STUDY

Childbearing Practices inKanadier Mennonite Women

CROSS-CULTURAL NURSING HAS FOCUSED ON UNDERSTANDING THE KNOWLEDGE,

BELIEFS AND PRACTICES OF UNIQUE CULTURAL GROUPS AND INCORPORATING THIS

INFORMATION INTO THE DELIVERY OF NURSING PRACTICE.

J U D I T H C. K U L I G , R N . D N S C

JUDITH C. KULIG IS A PROFESSOR, SCHOOL OF HEALTH SCIENCES,

UNIVERSITY OF LETHBRIOGE, LETHBRIDGE, ALBERTA.

B A R K Y L. H A L L , P h D

BARRY L. HALL IS A PROFESSOR, FACULTY OF SOCIAL WORK, UNIVER-

SITY OF CALGARY CALGARY, ALBERTA.

RUTH BA8C0CK, RN, MEd

RUTH BABCOCK IS A PUBLIC HEALTH NURSE, PALUSER HEALTH

AUTHORITY, MEDICINE HAT, ALBERTA.

ROBERT CAMPBELL, MAd, Ed

ROBERT CAMPBELL IS THE DIRECTOR, POPULATION HEALTH DEPART-

MENT, CHINOOK HEALTH REGION. LETHBRIDGE, ALBERTA.

M A R G A R E T W A L L , RN

MARGARET WALL IS A HEALTH PROMOTION CONSULTANT, CHINOOK

HEALTH REGK3N,

This article describes the fmdings of an exploratory,descriptive sludy conducted among Kanadier Mennon-itcs in southern Alberta.' A total of 86 individuals wereinterviewed, but the discussion here is limited to the infor-mation on childbearing (i.e.., knowledge, beliefs and prac-tices about pregnancy, labour, delivery and the postpar-tum),generated from the 45 women who were included inthe sample. Maternal and public health nurses ean use theresults presented here to plan and implement nursingpractice.

Kanadier Mennonites, sometimes referred to as Low Ger-man speaking Mennonites.are the group of Mennonites whomigrated to Mexico from Canada in 1922 in order to main-tain their conservative religious lifestyle.- Generally speak-ing, Kanadier Mennonites are a conservative religiousgroup that includes individual members from churchgroups such as the Old Colony, Sommerfelder,Rhuielander and Kleine Gemeinde (listed from most con-servative to most liberal). TTiere is variation between and

ABSTRACT

Cross-cultural nursing practices call for attention to be paid to theunique beliefs and practices of the groups with which nurses comeIn contact. The Kanadier Mennonites are a conservative religiousgroup who live in Alberta, Manitoba and Ontario. An exploratory,descriptive study was conductedwith this group in southern Albertato generate information abouttheir health and iilness beliefs. Thisarticle focuses on their knowledge,beliefs and practices in relation tocfiildbearing interviews were con-ducted with 45 women, the major-ity of whom were married and hadbeen born in Mexico Among thesample there had been a range ofone to 16 pregnancies. The partici-pants noted that childbearing Isnot a topic openly discussed withothers. Women iearn about child-bearing from their mothers and Authors (left to right); Margaret Wall, Robeit Cdi i

Barry L Hall, Judith C. Kulig and Ruth Babcock

other women but also from physicians and books. During pregnancy thereare particular activities to be avoided including the use of strong cleaningfluids and hand milking of cows. Foods such as milk need to be ingestedto ensure a healthy pregnancy Prenatal care was not emphasized in Mex-ico nor has it become a customary practice in Canada but deliveries in

hospital are the norm in both thesecountries. During the postpartum thewomen receive support from theirimmediate and extended family in orderto recuperate. Nurses need to exploreindividual Kanadier Mennonite beliefsregarding chiidbearing and work withthis group in developing acceptabletiealth promotion programs to helpensure healthy pregnancy outcomes.The blending of nursing practice knowl-edge in a non-intrusive manner with agroup of people with differing belief sys-tems is a necessary and achievable goal.

KEYWORDS: childbearing, KanadierMennonites, pregnancy

34 Canadian nurse OCTOBER 2004 VOL. 100 NO 8

among individuals and families in adhering to ministerialprescribed activities and behaviours within these fourgroups. Thus, while living in Mexico, the most cotiservativeKanadier Mennonites may only travel by horse and buggy,while others in the same group may travel in motorized vehi-cles. In Canada, their use of cars and trucks is very much thenorm. More detailed explanation of the differences betweenthe religious groups is not possible here due to the complex-ity of their beliefs.

