TRANSCULTURAL

PERSPECTIVES IN
CHILDBEARING

PROF. EDYN MICHAEL SUGANOB, MAN, RN

At the end of the lecture discussion,
the students will be able to:

1.Analyze how culturally related issues

influence behavior of the childbearing
woman and her family during pregnancy.
2.Understand one’s own cultural values
and norms toward members of
vulnerable population of childbearing
women.
3. Understand the childbearing beliefs
and practices of diverse cultures.
Vl. Transcultural Perspectives in
Childbearing
- Pregnancy and Culture
- Cultural Variations Influencing
Pregnancy Outcomes
- Cultural Issues Impacting
Prenatal Care
- Birth and Culture
- Culture and the Postpartum
Period
- Cultural Issues Related to
Domestic Violence During
Pregnancy
a. Hispanic Pregnant Women
b. African American Pregnant
Women
c. American Indian Pregnant
Women
 Transcultural Perspectives in Childbearing
Cultural Beliefs Related to Activity During Pregnancy

• Cultural variations also involve beliefs about activities during

pregnancy.
• A belief is something held to be actual or true on the basis of a
specific rationale or explanatory model

Cultural Beliefs
1. Prescriptive beliefs
2. Restrictive Beliefs
3. Taboos
1. Prescriptive beliefs - Which are phrased positively, describe what
should be done to have a healthy baby.
Example of Prescriptive Beliefs:
• Remain active during pregnancy to aid the baby's circulation (Crow Indian)
• Keep active during pregnancy to ensure a small baby and an easy delivery
(Mexican and Cambodian)
• Remain happy to bring the baby joy and good fortune (Pueblo and Navajo
Indian, Mexican, Japanese)
• Sleep flat on your back to protect the baby (Mexican)
• Continue sexual intercourse to lubricate the birth canal and prevent a dry labor
(Haitian, Mexican)
• Continue daily baths and frequent shampoos during pregnancy to produce a
clean baby (Filipino)
2. Restrictive Beliefs - Which are phrased negatively, limit choices
and behaviors that are practices/behaviors of the mother should
not do in order to have a healthy baby.
Examples of Restrictive Beliefs:
• Avoid cold air during pregnancy to prevent physical harm to the fetus
(Mexican, Haitian, Asian)
• Do not reach over your head or the cord will wrap around the baby's neck
(African American, Hispanic, White, Asian)
• Avoid weddings and funerals or you will bring bad fortune to the baby
(Vietnamese)
• Do not continue sexual intercourse or harm will come to you and baby
(Vietnamese, Filipino, Samoan)
• Do not tie knots or braid or allow the baby's father to do so because it will
cause difficult labor (Navajo Indian)
• Do not sew (Pueblo Indian, Asian)
3. Taboos - Is the restrictions with serious supernatural
consequences, are practices believed to harm the baby or the
mother.
Example of Taboos:
• Avoid lunar eclipses and moonlight or the baby might be born with a deformity
(Mexican
• Do not walk on the streets at noon or 5 o'clock because this might make the
spirits angry (Vietnamese)
• Do not join in traditional ceremonies like Yei or Squaw dances or spirits will
harm the baby (Navajo Indian)
• Do not get involved with persons who cast spells, or the baby will be eaten in
the womb (Haitian)
• Do not say the baby's name before the naming ceremony or harm might come
to the baby (Orthodox Jewish)
• Do not have your picture taken because it might cause stillbirth ( African
American)
• During the postpartum period, avoid visits from widows, women who have lost
children, and people in mourning because they will bring bad fortune to the baby
(South Asian Canadian)
Food Taboos and Cravings
• The phenomenon of pica has also been described in
other countries including Kenya, Uganda, and Saudi
Arabia (Boyle & Mackey, 1999).
• Another traditional belief in many cultures is that a
pregnant woman must be given the food that she
smells to eat; otherwise, the fetus will move inside of
her and a miscarriage will result (Spector, 2008).
• Pregnant women experience pica: the craving for and
ingestion of nonfood substances, such as clay,
laundry starch, or cornstarch.
• Some Hispanic women prefer the solid milk of
magnesia that can be purchased in Mexico, whereas
other women eat the ice or frost that forms inside
refrigerator units.
Mexican American childbearing women seem to represent a healthy
model for preventing LBW infants.
The influence of acculturation on pregnancy beliefs and practices of
Mexican American childbearing women.
"Selective biculturalism“ emerged as a protective approach to stress
reduction and health promotion. It means represents comfort and
proficiency with both one's heritage culture and the culture of
