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Frustrations in Obstetrical Care …Culturally Sensitive? Oppressive Male Partners?

027 The drama  that went on here this weekend would be fodder for 10 or more Jerry Springer shows!

~Unreal~

I kept thinking…

“Please help me”

I am not and never have been prejudiced or bigoted in thought process, personality or behavior towards others. I am actually on a campaign to help educate our staff on being culturally sensitive and delivering culturally competent care in relation to obstetrical, breastfeeding and newborn care…. I’m currently organizing a quick reference handbook so certain beliefs & cultural values are better understood by our staff.

This type of sensitivity is very important to me.

It may not matter how I say this. Despite me trying to convince you that I am not intending to offend any type of people…..someone will most likely get annoyed or upset. I don’t usually enter into this type of discussion. I am quite adept at diffusing anger. I am not singling out a problem with any specific culture, ethnicity, or country of origin. I am not attributing any certain behavior to any certain culture.

 

This weekend, we had mother’s giving birth who have recently arrived in the United States from the following  areas: Argentina, Poland, Liberia, Egypt, Iraq, India, Dominican Republic and Nigeria. Sometimes their husband,  boyfriend or significant other was from yet another different country.  These are not unusual immigrants for our patient population. It is however,  unusual to have such diversity in a single 2-3 day period!

My concern is this— As a health care provider– how do you even begin to try to understand another’s strong belief’s or values when you are treated with tremendous disrespect and confronted with attitudes which are unusually demanding of the caregivers to “provide” for any and all needs. Now this is of course what we do…. provide for the needs of those in our care. That includes our responsibility for understanding different certain religious beliefs, cultures and their various norms and values. But this should be done within an environment or culture of MUTUAL RESPECT.

As  much as it is our responsibility to provide for those individuals in our care….. to be culturally sensitive. I feel there should at least be some responsibility on the part of the patient — and or their family- to learn what may be expected of them …. to communicate their history, needs and or wishes to the doctors and nurses~~ or at least to try to understand when it is explained to them at the time of birth and not lash out with anger or disrespect to their caregivers.  Is it too much to ask for a little bit of responsibility to understand at least a little something about what is involved in childbirth, postpartum, newborn care and the legal recording of birth in the facility, state and country in which they have come to and chosen to give birth!  {Many times I have been told they came here so their baby would be an American citizen.} Am I allowed to ask that those from other countries try to be somewhat sensitive to and try to understand our culture? I am not trying to victim blame here.  Really. Many of the patients exhibited rude entitled behaviors and were very disrespectful to staff.  We are all “others” to each other –> but one big blending of society. Lets ALL understand and respect each other.

Some of the behaviors we dealt with include:

  • A mother is married, the father of her baby is NOT her husband. The FOB becomes physically violent that his name can not be on the birth certificate–yet– until there is an affidavit submitted that the husband is not the father…. This turned into an all out fist fight between the the 2 men. “SECURITY!!”
  • A husband refused to allow his wife to be examined in labor during his absence, yet left for hours at a time demanding the hospital provide for his transportation to and from his business 15 – 20 miles away.
  • This same father would not allow his wife to speak for herself…. then called our unit many times after the birth when he was not there to say he was sure his wife was suffering from post-partum depression and we needed to treat her!
  • An unmarried young girl had a PFO against the father of her baby — She did NOT want to see his family yet that FOB’s family demanded to be allowed to visit, displaying hostility, speaking loudly and threatening staff  in a non-English language outside the entrance to our unit!
  • Another mother delivered and the father of her baby was currently in jail on drug charges. She met the criteria (for other reasons) where she and her baby were screened for drugs…. Both were positive for cocaine and heroin… sadly.. 😦  This infant needed to be placed in protective custody of Children’s Services and treated for withdrawal. This is always difficult and heart wrenching. This mother spoke very little english, was ANGRY the tests were done and we were not able to help her understand a situation of this magnitude easily with the language line….
  • Frenzied inpatient banging on the window and yelling for the only nurses’s attention to simply ask a question or get more supplies for their infant even though she was involved in an exam with a doctor on a new very sick infant and had signaled she’d be there “in a moment’…
  • The family and multiple extended family members demanding minute by minute updates on a sick newborn, interrupting our care by knocking on the doors and windows to the nursery… after we have explained all  minute by minute updates to the parents of that baby who were at the bedside.  I have a feeling that culture may have placed a value on the elders decisions over the actual parents, but this mother did not want the father’s family to be in the nursery with her. They don’t understand HIPAA or even know what it is! My job is to support the mother and keep her informed and with her baby.
  • A family not wanting to answer most of the questions for the birth certificate because… it was simply an invasion of their privacy. Alright then.. it will remain blank and the Bureau of Vital Statistics can deal with it, right?
  • A father of a baby requesting then ultimately demanding to speak to the doctor ONLY for each and every one of his questions.. (I am just a nurse).. did I mention it was the weekend?? We don’t have doctors present 24/7 !

