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Child-birthing practices on a global level.

Introduction

When considering childbirth delivery, there are many factors that come into play. "It is known that adequate prenatal care leads to improved perinatal outcomes for all mothers and infants, but particularly those considered high risk" (Sweet, et al., 2015, p. 332). As birth related complications can lead to death or disability for the pregnant woman (Lori & Boyle, 2011), it is important to understand and identify resolutions for factors that hinder healthy childbirths. Such factors include personal economics, the presence of suitable birthing staff, facility reputation, family and cultural practices, and spirituality (Blanchard, 2015; Cipolletta & Sperotto, 2012; Sweet, et al., 2015). For many pregnant women, an interdependent relationship between family, community, and their economic situation determine where they deliver their child, not their personal desires. The purpose of this paper is to contribute to the discussion on factors that affect childbirth. Although there are a number of factors that pregnant parents must consider, this paper will only discuss decision making, cultural beliefs, and birth issues.

Decision Making

Birthing decisions may be made collectively by the future parents, in-laws, and community and depend on socio-cultural, economic, and community factors. For example, in Northern Karnataka, India, birth decisions may be a collective decision because of "household gender and power dynamics" (Blanchard, et al., 2015, p. 2074). Childbirth educators play a role in decision-making and often play integral parts in the team of healthcare professionals, providing support as the family begins to develop and transition through pregnancy into parenthood and promote the overall well-being of women as individual human beings (ICEA, 2016). Because of this childbirth educators need to know how to determine who's making birth decisions especially when working with high-risk deliveries. Appealing to the true decision maker early on helps to ensure appropriate measures are taken to ward off childbirth problems. In situations where the pregnant woman may disagree with the birthing decisions made by family and community decision makers, it is important that the childbirth educator work with both the family and community dynamics to facilitate the best decision for the pregnant woman and the child.

Another factor which influences childbirth decision-making is the birth parent's relationship with the service provider (Cipolletta & Sperotto, 2012). Whether the service provider is a midwife, physician, or facility, the pregnant parent must be able to discuss concerns and have a respectful conversation. The birthing experience can be negative when communication between the pregnant woman and the service providers is problematic. Well-meaning childbirth personnel who focus more on providing information than listening to concerns might remember that to adequately serve the pregnant and/or birthing parent, they must first have established a respectful relationship. Respect is built when both parties listen to each other. Finding respectful ways to dispel incorrect myths allow the childbirth educator to demonstrate their knowledge as well as their desire to learn from the pregnant woman. Allowing the pregnant woman to be the expert in her life/situation helps the childbirth educator understand how the pregnant woman thinks about her pregnancy. A major goal for the childbirth educator is to ensure maternity care throughout the pregnancy. Having a respectful relationship with the pregnant woman may increase compliance with treatment protocol.

Cultural Beliefs

As culture shapes a person's worldview, it is imperative that childbirth educators understand and respect the pregnant woman's culture. The pregnant woman's cultural view shapes her self-view and how she sees interactions with medical and support staff (Lori & Boyle, 2011). Find helpful but limited ways to include cultural healers and or cultural healing practices when developing service delivery material and/or educational products. For example, Lori and Boyle (2011) discussed the use of "black baggers" in Liberia. Black baggers were described as individuals who may have formal but limited medical training. According to Lori and Boyle (2011), these individuals dispensed medications, performed medical treatment, and provided overall medical advice. The childbirth educator is not expected to endorse black baggers' practices. The objective for childbirth educators is to understand their role in Liberian cultural medicine. The childbirth educator must find respectful ways to ensure the pregnant woman follows appropriate medical practices during her pregnancy and after the birth of her child without diminishing the pregnant woman's cultural beliefs.

Another cultural issue is communication. An example of how cultural communication influences the childbirth educator and the pregnant woman is language. Even in the same country, words can have both a global meaning and a cultural meaning (Choudhury, et al., 2012; Duncan & Gilbey, 2007). An example is the word "okay." In the United States, okay can globally mean "I understand and agree with you." This same word can culturally mean, "I understand but will do it my way. So stop talking to me about this issue." The task for the childbirth educator is to probe for consensus meaning without being rude, disrespectful, and/or challenging. Learning to listen to how words are used, the inference placed on a word, and the body language that accompanies a statement will help the childbirth educator fully understand the intent of the pregnant woman's message.

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Birth Issues

Issues related to childbirth include vaginal vs. planned caesarean section births, and local vs. facility births. In high income countries, many women now have the choice of vaginal or caesarean section births (Cipolletta & sperotto, 2012; Miller & Shiver, 2012) and while this is alarming to those of us who strive for low intervention in the birth process, it is still a choice. Believing that unbearable pain is associated with a vaginal birth may lead women to choose a caesarean section. "Between 7 and 26% of women in high income countries fear childbirth with 6% reporting the fear as "disabling" (Richens, Hindley, & Lavender, 2015, p. 574). According to Richens, Hindley, and Lavender (2015), in the United Kingdom fear of a vaginal birth "is an accepted reason for caesarean section" (p. 578). Whether these fears are justifiable or not, the childbirth educator must develop an extensive knowledge of issues that lead to difficult childbirths and the verbal communication skills required to fully explore the pregnant woman's fears. It could be beneficial to provide educational information on the benefits of vaginal births. The goal is to ensure the pregnant woman knows how her birth decisions influence her child and her experience.

