The Meaning of Giving Birth: Voices of Hmong Women Living in Vietnam.

Increasing knowledge about the sociocultural context of birth is essential to promote culturally sensitive nursing care. This qualitative study provides an ethnographic view of the perspectives on birthing of Hmong mothers living in the highlands of Vietnam. Unique cultural beliefs exist in Hmong culture about the spiritual and physical world as well as ritual practices associated with childbearing. This includes variations of ancestor worship, reincarnation, and healing practices by shamans. Traditionally, Hmong families take an active role in childbirth with birth frequently occurring in the home. Situated within a large collaborative anthropology project, a convenience sample of 8 Hmong women, who had recently given birth, were interviewed regarding the perinatal experience. In addition, ethnic traditional birth attendants (midwives) and other village women contributed perspectives providing richly descriptive data. This ethnographic study was conducted during 6 weeks of immersed participant observation with primary data collection carried out through fieldwork. Data were analyzed to derive cultural themes from interviews and observations. Significant themes included (1) valuing motherhood, (2) laboring and giving birth silently, (3) giving birth within the comfort of home and family, (4) feeling capable of birthing well, (5) feeling anxiety to provide for another child, and (6) embracing cultural traditions. Listening to the voices of Hmong women enhances understanding of the meaning of childbirth. Gaining greater understanding of Hmong cultural beliefs and practices can ensure childbearing women receive respectful, safe, and quality care.

Prevalence and predictors of postpartum depression among Arabic Muslim Jordanian women serving in the military.

The purpose of this cross-sectional correlational study was to investigate the prevalence of symptoms and psychosocial predictors of postpartum depression (PPD) among Arabic Muslim Jordanian women serving in the military. Jordanian active-duty military women who had given birth within the last year (n = 300) and were working in 4 military hospitals participated in the study. Tools used included the Edinburgh Postnatal Depression Scale, the Impact of Event Scale-Revised, and the Multidimensional Perception of Social Support. Sixty-seven percent of study participants had mild to moderate symptoms of PPD, and 16% had high levels of symptoms of PPD. Seventy-five percent reported having adequate social support, and 75% reported perceived stress above the cutoff score. There was a strong positive significant relationship between symptoms of PPD and perceptions of stress. There was a significant moderate negative relationship between symptoms of PPD and perception of social support. Income, intendedness of pregnancy, mode of birth, family social support, and perception of stress were the strongest predictors of PPD. There was a reciprocal relationship between PPD and psychosocial variables, with women having low levels of perceived stress and satisfaction with social support having fewer symptoms of postpartum. These findings demonstrate the need to address the psychosocial needs of Arabic Muslim Jordanian childbearing women serving in the military through comprehensive interventions. Findings highlight the importance of social support in decreasing perceived stress and symptoms of PPD in these women.

Global and cultural perinatal nursing research: improving clinical practice.

High-quality perinatal nursing care should be based on the best evidence including research findings, clinical expertise, and the preferences of women and their families. Principles of perinatal research initiatives are defined, with suggested research priorities designed to close current gaps in the micro and macro environments of perinatal nursing throughout the world. Nearly a decade ago, the following question was asked, "Where is the 'E' (evidence) in maternal child health?" Improving the quality and safety of perinatal nursing care for culturally diverse women globally is the primary goal of nurse researchers leading the future of perinatal healthcare.

Giving birth: the voices of Australian women.

BACKGROUND AND SIGNIFICANCE: Women's perceptions of childbirth are defined within sociocultural context. Listening to the voices of women is essential to increase nurses' sensitivity to the needs of childbearing women and help nurses provide culturally competent healthcare. PURPOSE: The purpose of this qualitative descriptive study was to identify Australian women's perceptions of giving birth. METHOD: Seventeen Australian women who had given birth in the past 12 months participated in audiotaped interviews. Trustworthiness of the findings was ensured. Themes were generated on the basis of rich narrative data. RESULTS: Themes included focusing on the moment of birth, being empowered by giving birth, defining the spiritual dimension of giving birth, having a diminished or traumatic birth, feeling concern for the child, coming to know the child, and receiving care: nurses making a difference. IMPLICATIONS FOR CLINICAL PRACTICE: Results confirm the findings of other studies suggesting that provision of educational resources and individualized nursing care creates a climate of confidence in childbearing women.