the country or region in which one has settled.
The women interviewed indicated that regardless of the level of
acculturation to US culture, during pregnancy, they returned to
traditional Mexican practices. ( low-fat, high-protein, natural diet (eat
right-come bien); exercise for well-being (walk-camina); and
avoidance of worry or stress, which could have a negative effect on
the pregnancy outcome (don't worry - no se preocupe).
The women described the family as a major support during
pregnancy, but also valued the economic and personal freedom
available to women in the United States.
These conflicting values lead to the adoption of a "selective bicultural
perspective." This perspective allowed the women to maintain or
reject cultural practices as needed.
Lived in a largely Latino town might have limited their bicultural
stress; pregnant Mexican women living in a more heterogeneous
environment might experience higher levels of stress related to
cultural conflicts.
The health care providers need to not only consider the support from
family and social support networks but also explore the impact of
stress from cultural conflicts on pregnancy outcomes.
Cultural Interpretation of Obstetric Testing
• For traditional Islamic women from the Middle East, the vaginal
examination can be so intrusive and embarrassing that they avoid
prenatal visits or request a female physician or midwife.
• For women of other cultural groups, common discomforts of
pregnancy might be managed with folk, herbal, home, or over-the-
counter remedies on the advice of a relative (generally the maternal
grandmother) or friends
• Nursing visits can be made to the home, or group prenatal visits
might be made based on self-care models instituted by nurses in local
community centers. Additionally, nurses can incorporate significant
others into the plan of care.
• During prenatal visits, nurses can provide information on normal fetal
growth and development, and they can discuss how the health and
behavior of the mother and those around her can influence fetal
outcome
Cultural Preparation for Childbirth
• Women from diverse cultural backgrounds often use culturally
appropriate ways of preparing for labor and delivery. These methods
might include assisting with childbirth from the time of: Adolescence,
1. Adolescence,
2. Listening to birth and baby stories told by respected elderly
women,
3. Following special dietary and
4. Activity prescriptions during the antepartal period.
• Most commonly in American culture, pregnant women and their
significant others attend childbirth classes/or get pregnancy
information from the Internet.
Cultural Preparation for Childbirth
• Preparation for childbirth can be developed through programs that
allow for cultural variations including:
1. Classes during and after the usual clinic hours in busy urban
settings,
2. Teen-only classes,
3. Single-mother classes, ff-up classes combined with prenatal
checkups at home,
4. Classes on rural reservations, and presentations that
incorporate the older "wise women" of the community.
• In addition, nurses can organize classes in languages other than
English and conduct these classes in community settings that are
culturally appropriate and welcoming to women
BIRTH AND CULTURE
Factors such as cultural attitudes toward the
.
achievement of birth, methods of dealing with the
pain of labor, recommended positions during
delivery, the preferred location for the birth, the role
of the father and the family, and expectations of the
health care practitioner might vary according to the
degree of acculturation to Western childbirth
customs, geographic location, religious beliefs, and
individual preference.
Traditionally, cultures have viewed the birth of
a child in one of two very different ways.
(For example, the birth of the first son may be
considered a great achievement worthy of
celebration, or the birth may be viewed as a state of
defilement or pollution requiring various purification
ceremonies.)
 Western culture generally views birth as an
achievement. (This achievement is not always attributed
.
solely to the mother but extends to the medical staff as
well. The celebrations are often centered on the newborn
rather than the mother)
Increasingly, pregnant women and their partners are
assuming more active roles in the management of their
own health and birth experiences. -Playing an active role,
however, does not always ensure the desired outcome.
(For example, some women who have prepared
themselves for a "natural" childbirth might ultimately
require analgesia or a cesarean section, potentially
causing feelings of disappointment or a sense of failure.)

