DMC COLLEGE FOUNDATION, INC.

COLLEGE OF NURSING

__________________________________________________________________

OVERVIEW OF THE CULTURAL BELIEF SYSTEMS AND PRACTICES RELATED TO

CHILD BEARING
Pregnancy and childbirth practices in contemporary. Western society have
seen dramatic changes over the past three decades. As global populations
become increasingly mobile, we are seeing cultures converge, which calls for a
reorientation of our nursing skills and nursing. In light of global population shifts
that are likely to continue for years to come, cultural beliefs regarding
childbearing and childrearing need to be examined to enable nurses to offer our
patients culturally congruent care throughout their pregnancy, birth, and the
early postpartum.

It is a known fact that the United States spends more money than any other
country on health care and more on maternal health than any other type of
hospital care; however, women in the United States have a higher risk of dying of
pregnancy-related complications than those in 40 other countries. Health
disparities in the United States also play a role in increased maternal morbidity
and maternal mortality, although it is unclear to what extent. For example,
African American women are nearly four times more likely to die of pregnancy-
related complications. Than White women. These rates and disparities have not
improved in more than 20 years (Amnesty International, USA, 2010). Subcultures
within the United States have very different practices, values, and beliefs about
childbirth and the roles of women, men, social support networks, and health care
practitioners.
One such subculture includes proponents of the “back to nature” movement,
who are often vegetarian, use lay midwives for home deliveries, and practice
herbal or naturopathic medicine. Other groups that might have distinct cultural
practices include African Americans, American Indians, Hispanics, Middle
Eastern groups, Orthodox Jewish groups, Asians, and recent immigrants, among
others.

Additionally, religious background, regional variations, age, urban or rural

background, sexual preference, and other individual characteristics all might
contribute to cultural differences in the experience of childbirth. Despite the
great variations that can exist in relation to the social class, ethnic origin, family
structure, and social support networks of women in the United States, many
health care providers mistakenly assume that pregnancy and childbirth are
experienced similarly by all people.
In addition, some professional nurses view some traditional cultural
beliefs, values, and practices related to childbirth as “old-fashioned,” “back in the
day,” or “old wives’ tales.” Although some of these customs are changing rapidly,
particularly for immigrants in the United States, many women and families are
attempting to preserve their own valued patterns of experiencing childbirth (see

Fertility Control and Culture

The professional literature lacks information specific to cultural beliefs and
practices related to the control of fertility. A woman’s fertility depends on several
factors, including the:
a. likelihood of sterility
b. the probability of conceiving
c. and of intrauterine mortality.
 In addition, the duration of a postpartum period, during which a woman is
unlikely to ovulate or conceive, influences fertility. These variables are further
modified by cultural and social variables, including marriage and residence
patterns, diet, religion, the availability of abortion, the incidence of venereal
disease, and the regulation of birth intervals by cultural or artificial means, all of
which are influenced by cultural norms, values, and traditions. This section
focuses on those societal factors that influence reproductive rights and
population control. Unintended Pregnancy In the United States, according to.

Pregnancy, Childbirth, and Motherhood: A Metasynthesis of the Lived

Experiences of Immigrant Women
Clinical Implications:
1. Provide increased emotional support to immigrant women during
pregnancy as needed.
2. Work to ensure that institutions provide linguistically informed and
culturally congruent services to enhance antenatal visits.
3. Make cross-cultural training available to providers in order to address
cultural issues that could negatively impact childbirth, such as female
excision.
4. Maximize involvement of lay community outreach workers with the same
cultural background, to inform women of available reproductive services.
5. Respect and consider traditional practices in the women’s care to improve
health outcomes for both mother and child.
6. Learn as much as possible about the cultural belief systems of your
patients in order to build an environment of trust and open
communication to improve the childbearing experience.
Religion and Fertility Control
The influence of religious beliefs on birth control choices varies within and
between groups, and adherence to these beliefs may change over time. Cultural
practices tend to arise from religious beliefs, which can influence birth control
choices.
For example:
 The Hindu religion teaches that the right hand is clean and the left is dirty.
The right hand is for holding religious books and eating utensils, and the left
hand is used for dirty things, such as touching the genitals