 

 

There are times when these situations unfortunately occur. Many times the individuals involved are Americans who are 2nd or 3rd generation of mixed ethnic background or are of no discernable ethnic or cultural background, have lived in this country all of their lives and still exhibit the same type difficult personality traits.  Since they are more “Americanized” shall I say-or however is politically correct to discuss it— it isn’t so difficult to diffuse hostility’s, discuss options, assist with birth, newborn care, breastfeeding, do birth certificates…etc. It is my opinion that sometimes they understand things better simply from living here. We will ALWAYS encounter individuals with difficult personalities regardless of background who may be demanding in nature. They may not initially understand what’s happening but usually respond well to a gentle receptive approach.

That was NOT the case this weekend!

I only wish for strength and future guidance to help and support those who don’t quite understand.

Don’t yell at me or treat me with disrespect.

I ask those individuals new to our country to help themselves a little and learn some of our language and the framework for which we deliver our obstetrical care.

Please.

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15 Comments Post a comment
  1. I have to say, the BoVS does ask some terribly none of their f*ing business questions, which, at the time really offended me. Did I mention none of their f*ing business? Of course, that’s my problem and theirs and it should never be taken out on the nursing/hosp staff.

    August 24, 2009
    • StorkStories #

      I couldn’t agree more! LOL … and they keep adding more and more statistical questions! But thank you for understanding that the nursing isn’t the culprit here.

      August 25, 2009
  2. The majority of your issues were not culturally, but gender issues. I see a lot of male partners exerting undue control over their wives/girlfriends to the point of arousing suspicion for domestic violence. Domestic violence is not acceptable in any culture, and tough sh*t if the male partner is offended that I ask them to leave the room during a history and physical.
    I also work in a very culturally diverse hospital. Over 60 different languages are spoken by patients on any given day. I love it, and would work with my poor, quirky, immigrant population any day, over the rich, rude, entitled patients that grace other, more well-funded hospitals.

    August 25, 2009
    • StorkStories #

      Hey RR. Yes I agree with you there. I was trying to describe that–> which you described very well. We have instances where the male partners exert undue control all the time and we do ask these women when we get them alone… if they feel safe in their own home. It is a problem all over, this weekend there was a strong cultural association with this behavior… and I’m shuttin up about that now.
      One of the things I forgot to describe, which you described well for me again… is that some of these mothers, recently immigrated… exhibited that rude–very rude–sense of entitlement. As if we were beneath them and our only purpose was to serve them and give them everything off our shelves while (and I don’t know their actual financial status) they took advantage of every public assistance program they could. It was not just the fathers displaying this rudeness. We had a feeling there was a cultural component to the behavior.

      August 25, 2009
      • In some countries, nurses *are* of the lower class. Perhaps this is their line of thought?

        FYI – I’ve totally “been there, done that” with the disrespect/rudeness/controlling FOBs/culture differences.

        September 1, 2009
  3. Gayle #

    Oh my gosh, what a weekend you had! I agree, there needs to be respect on both sides. Too often, I hear people talking about how “they’ll show those nurses what they want” said in an aggressive tone. 😦 I guess part of this is that maybe people feel there is an imbalance of power…even if you are being perfectly respectful of them, they may feel helpless under the circumstances…but still, there is a balance between being completely submissive and having no respect.

    Hope that next shift is better — and love your new look on the blog!

    August 25, 2009
    • StorkStories #

      Mutual respect… agreed. I don’t like that you hear that agression towards us often. Perhaps as you say, if there is an imbalance of power or even a perceived imbalance, they may behave as such.. same as what Rebecca says above. Thanks Gayle! I like to play with how things looks..change it up a bit. Thanks!

      August 25, 2009
  4. It sounds like a rough weekend! Communication with demanding, needy patients sounds so hard without the added stress of bridging cultural and language gaps.

    To my mind, the biggest issue is trust and communication. Working with immigrant families, I think it is often hard for them to trust strange medical professionals who speak another language and have a whole different set of behaviors, standards, expectations, etc. I don’t know what the prenatal care systems are like where you live, but if the families you work with are low-income, I expect a lot of them are arriving at your hospital having passed through a system that feels fairly impersonal – seeing different doctors for every prenatal appointment, and/or having providers they’ve never met deliver their baby and provide pediatric care. They are never able to form a strong relationship with a consistent set of people. They may come from a place where you do have to be extremely aggressive to get good medical care, and without having a personal connection with anyone they trust, they feel they need to challenge the system to get what they perceive to be appropriate care.

    I 100% agree with you that families need a better introduction to the obstetric care system! Unfortunately like language classes, this introduction doesn’t exist in most places. Is there any way your hospital could develop a special childbirth prep class (or video to distribute) for families from other cultures? They may not realize how different things are going to be, or what they need to learn, and they may not have anyone in their community to teach them.

    Of course, some families/patients are just going to be tough. And it’s good that there are people like you who see through the frustration, don’t let it prejudice you, and are working to bring better cultural understanding to your staff.

