, female
immigrants may face personal conflict in order to access prenatal education. According to Kim, &
et al. (2013), female immigrants are considered to be more vulnerable to social changes than their
PRENATAL EDUCATION AMONG IMMIGRANTS 5
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
PRENATAL EDUCATION AMONG IMMIGRANTS 6
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
PRENATAL EDUCATION AMONG IMMIGRANTS 7
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.





PRENATAL EDUCATION AMONG IMMIGRANTS 8
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