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ORIGINAL ARTICLE
Year : 2020  |  Volume : 47  |  Issue : 2  |  Page : 93-98

Nepalese women's cultural beliefs and practices regarding postpartum period


1 Department of Health Education, Kailali Multiple Campus, Dhangadi, Nepal
2 Department of Health and Population Education, University Campus Kirtipur, Kathmandu, Nepal
3 Saraswati High School Manehara, Dhangadhi, Kaiali, Nepal

Date of Submission25-Apr-2020
Date of Acceptance05-Jun-2020
Date of Web Publication11-Sep-2020

Correspondence Address:
Mr. Prayag Raj Joshi
Kailali Multiple Campus, Dhangadi
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_31_20

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  Abstract 


Introduction: This study is carried out to assess the postnatal traditional beliefs and practices among women of Bajhang district. Postpartum is an hour after the delivery of the placenta and the following 6 weeks. Methodology: An Explanatory Sequential Mixed Method was carried out in Jayaprithvi municipality, Bajhang district. A self administrative questionnaire was the data collection tool, and all women (124 women) having children below 2 years of age and residing in those areas were selected using the census sampling method from randomly selected wards for the quantitative survey. For the qualitative part, 21 young women, who had delivered at least one live baby, were selected purposively. The focus group discussion (FGD) was used as the data collection tool. Results: The findings show that postnatal practices are being influenced by several cultural beliefs and practices transmitted from generation to generation. Most of the practices were harmful to health; however, some traditional practices were beneficial to the mother and baby. Discussion: It is essential for planning and implementing health education programs for these women to be aware of beneficial and harmless practices and try to use scientific knowledge as a mean of eradication of the harmful ones. In the same way. Conclusion: Socio cultural practices need to be promoted, and some certain traditional medicines that have been used in society since ancient times should be identified and uplifted to improve the maternal and neonatal survival rates in Nepal, For this, maternity care providers must partner with local women and provide locally based primary maternity care. It can be recommended that future research should emphasize the in-depth study of cultural beliefs and practices and associated spiritual belief.

Keywords: Beliefs, Chhaupadi, culture, postpartum period, practices


How to cite this article:
Joshi PR, Maharjan RK, Dawadi CK. Nepalese women's cultural beliefs and practices regarding postpartum period. J Sci Soc 2020;47:93-8

How to cite this URL:
Joshi PR, Maharjan RK, Dawadi CK. Nepalese women's cultural beliefs and practices regarding postpartum period. J Sci Soc [serial online] 2020 [cited 2020 Sep 27];47:93-8. Available from: http://www.jscisociety.com/text.asp?2020/47/2/93/294793




  Introduction Top


The postpartum period is a critical period for a woman and her newborn baby,[1] and it is regarded as a period with greater outcome vulnerability, such as hemorrhages, infections, mammary lactation outcomes, and also puerperal depression. Childbirth, including the period immediately following birth, is an event in which traditions play an important part.[2] Although it is an hour after the delivery of the placenta and the following 6 weeks,[3] the first hours, days, and weeks after childbirth are hazardous for both mother and newborn.[4]

Pregnancy, childbirth, and the postpartum period are associated with special rituals and customs in many cultures. Among them, childbirth is a significant experience of women's lives that differ according to their culture and society. Therefore, it needs to know about their culture, tradition and social values, type of choice that women make during pregnancy and childbirth to understand the women's pregnancy, childbirth, and the postpartum period. People around the world have their own values about pregnancy and childbirth. We know that cultural beliefs and practices influence women's maternal behavior. Therefore, the impact of women's cultural practices on maternal and child health care.[5] Culture influences several aspects related to human life. Asia suffers the largest proportion of the world's maternal deaths. Of the 302,000 global maternal deaths that occurred in 2015, more than one-third took place in the Asian region.[6] However, the maternal mortality rate in Nepal decreased from 539 to 239 per 100,000 live births between 1996 and 2016. However it is not equally feared in all districts. Similarly, the institutional birth rate in Nepal is also increasing. Yet many women are still giving birth at home.[7] While one of the targets of the Sustainable Development Goals is to reduce the global maternal mortality rate to 70 per million by 2030.[8]

