Does culture influence the birth experiences of first-generation Nigerian women in London?

The purpose of this study was to explore the influence of cultural practices on the birth experiences of first-generation Nigerian women (FGNW) living in London. FGNW’s folk (emic) care practices were compared with midwifery (etic) perspectives to gauge the interplay with maternity care competency and congruency in meeting their needs. The objective was to highlight factors within emic and etic care that may influence birth outcomes of FGNW accessing maternity care in London. As midwifery does not have a specific culture care model, I have developed Culture Care Midwifery Model as a major contribution to underpin midwifery practice in providing care that is culturally congruent; to meet the care needs of first-generation Nigerian women during their birth experiences in London. The study entailed an exploratory, descriptive, contextual and qualitative methodology. An in-depth literature review was undertaken to identify gaps in knowledge on FGNW’s cultural practices as a trans-national population in London. The study had two stages. In stage one, focus group discussions and semi-structured interviews were conducted with six self-identifying first-generation Nigerian mothers with retrospective birth experiences in London and twelve (eight non-Nigerian and four Nigerian) midwives providing maternity care for this population in South London. The second stage of the study involved six first-generation Nigerian women prospectively studied at three intervals during a birth continuum. Edinburgh Postnatal Depression Scale (EPDS) was administered to screen for psychological health of the prospective sample to ensure data accuracy. The epistemologies adopted were a combination of culture, culture care and trans-cultural care theory. Data were analysed using thematic and ethno-nursing analytical approaches. This was achieved by identifying, analysing and reporting patterns and themes within the data. Confirmation and validation of data at intervals was undertaken to ensure accurate interpretation of data. Validation of findings was achieved through face validation and through member checking. Findings of this study indicate that culture exerts a significant influence on birth and maternity care experiences of first-generation Nigerian women in London throughout the birth continuum. Care meanings for first-generation Nigerian women in London are embedded in cultural values and beliefs, economics of the family and other networks of support, their new environment as migrants, their historical / inherent culture of expectations, rituals and taboos, kinship of support, politics of family dynamics and immigration in their negotiation of maternity care provision in London. Conflicts exist between aspects of emic care practices of first-generation Nigerian women and etic care approaches of midwives. This study uncovered that aspects of FGNW’s cultural practices warrant preservation and/or maintenance, whilst aspects require accommodation and/or negotiation; with some aspects needing re-patterning and re-structuring to ensure continuing perinatal health and wellbeing. Therefore, Culture Care Midwifery Model is espoused as the first module specifically to guide midwives in meeting the cultural needs of first-generation Nigerian women in London, which could also be useful for informing cultural care of other BME populations accessing maternity care in London