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Why cultural awareness matters in pregnancy care | Your Pregnancy Matters

Pregnancy care providers see a lot of cultural diversity every day. Our patients represent a broad spectrum of ethnicities and walks of life, as well as a tapestry of beliefs and customs that help shape their values.

Traditionally, doctors are scientific and data-driven. We recommend the safest, most effective treatments based on medical knowledge. But today, particularly in culturally diverse communities such as the Dallas-Fort Worth Metroplex, doctors must strive for cultural competence to provide optimal care. And it all starts with effective patient-doctor communication. 

“Cultural competence goes far beyond the Golden Rule – treat people as you would prefer to be treated. That works only when someone wants to be treated the same way as you.”

Patricia Santiago-Munoz, M.D.

Doctor and health care organization responsibilities

Cultural competence goes far beyond the Golden Rule – treat people as you would prefer to be treated. That works only when someone wants to be treated the same way as you.  

Especially in pregnancy care, there are cultural nuances to many aspects of communication, from religious and family dynamics to guidelines around personal space and privacy. While it’s not feasible for a doctor to be fully immersed in every culture represented by his or her patients, it is our duty to have a basic understanding of patients’ needs and communicate with them effectively and in a way that makes them feel comfortable.

The American College of Obstetricians and Gynecologists (ACOG) released a committee opinion urging doctors to recognize that their approach to patients’ behaviors and beliefs can negatively affect patient communications. 

Additionally, doctors should provide and advocate for improved access to care. For example, doctors who are not fluent in a patient’s primary language should enlist the help of an interpreter. UT Southwestern staffs a range of interpreters, but when a needed language isn’t available, we use LanguageLine, a paid service through AT&T. In those instances, doctors should direct all questions and comments to the patient, not the interpreter, to establish a connection and foster lasting, positive health care relationships.

Four important cultural considerations 

1. Family dynamics 

Men are household leaders in various cultures, and some Ob/Gyn patients defer to their partner for medical decisions. Additionally, some patients feel strongly that procedures such as a hysterectomy reduce a woman’s body image or womanhood. Doctors must approach these conversations differently from the way we might discuss less intimate procedures.

The topic of sexuality has become more mainstream, but conversations can become awkward quickly without a culturally competent provider. Pregnancy providers should be open-minded and get to know their patients’ situations and preferences without making assumptions. For example, we see patients with a variety of circumstances and unique situations, such as women with more than one partner, same-sex couples, and patients who are surrogates for other couples.  

2. Provider gender 

Some patients request a male or female doctor due to cultural or personal preferences. Usually that is an option, particularly at an academic medical center. When it is not, we recommend that the doctor have a conversation with the patient to find solutions to make the situation more comfortable. 

For example, I recall a patient who was in labor with a premature baby. She felt uncomfortable having men except her partner in the room during delivery and recovery. However, her baby needed immediate specialized care after birth, and all the pediatricians on staff that night were men. So, to respect the patient’s wishes and properly care for her baby, we partitioned the room with screens – the male doctor could be present without invading the patient’s privacy.

3. Religious and cultural beliefs

Certain medical procedures associated with pregnancy, such as circumcision and blood transfusions in emergency situations, are not acceptable by all religions. Some cultures also have guidelines or traditions around co-sleeping, baptism, and baby-naming. And patients might seek traditional remedies before or along with treatments prescribed by their doctor. 

Additionally, food is largely related to religious and cultural beliefs. We work to match offerings in the hospital with specific diets and personal likes and dislikes. Our intake team asks about vegan, gluten-free, kosher, and other needs and preferences in order to optimize nutrition and increase comfort during their stay.

4. Communication

Some patients and doctors still adhere to a paternalistic model of health care in which “doctor knows best.” Patients might be hesitant to ask questions out of fear of judgment, so doctors must provide every opportunity for open communication. Additionally, men and women, as patients and doctors, tend to have different communication styles.

Effective, culturally competent communication between doctors and patients is essential in pregnancy care. In the Ob/Gyn setting, we must ensure that patients are comfortable enough to be honest with us, particularly during sensitive and sometimes painful discussions. 

We must communicate in ways that make women feel cared for without judgment. And we must ask the right questions to ensure that patients understand why we are making certain recommendations and how we will care for them in a thoughtful, open-minded manner. 

Stay on top of health care news. Subscribe to our blog today.

