Perinatal Cultural Beliefs and Practices of Women

in Selected Municipalities of Laguna, Philippines: A Qualitative Research

A thesis presented to

the faculty of Department of Midwifery

School of Allied Health

Manila Adventist College

June 2020
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Abstract

Perinatal Cultural Beliefs and Practices of Women

in Selected Municipalities of Laguna, Philippines: A Qualitative Research

Culture has a significant influence in the manner women care for themselves

during the perinatal period. The beliefs and practices these women hold may even have

devastating effect to their own health and the unborn fetus. Although numerous studies

exist about cultural beliefs and practices around the globe, there is a dearth of literature

exploring the beliefs and practices of women during pregnancy, childbirth, and postnatal

period in the southern part of Luzon.

This study aimed to identify the beliefs and practices of women during pregnancy,

childbirth, and postpartal period in Laguna, Philippines. Anchored in the theory of

Normative Social Behavior, the study employed the descriptive qualitative research

design. Sixteen participants were interviewed face-to-face utilizing purposive sampling

technique. To ensure trustworthiness of the data the following Lincoln and Guba’s

criteria were used: triangulation, member check, peer debriefing, expert check, prolonged

engagement, and reflexivity.

Three themes emerged in the cultural beliefs and practices of women during

pregnancy, which include (1) protecting baby’s welfare, (2) promotion of pregnancy, and

(3) safety against bad elements. The cultural beliefs and practices during childbirth has

two themes namely (1) facilitating factors in childbirth and (2) myths on activities that

promote comfort. Lastly, two themes emerged in the cultural beliefs and practices of

women during the postpartum. It includes (1) food and activity that promote maternal

welfare and (2) myths on food and activity that promote the child’s welfare.
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Keywords: childbirth, cultural beliefs and practices, pregnancy, postnatal care

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Acknowledgements

First of all, we are grateful to the Almighty God for the countless blessings

offered to us.

It is a great pleasure to show our deepest thanks and gratitude to the following

persons:

Our thesis adviser, Dr. Maria Carmela L. Domocmat, for the unending support,

suggestions, and motivation;

Dr. Evelyn S. Alcoriza, the Dean of School of Allied Health, for the moral

support and words of encouragement;

The panel members, Dr. Wealthy C. Estrada, Dr. Evelyn S. Alcoriza, Lynette R.

Sulit, and Dr. Arceli H. Rosario, for the recommendations to improve our manuscript;

Dr. Rainier R. Moreno-Lacalle for his kind help and generous advice to make our

manuscript better;

Meishe Flores, MA, LPT for checking and giving suggestions on the style and

syntax of the manuscript, and Rachelle T. Alfiler, MaEd, LPT for the Filipino translation

of our consent form;

The participants who unselfishly shared their personal beliefs and practices.;

Engr. Justine Lagonoy, who helped us edit the manuscript and contributed much

in making our manuscript better;

All our friends and workmates who are there to cheer us and make our study light

and fun;
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Our respective families: the Cabayao-Sipat family, Gentolia family, Lagonoy

family, and Sahagun family, for the unending support physically, emotionally, mentally

and financially;

And, lastly, all the people who helped and motivated us including those whom we

were not able to mention. Thank you very much.

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Table of Contents

List of Tables and Figures .................................................................................................9

Chapter 1. The Problem and Its Background ...............................................................10
Statement of the Problem ....................................................................................11
Research Questions .............................................................................................11

Significance of the Study ....................................................................................11

Theoretical or Conceptual Framework ..................................................................... 13

Research Paradigm...............................................................................................13
Definition of terms ...............................................................................................14

Chapter 2. Review of Related Literature .......................................................................15

Cultural Beliefs and Practices during Prenatal Period ...........................................15
Cultural Beliefs and Practices during Childbirth ...................................................20
Cultural Beliefs and Practices during Postpartal Period ........................................23

Chapter 3. Methodology ..................................................................................................36

Research Design.....................................................................................................36
Population and Sampling Design................................................................................. 37

Setting of the Study................................................................................................37

Data Gathering Techniques....................................................................................38

Data Gathering Procedure ......................................................................................39

Data Analysis .........................................................................................................39

Trustworthiness ......................................................................................................40
Ethical Considerations ...........................................................................................43

Chapter 4. Result and Discussion ...................................................................................44

Cultural Beliefs and Practices in Pregnancy ..........................................................44
Protection of Baby’s Welfare .........................................................................44

Promotion of Healthy Pregnancy ...................................................................57

Safety against Bad Elements ..........................................................................66

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Cultural Beliefs and Practices during Childbirth ...................................................70

Facilitating Factors in Childbirth....................................................................70

Promotion of Comfort during Childbirth .......................................................79

Cultural Beliefs and Practices during Postpartal Period ........................................84

Food and Activities that Promote Maternal Welfare ......................................84

Myths on Foods and Activities that Promote Child’s Welfare.......................96

Chapter 5. Summary of Findings, Conclusions, and Recommendations ...................99

Summary of Findings.............................................................................................99
Conclusions ..........................................................................................................101
Recommendations ................................................................................................102
References ......................................................................................................................104
Appendices ......................................................................................................................114
Appendix A Informed Consent (English) ...........................................................114
Appendix B Informed Consent (Filipino) ............................................................118

Appendix C Interview Guide (English) ...............................................................123

Appendix D Interview Guide (Filipino) ..............................................................124

Appendix E Correspondence ...............................................................................125

Appendix F Ethics Review Approval ..................................................................128

Curriculum Vitae ...........................................................................................................129

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List of Tables and Figures

Page

Table 1. Characteristics of Participants ............................................................................37

Table 2. Triangulation Matrix ............................................................................................41

Figure 1. Research Paradigm of the Study.........................................................................13

Figure 2. Themes of Cultural Beliefs and Practices during Pregnancy .............................45

Figure 3. Theme 1: Protection of Baby’s Welfare .............................................................46

Figure 4. Theme 2: Promotion of Health Pregnancy .........................................................59

Figure 5. Theme 3: Safety against Bad Elements ..............................................................68

Figure 6. Summary of Cultural Beliefs and Practices during Pregnancy ..........................71

Figure 7. Themes of Cultural Beliefs and Practices during Childbirth..............................72

Figure 8. Theme 1: Facilitating Factors in Childbirth .......................................................73

Figure 9. Theme 2: Promotion of Comfort during Childbirth ...........................................81

Figure 10. Summary of Cultural Beliefs and Practices during Childbirth .........................83

Figure 11. Themes of Cultural Beliefs and Practices during Postpartal Period.................84

Figure 12. Theme 1: Food and Activities that Promotes Maternal Welfare ......................89

Figure 13. Theme 2: Myths on Food and Activities that Promote child’s Welfare ...........96

Figure 14. Summary of Cultural Beliefs and Practices during Postpartal Period ..............98
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Chapter 1

The Problem and its Background

For the past decades, numerous publications all around the world have been

brought together to highlight the importance of reproduction to women with their

personal identity and social status, and in terms of the way their lives have centered on

the events of biology (Hernandez & Blazer, 2006). The concern to ensure the health and

survival of the women and children is apparent in different rituals that are observed all

throughout the pregnancy and the following delivery in all cultures. With this, women are

typically encouraged by the people around her especially by the relatives to observe

various rules to ensure their health and safety for a successful pregnancy, easy delivery,

and healthy child.

