Cultural perceptions of childbirth: a cross-cultural comparison of childbearing women

Cultural Influences on Pain Perceptions and Behaviors

The perception of pain and behaviors associated with pain are influenced by the sociocultural contexts of the individuals experiencing pain. This article provides an overview of the literature on these cultural influences. With the increase in global migration, nurses need to develop increased sensitivity to the influence of culture on pain perceptions and behaviors. In the provision of home health care, it is essential that nurses are sensitive to such influences in the delivery of culturally competent care in the assessment and management of both acute and chronic pain.

Understanding childbirth practices as an organizational cultural phenomenon: a conceptual framework

Understanding the main values and beliefs that might promote humanized birth practices in the specialized hospitals requires articulating the theoretical knowledge of the social and cultural characteristics of the childbirth field and the relations between these and the institution. This paper aims to provide a conceptual framework allowing examination of childbirth practices through the lens of an organizational culture theory. A literature review performed to extrapolate the social and cultural factors contribute to birth practices and the factors likely overlap and mutually reinforce one another, instead of complying with the organizational culture of the birth place. The proposed conceptual framework in this paper examined childbirth patterns as an organizational cultural phenomenon in a highly specialized hospital, in Montreal, Canada. Allaire and Firsirotu's organizational culture theory served as a guide in the development of the framework. We discussed the application of our conceptual model in understanding the influences of organizational culture components in the humanization of birth practices in the highly specialized hospitals and explained how these components configure both the birth practice and women's choice in highly specialized hospitals. The proposed framework can be used as a tool for understanding the barriers and facilitating factors encountered birth practices in specialized hospitals.

The facilitating factors and barriers encountered in the adoption of a humanized birth care approach in a highly specialized university affiliated hospital

Background

Considering the fact that a significant proportion of high-risk pregnancies are currently referred to tertiary level hospitals; and that a large proportion of low obstetric risk women still seek care in these hospitals, it is important to explore the factors that influence the childbirth experience in these hospitals, particularly, the concept of humanized birth care.

The aim of this study was to explore the organizational and cultural factors, which act as barriers or facilitators in the provision of humanized obstetrical care in a highly specialized, university-affiliated hospital in Quebec province, in Canada.

Methods

A single case study design was chosen. The study sample included 17 professionals and administrators from different disciplines, and 157 women who gave birth in the hospital during the study. The data was collected through semi-structured interviews, field notes, participant observations, a self-administered questionnaire, documents, and archives. Both descriptive and qualitative deductive content analyses were performed and ethical considerations were respected.

Results

Both external and internal dimensions of a highly specialized hospital can facilitate or be a barrier to the humanization of birth care practices in such institutions, whether independently, or altogether. The greatest facilitating factors found were: caring and family- centered model of care, professionals' and administrators' ambient for the provision of humanized birth care besides the medical interventional care which is tailored to improve safety, assurance, and comfort for women and their children, facilities to provide a pain-free birth, companionship and visiting rules, dealing with the patients' spiritual and religious beliefs. The most cited barriers were: the shortage of health care professionals, the lack of sufficient communication among the professionals, the stakeholders' desire for specialization rather than humanization, over estimation of medical performance, finally the training environment of the hospital leading to the presence of too many health care professionals, and consequently, a lack of privacy and continuity of care.

Conclusion

The argument of medical intervention and technology at birth being an opposing factor to the humanization of birth was not seen to be an issue in the studied highly specialized university affiliated hospital.

Collaborative International Research

The current age of globalization poses challenges as to how to promote professional interaction to further international scholarly efforts in nursing. Models of global research are defined. Global health priorities are explicated, with recommendations for the conduct of outcomes-focused research leading to the generation of cost-effective interventions that contribute to the health and well-being of individuals, families, communities, and nations throughout the world. The challenges and opportunities in international collaborative nursing research are described based on the experiences of the authors during nearly two decades of collaborative work. International partnerships in globally relevant research, which respect and value equity between nurse researchers practicing in developed and developing countries, are essential.