.
 TRADITIONAL HOME BIRTH

.
• All cultures have an approach to birth
rooted in a tradition of home birth, being
within the province of women.
For generations, traditions among the
poor included the use of "granny" midwives
by rural Appalachian Whites and southern
African Americans and parteras by Mexican
Americans.
• A dependence on self-management, a
belief in the normality of labor and birth, and
a tradition of delivery at home might
influence some women to arrive at the
hospital in advanced labor.
.
 • The need to travel a long distance to the
closest hospital might also be a factor
. contributing to arrival during late labor or to
out-of-hospital delivery for many American
Indian women living on rural, isolated
reservations.
• Liberian women are reluctant to share
information about pregnancy and childbirth as
these subjects are taboo to talk about with
others.
• Husbands or male elders are the ones who
make decisions about allowing a woman to
seek care at a clinic or hospital when she is
experiencing a difficult and arduous labor.
.
SUPPORT DURING CHILDBIRTH
Spouses or partners are now encouraged and even
expected to make important contributions in
supporting pregnant women during labor.
US hospitals still enforce rules that limit the
support person from attending the birth unless he
or she has attended a formal childbirth education
program.
US hospitals still enforce rules that limit the
support person from attending the birth unless he
or she has attended a formal childbirth education
program.
Many women also wish to have their mother or
some other female relative or friend present
during labor and birth. Because many hospitals
have rules limiting the number of persons present,
the mother-to-be might be forced to make a
difficult choice among the persons close to her.
.
 CULTURAL EXPRESSION OF
LABOR PAIN
1. According to (Ludwig-Beymer, 2008) Pain is a
highly personal experience, dependent on
cultural learning, the context of the situation,
and other factors unique to the individual.
2. In the past, it was commonly believed that
because women from Asian and Native American
cultures were stoic, they did not feel pain in
labor (Bachman, 2000)
3. Callister and Vega (1998) reported that pregnant
women in labor tend to vocalize their pain..
4. Japanese, Chinese, Vietnamese, Laotian, and
other women of Asian descent maintain that
screaming or crying out during labor or birth is
shameful; birth is believed to be painful but
something to be endured (Bachman, 2000).
Birth Position
1. Mexican American women- favored
birth position is seated position in a
birth chair
2. Laotian Hmong women- squatting
position chosan
3. Many variables other than culture
influence a woman's choice of position,
and the socialization that occurs when
she enters a labor and delivery facility
may prevent her from expressing her
preference.
Cultural Meaning Attached to
Infant Gender
In United States, families saw males as
being the preferred gender of the firstborn
child for reasons including male dominated
inheritance patterns, carrying on the family
name, and becoming the "man" of the family
should the need arise
Although the "structural" conditions in
which son preference was originated have
eroded, the related "cultural" idea of boys
providing higher utility for the family, etc.,
may have survived
In undeveloped countries, depending on
the population and the cultural belief system
in place, sons continue to be desired as the
firstborn
 In Asian culture, the preferred sex of the firstborn
child is male.
If a mother does not have the preferred firstborn
sex, does this increase the likelihood of postpartum
depression (PPD) or negatively impact mother-infant
bonding -cultural belief that there is a relationship between
a mother's mood and the gender of an Asian woman's
firstborn child
There were no significant differences between Asian
women whose firstborn children were female or male in
their reports of feeling depressed or sad
For culturally competent care of Asian childbearing
women, signs of impending depression may be more
subtle such as constant physical complaints
Many Asian women may not be comfortable
expressing their feelings regarding mood, and, as their
cultural beliefs dictate, they may remain in bed for up to 1
month, to assist in healing. (These practices should not be
taken as signs of depression but rather as a trigger for
nurse to learn more about their childbearing cultural belief
system.
 CULTURE AND THE POSTPARTUM PERIOD
Western medicine considers pregnancy and birth the
most dangerous and vulnerable time for the childbearing
woman
Many cultures have developed special practices
during this time of vulnerability for the mother and the
infant in order to mobilize support and strengthen the new
mother for her new role - Influenced Japanese women's
postpartum experience either positively or negatively, that
lack of Japanese health literacy was more likely to obstruct
positive communication between the patient and health care
providers while in the hospital setting, leading to loneliness.
When women felt loneliness, they rated their care
satisfaction low (These findings underscore the need for
nurses to include the patient's health literacy level as part of
their regular assessment and make culturally appropriate I
adjustments to ensure proper patient education and
participation in care)
 POSTPARTUM DEPRESSION (PPD)
HOT/ COLD THEORY
Pregnancy is considered a "hot" state. Because a great
deal of the heat of pregnancy is thought to be lost during the
birth process, postpartum practices focus on restoring the
balance between the hot and cold, or yin and yang
This theory focus on the avoidance of cold, in the form
of air, water, or food. - Fear of detrimental effects of cold air
and water in the postpartum period that can cause cultural
conflict when the woman and infant are hospitalized.
Example: Some women may pretend to follow the activities
suggested by nurses, for example, pretending to shower.
Nurses must assess the woman's beliefs regarding
bathing and other self-care practices in a nonjudgmental
manner
The use of perineal ice packs and sit baths to promote
healing can be replaced with the use of heat lamps, heat
packs, and anesthetic or astringent topical agents for those
who prefer to avoid cold influences.
 POSTPARTUM DIETARY PRESCRIPTIONS AND ACTIVITY LEVEL
 Dietary prescriptions are also common in this period. The nurse might note
that a woman eats little "hospital" food and relies on family y and friends to
bring food to her while she is in the hospital. If there are no dietary
restrictions for health reasons, this practice should be respected.
 Fruits and vegetables and certainly cold drinks might be avoided because they
are considered "cold" foods.
 Nurse should assess what types of food are being eaten by the woman and
document them as appropriate to ensure the foods are nutritious and not
harmful.
 Regulation of activity in relation to the concept of disharmony or imbalance
neludes the avoidance of air, cold, and evil spirits
 Some women from traditional cultural groups view themselves as "sick"
during the post partal lochia flow. (They might avoid heavy work, showering,
bathing, or washing their hair during this time.
 Many traditional cultures suggest that a woman can resume normal activities
in as little as 2 weeks; others suggest waiting up to 4 months
 POSTPARTUM RITUALS