 . This belief complicates the use of contraceptives requiring the use of both
hands, such as a diaphragm. Control methods. However, in cases where the
mother’s life is in jeopardy, abortion is not opposed (Kolatch, 2000).
 In some African cultures, there are strongly held beliefs and practices related
to birth spacing. Because postpartum sexual activity has traditionally been
taboo, some women leave their home for as long as 2 years to avoid
pregnancy
Cultural Influences on Fertility Control
It is common for health professionals to have misconceptions about
contraception and the prevention of pregnancy in cultures different from their
own. A qualitative study by Eckhardt and Lauderdale (2013) sought to identify and
describe the barriers to family planning in North Kamagambo, Kenya, to
understand the cultural context in which they exist. Since the Lwala Community
Hospital’s opening in the North Kamagambo region of Kenya in 2007, the number
of patients seeking contraceptives and family planning counseling has increased.
However, maternal mortality remains high and the culture expects women to
bear many children. Although this places a large burden on women’s health and
increases a lifetime risk of maternal mortality, cultural and religious hesitance
toward family planning persists.
Nurses providing family planning services must take care to be culturally sensitive
so that women can be assisted in examining their own attitudes, beliefs, and
sense of gynecologic wellbeing regarding fertility control.
PREGNANCY AND CULTURE
Childbirth Postexcision
Excision has been described by the WHO (2010) as a complete or partial
removal of the clitoris and the labia minora, with or without the labia majora.
Although communal advantages and some personal benefits have been cited in
the literature for female excision, deleterious outcomes have been noted to
occur, including:
a. psychological stress
b. adverse obstetric
c. perinatal outcomes such as postpartum hemorrhage, and newborn risks of
stillbirth, death, need for resuscitation at birth, and LBW (. In order to
understand the impacts of excision on childbirth, hermeneutic
phenomenology was used to analyze the narratives of four women who had
been excised

Clinical Implications:
 Break the “taboo of silence.” The women prefer an open, respectful
discussion regarding their excision.

 Share explicit care plans to identify and share each woman’s wishes
regarding her excision, particularly when multiple providers are involved.

 Provide language/dialect interpreters when sharing information to prevent

frustration for the women.

 Ensure that the provider’s approach to excised women is as respectful as it

is for any other woman seeking maternity care. Remember, the woman in
front of you is a “woman who has been excised” versus an “excised woman
Cultural Variations Influencing Pregnancy
Several cultural variations may influence pregnancy. Those highlighted in
this section include:
a. alternative lifestyle choices
b. nontraditional support systems,
c. cultural beliefs related to parental activity during pregnancy,
d. and food taboos and cravings.
Nurses must be able to differentiate among beliefs and practices that are harmful
and those that are benign. Few cultural customs related to pregnancy are
dangerous and many are health promoting. However, one practice that is
dangerous is female excision. This cultural practice occurs in approximately 28
African countries and affects 100 to 140 million girls and women (WHO, 2008).
The emotional and psychological impact of this practice on childbirth is important
to recognize when providing childbearing care for women having undergone this
procedure.

Alternative Lifestyle Choices

Although the dominant cultural expectation for North American women
remains motherhood within the context of the nuclear family, recent cultural
changes have made it more acceptable for women to have careers and pursue
alternative lifestyles. Changing of cultural expectations has influenced many
middle-class North American women and couples to delay childbearing until their
late 20s and early 30s and to have small families. Many of today’s women are
career oriented, and they may delay childbirth until after they have finished
college and established their career.
Some women are making choices regarding childbearing that might not
involve the conventional method of conception and childrearing. Lesbian
childbearing couples are a distinct subculture of pregnant women with special
needs reports that the way intake forms are completed needs to be re-evaluated
in light of these social changes. How the patient became pregnant is one such
example. Instead of assuming she became pregnant via intercourse, Randi
suggests asking the patient to tell you “the story” of how she became pregnant,
thus keeping the interview less threatening and nonjudgmental. The author
underscores the need to be aware of the language used in the first encounter
with a pregnant woman in order to set the tone for future provider–patient
encounters.
The most common fear reported by lesbian mothers is the fear of unsafe
and inadequate care from the practitioner once the mother’s sexual orientation is
revealed. Reluctance to disclose sexual orientation to one’s health care provider
can act as a barrier to a woman receiving appropriate services and referrals
Four areas that are significant in regard to lesbians considering parenting:
1. Sexual orientation disclosure to providers and finding sensitive
caregivers,
2. Assurance of partner involvement
3. How to legally protect both the parents and the child. Lesbian and
heterosexual pregnancies have many similarities.
Issues of sexual activity, psychosocial changes related to attaining the
traditionally defined maternal tasks of pregnancy (Rubin, 1984), and birth
education all need to be addressed with lesbian couples. Special needs of the
lesbian couple requiring assessment include social discrimination, family and
social support networks, obstacles in becoming pregnant (i.e., coitus versus
artificial insemination), maternal role development, legal issues of adoption by
the partner, and coparenting roles

Vulnerable and Strong: Lesbian Women Encountering Maternity Care

Clinical Implications:
 Understand that being pregnant and living in lesbian relationship increase
visibility, thus enhancing vulnerability.
 Couples may take responsibility for acts of caring as they are accustomed to
health care providers being uncertain and anxious regarding their
relationship
 Lesbian pregnant couples prefer that health care providers not focus on
their sexuality, but rather treat them as any other laboring couple.
  The need to be accepted, cared for, and communicated with are essential
with this group of women.
 Not using words such as “lesbian” or “partner” can be viewed as
discriminating and reinforce a feeling of invisibility.
 Comprehend the responsibility of ethical caring for patients different than
themselves.

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.
Three Types of Beliefs
1. Prescriptive beliefs, which are phrased positively, describe what should be
done to have a healthy baby
- Positive beliefs often involve wearing special articles of clothing, such as
the muneco worn by some traditional Hispanic women to ensure a safe
delivery and prevent morning sickness

2. Restrictive beliefs, which are phrased negatively, limit choices and

behaviors and are practices/behaviors that the mother should not do in
order to have a healthy baby.