Nepal being a land of diverse cultures and traditions, postpartum care varies based on topography of the region, culture, tradition, and religious practices. Bajhang is a part of Sudurpashchim Province and one of the 77 districts of Nepal. This district consists of 12 municipalities, out of which two are urban municipalities and 10 are rural municipalities. It is one of the poorest districts, with 56.8% of people living below the poverty line.[9] The total population of the district is 195,159. The main profession of the people of the Bajhang district is agriculture. Annual income per person per year is Nepalese rupees 4930, which is equivalent to the United States dollar ($) 49.30 as of current exchange rate (wiki). As in other traditional societies, there are several cultural beliefs and taboos regarding pregnancy and childbirth are prevalent in Bajhang. Among them, Chhaupadi Pratha is one of them. They use the term “Chhaupadi Pratha” in two conditions: one is during the period of monthly menstruation and another is after childbirth. This study focuses on Chhaupadi after childbirth, which is called the postpartum in medical term. The postpartum has been influenced by several cultural beliefs and practices. Among them, some traditional practices are beneficial to the mother and baby, whereas other practices are not.[10] Most of the traditional postpartum beliefs and practices are common in non-Western countries. Almost mothers have certain beliefs, and these beliefs of a mother influence their practices during the postnatal period regarding food, rest, activities, hygienic care, and breastfeeding. Women are considered as untouchable and deprived of doing regular household activities, but medically, this seclusion of women in the cowshed during and after birth is considered as creating risks of infection leading to higher mortality (Thapa N, Chongsuvivatwong V, Geater AF and Ulstein M (2001)).[11] Hence, researchers have argued that tradition should be embedded in medical care.[12] According to Wang et al.,[13] postpartum traditions belong to the female domain. Normally, mothers and mothers-in-law help with child care and provision of food and they also share their postpartum traditions with the new mother, and women in rural Nepal prefer to birth in their community setting to maintain their cultural safety.[11] Similarly, as in most societies, women have for centuries relied on other women for social support during pregnancy, childbirth, and breastfeeding. Therefore, inadequate care might result in complications for the mother and the child. Some postpartum practices are similar in different cultures, whereas others are different. As a result, the health of the mother and their children becomes vulnerable. That's why it is important to gain an understanding of cultural beliefs and traditional practices related to the postpartum care of women and their babies in Bajhang district. Similarly, there are strict rules which govern what a new mother can or cannot do during the 10- or 12-day period after birth. Contemporary medical pieces of literature have failed to acknowledge the sociocultural understanding of pregnancy and childbirth,[14] but mothers are often blamed for their poor utilization of health services during pregnancy and childbirth,[15] and outsiders often see them as unaware of “real risks.”[16] On the other hand, cultures reflect life experiences, so the researcher should also be sensitive to cultural differences in postpartum beliefs and practices. With these references, this researcher has taken up a study related to cultural practices, hence exploring it in the society. In the same way, many international studies highlighted traditional postpartum beliefs and practices of women;[17] however, there have been a handful of documents on postpartum beliefs and practices in Bajhang. Moreover, this study attempts to explore the traditional beliefs and practices surrounding the postpartum period, and the results would give inputs for policymakers, program managers, and health service providers to provide culturally sensitive health-care interventions.


  Methods Top


The research was guided by social constructionist and critical feminist theories,[18] as it was conducted to uncover the Nepalese social constructions and give voice to women from one of the disadvantaged districts whose views are never heard by health service providers and policymakers. The explanatory sequential mixed method was applied in this study. The mixed-methods research is an approach to inquiry that combines both qualitative and quantitative forms. In this study, the quantitative part of the study was more concerned with assessing the behavior pattern related to dietary restriction and behavioral restrictions, whereas the qualitative part was concerned to explore the underlying sociocultural factors associated with maternal and neonatal health and their causes and impacts on health. In the same way, maternal and neonatal health-care utilization levels, husband's supportive involvement in maternal health, were also discussed during the study. The study area of this study was the Bajhang district, Nepal. Among 12 local agencies of the Bajhang district, I selected the Jayaprithvi municipality using a purposive convenience sampling method as there is the problem of Chhaupadi system which was found by my mini-research project. Then, I selected the two, eight, nine, and eleven wards using a random sampling method. All young women having children below 2 years of age and residing in those areas were chosen using the census sampling method for a quantitative survey. The face-to-face interview using a semi-structured questionnaire was performed. In total, 124 women were interviewed. As a pilot study, a survey questionnaire was pretested among 20 eligible young women residing in one ward of the study area which was not included in the study. Some questions were modified as per the results obtained from the pilot study. The questionnaire covered sociodemographic characteristics and postpartum beliefs and practices. The researcher took the help of his wife to collect the data as there were some sensitive issues.

