Book

Childbirth Across Cultures: Ideas and Practices of Pregnancy, Childbirth and the Postpartum

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Abstract

Childbirth Across Cultures explores the childbirth process through globally diverse perspectives to offer a broader context with which to think about birth. It addresses multiple rituals and management models surrounding the labor and birth process from communities across the globe. Labor and birth are biocultural events that are managed in countless ways. We are particularly interested in the notion of power. Who controls the pregnancy and the birth? Is it the hospital, the doctor, or the in-laws, and in which cultures does the mother have the control? These decisions, regarding place of birth, position, who receives the baby and even how the mother may or may not behave during the actual delivery are all part of the different ways that birth is handled. The cultures included range from the Solomon Islands to Africa, Asia and the Americas. Other chapters cover Midwives and other Birth Attendants, Evolution of Birth, Women’s Birth Narratives, and Child Spacing and Breastfeeding. This book will bring together global research conducted by professional anthropologists, midwives and doctors who work closely with the individuals from the cultures they are writing about, offering a unique perspective direct from the cultural group.

Chapters (22)

Once upon a time, there were six little pigs who set out to seek their fortunes in the world (okay, we know that in the original story there were only three, but just bear with us here!). Far away from home they journeyed, until the first little pig spied a peaceful meadow with a stream running through it; there he stopped his hot and weary journey. In 2 hours he had built himself a house of straw, then he spent another hour building animal traps, after which he set about to laugh and dance and play all day. It was like that every day – he would spend 3–5 hours hunting wild game, after which he could do as he pleased. The female pigs gathered wild grains, tubers and fruits so that food was available even when the hunt failed. Although the first little pig didn’t always like to admit it, the female pigs brought in 70–80% of the diet from foraging, and often helped with the hunting and trapping as well. He was feeling very content, for he had wished to find an environment that could sustain him and his small band of kin pigs, and he had. Sure, he and his like-minded friends experienced high infant mortality rates and a resulting life expectancy of around 35 years, as well as high death rates from endemic disease and accidental death. However, as they discussed frequently in their abundant leisure time (in between the long stories they loved to tell), these problems were offset by their varied and nutritious diets and high mobility, which made sanitation and infectious disease transmission non-issues. Life was good and gender relationships egalitarian for the most part.
Breastfeeding is an inexpensive, natural source of nature’s perfectly defined food for infants. In addition to optimal nutrition, breastfeeding provides infants with natural immunity to childhood diseases through antibodies in the mother’s milk, thereby increasing health and decreasing mortality. If both are in good health, breastfeeding can provide an important bonding experience between mother and child. But breastfeeding has another benefit as well: suppressing ovulation and delaying the return of menstruation, which effectively acts as a natural contraceptive to increase child spacing. Exclusive breastfeeding is a very active component of culture in many countries, where it is often used to lengthen the time between births of successive children.
Sixteen-year-old Anna gave birth to her second child in the Salvation Army Clinic in the Ashanti Province of Ghana, having lost her first. She thanked God for safe passage for herself and for the child. “Whether I cried or shouted I was going to give birth to the baby, so there’s no need for us to cry or shout. All that I needed to do was to keep calm and be praying in my mind to God so that He could help me to have a safe delivery.” Birth stories are a means of accessing the social context and meaning of bearing and rearing children in women’s lives. Birth stories document the profound experiences of culturally diverse childbearing women.
There is an abundant literature on the history and medicalization of birth and reproduction, from conception, to the maternal body, to the labors of birth itself (see Davis-Floyd and Sargent 1997; Devries et al. 2001; Ehrenreich and English 1973; Graham and Oakley 1981; Martin 1992; Rapp 2000; Trevathan 1997). Much of this research examines the cultural-social dimensions of medicine and women’s bodies within the biomedical model. But there is a complex history that has shaped how western medicine views pregnancy, labor and the maternal body that this chapter aims to examine through a chronological history of childbirth and labor in the last three hundred years that has put in place a static and potentially problematic medicalized model of birth, which, as western medicine permeates all parts of the world is becoming globally accepted. This chapter focuses primarily on the United States, recognizing occasionally its connection with Europe.