Jordanian women: Perceptions and practices of first-time pregnancy

A woman's child-bearing encounter is an experience that reflects the cultural beliefs and practices of the society. The purpose of this study was to describe the perceptions and practices of urban, low socioeconomic, Jordanian women (aged 18-30 years) in relation to their pregnancy career. An opportunistic sample consisting of 67 Muslim first-time pregnant women who followed up antenatal care at two maternity-care centres in East Amman was selected. A qualitative approach, including ethnographic semistructured interview, participant observation data from the households and clinics and oblique interviewing in random conversations initiated by the primigravidae, was conducted over 18 months. Women gave elaborative accounts of their pregnancy and childbirth expectations in narrative, phenomenological forms. Qualitative data analysis was performed concurrently with data collection, revealing the essential themes of immediacy of pregnancy; familial support and changing networks, especially for the after-birth period; fear of pain and medical interventions, all emphasizing the traditional and religious perceptions and practices in a familial context.

Swedish and Middle-Eastern-born women's beliefs about gestational diabetes

OBJECTIVE

to compare beliefs about health and illness between women born in Sweden and the Middle East who developed gestational diabetes (GD).

DESIGN

a qualitative, explorative study using semi-structured interviews.

SETTING

in-hospital diabetes specialist clinic in Sweden.

PARTICIPANTS

consecutive sample of women with GD; 13 born in Sweden and 14 born in the Middle East.

MEASUREMENT AND FINDINGS

all the women described health as freedom from disease, and expressed worries for the baby's health and well-being. Women from the Middle East did not know the cause of GD, discussed the influence of social factors, such as being an immigrant, and supernatural factors, tried to adapt to the disease and thought it would disappear after birth, felt they had more pregnancy-related complications but had not received any treatment. Swedish women attributed GD to inheritance, environment and hormonal change, feared developing Type 2 diabetes, found work-related stress harmful to their health, more often sought help, used medications against pregnancy-related complications, and were more often on sick-leave from work.

KEY CONCLUSIONS

Swedish women initiated a battle against GD, demanded medical treatment for pregnancy-related complications because of gainful employment and viewed pregnancy as a disease. Women from the Middle East temporarily adapted to the disease and perceived pregnancy and related problems as a natural part of life.

IMPLICATIONS FOR PRACTICE

it is important to assess individual beliefs, risk awareness and to meet individual needs for information.

Giving Birth: The Voices of Orthodox Jewish Women Living in Canada

OBJECTIVE

To describe the meaning of the childbirth experience to Orthodox Jewish women living in Canada.

DESIGN

In this phenomenologic study, audiotaped interviews were conducted. Tapes were transcribed verbatim and analyzed for emergent themes. Demographic data also were collected.

SETTING AND PARTICIPANTS

Thirty Orthodox Jewish women who had given birth to healthy full-term newborns at a university-affiliated Jewish hospital in Montreal, Canada, participated in the study. Data were collected within 2 weeks after childbirth, either in the mother's postpartum hospital room or in her home.

RESULTS

The following themes reflecting spiritual/cultural dimensions of the childbirth experience were identified: (a) birth as a significant life event, (b) birth as a bittersweet paradox, (c) the spiritual dimensions of giving birth, (d) the importance of obedience to rabbinical law, and (e) a sense of support and affirmation.

CONCLUSION

This study documents cultural, religious, and spiritual dimensions of the childbirth experience of Orthodox Jewish women living in Canada. Knowledge and appreciation of the multiple dimensions of childbirth reflected by this study's findings can contribute to holistic and culturally competent nursing care of women and newborns.

The pain of childbirth: perceptions of culturally diverse women

The pain experiences of culturally diverse childbearing women are described based on a secondary analysis of narrative data from phenomenologic studies of the meaning of childbirth. Study participants were interviewed in the hospital after giving birth or in their homes within the first weeks after having a baby. Transcripts of interviews with childbearing women who lived in North and Central America, Scandinavia, the Middle East, the People's Republic of China, and Tonga were analyzed. Participants described their attitudes toward, perceptions of, and the meaning of childbirth pain. Culturally bound behavior in response to childbirth pain was also articulated. A variety of coping mechanisms were used by women to deal with the pain. Understanding the meaning of pain, women's perceptions of pain, and culturally bound pain behaviors is fundamental in order for nurses to facilitate satisfying birth experiences for culturally diverse women.

