Chapter 5: Transcultural Perspectives in Childbearing

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Cultural Belief Systems and Practices #1

Converging cultures call for reorientation of skills and behaviors toward childbearing women.

Culturally congruent care should be maintained throughout pregnancy, birth, and postpartum periods.

Many women and families are attempting to preserve their own valued patterns of experiencing childbirth.

Cultural Belief Systems and Practices #2

Advanced medical technology has become common in childbirth; not necessarily leading to healthier newborns and mothers.

Women in the United States have a higher risk of dying from pregnancy-related complications than those in 40 other countries.

Health disparities in the United States play a role in increased:

Maternal morbidity

Maternal mortality

Question #1

Is the following statement true or false?

In contemporary Western society, an increase in the number of women in the work force, advances in reproductive technology, self-care, alternative therapies, the explosion of health information available on the Internet, and the influx of immigrants and refugees have dramatically affected pregnancy and birth practices.

Answer to Question #1

True

Rationale: Pregnancy and childbirth practices in contemporary Western society have seen dramatic changes over the past three decades. An increase in the number of women in the work force, advances in reproductive technology, self-care, alternative therapies, the explosion of health information available to consumers on the Internet, and the influx of immigrants and refugees are but a few of the trends that require nurses to examine and rethink how they can better care for their clients.

Fertility Control and Culture #1

Fertility depends on:

Likelihood of sterility

Probability of conceiving

Intrauterine mortality

Duration of a postpartum period

Fertility Control and Culture #2

Cultural and social variables influencing fertility :

Reproductive health

Residence patterns

Diet

Religion

History of abortion

History of venereal disease

Regulation of birth intervals

Fertility Control and Culture #3

Societal factors influencing reproductive rights and population control:

Contraceptive methods: fertility controls versus natural methods

Refugees and reproductive health: barriers to reproductive health

Religion and fertility control: beliefs

Cultural influences on fertility control: misconceptions

Pregnancy and Culture #1

Pregnancy is a special transition period often influenced by customs and beliefs that dictate:

Activity

Behavior

Prescriptive beliefs, phrased positively, describe what should be done to have a healthy baby.

Restrictive beliefs, phrased negatively, limit choices and behaviors; practices/behaviors that the mother should not do in order to have a healthy baby.

Pregnancy and Culture #2

Customs and beliefs:

Nursing care during pregnancy

Biologic variations: knowledge of certain biologic variations resulting from genetic and environmental backgrounds

Example: genetic disorders, diabetes

Cultural variations

Pregnancy and Culture #3

Cultural variations

Alternative lifestyle choices: pursuing careers, same- sex parenting

Nontraditional support systems: perception of the need for care

Cultural beliefs related to:

Parental activity

Food taboos/cravings during pregnancy

Examples: same-sex couples, supernatural consequences, pica

Pregnancy and Culture #4

Cultural variations (cont.)

Cultural issues impacting prenatal care

Cultural interpretation of obstetric testing

Cultural preparation for childbirth

Question #2

Is the following statement true or false?

Prescriptive or restrictive cultural beliefs practiced during pregnancy may lead to a mother’s guilt about the baby’s outcome.

Answer to Question #2

True

Rationale: Although cultural beliefs might not be the cause of a poor neonatal outcome, they may cause harm if there is a poor neonatal outcome and the mother blames herself.

For example, the mother whose fetus has died as a result of a cord accident might believe that hanging laundry caused the cord to encircle the baby’s neck or body and might, therefore, experience severe guilt.

Birth and Culture

Birth beliefs and culture influence:

Cultural attitudes

Methods of dealing with the pain of labor

Recommended positions during delivery

Preferred location for the birth

Role of the father and the family

Expectations of the health care practitioner

Culture and the Postpartum Period #1

Cultures have developed postpartum practices that mobilize and strengthen the mother and the infant during this perceived time of vulnerability:

Dietary customs

Activity levels

Taboos

Rituals

Culture and the Postpartum Period #2

Postpartum depression

All new mothers should be assessed for postpartum depression.

Some cultures do not recognize this as a medical disorder.

Mothers may still exhibit signs/symptoms (anxiety, crying, mood swings).

Pharmaceutical and/or culturally appropriate care and support may be necessary.

Culture and the Postpartum Period #3

Breast-feeding/weaning practices

Affected by a variety of values and beliefs:

Societal trends

Religious beliefs

Mother’s work activities

Ethnic cultural beliefs

Social support

Access to information

Past experiences

Cultural Issues Related to Domestic Violence During Pregnancy

Domestic violence is one of the most significant health care threats for women and their unborn children.

Outcomes of abuse include:

Stress (physical and emotional)

Poor lifestyle health practices

Delayed prenatal care

Lack of support

Question #3

A nurse demonstrates an understanding of the sociologically focused safety risks for a pregnant woman when:

Conducting a suicide assessment

Identifying her cultural health belief system

Evaluating her postpartum support system

Assessing the level of violence in her neighborhood

Answer to Question #3

A. Conducting a suicide assessment

Rationale: A study identified homicide as a leading cause of pregnancy-associated death and suicide. Health care providers must screen for both partner violence and suicidal ideation as essential components of comprehensive health and nursing care for women during and after pregnancy.

Culturally Competent Care

Nurses caring for pregnant women of all cultures (including Hispanic, African American, and American Indian) should:

Employ good assessment skills

Form trusting relationships

Perform patient education

Show concern, interest, and respect for backgrounds

Question #4

It is suspected that a pregnant Hispanic woman is being physically abused. Which intervention will be most helpful initially?

Arranging for a Spanish speaking nurse to assess and provide the client’s care

Providing the client with written and oral information on women’s abuse shelters

Explaining to the client that any information she gives will be held in strict confidence

Offering to call a female member of the woman’s family to help arrive at a solution

Answer to Question #4

A. Arranging for a Spanish speaking nurse to assess and provide the client’s care

Rationale: It is initially helpful that the nurse have strong interpersonal skills and a genuine interest in Hispanic culture. In this situation, a Spanish-speaking health care provider might be able to form a trusting relationship more quickly, enabling the woman to share information about domestic violence. The Hispanic culture is a male dominated one, leaving the females with little power to help in this situation. The remaining options will be of little value if implemented as an initial action.