A special project brings pregnant Eritrean women together for group care sessions. During these sessions, a key person in the Eritrean community co-facilitates and interprets.
There is often no interpreter present during the routine ultrasound appointment. During one of the group sessions it becomes apparent that this can cause a lot of confusion.
The midwife has the results of the scans and discovers that the scans of 2 women show serious abnormalities. Together with the co-facilitator she discusses the results with both women. She does this during the private moment all women have before the start of the group meeting. She spends a bit more time with the women than usual. One of the women’s babies shows signs of trisomy 19, also known as Edward’s syndrome. The woman had understood that the baby had an extra toe. She wasn’t worried since this was common in her family.
The other woman’s baby had been diagnosed with a gastroschisis [abdominal wall defect]. She thought however that her baby had no belly and no organs and was extremely upset. Supported by the co-facilitator and the use of drawings, the midwife is able to explain what is going on with her baby. Now that she understands that her baby does have all its organs, the woman is very relieved.
The group then discusses the subject of ultrasound scans in general. What is visible on a scan? What does it mean? They also discuss which options you have when an abnormality is found. The fact that you have a choice about the next steps and how you go about making this decision. This is new for the women. Contrary to the situation in Eritrea, in the Netherlands you can ask the doctor or the midwife questions.
The Midwife: “Information doesn’t come across because of the language barrier. Moreover, they think: you don’t ask the doctor any questions.”
After some time goes by, one of the women calls the co-facilitator:
“I went back to the hospital and I asked the doctor lots of questions. Now I understand the pros and cons of having more tests done. I have decided not to continue with more tests. I am so happy with the choice that I was able to make myself!”
The group meeting enabled her to make her own decision; one she stood behind. She was much calmer now that she understood the situation better.
The midwife: “Being part of the decision making and making your own decisions is so normal for us. If we are not careful, these women undergo their care and they miss out on the process of self-determination. During the group sessions, I have enough time to discuss everything thoroughly and I have the added luxury of a co-facilitator who is able to interpret.”
 Children with Edward’s syndrome have a serious mental disability. Most children die during pregnancy or shortly after birth. Because of serious physical problems, children with Edward’s syndrome rarely survive after one year.
It is not easy to find a suitable location for the first session of the new group. Eventually a location was found but the midwife was unable to check it out beforehand. On arrival, it turns out to be some kind of clubhouse with a pungent smell of sweat. A group of men hangs around in one of the corners. The room cannot be closed off and completely against the Centering tradition, a large, heavy table is blocking the middle of the room. The men help move the table. Because of this, the women keep bumping into the low hanging light fixtures in the middle of the room. Still, this doesn’t stop them from making the best of it.
The midwife has picked up Ayana, otherwise she wouldn’t have been able to attend. She is very quiet in the car, with a shy demeanor and her face taught with anxiety. Ayana is not yet able to speak the Dutch language.
The midwife sees that Ayana slowly relaxes during the first session. By the end of the session, a smile appears on her face. After the group session, when they are clearing up together, the co-facilitator shares with the midwife what Ayana told her: that for the first time in 6 months since she came to the Netherlands, she has had a lovely evening.
The midwife: “How deeply unhappy and how lonely this woman must have been. She felt connected for the first time since arriving in the Netherlands. For me this is one of the most beautiful effects of Centering: the contribution to forming networks.”
Suwa is home-brewed Eritrean beer. Most Eritreans have no idea that it is an alcoholic drink. “The reasoning being that if it isn’t added, it’s not in it”, the Eritrean co-facilitator translates for the midwife. The belief is that suwa washes everything clean, like the kidneys but also the baby in your belly. That makes it a very popular drink. “It is served at parties and it gets you really drunk!” she adds with a laugh. Everyone sings its praises and especially pregnant women are advised by their family to drink suwa.
The midwife and her co-facilitator decide to put this topic on the agenda during one of the group sessions. The reason being that they have noticed that when asked about the consumption of alcohol, the women do not associate that with drinking suwa. And what do you know? Almost everyone in the group drinks suwa on a regular basis. The women are interested in the subject. What is alcohol? Why is it in suwa? How does it affect the baby? How do you deal with it during pregnancy? The women have many questions.
By chance, this time the midwife gives Ayana another lift home. “Does she want to stay for dinner?”, Ayana asks. During dinner the midwife listens to the conversation in Tegrinya between Ayana and her husband. The only word she understands is “suwa”. She is curious and asks the husband to translate the conversation for her. “My wife tells me suwa contains alcohol and that it is not good to drink it during pregnancy. I am so happy that she now knows this.”
