Critique of Traditional Practices for Maternal and Newborn Care among Turkish Postpartum Women
The postpartum period is also known as puerperium. It is the period after delivery during which maternal psychological changes that are pregnancy-related return to the pre-pregnant state. Many mental changes that are pregnancy-related arise during the postpartum period. The period starts upon delivery of the baby and ends at six to eight weeks thereabouts. The reason is many systems by this time have mostly gone back to their pre-pregnancy state.
However, not all organ systems resume their original state within the stipulated period (Ozsoy & Katabi, 2008). For that reason, some scholars describe mothers as postpartum for as long as a year after delivery. As so, healthcare providers should pay attention to the mother’s psychological needs while being sensitive to the sociocultural differences surrounding childbirth in the area. These may range from the consumption of particular foods as well to the restraining some activities while encouraging others. It is a very critical time for both the mother and her newborn because care-related problems can result in maternal and infant deaths.
Realizing a reduction of maternal and infant mortality is a global priority. State of the World Mother’s reports 2013 indicated that annually, 278,000 women are lost during pregnancy or childbirth while 6-9 million children do not live to see their fifth birthday (Save the Children. 2014). Sadly, almost all the deaths are recorded in developing countries because of the scarcity of primary health facilities. Only 1 percent of newborn deaths are in industrialized countries. Despite the huge disparity, statistics showed that both infant and maternal mortality rates (MMR) are steadily continuing to increase in the majority of developed and developing countries (Say et al., 2014). If provided with holistic and safe healthcare during pregnancy, birth and after childbirth, this scenario can be avoided.
World Health Organization has noted some factors hindering access to maternal health services of good quality. They include inadequate facilities, poverty, and lack of accessing information as well as cultural factors. Identification and address of the stated elements can eradicate maternal and infant mortality. Sociocultural practices can be attributed to a majority of the mortality cases recorded. These include the influence of culture and religion and are not limited to social factors that affect individual preferences. Wholesomely, cultures have rich traditional practices that are passed on from one generation to the other. It is a reflection of the societal idea about life (Douglas et al., 2014).
The traditional practices that relate to maternal and infant care during the postpartum period in many cultures date back ages ago. These apply to nutritional intake, breastfeeding as well as newborn care. For instance, some South Asian and Turkish women wear a special amulet to prevent the mother and child from evil spirits. While some practices are harmless, others could be detrimental to the life of both the infant and the mother, and needless to mention some may result in death.
In Turkey a developing country, postpartum mothers and newborns are accorded healthcare for at least 24 hours for vaginal births and 72 hours for Cesarean deliveries. They are done via home visits particularly in rural areas by midwives while those in hospitals get information discharged from there. Mostly, education about how to practice hygiene and effective breastfeeding is offered. Home-birthing mothers do not receive postpartum care unless they seek it from hospitals after. Home births are still rampant and stood at 8% in 2013 (Say et al., 2014).
Currently, researchers emphasize that healthcare providers especially nurses acquire more knowledge and skills to be able to evaluate individuals’ sociocultural practices and beliefs. This will make them provide culturally sensitive care that recognizes the above-mentioned individual aspects. Understanding those methods as relating to maternal and infant care would assist in identifying harmful practices and also guide about how to counsel women during both antenatal and postnatal education (Ozsoy & Katabi, 2008). This eventually will improve maternal-infant well-being. However, limited literature regarding maternal and infant health exist in Turkey. The occurrence is despite the country having unique traditional maternal health practices.
Among the traditional practices by Turkish postpartum women include hanging garlic, onion, and a special amulet in the room where the postpartum mother and child are residing. Putting of the holy book Koran and placement of a needle and a packing needle under the mother’s pillow and not leaving a postpartum mother alone are also other widespread practices among Turkish women. All these are done to prevent “Al basmati,” the evil spirit from visiting the mother, and disrupting her mental health, (Chythra et al., 2014).This happens during the first 40 days after birth. The mother-in-law always accords the new mother company.
