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

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.