10 beliefs about pregnancy, most of which turned out to be nonsense in vegetable oil / AdMe

Pregnancy is a mysterious condition, and at this time, more than ever, a woman needs information about what is happening with her body. Back in the 19th century, brochures and books with advice and recommendations were published. Only now they were, to put it mildly, strange: to sleep so that the child’s head was directed strictly to the north, or not to think about ugly people so as not to “spoil the appearance” of the unborn baby. Today there is a lot of literature, and even on the Internet you can find advice from doctors and scientists, but it seems that some myths have become resistant to inoculations of the truth. nine0003

We at Bright Side decided to do a self-examination and figure out what is fiction and what is truth.

1. Pregnant women should avoid cats

©Depositphotos

• Myth

Mothers-to-be are often told that their furry friends are a threat to their baby. But there is no need to rush to give your beloved pet into good hands or avoid it because of the risk of contracting toxoplasmosis. Agree, it would be terrible to lose the opportunity to stroke your beloved cat. Often, domestic cats eat industrial food and do not go outside the apartment, which greatly reduces the likelihood that the pet will become infected somewhere. nine0003

In addition, a cat can only be a carrier for 2 weeks after exposure to Toxoplasma, and if it was, it most likely occurred when the animal was small. To bring Toxoplasma from a cat, you need to try hard: after cleaning the tray with unwashed hands, touch your mouth or food. It is enough to regularly clean up after your pet with rubber gloves and wash your hands thoroughly. But taking homeless animals from the street during this period is still not worth it. What's really dangerous is eating unwashed vegetables and even reusing a cutting board without sanitizing after cutting raw meat. nine0006

In rare cases, a woman can conceive while pregnant. When a woman becomes pregnant, hormonal changes occur, similar to natural contraception: ovulation stops, the walls of the uterus become thicker, which complicates the attachment of a fertilized egg, a special plug forms in the cervix that prevents sperm from entering. nine0005 But it happens that for some reason the ovaries do not fall asleep, and the barriers do not work. This phenomenon is called superfetation. Such children may have 2 different birth dates, but since conceptions are usually close in time, they are born at the same time.

In 2016, Jessica Allen decided to become a surrogate mother for another couple. Imagine her surprise when at the 6th month it turned out that she was pregnant with 2 children. At first, both she and the doctor decided that they were twins. But later it turned out that Allen and her husband conceived their own baby while carrying a surrogate child - this was confirmed by a DNA test. As a result, the kids were separated: one lives with the Allens, and the other stayed with his biological parents. nine0003

3. Dates can speed up labor

© Daniel R. Blume / Flickr

• True

Dates are a treasure trove of beneficial minerals (including iron amino acids and potassium). Pregnant women especially need them. The use of dates at a later date promotes natural childbirth, helps to do without stimulation. Thus, only 37% of women who ate 7 dates a day needed Pitocin injections compared to 50% of women in the control group. nine0006

The second case is much more interesting. It turns out that bacteria can "beg" from us for the food they need to survive. To do this, they use various tricks, for example, they send a signal to the brain through the vagus nerve and make us feel sad (and therefore crave sweets) or, on the contrary, cheer us up when we eat what they need. Here the reason is not what we have an unhealthy desire for. nine0005 By taking control of the diet and starting to consume a large amount of fiber and fiber, you can "grow" such microbes that will be useful to us, and they, in turn, will multiply, will demand from us more healthy food.

5. If the mother had an easy pregnancy, then her daughter bears without problems

© Unplash

• True How will her pregnancy proceed? nine0005 For example, if a mother or sister suffered from toxicosis, you can start preparing for such a scenario in advance. The size of the fetus also depends on how big the future mother and father of the child were born: if both were small, then most likely they were lucky and the baby will be small.

  The gestation period will also be approximately the same. If the pregnant woman was a "belated" child, then is it any wonder if her baby does not rush? As for the birth itself, it all depends on the type of physique: if a woman went to her mother, then the scenario may be similar. But, even if the birth of the mother was difficult, do not forget that medicine does not stand still. nine0003

  6. Pregnancy causes strange dreams

  © Pexels

  • True

  Pregnant women experience more vivid dreams and more frequent nightmares, especially in the 3rd trimester. One of the reasons is frequent sleep disturbances that are associated with physical discomfort: increased levels of the hormone progesterone can cause insomnia, sleep apnea or restless legs syndrome may appear. A woman wakes up during her dreams, which makes them seem especially colorful and memorable to her. nine0006

  Pregnant women have twice as many nightmares and are usually related to the baby. Most likely, this phenomenon is caused by stress adequate to the situation and thoughts that come to mind of expectant mothers during the day.

