Why One Birth?

Why is One Birth needed, specifically in the Somali community?

One BIrth is committed to providing services that are both not a duplicate of something that already exists in our community and also not providing a service that the Somali community does not want or need. We ensure these values are met by constantly researching and meeting with groups of Somali women who help steer One Birth in the direction that is most appropriate for them and the Somali community.

Here is what we know:

Robin Ann Narruhn, RN, has done an extensive amount of work on the Perinatal Profile for Patients from Somalia. The following is information pulled from her work.

High Cesarean Delivery rates

• cesarean births often clash with Muslim beliefs around Allah's will to decipher life
• in refugee camps, many practice vertical incisions for c-sections. Vertical cuts are very dangerous and often lead to death, however, in western medicine we now practice with horizontal cuts that are much safer-there is little communication between Practitioner and expecting mothers around this leading to fears and misconceptions around c-sections

Low attendance for pre-natal visits/birthing education classes within the Somali community and this is due to:

• fear of unnecessary interventions
• doctors dictate
• illiteracy and lack of transportation make it difficult
• childcare
-stigma in groups
• lots of trust building

There is a need for more information within the Somali community around delivery room procedures, medications sometimes used, use of interpreters...basically, the whole process:

• uncomfortable touring the hospital by themselves, prefer videotape for home viewing
-tour birthing unit with Somali speaker

Lack of resources for home birth:

• some women wish to have births at home, but at last minute panic or an emergency occurs-no resources for midwife presented and an emergency room birth occurs. Little information is being shared around funding for home births.

Birthing and Postpartum in Somalia versus the United States

• Natural birthing attendants (ie, mother, sisters, cousins, aunts, etc) were utilized in Somalia, however, due to western ways, busy work schedules and lack of childcare, women have lost these natural supports who have to be at work
• Postpartum: in Somalia women only worried about breast feeding and resting. Female familial supports came to take care of children and household duties; due to Western ways, this support no longer happens

Concept of Pain:

• in Somali, the word for pain and illness are the same, which creates confusion when it comes to birthing; emotional words are increasingly used for pain (ie, sadness, worry, etc.) leading to greater confusion for pregnancy care
-pain is seen as weakness and women will often not display pain
• deal with using herbs, hot needles and reading Quran. Are these practices allowed in all birthing settings?

Statistics:

Somali women were found to be:

• 9 times more likely than both whites and blacks to deliver past 42 weeks
• 4 times more likely to have oligohydraminos (low amniotic fluid volume)
• more likely to have gestational diabetes
-more likely to have significant perennial lacerations
• less likely to smoke Johnson, Reed, Hitti & Datra (2005)

Labor and Delivery in Somalia:

• Somalia maternal mortality rate
1600 per 100,000 lives
• US maternal mortality rate
 12 per 100,000 lives

Gender roles in the delivery room:

• Some Muslim men do not accompany their wives into delivery room leaving them with no support
• Difficulty in finding female interpreters, male interpreters not allowed in leads to lack of support

Trauma:

• refugee living, rapes, violence, past abuse of any sort may surface throughout pregnancy and during delivery

All of the above are things that can interupt a healthy birth. One Birth is committed to make space is created and cultural barriers knocked down to ensure a woman's birth happens the way she wishes it to happen.