Why cultural awareness matters in pregnancy care
February 26, 2019
Pregnancy care providers see a lot of cultural diversity every day. Our patients represent a broad spectrum of ethnicities and walks of life, as well as a tapestry of beliefs and customs that help shape their values.
Traditionally, doctors are scientific and data-driven. We recommend the safest, most effective treatments based on medical knowledge. But today, particularly in culturally diverse communities such as the Dallas-Fort Worth Metroplex, doctors must strive for cultural competence to provide optimal care. And it all starts with effective patient-doctor communication.
“Cultural competence goes far beyond the Golden Rule – treat people as you would prefer to be treated. That works only when someone wants to be treated the same way as you.”
Doctor and health care organization responsibilities
Cultural competence goes far beyond the Golden Rule – treat people as you would prefer to be treated. That works only when someone wants to be treated the same way as you.
Especially in pregnancy care, there are cultural nuances to many aspects of communication, from religious and family dynamics to guidelines around personal space and privacy. While it’s not feasible for a doctor to be fully immersed in every culture represented by his or her patients, it is our duty to have a basic understanding of patients’ needs and communicate with them effectively and in a way that makes them feel comfortable.
The American College of Obstetricians and Gynecologists (ACOG) released a committee opinion urging doctors to recognize that their approach to patients’ behaviors and beliefs can negatively affect patient communications.
Additionally, doctors should provide and advocate for improved access to care. For example, doctors who are not fluent in a patient’s primary language should enlist the help of an interpreter. UT Southwestern staffs a range of interpreters, but when a needed language isn’t available, we use LanguageLine, a paid service through AT&T. In those instances, doctors should direct all questions and comments to the patient, not the interpreter, to establish a connection and foster lasting, positive health care relationships.
Four important cultural considerations
1. Family dynamics
Men are household leaders in various cultures, and some Ob/Gyn patients defer to their partner for medical decisions. Additionally, some patients feel strongly that procedures such as a hysterectomy reduce a woman’s body image or womanhood. Doctors must approach these conversations differently from the way we might discuss less intimate procedures.
The topic of sexuality has become more mainstream, but conversations can become awkward quickly without a culturally competent provider. Pregnancy providers should be open-minded and get to know their patients’ situations and preferences without making assumptions. For example, we see patients with a variety of circumstances and unique situations, such as women with more than one partner, same-sex couples, and patients who are surrogates for other couples.
2. Provider gender
Some patients request a male or female doctor due to cultural or personal preferences. Usually that is an option, particularly at an academic medical center. When it is not, we recommend that the doctor have a conversation with the patient to find solutions to make the situation more comfortable.
For example, I recall a patient who was in labor with a premature baby. She felt uncomfortable having men except her partner in the room during delivery and recovery. However, her baby needed immediate specialized care after birth, and all the pediatricians on staff that night were men. So, to respect the patient’s wishes and properly care for her baby, we partitioned the room with screens – the male doctor could be present without invading the patient’s privacy.
3. Religious and cultural beliefs
Certain medical procedures associated with pregnancy, such as circumcision and blood transfusions in emergency situations, are not acceptable by all religions. Some cultures also have guidelines or traditions around co-sleeping, baptism, and baby-naming. And patients might seek traditional remedies before or along with treatments prescribed by their doctor.
Additionally, food is largely related to religious and cultural beliefs. We work to match offerings in the hospital with specific diets and personal likes and dislikes. Our intake team asks about vegan, gluten-free, kosher, and other needs and preferences in order to optimize nutrition and increase comfort during their stay.
Some patients and doctors still adhere to a paternalistic model of health care in which “doctor knows best.” Patients might be hesitant to ask questions out of fear of judgment, so doctors must provide every opportunity for open communication. Additionally, men and women, as patients and doctors, tend to have different communication styles.
Effective, culturally competent communication between doctors and patients is essential in pregnancy care. In the Ob/Gyn setting, we must ensure that patients are comfortable enough to be honest with us, particularly during sensitive and sometimes painful discussions.
We must communicate in ways that make women feel cared for without judgment. And we must ask the right questions to ensure that patients understand why we are making certain recommendations and how we will care for them in a thoughtful, open-minded manner.