PAPER

HEALTH CULTURE BELIEFS: PREGNANCY

(this paper is compiled to fulfill the assignment of the Transcultural Nursing course)
Lecturer:
Mum. Ni Putu Wulan P. S, S.Kep.,Ns.,M.Kep

Compiled by:
1. Rika Puspaningrum (9103022012)
2. Maryano Rayvalldy Saputra Soloilur (9103022029)
3. Sandro Joseph (9103019033)
4. Charinina Salsabila (9103022049)
5. Viemia Kilay (9103022047)
6. Angga Marcellino (9103022015)
7. Maria Merlinda (9103022030)

Faculty of Nursing

Widya Mandala Catholic University Surabaya

School Year 2023/2024

 CHAPTER 1
INTRODUCTION
1.1 Background
Living in the current era of transcultural is one of the things that is always considered,
the definition of transcultural when viewed from the meaning of the word, transcultural
comes from the words trans and culture, trans means the flow of displacement, cross
roads or connections. According to the Big Dictionary Indonesian; trance means
transverse, cross, penetrate, through. While Culture means culture. According to the Big
Dictionary Indonesian culture means; culture, ways of maintenance, cultivation. Common
beliefs, values and patterns of behavior apply to a group and are passed on to the next
generation, while cultural means; something related to culture. Culture itself means:
reason, results and customs. And culture means the result of human activities and inner
creation (reason) such as beliefs, arts and customs or the entire knowledge of man as a
social being used to guide his behavior. Culture is one of the manifestations or forms of
real interaction as humans of a social nature. So, transcultural can be interpreted as cross-
cultural which has the effect that one culture influences another culture or also the
meeting of two different cultural values through the process of social interaction (Ari
Pebru Nurlaily, 2018).
Transcultural is widely applied in various fields, one of which is nursing, In the world
of nursing, nurses are expected to be able to provide nursing care holistically or
comprehensively ranging from biological, psychological, social, cultural and spiritual. In
nursing, many theories underlie the science. Including one of the theories that underlies
how nurses' attitudes in applying nursing care. One of the theories applied in nursing care
is Leininger's theory of "transcultural nursing
Transcultural nursing is an area of nursing that emphasizes the importance of culture
to nursing services. The application of theory in transcultural nursing expects an
awareness of cultural differences. Cultural differences exert an influence in the provision
of nursing care that demands on the possibility of variations in nursing approaches by
respecting individual cultural values (Ari Pebru Nurlaily, 2018). The transcultural
approach is nursing care that is oriented to cultural backgrounds in the form of norms,
beliefs, customs, and lifestyles that become a reference for thinking and acting (Yuli &;
Arum, 2019).
This culture is also applied in pregnancy-related nursing, many beliefs arise in society
for example related to massageseeing the importance of this cultural aspect we want to
research culture related to pregnancy so we chose the title of the paper HEALTH
CULTURE BELIEFS: PREGNANCY.

1.2 General Purpose

1. To know the definition of transcultural nursing.
2. To know the purpose of using transcultural nursing theory.
3. To know the advantages and disadvantages of transcultural nursing.
4. To know the application of transcultural nursing in pregnancy.

1.3 Special Purpose

The specific purpose of making this Health Culture Beliefs: Pregnancy paper is to
fulfill the task of making transcultural nursing papers as well as increase the author's
skills in making papers.
1.4 Benefit
The making of this paper is expected to be useful to increase the insight of students
and the general public about public beliefs related to health in pregnancy.
1.5
 CHAPTER 2
LITERATURE REVIEW
2.1 Understanding Pregnancy
Pregnancy is a physiological process that occurs in women due to fertilization
between male sex cells and female sex cells. In other words, pregnancy is the
fertilization of the ovum by spermatozoa, so that it nidates the uterus and develops
until the birth of the fetus (Pratiwi and Fatimah, 2019).
According to Ambar, et al (2021) pregnancy usually lasts 40 weeks or 280 days,
from the first day of the last menstruation. Pregnancy that passes 294 days or 42
weeks is a postdate pregnancy, the diagnosis of gestational age more than 42 weeks is
obtained from calculations such as neagle formula or with fundus uterine height.
Postterm pregnancy has an influence on fetal development until fetal death. There
are fetuses that within 42 weeks or more their weight increases continuously, some do
not increase, some are born with less weight than they should, or die in the womb due
to lack of food or oxygen. Postterm pregnancy is closely related to mortality, perinatal
morbidity, or macrosomia. Meanwhile, the risk for postterm mothers can be in the
form of postpartum bleeding or increased obstetric measures (Ambar, et al. 2021).

