STANFORD, CALIF. — The young woman who arrived in labor was accompanied by a large and loud crowd of extended family members who spoke little English. With each contraction, the family yelled louder, Marylouise Martin recalled.
Instead of simply asking them to be quiet or leave, she pulled aside one of the family members and asked why they were all yelling. “Must yell,” the man told her. “Louder you yell, more beautiful baby will be.” Cultural differences made the yelling irritating to staff members but a routine part of the birth process to the family, she said at a conference on perinatal and pediatric nutrition.
After a separate, nearby room was found for the family to carry on in, everyone was satisfied, said Ms. Martin, a nurse educator at McLeod Regional Medical Center, Florence, S.C.
The clash of cultures in perinatal care doesn't always end so happily. She told another tale of a male resident physician at an unnamed hospital who was called to substitute at the last minute for a female physician who couldn't arrive in time to deliver her patient's baby. The mother cried and tried to refuse his care. The woman's husband fought to remove the resident from the room and was taken away by hospital security officers. The baby was delivered, but the parents left the hospital shortly after the birth without the baby. In their eyes, the woman had been violated, and they could not keep the baby.
The stories illustrate why it's important to pursue cultural competence—the accrual of knowledge and skills that enable providers to adapt health care in accordance with the ethnocultural or religious heritage of the individual patient and the patient's family and community, she said at the meeting, jointly sponsored by Symposia Medicus and Stanford University.
In the values of traditional American health care, life is sacred, autonomous decision making is paramount, telling the truth is essential, and suffering should be avoided. In some cultures, however, the family may be the primary decision maker. Some patients may not want to hear about health risks, out of the belief that once potential problems are mentioned, the problems are more likely to develop. Some cultures accept only short-term causes of health problems and don't believe in chronic disease.
Cultural differences go beyond words, Ms. Martin noted. In Greece and Bulgaria, shaking the head up and down means “No,” not “Yes.” Typically, white Americans prefer to keep about 3 or 4 feet between themselves and other people, but Native Americans usually prefer a greater distance.
To increase your cultural awareness and competence, evaluate your own attitudes and biases, and be open to change, she advised. Learn to treat each person with respect and equality, and never assume that a person's ethnic identity tells you anything about his or her cultural values or patterns of behavior.
Work with your patients toward common goals by asking questions and communicating effectively. Speak clearly and slowly in short sentences using simple words, not medical jargon. Avoid phrases like, “The baby crashed,” or “The belly blew up,” which can be taken literally.
For the newborn period, ask in advance about expectations for feeding the infant, including the best method and timing of the first feed. Talk with the parents about swaddling practices and about what kinds of caretaking are expected at home. Do they believe babies should be allowed to cry or should be comforted immediately? Do they plan ritual beautification practices? Where will the baby sleep? How will they care for the umbilical stump?
Incorporating new knowledge and experiences of different cultures in your practice will improve perinatal care, Ms. Martin said.
For more information, she recommended the American Academy of Pediatrics' “Transcultural Aspects of Perinatal Health Care: A Resource Guide.”
Evaluate your own attitudes and biases, be open to change, and treat each person with respect. MS. MARTIN