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Peripartum and Infant Care Issues and Practices among Refugee Groups in Seattle

Author(s): Elinor A. Graham, MD
Contributor(s): Community House Calls
Date Authored: August 01, 1996

Southeast Asian

Traditional practices are heavily based in concepts of "hot" and "cold" conditions. Younger women may no longer follow traditional practices but the family (mother or mother-in-law) may insist on following traditions and it is important to understand how an individual woman and the greater family compromise.

Pregnancy Practices - Pregnancy is considered a "hot" condition

Activity level

  • Women work until labor starts
  • Showering at night is to be avoided (Cambodian)

Foods

  • "Cold" foods are needed for the "hot" condition of pregnancy according to Chinese categories.
  • There are a wide range of foods which are felt beneficial or harmful between cultural groups.
  • Bean sprouts/green peas avoided - thought to cause SAB (Vietnamese)
  • Homemade rice wine, herbal medicines, coconut juice are taken to help give the baby good quality skin. Beer is thought to make the delivery easier (Cambodian)

Other

  • Drinking milk and gaining too much weight will make baby fat and difficult to deliver (all SE Asian)

Delivery

  • Use of midwife at home for delivery is traditional but many women had hospital deliveries in refugee camps or in city.
  • Men normally would not participate in the delivery but often are involved in the labor and the delivery room here in the United States

Post-Partum Practices

This post-partum period is considered a "cold" period and is very critical. The woman is felt to be weak and vulnerable to infection and disease. The frequent early doctor appointments for the infant and mother post partum in this country directly clash with the strong cultural belief in a need for rest and quiet during this period.

Activity Level

  • Kept warm and confined to bed x 30 days post-partum. Air conditioning and drafts from open windows are avoided. If women go outside during this period they wear coats and head coverings often even when the weather is warm. (In Cambodia this period, when the mother forms "new blood", is called "d'sai kchey" and lasts from 1-3 months.)
  • No immersion bathing showers or hair washing for 1 month to prevent "wind" from entering body system.
  • All care of infant except feeding done by female relatives in extended family. (especially the woman's mother or mother-in-law).

Food

  • Maternal diet balanced between "hot" (alcohol, ginger, black pepper & some high protein) and "cold" (fruits, vegetables, some seafood). No sour foods (cause incontinence), no raw foods. Pork felt very nutritious.
  • Cold ice water offered post delivery in the hospital may be seen as unhealthy.

Other

  • Inability to follow traditional post-partum practices is thought to cause later health problems, especially abdominal pain in women (which may occur months or even years later). Once a woman becomes sick from symptoms thought due to violation of "d'sai kchey", she is sick for the rest of her life.

Infant Care Issues

Breast Feeding/Bottle Feeding

  • Excessive hot foods thought to deplete breast milk supply.
  • Colostrum believed "dirty" and "stale" milk and is discarded. Infant fed by other, often lactating, women in the first few days.
  • If initially breast feeding in this country, moms often revert to bottle-feeding because, in part, they cannot follow dietary and rest traditions here without extended family support. Breastfeeding is considered more expensive because quality of mother's milk can only be enriched by consuming a special diet that is costly.

Weaning and Solid Food

  • Traditionally breastfed until 2-3 years of age. Early weaning to cup is not a cultural norm.
  • Solid foods introduced late, often after 1 year of age.

Toilet Training

  • Traditionally diapers are not used and training is started in early infancy with the infant held sitting on the mother's lower legs. A clean cloth is put under the baby when held or carried.
  • Diapers are usually used in this country and most children are toilet trained between 2 and 3 years of age.

Other

  • Tiger Balm, or a paste made from an herb similar to ginger, is placed on baby's soft spot and stomach to protect them. (Cambodian). Infants heads are shaved between 1 to 4 months of age.
  • Male infants not circumcised except for the Cham nationality which are Muslim.
  • Infants traditionally placed on their backs and the flat head which is created is felt desirable.
  • Maternal depression, resulting in failure to thrive in infants, may be related to mother's sense of bad outcomes/ future because of her inability to follow post partum rest and dietary practices in this country.
  • Traditionally children are not given a formal name until the child goes to school. In the US, families are giving formal names at birth that do not change (due to birth certificate requirements) and often combine western and traditional Asian names.

References

  1. Fishman C, Evans R, Jenks E. Warm bodies, cool milk: conflicts in post partum food choice for Indochinese women in California. Social Science Medicine. 26, 1988, pp1125-32.
  2. Rasbridge LA., Kulig JC. Infant feeding among Cambodian refugees. Maternal Child Nursing 20(4), 1995, pp213-8
  3. Rossiter JC. Maternal-Infant Health beliefs and infant feeding practice: The perceptions and experience of immigrant Vietnamese women in Sydney. Contemporary Nurse 1(2), 1992, pp 75-82.
  4. Wetzel, Linda. Cambodian Cultural Profile

 

East African

Related women and women within a neighborhood have very strong ties among each other in East African communities. In some cultures, such as that of ethnic groups from Ethiopia, women have a daily coffee ritual where they gather each day in homes to share coffee and talk. This daily gathering of women established support networks for pregnancy, post-partum help, and child care. Because refugee families in the US are often separated from extended family and live spread out from each other in different neighborhoods, similar women's socializing has been hard to recreate.