  7. The month of birth can tell something about the future child

  © Unsplash, © Depositphotos

  • True

  This is not about astrology. Fetal research shows that the time of year a baby is born can have a long-term impact on their mental and physical health. For example, children born in summer tend to be taller and healthier. nine0005 Summer babies are heavier, and as adults they are taller than everyone else. Winter ones, on the contrary, weigh less at birth and lower than others when they grow up.

  It is assumed that vitamin D, which the fetus receives in excess in summer, is to blame. It turns out that the moment of conception is a factor that does not depend on the salary of the parents, their social status, but at the same time determines the future life of the child even before he is born.

  8. If you had a caesarean once, you will always have a caesarean

  © Unsplash

  • Myth

  Not all women can give birth vaginally after a C-section, but for 60-80% it is still possible. Obesity (when the body mass index is 30 and above), high blood pressure, age over 35 years, large fetal size and a vertical suture on the uterus can be contraindications.

  The success of such a birth depends on what caused the decision to have a caesarean section in the previous case. nine0006 If a woman has complications, then she will be less likely to give birth on her own. Like a second caesarean, natural childbirth has its risks. The most important of them is uterine rupture. Fortunately, the probability of such a complication is less than 1%.

  9. Nothing can ease morning sickness

  © Pexels

  • Myth

  Nausea is one of the most common pregnancy symptoms, with about 80% of women experiencing it. Although it is called morning sickness, it can occur throughout the day and throughout pregnancy. Many women do not even report this problem to the doctor because they take it for granted. In fact, early detection and prevention are important to improve the condition. nine0003

  Sometimes it is enough to make some changes in your lifestyle to relieve an unpleasant symptom: eat less, but more often, increase activity, drink tea with chamomile and lemon. The doctor may prescribe medications.

  10. The heartbeat of the unborn child appears already at the 6th week in an unborn child. In fact, what the device measures is not a heartbeat at all. nine0005 The thing is that ultrasound captures the subtlest vibrations that occur in the place where the heart should eventually form, but the organ itself is not there yet.

  

  The sound is emitted by a group of cells, which at this time gains the ability to trigger electrical signals. The development of this organ will last the entire 1st trimester.

  What do you think is the most important advice to follow while expecting a baby?

  Preview photo on Unsplash

  Bright Side/Family/10 beliefs about pregnancy, most of which turned out to be vegetable oil nonsense

  Pregnancy and all about it

  Pregnancy is an amazing time filled to the brim with so many different and conflicting feelings and emotions. Here and happy expectations, and hopes, and worries, and fears, and joy. And how many myths exist around this topic! Of course, now no one takes seriously the belief that during pregnancy you can not cut your hair, stroke cats and crochet. But these were replaced by new beliefs. Which of them is true and which is a myth, helped us figure it out midwife, instructor in preparation for childbirth at the Center for Children and Parents "Rozhdestvo", perinatal psychologist Yulia Pavlova .

  Peace, peace and peace again!

  It is believed that the swimming pool, gym and cycling during pregnancy should be canceled and it is generally better to lie more, especially in the last months of pregnancy.

  “It is really necessary to cancel cycling and strength training in the gym, but this does not mean at all that you need to lie down more,” says Yulia Pavlova. - In general, you can lead a normal life if the regime was more or less correct. But be sure to add walks in the fresh air and gentle gymnastics. nine0003

  According to the childbirth instructor, gymnastics is needed, in particular, to save the spine. After all, when the belly grows rapidly, the load on the lumbar region increases significantly. There is even a set of exercises specifically for pregnant women, which includes exercises for the spine and to strengthen the muscles of the pelvic floor. It is also useful to swim in the pool. Yoga for pregnant women is also good.

  By the way, homework is also useful if it is not connected with lifting weights, but makes you bend and stretch. For example, it is useful to wash the floor with your hands! And if you have been doing gymnastics all the time, then this will not seem so difficult. nine0003

  Pregnancy is not a disease, so we live as we used to

  A point of view opposite to the first one also exists in society. Its supporters believe that there is no need to change anything at all: we live as we used to live.

