Counseling the Pregnant Woman

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Counseling the Pregnant Woman
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General strategies for providing effective
nutritional care

• Assess nutritional status
• anthropometric
• biochemical
• social
• medical
• dietary

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Dietary Assessment Selection of Methods

• Avoid collecting information that wont be used
• What is the language skill and literacy level of
  the woman?
• How will I use the information? How accurate and
  detailed does it need to be?
• What is the standard that will be used for
  comparison?
• What resources do I have for collecting,
  analyzing and interpreting the data?

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Essential Steps for Patient Education (IOM
Implementation Guide)

• Identify the problem(s)
• Develop a tentative clinical objective
• Discuss objective with the woman
• If woman does not perceive as a problem offer
  personalized information

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Essential Steps for Patient Education (IOM
Implementation Guide) Cont.

• With the woman
• Identify behaviors that support or impede
  achievement of the clinical objective
• Assess barriers to behavioral change strategize
  about removing barriers
• Plan one or two behavior changes
• Help to reduce barriers with referrals or
  information
• Offer feedback and reinforcement for success

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Referrals to Food and Nutrition Programs

• WIC
• Temporary emergency food assistance program or
  food banks
• Food stamp program
• Cooperative Extension- Expanded Food and
  Nutrition Program

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Family Food Hotline

• http//www.familyfoodline.org/
• Order outreach cards
• 1-888-4-food-wa

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Cultural factors affecting diet and pregnancy
outcome in Mexican-Americans (Gutierrez, J. J
Adolesc Health. 1999 Sep25(3)227-37.

• N48 primigravida adolescents aged 13-18 who self
  identified as Mexican-American.
• Questions
• In some parts of Mexican culture food is
  classified into hot such as pork or cold such
  as fruit juices to balance good health. Do you
  practice or follow such classification?
• Some people believe that cravings during
  pregnancy should be satisfied or the infant may
  be marked by whatever food was craved. What do
  you think?

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Cultural factors affecting diet and pregnancy
outcome in Mexican-Americans (Gutierrez, J of
Adolescent health, in press)

• Questions (cont.)
• Some people believe that nausea and vomiting
  during pregnancy should be treated by drinking
  flour and water, cornstarch and lemon juice, or
  chamomile tea. What do you think?
• Do you believe that heartburn is caused by eating
  chili?
• Some people believe that during pregnancy, if the
  woman sleeps too much it causes the baby to stick
  to the uterus. What do you think?

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Seven Domains of Cultural Competence

• Cultural Competence A Journey
  http//www.bphc.hrsa.gov/culturalcompetence/Defaul
  t.htm1

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1. Values and attitudes

• Promoting mutual respect . . . awareness of
  the varying degrees of acculturation . . . a
  client-centered perspective . . . acceptance that
  beliefs may influence a patients response to
  health, illness, disease and death. . .

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2. Communications styles

• Sensitivity . . awareness . . . knowledge . .
  . alternatives to written communication .

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3. Community/consumer participation

• Continuous, active involvement of community
  leaders and members . . . involved participants
  are invested participants, health outcomes
  improve. .

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4. Physical environment, materials, resources

• Culturally and linguistically friendly
  interior design, pictures, posters, and artwork
  as well as magazines, brochures, audio, videos,
  films. . . literacy sensitive print information .
  . . congruent with the culture and the language .
  . .

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5. Policies and procedures

• Written policies, procedures, mission
  statements, goals, objectives incorporating
  linguistic and cultural principles . . . clinical
  protocols, orientation, community involvement,
  outreach. . . multicultural and multilingual
  staff reflecting the community . .

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6. Population-based clinical practice

• Culturally skilled clinicians avoid
  misapplication of scientific knowledge . . .
  avoid stereotyping while appreciating the
  importance of culture . . . know their own world
  views . . . learn about populations . . .
  understand sociopolitical influences . . .
  practice appropriate intervention skills and
  strategies . .

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7. Training and professional development

• Requiring training . . . nature of cultural
  competence training . . duration and frequency of
  professional development opportunities . . .

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Ethnomed

• http//healthlinks.washington.edu/clinical/ethnome
  d/

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Southeast Asian
Traditional practices are heavily based in
concepts of "hot" and "cold" conditions. Younger
women may no longer follow traditional practices
but the family (mother or mother-in-law) may
insist on following traditions and it is
important to understand how an individual woman
and the greater family compromise.
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Southeast Asian Pregnancy Foodways - Ethnomed

• "Cold" foods are needed for the "hot" condition
  of pregnancy according to Chinese categories.
• There are a wide range of foods which are felt
  beneficial or harmful between cultural groups.
• Bean sprouts/green peas avoided - thought to
  cause SAB (Vietnamese)
• Homemade rice wine, herbal medicines, coconut
  juice are taken to help give the baby good
  quality skin. Beer is thought to make the
  delivery easier (Cambodian)
• Drinking milk and gaining too much weight will
  make baby fat and difficult to deliver (all SE
  Asian)

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Southeast Asian Postpartum Foodways - Ethnomed

• Maternal diet balanced between "hot" (alcohol,
  ginger, black pepper some high protein) and
  "cold" (fruits, vegetables, some seafood). No
  sour foods (cause incontinence), no raw foods.
  Pork felt very nutritious.
• Cold ice water offered post delivery in the
  hospital may be seen as unhealthy.
• Inability to follow traditional post-partum
  practices is thought to cause later health
  problems, especially abdominal pain in women
  (which may occur months or even years later).
  Once a woman becomes sick from symptoms thought
  due to violation of "d'sai kchey", she is sick
  for the rest of her life. (Cambodian)

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East Africa Pregnancy Foodways- Ethnomed
Related women and women within a neighborhood
have very strong ties among each other in East
African communities. In some cultures, such as
that of ethnic groups from Ethiopia, women have a
daily coffee ritual where they gather each day in
homes to share coffee and talk. This daily
gathering of women established support networks
for pregnancy, postpartum help, and child care.
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East Africa Pregnancy Foodways- Ethnomed

• Women try to have good nutrition and particularly
  may increase meat in their diet.
• Flax seed flour is mixed with warm water before
  delivery and drunk by the woman to help produce
  an easy delivery.

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East African Post-Partum Foodways - Ethnomed

• Traditionally women rest in bed for 40 days
  postpartum and are attended by other women who
  prepare nutritious food and do housework.
• Special teas, soups, and porridge are provided
  for the mother.
• Flax seed porridge with honey is commonly given
  to mothers post-partum.

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Adolescent Development (Drake P. J Obset.
Gynacol. Neonatal Nursing, 1996)
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Adolescent Development (Drake P. J Obset.
Gynacol. Neonatal Nursing, 1996)
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Responding to Developmental Differences of
Adolescence Goal Setting
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Responding to Developmental Differences of
Adolescence Professional Approaches