2.2 Signs and Symptoms of Pregnancy

Signs and symptoms of pregnancy are:
1. Sure signs of pregnancy
a. Fetal movements that can be seen/touched/felt, as well as parts of the fetus.
b. Fetal heart rate
i. Heard with a monoral leannec stethoscope.
ii. Recorded and heard Doppler tools.
iii. Recorded with feto electrocardiogram.
iv. Seen on ultrasound (ultrasound).
c. Visible fetal bones in X-ray

2. Uncertain signs of pregnancy (persumptive)

a. Amenorrhea Gestational age can be calculated from the date of the first
day of the last menstrual period (HPHT) and the estimated date of delivery
(TTP) which is calculated using the naegele formula, namely TTP =
(HPHT + 7) and (month HT + 3).
b. Nausea and Vomiting
It usually occurs in the first months of pregnancy to the end of the first
quarter. Often occurs in the morning, hence the name morning sickness.
c. Cravings
Pregnant women often ask for certain foods / drinks, especially in the first
quarter months, can not stand an odor.
d. Faint
When you are in crowded and crowded places you can faint.
e. Anorexia
It lasts only in the first quarter of pregnancy, then appetite recurs.
f. Fatigue
g. Mammae enlarged
The mammae is enlarged, tense and slightly painful due to the influence of
estrogen and progesterone which stimulate the ducts and alveoli of the
breast. Montgomery's glands look enlarged.
h. Miksi
 Micsy often occurs because the bladder is compressed by an enlarged
uterus. These symptoms will disappear in the second quarter of pregnancy.
i. Constipation / obstipation
Constipation occurs because intestinal muscle tone decreases by the
influence of steroid hormones.
j. Skin pigmentation
Skin pigmentation due to the influence of placental corticosteroid
hormones, found on the face (Chloasma gravidarum), breast areola, neck
and abdominal wall (linea nigra = grisea).
k. Epulis or can also be called hypertrophy of the gum papilla.
l. Expansion of veins (varicose veins). Occurs on the legs, calves and vulva.
This condition is usually found in the final quarter.

3. Signs of possible pregnancy

a. The belly is enlarged.
b. The uterus is enlarged.
c. Hegar Sign. Found in 6-12 weeks of pregnancy, that is, the presence of the
uterus of the lower segment of the uterus that is softer than the other parts.
d. Chadwick's sign There is a change in color of the cervix and vagina to
bluish.
e. Piscaseck's sign is an empty spot in the uterine cavity because the embryo
is usually located at the top, with bimanual will feel an asymmetrical lump.
f. Small contractions in the uterus when stimulated (braxton hicks).
g. Palpable ballotement.
h. Positive pregnancy reaction

2.3 Pregnancy Stage

Pregnancy is divided into three periods, namely:
1. First quarter pregnancy (between 0 to 12 weeks).
2. Second quarter pregnancy (between > 12 to 28 weeks).
3. Last quarter of pregnancy (between > 28 to 40 weeks).