Accurate statistics are not available on the number ofKanadier Mennonites in Canada, but some estimates indi-cate that there could be as many as 57,(KXP with 12,000 to15,(XX) in Alberta and the remaining living in Manitoba andOntario. Ttiey have been returning to Canada in order tolive in a country that can offer more economic, educationand healthcare opportunities. More often they work in theagricultural-based industry. Published literature on thisgroup's health beliefs is limited to a community assessmentconducted in southern Alberta, whieh revealed uniquehealth beliefs such as the use of specific herbal treatmentsobtained from Mexico for illness,-* and a study ofthe healthbeliefs of Oid Colony and General Conference Mennonitewomen in Mexico.^ Regarding childbearing, it was notedthat pregnancy is considered a private topic with no publicannouncements and interpretation of biblical verses is usedto justify large families. A woman who has a child out ofwedlock may have a difficult social existence if the manrefuses to marry her.*"

METHODSTWs study^ was conducted over a two-year period using apartnership model that included academic researchers, localhealth regions and the Mennonite Central Committee(MCC). Low German speaking Mennonite research assis-tants (RAs) were hired to conduct the interviews.There werethree female RAs, one male RA and one eouple. It wouldhave been preferable for only female RAs to speak with thewomen participants about childbearing but that was not pos-sibie or feasible because the childbearing questions were onlyone part of the larger study and there were few Low Germanspeaking individuals available. Despite the potential limita-tions, there were no apparent difficulties with the interviewsconducted by the male RA because the Kanadier Mennonitessee predominantly male physicians and they perceived theRA as a professional who was assisting them.

TTie participants were located through the research teamand existing community contacts. Informed consent wasachieved after a lengthy explanation of the study, both onthe telephone when booking the appointment and afterarriving at the home, where the interviews were conducted.Demographic information was collected on all participantsand included a detailed pregnancy history for the womenparticipants.

The interview was conducted in Low German and lastedup to two hours, of whieh one part foeused on ehildbearingissues. For the family, having the RA come to their home

TO SIGN A

was a social event; it was not uncommon for all family mem-bers to listen during the interview. Only the Kanadier Men-nonite women were asked questions about ehildbearingand in several instances when this topic was about to be dis-cussed, the children were asked to leave the area or thewoman and the RA went into another room to ensure priva-cy. Diseussions were held with each of the women aboutpregnancy, labour, delivery and the postpartum.

Due to the lack of comfort with technology among some ofthe Kanadier Mennonites, tape reeorders were not used, butshort notes were taken and subsequently a summary of theinterview was taped and later transcribed.The first two authors

trained the RAs,and continual eon-ALL MEMBERS OF tact was maintained throughout the

research project to provide feed-1 ML KLbLAKL^in back.TTie entire research team met

PROJECT WERE on a regular basis and discussed themeaning of the data within the larg-

REQUIRED er social context of the KanadierMennonites. All members of theresearch project were required to

STATEMENT OF sign a statement of confidentiality

to emphasize the importance of

CONFIDENTIALITY keeping the identity of the partici-

TO EMPHASIZE pants and their comments eonfi-dential. Ethical clearance had beenobtained from the first author'sacademic institution.

Establishing and maintainingIDENTI'IY OF THE ''"^^ among the Kanadier Men-

nonites was an essential step inPAxTiCIPANTS successfully conducting the

research and has been discussedat length elsewhere.** Meetings

COMMENTS were held at the beginning andend ofthe research with the minis-

CONFIDENTIAL ^^^ ^f jj g participating religious

groups. One group did not partici-pate, likely due to changes in church membership; despitethis, individuals from that church group were interviewed.The findings have been shared with the Kanadier Mennon-ites through community meetings and I-ow German tapesof the findings, for those who accept sueh devices.