Finding a safe and quality birth site is an important issue for many pregnant women in developing countries and poor areas of developed countries. According to Sweet et al. (2015), "almost one quarter of all women residing in rural South Australia relocate to another area to give birth" (p. 332). Traveling away from her community and family changes the support these women have available to them during and after childbirth. By relocating for childbirth, pregnant women may unintentionally signal to area midwives and birthing centers that she views them inadequate. This unintended message may impede the medical care pregnant women receive once they return home.

There are additional concerns when pregnant women are forced to give birth away from their support system. Sweet et al. (2015) reported, "... for women forced to travel for their maternity care. Such adverse effects include suboptimal antenatal care, lack of continuity of care, financial burden and stress from family disruption, travel and isolation, as well as culturally, socially and emotionally inappropriate models of care" (p. 336).

When discussing giving birth outside of their home communities, the childbirth educator must discuss the short-term and the long-term consequences of making such a decision. These consequences must be weighed against the medical needs of both pregnant women and their child.

Although giving birth in larger medical communities may be beneficial for some pregnant women, their decision also has consequences for their home community. The number and quality of medical personnel depend on usage. For example, "In rural South Australia, there has been a steady decline in the number of rural hospitals providing maternity birthing services" (Sweet et al., 2015, p. 334). This decline directly relates to pregnant women choosing to deliver their children in larger medical centers. Therefore, if community members consistently choose medical services outside of their home communities, the community medical staff and facilities can choose to move where they will find users for their services. The widespread decision to not use community services may change the quality of life for community residents as well as the community's economic position as money for birthing services are spent outside of the community.

Conclusion

There are times when pregnant women cannot make all of the decisions related to childbirth. Before and during the birthing process, pregnant women need help to prioritize differing birthing perspectives. Pressure to make a particular childbirth decision may come from family, community, and cultural beliefs. Helping pregnant women make birthing decisions is part of the role of childbirth educators. Further study is needed to determine how this added task for child birth educators might be addressed through maternal health literacy.

References

Blanchard, A. K., Bruce, S. G., Jayanna, K., Gurav, K., Mohan, H. L., Avery, L., Moses, S., Blanchard, J. F., & Ramesh, B. M. (2015). An exploration of decision-making processes on infant delivery site from the perspective of pregnant women, new mothers, and their families in Northern Karnataka, India. Maternal Child Health Journal, 19, 2074-2080. Doi: 10.1007/S10995015-1720-3

Choudhury, N., Moran, A. C., Alam, M. A., Ahsan, K. Z., Rashid, S. F, & Streatfield, P. K. (2012). Beliefs and practices during pregnancy and childbirth in urban slums of Dhaka, Bangladesh. BMC Public Health, !2(1), 1-6.

Cipolletta, S., & Sperotto, A. (2012). From the hospital organization to the childbirth practice: Italian women's experiences. Journal of Reproductive and Infant Psychology, 30(3), 326-336. Doi: 10.1080/02646838.2012.707777

Duncan, G. F., & Gilbey, D. (2007). Cultural and communication awareness for general practice registrars who are international medical graduates: A project of Coast City Country Training. Australian Journal of Rural Health, !5, 52-58. Doi: 10.nn/j.1440-1584.2007.00850.x

Lori, J. R., & Boyle, J. S. (2011). Cultural childbirth practices, beliefs, and traditions in postconflict Liberia. Health Care for Women International, 32(6), 454-473. Doi: 10.1080/07399332.2011.555831

Miller, A. C., & Shriver, T. E. (2012). Women's childbirth preferences and practices in the United States. Social Science & Medicine, 75, 709-716. Doi: 10.1016/j.socscimed.2012.03.051

Richens, Y., Hindley, C., & Lavender, T. (2015, Aug.). A national online survey of UK maternity unit service provision for women with fear of birth. The British Journal of Midwifery, 23(8), 574-579.

Sweet, L. P., Boon, V. A., Brinkworth, V., Sutton, S., & Werner, A. F (2015). Birthing in rural South Australia: The changing landscape over 20 years. Australian Journal of Rural Health, 23, 332-338. Doi: 10.nn/ajr.12214

by Barbara F. Turnage, PhD, Rebecca Smith, PhD, and Justin D. Succhio, PhD

Dr. Barbara F. Turnage holds a Bachelor of Science in Social Work, a Master of Social Work, and a PhD in Social Work.

Dr. Turnage is the coordinator of the Mid-Tennessee Collaborative-MSW-Program and teaches social work at Middle Tennessee State University.

Dr. Rebecca Smith holds a Master of Science in Social Work and a PhD in Social Work. Dr. Smith is the Chair of the Department of Social Work at Middle Tennessee State University.

Dr. Justin D. Bucchio is an Assistant Professor in Social Work and teaches undergraduate courses at Middle Tennessee State University.
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Author:Turnage, Barbara F.; Smith, Rebecca; Bucchio, Justin D.
Publication:International Journal of Childbirth Education
Geographic Code:1USA
Date:Apr 1, 2016
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