Focus group discussions (FGDs) were conducted for a qualitative study as it was difficult to explore their inner feelings and perceptions through the interview because talking with someone privately was not commonly appropriate in that culture. A purposive nonprobability sampling technique was used for participant selection. Young women, who had delivered at least one live baby, were selected, and they were recruited through local health staff and local ward authorities. The sample size for FGDs was 21 young women. FGD guideline was developed based on the findings derived from the survey. Four FGDs were conducted. FGDs were conducted on school grounds chosen by participants at their preferred time. The researcher acted as a moderator as well as a notetaker. Further, the audio recording was done after getting consent. Nonverbal cues were also recorded. At the end of each FGD, the researcher summarized the facts obtained from the discussion and allowed the participants to add or modify the facts. Researcher/participant relationship is an essential component of gaining trust to attain authentic data in research; thus, to enable participants to feel trusted and achieve authentic data in this research, all FGDs were conducted in a respectful conversational manner bracketing his values and perceptions during the research. Quantitative data were analyzed using SPSS 16th version. Simple descriptive analysis was done to find the demographic detail of respondents, qualitative texts were then analyzed manually using thematic analysis analyzed, and the rigor of data was maintained throughout the analysis process.[19] Findings derived from the quantitative survey such as dietary restrictions, behavioral restrictions, and postpartum observances were used in the initial analysis. Memoing was also made. Validation of the results was done by methodological triangulation.


  Results Top


Characteristics of survey participants

Most of the respondents were Hindus (99.0%). They ranged in the age group of 17–24 years. One-third of women had completed primary school education (35%). About 12.7% were illiterate. Regarding occupation, the majority (73.1%) were homemakers. Average marriage age and first childbirth were 18 and 20 years, respectively. Nearly 60% had only one child and 3.5% were multiparous.

The characteristics of the participants were involved in a qualitative study.

Thirty-one women participated in FGDs. All are married and the majorities of them are homemakers and had less than SEE level. In the case of age, five women were <20 years of age.

Perceived duration of postpartum

The average postpartum period was 16 days, and it ranges from 10 to 22 days. This period was varied by caste. However, the perceived postpartum period did not differ from the respondents' education level. For them, postpartum is a period of strict home confinement after childbirth.

Postpartum beliefs and practices

One: Postpartum restrictions

Almost all women followed dietary or food prohibitions (93.54%) and behavioral restrictions (95.16%) during postpartum.

Dietary prohibitions

A quantitative survey showed that 93.54% of women had followed the dietary restrictions during their postnatal period [Table 1]. The main reason for food avoidances was the well-being of a newborn (18.54%), followed by the well-being of both mother and newborn (37.12%). A few women (28.66%) mentioned the well-being of the mother, and 9.6% of respondents expressed that they abided food restrictions due to fear of disease. In case of types of restrictions, out of 116 women, 90.32% of mothers have restricted the sour and spicy foods, 92.74% were restricted the milk products, 95.96% were restricted the meat and vegetables, and 95.16% were restricted the foods related to health as per their beliefs.
Table 1: Description of food restriction (Source: Field survey, 2019)

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FGDs were also conducted to explore detailed prohibitions regarding food. They classified foods based on their cultural beliefs and its categorization and avoided these foods during the postpartum period as they considered that foods have short- and long-term effects on the health of the mother and baby just as cold foods cause diarrhea, hot foods raise blood pressure. Hence, they avoided foods such as sour and spicy food, green vegetables, and fruits. Similarly, dizziness, drowsiness, anorexia, and abdominal pain were also found in their beliefs on food. Women perceived that some foods were considered beneficial too such as meat soup promotes milk production and TELEY VAT, FADO, JAULO. (these are the local terms/ dialects) help in wound healing, etc. These food prohibitions were based on the common beliefs that what the mother eats will harm the newborn. They avoided cold baths or showers and some avoided consuming cold food and water. They recommended dried ginger in the belief that it helps control postpartum bleeding and acts as a uterine cleansing agent. Individual variation in food prohibition was seen. Similarly, the majority of the mothers believed that they should eat large quantities of food as they are weak during this period and food would help to rebuild their strength, promote their recovery, and improve their breastfeeding. Adhering to their traditions, they hoped to avoid bad health. One woman said: My mother told me that I must eat hot food so that my blood will flow properly. My body feels cold after I lost blood from birth. If I eat cold food after birth, my blood would clog. I would be unhealthy and sick all the time.