FINDINGSThe majority of the 45 women were married and their agesranged from 20 to 65 years old (with an average age of 38.5).Most were bom in Mexico and were educated there for anaverage of five years. Fewer women than men had attendedEnglish classes since moving to Canada. Of the 45 womenpartieipants, there was a range of one to 16 pregnancies andzero to 14 children, a few stillbirths with a range of zero toseven and only one therapeutic abortion among the group.Although the interview data indicates that there were fewspontaneous abortions or miscarriages within the participantgroup (range of zero to four), the detailed demographic >

THE IMPORTANCE

OF KEEPING THE

AND THEIR

VOL. 100 NO. B OCTOBER 2004 canaillan nurse 35

ABOUT

sheets revealed that several of the women had experienced anumber of miscarriages. For example, one woman had ninepregnancies and four miscarriages; another had six pregnan-cies and four miscarriages. One family that had experienceda high number of miscarriages pur-posely relocated to Canada in the THERE IShope of delivering a viable infant.The women attributed the loss of a LITTLEfetus from differing viewpoints. Onewoman said that after having threemiscarriages she had to "trust in BETWEENGod" and interpreted the loss of thefetuses to God's grace because the MOTHERSchildren would likely have been bom AND ADULTwith health problems. Severalwomen noted that the Mexican DAUGHTERSphysicians did not disclose the rea-son for the muitipie miscarriages.One woman who had miscarried CHILDBEARINGcommented that it was likely God'swill because the physicians could not give her any concretereasons for losing the baby However, another said that shefelt the miscarriages were due to incompetent medical carein Mexico.

Several of the participants noted prematurity as the reasonfor experiencing infant deaths. Others noted "heart prob-lems" and "birth complications" as the reason but no furtherinformation had been given to the women by the provider.

Childbearing as a private subject: There is little discussionbetween mothers and adult daughters about childbearing.The women had learned about pregnancy on their own,from their mothers or from other women, physicians orbooks. The majority had not told their children or closefriends when they were pregnant. Instead, the childrenwere told that the new baby was delivered to the hospitalby a bird or that the baby was bought from the physician.Tlie few exceptions regarding disclosure to children weremore often among the more liberal religious groups such asthe Kleine Gemeinde.

Based upon the way in which the women discussed theirpregnancy history, the RAs perceived that the women didnot emotionally attach themselves to the fetus during thefirst two months of pregnancy The participants shared thatbabies bom out of wedlock would have greater difficultiesgoing to heaven. Therapeutic abortions that were onlydone because of the mother's health were not otherwiseacceptable among the group.

Activities and foods during pregnancy: Regular house-work activities were conducted during pregnancy with theavoidance of the following:

• use of strong cleaning fiuids, i.e., lye or bleach• going through a fence because the cord would wrap

around the baby"s neck• hand-milking cows• painting or reaching high• heavy lifting or heavy work.

During pregnancy the women were to eat a "regulardiet," i.e., milk, meat, vegetables and fruit. Some womennoted the importance of ingesting more milk at this time.One woman said that eating raw sunflower seeds alleviat-ed heartbum. whereas roasted seeds would worsen thiscondition. Others said that pregnant women should avoideating canned fish and apples. One woman talked aboutthe "chiropractic" treatments in Mexico she had under-gone to align the fetus properly for an easier delivery. InMexico, there is a lack of health providers for the KanadierMennonites and hence prenatal care is not common.

In Mexico, a physician or a trained midwife conducted thedeliveries either in a hospital, a elinic or. in one instance, inthe woman's home. In Canada, all of the deliveries hadbeen conducted by physicians in a hospital and severalwomen underwent eaesarean sections. While in Mexico,the labour and delivery experiences reflected the time peri-od with women who delivered their babies in the 1950s andthe 1960s not having their husbands present.

Postpartum support: It was routine in Mexico to providethe new mother with support after the delivery. This sup-port varied, but normally included visits and food providedby other families for up to two weeks after the delivery.Other support included having a young Mennonite girl toassist with childcare and housework, having the husbanddo the housework or receiving assistance from thewoman's mother, mother-in-law or sisters and friends. Inlarger families, sisters would take turns giving help for two-week periods. Baby showers were common and providednecessary items for the new infant.The transition to retum-ing to work after delivery varied by family. One womancommented that the day after she retumed home sheresumed her schedule of milking the cows and doing thehousework; another stated that she rested for nine days andhad assistance with househoid tasks from her husband.Another woman rested for four months, slowly increasingher workload.

