Antenatal Depression in Immigrant Women: A Culturally Sensitive Prevention Program in Geneva (Switzerland)

Abstract

Introduction: Immigrant women in developed countries experience worse pregnancy outcomes than native women and are at high risk for antenatal depression and anxiety. Stresses related to the immigration and lack of cultural support affect emotional well-being, a situation calling for a response from primary caregivers and healthcare policies.

Main Body: The implementation, in Geneva, Switzerland, of a multicultural birth preparation program that integrates transcultural and community-oriented approaches is reported. The study conducted among women attending the program examined psychosocial risk factors for antenatal depression and pregnancy outcomes. The community sample included 209 women referred to birth preparation classes between 2006 and 2013. Sociodemographic profiles, antenatal depression, and pregnancy outcomes of women with precarious and non-precarious legal status were compared.

Discussion: More than half of the women had been living in Switzerland for less than 5 years, had precarious legal status, and presented diverse educational backgrounds. Women with precarious status presented more depressive symptoms than women with non-precarious status; 35 % of women presented either mild or serious complications, with no differences between the two groups, but women with several risk factors experienced more complications during the perinatal period.

Implications: These findings highlight the need for multidimensional targeted prevention programs to address psychosocial, cultural, and obstetric issues simultaneously. Improving communication and allowing immigrant women to preserve some of their traditions might be effective measures in enhancing their mental well-being. Migration indicators, such as length of time in the country, language fluency, legal status, ethnicity, should be considered as part of basic perinatal health information.

Response

• Fabienne Borel 

1. Arcade des Sages-femmes, Geneva, Switzerland

   Fabienne Borel

The “Pregnant in Geneva” Program: What Is so Special About this Program?

The warm and friendly atmosphere is the main characteristic of the multicultural groups that I have facilitated for several years now. Another specific feature is the duration of sessions (two and a half hours), which is longer than a usual antenatal education class. In fact, a lot of time is devoted to translation, and it is common for four or five languages to be spoken simultaneously in a group. The participants, the interpreters, and I perform the same exercises, contributing to the formation of a multicultural group of women talking, moving, and having a good time together.

I usually begin each session with a period of information, questions, and sharing of experiences. Then, I introduce a second period in which participants share cultural knowledge about pregnancy and delivery in different parts of the world. Finally, we end the sessions with 30 min of breathing exercises and relaxation. The following topics are discussed during the course: the growth and intrauterine life of the fetus, psychological upheavals during pregnancy, the first signs of labor, the course of childbirth, the medical institutions that provide obstetric services in Geneva, breastfeeding, the steps in the postnatal period, the re-establishment of sexual relations, and contraception. I illustrate this information with visual aids such as drawings and 3D materials. Women often ask questions concerning the reproductive system (“How did the baby get to where he is?” or “How is he living and developing now?”), the determination of the baby’s sex, the risk of maternal mortality during delivery, and the course of a birth in the case of genital mutilation (excision or infibulation).

I stress the importance of physical condition from the beginning of the course. The majority of women suffer from back pain and live in precarious conditions that give them little chance to relax or rest. A relaxation period at the end of each session allows women to learn simple exercises (such as breathing or body positioning) that can relieve pain and reduce stress levels; some women fall asleep during that time. Before the women leave, different activities such as singing or dancing are integrated, thus sharing traditions or songs linked to motherhood and childbearing in different countries. Working in groups composed exclusively of women offers considerable advantages and somehow replaces the group of elder females left behind in the home country: it gives the women more freedom to express their emotions and queries related to sexuality and permits them to engage in physical exercises, relaxation, dance, and songs related to infancy.

One entire session is devoted to psychological issues during pregnancy. I encourage women to express their emotional state and also to describe how they feel about the future. We discuss the psychological and emotional states and needs of women during pregnancy and after childbirth. We also address postnatal depression and its manifestations. This key session allows the participants to share emotions and strengthen bonds. I also try to do an overall evaluation of each participant’s living conditions and marital/social resources in order to assess her psychosocial needs and consider the best ways of optimizing emotional and affective help during the postnatal period.

A special evening meeting is devoted to future fathers. During this session, the men can ask me questions about pregnancy and childbirth. I stress the importance of their supportive role, especially during the postnatal period, when women are often alone without the assistance of their mothers.

During the 7 years of operation, few women quit the group or refused to attend, which shows that immigrant women appreciate this kind of intervention. I think that it is extremely important to adapt existing antenatal education classes to the hard-to-reach population of immigrant women with low French proficiency. This enables them to access information on physical and psychological symptoms during the perinatal period, learn more about professional assistance and treatment possibilities, and compensate for the lack of social support. We are planning to extend this antenatal prevention program to include a home visit during the first months postpartum.