The desire to control birth in China has roots in the country’s chaotic political history of the past several centuries and the resulting deep desire for stability in all aspects of life. For most of the country’s long history, China – with its large cities, extensive libraries, sophisticated technology, fine arts and silks, and rich medical tradition – was a civilization far ahead of its Western counterparts. Indeed, after visiting the Chinese capital in the thirteenth century, Marco Polo proclaimed the city to be “without doubt the finest and most splendid city in the world” (Hansen 2000: 409).
Hong Kong is located at the southeast tip of China and has a population of approximately seven million. She is a major international city with a unique blend of cultures of the East and the West. Although more than 95% of Hong Kong’s population is Chinese (Census and Statistic Department 2008), Western medical therapies are dominant. This situation illustrates a significant shift in Chinese culture over the years. The elder generation of Chinese mostly adheres to traditional rituals and customs dominated by Confucianism that emphasizes a harmonious relationship with nature. However, the younger generation may tend to relinquish the Chinese heritage or embrace a fusion of the Chinese and Western cultures in their daily lives (Giger and Davidhizar 1995).
Traditionally, Korean culture is hierarchical, and the man is the most important person in the family. The Korean woman is submissive to her husband and her husband's family, particularly her mother-in-law. Long ago, it was very desirable to give birth to boys who were treated with special care; this was especially the case for the first-born boy.
In a country of more than one billion people, with 20 odd principal languages, about 225 dialects, and at least two principal religions, it is difficult to say anything about a phenomenon like childbirth that would hold true for the different regions and peoples of India. But what can be said is that about 65% of the births are at home in opposition to perhaps 3% in the United States. If we break this down into rural and urban, then more than 70% of births in rural India are at home with about 74% of the total population living in rural India. And two thirds of these rural births are attended by family and other forms of local experts, which in the current anthropological and public health literature are called either dais, or traditional birth attendants (TBAs). Both are omnibus terms meaning many things depending on the context in which they are used. This has led Sarah Pinto (2006) to argue that the Indian dai, cast in the image of the European midwife, as someone who attends to the pregnant woman, delivers the child, the afterbirth and does post partum work may not necessarily exist in one person, or not in one person at all times and in all regions of India. Even the general consensus that in “North India”, (including Pakistan, Nepal and Bangladesh), the dai’s main task is not catching the baby (any of the many women who attend the birth may do so) but cutting the cord and subsequently removing “the polluted and dangerous” placenta is contradicted by the fact that among the very poor the dai is virtually never called. If called, she does not necessarily cut the cord. Instead the cord is cut by the mother as otherwise the child may turn its affection towards the dai rather than the mother (Blanchet 1984).
This chapter examines rural midwifery as a form of knowledge that is undervalued by both Indian and Western elite traditions. Even in asking, “What is the culture of birth like in non-Western societies?”, we assume a complete separation of Western and Indian knowledge systems. It is not simply today’s modern India which has brought about a blurring of such boundaries. Such bifurcations were muddied in the colonial period, with the founding of biomedical establishments such as maternity hospitals and baby clinics from the end of the 19th century onwards. In the course of the twentieth century, contemporary forms of Western knowledge such as biomedicine, family planning, demography and social science, have all played their parts in shaping the Indian state and intellectuals in India. These intellectuals in turn shape the interactions between rural women and institutions such as hospitals, family planning clinics, and schools. We therefore have to reckon with the presence of social sciences, not only among Western scholars working on India, but within the country itself. Part of this chapter will examine the legacies of my education both in India and in Australia, and the obstacles it has placed in my attempt to approach, let alone represent, the knowledge of midwives.