Giving birth. Voices of Chinese women

The meaning of the childbirth experience for Chinese women living in the People's Republic of China is described in this phenomenological study. Ten primiparous women participated in audiotaped interviews within 5 months of giving birth, 9 from Beijing and 1 from Chongqing. The interviews were translated by a bilingual native Chinese speaker and transcribed by the researcher. Themes were identified from the rich narrative data, including the One Child Policy's influence on childbearing, the transition to motherhood, and the influence of the cultural practice of "doing the month" (zuo yue zi). The findings provide insights into how nurses can provide better nursing care by learning about and validating specific cultural practices related to childbearing. The rising number of Chinese immigrants to the United States reflects the increasing need for more culturally competent care by nurses to ensure positive perinatal health outcomes.

Childbirth expectations of Chinese first-time pregnant women

BACKGROUND

This topic had not been researched previously and the information gained could have implications for midwives working with Chinese women everywhere.

AIMS

To explore the specific childbirth expectations of Hong Kong Chinese first-time pregnant women.

METHODS

This was a cross-sectional descriptive survey study and a Chinese version of the Childbirth Expectations Questionnaire was used to collect data. The sample consisted of 186 first-time pregnant women who first attended the antenatal clinic at a large public hospital in a major geographical region of Hong Kong.

RESULTS

Results showed that the Chinese pregnant women, the majority of who had not attended childbirth education classes, had high expectations of support from both their partners and midwives during labour and delivery. Conversely, expectations toward their own ability to cope with pain were relatively low. In addition, the pregnant women expressed concerns about the severity of labour pain and indicated low expectations about minimal use of medical interventions during labour.

CONCLUSIONS

This study results add to the existing literature about childbirth expectations of first-time pregnant Hong Kong Chinese women. Midwife educators should incorporate the findings into childbirth education classes to help pregnant women develop realistic and positive expectations.

Maintaining privacy on post-natal wards: a study in five European countries

AIM

Maintaining privacy on post-natal wards: a study in five European countries Aim. To describe how mothers' privacy is maintained on post-natal wards in five European countries: Finland, Spain, Greece, Germany and Scotland [United Kingdom (UK)]

BACKGROUND

Privacy is an important concept in nursing and nursing ethics. Empirical studies in this field, however, are few. In this study, privacy is defined as comprising both physical and social-informational dimensions and both the perceptions of mothers and professional were investigated.

METHODS

The data were collected by a questionnaire from mothers (n=1192) and midwife/nursing staff (n=952).

RESULTS

The results revealed differences both between the different countries and between patients' and professionals' views. Mothers in Finland, Germany and Scotland felt their privacy was maintained better than mothers in Greece and Spain. The differences in staff perceptions are less clear-cut. Different background factors emerge as statistically significant in different countries.

CONCLUSION

Empirical studies in privacy are important and give ideas about the problems in nursing practice. Future analyses should look also at other areas of nursing.

Culturally competent care of women and newborns: knowledge, attitude, and skills

In a variety of health care settings throughout the United States and Canada, nurses are caring for women and newborns from culturally diverse backgrounds. In the technologically complex and bureaucratic world of health care delivery, cultural considerations in provision of care often are overlooked and neglected. The purpose of this article is to define ways in which culturally competent nursing care can be implemented. Nursing education and clinical practice guidelines are clear on the importance of gaining cultural competence. Providing culturally competent care includes understanding the dimensions of culture; moving beyond the biophysical to a more holistic approach; and seeking to increase knowledge, change attitudes, and hone clinical skills. Building on the strengths of women rather than utilizing a deficit model of health care is an essential part of providing culturally competent care. The achievement of both measurable and "soft" outcomes related to the delivery of culturally competent care can make a critical difference in the heath and well-being of women and newborns.

Giving birth. Perceptions of Finnish childbearing women

PURPOSE

To describe the lived experience of childbirth with women giving birth in Finland.

DESIGN

Phenomenology.

METHODS

Twenty Finnish women who had recently given birth were interviewed within 2 weeks following childbirth, sharing their perceptions of meaning of their childbirth experiences. Culturally appropriate strategies for qualitative data collection were employed. Trustworthiness of the data was ensured.

