Let us look, for a few minutes, how the Somali community came to England.

Somalis have been established in the UK for different reasons.

The first generation arrived as sea men in the 1940s. The second generation are those who were born and bred in the UK and identify themselves as British citizens.

The most vulnerable are those who fled away from the civil war in Somalia and are shocked by the new environment, culture, language barriers and are unaware of the service for them.


(For more detailed information on this click here to enter Somali history)


SOMALI REFUGEES CAN BE CATEGORISED INTO 2 GROUPS:

- THOSE FROM URBAN AREAS

In Somali the women who live in the city are far more literate than the rural women.

The services they receive during childbirth are more modern. Because of the medical treatment received during difficult labour, there is an increased chance of survival for mother and child.

Women in the city are provided with medically trained midwives and doctors who know what FGM is. These women often have a choice of whether to give birth at home or in a hospital.


- THOSE FROM RURAL AREAS

Culturally, childbirth is seen as a natural process with little anxiety or problems.

This is not to say that problems do not exist in childbirth, but rather, that traditionally these rural women rarely discuss the issues with one another.


WAYS & METHODS OF CHILD DELIVERY IN THE NOMADIC SETTING

When a nomadic woman is about to give birth, a traditional midwife is called. This is someone who has no professional medical training and uses traditional methods.

The expectant mother is given a hot bath and a herbal enema will be given to loosen her bowel. This should assist a fairly easy labour.

If, however, delivery is delayed, the midwife gives some stronger herbs in order to reduce the labour pains and quicken the onset of labour.

In the occurrence of a breech delivery or difficult birth, to assist the mother to be, the midwife will stroke the womb with her hands for a period of time.

If this has no effect on the child the midwife then turns the baby with her hands to engage its head.

A Caesarean Section cannot take place for lack of appropriate medical instruments. If this does occur, the possibility of a successful birth is rare. Mother and child normally die.

No male, apart from her husband, will have ever seen a nomadic woman's genitalia.


THE EXPERIENCE OF SOMALI WOMEN IN WESTERN SOCIETY

On reaching Western society, Somali Women experience some distress.

According to refugee women who have arrived from Somalia within the last two years, major obstacles are: the different cultural norms, the language barriers and the general different way of life.

When giving birth they become traumatised and suffer great shock at the insensitive ways in which they are treated during labour.

Firstly, many health professionals have never seen a circumcised woman. This is therefore viewed as a medical abnormality hence the woman finds herself poked, and fiddled with in an undignified embarrassing way.

It is should be noted that, as said previously, a nomadic woman has never experienced any male apart from her husband looking at her genitalia. The presence of a male doctor to her is seen as degrading and humiliating.

Secondly, in teaching hospitals medical students are frequently taught on the labour ward. Many Somali women experience the ordeal of having up to 4-5 male and female students standing over them during labour. This practice is extremely alien to the women and many find it extremely upsetting.

The westernised woman has prior knowledge and/or experience of the intervention of male doctors, therefore, she does not encounter shock or trauma at this intervention in the same way as a nomadic woman does.


WOMEN AND THEIR DIFFERENT NEEDS

The time of childbirth for any woman is generally considered to be a time of joy. However, for the nomadic women in Western society, this time can induce a mixture of feelings and anxieties because of the obstacles faced by her during this period.

Somali Women living in Britain who are unable to find a doctor who is willing to perform de-fibulation often become pregnant whilst still fibulated.

This leads to a whole range of further complications for both the
women and the health-care professionals providing ante-natal services.

At this point it is often impossible to carry out vaginal examinations or to provide adequate care.

During labour and delivery the women usually experience severe tearing and there is the possibility of severe blood loss when the baby is born.

Aspect of childbirth and afterbirth.

To assist the Somali women the following needs are desirable.

- A trained interpreter to assist during labour

- More advocate workers to work in hospitals

- Antenatal classes with an interpreter

- Professional training for medical staff to cope with shock and trauma of patients.

- A written protocol in hospital maternity units for medical professionals and Locum officers.

- Written posters translated in Somali of available services e.g. Ante-natal classes and clinics.

- A clinic where women can come together once a month, run by trained doctors, advocates, midwife, to discuss issues of FGM, gain support and inquire about and receive de-fibulation.

- The Government to offer training to the recognised qualifications of Somali trained professionals to encourage them to come forward and offer their skills.