Cultural adaptation of birthing services in rural Ayacucho, Peru
Sabine Gabrysch, Claudia Lema, Eduardo Bedriñana, Marco A Bautista, Rosa Malca, Oona MR Campbell & J Jaime Miranda
Volume 87, Number 9, September 2009, 724-729
Table 1. Some barriers identified and solutions proposed for new delivery model
| Barriers identified | Solutions proposed | |
|---|---|---|
| Providers speak Spanish which is not understood by many. | Health professionals attend in the Quechua language. | |
| Rotation of health personnel does not allow time to build trust. | Better conditions for health professionals to improve retention. | |
| Health professionals treat women in unfriendly, brusque and sometimes discriminatory ways. | Health professionals are friendly and respectful of local culture. | |
| Family has no opportunity to stay. | Room for accompanying family members provided with beds, chairs and cooker. | |
| Long travel time to facility means the women need to come early before labour starts, but have no place to stay. | Waiting room provided for women and families awaiting delivery, later upgraded to waiting home in line with national policy. | |
| Husband, family and traditional birth attendant excluded from delivery room. Women want them to actively participate in labour. | Husband and/or traditional birth attendant can accompany and help physically with pushing. | |
| Unfamiliar hospital food, no option to cook traditional food and drinks. | Kitchen and utensils provided where family can prepare food and drinks. | |
| Use of natural oils and creams or traditional herbs as treatment for labour difficulties not permitted. | Various traditional medicines provided (oils, eggs, herbs, etc.) for use and women are welcome to use. | |
| Use of hospital gown required. | Women can wear their own clothes. | |
| Cold, loud, bright and sterile delivery room. | Quiet, dark, shielded room with windows and curtains to protect from view. | |
| Unknown people may enter the room. | No others allowed without permission of the woman. | |
| Shame because genitals are exposed during vaginal examinations and hygiene procedures. | Hygiene procedures done by woman herself or family after explanations. | |
| Fear of unknown procedures. | Health professionals explain all procedures and ask permission before any exams. | |
| Horizontal position on gynaecological bed enforced instead of preferred vertical position with a rope for pushing during contractions. | Vertical crouching position allowed and facilitated by providing rope and bench. Normal bed also provided instead of gynaecological bed. | |
| Umbilical cord should be cut by family member according to tradition. | Sterile cutting of umbilical cord by health professional was non-negotiable. | |
| Tablets for uterine contraction are used instead of traditional “rollete”, a belt placed tightly on the women’s abdomen after delivery. | “Rollete” used if desired after the baby’s delivery in addition to tablets to help uterine contraction. | |
| Placenta thrown away while it should be shielded and buried in a warm place according to tradition. | Placenta carefully handled and handed to family for burial. | |
| Weak referral possibilities in case of complications that cannot be dealt with at health centre level. | Free ambulance referral if needed for complications. However, not implemented due to difficulties in covering petrol costs. | |
| Women discharged 72 hours after delivery. | Women decide length of their stay postpartum, can rest as long as needed. |