The Philippines has a diverse culture due to difference in history, geography, and

religion. These beliefs have been part of the Filipino culture even before the colonial

times since it is evident that some of these traditions are unique and incomparable with

respect to the beliefs of the colonizers. These traditions are followed because some

believe that it will keep the mother and child from possible danger, while others believe

that they would not lose anything if the beliefs were followed. These traditions are still

practiced even in urban areas where advanced technology and scientific knowledge

dominate.

However, there is a need to explore the existing cultural beliefs and practices of

women. As midwives, we have observed some practices that maybe harmful to the

women’s health such as the application of gasoline on the abdominal area by the pregnant

women. Further, although numerous studies in the Philippines and around the world
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about cultural beliefs and practices exist, there is still a need to do further study for the

researchers to have better understanding about the beliefs and practices in pregnancy,

childbirth and postnatal care (Abon et al., 2016). However, based on our review there is

dearth of literature in the province of Laguna, which focuses on the perinatal cultural

beliefs and practices. Only one study is found which was conducted more than four

decades ago (Jocano, 1968).

Statement of the Problem

The main problem of this study is to determine the perinatal cultural beliefs and

practices of a woman. The aims of the study are to determine the beliefs and practices

that may be harmful to both the mother and the baby. Aside from providing additional

knowledge on the current cultural beliefs and practices of mothers in the selected

municipalities of Laguna, it is also the intention of this research to explore the cultural

beliefs and practices of women in the midst of modern technology and advances in

research and evidence-based medicine. Specifically, this study sought to answer the

following questions:

1. What are the participants’ prenatal cultural beliefs and practices?

2. What are the participants’ cultural beliefs and practices regarding childbirth?

3. What are the participants’ postnatal cultural beliefs and practices?

Significance of the Study

This study is significant to the following:

Pregnant and postnatal women. The women will be given the opportunity to

share their experiences in doing or following the beliefs and practices in their pregnancies

up to post-natal days. It is also for them to make a stand and express their own beliefs.
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They can also identify those practices that maybe harmful to the mother and the unborn

baby.

Midwives. The registered midwives will be able to identify the different beliefs

and practices, respect them without judgment, and eventually provide a culturally

congruent care. Further, they will also be informed of the practices that are unscientific

and maybe harmful to the mother and the unborn baby. The midwives will also be able to

guide them for their safe pregnancy outcome, to improve the maternal and child health

and to emphasize the importance of prenatal and post-natal care.

Midwifery students. Through this study, the midwifery students could develop

cultural awareness on the different beliefs and practices of women during pregnancy,

childbirth, and postpartal period. Also, this study would help us understand the women’s

culture and therefore, provide proper guidance to women in avoiding beliefs and

practices that could harm the women and their unborn child.

Community. People in the community will be aware and sensitive to people

around us. They will be able to guide and educate every woman in childbearing age on

proper care while pregnant.

Municipal Health Officer. The municipal health officers will have an increased

awareness of the beliefs and practices in the community that would assist them in

providing culturally congruent health care. They will also be informed of these practices

that could pose harm to the women themselves and to the unborn child which could be a

basis for program development on maternal and child health.

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Theoretical Framework

This paper was anchored in the Theory of Normative Social Behavior (TNSB).

TNSB assumes that behavior is affected by descriptive and injunctive norms (Pooja,

2011). Descriptive norm refers to the people’s beliefs about the prevalence of a behavior

while an injunctive norm refers to the people’s beliefs about how much pressure they feel

to conform. This study is focused on how women develop these beliefs and practices and

what influenced them to follow such beliefs and practices. This theory best explains our

study because women follow certain beliefs and practices during pregnancy, childbirth,

and postpartal period that are based on the prevalence of a behavior (e.g., raw egg and

bigkis) and the pressure they feel to conform (e.g., saliva on abdomen) even if they do not

really understand.

Definition of Terms

For better understanding, the study used the following terms:

Childbirth. Childbirth includes the time from labor up to the delivery of placenta.

Cultural beliefs and practices. Cultural beliefs are statements or principle

regarding the culture that women accepted as true. Cultural practices are rituals which is

mainly based on the tradition and customary practices of a particular ethnic or culture

group. These beliefs and practices usually have been passed through tradition from one

generation to another that may or may not have scientific bases.

Myths. Myths are those traditional beliefs and practices that are without any

scientific basis and believed by people to be true.

Perinatal period. Perinatal period refers to the period of whole pregnancy (i.e.,

pregnancy, labor and delivery, and postpartal period).

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Postpartal period. Postpartal period refers to the period immediately after

childbirth up to six weeks after delivery.

Prenatal period. Prenatal period refers to the beginning of pregnancy and ends

when labor starts.

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Chapter 2

Review of Related Literature

This chapter presents the related literature and studies we read from books,

journals, unpublished materials, and electronic publications which will provide a clear

understanding of the problem stated in the study.

The perinatal beliefs and practices encompass rituals that women perform during

the prenatal period, childbirth, and during the postpartal period. These beliefs and

practices may include foods avoided and recommended, activity promoted and restricted,

medicinal herbs and other beliefs and practices. It features various beliefs and practices

such as paglilihi, wearing a thin long cloth called bigkis, massage and sponge baths with

warm decoction using various leaves, and smoking or roasting called rimon or dimon

(Jocano,1970).

Cultural Beliefs and Practices during Prenatal Period

During the prenatal period, a pregnant woman embraces various beliefs and

practices that are thought to have effect on her and the growing fetus. These beliefs and

practices include promotion or avoidance of food and activities.