2.4 Physiological Changes in Pregnancy

Physiological changes that occur in pregnancy are:
1. Changes in the reproductive system
a. Uterine
b. The size of the uterus is enlarged.
c. Weight from 30 grams to 1000 grams by the end of pregnancy.
d. The shape and consistency become longer and softer (hegar mark, and
pisscacek.
e. Vascularization occurs.
2. Vagina
The vagina and vulva have increased blood vessels due to the influence of
estrogen so that they appear red and bluish.
3. Ovary
The ovaries cease to exist, there is still a corpus luteum gravidarum until the
placenta is formed, which takes in the secretion of estrogen and progesterone.
4. Breast
As a preparation for breastfeeding, breast development is influenced by estrogen
and progesterone, and sosamomamotropy.
 5. Changes in other organs and systems
1. Maternal blood circulation
a. Increase circulatory needs to meet the needs of fetal growth and
development.
b. Direct connection between arteries and veins in retnoplascenter.
c. The effect of an increase in the hormones estrogen and progesterone.
d. The volume of blood is increasing and the amount of serum is more
than cell growth occurs hemodilution.
e. Experiencing physiological anemia as a result of hemodilution.
2. Digestive system
The influence of estrogen increases, the release of stomach acid causes
hypersalivation, morning sickness, emesis gravidarum, feeling hot in the
stomach due to the influence of progesterone causes slower bowel movements
resulting in constipation.
3. Respiration system
There is an urge to diaphragm due to the push or enlargement of the uterus and
as a result of increased oxygen demand, pregnant women will breathe deeper.
4. Changes in the skin
Occurs cloasma gravidarum, striae livida, strie alba, strie nigra, pigmentation
on mamae or papillae mamae.
5. Metabolic changes
a. Basal metabolism rises by 15-20%.
b. Acid-base balance is reduced due to hemodilution of blood and mineral
needs for the fetus.
c. The need for nutrients increases.
d. Normal pregnant women's weight gain is between 6.5-16.5 kg during
pregnancy or 0.5 kg per week.

2.5 Psychological Changes in Pregnancy

Psychological changes in pregnant women according to the trimester of pregnancy
are:
First trimester
1. Anxiety Mixed with Happy
The most prominent psychological change in the first trimester of pregnancy is the
emergence of anxiety and doubt as well as a sense of happiness. The emergence of
doubt and worry is closely related to the quality of the ability to care for and
nurture the baby and her womb, while the feeling of happiness is because she feels
perfect as a woman who can conceive.
2. Emotional Changes
Emotional changes in the first trimester cause a decrease in sexual will, fatigue
and nausea, mood swings, anxiety, depression, worry about the mother's well-
being and her baby, worry about the form of self-appearance that is less attractive
and so on.
3. Ambivalent Attitude
Ambivalent attitudes describe a simultaneous conflict of feelings, such as love and
hatred towards someone, something or condition. Although ambivalent attitudes
as individual responses are normal, but when entering the postpartum phase can
create new problems. The causes of ambivalence in pregnant women are changes
in physical condition, poor pregnancy experiences, career mothers, new
 responsibilities, anxiety about their ability to be mothers, finances and acceptance
attitudes of their closest family.
4. Uncertainty or Uncertainty
Early in the week of pregnancy, mothers often do not feel unsure of their
pregnancy. And this is exacerbated if the mother has emotional and personality
problems. However, most pregnant women continue to try to find reassurance that
they are pregnant and must need special attention and care for their babies.
5. Sexual Changes
During the first trimester a woman's sexual desire decreases. The things that cause
it come from the fear of miscarriage that encourages both partners to avoid sexual
activity.
6. Focus on Yourself
In the first months of pregnancy, often the mother's mind focuses more on her
own condition, not on the fetus. However, it does not mean that mothers pay less
attention to the condition of their babies. The mother feels more that the fetus she
is carrying becomes an inseparable part.
7. Stress
The possibility of stress that occurs during the first trimester of pregnancy can
have a negative and positive impact, where both of these stresses can affect the
mother's behavior. Sometimes the stress is intrinsic and extrinsic. Extrinsic stress
arises due to external factors such as illness, loss, loneliness and reproductive
period.
8. Psychological Shock
The occurrence of mental shock is estimated to be smaller in the first trimester and
more focused in the first pregnancy.