RESULTS

The richness and diversity of the childbirth experience emerged from the data. One theme identified was a sense of awe at the creation of a new life within the context of birth as a bittersweet paradox. A strong sense of maternal confidence or self-efficacy was identified, which influenced the women's perception of and management of childbirth pain. Feelings of self-actualization were articulated as Finnish women successfully negotiated a challenging life event.

CLINICAL IMPLICATIONS

Perinatal nurses should increase their sensitivity to the socio-cultural context of giving birth by acknowledging women's experiences as legitimate sources of knowledge.

A review of the concept of culture in holistic nursing literature

Core Value IV of the American Holistic Nurses' Association includes valuing the client's cultural background. The authors reviewed all article abstracts from two major holistic nursing journals for a 3-year period (N = 198). References to concepts of culture or ethnicity were found in only 9.6% of abstracts. Many theorists and researchers did not discuss how the theory or research findings varied between culturally or ethnically diverse samples. When culture is a core value, practitioners and researchers cannot assume that culture has been considered without stating what was the interaction of culture with the phenomenon of concern. The authors recommend that nurses develop cultural competence in caring for clients from differing cultural orientations by (a) committing to improve their knowledge of multiple cultures; (b) exploring their own cultural background; (c) seeking exposure to cultures other than their own; and (d) regularly discussing culture and ethnicity in nursing theory, research, and practice.

Cultural and spiritual meanings of childbirth. Orthodox Jewish and Mormon women

This descriptive, phenomenological study investigated the cultural and spiritual meanings of the childbirth experience from the personal perspectives of 30 Canadian Orthodox Jewish and 30 American Mormon women. Fewer Jewish women had childbirth education and attendance of their partners during childbirth than did Mormon women. Participants in the study, having codified belief systems, expressed the primary importance of bearing children in obedience to religious law. Birth was articulated as a bittersweet paradox, often accompanied by a sense of empowerment. Women described the importance of personal connectedness with others and with God, the importance of childbearing, and the spiritual and emotional dimensions of their childbirth experiences. Religious beliefs help women define the meaning of childbirth and may provide coping mechanisms for the intensity of giving birth. It is essential for holistic nurses to value and acknowledge the cultural and spiritual dimensions of the childbirth experience.

Giving birth: Guatemalan women's voices

OBJECTIVE

To gain an understanding of the cultural meanings of giving birth for Guatemalan women.

DESIGN

Ethnographic, focusing on the birth stories of Guatemalan women and their perceptions of the sociocultural context of childbearing.

PARTICIPANTS AND SETTING

Thirty Guatemalan women (15 primiparae and 15 multiparae) of mixed Mayan and Ladino heritage who had given birth to healthy full-term infants were interviewed during the early postpartum weeks. These women lived in small villages in the Sacatepéquez District of Guatemala. These audiotaped interviews were conducted in the Nacional Pedro de Bethancourt Hospital, in clinics, in the homes of the women, or in central plazas.

RESULTS

The sociocultural context of giving birth in Guatemala is described, including common beliefs about pregnancy and childbirth and the meaning and significance of having children. The predominant themes found were the sacred nature of childbirth; the need for reliance on God during pregnancy, childbirth, and childrearing; and the bittersweet paradox of giving birth.

CONCLUSION

With increasing numbers of Central American refugees and immigrants of childbearing age entering the United States, it is important for nurses to recognize, acknowledge, and respect specific cultural practices related to childbearing.

Cultural meanings of childbirth: Muslim women living in Jordan

This descriptive, ethnographic study focuses on the experience of childbirth for Muslim women living in Jordan. Thirty-two childbearing women were interviewed in the early postpartum weeks. The audiotaped interviews were transcribed and translated. Themes were identified from the rich, narrative data. Motivations for having children, as well as what constitutes the motherhood feeling, were described. Themes also included the importance of relying on God or Allah for support in childbearing and child rearing. A strong sense of the spiritual dimensions of giving birth within women's traditional, religious, and cultural context was identified. Findings from this study provide insight into the meanings of childbirth for Muslim women living in Jordan. These meanings assist nurses in providing culturally competent care.