Foods. Certain foods are encouraged while others are avoided. For instance, it is

recommended that pregnant women must drink milk so that the child will have a lighter

complexion (Bermio & Reoututar, 2017). According to Filipino Ethnicity and

Background, cravings for food must be satisfied to prevent miscarriage. Bermio and

Reoututar say that pregnant women should eat round fruits and vegetables to give birth to

a baby girl and eat long vegetables like carrots and cucumber if she likes to deliver a

baby boy. In Cambodian beliefs, pregnant women should eat nutritious food so they
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would be strong to deliver their baby (Turner, 2017). They also believe that eating

peanuts makes the baby witty (Ocampo & Moriya, 1992). According to Kenyan beliefs,

the Ugali dish, made from sorghum and finger millet flour or maize flour, is

recommended during pregnancy, and milk mixed with animal blood (cow, sheep or goat)

is suggested since it is known to raise blood levels (Riang'a et al., 2017). In Ghanaian

beliefs, women who are pregnant should eat green leafy vegetables (consumed as stews

or soup) to “give blood” or prevent anemia. They should also eat palm nuts to strengthen

the pregnant body and should take food supplements such as prekese (Tetrapleura

tetraptera), alefi, and kwawu nsua to augment the process of giving blood and body or

minimizing physiological disruptions such as nausea (Aikins, 2014).

There is also some food that are avoided during prenatal period. Such foods may

include twin bananas, tutong (crisp brown layer of cooled rice), uncooked rice, puso ng

saging (banana inflorescence), or crabs. In the Philippines, the pregnant woman could

avoid giving birth to twins if she will not eat twin fruit like bananas (Bermio &

Reoututar, 2017). Eating eggplant has to be avoided because this will make the infant

sickly, and the mother has to refrain from eating tutong to ensure the immediate ejection

of the placenta and also the mother must not eat uncooked rice or banana inflorescence,

known as puso ng saging, or else the baby inside her womb will have skin ailments

(Jocano, 1970). Further, Filipino mothers moderately agreed that eating crabs must be

avoided so that malformation of the hands or feet will be avoided (Ocampo & Moriya,

1992).

Fair skin is an advantage in many cultures. Some pregnant women may avoid

eating black foods to avoid the birth of an infant with a dark skin tone (Catherin et al.,
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2017). India has similar beliefs about promotion of fair skin for baby. For them, the skin

color of the baby is a priority. Fairer skin is attributed to increased physical attractiveness

and all efforts are taken by the parents to lighten the skin color (Catherin et al., n.d.).

According to Yeasmin and Regmi (2013), pregnant women should eat more fruits so their

baby’s skin will be nicer and smoother. Further, in a survey conducted by the Japanese,

Filipino mothers moderately agreed that eating light-colored foods would cause the baby

to have a white complexion and others.

Some foods are also avoided to avoid miscarriage. According to some Filipinos,

cravings for food during pregnancy should be satisfied (Filipino Ethnicity and

Background cravings, n.d.). A pregnant woman's food cravings must be fulfilled

promptly, or she may suffer a miscarriage (Wilde, 2013). However, Washington (2015)

found that pregnant women must avoid eating or even preparing cooling foods, like ice

cream, watermelon, bananas, and mung beans among Chinese because such foods have

too many yin qualities, and might cause a miscarriage.

Some foods are also avoided to prepare for an easy delivery. Filipino mothers

often restrict their diet in an attempt to have a small baby and then an easy delivery. As a

consequence, the fetus receives inadequate nutrients from the mother. In a study among

Japanese mothers, it was found that women moderately agreed that sweet foods are

prohibited because the baby will become too big (Ocampo & Moriya, 2001).

Most mothers agreed that green leafy vegetables, rice, less spice, bread, ragi,

jowar, groundnut powder, meats, eggs, fruits like apple, mosambi, and sapota improve

the health of the mother and child. According to Indian beliefs, the antiemetic properties

of condiments like rasam, coriander powder and red chilli powder were more routinely
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consumed during first trimester. Chicken, mutton and green leafy vegetables are thought

to be galactogogues and are consumed ante-natally usually from second trimester

onwards, to ensure a bountiful supply of milk to the newly born. Ridge guard, rice, white

pumpkin and green beans were considered to have cooling properties and were given to

majority of mothers during the antenatal period. Fish was particularly stressed upon with

regard to its ability to improve the intelligence of the baby. Closer to term, certain food

practices like eating the meat of a lamb’s head was followed by few mothers. They

believed that this would help the newborn child attain head control earlier and achieve

motor milestones quicker (Catherin et al., 2015).

Indian women are encouraged to increase the number of meals, and it is supposed

to be of prime importance during the first and second trimesters. It is considered to be

quintesssential by most mothers for maternal and child health. “Increased quantity of

food is important during antenatal period as they need more nutrition for themselves and

the growth of the baby.” However, during the last trimester food consumption is reduced

to avoid abdominal distension (Catherin et al., 2015).

Activities. There are also activities that pregnant women are encouraged or

discouraged to do since these are believed to have effects on the mother and the unborn.

For instance, women are encouraged to cover their head when going out in a certain part

of the day, rub coconut milk, keep oneself tidy, and go to the hilot, a traditional birth

attendant. On the other hand, pregnant women are discouraged from watching lunar

eclipse or a scary movie, crossing her legs on the floor, and pulling the stomach in to hide

the pregnancy. She should also avoid wearing anything around her neck or wear any

tight-fitting clothes or mingle with the deaf and tongue-tied.

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Jocano (1970) stated that in going out in the afternoon, a pregnant woman must

cover her head with a piece of cloth in order to prevent the cold air (sareno) from entering

at the crown of her head else, she will have a blue baby. Rubbing coconut oil in the belly

will prevent stretch mark (Chang et al., 2016). Some Filipinos believe that, the hilot

should massage the woman to put the baby in its right position in order to prevent the

difficulty in delivery (Jocano). While according to Filipino Ethnicity and Background

some pregnant women should put more effort on being tidy and beautiful, because these

practices will influence the appearance of the child and the unpleasant emotions

experienced by pregnant women cause the birthmarks (Filipino Ethnicity and

Background (n.d.).

On the other hand, a pregnant woman is discouraged from watching lunar eclipse

because it will cause her to bear a child with a cleft lip. She can be protected by carrying

a key or safety pin (Bermio & Reoututar, 2017). Further, pregnant women should not

watch scary movies because it may cause pre-term labor (Chang et al., 2016). Chang and

colleagues recommend that she should sleep with a Bible under her bed to scare away the

evil and should not sit with cross legs on the floor because her fetus’ head will flatten. A

woman should not also pull her stomach in because her fetus will be suffocated inside

and she should not hide her pregnancy because her child will become deaf or powerless

(Bermio & Reoututar, 2017). Further, a pregnant mother should not wear anything

around the neck because it will cause the umbilical cord to wrap around the fetus and

must not wear tight-fitted clothing because it might cause the baby to become

handicapped (Chang et al., 2016). She should not mingle with the deaf and tongue-tided
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because she will give birth to a child with same characteristics and should not kiss the

cross, or the statue, because her baby will become mute (Bermio & Reoututar, 2017).

