Traditional birthing practices in a multi-cultural society: effects on women's sense of well-being, support and breastfeeding self-efficacy

Abstract

This study explored traditional birthing practices of Singaporean women who live in a contemporary multicultural society. It examined the impact of these practices on women?s sense of well-being (as measured by depressive symptoms), perceived social support, and breastfeeding self-efficacy. This two-phase study consisted of a qualitative and quantitative data collection phase.

The aims of this study were to identify the traditional birthing practices of Singaporean Chinese, Malay and Indian women and their effect on emotional well-being, social support and breast feeding self-efficacy.

Phase 1 of the study consisted of face-to-face interviews with a purposeful sample of 30 women recruited from outpatient maternity clinics in a tertiary hospital in Singapore. The analysis using Colaizzi?s method, identified women?s perceptions of their traditional birthing practices, reasons for adherence, and sources of influence. These findings were used to inform the development of a questionnaire that was piloted and distributed to postnatal women in Singapore. Phase 2 of the study was conducted in three tertiary hospitals in Singapore, from March 2010 until July 2010. Women attending their sixth week postpartum clinic visit were recruited. Five hundred and twenty women (n= 520) participated in the survey on traditional birthing practices, sources of influence, reasons for adherence, symptoms of postnatal depression, perceptions of social support, and breastfeeding self-efficacy. Questions included: (1) antenatal traditional birthing practices; (2) antenatal dietary practices; (3) labour and delivery practices; (4) postnatal practices; (5) reasons for adherence to traditional birthing practices; (6) persons influencing adherence to traditional birthing practices; (7) women?s emotional well-being using the Edinburgh Postnatal Depression Scale (EPDS); (8) women?s perception of support using the DUKE-UNC Functional Social Support Questionnaire (FSSQ) and (9) women?s breastfeeding self-efficacy using the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF).

Two broad themes emerged in Phase 1?following tradition and challenging tradition. Singaporean women experiencing pregnancy and childbirth follow tradition and these practices are influenced by their mother and mother-in-law. Women also adhered to some traditional practices because of worry over possible consequences if they do not. Tradition was also challenged through the modification or rejection of traditional practices and changing family roles and expectations. In Phase 2, multiple linear regression was used to calculate the effect of traditional birthing practices on women?s sense of well-being, preception of social support, and breastfeeding self-efficacy. It was found that emotional well-being was significantly predicted by dietary practices, antenatal activities and labour/postnatal practices. The results indicate an inverse relationship between dietary practice and labour/postnatal practices and reported emotional well-being. There was a positive relationship between antenatal traditional birthing practices and emotional well-being. The results of the study showed that adherance to total traditional birthing practices had no significant effect on women?s perceived social support as measured by the DUKE-UNC (FSSQ). It was found that adherence to total traditional birthing practices explained only 1% of variance and did not significantly predict perceived social support. It was found that adherence to total traditional birthing practices explained 2% of variance (Adjusted R square = 0.02) and there was an inverse relationship between adherence to antenatal activities and predicted breastfeeding self-efficacy. This study identified that traditional birthing practices are important activities and the main reason for adherence was to safeguard women?s health and that of their babies.