This chapter is about the construction of birth in rural Bangladesh. In Bangladesh, maternal deaths are very prevalent, 320 per 100,000 live births annually, and the construct of birth that is produced in everyday life results in many unwarranted and unnecessary deaths. Various social constructions of birth are observed in everyday life, both in indigenous ways and hospital birth practices. The power of knowledge is multidirectional and influences individuals to follow certain norms and practices which critically shape health-seeking behaviour. This chapter draws on numerous case studies and observational experiences from ethnographic studies carried out in 1998 and 2001 to highlight how understanding of birth is shaped by birth experiences of women and influenced by the context in which meaning is produced. In Bangladesh, most poor women prefer indigenous birth or home birthing. No matter where and how the birthing is constructed, ultimately it affects the marginalized populations, that is, poor, rural women. Women face poor care in a health system which is inadequate and over-medicalised and marginalises local knowledge and practices. The critical gap in understanding the meaning of home births as opposed to hospital obstetric care needs to be recognized, if we want to see improvement in the maternal health situation in Bangladesh.
Nepal is a land-locked country situated between India and China. The landmass of Nepal is 147,181 sq. km and the population is 23.1 million (Central Bureau of Statistics 2001).
To Tibetans life does not begin at birth, but rather at conception. After death, a being’s consciousness… wanders in an intermediate realm until impelled by the forces of its own karma to enter a womb at the instant of conception. Gestation is a hazardous time when women try to consume foods and seek spiritual means to prevent any harm coming to their growing baby. Once born, the child must fight for survival against daunting odds. Infancy is fraught with more hazards than any other stage of the life course, and the infant mortality rate in Nubri is frightfully high. Nearly one in every four children born alive does not live to see his or her first birthday. (Childs 2004: 38)
Childbirth, including the period immediately following birth, is an event in which traditions play an important part (Symonds 1991; Liamputtong Rice 2000a; Liamputtong 2004, 2007a, b).
Childbearing in any society is a biological event, but the birth experience is also socially constructed. It takes place within a cultural context and is shaped by the perceptions and practices of that culture (Steinberg 1996 Liamputtong Rice 2000a, b Liamputtong 2007a, b). Therefore, there are many beliefs and practices relating to the childbearing process that the woman and her family must observe to ensure the health and wellbeing of not only herself but also that of her newborn infant (Steinberg 1996 Jordan 1997 Liamputtong Rice 2000a, b Liamputtong 2007a, b).
Israel is a small country of great diversity. The winter in the north is cold and snowy, yet 5 hours drive to the south the weather is sunny and dry. It takes an hour to drive from the Mediterranean Sea to the dry deserts near the border with Jordan (Fig. 1). Even more diverse than the weather are the people living in Israel. According to the Statistical Abstract the population of Israel in 2008 was 7.2 million, 75% of whom are Jewish (of different cultural backgrounds), 20% Arabs (Muslims, Christians, Druse and Bedouins) and “others” who are mainly newcomers without religious classification.
The health care system in Zimbabwe is characterised as pluralistic, because of the co-existence and concurrent use of traditional and biomedical practitioners. The traditional healers, including Traditional Birth Attendants (TBAs), continue to play an important role in the provision of health care in Zimbabwe (Mukumbura 2000). They are often used for conditions such as infertility (Mutambirwa 1989) and mental health, as well as those diseases believed to be incurable through biomedicine (Nyazema et al. 1992). Of late, however, due to the high exodus of staff, high hospital costs and shortage of essential drugs, many more people are forced to seek traditional care (Chimhete 2003).
Nigeria is a huge African country, home to 20% of Africans, with a population of about 140 million people (National Population Commission 2006). It also has a high fertility rate, although the 2003 Nigerian Demographic and Health Survey (NDHS 2001) shows a slight decline in the total fertility rate. Fertility also varies by region. In the South women have 4.1 children on average, compared to 7.0 children in the Northeast and 6.7 in the Northwest (NDHS 2003). In spite of this high premium given to childbirth in Nigeria, it is still a challenge for the majority of our women, with an unacceptably high maternal and neonatal mortality rate. The maternal mortality rate is estimated to be 800/100,000 live births (NDHS 2001). While this is lower than the sub-Saharan Africa average of 910/100,000, wide variation exists across the geopolitical zones.
