Vietnamese women

• During pregnancy, some women may follow dietary restrictions to prevent difficult labour due to a large fetus. These restrictions may vary across trimesters and are in accordance with ‘hot and cold’ theory. The first trimester of pregnancy is considered a ‘cold’ state. Women are recommended to eat ‘hot’ foods, including ginger and black pepper and to avoid ‘cold’ foods, including lemon, melon, pineapple, spinach and green papaya. Vietnamese women believe that it is important to avoid eating green papaya throughout pregnancy because it will cause early labour.
• Women believe that eating cooked goose eggs will protect the fetus from any evil spirits and negative influences. Drinking sugar cane juice or coconut water during pregnancy is believed to make the baby's skin clean and beautiful (i.e pinkish, fair and smooth). It is believed that eating or drinking dark-coloured food or beverages will make baby's skin dark and so they will avoid drinking or eating dark-coloured foods or beverages. Women also believe that looking at photographs s of beautiful people will make the baby beautiful too.
• In the second trimester, which is considered a ‘neutral’ state, women may be allowed to eat these foods.
• In the third trimester, which is considered a ‘hot’ state, women may decrease the amount of food they consume and avoid taking natural supplements.
• It is believed that when the fetus starts growing hair, the hair will make the mother cough.
• Vietnamese women remain physically active during pregnancy, but usually avoid strenuous work.
• It is often believed that sexual intercourse during pregnancy can cause fetal illness and abnormalities. It is also believed that sexual intercourse during pregnancy may cause miscarriage, blemish the baby’s skin and reduce the baby’s intelligence.
• Some women may be concerned about invasive tests during pregnancy (eg. blood tests). Women may benefit from additional explanations regarding the ability of the body to replace lost blood.
• Pregnant Vietnamese women may regularly use traditional plant medicines and herbal tonics to maintain their own and fetal health and to stimulate labour. Concerns about the harmful effects of certain traditional medicines during pregnancy should be explained as early as possible.

• Some women usually avoid excessive movement while in labour.
• The preferred position for a labouring woman is to lie on her back.
• Most women, these days prefer to have their partners with them in the labour ward. However, this will depend on the couple and their family’s choice.
• Caesarean section may not be a preference due to fear of surgery, complications, blood loss and the length of recovery time. Health professionals should provide additional explanation about caesarean sections when discussing the labour management plan.
• Most Vietnamese women do not wish to keep the placenta after labour.
• Women may prefer themselves or their spouses/partners, or their support people to cut the baby's umbilical cord.

(Queensland Health Multicultural Services, 2009)

Vietnamese women may follow traditional post-partum practices including strict bed rest and keeping warm to avoid potential ‘colds’ for 30 days or up until 3 months postnatally.

• Air conditioning and drafts from open windows are avoided.
• Traditionally, all care of the baby except feeding is done by female relatives in the extended family. (especially the woman's mother or mother-in-law) (Thai, 2005).
• Some women may not wish to use a pillow after birth.
• Many women will follow traditional dietary restrictions after birth. Dietary restrictions include:
  • All cold food and drinks including ice water.
  • Sour food and fruits.
  • All fresh fruits and vegetables.
  • Some women have also been encouraged by their families to restrict fluid intake.
• Foods new mothers are encouraged to eat include rice, pork (particularly very salty braised pork to restore tone and muscle strength), boiled spring onion, black pepper, turmeric, black-skinned chicken soup, bean curd, gluten rice, garlic, ginger, and sometimes, wine (particularly wine made from dark purple glutinous rice). These are considered neutral or warm and are beneficial. All foods are well cooked and served hot. Women avoid seafood as this is believed to be a ‘cold’ food which may cause her and her baby stomach upsets, poor digestion, and skin allergies and allergic reactions.
• Women may avoid showering and washing their hair for a month or longer after birth to avoid having headaches later in life.
• It may be believed that the postpartum woman may be affected by ‘cold’ and ‘wind’ while showering, and this may weaken her body. A sponge bath may be an acceptable alternative. Hot baths and steam baths may be possible after the second postpartum day.
• Some women practice variations of ‘mother roasting’. Traditionally, this involves lying beside or over a small stove. In New Zealand, women may place a portable heater close to the bed or use a hot water bottle.
• If these practices are not followed, some women may become anxious that postpartum conditions such as weakness, headache, palpitations and abdominal cramps may re-occur.
• Additionally, the inability to follow traditional postpartum practices is thought to cause later health problems, especially abdominal pain in women (which may occur months or even years later). Once a woman becomes sick from symptoms thought to be due to neglected postpartum practices, she is sick for the rest of her life (Thai, 2005). Her symptoms may include life-long aching muscles and joints, palid skin colour, and poor digestion lasting into old age.
• Younger women may no longer follow traditional practices but the family (mother or mother-in-law) may insist on following traditions. It is important to understand how an individual woman and the greater family will reach a compromise (Thai, 2005).

