Culturally appropriate Maternity Nursing Care for the Muslim mother

1. Culturally appropriate Maternity Nursing Care for the Muslim mother Maternity Cultural Competency

2. Muslim Culture Refresher • Eye contact- Muslims typically will avoid direct eye contact during a conversation as a sign of respect for the speaker. • Touch- Muslim patients avoid excessive touch between members of the opposite gender or strangers, including shaking hands, hugging, or patting the shoulder. • Handedness- The left hand is considered unclean in many Muslim cultures (used in toileting) To avoid offence, use the right hand for feeding, administering medications, or handing something to a Muslim patient. • Dress- Muslim women are expected to wear loose clothing that covers their arms, chest and legs. Many Muslims women also wear a head covering called a hijab • Same gendered- In a healthcare setting, there may be a strong preference for treatment by providers of the same gender. Women will specially appreciate treatment by another woman during gynecological exams and during childbirth. • Dietary- Forbidden foods include pork, lard, and gelatin made from pork products. Fasting during Ramadan is excused for women who are pregnant, menstruating, lactating, or within 40 days of childbirth.

3. Pregnancy • Muslims place a strong emphasis on legal marriage between a man and woman as the only appropriate venue for sexual intercourse and the raising of children. • The birth of a child is a joyous event and all children are seen as gifts from God; boys and girls

4. Pregnancy Classes • Sources of childbirth education among Muslim women are the same as those for other women: prenatal classes & regular doctors visits. • Muslim husbands also attend childbirth education classes with their wives. • Culturally competent ways of giving information may include letting couples know they don’t have to watch the birthing videos if they are not comfortable with viewing it (graphic)– respecting beliefs and modesty

5. Childbirth • In the Qur’an (Muslim Holy Book), childbirth and labor are recognized as extremely painful and taxing experiences. • The physical and emotional pain a mother endures during pregnancy, labor, delivery and postpartum = elevated status to mothers.   • The Qur’an says to, “Respect the womb that bore you.” • One owes to their mothers three times more love and obedience than that owed to one’s father, and that “Paradise lies at the feet (serving the needs) of one’s mother.”

6. Postpartum - Mother • Medications: May be resisted if contains alcohol or pork. Will ultimately chose to use medications if mother’s life is in jeopardy. • Diet: Hot liquids such as tea or soup are common postpartum foods. Bread is also common at every meal. • Hygiene: Muslims generally cleanse themselves with running water after toileting and thus find proper perineal care after birth a natural extension of this practice. Muslim women are exempted from performing ritual prayers and fasting during postpartum bleeding (up to 40 days), and they are not required to make up for these missed obligations. • Breastfeeding: Islamic teachings encourage Muslim women to breastfeed their newborns up to two years. Provisions for modesty of the mother in the hospital are key to encouraging breastfeeding practice.

7. Birth Customs • Placenta: After the birth of a child, some Muslim parents may request the placenta for burial. • Involvement of father: In some Muslim cultures, childbirth is seen as a female issue only. A woman in labor is usually surrounded by female relatives and friends. Fathers may need assurances that the woman’s modesty is respected during her stay.

8. Ritual Welcome of the Newborn Child Adhan: The father or elder male relative will whisper in the baby’s right ear a call to prayer. This is done so that the first word a baby hears is the name “Allah,” followed by the shahadah - ‘There is no God except God, and Muhammad is God’s messenger.’ Igamah: A second call to prayer performed shortly after the Adhan, reminding all present that 'Our stay on earth is short … so life should be spent wisely and diligently, and not wasted'. Tahneek: A respected family member rubs a small piece of softened date (or honey) onto the infant's upper palate, preferably before the infant is first fed. The hope is that positive qualities of the family member will be imparted to the newborn child.

9. Ritual Welcome of the Newborn Child-continued Taweez: In some Muslim cultures a black string with a small pouch containing a prayer may be tied around the baby's wrist or neck to protect the baby’s health. Male circumcision: Muslims generally circumcise boys within a few weeks of birth. Agigah: On the seventh day following a birth, the family may arrange for a sheep to be slaughtered as a sign of gratitude. The meat is distributed to the family and the poor. Shaving the hair: Also on the seventh day, many Muslim will shave the infant’s hair, signifying the child’s pure state at birth. An equivalent weight in silver may then be donated to charity.

10. Conclusion • It is important to recognize the practicing Muslim mother in order to provider her with the most appropriate and culturally specific care available. • Understanding the customs and beliefs of the Muslim family during the birthing process allows for greater individualized care and better outcomes.

11. Resources • American Psychological Association, (2009). Publication manual for the american psychologicalassociation, (6th ed.). Washington DC: American Psychological Association. • Charles, Carise. (2012). Culturally competent nursing care of the muslim patient. Issues in Mental Health Nursing, 33, 61-63. doi: 10.3109/01612840.2011.596613 • Linda L. Barnes. (2012). Boston Healing Landscape Project. In Islam and Healing: Guidelines. Retrieved October 1, 2013, from http://www.bu.edu/bhlp/Resources/Islam/health/guidelines.html. • Lipson, J., & Dibble, S. (2005). Culture & clinical care. (pp. 46-57)San Francisco: USCF Nursing Press. • Walker Karraa. (April 29, 2011). Postpartum Care Considerations in Muslim Communities: Part II of the Interview with HajaraKutty.. In Science & Sensibility. Retrieved September 22, 2013, from http://www.scienceandsensibility.org/islam-and-postpartum-care.