In Uganda, there are diverse and distinct cultures, and people give specific expressions or attach particular interest to basic events in life such as pregnancy and childbirth. Although much is known about the clinical aspects of conception, pregnancy, birth and the postpartum, it is widely believed that these events are greatly influenced by, among others, social and cultural beliefs, including gender and power relations and differences in roles and status between the sexes (Vlassoff and Bonilla 1994 Ubot 1992 Koblinsky and Anne 1993 Caldwell and Caldwell 1990 Mukhopadhyay and Higgins 1988). Socio-cultural expectations, such as the desire to have a large number of children or deliver children of a particular sex, and also the meaning of birthing, are key motivations for child bearing and getting pregnant. These also bring with them associated health risks (Kyomuhendo 2003 Ntozi 1990).
Childbearing women the world over share the common events that signal the existence of a pregnancy: the physiological changes that take place and the fact that the baby will be born either vaginally or through a caesarean birth. However there are always elements of pregnancy, labour and puerperium that will be unique for every woman and this will in some way be influenced by the woman’s cultural background and societal expectations. In Malawi, a small country in East Central Africa (See Fig. 1), there are various cultural practices related to childbirth. The country is divided into three geographical regions which are further subdivided into 28 administrative districts.
Mayan worldview and traditional religion have long woven interpretations of dreams and visions into the beliefs and lifeways of the community members. In the 1950s and 1960s strongly organized evangelical Protestant and conservative Catholic groups attacked dream interpretation as paganism, which led to the formation of distinct factions that devalued the practice. Recently there has been a rebirth of the inclusion of dreams and visions in Mayan interpretation of the world around them (Tedlock 1992:453).
Since the early twentieth century, Simbo women have given birth in a biomedical clinic, a shift accompanied by remarkable falls in maternal and infant death rates. Conversion to Christianity accompanied this conversion to biomedicine and the two remain deeply entangled. Many women express their ambivalence about these changes in terms of shifting birthing positions from vertical to horizontal, sitting to lying: birthing in the clinic means lying down and exposing oneself to the nurse in contrast to the upright, unexposed position of the past. If the dominant sentiment before this conversion was fear of death, that has been much assuaged, but at the cost of the shame of display and scrutiny.
Across rural and remote Australia women are being relocated so that they can give birth at regional settings. Many of these women are Aboriginal and Torres Strait Islander Australians, who are birthing alone in a hospital where staff do not speak their language. They may have to wait weeks in a hostel where they are lonely and at times do not feel safe.
... Respectful maternity care (RMC) has been promoted in recent years due to the importance of ethical, psychological, social, and cultural aspects of childbirth among different populations [1]. Although there is no consensus on the respectful maternity care definition, it is usually regarded synonymous with friendly and woman-centered care. ...
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Background: Intrapartum respectful maternity care is defined as a fundamental human right that can affect the mother's experiences. This study aimed to determine the status of respectful maternity care and its relationship with childbirth experience among Iranian women. Methods: This prospective cohort study recruited 334 postpartum women in postpartum wards of two public and four private hospitals in Tabriz, Iran. Quota sampling was used based on the number of births in each hospital. Data were collected through interviews with the use of the following tools: sociodemographic and obstetrics characteristics questionnaire, respectful maternity care scale (6 to 18 h postpartum), and childbirth experience questionnaire (30 to 45 days postpartum). The General Linear Model was used to determine the relationship between respectful maternity care and childbirth experience. Results: The mean respectful maternity care score was 62.58 with a range of 15 to 75, and the total childbirth experience score was 3.29 with a range of 1 to 4. After adjusting for sociodemographic and obstetrics characteristics, a statistically significant direct correlation was found between respectful maternity care and a positive childbirth experience (P < 0.001). Conclusions: The findings reveals a direct relationship between respectful maternity care and positive childbirth experience. Therefore, it is recommended that mangers and policy makers in childbirth facilities reinforce facilitating a respectful maternity care to improve women's child birth experience and prevent potential adverse effects of negative childbirth experiences.