 Placental burial rituals are part of the traditional

Hmong culture, and with the continued growth
in the number of Hmong Americans emigrating
from California to different areas of the United
States, cultural conflicts are common,
especially in the areas of reproductive health
(Clemings, 2001).
 In an effort to assimilate, many Hmong have
continued to use animistic ceremonies and
herbal remedies in addition to using Western
medicine.
 Helsel and Mochel's (2002) study explored
Hmong Americans' attitudes regarding placental
disposition, cultural values affecting those
attitudes, and perceptions of the willingness of
Western providers to accommodate Hmong
patients' wishes regarding placental disposal
 POSTPARTUM RITUALS
 The Hmong believe the placenta is the
baby's "first clothing" and must be buried
at the family's home, in a place where the
soul can find the afterlife garment once
the person is deceased.
 If the soul is unable to find the placental
"jacket." it will not be able to reunite with
its ancestors and will spend eternity
wandering.
 Helsel and Mochel's study (2002) suggests
that even though Hmong immigrants have
embraced Western culture, traditional
Hmong beliefs about placental burial
remain an important cultural belief.
 These beliefs should be respected, and the
staff should make every effort to
accommodate their request.
 CULTURAL INFLUENCES ON BREAST-FEEDING
AND WEANING PRACTICES
 Culturally, breast-feeding and weaning can be affected by a variety of values
and beliefs related to societal trends, religious beliefs, the mother's work
activities, ethnic cultural beliefs, social support, access to information on
breast-feeding, and the health care provider's personal beliefs and
experiences regarding breast-feeding and/or weaning practices, to name a
few.
 The World Health Organization and UNICEF (2010) recommend children
worldwide be breast-fed exclusively for the first 6 months of life followed by
the addition of nutritional foods, as they continue to breast-feed for up to 2
years, with no defined upper limit on the duration.
 While this is common in other cultures, few women in the United States
participate in extended breast-feeding for fear of disapproval; if prolonged
breast-feeding does occur, it is often concealed from family, friends, and
health care providers
 CULTURAL INFLUENCES ON BREAST-FEEDING
AND WEANING PRACTICES
 For breast-feeding women from traditional backgrounds, it is important for
nurses to be aware of factors that have been shown to affect the quality and
duration of the breast-feeding experience, along with factors impacting
weaning practices.
 English-speaking adolescent mothers, who were currently breast-feeding or
had breast-fed their infants within the past 6 months, were invited from teen
obstetric clinics at two urban university-affiliated medical centers.
 Among those who weaned, problems, such as perceptions of insufficient milk
supply, nipple/breast pain, time demands of school or work, problems with
pumping, embarrassment, lack of support, and feeling overwhelmed and
frustrated led to weaning.
 Reported influences included perceptions of breast-feeding benefits (bonding,
baby's health), perceptions of the problems with breast-feeding (pain,
embarrassment, no experience with the act of breast-feeding), and respected,
influential people (Hannon, Willis, Bishop-Townsend, Martinez, & Scrimshaw,
2000).
 CULTURAL INFLUENCES ON BREAST-FEEDING
AND WEANING PRACTICES
 Breast-feeding among indigenous populations (e.g., Aboriginal/Alaska Native
and American Indian women) declined with the advent of infant formula
availability. - However, there has been a push from within Native American
communities to a return to infant feeding "the natural way."
 There has also been research suggesting that breast-feeding may have a
significant impact on the development of diabetes in later life. - A program
that targets promotion of breast-feeding among Native women as a type 2
diabetes prevention intervention promotes the use of elders and family for
support (Murphy & Wilson, 2008). - The promotion strategies include
educating extended family on breastfeeding benefits; teaching the nutritional
merits of breast-feeding, particularly to the maternal grandmother;
addressing the social, emotional, and spiritual aspects of breast-feeding;
using the oral tradition as a way to share information; setting the stage for
cooperative and interactive learning; and creating teaching methods that
avoid conventional courses, lectures, or written materials on infant-feeding
practices, as native women are not attracted to or affected by these methods.
 CULTURAL INFLUENCES ON BREAST-FEEDING
AND WEANING PRACTICES
 In the Kanesatake project, a respected elder volunteered to promote breast-
