An Illustrative Case
On a cold November night, a young Japanese woman living in Detroit went to go comfort her crying newborn baby son. She saw he was in distress so she carried him outside and laid him on the bank of a pond. Sometime later, she awoke her husband, who found the infant in the pond, dead from drowning. After the incident she was charged with homicide and was incarcerated.
It was later determined that she had been suffering from severe postpartum depression with psychotic features. How might the fact that she was Japanese have influenced what happened?
This case illustrates how pregnancy and birth can differ among cultures and underlines the important differences to keep in mind. It is crucial to be aware of these cultural differences in the stages of pregnancy including before, during and after the birth.
Let’s look at some of the cultural differences this young woman may have encountered during her pregnancy.
PRENATAL CARE: At her first prenatal visit she would have been asked to fill out an endless list of forms regarding her personal health history, medical insurance, financial arrangements and other medical providers she may have seen, culminating in a several-page document, all in legal terminology, describing the practice’s privacy policies and absolving her doctor from legal responsibility.
Then, all alone except for an English-speaking nurse, she would have had a physical exam, including a Pap smear and vaginal cultures. These would be explained to her, likely in medical terminology, stressing the importance of these tests to identify a long list of diseases and medical conditions from which she might be suffering.
At the end of the visit she would have been sent home with a whole packet of pamphlets, almost all produced by medical companies to advertise their products, often with confusing and conflicting claims.
Compare this with Japan, where there would have been no legal or contractual forms to fill out. She likely would have had her physical exam surrounded by other happy, Japanese-speaking mothers in adjoining cubicles. The Pap smear, etc., would probably have been done but without her knowing it because the doctor is the one who knows about such things and takes care of them. Finally, she would have been given a single booklet about pregnancy, officially published by the government authorities on such matters and thus entirely trustworthy.
At each of her subsequent prenatal visits in Japan she would have had an ultrasound to check on the baby whereas in the U.S. only one or two ultrasounds would be done. Is it any surprise, therefore, that she would find the American way of doing things cold, confusing, frightening and in many ways (to her mind) substandard?
AT DELIVERY: Upon arriving at the hospital she would again have been presented with numerous forms to sign and then be whisked off to her room, an intravenous started and numerous blood samples drawn. Rather than her being surrounded by female family members, her husband would have been invited to be her “coach”, a role that he was most likely unprepared for and uncomfortable with. Furthermore, Japanese women tend to be stoic during labor so it would be very likely that her pain would be underestimated and therefore under-treated.
AFTER DELIVERY: In Japan, women typically spend five to seven days in the hospital, or three weeks after a Cesarean. Upon discharge, she would be presented with the baby’s umbilical cord in a box and then go home to be pampered for several weeks by her family. Her activities would be severely restricted and her emotions carefully guarded. Compare this to being discharged two days after delivery and sent home to care for herself. In addition, care of the infant is radically different between the U.S. and Japan.
Practices In Other Cultures
This case is only one example of the many cultural differences around the world regarding pregnancy and child care. Cultural practices that may seem totally weird to one culture may be found to be perfectly logical given the cultural mindset, history and circumstances.
Thus, if you might be receiving prenatal care or delivering in a culture different than your own, there are some questions that it might be wise to ask in advance.
Some examples are:
- What activity level will be expected of me during pregnancy?
- Are there foods that might be either encouraged or forbidden during pregnancy?
- Whom should I expect to accompany me at the time of delivery?
- If there is news regarding my condition, will it be disclosed to me or will another family member be sought to tell it to?
- What types of pain relief are acceptable and available during labor?
- Will my baby be with me after it is born or will he or she be confined to a nursery?
- What is considered an acceptable way to dress my baby?
- Are there cultural rules regarding breast feeding?
- What citizenship will my child have after he or she is born?
Being pregnant and traveling away from home may seem like a daunting task during every pregnancy stage. It’s important to do your research and be alert to the cultural differences. Other cultures have held these customs for hundreds, sometimes thousands, of years and one must compromise, not criticize, these changes. And last but certainly not least: be kind. Remember that personal relationships can outweigh medical expertise in many cultures so it’s important to treat others with respect for following their cultural practices.
Safe travels…until next time.