... The literature is replete with examples of traditional practices for childbirth and maternal health [34][35][36][37][38][39]. Traditional practices associated with maternal health are best viewed as complex interventions with many interacting aspects. ...
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Background: Effective health care requires services that are responsive to local needs and contexts. Achieving this in indigenous settings implies communication between traditional and conventional medicine perspectives. Adequate interaction is especially relevant for maternal health because cultural practices have a notable role during pregnancy, childbirth and the postpartum period. Our work with indigenous communities in the Mexican state of Guerrero used fuzzy cognitive mapping to identify actionable factors for maternal health from the perspective of traditional midwives. Methods: We worked with twenty-nine indigenous women and men whose communities recognized them as traditional midwives. A group session for each ethnicity explored risks and protective factors for maternal health among the Me'phaa and Nancue ñomndaa midwives. Participants mapped factors associated with maternal health and weighted the influence of each factor on others. Transitive closure summarized the overall influence of each node with all other factors in the map. Using categories set in discussions with the midwives, the authors condensed the relationships with thematic analysis. The composite map combined categories in the Me'phaa and the Nancue ñomndaa maps. Results: Traditional midwives in this setting attend to pregnant women's physical, mental, and spiritual conditions and the corresponding conditions of their offspring and family. The maps described a complex web of cultural interpretations of disease - "frío" (cold or coldness of the womb), "espanto" (fright), and "coraje" (anger) - abandonment of traditional practices of self-care, women's mental health, and gender violence as influential risk factors. Protective factors included increased male involvement in maternal health (having a caring, working, and loving husband), receiving support from traditional healers, following protective rituals, and better nutrition. Conclusions: The maps offer a visual language to present and to discuss indigenous knowledge and to incorporate participant voices into research and decision making. Factors with higher perceived influence in the eyes of the indigenous groups could be a starting point for additional research. Contrasting these maps with other stakeholder views can inform theories of change and support co-design of culturally appropriate interventions.
... Although it is generally assumed that all married women are sexually active, in some countries in Africa postpartum abstinence is common, lasting up to 1-2 years (Caldwell & Caldwell, 1990;Bledsoe, 2002), which has an impact on fertility, as compared with shorter periods of postpartum abstinence in other parts of the world, such as 'doing the month' in China or cuarentena in some countries of Latin America and the Caribbean (Kim-Godwin, 2003;Selin & Stone, 2009). Terminal abstinencethe Grandmother Ruleis practised in some parts of Western Africa at the time of becoming a grandmother (Bledsoe, 2002). ...
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This paper presents an analysis of trends in sexual activity by marital status and age, and their associations with contraceptive use. Understanding levels of, and trends in, sexual activity is important for assessing the needs for family planning services and for analysing commonly used family planning indicators. Data were taken from 220 Demographic and Health Surveys (DHSs) and 62 Multiple Indicator Cluster Surveys (MICSs) to provide insights into sexual activity by marital status and age in a total of 94 countries in different regions of the world. The results show the sensitivity of the indicator with respect to the definition of currently sexually active, based on the timing of last sexual intercourse (during the last 4 weeks, 3 months, or 1 year). Substantial diversity in sexual activity by marital status and age was demonstrated across countries. The proportion of married women reporting recent sexual activity (sexual intercourse during the last 4 weeks) ranged from 50% to 90%. The proportion of unmarried women reporting recent sexual activity did not exceed 50% in any of the 94 countries with available data, but showed substantial regional differences: it appeared to be rare in Asia and extremely varied within Africa, Europe and Latin America and the Caribbean. Among married women, sexual activity did not vary much by age group, while for unmarried women, there was an inverted U-pattern by age, with the youngest age group (15–19 years old) having the lowest proportion sexually active. The proportion of women who reported currently using contraception and reported not being sexually active varied by the contraceptive method used and was overall much greater among unmarried women. The evidence presented in this paper can be used to improve family planning policies and programmes to serve the diverse needs, for example regarding method choice and service provision, of unmarried women.