feeding in her community. After completing a training session, she chose
toluse subtle teaching encounters at banks, grocery stores, and social
gatherings as a way to promote breast-feeding. Support groups or "talking
circles" were organized for extended family and grandmothers of pregnant
women where breast-feeding issues were discussed openly and freely, led by
the elder. This approach is a good example of how community strengths,
incorporation of culturally specific learning styles, and cultural sensitivity can
be used as the foundation for successful program development.
 Prior to the industrialized age, women always breast-fed or, if they were of
"royal" blood or upper class, they used "wet nurses," women who had
recently had a baby themselves and breast-fed other women's babies. -
Midwives attended births.
 CULTURAL INFLUENCES ON BREAST-
FEEDING
AND WEANING PRACTICES
 They had a variety of names: aunties, medicine
women, midwives, doulas, or grand-mothers
(grannies), but whatever their names, they were
women that have and still are providing the
support necessary for successful birthing and
breast-feeding experiences. -As immigrants
continue to pour into the United States and
American-born women adhering to their traditional
cultural heritage attempt to make informed
decisions regarding infant-feeding practices, it is
imperative as nurses to examine specific cultural
norms and practices that influence breast-feeding
outcomes as we work to develop successful
strategies.
 CULTURAL ISSUES RELATED TO INTIMATE
PARTNER VIOLENCE DURING PREGNANT
 Domestic violence has emerged as one of the most
significant health care threats for women and their
unborn children. . A study by Shadigian and Bauer
(2005) identified homicide as a leading cause of
pregnancy-associated death and suicide also as an
important cause of death among pregnant and recently
pregnant women.
 Health care providers must acknowledge and
understand that homicide is a leading cause of
pregnancy-associated death and commonly is a result of
intimate partner violence (IPV).
 Screening for both partner violence and suicidal ideation
is an essential component of comprehensive health and
nursing care for women during and after pregnancy.
 It has been well documented (Bewley & ffibbs, 1994) that
physical abuse during pregnancy is often focused on the
abdomen, breasts, and/or genitals, which puts both the
mother and her unborn child at risk. These factors can
also affect both the mother's health and potentially affect
the future health of the newborn and later as the child
develops.
 Information regarding women in abusive situations is
scarce, partly because of underreporting.
 We do know, however, that abused women are less likely
to seek health care because their abuser limits access to
resources and that battering occurs more frequently
during pregnancy. It is estimated by the CDC (2009) that
24,000 pregnant women are victims of IPV each year.
 An abused pregnant woman has a greater risk of
delivering an LBW infant. One of the associations
between abuse and LBW is delay in obtaining prenatal
care.
 Indeed, findings from studies conducted during the past two
decades have clearly shown that physical and sexual abuse
predicts poor health during pregnancy and the postpartum
period (Leserman, Stewart, & Dell, 1999).
 Taggart's and Mattson's (1996) study of the relationship
between battering and prenatal care is still pertinent for
nurses who care for pregnant women.
 The legacy of patriarchy, which is still deeply embedded in
our culture, undoubtedly contributes to violence against
women as do other factors, especially alcohol and drug
abuse.
 Kita, Yaeko, and Porter's (2014) study of intimate partner
violence (IPV) in Japan reported risk factors associated with
IV during pregnancy, which included pregnant women,
multiparous, previous abortion experience, and having a male
partner.
 American Indian Pregnant Women Violence within families has
not always been part of American Indian society.
 Traditionally, American Indian cultures were based on harmony
and respect
 Many activities Western culture has ascribed to one sex were
shared in American Indian society, including the roles of warrior
and hunter.
 As Indian communities strive to maintain their cultural
heritage, the concepts of spirituality (balance, harmony,
oneness), passive forbearance (humility, respect, circularity,
connection, honor), and behaviors that promote harmonious
living are reinforced in daily living (Nichols, 2004). –
 Historically, cruelty to women and children resulted in public
humiliation and loss of honor.
 Cultural disintegration, poverty, isolation, racism, and
alcoholism are just a few of the problems that have fostered
violence in American Indian.