*Pregnancy and culture

All cultures recognize pregnancyall cultures recognize pregnancy as a special position. I may have
practice tonight. They activity and behavior during pregnancy.

 Biologic Variation

Knowledge of certain Biologic variation resulting from genetic and environmental backgrounds is
important for nurses who care for childbearing families. For example, pregnant women who have
the sickle cell trait and are heterozygous for the sickle cell gene are at increased risk for
asymptomatic bacteriuria and urinary tract infection such as pyelonephritis.

 Cultural Variation

Several cultural variation might influence pregnancy. Those highlighted in this chapter include
alternative lifestyle choices nontraditional system culture believes related to parental activity
during pregnancy and food Taboos and cravings .

 Alternative lifestyle choices

-Despite recent cultural changes that have made it more acceptable for a woman to have careers
and pursue alternative lifestyle, the dominant cultural expectation for North American women
remains motherhood within the context of the nuclear family.

 Infant relinquishment

-is In direct conflict with western idea cultural values, which suggests that all parents Want a
child.

 Lesbian couple childbearing

- occurs in another subculture of pregnant women with special needs. This group of women faces
psychosocial dilemmas related to their lifestyle and social stigma.

 Nontraditional support systems

Culture of variation that Has important implication is a woman’s perception of the need for
formalized assistant from healthcare providers during the other antepartum period. Western
medicine is generally perceived as having a curative rather than a preventive focus. Indeed, may
healthcare providers view pregnancy as a disaster waiting to happen, a psychologic state that at
any moment will become pathologic.
  Cultural Beliefs Related to Parental Activity During Pregnancy

Cultural variation also involve beliefs activities during pregnancy . A belief is something held to be
actual or true on the basis of a specific rationale or explanatory model. Prescriptive beliefs,
which are phrased positively, describe expectancies of behavior,the more common restrictive
beliefs which are phrased negatively, limit choices and behavior.

 Food taboos and cravings

Among many subcultures , women perceive little personal control over the outcomes of
pregnancy except through the avoidance of foods that are considered taboo.

 Cultural Prenatal Care

Morgan’s (1996) study of African- American women explored beliefs,practices, values related to
prenatal care. The findings indicated that many of the women in urban areas lacked trust and
were apprehensive about their current life circumstances. Urban African- American women
indicated that they had less support than their contemporaries in the rural South.

 Cultural Interpretation of Obstetrics Testing

Many women do not understand the emphasis that western prenatal care places or urinalysis,
blood pressure readings, and abdominal measurements.For traditional women,the vaginal
examination might be so intrusive and embarrassing that they might avoid prenatal visit or
request a female physician or midwife.

 Cultural Preparation for Childbirth

Preparation for childbirth can be developed through programs that allow for cultural variation,
including classes during and after the usual clinic hours in busy urban settings,teen - only classes,
single mother classes, group classes combined with prenatal checkup at home, classes on rural
reservation, and presentation that incorporate the other “wise women” of the community. In
addition, nurses can organize classes in language other than English.

*Birth and culture

Beliefs and Customs surrounding the experience of labor and delivery are influenced by the fact
that the physiologic processes are basically the same in all culture. Factors such as cultural
attitudes towards the achievement of birth, methods of dealing with the pain of labor,
recommended position during delivery, the preferred location for the birth, the role of the father
and the family, and expectations of the health care practitioners might vary according to the
degree of acculturation to Western childbirth customs, geographic location,religious beliefs , and
individual preferences.

 Traditional Home Birth

All cultures have an approach to birth rooted in a tradition in which childbirth occurs at home,
within the province of women.For generations, traditions among the poor included the use of “
granny” midwives by ruralAppalachian whites and southern African American and parteras by
Mexican Americans.

 Support During Childbirth

Despite the traditional emphasis on female support and guidance during labor, the inclusion of
spouses and male partners in North American labor and birth rooms has been seen as positive by
women of many cultures. Fortunately,this situation has changed a great deal in the past few
years, so that husbands or partners now make important contributions supporting and helping
pregnant women during labor.

Some women and families, particularly those from Orthodox, Jewish, Islamic , Chinese, and Asian
Indian backgrounds, might follow strict religious and cultural prohibition against viewing the
woman’s body by either the husbands or any other man, or they might practice separation of the
husband and wife once the “ bloody show” or cervical dilation has occurred.

 Cultural Expression of Labor Pain

Although the pain threshold is remarkably similar in all persons regardless of gender,
social,ethnic,or cultural differences, these differences play a definite role in a woman’s perception
of labor pain.

 Birth Position

Numerous anecdotal reports in the literature describes “ typical “ birth positions for women of
diverse cultures, from the seated position in a birth chair favored by Mexican-American women
to the squatting position chosen by Laotian Hmong women.