3. Taboos, or restrictions with serious supernatural consequences, are

practices believed to harm the baby or the mother. Many people believe
that the activities of the mother—and to a lesser extent of the
father—influence newborn outcome.
These beliefs are attempts to increase a sense of control over the outcome of
pregnancy.
o Negative or restrictive beliefs are widespread and numerous. They include
activity, work, and sexual, emotional, and environmental prescriptions.
 o Taboos include the Orthodox Jewish avoidance of baby showers, divulgence
of the infant’s name before the infant’s official naming ceremony, and laws,
customs, and practices during labor and delivery

o One Hispanic taboo involves the traditional belief that an early baby shower
will invite bad luck, or mal ojo, the evil eye
Other beliefs and practices involve ceremonies and recommendations about
physical and sexual activity.
A cultural belief 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,
and who believes that hanging laundry caused the cord to encircle the baby’s
neck or body, might experience severe guilt.

The nurse who is sensitive to the mother’s anguish might say,

 “Many people say that if you reach over your head during pregnancy, it will
cause the cord to wrap around the baby’s neck. Have you heard this belief?”
Once the woman responds, the nurse can explore her feelings about the
practice. Do others in her family or social support network share her belief?
The nurse might share her own views by saying, “I have not read in any
medical or nursing books that this practice is related to cord problems,
although I know many people share your belief.” The discussion can then
continue focusing on the feelings and perceptions of the event as experienced
by the woman and her family.
Cultural Beliefs Regarding Activity and Pregnancy

Prescriptive Beliefs
Countries Beliefs
Crow Indian Remain active during pregnancy to aid the
baby’s circulation
Mexican and Cambodian Keep active during pregnancy to ensure a small
baby and an easy delivery
Pueblo and Navajo Indian, Remain happy to bring the baby joy and good
Mexican, Japanese fortune
Mexican Sleep flat on your back to protect the baby
Haitian, Mexican Continue sexual intercourse to lubricate the
birth canal and prevent a dry labor
Filipino Continue daily baths and frequent shampoos
during pregnancy to produce a clean baby
Restrictive Beliefs
Mexican, Haitian, Asian Avoid cold air during pregnancy to prevent
physical harm to the fetus
African American, Hispanic, Do not reach over your head or the cord will
White, Asian wrap around the baby’s neck
Vietnamese Avoid weddings and funerals or you will bring
bad fortune to the baby
Vietnamese, Filipino, Samoan Do not continue sexual intercourse or harm will
come to you and baby
Navajo Indian Do not tie knots or braid or allow the baby’s
father to do so because it will cause difficult
labor
Pueblo Indian, Asian Do not sew
Taboos
Mexican Avoid lunar eclipses and moonlight or the baby
might be born with a deformity
Vietnamese Do not walk on the streets at noon or 5 o’clock
because this might make the spirits angry
Navajo Indian Do not join in traditional ceremonies like Yei or
Squaw dances or spirits will harm the baby
Haitian Do not get involved with persons who cast
 spells or the baby will be eaten in the womb
Orthodox Jewish Do not say the baby’s name before the naming
ceremony or harm might come to the baby
African American Do not have your picture taken because it
might cause stillbirth
South Asian Canadian 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

FOOD TABOOS AND CRAVINGS

Many cultures traditionally believed that the mother had little control over
the outcome of pregnancy except through the avoidance of certain foods.
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). –
 Spicy, cold, and sour foods are often believed to be foods that a pregnant
 woman should avoid during pregnancy. Some 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. The causes of pica are poorly understood, but there are
some cultural implications because women from certain ethnic or cultural
groups experience this disorder more frequently than others. In the United
States, pica is common in African American women raised in the rural South
and in women from lower socioeconomic levels. It is not uncommon to see
small balls of clay in plastic bags sold in country stores in the rural South. The
phenomenon of pica has also been described in other countries including
Kenya, Uganda, and S

BIRTH AND CULTURE

 Beliefs and customs surrounding the experience of labor and delivery can
vary, despite the fact that the physiologic processes are basically the same in all
cultures. Factors such as
a. cultural attitudes toward the achievement of birth
b. methods of dealing with the pain of labor
c. recommended positions during delivery, the preferred location for the
birth
d. the role of the father and the family,
e. 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. Gifts and 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. Further
complicating this situation, women are reluctant to seek professional health care
at clinics or hospitals because they are more comfortable in their own homes with
traditional (but untrained) birth attendants (Lori & Boyle, 2011).
These findings highlight that the influence of culture on childbirth extends
beyond the birth experience itself, often affecting the outcome. The literature
offers another recent example of the impact culture has on childbearing care
practices of a remote population of women in Mexico. These findings indicate
that as health care groups working with indigenous populations strive to design
programs to improve health outcomes, integrating cultural beliefs into Western
health care education might ultimately improve client satisfaction and health
outcomes.
NOTE: After reading this module answer the post-test.