Second Trimester
During the second trimester phase of life the psychology of pregnant
women seems calmer, but the mother's attention begins to turn to changes in body
shape, sex life, family and inner relationships with the baby she is carrying, as
well as an increased need to be close to the mother figure, see and imitate the
mother's role and the mother's increasing dependence on her partner. Some forms
of psychological changes in the second trimester, namely:
1. Worry / Anxiety
The basic concern for mothers is if the baby is born at any time. This situation
causes increased alertness to the arrival of signs of labor. This is exacerbated
by concerns if the baby she gave birth to is abnormal. This paradigm and
anxiety makes most mothers try to reduce it by protecting their babies by
taking vitamins, diligently controlling and consulting, avoiding people or
objects that are considered harmful to their babies.
2. Emotional Changes
The most prominent emotional changes in the second trimester are the fifth
month of pregnancy, because the baby begins to move a lot so that the mother
begins to pay attention to the baby and think about whether the baby will be
born healthy or deformed. This anxiety continues to increase as she gets older
in pregnancy.
3. Desire to Have Sex
In the second trimester there is an increase in libido energy so in most mothers
it becomes concerned if she has sex whether this can affect her pregnancy and
fetal development. A common form of concern is whether there is a possibility
 of fetal injury due to penis, maternal orgasm, or ejaculation. However, what
you need to know is that sex during pregnancy has no effect because the fetus
is protected by amniotic fluid in the uterus.
Third Trimester
1. Discomfort
Discomfort due to pregnancy reappears in the third trimester and in most
mothers feel the body shape is getting worse. In addition, feelings of
discomfort are also related to feelings of sadness because they will be
separated from their babies and lose the special attention received during
pregnancy so that mothers need support from husbands, families, midwives.
2. Emotional Changes
In the last months before delivery, the mother's emotional changes are
increasingly changing and sometimes become uncontrollable. This emotional
change boils down to feelings of worry, anxiety, fear, doubt and doubt lest the
current condition of her pregnancy is even worse before labor or worry and
anxiety due to her inability to carry out her duties as a mother after the birth of
her baby.

2.6 Psychosocial Support for Pregnant Women

Psychological support provided to pregnant women are:
1. Husband Support
Positive husband support to pregnant wives will have a positive impact on fetal
growth and development, physical and psychological health of the mother. The
form of husband support is not enough from the financial side alone, but is related
to love, instilling self-confidence, open and honest communication, caring, caring,
responsiveness and readiness to be a father.
2. Family Support
Pregnant women often feel dependence on others, but the nature of dependence
will be great when approaching labor. This trait is influenced by the need for a
sense of security, especially security and safety during childbirth. The support of
extended family increases the confidence and mental readiness of mothers during
pregnancy and when facing childbirth.
3. Mother's Personal Readiness Level
Personal readiness is a great capital for the physical and psychological health of
the mother. Related to personal readiness is the ability to balance physical changes
with psychological conditions so that physical and mental burdens can be passed
with joy, without stress or depression.
4. Mother's Traumatic Experience
Trauma that occurs in pregnant women is influenced by the attitude, mentality and
quality of the mother. The occurrence of fear like this excessively will inhibit and
disrupt the mother's mental immunity. The heavy burden of trauma will affect the
fetus and the mother. Mother will be difficult to think, difficult to control
emotions, impulsive, afraid and so on.
5. Mother's Activity Level
Doctors recommend mothers to do prenatal exercises that have been specially
designed for pregnant women. Exercises that are beneficial for pregnant women
are exercises to strengthen the abdominal wall that will support the uterus and
pelvic muscles, leg exercises to improve circulation and avoid muscle cramps.
Transcultural Understanding When viewed from the meaning of the word,
Transcultural comes from the word trans and culture. According to the Great
Dictionary of Indonesian, trance means transverse, cross, penetrate, through.
According to the Big Dictionary Indonesian culture means culture, ways of
maintenance, cultivation, beliefs, values and patterns of behavior that generally
apply to a group and are passed on to the next generation. Culture itself means
reason, results and customs, and culture means the results of human activities and
inner creation (reason) such as beliefs, arts and customs or the entirety of human
knowledge as a social being used to guide his behavior. So, transcultural can be
interpreted as cross-cultural that has the effect that one culture influences another
culture or also the meeting of two different cultural values through the process of
social interaction.
Transcultural Nursing is an area related to differences or similarities in
cultural values (different cultural values, race, which affect a nurse when doing
nursing care to clients or patients. (Leininger, 1991). Leininger thinks it is
important to pay attention to cultural diversity and values in applying nursing care
to clients. Leininger defines transcultural nursing as a broad area in nursing that
focuses on the comparative study and analysis of cultural and subcultural
differences by appreciating caring behavior, nursing care and health-sick values,
beliefs and patterns of behavior with the goal of developing a scientific and
humanistic body of knowledge for a specific culture and a universasl culture in
nursing (Andrews andBoyle, 1997: Leininger and McFarland, 2002).
 CHAPTER 3
PREGNANCY-RELATED CULTUR IN INDONESIA
3.1 Eastern Indonesia (Papua, Yepase Tribe)
One example in Eastern Indonesia is in the Papua region, namely the Yepase
tribe. The people of the yepase tribe believe in abstinence from certain types of
nutritious foods such as abstinence from eating large fish which according to beliefs
can cause bleeding, eating fruit can cause watery genitals. This behavior can affect
nutritional intake during pregnancy and birth (Agustina et al, 2013).
As a community whose livelihood pattern is gathering and cultivating, the
Yepase People have traditionally used natural resources as traditional medicine. The
mother during pregnancy and the baby will be advised to use traditional methods and
herbs as treatment materials (Agustina et al, 2013).