  “Pregnancy, of course, is not a disease,” says Yulia Pavlova. - But you need to lead a sparing lifestyle: do not work from morning to night, but also devote time to walks and good rest. A pregnant woman should have a healthy daily routine. And the diet has to change, especially if it wasn't right. After all, there are foods that pregnant women need to eat, but there are also those that are better to refuse. Not to mention bad habits, which include not only alcohol and smoking, but also many hours of sitting at the computer. ” nine0003

  During pregnancy, a woman becomes stupid and her character deteriorates

  “The condition of a woman can probably be described in these words,” laughs the birth preparation instructor. “This is because the hormone progesterone released during pregnancy affects the neocortex, the part of the brain that is responsible for human thinking and emotions.”

  However, character deteriorates only in the sense that a woman becomes more emotional, for example, she may burst into tears in a situation that she would not have previously considered worthy of attention. Therefore, during this period, a woman should be treated more carefully and more patiently, with the understanding that her condition is due to biochemistry, and she cannot do anything about it. As a consolation, we can say that this is a temporary phenomenon, and not everyone has it so clearly manifested. nine0003

  On the other hand, it is during this period that many women discover hidden talents in themselves that they were not even aware of. Some begin to write poetry, sing or draw amazing pictures.

  All doctors are reinsurers, and women's consultations are evil

  This point of view has emerged in recent decades, after natural pregnancy and home birth became fashionable. However, even those experts who prepare pregnant women for home birth do not recommend avoiding antenatal consultations. nine0003

  “There are differences between doctors and doctors,” Yulia Pavlova says. - It is necessary to visit a antenatal clinic, at least in order to take tests and be observed in a timely manner. But the recommendations of doctors can be questioned. It is best to have an additional opportunity to consult with a doctor who is aimed at the most careful, drug-free pregnancy management and an individual approach.”

  According to the birth preparation instructor, in our antenatal clinics there are indeed sometimes doctors who do not always give adequate prescriptions. For example, as a preventive measure, many pregnant women are prescribed Duphaston or Utrozhestan. They are prescribed to everyone in a row: both women after 35 years of age, and those who have had a miscarriage before, and those who have an increased uterine tone. These are hormones, and in most cases this appointment is not justified. Everyone is also prescribed Magnesium B6, which not every woman needs. And in the third trimester, the craze for antenatal clinic doctors is to prescribe “chimes” to support cardiovascular activity. Meanwhile, this preparation has very good natural substitutes. nine0003

  “It's best to listen to everything, write it down, and with the results of the examinations received during the consultation, go for additional consultation with the doctor you trust,” Yulia says. – How to find it? Either on the recommendation of friends and relatives, or through courses for pregnant women, since this is where a lot of experience has been accumulated in managing a wide variety of pregnancies. They found out a long time ago which clinics and medical centers offer what approach and what worthy doctors there are. ”

  Of course, we are not talking about courses for pregnant women at antenatal clinics. It is necessary to look for alternative courses, best of all, again, according to recommendations, through acquaintances.

  A healthy woman can give birth at home

  Home births exist. This is no longer a secret. “But you need to seriously prepare for home birth: both psychologically and physiologically,” says Yulia Pavlova. “Evaluate whether a woman can give birth at home can only be a qualified specialist who has complete information about the woman’s health and how her pregnancy went.” nine0003

  Therefore, it is not enough to assess your health on your own, you need to take a complete history and consult with the specialist who will take care of the birth at home. Sometimes the woman herself says that she feels great, but she, for example, has low hemoglobin. So, her condition needs to be corrected. Not to mention other, more complex deviations from the norm.

  The whole process is accompanied by very severe pain

  According to midwife Yulia Pavlova, it depends on how much a woman understands what she should do at any given time. nine0003

  “Yes, we all know that giving birth is painful,” she says. - And how else should nature give us a sufficiently noticeable signal that cannot be ignored, if not through pain? If a woman did not receive this signal, then she would not know at all that she was giving birth, and would not have prepared for this in the best possible way: she could give birth anywhere, literally on the go.