While some practices like possession of amulets could be harmless, others like the placement of the needle under the mother’s pillow carry substantial risk. The needle can inflict physical harm to the mother, especially if it pricks the head. This can result to bleeding to the already weak mother. Is ironic that Turkish women believe that postpartum hemorrhage is the most significant threat to postpartum women, yet they authorize placement of the needle practice which harbors the potential risk of loss of blood. Such practices should be entirely discouraged as a measure to attempt the reduction of maternal and infant mortality rates in Turkey.
Early marriage among Turkish women is another traditional practice that affects the postpartum women’s healing process. The method paves the way for all the other traditional practices because after marriage automatically comes the kids. Having children raises the status and value of a woman in Turkish society. Conversely, lack of conceiving may lead to a marriage dissolution (Ozsoy & Katabi, 2008).
Upon conception, young women are subjected to many health problems with some attempting to induce abortion something that escalates maternal mortality. The women are mostly illiterate and hence lack basic knowledge of family planning methods. Research has shown that bearing a child at an early age dramatically risks the mother’s life. This is through disease and bleeding during pregnancy, prolonged difficult labor, and severe anemia among others. This is very unfair to young mothers because it is a traditional societal requirement dictating that a girl marries early. It is most rampant in rural areas where religious cultures are observed( Save the Children, 2014).
The Turkish government has come up with measures to curb this menace of early marriages. One such measure is a program for women of marital age to get pre-marriage and sexual health counseling. It was launched in 2007 and aims at raising the health status of women, educating them on modern family planning methods, and reducing unwanted pregnancies. Eventually, this move will contribute to the reduction of maternal and infant mortality in Turkey.
Another traditional practice that should be stopped is the pouring of cold water on the stomach of the mother. It is a dangerous, harmful practice and not supported by any scientific evidence. The method does not stop the bleeding of the uterus (Say et al., 2014). If the postpartum mother delay seeking medical attention while believing in the practice, her life can be in danger. The practice of placing a heated stone called “Holluk” on the mother’s belly is another dangerous act that is widely practiced. Assumedly, when coupled with belly binding they are prevent maternal hemorrhaging in Tukey. The women believe that wrapping the abdomen with a cloth makes it regain its pre-pregnancy shape and that the bleeding will stop (Ozsoy & Katabi, 2008).
However, the literature suggests that belly binding is beneficial. This is because it promotes a healthy posture when the mother is breastfeeding, pushes back stomach muscles, repositions the uterus, and reduces stretch marks occurrence, (Chythra et al.,2014). Healthcare providers should embark on eroding such beliefs and instead teach Turkish women about lochia and its characteristics and how dangerous the attempt to stop it is. Also, they should recommend the women receive the right care when the bleeding becomes excess or if any postpartum problem occurs.
Lack of proper antenatal care among a majority of postpartum women in Turkey fuels the mortality rate of both mother and child. Upholding of the traditional practice of home delivery hinders women from seeking antenatal care (Douglas et al., 2014). The reason is that they have no confidence in hospitals and overall no regard for it. If complications occur and the midwives cannot handle them without an expert’s support, women end up losing their lives. Through the ministry, the government has launched an antenatal care services program that they hope will curb maternal mortality.
The program seeks to monitor pregnant women up to four times and attends three postpartum follow-ups both at home and hospital. Also in the program, a woman should be monitored for 24 hours after a usual delivery and 72 hours after a Cesarean section. Home deliveries should cease allowing every birth to occur at a health facility. Postpartum monitoring stretches up to the 42nd day after birth. This is because pregnancy-related anemia is common in Turkey. In conjunction with this is vitamin- D supplementation for breastfeeding women. The supplements guarantee the mother good health and prevent deficiency in babies. It is done from the 12th week of pregnancy and stops at 12 weeks after birth, totaling to 12 months of vitamin-D supplementation.