Giving birth: the voices of Ecuadorian women.

PURPOSE: The purpose of this ethnographic study was to describe the perceptions of Ecuadorian childbearing women BACKGROUND: No studies published in English could be found documenting the perspectives of Ecuadorian childbearing women about their birth experiences. METHOD: Thirty-two women who had recently given birth in Guayaquil, Ecuador participated in audiotaped interviews, which were analyzed as appropriate for ethnographic inquiry. RESULTS: "Enduring birth to obtain the gift" was the overarching theme. Supporting themes included caring for self and accessing prenatal care to have a healthy newborn; relying on God to ensure positive maternal/newborn outcomes; submission of self to healthcare providers because of fear, pain, and lack of education; and valuing motherhood. The focus was on the well-being of the child rather than the quality of the birth experience. IMPLICATIONS FOR CLINICAL PRACTICE: With a growing population of women of childbearing age immigrating into the United States from Central and South America, the need for culturally competent care is increasing. Sensitivity to the cultural beliefs and practices of Hispanic and other culturally diverse childbearing women is critical. Women's reliance on God to ensure positive outcomes should be respected. The provision of education and supportive care will help ensure positive outcomes in culturally diverse women.

Parental hesitation in immunizing children in Utah.

OBJECTIVES: To determine why parents in a Utah community hesitated in immunizing their children. DESIGN AND SAMPLE: Cross-sectional descriptive study. Data were collected from a convenience sample of 86 parents of under-immunized children in the county health department and local pediatric and family practice offices. MEASURES: Participants were asked to complete an immunization hesitancy survey including questions regarding why parents hesitated to immunize their children, parental concerns regarding immunizations, and what advice they would give to a friend or family member who had concerns about childhood vaccines. Parents could also write in any other comment, concern, or suggestion they had regarding childhood immunizations. RESULTS: 2 major themes were identified: concerns regarding immunization safety and lack of perceived need. The most commonly reported concerns regarding immunization safety included autism, immune system overload, and other adverse reactions. Many parents did not recognize the need for childhood immunizations, especially multiple immunizations given simultaneously on a strict timeline. CONCLUSIONS: The manner in which immunization information is shared with hesitant parents can be particularly important. There is a need for health care providers to assess and increase parental knowledge regarding immunizations.

Giving birth: the voices of Ghanaian women.

Childbirth is significantly influenced by women's cultural perceptions, beliefs, expectations, fears, and cultural practices. Our purpose in conducting this focused ethnography was to determine the perceptions of Ghanaian childbearing women. Twenty-four mothers who received health care at the Salvation Army Clinic in Wiamoase, Ashanti, Ghana, participated in audiotaped interviews. Patterns of thought and behaviors were analyzed, describing the realities of the lives of Ghanaian childbearing women. Themes included centering on motherhood, accessing health care, using biomedicine, ethnomedicine, and spiritual cures; viewing childbirth as a dangerous passage; experiencing the pain of childbirth; and fearing the influence of witchcraft on birth outcomes. Culturally specific knowledge obtained in this study can be utilized by health care providers, health policymakers, and those designing health care interventions to improve the health and well-being of childbearing women in developing countries.

Use of facilitated tucking for nonpharmacological pain management in preterm infants: a systematic review.

