By Kalee Hovetter
As the population in the United States continuously changes and incorporates an increasing population of the Latinx community, the current healthcare system should also continue to adapt and grow with these changes. It is imperative that all people, no matter their cultural beliefs, feel comfortable obtaining medical attention wherever they are. This is especially crucial in the case of women giving birth. During such an important and intimate moment in a woman’s life, it is crucial they feel safe and secure throughout the difficult process. A key part of ensuring these feelings of safety includes having medical professionals who understand their cultures and the reasoning behind their medical decisions in order to know how to respect these decisions. However, minimal research has been done regarding how culture can play a role in birth. While this review seeks to analyze the existing literature, it also should serve as a wakeup call to the dire need of more research on this subject, especially as it relates to the Latinx community.
What are the current birthing options for women in the US?
In the US, as in many other high-income countries, hospitals tend to be the preferred setting for women to give birth. According to multiple sources, alternative options of birth for women in the US include home births, birth centers, as well as the use of midwifes and doulas throughout the birthing process (Caughey & Cheyney, 2019; Kang, 2014). Unsurprisingly, as of 2019, the majority of births in the US took place in hospitals under the supervision of medical professionals like doctors. However, beginning in the early 2000s, there has been an increasing rate of community births, including both at-home births and those taking place in a birth center. Despite the continual increases, it is estimated that the overall rate of these out-of-hospital births remains under 2% of all births (Caughey & Cheyney, 2019). It should be noted that research has shown that women who are able to successfully complete a planned home birth have “high rates of satisfaction.” Primary factors contributing to these levels of satisfaction are comfort and feeling in control of a rather uncontrollable event (Zielinski et al., 2015).
How accessible are these alternate options for women?
The increasing rates of community births leads to the understanding that such alternative birthing options are becoming more accessible to women (Caughey & Cheyney, 2019). Although the accessibility to alternative birthing options is increasing, one of the main concerns limiting this increase is about doctors who either lack the knowledge of such options or are hesitant to share them with their patients. Women have major concerns about the lack of respect and understanding shown by medical providers. In these cases, doulas are particularly important as they act as a liaison to support the women and their families by serving as advocates for them throughout the pregnancy and birth (Kang, 2014).
What are the current barriers to implementing changes?
In order to move forward and create the necessary changes in the birthing process, it is imperative to understand the principal barriers currently standing in the way of the implementation of these changes. Although there are few explicit studies for the US, similar studies have been done elsewhere, including Canada. Behruzi et al. describes the main factors contributing to the use of intercultural medicine in a large, university-affiliated hospital. A main concern in terms of these barriers is the medicalization of birth. This increase in the use of various medical interventions is sometimes seen as straying from a humanized birth, which many cultures value. Additionally, the structure and policies of university-affiliated hospitals negatively impact women’s comfort in the hospitals. These include the lack of communication between different departments and different shifts as well as the high number of professionals present during birth in teaching hospitals (Behruzi et al., 2011).
What alternate birthing options exist in Latin America?
With a large presence of various indigenous cultures throughout Latin America, it is imperative that the generally Westernized healthcare system throughout Latin America is able to properly treat these communities. There are various factors differentiating indigenous cultures and perceptions of health and medical care and those of the Westernized portions of each country. These differences were investigated using specific cases in Bolivia and Mexico.
In 2008, the Machacamarca Hospital, located in the southwestern portion of Bolivia, added a “culturally adapted birthing room” to the hospital (Morales, 2018). This room aims to mirror the homes of local indigenous communities like Aymara and Quechua, where women would typically give birth. Morales investigated the functionality of this addition, getting input from doctors who both supported and opposed the presence of this room in a hospital that followed Western medical standards. The main arguments against the birthing room on behalf of the doctors was the lack of hygiene due to the textiles present in the room as well as saying that family members made “obstetric practice more difficult” (Morales, 2018). One of the doctors who spoke out in favor of the birthing room, pointed out the return to a more compassionate and humanistic birth that focused on the wishes of the mother and emphasized “calidad y calidez” (“quality and warmth”) (Morales 2018).
In the Chiapas region of southern Mexico, a similar setting for birth was attempted with the creation of a birth center attached to a hospital in San Andrés Larraínzar. Tucker et al. investigated factors affecting the use, or lack thereof, of this annex after noticing that despite being open for three months the birth center, Casa Materna, had not seen any women. Casa Materna was founded under similar ideas as the birthing room in Bolivia with the goal of creating a space for indigenous women to feel more comfortable in the hospital. The center included beds with textiles as well as a steam bathing room common in the indigenous cultures in this region. However, creators of this space failed to include the perspective of the birth attendants that worked with the indigenous communities on a daily basis as well as these women or their families. This created a gap in the functionality of the birth center as it was intended to be used.
