Samoan women's voices : alternative ways of doing birth

Childbirth Maternal health services Samoa

The aim of this thesis was to examine the way in which migrant Samoan women did birth in Wellington in the mid 1980's. The thesis draws on interviews conducted with fifty Samoan women and interweaves the findings of these interviews with analyses of material drawn from the hospital records of a larger cohort of two hundred and forty eight Samoan women who gave birth in Wellington in 1985-86. The cross-cultural context in which this research was conducted demonstrated the need for such research approaches to be developed in a collaborative manner. The problems of establishing contact with Samoan women through standard letter/phone approach highlighted the need to explore alternative methods in ascertaining the needs of Samoan health consumers in New Zealand. Samoan and obstetric expert accounts of birth are examined through written and oral data sources and compared and contrasted with the way in which Samoan women constructed pregnancy and birth.The thesis demonstrates that the construction of knowledge about reproduction is not confined to experts. Samoan women gave meaning to the changes which were occurring in their bodies by drawing on their own experientially created knowledge as well as drawing from and re-creating the knowledge of Samoan and obstetric experts. Expert knowledge about reproduction is shown to co-exist for the Samoan women, demonstrating that for Samoans, though not necessarily for health professionals in Wellington, Samoan and obstetric ways of doing birth are viewed as complementary rather than competitive approaches.In following Samoan womens' voices, theoretical and methodological approaches, which frame explanations of migrant behaviour in terms of differences in migrant adaptation to the host society, were shown to fail to do justice to the active ways in which women constructed their pregnancy and birth experiences. The way in which Samoan women drew from both Samoan and obstetric understandings of reproduction could not be simply explained by fitting women into classificatory boxes, such as cultural orientation, being a first time or experienced mother, being married or single or engaged in a planned or unplanned pregnancy. Such assumptions failed to account for the richness and diversity in the ways in which Samoan women made sense of and acted to shape their experiences.The thesis demonstrates the continuing importance for Samoans living in New Zealand of Samoan ways of explaining physiological changes which result from pregnancy and Samoan approaches to caring for a pregnant woman and her unborn baby. For most of the Samoan women going to the fofo (traditional healer), was as much a part of their pregnancy experience as making antenatal visits to their doctor.The power of obstetrics to control and shape the encounter between women and their doctors is demonstrated at many points in the thesis. During pregnancy Samoan women were able to largely control their own agenda. This was less true for most women during labour. Birth in hospital meant that women were more intensively exposed to obstetric control of their bodies than during pregnancy. For many of the Samoan women birth was a medically constructed event.The thesis evidences the need for effective cross-cultural communication between health professionals and the women for whom they provide services. The Samoan womens' voices show this need.

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