Appraising the Negative Influence of Cultural and Environmental Factors on the Normal Progress of a Woman’s Labour and Birth and Role of Midwife in Relation to These Factors

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Appraising the Negative Influence of Cultural and Environmental Factors on the Normal Progress of a Woman’s Labour and Birth and Role of Midwife in Relation to These Factors

In an article published in midwifery Smythe et al. (2016) argued that what makes a good childbirth experience is not about one thing. Their argument is write considering that the same argument has been corroborated in Roudsari et al. (2017); Triche and Hossain (2018). Roudsari et al. (2017) for instance cited Socio-Cultural Beliefs and values as having monumental role normal progress of a woman’s labour and birth. Triche and Hossain (2018) on the other hand succinctly put it that pregnant women are often involved in decision making progress regarding the delivery mode. Among the factors that they note as influencing the delivery mode includes a woman’s environment, cultural values and psychosocial factors (Downe et al., 2018). Anecdotal research has revealed that revealed that in the countries such as Iran, delivery through the C-section is thrice higher than the global rate (Ahmad Nia et al., 2009).  This paper provide an appraisal of the negative influence of cultural and environmental factors on the normal progress of a woman’s labour and birth and role of midwife in relation to these factors.

In 2002 for instance the rate of C-section in Iran stood at 36%, in 2006 it increased to 42.3% (Ahmad Nia et al., 2009; James et al., 2010). Ahmad Nia et al. (2009) revealed that what is fueling increase in C-section in Iran account experiences that mothers hear concerning the normal deliver. These stories they get in social gatherings as well as gabfest (McGrath et al., 2010). Besides these stories, as elucidated above, there have been numerous questions regarding the influence of cultural and environmental factors on the normal progress of women’s labour and birth (Ahmad Nia et al., 2009; James et al., 2010). Although culture and environment might have a positive influence on a woman’s labour and birth progress, the argument in this essay is that cultural and environmental factors have a negative influence on the normal progress of a woman’s labour and birth.

Concerning culture, Hofstede (2003) defined it as the collective programming of the mind that differentiates category of people or members of one group from the other. In the views of Azuh et al. (2015), culture is defined by values, beliefs, social behaviour, language and religion that a particular group of people believes in. Azuh et al. (2015) in his article confided that although midwives and nurses might have distinguished knowledge regarding women’s labour and birth, cultural competence is necessary in understanding a pregnant woman. He however, confided that some of the cultures are retrogressive and should be checked by midwives since they can negatively impact of a woman’s labour and birth that might lead to death (Downe et al., 2018).

Chakona and Shackleton (2019) mentioned that in a country like South Africa, some cultural beliefs and food taboos are followed by pregnant women. This influences food consumptions and nutritional need. Some of the foods that Xhosa culture in South Africa prevents women from eating includes; fruits, eggs, butternuts, pumpkin, fish, beans and potatoes. These foods according to Chakona and Shackleton (2019) are rich in carbohydrates, proteins, and other micronutrients that are critical for a pregnant woman and the inborn. The Xhosa cultural practices therefore force women to what Golden et al. (2019) has termed as ‘hidden hunger’ (inadequate intake of micronutrient). In the United States, a research by DiFranco and Curl (2014) revealed that the culture pushes majority of women to give birth in the supine position as opposed to pushing in upright or relying on the gravitational force. This approach has meant that most women in the US have harrowing birth experiences because they have been forced to use anesthesia to help in the reduction of unbearable pain. 

In a research of Cameroonian women by Weinger and Akuri (2007), it was revealed that although a typical Cameroonian woman is worried about her health, her cultural background of gender role often blind her to recognize the right to good health.  The right to good health is therefore considered by a Cameroonian woman as secondary to the fulfilment of purpose of taking care of the family and meeting the need of the husband (Hansford et al., 2014). This is becoming detrimental especial during labour and giving birth has the woman do not have enough information regarding both. Secondly, in Nigeria among the Hausa community, there is a religious and a socio-cultural dimension that contributes to high maternal deaths (Azuh et al., 2015).