How do cultural differences affect the Latinx population’s decisions regarding birth?
According to various sources, it can be understood that family plays a large part in the process of making decisions related to health in Latin America. In the specific case of giving birth, the decision tends to lay in the hands of the father of the baby and his mother (Tucker et al., 2013; Ibáñez-Cuevas et al., 2015). Additionally, as explained in Tucker et al. many indigenous women in this community simply prefer to give birth at home because it is more comfortable and they are able to be surrounded by family (2013). Furthermore, Morales explains another aspect that may affect Bolivian indigenous women’s decision to give birth in a hospital is fear of sobreparto, a cultural illness (2018). This cultural illness is caused by a temperature imbalance in the body and can lead to life-long sickness. Indigenous women believe that the coldness in the hospital can enter their bodies during birth and cause sobreparto so they prefer to give birth surrounded by warmth provided by their house (Morales, 2018). However, these studies took place in indigenous communities in Mexico and Bolivia, not in the US. In the US there is a clear lack of research regarding what factors affect members of the Latinx community when making their healthcare decisions.
As the US looks towards a better future, there is a clear need for more research related to the Latinx population. There is an obvious lack of information not just on the Latinx communities’ preferences for giving birth, but on their preferences for healthcare in general as well as the preferences of many minority communities in the US. Because the Latinx population is growing every day in the US, literature available for clinicians should mirror this growth. In the future, the US healthcare system should look into the cultures of the people it is serving. It is the duty of medical providers to ensure that anyone seeking their services feels comfortable and respected throughout the entire process of receiving medical attention. Furthermore, it is the duty of clinicians to learn all available options in their community and share them with patients. This is important so that mothers and their families can make their own autonomous and informed decisions regarding their birth plan and preferences.
Kalee Hovetter is a senior majoring in Spanish with a minor in Chemistry on the pre-med track. She is the current President of Pitt Spanish Club and a member of the American Medical Student Association. Kalee's research interests are interculturality in medicine, specifically as it relates to Latin America and the Latinx community in the US. Additionally, she is investigating intercultural birth options for her honors thesis.
Behruzi, R., Hatem, M., Goulet, L., & Fraser, W. (2011). The facilitating factors and barriers encountered in the adoption of a humanized birth care approach in a highly specialized university affiliated hospital. BMC Women's Health, 11(1). https://doi.org/10.1186/1472-6874-11-53
Caughey, A. B., & Cheyney, M. (2019). Home and Birth Center Birth in the United States. Obstetrics & Gynecology, 133(5), 1033–1050. https://doi.org/10.1097/aog.0000000000003215
Ibáñez-Cuevas, M., Heredia-Pi, I. B., Meneses-Navarro, S., Pelcastre-Villafuerte, B., & González-Block, M. A. (2015). Labor and delivery service use: indigenous women’s preference and the health sector response in the Chiapas Highlands of Mexico. International Journal for Equity in Health, 14(1). https://doi.org/10.1186/s12939-015-0289-1
Kang, H.-K. (2014). Influence of Culture and Community Perceptions on Birth and Perinatal Care of Immigrant Women: Doulas’ Perspective. The Journal of Perinatal Education, 23(1), 25–32. https://doi.org/10.1891/1058-1243.23.1.25
Morales, G. E. (2018). There Is No Place Like Home: Imitation and the Politics of Recognition in Bolivian Obstetric Care. Medical Anthropology Quarterly, 32(3), 404–424. https://doi.org/10.1111/maq.12427
Tucker, K., Ochoa, H., Garcia, R., Sievwright, K., Chambliss, A., & Baker, M. C. (2013). The acceptability and feasibility of an INTERCULTURAL birth center in the highlands OF Chiapas, Mexico. BMC Pregnancy and Childbirth, 13(1). https://doi.org/10.1186/1471-2393-13-94
Zielinski, R., Ackerson, K., & Kane-Low, L. (2015). Planned home birth: benefits, risks, and opportunities. International Journal of Women's Health, 361–377. https://doi.org/10.2147/ijwh.s55561
 This review will use “Latinx”, the gender-neutral term commonly used to refer to the “Hispanic or Latino” population in the US.