... IJCBNM October 2018; Vol 6,No 4 intrOductiOn Disrespectful and undignified care during childbirth has been reported and documented in health facility centers all over the world. 1 Over recent years, promotion of the usage of Respectful Maternity Care (RMC) has been developed gradually, emphasizing the importance of underlying professional ethics and considering psychological, social and cultural aspects of health care delivery as essential elements of care. 2 While medical treatment is only one aspect of RMC, failure to focus on the well-being of women and newborns by imposing unnecessary or harmful practices can be considered abusive and disrespectful. 3 Respectful maternity care obviously leads to patient satisfaction during childbirth including the quality of both physical interactions and inter-personal relations between care provider and pregnant woman. ...
Article
Background: Disrespectful and undignified care during childbirth has been documented in health facilities all over the world. The purpose of this study was to develop and pretest a new instrument, the Quality of Respectful Maternity Care Questionnaire in Iran (QRMCQI), with an ensured validity and reliability to evaluate and measure Respectful Maternity Care (RMC) in three sections of labor, delivery and post-partum. Methods: This is a study with mixed sequential exploratory design. Here, the questionnaire design is a part of descriptive survey study and consists of five phases implemented in one year. The phases include item or questions generation, face validation, content validity assessment, confirmatory factor analysis and reliability assurance of the questionnaire. The participants were selected from the mothers referring to health care centers affiliated to Iran University of Medical Sciences in five cities after recruitment from hospital for after-care services of delivery. Results: The primary questionnaire was developed, face validity was performed by experts and their comments were implemented. The content validity index (CVI), Kappa index and Content Validity Ratio (CVR) were calculated for each item and they were satisfactory in an acceptable range. Confirmatory factor analysis (CFA) showed good fit of the hypothesized model for 453 participants in the interview. Testing showed an acceptable internal consistency and reliability by calculating Cronbach's alpha coefficient for questions in labor (0.86), in delivery (0.85), and in postpartum care (0.78). Conclusion: We have developed a new instrument as the 59-item QRMCQI for evaluating respectful maternity care in Iran through a rigorous process of item generation and validity-reliability assessment besides confirmatory factor analysis that were in an acceptable range and can be used as a reliable instrument for RMC in Iran.
... We also teach women how to write a birth plan in English, mainly to help the family request a segment of the umbilical cord as a keepsake. Japanese birth centers place a dried cord segment in a traditional box specifically designed for this purpose and give it to the mother at discharge-the umbilical cord segment symbolizes the bond between the mother and child's fate, and keeping it safe is believed to ensure the health and luck of the child (Ivry, 2009;Selin & Stone, 2009). ...
Article
Introduction: The CenteringPregnancy model has been demonstrated to improve birth outcomes for certain cultural and ethnic groups, but the literature lacks examples on how to modify their guidelines for socioculturally isolated women. Our aim is to examine the modifications we made to the CenteringPregnancy group prenatal care for Japanese women and to examine the implications for transcultural modification. Methods: Using a descriptive case study design, we examined the cultural fit and modifications of our Japanese prenatal group approach. We report the aspects that do not require modifications and the transcultural modifications that are needed. Based on this descriptive case, we discuss the lessons learned for making transcultural modifications that may apply to other cultural groups. Results: Many aspects of the CenteringPregnancy were readily adopted. We made 10 substantive transcultural modifications and articulate considerations for transcultural modifications. Discussion/conclusion: This research illustrates transcultural considerations for modifying the CenteringPregnancy model and provides implications for use in other isolated populations of pregnant women.
... Previous research has focused on the meaning of childbirth to culturally diverse women, including Guatemalan, 20 Mexican immigrants, 21 and other groups of childbearing women. 22 Further research was proposed to describe the childbirth experience of Ecuadorian women. It is crucial to gain knowledge of women's perceptions of childbirth, which will enhance nurses' ability to provide culturally sensitive care. ...