It is also believed that the contour of the abdomen and the woman’s emotion and

husband activities determine the gender of the fetus. A pregnant woman with pointed

belly will give birth to a baby boy but if it spreads out to the sides it is believed to be a

girl (Bermio & Reotutar, 2017). Further, a woman will bear a female child if her face

looks rounder, if she feels having difficulty on her left side, if she listens to music and

sings, and if she is fond of watching dances (Bermio & Reoututar). Furthermore, when

the woman hates her husband during her conception (lihi) period, the baby will be a girl

and will look like the mother. On the other hand, if the husband is the one who suffers the

lihi or discomforts during pregnancy, the baby will be a boy and will look like the father

(Jocano, 1970).

Cultural Beliefs and Practices during Childbirth

The childbirth beliefs and practices include those rituals that women perform

from the time of labor up to delivery of placenta. Common beliefs and practices included

are promotion or avoidance of certain food and activities.

Foods. Certain foods are avoided during labor and delivery. In the Philippines

pregnant women must avoid sweets like sugar, cakes, soft drinks, candies, and so forth,

because it is believed to make the fetus big and therefore bring difficulty in delivery

(Jocano, 1970).

There are certain medicinal herbs used by every pregnant woman in labor. Among

the Tagalogs in Bay, Laguna, Philippines, it is believed that if the woman becomes sick

or suffers from certain discomforts, the hilot gives her medicine to drink- usually a
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concoction derived from the bark of a tree called balimbing and the leaves of sulasi (a

kind of seaweed). The brew is intended to force the mother to vomit sumilim, a gelatinous

substance coming from her womb. If this is not removed, she will have a difficult

delivery (Jocano). Other women drink hot liquids (water, tea) eat hot foods like porridge

or soup to relieve pain (Higginbottom et al., 2013).

There are also foods that are recommended to pregnant women that are believed

to have effects to the mother and unborn child that may help to have an easy delivery. In

some parts of the Philippines, women are told to eat a raw egg just before the delivery, to

help lubricate the birth canal (Adamson, 2015). Bermio and Reoututar (2017) have also

studied some beliefs and practices regarding eating fresh native egg as a source of energy

and to deliver the baby easily. They also stated that drinking coconut oil will facilitate the

delivery of the baby. Chang et al., (2016) affirmed that drinking boiled ginger reduces

pain and has anti-inflammatory effects. They also noted that putting squashed leaves on

the belly of the woman facilitates childbirth, which is also believed in other regions of the

Philippines (Cabigon, 1996). Many Filipinos believe that drinking medicinal herbs like

boiled ginger reduces the pain during labor and putting squashed leaves on the belly of

the women will facilitate childbirth (Chang et al., 2016).

Activities. There are also activities that laboring women are encouraged to do

since these are believed to have effects to the mother and the unborn. For instance, the

pregnant mother is encouraged to walk during labor to facilitate descent of the head of

her fetus. According to Higginbottom et al., (2013), kneeling and squatting are the most

effective position in giving birth and during labor women are encouraged to have a hot

shower to relieve the pain they are experiencing. In addition, Filipinos believe that
 21

rubbing the abdomen into a wooden post will facilitate the delivery (Bermio & Reoututar,

2017). Chang et al., (2016) said that rubbing the abdomen with boiled ginger will reduce

the pain. But Jocano (1970) declared that hilot fixes the baby’s position by massaging the

expectant mother’s belly and massaging the buttocks of the mother in an upward

direction may relieve any uncomfortable feeling.

There are also activities that should be avoided when pregnant women are in

labor. Bermio and Reoututar (2017) say that women in labor should not to be visited by a

person born via breech because it will complicate labor. Further, all guests of the

pregnant mother should not to stand too near or at the door and at the stairs to prevent

complications in labor.

Women in Thailand reported to do “Kashaya “or “ya tom,” a decoction of herbs

during pregnancy is prepared to have an easy delivery (D’souza, 2016). In the

Philippines, women in labor will be attended by female family member during labor and

cannot be visited by a person born via breech position. Jocano (1970) found that among

pregnant women in Laguna, all covered objects such as pots, bamboo tubes, glasses, and

so forth are removed from the house to ease the chills in delivery. In Sudan, the

expression of pain during labor and delivery (e.g., screaming and exhibiting distress) is

associated with weakness and only midwife and traditional attendant with experience in

delivering babies but with no formal training are the ones who commonly assist the

mothers in their delivery (Higginbottom et al., 2013). For Higginbottom et al., (2013)

epidural is not needed if the delivery time is expected to be short and going to doctors for

delivery means having caesarian section. In Liberia, if they tie the lappa (cloth covering

used as a skirt in Liberia), the woman cannot deliver right away (Lori, 2011).
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There are also activities that the family member of pregnant women in labor

practices. For instance, some fathers are preferred to be close to their laboring wife, so

they can bury the placenta (Cabigon, 1996). The birthing position is to lie down. Some

woman may prefer a squatting position. (Cabigon, 1996).

Cultural Beliefs and Practices during Postpartal Period

The postpartal beliefs and practices include those rituals that women perform

from childbirth until six weeks after delivery. Common beliefs included are promotion or

avoidance of certain food and activities.

Foods. There are foods and drinks that are avoided during postpartum period.

Some Asian countries prohibit taking in cold drinks. In the Philippines, mothers are

instructed not to take in cold drinks after giving birth so that she will not easily chill

(Bermio & Reoututar, 2017). In Thailand, women are restricted from eating cold foods,

juicy fruits and vegetables, sour fruits, vines, creepers, and climbers (Prangthip, 2010).

Moreover, Chinese women are also prohibited from eating cold food such as fruits to

avoid delay in lochia discharge, teeth pain, or a discomforted stomach (Wang, 2019).

Also, Filipino mothers are being instructed to avoid bananas, jackfruit, young

coconuts, guavas, and papayas because these foods were believed to cause binat or

relapse (Jocano, 1970). Gabi roots are also prohibited because these will make the infant's

navel itchy (Jocano). According to Ocampo and Moriya (1992) eating milkfish will make

the mother not feel good and watermelon makes the wound of the mother fresh again and

foods with lots of fat is also prohibited. Malays believed that bias (certain kind of fish)

must not be consumed because it is known to cause digestive disorders and postpartum

hemorrhage in women (Prangthip, 2010). However, women in Thailand consume less

 23

buffalo meat due to the belief that it is harmful and poisonous for postpartum women and

vegetables are not allowed to be eaten in the first week after delivery (Prangthip). In

Laos, white skinned meat is avoided because it is believed that eating such foods can lead

to weakness (Prangthip).

