Southeast and East Asian immigrant women's transnational postpartum experiences: A meta-ethnography

Stress interventions for immigrant parents in the United States: a scoping review protocol

OBJECTIVE

This review will map stress interventions designed for and implemented among immigrant parents in the United States (US) according to intervention characteristics, participant characteristics, and reported outcomes and measurement tools.

INTRODUCTION

In addition to parenting stressors shared with their non-immigrant counterparts, immigrant parents also face immigration stressors. Although stress interventions can effectively manage, reduce, or prevent stress among non-immigrant populations, we know little about stress interventions designed for immigrant parents in the US. This study will be the first to explore stress interventions implemented among immigrant parents in the US.

INCLUSION CRITERIA

This scoping review will include published, peer-reviewed quantitative, qualitative, and mixed methods studies that evaluate stress interventions designed specifically for US immigrant parents with at least 1 child under the age of 18 years. Reported interventions must include stress as a primary or secondary outcome or be labeled as a stress intervention. Stress interventions are broadly defined, with no restrictions on the type of stress targeted (eg, job, general, parenting) or the intervention's nature (ie, prevention vs. management/reduction vs. treatment).

METHODS

A literature search will be conducted in ProQuest's APA PsycINFO and PsycARTICLES, CINAHL Plus (EBSCOhost), ERIC (ProQuest), Embase, MEDLINE (Ovid), International Bibliography of Social Sciences (ProQuest), and the Cochrane Library. Only English-language publications will be eligible, with no date restrictions. Retrieved titles and abstracts will be screened by at least 2 independent reviewers in duplicate. Data will be extracted using a self-developed data extraction tool. Findings will be presented in tabular or diagrammatic format, accompanied by a narrative summary.

REVIEW REGISTRATION

Open Science Framework osf.io/ec39j.

The Lived Experience of Postpartum Intergenerational Conflict of Vietnamese American Women with their Vietnamese Immigrant Parents: It's A Generational Thing!

PURPOSE

US-born Vietnamese women who are in their childbearing years are more likely to identify with "western" perspectives when compared to their immigrant mothers who were born in Vietnam. Still, a gap in knowledge exists of their intergenerational differences. The purpose of this study was to explore and better understand Vietnamese American women's experiences of postpartum intergenerational conflict.

STUDY DESIGN AND METHODS

van Manen's methodological approach (1997) was used. The purposive sample included 11 US-born Vietnamese women who experienced postpartum intergenerational conflict with their parents. Data were transcribed verbatim and analyzed using thematic analysis. The researcher transcended the themes through music. Songs and lyrics were arranged for guitar to bring the phenomenon to life.

RESULTS

Four themes were identified: (1) "It's a Generational Thing!" (Một điều thế hệ): Leaning both ways; (2) "To rebel or not" (Nổi loạn hay không): Weighing the evidence of postpartum cultural practices; (3) "Stand My Ground" (Giữ vững lập trường của tôi): Keeping my newborn safe and healthy; and (4) "See Me" (Nhìn con): My mental health overshadowed by my mother's thoughts. This study revealed that the intergenerational conflict was influenced by the family's understanding over the division of infant care tasks, disagreements over cultural practices, and generational differences such as age, consistent with previous research.

CLINICAL IMPLICATIONS

Tailored interventions for Vietnamese American women should consider the family as a whole. Nurses can assess proactively in prenatal care if there are cultural issues such as family hierarchy, gender, and history influencing one's choices or maternal autonomy.

Asian-White disparities in obstetric anal sphincter injury: a systematic review and meta-analysis

OBJECTIVE

Obstetrical anal sphincter injury describes a severe injury to the perineum and perianal muscles after birth. Obstetrical anal sphincter injury occurs in approximately 4.4% of vaginal births in the United States; however, racial and ethnic inequities in the incidence of obstetrical anal sphincter injury have been shown in several high-income countries. Specifically, an increased risk of obstetrical anal sphincter injury in individuals who identify as Asian vs those who identify as White has been documented among residents of the United States, Australia, Canada, Western Europe, and the Scandinavian countries. The high rates of obstetrical anal sphincter injury among the Asian diaspora in these countries are higher than obstetrical anal sphincter injury rates reported among Asian populations residing in Asia. A systematic review and meta-analysis of studies in high-income, non-Asian countries was conducted to further evaluate this relationship.

