NUR505- REPLY TO DISCUSSION DANETTE

Module 3 Discussion

The Amish people, as a whole, live clean and simple lives based in their faith in God. They are generally hard-working people with a strong sense of family and community, and live their lives in service to God and others (Purnell, 2013). They will help a fellow community member in times of need, often without being asked. They have a strong community bond and pride in their heritage and multi-generational family structure (Purnell, 2013). Pregnancies are often more private, with families not announcing the impending event, but allowing others to know only when the expectant mother can no longer hide her advancing pregnancy (Purnell, 2013).

Amish women do not often seek outside prenatal care, instead preferring to utilize lay midwives and the experiences of her elders. They have a preference for home deliveries, and the Amish women are less likely to use hospital-based obstetric services for their prenatal care as well as the actual delivery (Jolly, 2017), therefore supporting the higher rates of homebirths attended by midwives. These values and beliefs can come in conflict with what a non-Amish healthcare provider may be ordinarily accustomed to. With this knowledge, we should be prepared to discuss the benefits and concerns we may have in regards to pre and perinatal care of mother and child. In so discussing this with our prospective pregnant Amish patients, we must carefully also take in to consideration their beliefs when broaching certain topics related to prenatal education classes with the Amish patient.

Prenatal care usually consists of a physical exam, weight checks, and depending on the stage of the pregnancy, the healthcare provider may also perform blood tests and imaging tests, like an ultrasound (National Institute of Child Health and Human Development [NICHD], 2017). Prenatal visits also include discussion about the health of the mother, the state of the fetus’s health, and any questions the expectant mother may have pertaining to pregnancy (NICHD, 2017). Prenatal care can help prevent unforeseen complications and keep the patient informed about things that they can take and do to protect their unborn child and ensure a healthy pregnancy (NICHD, 2017). Approaching these benefits and topics of prenatal care must be done with caution and respect to the Amish and their cultural beliefs.

When preparing to provide prenatal education classes with the Amish patient, we need to take into consideration first is the location of the classes. The Amish patient will need to consider the distance from their home to the class, as their means of transportation is traditionally a horse and carriage (Purnell, 2013). The carriages may be lit by oil lamps, and have reflective signs on the back of the carriage as a safety measure, but if the patient is travelling a fair distance, and the classes are close to dusk, this could pose a serious safety concern to the patient. Another concern for the Amish patient and prenatal classes would be about certain types of media being used to educate the patients. If watching a video on television is to be utilized, the patient should be informed ahead of time, so as not to conflict with their cultural beliefs (Purnell, 2013).  Discuss three Amish values, beliefs, or practices to consider when preparing to do prenatal education classes with Amish patients. The third thing to consider when providing prenatal care to the Amish patient would be their use of herbal medications. Pregnant women should not take certain medications, including some dietary and herbal supplements, during pregnancy because they can cause harm to the unborn child (NICHD, 2017). Even though Amish women may not take many prescription medications, their normal daily use of herbal remedies may be cause for concern. This topic needs to be brought to the attention of the patient, and possible side effects during a pregnancy need to be made known to the mother. The more education we provide to the patient, the better the informed decision they can make.

Two areas of prenatal care I would have wanted to discuss with Mary would have been about her previous pregnancies, and if there were any issues or concerns with them, that might have foreseen a premature delivery with Melvin, her 1-month-old son, who is currently ill. The second area of her prenatal care I would have discussed was her daily use and increased used during pregnancy of herbal medications. Pre-clinical in vivo and in vitro studies describing the potential embryotoxicity have been conducted for certain herbal medications. A few studies had revealed the scientifically evaluated safety of some herbal medications, including blue cohosh, ginger, and ginkgo (Illamola et al, 2020). Blue cohosh has been shown to stimulate the uterus and bring on the start of labor, which could be a factor in premature births.  Having the knowledge as a healthcare provider about these two aforementioned topics, one would also need to exert caution and respect due to the patient to openly discuss concerns and questions in a manner that is culturally congruent. Knowing that Amish women can be viewed as being closed about sharing private matters, one would have to begin the conversation with acknowledging that the topic may be sensitive, and offer some general basic knowledge. In the discussion, the healthcare provider could ask the patient if there are concerns or questions that she may have, and if she does not express any, end the conversation with the offering that if she does have any, or the time comes that she would like to discuss concerns, that as a provider you respect her culture and her values, but are available to address any concerns she may have (Purnell, 2013). As with the herbal medications, be sure to mention that these may be important to her, and her way of life. They can prove to be beneficial in preventative and maintenance care of one’s health. I would ask what she is taking, how often and for what ailment or preventative measure. Being sure to provide the patient with information about toxicity of certain herbals, as well as the negative aspect they may hold for an unborn child, should all be explained with the understanding that the patient herself has free will. The Amish view children and pregnancies as a gift from God (Purnell, 2013), so we can do our best to educate them on the scientific aspects of what we know to be proven, evidence-based practices, but what the patient chooses to do with the information is ultimately up to them.

References

Illamola, S. M., Amaeze, O. U., Krepkova, L. V., Birnbaum, A. K., Karanam, A., Job, K. M., Bortnikova, V. V., Sherwin, C., & Enioutina, E. Y. (2020). Use of herbal medicine by pregnant women: What physicians need to know. Frontiers in pharmacology 10:1483. https://doi.org/10.3389/fphar.2019.01483

Jolly, N. (2017). Birthing new kinships: The cross-pollinating potential of Amish health research. Journal of Amish and Plain Anabaptist Studies 5(2):147-61.

National Institute of Child Health and Human Development (2017, January 31). What is prenatal care and why is it important? https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care#:~:text=Prenatal%20visits%20to%20a%20health,tests%2C%20such%20as%20ultrasound%20exams.

Purnell, L. (2013). Transcultural health care: A culturally competent approach (4th ed.). Philadephia, PA: F. A. Davis Co.