ObGyn Jobs and Pregnancy Norms in Appalachia

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The Appalachian area of the United States has unique cultural and linguistic traits. Not surprisingly, these unique features also influence the way patients and physicians from this area interact. The area known as Appalachia is comprised of 406 counties in more than 13 states - Georgia, Alabama, Mississippi, Virginia, West Virginia, North Carolina, South Carolina, Kentucky, Tennessee, Ohio, Maryland, New York, and Pennsylvania. The primary groups that settled these regions were German, Scots-Irish, Welsh, French, and English; the region was settled between the 17th and 19th centuries. Medical practitioners in these areas must become accustomed to the distinctive ways of being and doing that their patients possess. This is especially true when physicians are treating pregnant women.

Traditional family roles dictate that men are the heads of families, but older women and pregnant women are accorded increased status in the family, church, and community. For various reasons that are beyond the scope of this article, teen pregnancy rates are higher among this population than among non-Appalachians. For this reason, physicians may offer assistance or advice on family planning to women before they conceive, as well as explain the progression of pregnancy stages as they occur. By explaining the process from a scientific standpoint, some of the fears that women have may be lessened, and at the very least, traditional or social behaviors that could prove harmful to the fetus and its mother can be avoided.

There are several common beliefs that members of the Appalachian culture may share. For instance, it is believed that if a mother raises her hands over her head, the baby's cord will become tangled around its neck, resulting in fetal death. Eating strawberries or citrus fruits are thought to cause birthmarks, yet if a mother experiences a craving for a particular food, it is believed that she must eat that food right away to avoid giving the baby a birthmark similar to the food the mother craved. Another common belief shared by both people of Appalachian descent as well as others is that the shape of the mother's belly indicates the sex of the unborn child - boys are thought to be carried high, while girls are thought to be carried lower on the mother's belly.

During the experience of labor itself, women from this cultural group are generally expected not to show pain the same way that other groups may. The mother is generally expected to accept the process of labor with little complaint. The physician can help explain gently to all parties (and most especially to the woman) that pain medication is available and can be used safely should she desire it.

Another important role for the Ob-Gyn or the pediatrician is to explain healthy ways of infant care and feeding. Surprisingly enough, cultural norms dictate that babies be fed grease, sugar, and even coffee to promote strength as early as four weeks after birth! The general belief is that the sooner an infant begins to consume foods other than milk, the stronger the infant will become. To combat this belief and help reduce the risk for any harm, the physician can explain the benefits of delaying solid foods until 5 or 6 months of age; of particular importance are the risks of food allergies or sensitivities that may develop from solid food that is given too soon.

While the Appalachian cultural group has some unusual features, none of these should present barriers to good health care, especially in the case of women. Good communication between physicians and patients is an achievable goal made more obtainable through good communication and understanding. All physician jobs naturally involve seeking to bridge the divide between patient and practitioner, so it should be a natural step.



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