Some Brahmin women did not eat chicken as such food is not allowed in the home. One woman with allergy after eating chicken said: My father in law is strict in religion; he punishes us if I bring chicken in home, but permits to eat mutton. It is costly and rarely provides.

Behavioral restrictions

Almost all women (95.16%) abided sexual abstinence during the postnatal period [Table 2]. They abided sexual abstinence with afraid of reversed dirty blood flow (25.12%), fear of getting pregnant (18.24%), fear of uterine prolapsed (13.6%), for the well-being of newborn's health (7.9%), to prevent tingling and numbness (11.9%), afraid of wound gaping (7.1%), instructions by elders (5.2%), afraid of swelling body (6.1%), etc., Similarly, most of the respondents (95.16%) abided some household works. Among them, majority of the women (69.5%) avoided in believing it is a sin to touch family members and utensils, 13.5% were asked to take full rest by their husbands, and 12.16% of women discarded their household activities because of their health condition. In the same way, the majority of the women (87.6%) discarded colostrums. Among them, 43.1% of mothers did not know positive impacts of colostrum feeding, 31.21% of mothers believed that it has no benefits because it is like pus, and 13.29% of mothers discarded it as they claim that it may cause diseases such as vomiting.
Table 2: Behavioral restrictions (Source: Field survey, 2019)

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FGDs were also conducted to explore detailed restrictions regarding daily household works and other behaviors. Some behavioral restrictions explored in FGDs included home confinement, abstinence of sex, avoidance of exposure to wind and cold, washing clothes, cooking foods, worshipping and walking nearby temples, and touching male members of the family and cattle. Behavioral restrictions were performed to protect their current health during postpartum and future health at old age. All women avoided having sexual intercourse with their husbands for 3–4 months after childbirth. They believed that having sex earlier would not be good for their health or perineal wounds. They were also afraid of uterine prolapsed and pregnancy.

Women mentioned that not only do they avoid sexual intercourse for fear of a uterine prolapsed, but their husbands also fear it. A woman explained: My husband did not want to have sex because he was afraid that I might be hurt and it will be dangerous to the baby. If we had sex and if our action was too hard, it might have an impact on the baby, it might be dangerous for the baby. And this may make me miscarry and then everything will be damaged.

Some mentioned that they were very tired due to taking care of their babies and therefore did not want to have sex with their husbands. One woman mentioned that having sex at that period is a sin. A 27-year-old woman who had her second baby stated: I resumed sex with my husband after three months only. My mother in law advised me to have sex before three months as it is the sin. So, I started after having completely free from discharging blood from the vagina.

Women avoided performing hard tasks such as fetching water and lifting heavyweights. They believed that as they are weak, they need rest as this excessive labour could lead to heavy bleeding and uterine prolapsed. In the same way, housework requires contact with water and wind which may enter the body and cause problems and diseases. Similarly, they did not lift the heavy things to avoid uterine prolapsed. Most of the women were helped with housework for 1 month by mothers, mothers-in-law, and other family members.

A 25-year-old woman who had her first child said: My sister helps me with housework for one month after birth. I have been told not to lift heavy things for a long time because the inner of my body is very loose and I may get a uterine prolapsed. My body may not be pretty anymore.

Most women were cautioned about this and tried to avoid rigorous activities. However, for some poor women, this advice would be difficult to follow and may even be impossible. As a mother remarked: People told me not to lift heavy things because they said the baby would be harmed. But I still had to do it. We work on a farm and I often have to lift a load of grains into the farm. Even when I was 8 months pregnant I still had to help my husband doing that.

A rural woman also commented on the difficulty in observing this cultural knowledge. She remarked: My parents told me that I should not do too much heavy work and that I should rest more so that I won't miscarry. But being poor, not working at all is impossible. We have to continue working throughout pregnancy for survival.

Some cultural knowledge is more symbolic. Women mentioned the prohibition of attending a funeral as a strong cultural prohibition during pregnancy. An educated woman told us: People told me not to attend on a sad event as it can affect pregnancy. They said it is a prohibition as it is not good for a pregnant woman. So, I did not attend such activities during my pregnancy.

Moreover, another belief is that the people of that area did not prepare anything in advance before giving birth as they believed in the older generation's wisdom and knowledge. A mother said: I did not prepare anything in advance because I was afraid that what people told me would become true. People believe that something will happen to the baby if we prepare things for it. The baby will die. After I gave birth we bought something for the baby.