However, Raven and Garner (2007) noted that postpartum women are encouraged

to consume more food after birth. Two main reasons were given: first, women at this time

are weak, and food will help rebuild her strength, promote recovery, and improve

breastfeeding; second, the relatives’ own experience (usually the postpartum mother’s

own mother) of "doing the month". In the Philippines, women should be given hot soup

and nutritious foods to eat so they can make the most nourishing milk (Bermio &

Reoututar, 2017); while Chang et al., (2016) says lugaw (rice porridge) is given to

encourage lactation. In Thailand, the commonly allowed foods for postpartum women

include sticky rice, grilled chicken, garlic, lemon, hot water, and herbal medicines

(Prangthip, 2010). Prangthip explained that grilled animal meat consumption is believed

to prevent cardiac failure and heal internal organ injuries. Further, pickled vegetables,

pickled fruit, and spicy food are known to have a positive effect on baby’s health and

uterus involution. Thai women are also recommended to eat hot food which includes fats,

alcohol, spices, protein-rich animals, salty food, and bitter food (Prangthip, 2010).

According to Higginbottom et al., (2013), hot foods are recommended after delivery to

reduce the blood in the stomach and to benefit the baby.

There are also food recommendations for women who have given birth to increase

their milk production. Wang (2019) says that crucian soup, huang hua (yellow flower)

pork troller soup and so forth were believed to increase the breast milk production.
 24

However, people in Bangladesh eat dry food, which was cooked without water, and rice

with mashed potato and black cumin seed. This is believed to keep the stomach of a

woman cool and initiate the production of breast milk (Choudhury et al., 2012). Regmi

(2009) stated that Jhoho ko jhol, a special soup from a kind of seed, is believed to

promote lactation. Also, Fadzil (2016) says that eating green leafy vegetables, garlic,

shark’s meat, black dhal pudding, and boiled fenugreek seeds (halba) increases breast

milk.

There are also medicinal herbs and foods that are encouraged to be taken by

postpartum women. For instance, special tonics are sometimes used, consisting of herbs

or foods with special medicinal properties. In Nepal, sathora, an herbal tonic, and haluua,

a kind of wheat semolina with added heating substances such as ginger, cumin and

turmeric, are used to promote milk production, warm the mother, and expel childbirth

blood (Dennis et al., 2007). Malaysian mothers also use ‘hot’ herbal medicines. Among

Guatemalan women, herbal teas and green herbs are used for pain relief, producing extra

blood, ‘washing out’ childbirth blood and placenta, replacing energy and strength,

promoting appetite, improving weight loss, and increasing breast milk. They may also

use chicken soup boiled with the plant ntiv to rid of postpartum blood (Dennis et al.,

2007). In Korea, brown seaweed miyuk and beef broth miyuk guk are used for cleansing

the body (lochia and postpartum blood) and increasing breast milk. Shenghuatang, an

herbal soup with ingredients including dang quai (Chinese Angelica Root, Ligusticum

acutilobum) and ginger, is used among some Chinese mothers to help renew blood in the

early post-partum period. Dang quai is also used in combination with other foods for

anemia and gynecological conditions. Du Zhong, powdered Eucommia ulmoides bark, is

 25

sometimes an added ingredient in special broth and deer antlers may be used as a tonic.

In Nepal, warming foods such as heated milk are given immediately following delivery to

avoid indigestion and diarrhea. Food such as rice cannot be eaten until the second or third

day, at which time the stomach and womb have started contracting towards its normal

state. Among Chinese women, various sanctioned foods are often introduced in a

particular order. For example, the consumption of sesame oil-chicken is delayed

postnatally due to the belief that the sesame oil is ‘heavy’ and may lead to a vaginal

infection if consumed too early (Dennis et al., 2007). In the Philippines postpartum

mother 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 (Cabigon, 1996). In Thailand, Nam pu leoi (decoction of cassumunar

ginger) is a drink consumed by postpartum women because it is thought to enhance the

proper flow of blood and herbs are commonly used as supplements to dietary regimens

prescribed by the healer (Prangthip, 2010). Also, in Thailand, wan kae kam, wan jai dam,

and medicinal roots such as ya nang dang or nang tang dang are used to treat the

symptoms of Phit kam. Hot herbal concoctions, that may include ginger, potash alum,

garlic, galingale, and an herbal bulb wan shuk mod look, were internally and topically

used by women (Prangthip, 2010).

Activities. Postnatal women are encouraged to do some activities or rituals.

According to Jocano (1970) scrapping from coconut shells, known as bud-bud, are

applied to the vaginal wound. On the tenth day after delivery, the mother is given a

sponge bath with a warm decoction of lagundi (Vitex {VerbanaeaeJ, spp.), salag
 26

(Hemigyrasa canescens Thw.), lukban (CitTus, spp.), sambong (Blumea, spp.),

galamayamo (Hep'tapleurum vemilosum ·Seem), and palad buli (Corypha umbraculifem

Linn.).

There are some activities that are encouraged and discouraged to be done during

postpartum periods. In Thailand, massage done by well-trained spiritual healers is used

for the maintenance of body’s energy (Prangthip, 2010); while in India, massage using an

herbal wrap helps mother regain her figure (Fadzil, 2016). According to Filipino

Ethnicity and Background, postpartum women may be massaged with coconut oil to

restore their lost health, expel blood clots from the uterus, return the uterus into a normal

position, and promote lactation. Postpartum women’s abdomen will be massaged by

hilots so that retained blood and blood products will be expelled (Bermio & Reoututar,

2017). Massaging women during the postpartal period is a common practice. In Malaysia,

a new mother receives a thorough massage from her midwife for three days to increase

circulation and bring healing heat to all parts of her body (Dennis et al., 2007). Among

the Thai women, they are massaged with hot salt to loosen tendons and prevent blood

clots (Dennis et al., 2007). Vietnamese mothers keep warm to avoid the ‘wind’ and

prevent headaches, facial wrinkling, varicose veins, and other health problems. A fire is

also placed under the mother’s bed to prevent blood clots and backaches. Chinese

mothers may follow similar practices. Cambodian mothers place heated rocks on their

stomach to prevent blood clots and flatten their stomach. They ‘roast’ on a bamboo bed

over a wood or charcoal fire for 3 days and nights to heat sawsaye (fibers, ligaments) and

prevent uterine blood clots, ensure good skin, and promote overall long-term health.