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PURPOSE: The purpose of this qualitative descriptive study was to describe the perceptions of Ecuadorian women about giving birth. BACKGROUND: No studies could be found documenting the perspectives of Ecuadorian childbearing women about their birth experiences. With the growing influx of immigrants into the United States from South and Central America, the need for nurses to provide culturally competent care increases. A culturally competent nurse understands the importance of social and cultural influences on women’s health beliefs and practices, and generates interventions to assure quality health care delivery to diverse populations of women. METHOD: Thirty-two women who had recently given birth in a large maternity hospital were approached on the postpartum unit or in communities surrounding Guayaquil, Ecuador and consented to participate in the study. Audio-taped interviews were conducted. Interviews were transcribed and translated and analyzed as appropriate for qualitative inquiry. Members of the research team analyzed data separately to identify preliminary themes, and analysis continued as a team to finalize the results and identify the final themes arising from the narrative data. It was not feasible to contact study participants to do member checks, but other methods were utilized to ensure the trustworthiness of the data. RESULTS: “Enduring birth to obtain the gift” was the overarching theme. Supporting themes included caring for self and accessing prenatal care to have a healthy baby; relying on a Higher Power to ensure positive maternal/newborn outcomes; submission of self to health care providers because of fear, pain, and lack of education; and valuing motherhood. One woman said, “Endure it because the pains come, but then they are gone and then comes the joy because you have your baby.” Another woman said, “I asked God and the Virgin that everything would turn out good and yes, they helped. The Virgin, I even saw her at my side. It helped me being by my side between her and God.” The focus is on the well being of the child rather than the birth experience. It’s not about the birth experience, it is about the outcome. The woman endures to obtain the gift of the child. IMPLICATIONS FOR CLINICAL PRACTICE: Understanding the importance of having a child to women from South and Central America is essential. Sensitivity to the stoicism and passivity of some women is important. Women’s reliance on a Higher Power to ensure positive outcomes should be respected. The provision of education and supportive care are helpful strategies to ensure positive physiological and psychosocial outcomes in culturally diverse women. A culturally competent nurse understands the importance of social and cultural influences on patients’ health beliefs and behaviors and generates interventions to assure quality health care to diverse populations of women.
... Something special attunes at birth that makes the occasion different from other daily experiences. Birth experiences are culturally determined, enmeshed in the context and culture of society (Selin and Stone, 2009;Clarke, 2012;McIntosh, 2012). Thus birth can be viewed as social metaphor reflecting interpretation according to the dominant social context (Crouch and Manderson, 1993). ...
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Objectives This literature review examines the experience of joy at birth and what that joy means. The premise is that the whole of the birthing experience has not been fully explicated in the literature and that something of significance remains unexplored and unspoken. It is argued that a hermeneutic phenomenological approach to reviewing literature provides unique insights and leads to deeper understandings about birth and the experience of joy that attunes at that moment. Methodology The philosophical underpinnings informed by Heidegger and Gadamer are central to this review and therefore the process of reviewing literature hermeneutically is described. Heideggerian phenomenology is used as the method to ask the questions of the literature in order that concealed and hidden experiences of joy at birth are made visible where they are gleaned from the literature. A hermeneutic lens is used to uncover relationships within the phenomenon of joy at birth and meaning. Results Although a vast birth literature was reviewed joy at birth was often ignored, hidden or covered over. Reviewing the literature on relationships, professional presence, place of birth, birth satisfaction studies and birth as peak and spiritual experience provides glimpses of the phenomenon ‘joy at birth’. Conclusion It is argued that joy at birth remains largely neglected as a phenomenon worthy of consideration. Plausible interpretations are presented that suggest that joy at birth points to something significant and meaningful. Spiritual and sacred meaning is alluded to in the papers reviewed yet the majority of papers that investigate birth leave this meaning unspoken. The review highlights a need for further thinking and questioning about birth that would direct on-going investigation.
... The default mode of childbirth in high income, and increasingly in middle to low income contexts such as South Africa (Humphreys, 1998; Selin and Stone, 2009), is medicalized hospital birth. While many pregnant women enter hospital hoping to have a 'natural' birth, substantial research in high income contexts (Davis-Floyd, 1992; Martin, 1987; Miller, 2005; Oakley, 1980) and some research in South Africa (Humphreys, 1998; Lawrie et al., 2001) shows that a large proportion of women end up disappointed, with highly medicalized births. ...