Almost all women believed that breast milk was the best food for their babies, but they had a negative attitude toward colostrum feeding. They discarded the colostrum and did not breastfeed their babies directly after childbirth. Some mothers believed that it has no benefits because it is like pus which can be feed to newborn, and some mothers claim that it may cause diseases such as vomiting. Similarly, they discarded breast milk after 4 or 5 months. Most of them mentioned that we started bottle feeding with introduced solid food celebrating the weaning ceremony in 5 months. They replied that they were compelled to go out for daily work due to which they did not fed optimal proportion of milk in fear of malnutrition. One woman with two children stated: I gave breast milk to my baby for only 5 months, then we celebrated weaning program because I had to out for time taking task and breast milk was also not sufficient. Similarly, it was my girl child; girls are automatically healthier than boy babies, so I quitted continuous breastfeeding. My mother in law used to feed other solid foods.


  Discussion Top


In the present study, it is found that more than half of the participating women stated applying traditional practices of maternal and newborn care in the postpartum period and the young generation still has traditional beliefs and practices because these beliefs and practices are being handed down from generation to generation and women have the following them without questioning. This study revealed that there was a great variation in the duration of postnatal confinement. It ranged from 10 to 22 days. Similarly, sexual abstinence was also varied from 45 days to 3 months. There was an individual variation among postnatal women regarding food restrictions, housework, sex, home confinement, and uterine massage, and there were some common practices that were also there. Agreeing with this statement Piperata[20] stressed on that the prevented activities during postnatal period were sex abstinence, taking hot drinks, having hot baths, food restrictions, home confinement and avoiding household works and all the participants had agreed with intentions of the well-being of both mother and newborn health. Some foods were considered harmful, so they were not allowed to consume them in believing their negative impacts on health such as cold water and cucumber were not eaten by mother, and similarly, some women discarded egg, chicken, pork, and buffalo as their parents did not permit them. In the same way, some women reported that they practiced abdominal binding in believing it prevents pendulous abdomen after birth, and some believed that it helps in making abdomen desirable shape. Some women disclosed that they applied several things to prevent the evil eye. Among them, some women applied the hanging onion, garlic, and amulets in the room and some kept the needle under the newborn's pillow and some women applied the Kajal in the eyes, black dot on the forehead, and use of black thread around the lumbar of the newborn after the purification ceremony. Some mothers had practiced exposing the baby to the wooden smoke after bath to protect the baby from evil spirits as the smoke is not good for health. According to Geçkil et al.,[21] there is a common practice of tight wrapping of the abdomen. Among these women, some women had applied uterine massage and traditional medicines too in believing the blood purifying effect and covered newborn's face with a piece of yellow cloth to prevent jaundice. The findings of some studies revealed that there is a uterine massage and taking indigenous medicine practice.[22] Turner et al.[23] claim that it is possible to make changes in the behavior of women during the postnatal period by providing evidence-based information without criticism and in an atmosphere of trust.


  Conclusions Top


In this study, I found that traditional practices were widely used among postpartum women. These beliefs and practices were handed over by generation to generation and women's close social network which they have following without questioning. It is also found that age, parity, education, and place of birth were the main factors affecting the use of these traditional practices. Women who were older and less educated were more likely to use traditional practices related to maternal and newborn care in the postpartum period. Health professionals should emphasize raising public awareness about harmful postpartum traditional practices, by reaching out through trusted people from their own culture and using media to improve maternal and infant care. They should pay special attention to less educated and older women and enable them to reinforce positive cultural practices, and discourage them from using harmful ones by providing noncritical scientific explanations. Thus, it is recommended that nurses respect each woman's cultural beliefs and gain more knowledge about women's culture and religion to give culturally sensitive and competent care. Similarly, existing sociocultural practices, traditions, rituals, spirituality, birthplace, birth support, and familial social relationships should be monitored and evaluated regularly. Similarly, socio-cultural practices and the positive effects they have on maternal and neonatal health need to be explored. In addition, some of the traditional medicines used in our society need to be identified. For this maternity health care organization should cooperate with the locally based primary maternity care. Finally, it can be recommended that future research should emphasize an in-depth study of cultural beliefs and practices.

Limitation of the study

This study included women who had delivered at least one live baby or having children below 2 years of age; thus, the findings could not be generalized to all women. Thus, the mother of all ages should be included to obtain a comprehensive picture of postpartum beliefs and practices. In the same way, being this study is based on retrospective information, recall bias is negligible as childbirth is a significant life event.

Acknowledgments

I acknowledge all members of my family.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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