Japanese Cultural Practices in Antepartum, Intrapartum ...



Japanese Cultural Practices in Antepartum, Intrapartum, Postpartum and Newborn CareBrandi-Nicole M. AnastacioKapiolani Community CollegeJapanese Cultural Practices in Antepartum, Intrapartum, Postpartum and Newborn CareIn nursing practice we come across clients with varied cultural backgrounds. The following will be focused on the Japanese cultural practices in reference to antepartum, intrapartum, postpartum and newborn care. These views have been obtained through interviews with various Japanese women in our local community and journal articles.AntepartumIn the Japanese culture, woman often seek prenatal care early with a midwife. Midwives are primarily used with the doctor only being seen just before the baby is born. Also, in Japan, a woman would obtain a copy of ‘The Maternal Health and Child Handbook”. This is meant to be used as the woman’s recording of her prenatal visits and care. The father is not normally present as pregnancy is viewed as happening only to the mother; so, he is not expected to play an active role. In our community, this view is varied, some mothers prefer to have their mother or sister involved, but others have had the father attend every appointment and parenting class. In regards to nutrition, prenatal supplements are not routinely prescribed or emphasized and the diet consists of foods that are considered ‘hot’, i.e. miso soup, green tea, fish, carrots, ginger and most root vegetables; asparagus; kabocha squash; onions and garlic; eggs; and meat, especially liver. This is based on the yin (cold) versus yang (hot) diet of keeping internal balance, originating in the Chinese culture. So, the mother will not consume any ‘cold’ foods, in regards to temperature and the yin v. yang diet. The mother is thought to be responsible for ensuring a good outcome for the fetus. In order to do this, she discontinues work early in her pregnancy, only gains between 10-20 pounds despite pre-pregnancy weight, must keep her body warm with a haramaki (a cloth that wraps the abdomen) and should not have any negative thoughts or listen to negative music. This is all believed to directly affect the fetus. One mother told me that her mother told her she was not allowed to attend any funerals or step onto any graveyards because this was like tempting evil spirits. Another told me that she became obsessed with her weight, weighing herself every day and reporting to her mother. Japanese woman may not voice concerns or questions to doctors or midwives, as they see this as a form of disrespect. Those that I spoke with said they say this is starting to change, but do notice that they often research concerns on the internet or ask female family members, prior to bringing up a concern. Common practices during antepartum are chakutai (or iwaiobi) and saetogari. Chakutai is the practice of wrapping the mother’s abdomen in a bleached cloth, blessed at a Shinto shrine, during the fifth month of pregnancy. This is believed to ensure an easy birth. A mother I spoke to said that her mother had family from Japan send her a cloth like this. It looked like a sash and she wore it at home, as much as possible, before birth. Saetogari means to return home and occurs during the eighth month of pregnancy. The mother usually returns to her parent’s home and resides there until 4-6 weeks after birth. The father will usually not follow. One woman said that she did not go home, but her mother-in-law did live in her home for three weeks after she gave birth. IntrapartumDuring labor and child birth it is not uncommon for the mother to remain silent and not voice concerns about pain. Labor pain is viewed as strengthening the bond between mother and child, so the use of epidural and other pain medications are not procured. Often, the only form of pain relief used is massage, breathing and movement. The mother will continue to eat to keep her energy up. She will eat things like mochi, miso soup and fish. She will also only drink warm liquids. Labor is also viewed as a goal that they want to do well in. A good birth is viewed as one that is quick, quiet and without use of pain medication. Japanese will only consider a C-section if it is medically necessary and recommended by the doctor, not considered elective. Doctors hold a highly respected position and they will not easily go against his suggestions. The father or other males, besides the doctor, may not attend the birth. Locally, this concept is changing as well. Several mothers I spoke to have the father present for the entire process. Afterbirth, a portion of the umbilical cord is kept and given to the parents. It is kept in a kotobuki bako or long life box and saved until given to the child’s spouse. If a portion of the umbilical is not kept, then the portion that falls off from the umbilicus is kept. In Japan, circumcision is not common, but in our community, the mothers I spoke with that had sons, did. They believed that they wanted them to ‘fit in’ and it was ‘cleaner’. Soiled linen with blood from the birth is usually buried or burned because it is thought to be bad luck.PostpartumImmediate postpartum care in Japan usually lasts at least seven days for a normal vaginal birth, compared to our two to three days. The woman is not expected to do any strenuous work and encouraged to rest. Breastfeeding is common practice and midwives offer