The Hausa Islamic culture in Nigeria undervalues women. The women perceive social need and reproductive health are under strict control by men. The culture restricts women’s medical care, encourages marriage at early age and universal female illiteracy (Azuh et al., 2015). Besides this, religions such as Jehovah Witness, Amish and Christian Scientist discourages their worshippers from going to the hospital as they claim that the lives of their believers are in the hands of God and physicians are not God (Guzder, 2009). For pregnant women, such policies or proclamations can adversely affect their labour progression and birth (Downe et al., 2018).

Besides the cultural factors environmental factors can also negatively influence a woman’s labour and birth progression in a number of ways. In a research by Triche and Hossain  (2007), it was revealed that good environment has a positive effect in increasing the woman’s ability to cope with labour pain and delivery and the vice versa is true for bad environment. Women during labour pain and delivery needs environment that care and protect their privacy. Maternity as compared to the traditional environment often offer such elements (Dijkstra et al., 2006). On the sense of privacy during birth, Borja-Aburto et al. (1999) mentioned that in situation where a woman feels her privacy has been breached this can disturb her and result into increase stress and painful experience during the time of delivery. Besides privacy is smoking and inhalation of anesthesia by women during pregnancy. Smoking for instance has been associated with low birth weight, intrauterine growth retardation, placental problems and other congenital abnormalities (Triche and Hossain, 2007).

The research in the US established that young women in low socioeconomic environments are likely to smoke compared to their counterparts in rich neighborhoods (Arnett et al., 1998). Moreover, women who work in paint industries are likely to be exposed to metals like mercury, nickel and manganese (Borja-Aburto et al., 1999). These metals have been associated with poor reproductive outcomes such as spontaneous abortion. Additionally, a case control research by Croteau et al. (2006) revealed that stressful environmental context might induce a woman’s labour before her due date. For a woman, the stress increases with shift-work schedules and following and occupational schedule during pregnancy. Physical stress like long standing, lifting of heavy weights, long working hours and bending results have been linked to pregnancy outcomes like low birth weight, preterm delivery and SGA (Borja-Aburto et al., 1999).

In the literature of Dijkstra et al. (2006) a midwife is defined as a person who is trained to care and support women during their time of pregnancy, labor and birth. In this context therefore, it is the work of the midwives to help women stay healthy and give birth with limited intervention if there is no complication that a rise. If midwives’ roles are to offer support and care for pregnant women, they have to asses and help these women plan well for safe delivery. In light of the discussion above, where there are retrogressive cultural practices and environmental factors that might complicates women’s labor and birth, Azuh et al. (2015) explained that midwives have to come in and advise women on the best practices during pregnancy that might result in not so painful birth experience. For instance, take the case of Xhosa community discussed above where a pregnant woman is barred from eating specific foods. The role of a professional midwife in such a community is to assess the nutritional need of the woman and advice on what it needs to eat as such a time without having to disregard the community culture.

However, it is critical the midwives do not get immersed entirely in every cultural aspect of their clients (Downe et al., 2018). For example, it has been discussed above that in Hausa community in Nigeria, the culture that undervalues women and women have been made to believe that their health need is secondary to caring for their family and the husband. Midwives in such a context might need to provide right information to the Hausa women to help in curbing the rampant maternal death. Besides this, it is critical that midwives assess the environments under which their patients work and lives as these have been found to have a direct impact on delivery outcome (Hansford et al., 2014). Moreover, Ayerle et al. (2018) mentioned that women in labor expect a continuity of choice, control and care. They expect midwives to continuity their active involvement in care and also provide emotional support during labor and birth (Downe et al., 2018).

As shown throughout the essay, childbirth is a significant life event for a woman. It can be influenced negatively by both cultural and environmental factors. It is therefore incumbent above midwives to support the woman by providing right information and advice based on scientific evidence to enhance positive delivery outcome. It is however, important that midwives recognize cultural background of their clients in the process of offering care to tailor the care based on culture.


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