During roasting, mothers tie strings their waist/wrist, paint lime crosses in corners of
 27

homes or on necks or ankles, and place thorns under their bed to ward off priey krawlah

pleungh, a spirit that attacks a woman while roasting, causing seizures, fainting, loss of

consciousness and bizarre behaviours. Herbs are used with hot rocks (tshuaj ntxhawb) to

treat ill health arising from not keeping the body warm enough. Hmong mothers in

Thailand wear warm clothing to avoid the ‘wind’ and sleep near a fire for three days

postpartum. The mother’s straw bed is then burnt. This practice was developed to cope

with scarcity of the blankets and sanitary pads and to avoid washing material containing

childbirth blood in water sources (Dennis et al., 2007). Some women in the Philippines

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. For Australian mothers, they practice putting

a postpartum woman into heater instead of putting hot water in bottles. A common

practice in Thailand, Vietnam, Cambodia, Mexico, Guatemala and among the Hmong is

binding of the abdomen to return it to its normal size. Among Muslim families, the baby's

abdomen is bound around the umbilical area to prevent abdominal colic, while the

mother's abdomen is bound to hasten uterine involution and to flatten the stomach. In the

Philippines, there is the same practice of binding the abdomen tightly believing that it

may help prevent bleeding and help the uterus to retract to its normal size (Cabigon,

1996). Among mothers in Goa, India, an oil massage is believed to improve strength and

maintain general health, while Hawaiians use lomilomi massage to remove tensions,

emotional anxieties and negative thoughts and feelings (Dennis, et al., 2007). Filipino

postpartum women are massaged with coconut oil, with the aim of restoring their lost
 28

health, expelling blood clots from the uterus, returning the uterus into a normal position,

and promoting lactation (Cabigon, 1996).

There are some activities in hygiene that a postpartum mother is encouraged and

discouraged to do. In many cultures, postpartum women are seen as contaminated, and

therefore special hygiene practices are required. Jordanian mothers wash their genitalia

thoroughly with soap and water because they are thought to be temporarily ‘polluted’ by

childbirth. Muslim women take a purification bath called a ghusl after they have stopped

bleeding. In some cultures (e.g., Arabic, Thai and Chinese), women are considered to be

unclean until the postpartum period of rest has been completed or bleeding has

discontinued. Prior to this, women are often prohibited from sexual intercourse. They are

also prohibited from entering other people's homes, or entering through the front door of

their own home to avoid offending guardian gods or spirits. Similarly, family members

may be unwilling to eat food prepared by the new mother during this period to avoid

illness or death. Among Hindus, the new mother is not allowed to cook or receive male

visitors until the tenth or twelfth day postpartum when she is considered ‘clean’ and can

carry out normal household chores. For some Eastern Indian Hindus, the whole family is

considered impure. No outsiders are allowed to eat or drink in the house until a day

determined by caste and a ritual bath and religious ceremony is performed. In Pakistan,

heavy postpartum bleeding is considered ‘healthy’ in order to release the ‘unclean’

menstrual blood that accumulated prenatally. For the Hmong women, any material that

contacts childbirth blood must be washed in the house and buried in a hole in the dirt

floor to avoid attracting the attention of spirits, which could harm the mother or infant

(Dennis et al., 2007). Traditionally, women should not bathe or wash hair in the
 29

postpartum period, and this was well known in all families. They believed that as the

postpartum woman's skin is loose, water can enter the body through holes in the skin.

This will cause body swelling, arthritis and rheumatism later in life or a cold which can

be passed to the baby (Raven & Chen, 2007). In Malaysia, mothers bathe in warmed

water, bind ‘hot’ substances around their abdomens and lie above or near a fire source.

Thai women practice yu fai, a practice where the mother, wearing warm clothes and

wrapped in blankets, lies on a wooden bed over a warm fire for 30 days to flush out

retained blood and placenta, increase involution of her uterus, flatten her stomach,

remove stretch marks, and heal perineal tears (Dennis et al., 2007). According to Bermio

and Reoututar (2017), women who have given birth must be protected from cold wind,

rest completely, and stay inside the house for 30 to 40 days after delivery. This will help

them heal, facilitate and keep “cold” or “wind” from getting inside her body. They must

refrain from taking a bath for 35 days to avoid headache and must perform hot sitz bath

to heal the perineal lacerations. However, Chang et al., (2016) mentioned that postpartum

women must avoid taking a bath for 10 days after giving birth because it can cause ill

health and rheumatism in old age. Sponge bath could be an alternative while binding the

abdomen tightly to help prevent bleeding and to help the uterus to retract. But in Filipino

Ethnicity and Background, some women perform ‘mother roasting’ to dry-out the wound.

This involves 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 smoldering leaves.

However, in many cultures, specific bathing restrictions or prohibitions exist,

some of which relate to the ‘hot’ and ‘cold’ beliefs already described (Dennis et al.,
 30

2007). For instance, cold baths or showers are often strictly prohibited to avoid blood

clots, sore bones and joints, and an itchy body. In Guatemala, midwives believe that

bathing in cold water causes fever, infection, edema and decreased milk supply, and that

bathing too soon causes stomach pains or prolapsed uterus (Dennis et al., 2007). In

Mexico, bathing is restricted to protect the mother from cold or ‘evil air’. Similar

concerns are reflected in some Eastern Indian Hindus and Chinese beliefs that air

conditioners and fans are dangerous for new mothers. By contrast, warm baths are

acceptable in the Hmong culture and in Malaysia, India and Thailand. Among Arabic and

Thai women, it is acceptable to take a quick, warm shower but hair washing is prohibited.

A steam bath (sitting on hot bricks and medicinal leaves or inhaling steamed medicinal

herbs) is prescribed in Thailand to sweat out poisonous water and absorb good water, dry

the perineum, and assist healing. Among Jordanian and Guatemalan women, sitz baths

are recommended to facilitate healing. Thai mothers practice Kao krachome, where

several types of herbs are boiled in a pot. The mother then sits on a bed and covers

herself and the pot with a blanket. Kao krachome is believed to help sweat out

‘poisonous’ water so that the mother can absorb ‘good’ water in order to promote healthy

skin and protect against blurred vision, dizziness, headaches and fatigue in later life

(Dennis, et al., 2007).

Beliefs and practices on activities during the postpartal period may include

physical and social activities. Organized support typically corresponds to a prescribed

period of rest, during which the mother is prohibited from performing her usual

household chores (Dennis et al., 2007). In most cultures, the rest period spans between 21

days and 5 weeks and is considered a period of vulnerability for future illness. For
 31

example, in Korea, a three to five-week rest period is known as sam chil il. In China,

many women participate in zuo yue (or tso-yueh-tzu in Taiwan), commonly referred to as

‘doing the month’. This is a formalized, month-long period of rest during which mothers

are assisted by extended family to promote recovery and allow ‘loose’ bones to return to

their previous positions. Many Thai women remain at home and are cared for by female

family members and their husbands for approximately 30 days, a practice known as yu

duan. Among Mexican women, a 40-day rest period is known as la cuarenta. Among

Muslim women, a 40-day period of rest is observed according to Islamic beliefs. A

designated period of rest is similarly practiced among Amish, Japanese, Hmong, Malay,

Eastern Indian Hindus, and South African women (Dennis et al., 2007). Women fear

what is referred to as a ‘relapse’ if they become active too soon. This involves extreme

tiredness, weakness, and chronic headache. In the Philippines, when a woman has a baby,

she usually rests while her relatives do all the housework and cooking. 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 (Cabigon, 1996).