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Since the 1970s, feminist research has provided a powerful critique of biomedical models of childbirth. While this critique has been extremely important, it has to some extent led to the neglect of other forms of power. For example, there has been little research which has explored childbirth as a way of ‘doing gender’ in which normative or resistant forms of gender and femininity are (re)performed. Drawing on the Foucauldian notion of ‘technologies of power’, we argue that gender is a form of disciplinary power which shapes the choices that women make in relation to childbirth. Drawing on pre-birth interviews with 21 white, middle-class pregnant South African women who were planning on either a home birth (n = 12) or an elective caesarean section (n = 9), we show how three central technologies of white femininity shaped and regulated women’s childbirth choices. These included: a patriarchal optics of childbirth, the ‘natural childbirth’ ideal and the ‘good mother’ imperative. The article concludes that women’s childbirth choices are heavily shaped by gendered technologies of power and that the decision to have a home birth or an elective caesarean section intersects with scripts of ‘doing white femininity’ in South Africa.
... Previous research has focused on the meaning of childbirth to culturally diverse women, including Guatemalan, 20 Mexican immigrants, 21 and other groups of childbearing women. 22 Further research was proposed to describe the childbirth experience of Ecuadorian women. It is crucial to gain knowledge of women's perceptions of childbirth, which will enhance nurses' ability to provide culturally sensitive care. ...
Article
The purpose of this ethnographic study was to describe the perceptions of Ecuadorian childbearing women No studies published in English could be found documenting the perspectives of Ecuadorian childbearing women about their birth experiences. Thirty-two women who had recently given birth in Guayaquil, Ecuador participated in audiotaped interviews, which were analyzed as appropriate for ethnographic inquiry. "Enduring birth to obtain the gift" was the overarching theme. Supporting themes included caring for self and accessing prenatal care to have a healthy newborn; relying on God to ensure positive maternal/newborn outcomes; submission of self to healthcare providers because of fear, pain, and lack of education; and valuing motherhood. The focus was on the well-being of the child rather than the quality of the birth experience. With a growing population of women of childbearing age immigrating into the United States from Central and South America, the need for culturally competent care is increasing. Sensitivity to the cultural beliefs and practices of Hispanic and other culturally diverse childbearing women is critical. Women's reliance on God to ensure positive outcomes should be respected. The provision of education and supportive care will help ensure positive outcomes in culturally diverse women.
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We developed and psychometrically tested a Theory of Planned Behavior (TPB) questionnaire which focused on assessing the midwives’ intention to provide planned home birth (PHB) services. This is a quantitative, cross-sectional survey, conducted among 226 midwives working in ten participating health facilities. The reliability and validity of the theoretical constructs were assessed. The Cronbach’s alpha values were >0.8 for all scales, suggesting satisfactory internal consistency. Confirmatory factor analysis revealed sufficient convergent validity (the average variance extracted was >0.5 for each construct) and discriminant validity. The study gathered an evidence of the usefulness of TPB in the specific context of PHB.
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Among the various forms of transnational grandparenting is the engagement of the so‐called zero generation – the transnationally mobile parents of adult migrants – in caring for their grandchildren abroad. It constitutes a distinct kind of intergenerational solidarity within transnational families. By taking migrant families in Switzerland as a case in point, in this article we attempt to broaden the existing research by adopting a comparative, qualitative approach towards understanding the commonalities and differences of childcare organization involving grandparental support in European and non‐European transnational families. By taking into account the main objective and the temporality of grandparents' visits in Switzerland, we identify six different types of childcare arrangements. While these arrangements are shaped by the discriminatory Swiss migration regime, several other institutional, familial, and individual factors help to promote or impede them, or to change their dynamics. Thus, we introduce an innovative, multi‐level, analytical approach towards studying the various ways in which the parents of adult migrants of different nationalities take part in the transnational circulation of care.
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