The Midwife: “I saw it on his face that he understood. He understood the fact that suwa is not good for you when you are pregnant. This confirmed to me that the message had been understood. We had a hard time finding the right ‘Centering way’ to address this in the group. You really do not want to revert to giving health information in the traditional manner. This story shows the power of discussing this kind of topic in a group format. Apparently everyone felt safe enough to honestly admit that they regularly drank suwa and could talk about it together. Without the group and my co-facilitator, the subject would never have surfaced. Suwa is not associated with alcohol and in a one-to-one consultation there would never be a reason to bring it up. Above all, there is time during group sessions for these kind of topics”.
As in the ‘regular’ group care sessions, the Eritrean women also discuss pain relief and labor positions. They talk about the fact that they have a choice in these matters, and how to communicate your choices clearly to the midwife or doctor.
The women practice the use of the birthing stool and the hands and knees and side-lying positions. The women seem not to have a lot of basic knowledge. It is difficult to explain the importance of calling the midwife when you have contractions every 5 minutes when you don’t even know what a contraction is and that it can be painful. It is not surprising that the message doesn’t always come across.
Because she is 42 weeks pregnant and the ultrasound scan has shown a reduction in amniotic fluid, Halewat’s labor is induced. She enters the labor ward at the agreed time. “You do know that I don’t want an epidural?” she asks the midwife. “And I want to use the birthing stool”, she announces with determination. The midwife is a surprised, “I have never met an Eritrean woman who speaks her mind like you. How did you come to these decisions?” Halewat proudly tells her about group care sessions and how much she has learned there.
Halewat cannot attend the postnatal group care session where birth stories are exchanged and babies are proudly shown to each other. Halewat did however tell the co-facilitator that she really wants to let them know what she has gotten out of the group. How strong she felt giving birth and how proud she is of how the birth went.
The midwife: “We caregivers are not used to Eritrean women speaking out for themselves. The hospital midwife expressed the reality of everyday life. Many (Eritrean) women do not know they have choices. They just do what the midwife or doctor tells them to do. They don’t have enough knowledge to make their own decisions. Centering is so much more than just antenatal care. It connects the women at a very special moment in their lives when they need all their strength. I realize this even more with the Eritrean women. It is wonderful to see how involved the co-facilitator is with the group. Antenatal group care is what you call true integration!”
The co-facilitator tells the midwife about the Eritrean custom of removing the uvula when the baby is only a few weeks old. This is sometimes done surgically by a doctor but more often it is carried out at home with a pair of scissors or a kitchen knife. When this goes wrong, there is risk of heavy bleeding and further complications as a result of this. It is believed that the babies with uvula are thirsty, vomit more and are more often sick.
The midwife can hardly believe that this still happens and certainly not in the Netherlands. One of the regular topics during group care is female genital mutilation (FGM). During this session the midwife decides to address the subject of uvula removal.
As usual, she draws an imaginary line across the floor. The women then choose where to stand, somewhere in between the two ends of the line: “I want this” or “I don’t want this.” She is amazed when 90% of the group says they want their baby’s uvula removed. She uses this to start a discussion. “Why would you do this? What is the effect on the baby?” The women explain to her that children with uvula are often more thirsty. “Just look at all those Dutch people with their water bottles” declares one of the women triumphantly.
“Can you imagine a reason why this is forbidden in the Netherlands?” the midwife asks the group. At the end of the discussion she draws another imaginary line across the floor. The distribution of the women along the line is different this time. There are more women standing towards the end that indicates “I don’t want this”.
The midwife: “It is important to me that the discussion leads the women to realize themselves that, in the Netherlands, you can’t just cut off a body part. The power of group care is having time to address these kinds of topics. Using different methods and games during the sessions, you listen to each other and the women come up with their own answers. It shows again how important it is having the Eritrean co-facilitator present: without her I would never have brought this up.”
Researchers and policymakers regularly hear impressive stories about the results of group care according to the Centering model, which are not visible in research results. These stories from healthcare show in a different way how group care works. With the help of interviews with women, midwives, nurses and doctors, these powerful and often moving stories will be collected and written down during the GC_1000 project.
The process of implementing group care will start at the end of 2021. The following stories have been collected before 2020 and were published in the book "Little Pearls, short group care stories with a large impact". The book was a joint publication of TNO, the KNOV, the Centering Nederland Foundation and Group Care Global. The book was first distributed in the English version at the GC_1000 launch meeting in Leiden, Netherlands, February 2020.
Read the full publication here:
We would love to hear your group care story, big or small! Please send an e-mail to email@example.com to share your story.