Pregnancy Practices

Activity Level

  • Women usually work until delivery.

Food

  • Women try to have good nutrition and particularly may increase meat in their diet.
  • Flax seed flour is mixed with warm water before delivery and drunk by the woman to help produce an easy delivery.

Other

  • Community women hold a party (somewhat like a baby shower) for the pregnant women in most East African cultures. This tradition continues in Seattle and helps families obtain baby supplies.

Delivery

  • Home deliveries with a midwife or traditional birth attendant are the norm in their native country. Some women from urban areas may have had a hospital delivery but technology intervention does not happen.
  • Men do not participate in the delivery. Male interpreters are considered inappropriate in labor and delivery although a male doctor may be tolerated. The husband must be involved in any decisions for surgical interventions but he may defer a decision to the wife or female relatives.
  • Multi-parous women do not like the interventions in the U.S. and may wait until late in labor to come to the hospital. C-sections may be refused in emergency situations.
  • Somali women who have had the complete infibulation type of ritual surgery of the female genitalia (removal of clitoris, labia minora and part of majora with a central surgical scar and a small posterior introital opening) may need a midline anterior episiotomy. If a second episiotomy is required, a mediolateral is done in Somalia and women may resist having several small posterior episiotomies as is recommended as safer at U.W. Most Somali women want to have closure of the anterior episiotomy to approximate the size of their opening prior to the delivery.

Post Partum Practices

Activity

  • Traditionally women rest in bed for 40 days post partum and are attended by other women who prepare nutritious food and do housework.
  • This period is known as "afantanbah" in Somali culture and during this time the mother wears earrings made from string placed through a clove of garlic, and the baby wears a bracelet mad from string and "malmal" (an herb) in order to ward away the Evil Eye. Incense (myrrh) is burned twice a day in order to protect the baby from the ordinary smells of the world which can make him/her sick. At the end of 40 days there is a celebration at the home of a relative or friend. This marks the first time the baby and mother have left the home since delivery. This celebration may be combined with a naming ceremony for the baby.
  • In some Ethiopian cultural groups, a woman carries a metal object (often a knife) with her at all times to prevent evil eye.

Foods

  • Special teas, soups, and porridge are provided for the mother. Flax seed porridge with honey is commonly given to mothers post-partum.

Infant Care Issues

 

Breast Feeding and Bottle Feeding

  • Breast feeding is equated with motherhood in all East African cultures. Almost all mothers at least initially breast feed and it is often continued for 2-3 years.
  • Some mothers may be reluctant to put the infant to the breast or will ask for formula supplements in the first days before the breast milk comes in. Traditionally infants may have been given fresh goat, cow or camel milk or sugar water during this time.
  • Rickets is common in East Africa and the importance of sunshine for good growth and bone development in infants is known to mothers from public health campaigns in their countries. Mothers gladly accept Vitamin D drops for breast fed infants to prevent rickets in Seattle born children.
  • Mothers are unfamiliar with pumping and storage of breast milk and need education about how to do this.

Weaning and Solids

  • Soft foods are offered starting at a few months of age and drinking from a cup is offered at 6-8 months of age.

Toilet Training

  • Toilet training is started at a few months of age by closely watching the infant's behavior and gradually training it to go in a small bowl or potty. Bowel training may be achieved by 6-7 months and bladder after a year. Diapers may never be used in their native country (especially Somali) and diaper rashes are unknown and therefore distressing when experienced here.

Other

  • Fresh butter is given to the infant in the first few days to help clean the meconium out of the bowels (Oromo).
  • Newborn care may include warm water baths, sesame oil massages, and passive stretching of the baby's limbs among Somali. An herb, called malmal (available in Asian markets) may be applied to the umbilicus for the first 7 days of life (Somali).
  • Male circumcision is done between the newborn period and 5 years of age and varies greatly in timing in different cultures. Because of the inability to have them done beyond the newborn hospitalization in the U.S., parents have them done early.
  • Female ritual genital surgery practices vary from region to region even within cultures. Minor procedures involving a cut on the clitoral hood or partial removal of the clitoris (sunna) may be done in the newborn period. Procedures involving more extensive removal of tissue such as infibulation is not done until ages 5 to 12 years. Most families understand that these procedures would not be considered legal in this country but may ask providers about them.
  • Orthodox Christian infants are baptized at 40 days for boys and 80 days for girls.
  • Infants are given an informal family name at birth. After a few months, as the personality of the child becomes apparent, they are given a formal name.
  • Uvulectomies are done on many East African infants usually at a few weeks of age. Families say that this is done to prevent throat infections and at times to cure a wide range of problems from tonsillar infection to growth retardation. The surgery leaves a variety of anatomic changes in the soft palate.

References

  1. Lewis, Toby MD: Somali Cultural Profile, EthnoMed
  2. Omura, Susan MD: Oromo Cultural Profile, EthnoMed
  3. Eritrean Cultural Profile, EthnoMed