• Vietnamese women may expect health practitioners to provide advice regarding baby care.
• Baby fatness may be considered a sign of good health.
• The ‘Mongolian blue-spot’ – a bluish pigmentation on the body of the baby – is common at birth among Indo-Chinese and other Asian babies, and persists until the age of 18 months to two years. Health practitioners should be aware of this as it may be misinterpreted as a sign of child abuse.
• Vietnamese women want to keep the baby warm and may over wrap the baby leading to hyperthermia, itchy skin rashes and a crying baby.
• Women tend to keep the baby indoors for the first postpartum month to avoid evil spirits and ‘wind’ affecting the baby.
• Vietnamese parents allow the baby to stay in the same bed as the mother and father to keep an eye on the baby.
• Parents do not like people to praise the baby in any way because they believe that evil spirits can hear the praise, and will cast a spell on the baby causing sickness.

(Queensland Health Multicultural Services, 2009)

• Some women may not start breastfeeding until colostrum is fully expressed. They believe that colostrum is not nutritious because it is a clear fluid. Women refer to this as “premature milk” and so they discard the colostrum. An explanation of the nutritional value of colostrum may be required (Rossiter, 1992).
• Health practitioners should explain the benefits of breast feeding as early as possible, preferably during antenatal visits.
• Women who breastfeed their infants may start adding formula very early, believing that this is more nutritious and better than breast milk.

• Vietnamese women living in New Zealand, where care for mother and baby differs from traditional practices and support, may be at risk for postnatal depression. Women may feel guilty, if the baby becomes sick, because they cannot look after the baby in the traditional way.
• For Vietnamese women, a poor quality of relationship with her partner and wanting more practical support is associated with higher Edinburgh Postnatal Depression Scores (EPDS) scores (Stuchbery et al, 1998).
• Women want more practical support from their partners as they are in many cases their only source of family support in New Zealand.
• Without having mothers or other female relatives around to help, postnatal mothers may not be able to observe the traditional 40 days of rest which is usual in Vietnamese society.
• The lack of support during the postnatal period, may contribute to risk for postnatal depression in Vietnamese women.

(Queensland Health Multicultural Services, 2009)

• Vietnamese people generally value flexibility, a readiness to compromise, and the avoidance of conflict.
• People from a Vietnamese background usually list their family name first, then their middle name, with their first (given) name listed last. Many given names are common to both men and women. It is preferred that people are addressed using their title (eg. Mr or Mrs) followed by their first name, or middle name together with their first name. Vietnamese people do not address others by their surname as Westerners do because Vietnamese people consider that surnames represent their ancestry and as such, surnames are highly respected. For example Phan is the surname of Phan Thanh Hung. In this instance, this Vietnamese man would prefer to be addressed as Mr Hung or Mr Thanh Hung.
• Vietnamese people usually avoid eye contact as a sign of respect, particularly when talking to a person of higher status or opposite gender.
• Vietnamese people usually bow their head to show respect.
• Smiling is a common social response, which can sometimes be difficult to interpret. In Vietnamese culture, smiling can show respect or express agreement, apology or embarrassment. Vietnamese people may also smile when they do not understand what you are saying or understand your question; or when they cannot answer your question; or when they are reluctant to answer.
• In Vietnamese culture, items are passed with both hands. Passing an item with one hand or passing an item over someone’s head is impolite.
• Touching the head of other people is considered highly insulting as Vietnamese people believe the head is for worshipping the ancestors.
• Women usually do not shake hands with each other or with men.
• Giving someone a hug is not an acceptable greeting. This is particularly inappropriate between a man and woman.
• Most Vietnamese women prefer a health practitioner of the same gender.
• Vietnamese women may wish to be assisted by family members instead of trained interpreters. Health practitioners should explain their DHB policy on the use of professional interpreters early during antenatal visits, and the benefits of engaging a professional interpreter.
• Vietnamese women may place great value on a health practitioner’s awareness of their traditional practices, and place importance on the opportunity to follow or observe these during their maternity care.
• The answer ‘yes’ may be used to indicate that the listener is paying attention. It does not necessarily indicate agreement. It is important to obtain feedback from your client to ensure understanding, especially when they are giving consent to treatment (Queensland Health Multicultural Services, 2009).