3.2 Central Indonesia (East Sumba)

One example of pregnancy culture in central Indonesia is the pregnancy
culture in East Sumba, where people from east Sumba have a belief that during
pregnancy pregnant women should not sit at the door of the house, weave, enter the
house where there is a corpse, catch fish, eat eggs while the husband should not spin
ropes, cut off animal ears, comb hair, they are prohibited from slaughtering animals
and are prohibited from having intercourse since the age of four months, People
from Sumba believe that the taboos that must be done by the sumi and the wife must
be considered because according to Sumbanese people the period of pregnancy and
childbirth is considered a period full of dangers that can threaten the fetus and its
mother (Domianus, 2018).

3.3 Western Indonesia (Madura)

One example of pregnancy culture in western Indonesia is the pregnancy
culture in the Madura area, Madurese people still consider baby shamans to have an
important role in pregnancy services, one example is pregnancy massage. It is
described as done for generations as gratitude to God for the blessing of pregnancy,
so that the pregnancy is safe, the fetus is healthy. Pregnant women fear that if they
do not follow existing traditions, it will cause problems during their pregnancy, such
as miscarriage, difficult birth or other negative impacts on mother and baby. All
traditional beliefs and practices are adhered to and carried out to ensure the health
and safety of mother and baby, facilitate birth and ensure the baby becomes a good
person.
The pregnancy massage process was first carried out on pregnant women at 4
months gestation; Less than 4 months is considered too young to get a massage. The
goal is to improve the position of the baby and reduce the stiffness and fatigue of the
mother during pregnancy. This can take up to 30 minutes, and involves the use of
olive oil or coconut oil. If the position of the baby is incorrect, the mother will
experience discomfort and difficulty walking and urinating; The baby shaman will
'fix' the baby's position with a 'junjung' (dizziness up' massage. All pregnant women
in Madura Most do "uphold" at least 1x in the period of pregnancy between 4
months - 9 months before death.
 CHAPTER 4
PREGNANCY-RELATED CULTUR ON 5 CONTINENTS
4.1 Asian continent
According to Filipino beliefs, eating raw eggs before giving birth to help
lubricate the course of labor. This is believed to make the baby come out more
easily.
Rubbing the belly seems like a natural thing to do, but according to the story
of an old wife in China, a pregnant woman should refrain from rubbing her belly
excessively. This is believed to cause babies to become spoiled and fussy after birth.
Chinese women also believe sleeping with a knife under their bed can scare away
evil spirits. Some even have a piece of paper cut to resemble scissors hanging on the
bed.
In some parts of India, a ceremony called valaikaapu is held to celebrate a
pregnant woman in her seventh month of pregnancy. This event is a Tamil ritual
ceremony that is carried out in late pregnancy, and the mother-to-be will be
decorated with bracelets on both hands with an odd number. Society believes that the
loud sound of a bracelet will increase a child's senses and brain activity.
Some cultures believe that pregnant women should not attend funerals. For
example, there is a belief in Thailand that says if a pregnant woman attends a
funeral, her baby will be haunted by the spirits of the dead once born. Then, in order
for the childbirth procession to be easy, the mother-to-be is told to eat the lotus bud
that a Buddhist monk has prayed for. Doing so is said to open up their bodies like
lotus flowers, making childbirth easier.
In Vietnam itself there are many pregnancy restrictions, one of which is that
pregnant women should not step on hammocks, otherwise the baby will become
lazy.
While in Korea, they believe that if you want a good-looking baby, expectant
mothers are encouraged to eat interesting foods such as the middle piece of kimbap.
This is because the middle of kimbap is usually more regular and prettier than the
tip. This belief applies not only to kimbap, but also to other foods, which means you
should eat more appetizing portions of the food.

