Transcultural Aspects of Perinatal Health Care

“Culture is an integrated system of learned behavior, ideas and products. It is a philosophy of life and death that is passed on from generation to generation and is dynamically changing within itself and is practiced by its members.” Culture can be based on geography, racial origin, religion and other factors.

National Perinatal Association Position Paper “Transcultural Perinatal Care”


Who Am I? A Cultural Self Assessment


I was born in what city, state, country?

My primary language is? My second language is?


How long have I lived in this country?

Can I read and write in my primary and secondary languages?


My ethnic affiliation?

Nonverbal communication?


Who are my major support people?

My religion, is it important?

What are my food preferences and prohibitions?

What are my health and illness beliefs and practices?


Is my income adequate to meet the needs of my family and me?

What are my customs and beliefs around life events such as births, illness and death?



What is my attitude toward cultural diversity?

  Do I react adversely to the patient's accent, if any?

  Am I open to differences between cultures, and different ways of doing things?

  Do I respect diverse practices and requests without judgment?

  Do I recognize that patients require equality of care irrespective of their cultural and linguistic background?

  Do I recognize and actively accommodate patients' choices about their care?

  Do I assume I know what a patient wants/needs?

  Do I identify the need for resources to overcome barriers, like poor or insufficient English proficiency, lack of support networks?

  Do I identify the need for, and obtain knowledge of sources of extra social support, for example community organizations?

Language and cultural barriers continue to interfere with the provision of health care in the United States. Let’s take a look at the present and predicted makeup of the US population.


Who Are We? United States Population








Whites, Non Hispanic








African American




Asian American




Native American




Source: Workforce 2020, Hudson Institute


Barriers to health care caused by diversity issues have huge impacts on maternal and infant morbidity, mortality and results in wasted health care dollars. Understanding these barriers is a start. Begin with a self-assessment and look at your practice setting. Here are some stories from care providers across the US provided by Perinatal List Serve, Patricia McCartney, librarian.

 “Nurse Stories From Perinatal List Serve”

“Respecting the culture of our patients is very important, as well as respecting any special requests or concerns that a patient may have. We have a question on our admitting form that asks if they have any religious or cultural beliefs or practices that may impact our care during their stay. We have many different cultures represented in Central Florida. We have Muslims who keep their faces covered in front of men who are not family members & have dietary requests. Chinese want their water pitchers filled with HOT water--not cold. On occasion we will have parents place a religious article in the cribs with babies. Our hospital is owned by Seventh Day Adventists & has vegetarian meals readily available for staff & patients (they also serve some meats). Many different cultures will bring in food from home, which we can keep in our refrigerator for them. Even for our American culture, we have a book of menus for area restaurants with delivery or take-out service. (This was actually for nurses' use, but we share with our families.) Recently an Asian couple gave small gifts to all the nurses who took care of them. I received a tiny pair of red slippers, a symbol of good luck. It is fun to learn about different cultures. We had a family from New Orleans bring in a king cake. Even different regions of our country have customs that differ from our own.”

Laura Hart Winter Park, FL


“Indian women often want only female attendants. We had a Muslim woman who could not see a male pediatrician, so we had a female come see her the next visit. Hispanic women often don't nurse "until their milk comes in." You do what you can with that one. Some Asian cultures do the Ying/Yang thing regarding foods after delivery. They want hot water in their bedside pitcher. Not too hard to accommodate!! I once took care of a woman who was ONE wife of many for the husband. He would not come into the room when two of his wives were together. I learned a lot with that one.  Grandmother spent a lot of time on a prayer rug so we walked around her.”


“It's not hard to be sensitive to a cultural thing, especially if you just ask for an explanation.”

Betsy RNC Connecticut


“The belief systems in Mexican culture involve burying the placenta of a male child far from the house, whereas the placenta of a female child is buried near the house.”

Marge Zerbe

“A Cambodian dad who needed to take the placenta back down to the OR to pray. Something about getting the "spirit" back. Couldn't understand all of what he said, so I never found out whether it was the mom's or babe's.”

“Also had a G15 P14 Southeast Asian lady who had to have a section for labor that stopped and even Pit would not start it”

Sharon, RN California

“A Laotian father in Lamaze classes who said his father was a magic man back home, and had special chants to use during birth. Then got a very confused look on his face and said ‘I don't think that magic works here.’ (I explained that we really basically just used a different set of magic.)”

Dad from Ireland who described the drumming that went on outside the house where a baby was being born, back in their home village…”

“G9P8 mom in the middle of an ice storm, feeling guilty because she was 4cm dilated at the doc's and decided to come in and get her waters broken since they lived on a mountainside and she always precipped and the past two births had PPH (postpartum hemorrhage).

Dawn Kersula in Southern Vermont

“Newborn babe on mom's chest, and the father lays his hands on the little girl and prays aloud, thanking God for this new life and the special purpose God had for that life, this child ‘called to be here and called to serve You’. I think it warmed my heart so much because it was a girl!”

Dawn Kersula in Southern Vermont

“One had to have major reconstructive surgery post vaginal del and begged us to turn her over to social services. She had had a girl and wanted to protect the baby from the paternal grandmother. She was a college grad and eventually entered a program similar to the "Witness Protection Program" to get away from her husband and his family (arranged marriage).”                              


“Female gay couples are quite common due to the availability of artificial insemination.”

  “Providers shouldn't make moral judgments about patient's they have to care for. They shouldn't discriminate either. Sad that they were slow enough to gossip about patients.”

Shirley Ehlers RNC, BSN, ACCE

And my last story to share comes from an EMS provider who attended the Transport Conference in February. He shared this experience he had had in a Pennsylvania Dutch Community: There had been a huge tractor-trailer accident with a horse and buggy. The EMS provider saw that a small Amish boy was critically hurt. EMS provider’s focus was naturally with the young boy. The father of the boy was concerned with the location and condition of his horse.

After completing my self-assessment and evaluating my practice setting, what’s next? Well, the State of Georgia and Georgia Perinatal Association have partnered with the Perinatal Outreach Coordinators to provide cultural diversity training sessions for all care providers in Georgia. Becoming culturally proficient takes more than a class, it’s an attitude and belief that you are willing to adjust and accommodate the beliefs, traditions and practices of patients and families you serve.

Building Partnerships: The Department of Human Resources (DHR), under the leadership of Deidre Michelson, provided the train the trainer programs for all outreach coordinators in Georgia. Georgia Perinatal Association provided funding through the Education Grants for the planning and implementing of these statewide offerings. GPA was well represented in the planning sessions by President Edward Clark, Immediate Past President Dianne Norris and Education Chair Erin Wood. Treasurer George Bugg was absolutely essential in two aspects, reimbursement of related expenses and by making an excellent suggestion for use of Educational Grant. His suggestion was along to Conference Chair Marcia Bishop who made a grant application for the cultural diversity presentation at the Transport Conference this past February.

If this topic interests you, and we certainly hope it does, we have a lot more to do, so get involved with GPA. There are lots of resource people in the State of Georgia. Perinatal Center Directors, Health District officers, Planners, Outreach Educators are all involved in projects to identify and reduced health disparities. GPA and NPA Board Member, Lou Steil is a contributing author for National Perinatal Association’s “Transcultural Aspects of Perinatal Health Care: A Resource Guide”. This guide is available from American Academy of Pediatrics bookstore, and at the NPA website. Educational Grants may still be available through GPA. Grant application is located on GPA’s web site at:

Respectfully Submitted, Debbie Sibley Monday, April 12, 2004


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