Going back to a previous topic of discussion in this blog –teaching the intersection of Latino culture and medicine to healthcare professionals–, in this post I would like to present one that is often forgotten: pregnancy and childbirth beliefs. This is actually one of my favorite topics, in part because of the importance it has to the woman herself and in part because of the great diversity in beliefs regarding pregnancy and birth. In this post, I will explain why I believe this to be an important issue to address in class, then I will describe a few examples of pregnancy and childbirth beliefs and how they can impact health and care, and finally I will offer some suggestions regarding how to address the subject in class.
When computers were first being invented and the idea of creating artificial intelligence came about, psychologist, pragmatists, linguists and others came together to work out a model of human behavior. One such model developed by Schank and Abelson (1977) is still used by pragmatists and linguists today. It describes the idea that humans have “scripts” in their mind for situations with which they interact often, allowing them to have a preconceived idea of what the situation will be like and how then they should or should not act or speak. For example, whenever a person enters a nice restaurant, they know to wait to be seated, they know they will be asked their drink orders and will be brought a menu, and they know that they will be expected to pay at the end. It is not something that must be relearned every time one decides to go out to eat. The same is true when we go to the doctor’s office: we know to sign in, sit and wait until we are called back by the nurse who will take our vital signs and chief complaint, and then we know to wait until the doctor comes. If we were to go to the clinic one day and that order is changed or the actions do not match what we are expecting, we would probably be confused and maybe even distrustful (this sometimes occurs for those who seek medical assistance in another country, since the routine of care is not internationally equivalent). According to Schank and Abelson, the idea of what we expect when we enter a clinic is a “script” in our mind regarding medical care.
So, what does that have to do with pregnancy beliefs? When a woman is pregnant and seeks care, she has pre-conceived ideas of what that care will entail, how she will be treated and what kind of information she will receive from the doctor. However, this “script” is culturally dependent. This means that, for a woman living outside of her own culture, her “script” may not match what actually happens and the care received. On top of not understanding everything that is being said (even if translated to Spanish, not all women are familiar with terms like “c-section” or “episiotomy”), this cultural difference in the “script” can result in discomfort, stress and confusion. This situation becomes even more difficult when we take into account that some cultures (such as the Latino one) sometimes find it difficult to ask the doctor questions (see post on respeto). Additionally, some pregnancy beliefs, like any other beliefs, can affect health outcomes or can result in excessive stress or fear if unaddressed. I will return to this later in the post.
While working in the clinical setting and studying to teach prenatal classes, one of my responsibilities was to help enroll the Latina women in pregnancy Medicaid, connect them to any other needed resources, and offer some basic pregnancy education that supported what the doctor was also telling them. Thanks to the relationship that I fostered with the women, many were open about their beliefs and questions, which in turn allowed me to begin to understand the difficulties of childbirth in countries that do not hold or respond to the same beliefs that I or others like me hold. Additionally, I participated in Centering Pregnancy classes for Latina women where at the beginning of each class they would write on the board any of their questions or concerns. Many turned out to be based on cultural beliefs. All that to say, it was through those experiences that I was able to witness the diversity of beliefs and because of those experiences it is my opinion that teaching medical professionals how to interact with pregnant patients is a key ingredient in adequate cross cultural education.
However, before going on to describe how to teach this topic in class, I would like to present a few examples of the beliefs that I encountered in clinic and how they affected the woman´s well-being, both physically and psychologically, as well as her relationship with others.
- “If I kiss my husband too much, I will pass my pregnancy symptoms to him”. This belief was the cause for some marital strain as the couple attempted to avoid touch during the pregnancy.
- “If I go to a funeral while I am pregnant, my baby will die or be born sickly”. One patient struggled particularly with this belief since a close relative died during her pregnancy and she wanted to go to the funeral for closure but was afraid to. The mental and cultural conflict was quickly leading her into depression.
- “If I undergo too much stress during pregnancy, I will have a miscarriage”. The patient who most struggled with this belief first presented in clinic saying that her ex-boyfriend wanted to kill her unborn baby as payback for her leaving him and she wanted a restraining order. She was sent to me after the doctor could not find a basis for the accusation. She explained that her ex would call her and threaten her in ways that he knew would stress her out because he wanted her to lose the pregnancy (something he explicitly stated in these phone conversations). Though we were unable to help her get a restraining order, understanding her cultural belief enabled us to work with her in such a way that allayed her fears.
- “After giving birth, I can only eat eggs and chicken stock.” I was sent for by a patient´s family after she gave birth because the hospital did not give her eggs or chicken stock. Since they did not know how to ask for it, the patient had not been eating since the birth.
There are many more beliefs regarding pregnancy and birth; this post is not intended to present all (or even many) beliefs, but instead to create awareness around the issue. However, a few more interesting beliefs can be found in this post written by Lourdes Alcañiz, author of the book Esperando a mi bebé: una guía del embarazo para la mujer latina.
How then can we approach this issue in Spanish for healthcare professionals courses? As always, instructors need to first create an environment of cultural self-awareness among the students and of respect towards the cultural ideas they will be studying. Instructors also need to stress that not all patients hold to the same beliefs nor do they hold to them to the same degree. In presenting pregnancy and childbirth beliefs, I would not recommend attempting to offer all of them to the students. This may result in overwhelming (given the number) or frustrating (given the variety, they may never run across most present to them but run into others that were not) the students. Instead, I would suggest that instructors only present a couple of beliefs as examples to work with in class and instead focus on developing skills to interact with the Latina patient and invite her to discuss her concerns. To say it all together: the information given in class should make professionals aware that various cultural pregnancy and childbirth beliefs exists and can affect the health or wellbeing of the woman, and the activities should center on building skills that promote a “safe” environment to discuss concerns and techniques for welcoming culturally-related questions.
Alcañiz, Lourdez (2011). “Mitos y creencias tradicionales sobre el embarazo”. Baby Center. URL: http://espanol.babycenter.com/a900142/mitos-y-creencias-tradicionales-sobre-el-embarazo
Peterson-Iyer, Karen (2012). “A difficult birth: Navigating Language and Cultural Differences”. Markkula Center for Applied Ethics, Santa Clara University. URL: http://www.scu.edu/ethics/practicing/focusareas/medical/culturally-competent-care/difficult-birth-peterson-iyer.html
Schank, Roger C. & Robert Abelson (1977). Scripts, Plans, Goals and Understanding. Lawrence Erlbaum Associates: NJ.