AMISH BIRTHING PRACTICES

By LoriJessie &

Jackie

AMISH HEALTHCARE

Amish Healthcare In a multicultural society, culturally competent nursing

needs to be informed of the needs of patients from all cultures.

Nurses and midwives care for Amish women through pregnancy and childbirth in a variety of settings, including home births, birthing centres, and hospitals.  Health care professionals need to be aware of and respect the ways the Amish culture impacts on their health care practices.

Most Amish do not have any health insurance by choice.  The community supports those with serious illness or accident, with a “prescribed, ritualistic response to human tragedy” (Julia 1996), through fundraising, and monthly contributions to a fund if required.

Amish HealthcareAmish and Mennonite are conservative

Protestant groups that developed after 1693 from the Anabaptist movement in Switzerland.  These groups believe in adult baptism.  There are subgroups in the Amish culture that range from ultra conservative to New Order.  Amish adapt to changing technology carefully, with much consideration by the elders.

Amish women have an average of seven children (Purnell and Paulanka, 1998).  Children work on the farm performing chores which ensures the survival of the Amish lifestyle.

Amish HealthcareConsanguinity (relatives marrying relatives) in the

Amish culture results in a number of recessive disorders, many of which are seen only in the Amish population.  Having a child with a hereditary defect is accepted as God’s will, and parents are not encouraged to stop having more children.

Babies are viewed as a gift from God, and children are nurtured in preparation for eternal life (Pumell 1998).  Most couples do not use birth control, and therapeutic abortions, amniocentesis and other invasive techniques are not acceptable.  Distance and cost affect when prenatal care begins and the number of visits scheduled.

Amish HealthcareMothers are generally in good health, well-

nourished, and complications of pregnancy such as gestational diabetes and hypertension are infrequent.

“Five week formula” is used for the last five weeks of pregnancy, to tone and calm the uterus, quiet the nerves, improve labour and ease pain.  This formula is also used for menstrual disorders, morning sickness and hot flashes.  Herbs in the formula are red raspberry leaves, butcher’s broom root, black cohosh root, dong quai root, and squaw vine root.

Amish HealthcareSome Amish folk wisdom for pregnant

ladies:Walking under a clothesline – stillbirthCrawl through a window or under a table

– umbilical cord around baby’s neck

Husbands may be present for delivery, and there are no major taboos or requirements for labour and delivery.  The women wear soft pastel-coloured gowns when labouring.  Other ladies in the community assist the mother for about six weeks post-natal.

Non-Amish Birth with a Midwife

What is a Midwife? The word "midwife" comes from Old

English and means "with woman”. (Association of Ontario Midwives, 2008).

Midwives have helped women deliver babies since the beginning of history. References to midwives are found in ancient Hindu records, in Greek and Roman manuscripts, and even in the Bible.

Registered midwives are health professionals who provide primary care to woman and their babies during pregnancy, labor, birth and the postpartum period.

What Do Midwives Do?Provide complete course of low-risk

prenatal, intrapartum and postnatal care.Physical examinationsScreening and diagnostic testsAssessment of risk and abnormal conditionsConduct normal vaginal deliveries.Work in collaboration with other health

professionals and refer to specialists as appropriate.

Attend births in the hospitals, birth centres and at home.

Midwives Con’tDuring regularly scheduled visits midwives

provide:Clinical examinations and routine tests of

pregnancy i.e. Blood work, ultrasounds etc.

Counselling & Education.

Between visits midwives provide:24 hours a day call availability for

questions, labour/birth & emergencies.

Education:Midwives have a 4 year degree in

Midwifery.

Issues Affecting MidwivesStereotypes of

midwives(uneducated, unsafe etc.)

Misconceptions or misunderstanding of the midwifery scope of practice and care process

Some Physicians fear regarding litigation if involved in the care of a midwife patient.

Why do we need midwiferyThe top 10 reasons:(Adapted from Midwifery coalition of Nova Scotia)

Midwives are expertsMidwives promote the health of women and

babies.Midwifery is family-centred.Midwifery is safe.Midwives offer personalized care.Midwives are flexible and accessible.Midwives respect diversity.Midwives are part of the health care team.Midwifery care is a choice more families are

making.You Deserve it.

Contrasts between a Midwife and an Obstetrician

Midwives tend to have a more holistic, natural philosophy about childbirth, whereas obstetricians are more likely to have a medical perspective and view birth as a risk.

Midwives tend to spend more time with you during labour and in prenatal visits than an obstetrician, who may be in and out of the birthing room until the final stages of pushing and birth.

Obstetricians are more likely than midwives to use medical interventions such as inductions, continuous monitoring, episiotomies as well as recommend caesarean.

Contrasts between a Midwife and an Obstetrician Con’tObstetricians are trained as surgeons

and can do a caesarean, whereas a midwife cannot perform major surgery.

Obstetricians can treat both low and high-risk mothers but midwives can see only low-risk patients.

Midwives, in some cases, practice in birth centers or a homebirths in addition to hospital births, unlike obstetricians who practice only in a hospital setting.

The Ontario’s Ministry of Health recently completed an evaluation of it’s midwifery programme and found:

With Midwife Care

With Physician care

Improved breastfeeding rates (at 6 weeks)

90.7% 71.5%

Reduced caesarean rates 12.7% 20.6%

Fewer operative vaginal deliveries

5.4% 14.4%

Fewer Episiotomies 7.2% 16.6%

Early hospital discharge <24 hours

74.2 2.36%

OBSTETRICIAN

OBSTETRICIAN

When having a baby in the hospital your family doctor may refer you to an OB (Obstetrician).

The OB will handle every conceivable medical aspect of your pregnancy, labour, delivery and postpartum period.

If you are a high risk pregnancy you will most likely be seeing an OB.

More than 90% of women see an OB when they are pregnant

Tests that your Obstetrician will be giving you during your pregnancy:

Prenatal blood test

This test will check your blood levels to detect a pregnancy.

It tests the HCG level (human chorionic gonadotropin) in your blood. This should double every day to detect a normal pregnancy.

Obstetrician Con’t16 – 18 weeks of your pregnancy your OB

will give you another blood test to detect:-enhanced AFP- Alpha-fetoprotein screening- this can show a risk of an abnormality of the fetus.

Or absence of all or part of the fetal brain material (anencephaly)

Can diagnose a high % of anencephaly and spina bifida cases.

Low level of MSAFP could indicate down syndrome

Obstetrician Con’tUltrasoundcan be done according to your OB’s preference

starting at 6 weekscan also have one at 18-20 weeks to look for

any abnormalities in the fetus

Glucose Tolerence Test (diabetes test)screened between 25th and 28th weeksyou take a non-carbonated bottle of a

sweetened beverage to drink 1 hour before the blood test

Obstetrician Con’tAt every doctors appointment your OB

will take your blood pressure, your weight, check the size of your uterus and answer any questions or concerns you might have.

By the 42 week of your pregnancy (if you already haven’t had the baby) then the OB will discuss whether he/she will induce you into labour.