There are within-culture differences in the extent to which these periods of

organized support and period of rest are observed. Younger women and those living in

major urban centres may be less likely to participate in these practices or may observe

them for a shorter period of time. As another example, many factors affect the traditional

practice of yu duan in Thai women. Mothers of female infants observe a longer rest

period since females are thought to work harder in life than males and therefore deserve

additional time with their mother in infancy. Yu duan is considered particularly important

for primiparous women. Availability of family members and friends to facilitate Yu

 32

duan may be a limiting factor. Middle-and upper-class women may be able to hire people

to provide the necessary support, while poorer women may be unable to practice or

shorten the period since they or their husbands may need to return to work. Some women

believe that traditional practices are only necessary for women living in their native

countries, and are no longer important postimmigration (Dennis et al., 2007). Not

observing the traditional period of post-partum rest is generally believed to result in

premature aging or ill health, either immediately or in later life. In the Vietnamese

culture, facial wrinkling is perceived by some to be very shameful, as it is seen to be

evidence that the mother may have poor relationships with her family members who

typically provide postpartum support. In Thai culture, practicing yu duan is believed to

protect a new mother from lom pid duan, illnesses thought to develop as a result of

inappropriate postpartum care. Cambodian women believe that violations of postpartum

traditions may result in toas, specific illnesses following childbirth with distinct patterns

of symptoms depending on the specific type of violation. In addition, if the new mother

feels unsupported by her partner, she may develop pruey cet or ‘sad heart’, primary

symptoms of which are unhappiness/depression, frustration, anger, unhappiness, and

‘crazy’ behavior. Finally, some cultures, such as the Hmong and Arab women, believe a

major potential consequence of incomplete postpartum recovery is future infertility

(Dennis, et al., 2007).

During the postpartum period of rest, specific activities may be prohibited.

Among Vietnamese and Chinese women, crying, reading or watching television is not

allowed in order to prevent later eye problems. In Cambodian culture, women are

discouraged from feeling strong emotions or ‘thinking too much’. In many cultures,
 33

sexual activity is avoided for a variable length of time, ranging from 20–100 days. Often,

this practice is encouraged not only by the cultural community, but also by medical

practitioners, to encourage appropriate healing following childbirth. In Cambodian

culture, sexual activity before the new mother considers herself to be ready is thought to

be associated with negative health consequences. In other cultures (e.g., Jordanian and

Chinese), postpartum women are considered to be ‘polluted’ and therefore sexual activity

is considered to be dangerous for the partner. Fijian women are to avoid any activities

perceived to be potentially harmful to the mother or the infant such as sitting up, physical

exertion, combing her hair or exposing herself to the sun (Dennis et al., 2007).

Several cultures have special practices related to the placenta. In Malaysia, the

placenta, considered the baby's sibling, is placed in a ‘winding’ sheet and coconut shell

and then buried. In the Muslim culture, the placenta is also buried, while among rural

Koreans, the placenta is burned on the third day postpartum and the ashes are either

buried or scattered on a road in a long black line to promote longevity (Dennis et al.,

2007). In some regions, a father is responsible for the burial of the placenta. He usually

buries the placenta very quickly, 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.

Finally, some rituals are based on spiritual or superstitious beliefs. In Mexico, a

specialized sequence of visits from female relatives is performed to neutralize spiritual

impurities. In Nepal, senior women of the household bless the new mother by applying

a tikka to her forehead. In parts of rural Korea, little mounds of yellow earth are placed

by the family's front door to announce the birth of the baby and the sex, a practice
 34

called Iwanyt'o p'iuda. Alternatively, a straw rope, pine branches, red peppers or charcoal

are hung across the entrance in other areas of Korea. These indicators warn others not to

enter the house, as outsiders, especially a woman in mourning, are thought to bring

danger to the child and mother and prevent breast milk production. In addition, anyone

who has recently travelled is forbidden to enter the house (Dennis et al., 2007).
 35

Chapter 3

Methodology

This chapter presents the methods and procedures that were utilized in the study.

It includes the research design, the description of the population and the setting of the

study, data gathering tools and procedures, and data analysis and management. It also

discusses the nature of the sample and the sources of data.

Research Design

This study employed the qualitative research design. Qualitative research is “an

approach for exploring and understanding the meaning individuals or groups ascribe to a

social or human problem” (Creswell & Creswell, 2018, p. 38). Merriam (2009) explained

that qualitative researchers are interested in understanding how people interpret their

experiences, how they construct their worlds, and what meaning they attribute to their

experiences.

This study specifically used the descriptive qualitative research. Descriptive

qualitative studies “offer a comprehensive summary of an event in the everyday terms of

those events” (Sandelowski, 2000, p.336). Sandelowski contended that qualitative

descriptive study is the method of choice when straight descriptions of phenomena are

desired. Further, it is aimed at casting light on current issues or problems through a

process of data collection that enables them to describe the situation more completely

than was possible without employing this method (Fox & Bayat, 2007).

Qualitative research was used in this study for it aims to explore the perinatal

cultural beliefs and practices of women considering their own perspective. Further,

descriptive qualitative design has been used since we would like to have an in-depth
 36

knowledge and understanding on the women’s cultural beliefs and practices surrounding

pregnancy.

Population and Sampling Design

The population of the study was composed of adult mothers and pregnant women.

The inclusion criteria for mothers are (1) mothers who are currently pregnant or have

given birth not greater than one month, (2) resident of Laguna, and (3) willing to

participate in the study. The inclusion criteria for pregnant women include (1) currently

pregnant, (2) resident of Laguna, and (3) willing to participate in the study.

Purposive sampling was used among 16 participants. Upon interviewing 14

participants, we believed we have already reached the data saturation since there are no

new categories emerging from the transcripts. However, we added two more participants

to ensure data saturation.

Table 1

Characteristics of the Participants: Frequency and percentage

Characteristics of Participants f %
Age group
20-25 3 18.75%
26-30 7 43.76%
31-35 4 25.00%
36-40 1 6.25%
41-45 1 6.25%
Marital status
Married 15 93.75%
Live-in 1 6.25%
Educational attainment
College 9 56.15%
High school 7 43.75%

Setting of the study. Laguna has twenty-four municipalities and majority of the

population speak Filipino (Tagalog). According to Ethnic Groups of the Philippines

 37

(n.d.), Tagalog culture is considered to be westernized of all Filipino ethnic groups and it

is influenced particularly by Spanish, Chinese, and American cultural traditions. Laguna

province is chosen as the locale of this study since it is observed that there are still some

existing beliefs and practices about pregnancy, childbirth, and postpartal beliefs that

necessitate further exploration.