DATA SOURCES

MEDLINE, Ovid, Embase, EmCare, and the Cochrane databases were searched from inception to March 2023 for original research studies.

STUDY ELIGIBILITY CRITERIA

Observational studies using keywords and controlled vocabulary terms related to race, ethnicity and obstetrical anal sphincter injury. All observational studies, including cross-sectional, case-control, and cohort were included. 2 reviewers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Meta-analysis of Observational Studies in Epidemiology recommendations.

METHODS

Meta-analysis was performed using RevMan (version 5.4; Cochrane Collaboration, London, United Kingdom) for dichotomous data using the random effects model and the odds ratios as effect measures with 95% confidence intervals. Subgroup analysis was performed among Asian subgroups. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools. Meta-regression was used to determine sources of between-study heterogeneity.

Results

A total of 27 studies conducted in 7 countries met the inclusion criteria encompassing 2,337,803 individuals. The pooled incidence of obstetrical anal sphincter injury was higher among Asian individuals than White individuals (pooled odds ratio, 1.64; 95% confidence interval, 1.48-1.80). Subgroup analyses showed that obstetrical anal sphincter injury rates were highest among South Asians and among population-based vs hospital-based studies. Meta-regression showed that moderate heterogeneity remained even after accounting for differences in studies by types of Asian subgroups included, study year, mode of delivery included, and study setting.

Conclusion

Obstetrical anal sphincter injury is more frequent among Asian versus white birthing individuals in multiple high-income, non-Asian countries. Qualitative and quantitative research to elucidate underlying causal mechanisms responsible for this relationship are warranted.

Immigrant Southeast and East Asian mothers’ transnational postpartum cultural practices: A meta-ethnography

Objective:

Southeast and East Asian mothers experience the postpartum period differently than that of the general population. Despite the documented difference, there is limited representation of postpartum cultural practices in nursing and midwifery research. The purpose of this meta-ethnography is to synthesize qualitative findings from studies that examined postpartum cultural practices of Southeast and East Asian mothers globally to ensure better maternal health outcomes.

Methods:

Noblit and Hare’s seven-step meta-ethnographic approach was used. We analyzed constructs, concepts, themes, and metaphors using Krippendorff’s content analysis. The guidelines for preferred reporting the synthesis of qualitative research were adhered to enhancing transparency (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

Results:

The collaborative search process in the following databases, PsycINFO, CINAHL, and Scopus, resulted in eight high quality research studies published between January 2017 and February 2020. Five studies discussed postpartum traditions of immigrant mothers (n = 67) living in North America (n = 67), while three studies explored that of mothers living in Southeast and East Asian. Mothers (n = 132) from China, Hong Kong, Taiwan, Korea, Vietnam, and Hmong participated.

Findings:

Three themes emerged: (1) importance of maintaining postpartum cultural practices; (2) barriers of “doing-the-month”; and (3) modification: practicality over tradition. Although participants recognized value in postpartum traditions, the lack of social support deterred more immigrant than non-immigrant Southeast and East Asian mothers from “doing-the-month.” Due to the influence of western medicine, clinicians’ postpartum care suggestions, and use of modern technology (e.g., Internet), Southeast and East Asian mothers had informed choices to adapt, modify, or “break with tradition.”

Conclusion:

Similarities and differences existed in how each Southeast and East Asian mother accepted and engaged with postpartum cultural practices, a process which aligned with one’s definition of health. Maternity care providers should further elicit Southeast and East Asian mothers’ needs based on individualized assessments beginning in prenatal care with emphasis on social support for mothers who have recently immigrated and given birth in their adopted countries.