frequent breast massaging to promote lactation. One mother said she felt it was her duty to breastfeed her infant, but also would never consider doing it publically, although she did not look negatively on those that did. The postpartum diet is similar to the antepartum diet, consisting of hot foods, primarily soup based. Pain is still considered virtuous, but they may be more willing to accept medication. The mother returns either to her parent’s home or her own, where she will remain for one month to six weeks, along with her baby. This seems to be the continued norm and to be taboo to have the mother or baby leave the home earlier, but an exception is made for medical appointments only. Also, the mother will not shower for one month after the birth, also viewed as bad luck. This still remains true for about half of the mothers, but for a shorter timeframe, about two weeks. Wiping the body down with cloths and peri-care are permissible.Newborn CareNewborn care is primarily taken on by the mother and other female family members. Care is performed attentively and quickly. How the baby is cared for is viewed as a direct result of how good of a mother one is. In Japan, the umbilical cord is believed to be okay to submerge in water, often hot water, believed to keep away infection. After one week, the baby begins to take baths with the parents. Babies and children co-sleeping with parents is common practice and not negatively viewed. This is thought to strengthen the bond. A ceremony that takes place for babies is the naming ceremony, seven days after birth. During this ceremony, the baby’s name is written on a poster and displayed within the home. The baby is dressed in white and the center of attention. Friends and family greet the newborn with monetary gifts and celebrate with a meal consisting of traditional foods like red rice (sweet rice with red beans) and sea bream (white fish). When the newborn is 100 days old, there will be another celebration initiating the transition to food, called okuizome or the first meal. Some of the mothers in the community still share similar beliefs. They agree that fathers currently play a more active role, especially since most homes are now dual income homes. Almost all still perform the naming ceremony, with some updates, like offering more local foods for their guests.Nursing ConsiderationsIn considering nursing care and the above stated cultural practices, there are a few alterations that we, as nurses, need to consider in order to be culturally competent when caring for these patients. Some teaching topics and nursing interventions for antepartum could include the following: the use of dietary supplements, i.e. folic acid and calcium, assessing food prep and raw fish intake, assessing weight maintenance goals, and psychosocial support with local resources available to her, along with a medical translator if needed, to attend appointments and procedures with her. We would want to always remain respectful and ask permission prior to performing any treatments or interventions. For intrapartum, we could offer assistance with alternative pain control methods, supply warm foods and drinks, and routinely assess her pain levels. Just because she is quiet does not mean she is not feeling any pain. Also, we would want to know what pain level is tolerable for her and when she would want us to intervene. In postpartum care, we want to continue to routinely assess her pain, assist with breastfeeding and massaging her breasts. We must understand that she may not want to shower and may want to be offered a sponge bath instead. Consider also how and if the mother and baby will be able to return for a follow up appointment. If this is a problem, we should discuss alternatives with the doctor. As far as newborn care, we may want to inform them on the risks associated with co-sleeping related to SIDS, but also understand that it is a cultural norm. In regards to naming, since it is not determined until a week after birth, we should show them how to apply for their child’s birth certificate with the proper forms, before they leave the hospital.In ConclusionThe Japanese culture is filled with strong values like respect and strength through adversity. They believe in a harmonious balance through yin and yang, to ensure positive outcomes. They also perform various traditions that mark varied rites of passage. After learning this, I can see that cultural competency and sensitivity is a very important part of nursing care. Japanese is just one culture that is intertwined here on our island, along with many others. There is not one culture that is better than another, and in order to provide the best nursing care, we will need to take an active role in learning our cultural differences. This will help to ensure positive outcomes and health care experiences throughout our entire community.ReferencesIto, M. C. (2002). Japanese women’s experience of childbirth in the United States. Health Care for Women International, 23(6/7), 666-677.Kishi, R. (2011). Japanese women's experiences from pregnancy through early postpartum period. Health Care for Women International, 32(1), 57-71.Lowdermilk, D. L., Perry, S. E., & Cashion, K. (2010). Maternity nursing. (8th ed. ed.). Maryland Heights, MO: Mosby.University of Hawai'i Community College. (n.d.). Retrieved from ................
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