Economically disadvantaged women from culturally diverse backgrounds have few birth options;
most labor and given birth in large public hospitals.

 Cultural Meaning Attached to Infant Gender or Multiple Births

The meaning that parents attach to having a son, daughter, or multiple births varies from culture
to culture. Traditionally, the male gender is highly regarded, which places female infants in a
position of “ less than favorable”. In certain Asian and Islamic cultures, it is felt that a male child is
preferable to a female child .

*The Postpartum Period

Western medicine considers pregnancy and birth the most dangerous and vulnerable time for
the childbearing woman. However other cultures places much more emphasis on the postpartum
period.

Routine postpartum nursing care usually includes encouraging a healthy diet, adequate fluid
intake , and self -care practices such as good hygiene practices ,site baths , showering , bathing ,
ambulating, and exercise . However, these practices, common in North American obstetrics
care ,might seems strange and even dangerous to women of other cultural groups.

Imbalance is perceived to be the result of disharmony caused by the processes of pregnancy and
birth, and pollution is seen to be caused by the “ unclean” bleeding associated with birth and the
postpartum period.Restitution of physical balance and purification might occur through many
mechanism, including dietary restrictions, rituals baths,seclusion,restrictions of activity, and
other ceremonial events.

 Hot/Cold Theory

Central to the belief of perceived imbalance in the mother’s physical state is adherence to the
hot/coldtheories of disease causation. 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/cold beliefs , Yin and Yang .

Postpartum Dietary Prescriptions and Activity Levels

Dietary prescription are also common in this period. The nurse might note that woman eats little
“hospital” food and relies on family and friends to bring food to her while she is in the hospital. If
there are no diet restrictions for health reasons this practice should be respected indeed the
nurse should assess what types of food are being eaten by the woman and documenting them as
appropriate.
*Culturally Competent Nursing Care for Vulnerable
Clients During Pregnancy
In this section culture not only will be viewed from an ethnic or culturally diverse point of view
but additionally will examine “cultures within a culture “or subcultures. Some of the shared
characteristics include stress (physical and emotional) poor lifestyle health practice, delayed
prenatal care, lack of support , and exposure to violence. This section will examine the ideologist
of each group and offer recommendations about how nurses can offer support to vulnerable
pregnant women in these unique circumstances.

 Physically Abuse Pregnant Women

Main forms of abuse in the pregnant population warrant attention and discussion . In This section
however the focus will be on the physical abuse of pregnant women. Information regarding
women in abusive situation is scarce, partly because of under reporting.Important information
we do know is that abuser women are less likely to seek healthcare because their abuser limits
access to resources and battering occurs more frequently during pregnancy.

 Hispanic Pregnant Women

Although there are many different Hispanic groups they do share some important commonalities
example religion,customs, and language as with any cultural group differences exist among the
members. Incidence of wife abuse among pregnant Hispanic women is not clear in the literature.

Access to healthcare for pregnant and Hispanic women is problematic barrier to prenatal
healthcare include lack of healthcare insurance; low levels of education ,which encourages the
use of traditional healers and remedies and my foster mistrust of physicians and nurses and lead
to non compliance when pregnant women do use modern medicine; lenghtly travel time to clinic
it followed by long waits and the lack of Spanish speaking healthcare professionals. Hispanic
women tend to be in low-paying jobs whose annually earnings are considerably less than those
non-Hispanic women.

 Black Pregnant Women

Cultural Beliefs of blacks emphasize the larger black society rather than focusing on
individuals, making ‘’all’’ collectively responsible for one another [McNair,1992].
Therefore, black women exists in a social context supported by social connectedness
versus that of autonomy. One of the most difficult barriers confronting black abused
women attempting to get help from police or from the legal system is the stereotypical
 view suggest that violence among Black is normal [Hawkins,1987].
 NATIVE NORTH AMERICAN PREGNANT WOMEN
Violence with families has not always been part of Native North American society. Albers
and medicine [1983] noted that before contact with Europeans , Native North American
society was based on harmony and respect for nature and all living things , sharing , and
cooperation. Traditionally , cruelly to women and children resulted in public humiliation
and loss of honor.
Since the 1970s , Native North American tribes have made an effort to develop programs
to meet the needs of their communities. However , abuse among women has not been
addressed adequately because of the male – dominated leadership , other needs of
tribes , and the shame associated with abuse [ Bohn , 1993].
 HOMELESS PREGNANT WOMEN
Issues related to homelessness are multiple and complex , but for a pregnant homeless
woman , this time of physiologic and psychologic change without proper medical
management is particularly problematic. Evidence – Based practice 5-7 summarize a
study by killion (1995) and includes interventions for criminal appilication.