Traditional practices in Turkey do not recognize such supplements as they do not know the bodily health requirements during pregnancy. In fact, when an expectant mother experiences cravings for some foods, it is the traditional practice that the food must be provided for her and must be procured by relatives. While desires are harmless and a result of hormonal changes due to pregnancy, to them, the belief was purely linked to nutrition issues. They believe that the cravings could predict the sex of the baby, where if sweet foods are consumed the mother will give birth to a boy, and sour foods result in a girl (Chythra et al., 2014). This is scientifically incorrect as sex determination is purely a genetic issue since sex chromosomes determine gender.
Mothers feed only on readily available foods irrespective of their nutritional importance resulting in a weakened immune system. Sometimes the mother dies during delivery due to poor health or ends up with deficiency diseases which at times affect the infant as well. Also in the program is access to iron supplements by pregnant women from the 16th week of pregnancy and three weeks after birth.
Another traditional Turkish practice is forcing the mothers to take a concoction of mixed grape molasses and butter to make breast milk enriched. Additional top of non-nutritive breast suckling and expressing the milk when you are near the infant and eating of some foods. These practices do not hold any water since there is no literature showing that the consumption of sweet foods increases breast milk during the postpartum period. Therefore, healthcare providers should sensitize women to increasing fluid intake to enhance milk production and stop consuming sugary foods which increase the risk of obesity among them and predispose them to diabetes (Ozsoy & Katabi, 2008).
Pouring lead over the infant’s head to prevent them from being bad-eyed and also covering their faces with yellow fabric to keep neonatal jaundice away are harmful traditional practices and are detrimental to newborns. The latter result in delayed diagnosis of physiological jaundice if any. These remain mare widespread superstitions in Turkey that are scientifically unfounded. The health fraternity should advise the community to foster positive cultural practices and shun harmful ones (Chythra et al., 2014).
In conclusion, Turkey has recently attained a good trend geared toward decreasing maternal and newborn mortality. The achievements have been realized through streamlined and improved healthcare policies. Causes of neonatal deaths can all be through appropriate intervention during pregnancy, birth, and after birth. Hospital deliveries, as opposed to home deliveries, promotion of fundamental postpartum care, and efficient antenatal and postnatal practices, have played a significant role in the decline.
As the study has shown, educational activities have been found to increase awareness of the kind of harm these traditional practices pose to mothers. Firstly, healthcare providers should keenly pay attention to the less educated and older ones. Focusing on those living in rural areas first should be the priority. In urban centers, the usage of traditional practices is less likely. Employing means of raising public awareness about dangerous conventional methods should be the ultimate goal. By using trusted people from their communities and the use of media improvement in maternal and newborn care will be noted. Shedding some light on the less educated and older women residing in rural areas will be of high essence because they are more likely to engage in the practices.
Secondly, they should consider fostering public awareness should refrain from using critical examples. Instead, they should adopt non-critical scientific explanations that the target audience can understand. For respect for each other’s culture, midwives and nurses should try to develop discharge education that is culture-specific to be able to offer competent and sensitive training (Douglas et al., 2014). There exist a vast disparity between western and eastern Turkey on maternal and infant mortality.
Giving serious attention to this critical issue is unavoidable. Through continually educating the communities on the importance of hospital deliveries, proper breastfeeding practices, and care of postpartum mothers and their newborns will bridge the gap.
References
Chythra, R. R., Dhanya, S. M., Ashok, K., & Niroop, S. B. (2014). Assessment of cultural and practices during the postnatal period in a coastal town of South India: A mixed method research study. GJMEDPH, 3(5), 1
Ouglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M., Lauderdale, J., … Purnell, L. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing.
Ozsoy, S. A., & Katabi, V. (2008). A comparison of traditional practices used in pregnancy, labor and the postpartum period among women in Turkey and Iran. Midwifery, 24(3), 291–300.
Save the Children. (2014). State of the world’s mothers 2013. The Bill & Melinda Gates Foundation, Johnson & Johnson and Mattel, Inc.
Say, L., Chou, D., Gemmill, A., Tunçalp, Ö. Moller, A. B., Daniels, J., … & Alkema, L. (2014). Global causes of maternal death: A WHO systematic analysis. The Lancet Global Health, 2(6), e323-e333.
