TRANSCULTURAL

PERSPECTIVES
IN CHILDBEARING

BY. NS. WULAN PURNAMA

 Cultural Beliefs Systems and Practices

Childbearing is a time of transition and social

celebration of central importance in any society,
signaling which a particular society view a realignment
of existing cultural roles and responsibilities,
psychologic and biologic states, and social relationships.
The different ways in which a particular society views
this transitional period and manages childbirth are
dependent on the culture’s consensus about health,
medical care, reproduction, and the role and status of
women (Dickason, Silverman, and Schult, 1994).
Medical care focuses on the pregnant woman and fetus.
 Fertility Control and Culture

Fertility varies depending on several factors: the likelihood

of sterility, probability of conceiving and of intrauterine
mortality, duration of postpartum period, and cultural and
social caution variables: marriage, residence patterns, diet,
religion, the availability of abortion, the incidence of
venereal disease, and the regulation of birth intervals by
cultural or artificial means.
The religious beliefs of some cultural groups might affect
their use of fertility control, such as abortion or artificial
regulation of conception. It also influence birth control
choices.
Women from traditional societies are questioning long-held
beliefs related to fertility control.
 Pregnancy and Culture

All cultures recognize pregnancy as a special

transition period, and many have particular customs
and beliefs that dictate activity and behavior during
pregnancy.
Culture influences biologic variations, pregnancy
outcomes, and prenatal care.
 Biologic Variations

It resulting from genetic and environmental

backgrounds.
E.g. congenital anomalies, sickle cell disease,
stillbirth, macrosomia, birth injury, cesarean section,
neonatal hypoglicemia, gestational diabetes.
 Pregnancy Outcomes

1. Alternative lifestyle choices.

2. Maternal role attainment alterations.
3. Nontraditional support systems.
4. Cultural beliefs related to parental activity during
pregnancy: prescriptive, restrictive, and taboos.
5. Food taboos and craving.
 Prenatal Care

Establishment of good relationship with nurses and

providing a safe environment increased attendance at
prenatal clinics (Morgan, 1996).
Professional culture included respecting the family
roles of caring for the mother in relation to age and
gender, expressing concern knowledge protection and
explanations and attending to the needs of the
mother, using mother language while caring for the
mother, and believing that professional prenatal care
was valued by the women even though access was in
many cases problematic (Berry, 1999).
 The Ways to Establish a Good
Nurse-Patient Relationship
1. Supporting the religious or spiritual needs of clients by helping to
locate religious advisors and providing time for prayer when indicated.
2. Addressing clients by last name and conversing with clients about
their families before the initiation of care.
3. Acknowledging elder generic guidance during pregnancy and, when
appropriate, incorporating these practices into the client’s care.
4. Respecting the family’s beliefs in a male authority as the protector and
final decision maker.
5. Encouraging a client to include her spouse in prenatal visits when
decisions regarding care must be made, or making the information
available for the client to take home for approval, especially when
consents are required.

(Berry, 1999)
 Barriers to Prenatal Care Access

1. Lack of telephones for communicating with health

care providers.
2. Lack of transportation to the clinics.
3. Legal issues surrounding immigration that affected
access.
4. Bureaucratic paperwork.
5. Inflexible clinic schedules.

(Morgan & Berry)

 Cultural Interpretation of Obstetric Testing

Many women do not understand the emphasis that

Western prenatal care places on urinalysis, blood
pressure readings, and abdominal measurements.
The vaginal examination might be so intrusive and
embarrassing.
Refusal of prenatal visits or request a female physician
or midwife.
Common discomfort of pregnancy might be managed
with folk, herbal, home, or over-the-counter remedies
on the advice of a relative or friends. (Spector, 2003)
 Cultural Preparation for Childbirth

Classes during and after the usual clinic hours in

busy urban settings.
Teen-only classes.
Single-mother classes.
Group classes combined with prenatal checkups at
home.
Classes on rural reservations.
Presentations that incorporate the older “wise
woman” of the community.
Classes in language other than english.
 Birth and Culture

Beliefs and custom surrounding the experience of labor

and delivery are influenced by the fact that the physiologic
processes are basically the same in all cultures.
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,
the 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.
 The Meaning of Birth

The birth of the 1st son may be considered a great

achievement worthy of celebration.
Birth may be viewed as a state of defilement or pollution
requiring various purification ceremonies.
Birth is often viewed as an achievement for medical staff.
The recent consumer movement in childbirth and the
upsurge of feminism has caused some redefinition of the
cultural focus and has encouraged women and their
partners to assume active roles in the management of
their own health and birth experiences.
 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.
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 only 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 women. In
additions are rural isolation, economic an cultural factors.
 Support During Childbirth

