TRADITIONAL BIRTHING PRACTICES IN A MULTI-CULTURAL SOCIETY: EFFECTS ON WOMEN’S SENSE OF WELL-BEING, SUPPORT AND BREASTFEEDING SELF-EFFICACY ELIANA NASER Master in Healthcare Management, (Sydney), B.HS, Nursing (Sydney), Advanced Diploma in Critical Care Nursing (Singapore) A THESIS SUBMITTED FOR THE DEGREE OF DOCTOR OF PHILOSOPHY (NURSING) ALICE LEE CENTRE FOR NURSING STUDIES NATIONAL UNIVERSITY OF SINGAPORE 2012 i Acknowledgements I would like to acknowledge the supervision and support provided by Professor Debra Creedy, Dr Piyanee Yobas, and Dr Sandra Mackey. They willingly gave invaluable guidance and constructive criticism in relation to this research. To my parents, husband, and siblings, I thank them for their understanding, patience, interest, and endless support and love. Finally, I am indebted to all the women who so willingly gave of their time to share their experiences of birth and without whom this study would not have been possible. Statement of Originality This work has not been previously submitted for a degree or diploma in any university. To the best of my knowledge and belief, this thesis contains no material previously published or written by another person except where due reference is made in the thesis itself. Eliana Naser ii Table of Contents Acknowledgements .......................................................................................... ii Statement of Originality .................................................................................. ii Table of Contents ........................................................................................... iii Summary ....................................................................................................... viii Background ................................................................................................ viii Aims viii Methods viii Results of the study ....................................................................................... ix Conclusion ..................................................................................................... x List of Tables ................................................................................................... xi List of Figures ................................................................................................. xii Glossary of terms ......................................................................................... xiii List of Symbols ............................................................................................... xv Chapter 1 Introduction .............................................................................. 16 1.1 Research aims ................................................................................ 18 1.2 Significance of the research ........................................................... 18 1.3 Organisation of the thesis .............................................................. 19 Chapter 2 Literature Review .................................................................... 21 2.1 Introduction ................................................................................... 21 2.2 Traditional birthing practices ......................................................... 22 2.2.1 Concept of ‘hot’ and ‘cold’, and ‘humoral theory’ .................... 22 2.2.2 Antenatal traditional birthing practices ...................................... 23 2.2.3 Concept of ‘conception’ ............................................................. 24 2.2.4 Behavioural precautions in antenatal period .............................. 24 2.2.5 The ceremony of ‘rocking the abdomen’ ................................... 25 2.2.6 Dietary practices during pregnancy ........................................... 26 2.2.7 Fasting in pregnancy .................................................................. 27 2.2.8 Factors influencing adherence and traditional antenatal practices ................................................................................................... 28 2.3 Labour/Birth traditional birthing practices .................................... 29 2.3.1 Treatment of the placenta ........................................................... 30 2.4 Postnatal traditional birthing practices .......................................... 30 2.4.1 Confinement period ................................................................... 31 2.4.2 Behavioural practices during the postnatal period ..................... 32 2.4.3 Applying hot stones ................................................................... 33 iii 2.4.4 Staying indoors .......................................................................... 33 2.4.5 Pampering the mother ................................................................ 34 2.4.6 Sexual activity ............................................................................ 34 2.4.7 Bathing restrictions .................................................................... 35 2.4.8 Diet during the postnatal period ................................................. 35 2.4.9 Toxic foods to avoid .................................................................. 36 2.4.10 Traditional medicines................................................................. 37 2.5 Emotional well-being .................................................................... 37 2.6 Social Support................................................................................ 39 2.7 Breastfeeding self-efficacy ............................................................ 40 2.8 Implications of the review for the proposed study ........................ 42 2.9 Conclusion ..................................................................................... 43 Chapter 3 Phase 1: Methods and Findings .............................................. 45 3.1 Introduction ................................................................................... 45 3.2 Purpose of Phase 1: The qualitative study ..................................... 45 3.3 Research questions ........................................................................ 46 3.4 Research design ............................................................................. 46 3.5 Recruitment ................................................................................... 47 3.5.1 Sample........................................................................................ 47 3.5.2 Inclusion/Exclusion criteria ....................................................... 47 3.5.3 Ethical considerations ................................................................ 47 3.5.4 Data collection ........................................................................... 48 3.5.5 Approach to data analysis .......................................................... 49 3.6 Rigour ............................................................................................ 51 3.7 Participants .................................................................................... 51 3.8 Findings ......................................................................................... 52 3.8.1 Theme 1: Following tradition .................................................... 53 3.8.2 Filial piety .................................................................................. 53 3.9 Worry about consequences ............................................................ 55 3.9.1 Worry about being sick in later life ........................................... 55 3.10 Fear for the well-being of the baby ............................................... 57 3.11 Worry about going against tradition .............................................. 58 3.12 Theme 2: Challenging tradition ..................................................... 59 3.12.1 Seeking information in new ways .............................................. 59 3.12.2 Modification and rejection of practices ..................................... 60 3.13 Changing family ............................................................................ 61 3.14 Gender preference .......................................................................... 61 iv 3.14.1 Structures for support and caregiver roles ................................. 62 3.15 Discussion ...................................................................................... 63 Chapter 4 Phase 2: Methods and Findings .............................................. 66 4.1 Introduction ................................................................................... 66 4.2 Design of the study ........................................................................ 67 4.3 Setting ............................................................................................ 67 4.4 Sampling design ............................................................................ 67 4.5 Sample size calculation ................................................................. 68 4.6 Inclusion criteria ............................................................................ 68 4.7 Exclusion criteria ........................................................................... 69 4.8 Instrument ...................................................................................... 69 4.9 Pilot testing of Traditional Birthing Practices Questionnaire ........ 71 4.10 Edinburgh Postnatal Depression Scale (EPDS) ............................. 71 4.11 Duke-UNC Functional Social Support Questionnaire (FSSQ) ..... 72 4.12 Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) .........