    August 25, 2009
    • StorkStories #

      Hi Rebecca, you are right about everything. There is only one physician practice right now where they see all the docs but they haven’t met us. That’s true for all patients unless they’ve had OP visits to L&D for NST’s etc.. Thanks for the kudo’s to my understanding…. now 2 days later, I’ve all but forgotten about it. I do like this video idea. I will delegate that thought over to my co-worker who does prenatal ed for the crisis pregnancy center in town and she is also the EFM instructor for the staff. Thanks!

      August 25, 2009
  5. Joy #

    I live in a culturally diverse city as well. And I see a lot of the same attitudes (and I’m not even a nurse or in the medical field!!!). We do things differently here, men do tend to be overbearing and dominating in other countries, and the communication barriers are BEYOND frustrating.

    And of course all the blame gets dumped on the hospital/nurses/doctors.

    August 25, 2009
    • StorkStories #

      Thanks Joy… guess that is how I was feeling when i wrote this… “dumped on” 😦

      August 26, 2009
  6. MomTFH #

    I think this is the key:

    “There are times when these situations unfortunately occur. Many times the individuals involved are Americans who are 2nd or 3rd generation of mixed ethnic background or are of no discernable ethnic or cultural background, have lived in this country all of their lives and still exhibit the same type difficult personality traits.”

    Here is a good example of what happens in obstetrics when it is harder to relate to people who are “other” than us for some reason.

    I know it is frustrating when there are language and cultural barriers, but I am not sure any of the people you described were necessarily fully choosing to be in the situation they were in. I don’t think many women want to be in a hospital in which their culture and language are not well understood or well received, and would prefer to be white, insured, from the United States, and would prefer not to be drug addicted or have aggressive men fighting outside of their room. But, since becoming privileged and safe is not in their control, let’s try to show a little empathy to people who need it more, not less.

    I understand these situations are more trying since there are language and culture barriers, but think how much worse it is for the patients, too, and try to step back from making sweeping generalizations about anyone.

    August 26, 2009
    • StorkStories #

      Hello Mom TFH… I am thanking you for your insightful views on my dicussion of my experiences. I did place at the top of my post how extremely important it is for me to be culturally sensitive and provide culturally competent care. I thank you for seeing and saying that I am a conscientious OB nurse and CLC. I found it very difficult to try to describe what we/I went thru without giving away too much pt identifying information. I do go out of my way to make sure the needs are met for ALL patients under my care no matter how difficult. I feel that RR made a good point that these issues may be more male partner dominance issues. You make a good point that many things are out of their control, that they are possibly more or less victims and that all individuals are “real people with real needs”. These are important points!
      I have now over 35yrs in this business and what prompted me to write this particular post was the sheer amount of total disrespect exhibited towards me (and my co-workers) as I/we tried to care for and help those individuals. Possibly I was wrong to think it had anything to do with the diverse patient population. I am not sure why you were bothered by or think it is wrong or insensitive to ask for a little bit of understanding from those individuals new to our country? I ask so much more of myself…constantly asking a lot of myself, to better myself and treat others with the dignity and respect that all individuals deserve.
      NOT ALL these individuals are “victims”…. some are victims of circumstance, some of domestic abuse, but others… I am not so sure. Many people come here for opportunity, to better their circumstances. Some exhibited signs of wealth and privlege. No matter what their situation… Each individual is responsible for his or her own behavior and to possible try to understand a little of where they are…. even if that may not be where they want to be. I go out of my way to help individuals in need of support and education.
      I felt a little victimized myself this weekend. I ask only for a little respect, understanding and to NOT be YELLED at! That has nothing to do with race or ethnicity. That has nothing to do with privelege or poverty. I have one of the most gentle approaches of anyone in my area of expertise! So I will leave you quoting back to you…. what you said about your response…wondering if you did OK..
      …because I hope I did OK…. each and every day.

      “However, discussing problems with experiences with people of other races and ethnicities is really difficult, even with the most conscientious and progressive people. I hope I did OK”

      August 26, 2009
  7. ryeblossom #

    Oh, my.
    I just got to read this, and I truly feel for you.
    I come from a different country, and spoke English before. Also, my husband in american. Though I wish to go back to my country, I think it’s horrible of people to come here, want to stay forever, but have nothing to do with anything american, including learning the language and common courtesy. Many of those feel, as you suspect, indeed, that they are better than americans and are entitled to use whatever the US has to offer, without even being minimally polite to its residents or even the providers of whatever benefits they get.

    That husband who disappeared must have come from one of 2 countries, out of the ones listed… Can you imagine to yourself he comes from a society where they ALL behave like that to their wives??? It’s a cultural thing.

    I know someone who came from not far from there, and she said that with the first pregnancy, her husband dropped her off at the entrance to the hospital and kept on going to get the car fixed. She had to have a c-section at the end, and 2 days after coming home, she had to drive herself to the grocery store to get some groceries and food, as he wouldn’t do even that.
    Maybe she should be happy he decided not to be with her for few hours while in the hospital???

    October 9, 2009

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