BACKGROUND: Neonatal care demands attention to interventions that effectively reduce pain with pharmacological and nonpharmacological methods in preterm infants during invasive procedures. PURPOSE: The aim of this systematic review was to determine the efficacy of facilitated tucking as nonpharmacological pain management in preterm infants. METHOD: Electronic searches were conducted using the following databases: Ovid, Blackwell Synergy, ScienceDirect, PsychINFO, and CINAHL and with the following key words: facilitated tucking, preterm infant's pain responses, and randomized clinical trials for the period of 1995 to May 2008. RESULTS: The search generated 15 articles; 5 articles fit to the criteria of the systematic review. The following outcomes were statistically significant: heart rate; increase in oxygen saturation; sleep-wake state; Premature Infant Pain Profile scores; and neonate infant pain scores. CONCLUSION: The studies reviewed provide important preliminary findings that suggest facilitated tucking may be beneficial to preterm infants in attenuating their responses to painful procedures.

Outcomes evaluation of St Petersburg Russia Women's Wellness Center.

Researchers demonstrate that investing in women's health yields great social and economic dividends, yet the health of women often receives little attention throughout the world. Women's wellness centers (WWCs) were established in the former Soviet Union beginning in 1992 under the sponsorship of the American International Health Alliance (AIHA) in conjunction with the United States Association for International Development (USAID) to provide a women-centered approach to primary care, providing access to a wide range of clinical services and educational outreach programs. Because the St Petersburg Women's Wellness Center (WWC) is considered one of the more advanced centers and represents a microcosm of opportunities and challenges in women's health care delivery in the Russian Federation, a descriptive qualitative outcomes evaluation of the clinic was conducted. In the spirit of continuous quality improvement, interviews were conducted with childbearing women. Findings are categorized into the dimensions of access, privacy and comfort, communication with providers, comprehensiveness of care, and follow-up care. Strengths of the clinic include the "woman friendly" environment and educational offerings. Suggestions also were made by study participants for improvement of clinic services. Qualitative research can be translated into clinical practice guidelines for WWCs in Eastern Europe.

"It's what we're here for:" nurses caring for military personnel during the Persian Gulf Wars.

Military nursing service during wartime represents significant contributions to a unique type of health care. The purposes of this study were to: (1) generate themes that elucidate combat nursing experiences, (2) honor nurses who served by sharing their stories, and (3) permanently archive accounts of nursing personnel who served during the Persian Gulf Wars during the late 20th and early 21st centuries. Eleven military nurses who provided health care to American troops in the Persian Gulf participated in a historical study as part of the ongoing Nurses at War oral history project documenting the experiences of nurses during times of armed conflict. The overriding theme, "It's what we're here for," demonstrates the commitment of nurses: a commitment to care and to sacrifice. Other themes drawn from the study included lessons learned from their wartime nursing experiences, sacrifices made, and chronicles of caring. During armed conflict in the Persian Gulf Wars, military nurses' personal stories demonstrated the importance of being engaged in making meaningful professional and historical contributions. These nurses displayed professional commitment and hardiness in the face of difficult life circumstances, saying, "We did what we had to do."

Jordanian women's experiences with the use of traditional family planning.

The United Nations Population Fund (UNFPA) and the Hashemite Kingdom of Jordan Ministry of Health (MOH) have identified the importance of strengthening national capacity through the integration of reproductive health (RH) services into the primary health care system. It is reported that a high percentage of Jordanian women use traditional family planning (TFP) methods, frequently using them incorrectly. Our purpose in this qualitative descriptive study was to explore the issues and challenges related to the use of TFP among Jordanian women. Six focus groups with women of childbearing age (18-44 years of age; n = 51) were held in the northern, central, and southern regions of Jordan. Study participants used traditional methods such as withdrawal, periodic abstinence, and breastfeeding. Often TFP methods were used incorrectly, resulting in a high failure rate with unplanned pregnancies occurring within short inter pregnancy intervals. Women preferred using TFP because of side effects experienced while using modern family planning (MFP) methods, misconceptions, and lack of correct information about MFP methods. Husbands often declined to use condoms but supported the use of TFP methods. Women indicated that they have unmet needs for family planning and that they would consider using MFP methods if accurate information was available at health centers. They emphasized the importance of competent and knowledgeable health care providers (HCPs) who contribute to decision making regarding use of family planning.