  In addition, during childbirth, endorphins, analgesic substances, are released, sufficient for a woman not to experience pain shock. Therefore, the pain during childbirth is always exactly the kind that a woman can endure, she never goes beyond this line. And then there are pain relief techniques: proper breathing, correct postures, relaxation techniques, acupressure and much more, which allows a woman to keep this pain in check during childbirth and prevent it from growing excessively. It is better to learn these tricks. You can, of course, give birth without it, but how painful it will turn out depends largely on the behavior of the woman. nine0003

  During childbirth a woman is helpless and does not decide anything herself

  During childbirth, it is really difficult for a woman to assess how well doctors act. The doctor has the right to act as he considers most correct. But still, one should not forget about the Hippocratic oath and that no doctor will harm either you or your child. But how the whole process will coincide with your ideas and desires, this is really a question.

  “If you want your wishes to be taken into account in a maternity hospital, you need to specifically look for such a maternity hospital,” says Yulia Pavlova. - In Moscow and the Moscow region, they definitely exist, and there are several of them. A woman must arrive in advance and talk with the doctor who will take care of her childbirth. In this conversation, she should directly state what she wants and ask what are the rules of the maternity hospital. nine0003

  For example, she wants to do without stimulation and pain relief so that her husband is present at the birth or he can come to the room after the birth. And also that her child was not given any vaccinations. In some maternity hospitals this is possible, in others almost none of this is possible.

  “During childbirth, it's very difficult to argue with the doctor,” says the midwife. - Because the argument “you need to do this, otherwise you will lose the child” works for everyone. A woman must be sure in advance that she will be reckoned with, and that doctors themselves are for natural childbirth and will not offer anything extra. When you conclude a contract, you need to find out everything, because each maternity hospital in our country is like a separate state. And you have to accept the rules that exist there. nine0003

  According to Yulia, even expensive maternity hospitals do not guarantee that you will be met halfway. Yes, they will smile at you and spin around in front of you, but they will do everything as they usually do, and they will explain to you in detail that in your case it was impossible to do otherwise and everything was done for your own good.

  “This does not mean that you have to give birth at home,” the midwife says, “but you need to be very meticulous about what you can count on and what you can’t, and ask a lot of questions, demonstrating that you know what you want. And for this, of course, you really need to be prepared and know this. nine0003

  Everyone gets fat during and after pregnancy

  No, it's not. On the contrary, pregnancy does not contribute to weight gain. And the hormones that are released during pregnancy rejuvenate a woman. It is flourishing, and many are also losing weight. Of course, eating right is important. Completely, providing the body with all the necessary substances, but no more in volume than before.

  Of course, if a woman's metabolism is disturbed, then she can get better even with the most proper nutrition. Weight gain often also comes from overwork. Therefore, it is necessary to ensure proper postpartum recovery. After childbirth, it is imperative to rest, and not take on the entire burden of household chores on the second day after childbirth. And if a woman correctly goes through the recovery period after pregnancy, then she will not recover. There will be no weight gain. nine0003

  You need a special cream for stretch marks

  “Balanced, proper nutrition helps with stretch marks, so that all the necessary substances enter the skin,” says Yulia. - The skin is nourished by 90% of the blood, and only 10% of the substances can be replenished externally. In order to avoid stretch marks, a sufficient amount of vitamin E should be supplied with food, which makes the skin supple. And outside, no expensive cream is needed. It is enough to use natural oils, especially if the skin is a bit dry. nine0003

  But it's wrong to think that a synthetic prenatal vitamin complex solves all problems, reminds a birthing instructor. Moreover, these synthetic vitamins should not be used if it is possible to ensure the intake of all vitamins in their natural form, with food. And even if you use a complex of vitamins, it is not synthetic, but natural. For example, all the necessary substances in their natural form are present in such a beekeeping product as perga. A good, full-fledged bee bread must certainly be in honey, and not in powder. Sometimes perga is also sold under the name "bread", this is also a high-quality, good product. nine0003

  By the way, cosmetics used by a pregnant woman should not contain vitamin A. Pregnant women generally need to handle this vitamin very carefully, as scientists have found that its excess can adversely affect the development of the fetus.

  Depression usually sets in after childbirth

  Indeed, there is such a thing as “postpartum depression”, and there is a percentage of women who experience it after childbirth. But if you spend the recovery period correctly, then no depression is observed. A woman after childbirth needs psychological support from loved ones and normal rest. If the first 40 days after childbirth, someone close will take over all the housework, and the woman will only be immersed in motherhood, in taking care of the baby, then there will be no depression.

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