4.2 Continental Europe

 Expectant mothers in the Netherlands feel more comfortable and happy if
they give birth at home. So this windmill country is recorded as the country with the
highest homebirth perpetrators in Europe. There are about 33 percent of babies in
this country who are born at home. After giving birth, the mother will be assisted by
a nurse to take care of all the needs of the little one. Uniquely, nurses will also take
care of the needs of mothers, including household chores, you know. Generally, this
nurse will stay for 10 days at home after the mother gives birth.
In Munich, Germany, instead of a blanket, the newborn will be wrapped in
the father's shirt before being handed over to the mother. This is done so that the
little one not only feels close to his mother but also to his father as well.
Due to the low air temperature, for comfort when giving birth to pregnant
women Finland has its own unique way. The tradition in this country is that mothers
choose to give birth in a sauna. Comfortable and warm so that it can make it easier
for mothers to concentrate when giving birth.

4.3 The Americas

People in the Americas believe that if mothers-to-be have difficulty giving
birth, the tradition in Guatemala will ask mothers to drink liquid from onion stew.
This is done so that the labor process is completed immediately. Then, in Peru if the
placenta does not come out after the little one is born, the mother must smear her
tongue with salt. That said, it is believed to make the placenta come out quickly.
Meanwhile, Native Americans have a belief that mothers who love to knit
must finish their knitting before giving birth. If not, then the process of giving birth
to your little one can later be hampered. Another unique thing is, congratulations for
women who give birth in America. Instead of getting hugs but formal handshakes
from everyone you meet, this position is a form of congratulations for getting
through difficult times.

4.4 African continent

Expectant mothers in some parts of Africa have the belief to squat on hot
rocks to flex the perineal area before giving birth. In Nigeria, Nigerists believe that
the vagina of a mother-to-be who is about to give birth should not be touched by
anyone, except their husbands. So even midwives who help with labor only help by
saying prayers and applying herbs to the abdomen to stimulate contractions.
4.5 Continental Australia
Many people in Australia believe that it is important to follow their culturally
appropriate pregnancy and birth practices, for example Australians choose not to eat
certain foods during pregnancy, During labor Australian society chooses not to move
too much, or to lie down, sit or squat, In some cultures, the father does not attend the
delivery, but the mother or mother-in-law does, there are also cultures that have
specific rules after you give birth, such as staying in bed for a few days.
 BIBLIOGRAPHY

Leininger (1991) Cultoral Care: Diversity and Universin, a Theory of Nursing, New
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Marine. A and Temey. (1994). Nose Theorists and Their Work. University of
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Namuwali, D. (2018). THE CHALLENGES OF THE MATERNAL AND CHILD HEALTH

REVOLUTION (MCH) IN EAST SUMBA CULTURE. Forikes sound health
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Nurlaily, A. P. (2018). THE CONCEPT OF TRANSCULTURAL NURSING. Surakarta.
Rachmayanti, R. D. (2023). Culture, traditional beliefs and practices during pregnancy among
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