Despite the traditional emphasis on female support and guidance

during labor, the inclusion of spouses and male partners has been seen
as positive by women of many cultures. They have a desire to have
husbands or partners present for the birth.
Some hospital still maintain rules that limit the support person to the
spouse or that prevent a husband from attending the birth unless he has
attended a formal childbirth education program with his wife.
Nurses must determine how much personal control and involvement
are desired by a woman and her family during the birth experience. Due
to a wide variation of customs and beliefs, it is always best for the nurse
to ask patients directly about the level of observance followed so that
hospital practices can be aligned with individual’s needs.
For some women, religion or spirituality is central to their belief system
and is the guiding factor in the childbirth experience.
 Birth Positions

The choice of positions is influenced by many factors

other than culture and that the socialization that
occurs when a woman arrives in a labor and delivery
unit might prevent women from stating her
preference.
E.g. seated position chose by Mexican-American
women, squatting position chose by Laotian Hmong
women.
 Cultural Meaning Attached to
Infant Gender or Multiple Births
Traditionally, the male gender is highly regarded,
which places female infants in a position of “less
than favorable”.
Male child is preferable to a female child (Asian and
Islamic cultures).
Twins may be viewed as something very special,
while other cultural groups may view multiple births
more negatively.
Nurses should point out all the positive attributes of
the newborn.
 Culture and the Postpartum Period

Western medicine considers pregnancy and birth the most dangerous

and vulnerable time for the childbearing woman.
Some cultures place much more emphasis on the postpartum period.
Many cultures have developed practices that balance and cushion this
special time of vulnerability for the mother and the infant.
The cultural differences: restrictive dietary customs, activity levels, and
certain taboos and rituals associated with purification and seclusion.
In many cultures, the concept of postpartum vulnerability is based on
one or more beliefs related to “imbalance” (the result of disharmony
caused by the processes of pregnancy and birth) and :pollution”
(“unclean” bleeding associated with birth and the postpartum period).
Restitution of physical balance and purification might occur through
many mechanisms, including dietary restrictions, ritual baths,
seclusion, restriction 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 this theory.
Pregnancy is considered a “hot” state, because a
great deal of the heat of pregnancy is thought to be
lost during the birth processes.
Postpartum practices focus on restoring the balance
between the hot/cold beliefs, or Yin and Yang. “Cold”
in the form of either air or food.
 Postpartum Dietary Prescriptions and
Activity Levels
Regulation of activity in relation to the concept of
disharmony or imbalance includes the avoidance of
air, cold, and evil spirits.
Fruits and vegetables and certainly cold drinks might
be avoided because they are considered “cold” foods.
Cultural prescriptions vary regarding when women
can return to full activity after childbirth, but many
traditional cultures suggest that a woman can
resume normal activities in as little as 2 weeks, and
some take up to 4 months.
 Postpartum Seclusion

The period of postpartum seclusion and vulnerability in most

non-Western cultures varies between 7 and 40 days.
The Hispanic midwife will stay at the home of the mother for
several hours after the delivery and will make a follow-up visit
the next day.
Placental burial rituals are also part of the traditional Hmong
culture, because they believe it is the baby’s 1 st clothes. 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. In
an effort to assimilate, many Hmong have continued to use
animistic ceremonies and herbal remedies in addition to using
Western medicine.
In some cultures, women are considered to be in a state of
impurity or pollution during the postpartum period.
 Cultural Influences on
Breastfeeding and Weaning Practices

WHO and UNICEF recommended children worldwide be breastfeed

for a minimum of 2 years, with no defined upper limit on the
duration. (2004)
Only a few women participate in an extended breastfeeding (mostly
nurse), longer than 3 years.
Culturally, breastfeeding 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 breastfeeding, and the health care provider’s
personal beliefs and experiences regarding breastfeeding and or
weaning practices, to name a view.
The women with a strong cultural identification and cultural social
support, tended to initiate breastfeeding and continue with
breastfeeding longer than those in the groups who did not have
strong cultural identification (McKee, Zayas, and Jankowski (2004).
 Cultural Issues Related to
Domestic Violence During Pregnancy

Domestic violence has emerged as one of the most

significant health care threats for women and their
unborn children.
Numerous issues cross all cultural boundaries and
influence the prevalence and response to domestic
violence.
E.g. family violence, sexual abuse experienced as a
child, alcohol and drug abuse by the mother or
significant other, shame associated with abuse fear of
retaliation by the abuser, to cite a few.