Title: Counseling the Pregnant Woman
1Counseling the Pregnant Woman
2General strategies for providing effective
nutritional care
- Assess nutritional status
- anthropometric
- biochemical
- social
- medical
- dietary
3Dietary 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?
4Essential 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
5Essential 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
6Referrals to Food and Nutrition Programs
- WIC
- Temporary emergency food assistance program or
food banks - Food stamp program
- Cooperative Extension- Expanded Food and
Nutrition Program
7Family Food Hotline
- http//www.familyfoodline.org/
- Order outreach cards
- 1-888-4-food-wa
8Cultural 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?
9Cultural 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?
10(No Transcript)
11Seven Domains of Cultural Competence
- Cultural Competence A Journey
http//www.bphc.hrsa.gov/culturalcompetence/Defaul
t.htm1
121. 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. . .
132. Communications styles
- Sensitivity . . awareness . . . knowledge . .
. alternatives to written communication .
143. Community/consumer participation
- Continuous, active involvement of community
leaders and members . . . involved participants
are invested participants, health outcomes
improve. .
154. 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 .
. .
165. 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 . .
176. 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 . .
187. Training and professional development
- Requiring training . . . nature of cultural
competence training . . duration and frequency of
professional development opportunities . . .
19Ethnomed
- http//healthlinks.washington.edu/clinical/ethnome
d/
20Southeast 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.
21Southeast 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)
22Southeast 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)
23East 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.
24East 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.
25East 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.
26Adolescent Development (Drake P. J Obset.
Gynacol. Neonatal Nursing, 1996)
27Adolescent Development (Drake P. J Obset.
Gynacol. Neonatal Nursing, 1996)
28Responding to Developmental Differences of
Adolescence Goal Setting
29Responding to Developmental Differences of
Adolescence Professional Approaches