[Newborn care: International recommendations confronted with the social challenges surrounding birth]

Transcultural skills for early childhood professionals

Context

Transcultural skills are especially useful for those involved in the perinatal period, when parents and babies must adapt to one another in a setting of migration a long a focus of transcultural clinical practice.

Objective

The aim of this article is to provide useful transcultural skills for any health care worker (e.g., psychologists, child psychiatrists, midwives, family doctors, pediatricians, specialized child-care attendants, and social workers) who provide care or support to families during the perinatal period. It highlights the cultural aspects requiring attention in relation to representations of pregnancy, children's needs, obstetric complications, and postnatal problems. Taking into account the impact of culture on clinical evaluation and treatment can enable professionals to distinguish what involves cultural representations of pregnancy, babies, and sometimes of disease from what is associated with interaction disorders or maternal psychopathology.

Methods

After explaining the relevance of transcultural clinical practices to provide migrant mothers with better support, we describe 9 themes useful to explore from a transcultural perspective. This choice is based on the transcultural clinical practice in our specialized department.

Results

The description of these 9 themes is intended to aid in their pragmatic application and is illustrated with short clinical vignettes for specific concepts. We describe situations that are extreme but often encountered in liaison transcultural clinical practice for maternity wards: perinatal mourning with cultural coding, mediation in refusal of care, cultural misunderstandings, situations of complex trauma and of multiple contextual vulnerabilities, and difficulties associated with acculturation.

Discussion

The transcultural levers described here make it possible to limit cultural misunderstandings and to promote the therapeutic alliance. It presupposes the professionals will concomitantly analyze their cultural countertransference and acquire both the knowledge and know-how needed to understand the elements of cultural, political, and social issues needed to develop clinical finesse.

Conclusion

This combined theoretical-clinical article is intended to be pedagogical. It provides guidelines for conducting transcultural child psychiatry/psychological interviews in the perinatal period aimed at both assessment and therapy.

Grandmothers - a neglected family resource for saving newborn lives

Across the globe, the well-being of newborns is significantly influenced by the knowledge and practices of family members, yet global health policies and interventions primarily focus on strengthening health services to save newborn lives. Predominant approaches to promote newborn survival in non-western cultures across the Global South are based on a western, nuclear family model and ignore the roles of caregivers within wider family systems, whose attitudes and practices are determined by culturally prescribed strategies. In this paper, I review evidence of a neglected facet of newborn care, the role and influence of senior women or grandmothers.

Based on a family systems frame, I reviewed research from numerous settings in Africa, Asia and Latin America that provides insight into family roles related to newborn care, specifically of grandmothers. I identified primarily published studies which provide evidence of grandmothers’ role as culturally designated and influential newborn advisors to young mothers and direct caregivers. Research from all three continents reveals that grandmothers play similar core roles in newborn care while their culturally specific practices vary. This review supports two main conclusions. First, future newborn research should be conceptualised within a family systems framework that reflects the structure and dynamics of non-western collectivist cultures. Second, newborn interventions should aim not only to strengthen health services but also influential family caregivers, particularly grandmothers and the indigenous social support networks of which they are a part, in order to improve family-level newborn practices and save newborn lives.

[The challenge of implementing exclusive breast-feeding in Burkina Faso]

INTRODUCTION

The WHO and UNICEF have declared exclusive breast-feeding one of the essential tools in the fight against neonatal mortality. Both international bodies finalized a 40-hour training program to provide counseling in feeding, to teach a body of care-givers to bring qualified assistance to the breast-feeding mothers and to help them to overcome their difficulties. However, in the field and in maternities such as those where the study took place (Boucle du Mouhoun region in the northwest of Burkina Faso), although technical recommendations are generally adopted and respected, exclusive breastfeeding makes it difficult for mothers to find their way. The aim of this study is to examine the blockages existing at the maternity ward and in families which prevent the practice of exclusive breastfeeding from becoming widespread. A qualitative approach was used through open interviews with various socio-professional medical categories and community members.

METHOD

Fourteen observations were made in the families. Twenty-four observations were made on the care of the newborn at home. Thirty-eight interviews with health and administrative staff and nine interviews with healers using traditional knowledge were also conducted.

RESULTS

The results show that exclusive breastfeeding is complicated to implement particularly in rural areas because of the use of medicinal plants in the form of washing and gavage. Moreover, the information is not given to mothers of families at the appropriate time.

CONCLUSION

In conclusion, we suggest that maternities be thought out and designed in partnership with the health workers who use them.

[“Forgetting” the newborn: An anthropological analysis in Mauritania]

INTRODUCTION

In Mauritania, as in other West African countries, a series of actions has been taken to combat neonatal mortality. Considering the mixed success of these programs, we wondered how health workers are investing in neonatal care.

METHOD

An anthropological study was carried out in a locality in the Senegal River Valley. The surveys consisted of an ethnography of a health center, which resulted in detailed observations of care and interviews with health workers.

RESULTS

Our observations reveal that in the crucial minutes and hours following a normal birth, the attention of caregivers tends to turn away from the newborn. Recommended care such as keeping warm, examining and monitoring the newborn is not provided, while early breast-feeding occurs in a fluctuating manner. The newborn is quickly handed over to the family. Newborn care is thus "forgotten", both in the sequence of actions around childbirth and in the collective distribution of professional responsibilities.

DISCUSSION

Newborn care at birth remains poorly medicalized. We analyze the least involvement of health workers with newborns in two aspects : the perception of the uncertainty of neonatal survival, and the predominance of local childbearing. We are making proposals to put the spotlight back on the newborn in order to promote a better quality of neonatal care.