Filipino women

Health related beliefs and practices

Traditional Filipino medicine, religious beliefs and cultural values can lead to misunderstandings and conflict with healthcare providers. These issues include dietary restrictions which need to be observed for every stage of pregnancy, for example, using certain kinds of herbs when preparing special food for the expectant mother. In the Philippines, as well as using medical services, women may use traditional healers and herbal remedies, massage, and spiritual healing through the power derived from Christian saints.

The role of family

Mothers and mothers-in-law have a significant role in providing guidance and support during pregnancy. Women may face a difficult choice between following the guidance of their older family members and those of health care providers (Stewart & Das, 1997). For example, the belief that any kind of medication during pregnancy is dangerous and could affect the physical development of the baby, even including prenatal vitamins.

Gender issues

Vaginal examination by a male doctor is embarrassing for Filipino women. Not only is this a gender issue but it is also a violation of religious and cultural beliefs. Female health practitioners are strongly preferred.

• The most common birthing position is to lie down. Some women may prefer a squatting position.
• In the Philippines, women are not usually allowed to have their husbands present during the birth. There is a belief that the presence of the husband could lead to a difficult labour.
• In some regions of the Philippines, it is believed that putting squash leaves on the abdomen of a labouring woman can facilitate labour.
• Some women believe that drinking coconut water can facilitate a fast labour.
• In some regions a father is responsible for the burial of the placenta and may prefer to remain close to their labouring wife so he can collect the placenta. He usually buries the placenta as soon as possible, because the burial of the placenta indicates the end of the labour and therefore the end of pain and blood loss experienced by the labouring woman. The placenta should be offered to the postpartum woman or the father.

• Women use the concepts of ‘hot’ and ‘cold’ to classify and explain illnesses. Foods, medicines and temperature/weather conditions are classified according to their hot or cold qualities and their effects on the body. Extra care is required to re-establish the balance of ‘hot’ and ‘cold’ prior to and after birth (Stewart & Das, 1997).
• Many Filipino women observe a period of postnatal rest of between 30 to 40 days to restore lost heat. This includes extra clothing to keep warm, extra blankets, staying inside the house to avoid the wind and rain, and avoiding showers and baths.
• There is a belief that if these precautions are not properly observed it could lead to other health problems, especially arthritis, in later life.
• Traditional custom in the Philippines dictates that women should not bathe for about ten days after giving birth and during menstruation. Bathing during these times is seen as a cause of ill health and rheumatism in old age and women may object to having a shower immediately after giving birth. Sponge baths and steam baths could be used as alternatives.
• Some women do not want to comb their hair for considerable periods after giving birth, as they believe it can lead to loss of body heat.
• In the Philippines, new mothers are well looked after by relatives and close friends. Usually a female relative takes care of the newborn baby and the mother is expected to stay inside the house and rest.
• Many women can have difficulty coping with the daily routine of looking after a baby in a country where they may not have the support of an extended family. During the postnatal period some women feel the lack of support from friends, family and relatives most intensely (Stewart & Das, 1997).
• Some Filipinas bind their abdomen tightly, believing that this practice helps to prevent bleeding and helps the uterus to retract.
• New and lactating mothers are often given rice porridge (rice boiled soft to a consistency halfway between soup and puree). This may be served with sweet, salty or spicy accompaniments. Soup made of meat and vegetables is also believed to help promote lactation. Many women prefer to eat this food in the birthing unit.
• Women fear what is referred to as a ‘relapse’ if they become active too soon. This involves extreme tiredness, weakness and chronic headaches.
• Postpartum women may be massaged with coconut oil, with the aim of restoring their lost health, expelling blood clots from the uterus, returning the uterus into a normal position, and promoting lactation.
• Some women perform various practices for the purpose of ‘drying out’ the womb. For example, ‘mother roasting’ can involve lying beside a stove for up to 30 days, squatting over a burning clay stove, sitting on a chair over a heated stone or a pot with steaming water, or bathing in smoke from smouldering leaves. These practices may be replaced by hot water bottles and by placing a postpartum woman close to a heater.

Traditionally, parents sleep with their children or have their children sleep with another relative, and do not separate from them when they are unwell.

• Colostrum may be considered unhealthy for the baby and may be discarded. Women may not start breastfeeding until 2-3 days after birth when lactation is well established. Some women may be reluctant to feed colostrum to their baby, in spite of encouragement from health professionals.
• Breastfeeding on demand is normal. Women may adopt mixed feeding because to the demands of work outside the home.
• Some women believe that a mother’s mood can be transmitted through breast milk and therefore do not feed if they feel sad, upset or angry.
• Women may stop breastfeeding if the baby has diarrhoea, in case the illness becomes worse.

• Filipino women may be poorly informed about maternity services in New Zealand, including the role of the LMC, antenatal care and child birth education. It is important to explain your service and your role to help them understand what you are offering.
• Filipinos come from a high power-distance society. Women may feel uncomfortable questioning their GP and LMC. To ensure effective communication, it would be helpful to encourage Filipino women to ask questions, and also clarify their understanding of the conversation.
• In an Australian study of Filipino women’s experiences of childbirth, women found the communication style of health care providers to be too direct, immodest and confronting (Stewart & Das, 1997). They reported that they felt very uncomfortable when health care providers enquired about intimate matters without first engaging in general social pleasantries. This may not apply to all Filipino women but it would be good practice to start with general pleasantries to develop a rapport with the woman, especially when the conversation is requiring to elicit sensitive information.