While they lived in Mexico, it was common during thepostpartum period for the women to foiiow specificbeiiefs. For example, putting one's hands in hot, soapywater would decrease breast miik, whereas ingestingaifalfa seeds would increase breast milk. One woman wasemphatic that raw foods {e.g., tomatoes, cabbage,bananas) shouid not be eaten during the first threemonths of the infant's iife. She beiieved that certain foodscaused infection in the body, led to bad veins in the moth-er and turned the breast milk such that the infant wouidbecome ill. Other foods to be avoided by breastfeedingwomen were watermelon, cabbage, beans and hot pep-pers as these would stimuiate the baby and prevent sieep.Another woman said that excessive amounts of bakedgoods, potatoes and raw fruits and vegetabies give thebaby gas. One woman avoided canned fish and rawappies in the first week after the delivery to prevent herfrom experiencing pain. In addition, pop and juice wereto be avoided but meat and miik were important.

36 Canadian nurse OCTOBER 200a VOL. TOO NO. B

In both Mexico and Canada, the umbilical cord receivedspeciai attention that inciuded covering it with cotton bat-ting and tape or additionaily with salve. Other partici-pants related that iittle belts were sewn to cover theumbilicai cord and hence keep it down to prevent hernias.Another exanipie was to soak the cotton covering in aico-hol for its drying effect, and pass the cord through thehole of the covering. Details were not coilected regard-ing how iong the covering was kept in place or therationale for maintaining this practice. Only one moth-er noted that she followed the hospital's advice aboutthe navel. More often, regardless of the method used tocover it, when the umbilical cord broke off. alcohol wasused to clean the navei for a few weeks.

One of the participants noted that the heaith profes-sionais in Mexico did not assist women who were hav-ing difficulties with breastfeeding. One of the youngwomen indicated she was bottle-feeding because she"had nothing for the infant," and did not have anydietary restrictions after birth. This thinking wasnoted among a few other women who did not per-ceive tbat their infants were satisfied with breast milk.

DISCUSSIONThe wide variety of beliefs described by the participantspoint to the need for nurses to explore the individualKanadier Mennonite woman's understanding and prac-tices surrounding childbearing and to confirm theimportance of beliefs and practices held in Mexico fortheir new Canadian setting. Variation is expectedregarding nutrition and activities during pregnancy.Establishing a baseline of knowiedge and behefs wiilassist in the planning and implementation of culturallyappropriate care. The need for privacy regarding child-bearing shows that nurses need to approach this topicwith sensitivity. When a nurse cares for a woman whohas miscarried, for example, an exploration of herbeliefs may reveal that she feels it is due to God's will.Such a belief needs to be respected; at the same time, otherpossible reasons for the miscarriage can be explored.

Prenatal care is not something that is routinely soughtamong the Kanadier Mennonite women, but they wantto ensure a healthy birth outcome. The women need to

be encouraged to seek and use healthcare providers.Interpreters may be necessary in providing a rationalefor this preventive health activity, given the KanadierMennonite's minimal experience with using healthcareproviders during pregnancy. It is crucial to identifywomen early in their first pregnancy and to provide edu-

cation to respected KanadierVARIATION Mennonite women.

IS EXPECTED Change is difficult for theKanadier Mennonites and initial

REGARDING rejection of chiidbearing healthprograms is a possibility. Commu-

N U T R I T I O N njty development approaches can

AND ACTIVITIES ^^ instrumental in gaining supportfrom certain community members

DURING (e.g., ministers and men). Healthproerams need not be intrusive,and indeed can benefit this group's

ESTABLISHING ^^^ ^^ ^ ^"^ religious practices.Nurses need to promote matemal-

A BASELINE child health from the stance ofOF KNOWLEDGE ensuring healthy families and com-

munities..AND BELIEFS Cross-cultural nursing has

focused on understanding theWILL ASSIST knowledge, i eliefs and practices of

unique cultural groups and incor-porating this information into the

PLANNING AND deliveryofnursingpractice.Nursesare well positioned to assist

IMPLEMENTATION Kanadier Mennonites through

OF CUT TURALLY provision of health education andpromotion of women's health.*

APPROPRIATEAcknowled^ent: The authorsthank the Kanadier Mennonites who

participated in this study; Biii Janzen,

research team member; the Mennonite Central Committee, Aiberta

division; research assistants Mary Belcastro, Ruben Bueckert, Esther

Oifert, Tom olfert and Susan Tashiro; student research assistants

Meiissa Hart and Lesley Masuk; and transcriber Tina MacQuarrie.Ttie

study was supported by a research grant from the Alberta Hentage

Foundation for Medicai Research.

IN THE

GARE

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