Three (3) towns were included in this research endeavor which are characterized

as either urban or rural area. These municipalities are Sinaloan, Calamba, and Cabuyao.

The municipality of Sinaloan is a rural municipality. It is L-shape located between the

plains of sierra mountains ranges and Laguna the bay and their major source of income

come from agriculture or farming. Calamba is an urban municipality known as “the city

of growth, leisure and national pride” and their source of income come from

manufacturing service, agriculture, and tourism. Cabuyao is an urban area known as “the

richest municipality in the Philippines” due to the large number of immigrants who work

in the city, which has a lot of industrial estate (DILG, Region 4-A).

Data Gathering Techniques

In-depth interview (IDI) using semi-structured question is the data gathering

method used. In-depth interview is a qualitative data collection method that involves

direct, one-on-one engagement with individual participants (Doyle, 2019). In semi-

structured interview, the interviewer may prepare a list of questions but does not

necessarily ask them all, or touch on them in any particular order, using them instead to

guide the conversation (Doyle). The interview guide used in this study is found in

Appendix C.
 38

Data Gathering Procedure

Data gathering commences after receiving the approval from the Ethics Review

Committee. We submitted a letter to the selected municipality and their respective

municipal health officers (see Appendix E for the correspondence). After the approval

was received, a courtesy call to the mayor and barangay officials was conducted and

subsequently explained the purpose of the study. After receiving the proper endorsement,

we requested the personnel from the different health centers for a copy of the list of

pregnant women and women who have given birth not more than one month.

Recruitment of the participants that passed the predetermined inclusion criteria

commenced. Explanation to the prospective participants such as the purpose of the study

and consent was provided. The interview lasted for only 15-30 minutes in the

participants’ own homes and all interviews were audio recorded. After each interview,

our group did a group discussion as our peer debriefing to discuss our thoughts and

feelings about the recent interview we conducted. We then assigned one group member to

do the verbatim transcription of the audio recording.

Data Analysis

Transcriptions were read and re-read by at least two of our group members. We

then started the coding line-by -line or by thought. We consulted and discussed with our

advisor the codes and themes for further checking and then returned to our participants

for member check. Codes and themes were reviewed at least three times among us

researchers. After all data have undergone the procedure mentioned, we sent the

developed codes, themes, and the participant statements to an external reviewer who is
 39

considered an expert in qualitative research. His suggestions and recommendations were

properly considered in consultation with our adviser.

Trustworthiness

Trustworthiness in a qualitative research is important to evaluate its worth

(Lincoln & Guba, 1985). Lincoln and Guba’s evaluation criteria for trustworthiness

involve establishing the credibility, transferability, dependability, and confirmability.

Credibility is confidence in the truth of the findings.Transferability is showing that the

findings is applicable in the context. Dependability is showing that findings are consistent

and could be repeated. Confirmability is the degree of neutrality or the extent to which

the findings of the study are shaped by the respondents and not researchers bias,

motivation, or interest (Lincoln & Guba, 1985).

Trustworthiness has been observed in this study by employing the following

techniques: triangulation, member check, peer debriefing, prolonged engagement, expert

checking, and reflexivity. Triangulation refers to the use of multiple methods or data

sources in qualitative research to develop a comprehensive understanding of the

phenomena (Patton, 1999). Triangulation methods that have been used are found in the

Triangulation Matrix Table (see Table 2).

Member checking is the informants’ feedback about what the participant meant. It

is used to ensure if the researcher interpretation is accurate (Thomas, 2016). Typically,

member checking is viewed as a technique for establishing to the validity of an account

(Lincon & Guba, 1985). Member checking has been conducted by returning the

transcribed interview and initial coding to the participants to ensure accuracy of the

interpretation.
 40

Prolonged engagement is spending adequate time observing people and

developing relationships and rapport with members. Development of rapport

and trust facilitates understanding and co-construction of meaning between researcher

and members of a

Table 2

Triangulation matrix

Research question Data source #1 Data source #2

What are the participants’ Literature Review Interview of the
prenatal cultural beliefs and participants
practices?
What are the participants’ Interview of the Literature Review
cultural beliefs and practices participants
regarding childbirth?
What are the participants’ Interview of the Literature Review
postnatal cultural beliefs and participants
practices?

setting (Cohen, 2006). Prolonged engagement has been ensured that sufficient time has

been provided to each participant during interviews. At the end of each interview, the

participants were asked “Is there anything else you would like to say that I have not

asked?” The interview lasted for about 15-30 minutes.

Peer debriefing is a process of exposing oneself to a disinterested peer in a

manner paralleling an analytical session and for the purpose of exploring aspects of the

inquiry that might otherwise remain only implicit within the inquirer's mind (Lincoln &

Guba, 1985). After every interview, the researchers met and discussed any thoughts and

opinions about the IDI.

 41

Reflexivity

In conducting qualitative research, the “subjectivity of the researcher and of those

being studied becomes part of the research process” (Flick 2018, p.16). Reflexivity is

defined as an attitude of attending systematically to the context of knowledge

construction, especially to the effect of the researcher, at every step of the research

process (Malterud, 2001).

Reflexivity should be considered since this research study employs qualitative

research design. We, the researchers, are the instruments and it is necessary that we

explore our own points of view about the cultural beliefs and practices of women

throughout their pregnancy. All of us are registered midwives and currently working in

various lying-in and hospitals. Three of us are mothers who have experienced giving

birth. We do hold some beliefs and followed various practices surrounding our pregnancy

that are mainly based on culture and traditions. We are also instructed or even imposed

some of these beliefs and practices to our clients. To ensure that we do not impose these

personal beliefs, we, as a group. talked about our preconceived ideas about our personal

and professional cultural beliefs and practices that have been handed down from

generations, which may or may not have any scientific basis. Our group talk happened

after all the data needed, were gathered. It has been recorded and transcribed.

As researchers who are searching for truth and reality hence, we tried to be aware of our

personal biases to meet the intention of this research to explore the perinatal cultural

beliefs and practices of mothers. It is imperative that we also reflect on our thoughts,

actions, observations, impressions, irritations, etc. We had peer debriefing every after

interviews and documented research diaries to ensure quality of our data.

 42

Ethical Considerations

Ethical considerations have been followed throughout this study. Manila

Adventist College Ethics Review Committee approved our research study. The Consent

form with Filipino translation was used (see Appendix B). Confidentiality of the

information as well as anonymity of the participants was observed. All the original

names of the participants were not used in this report, instead, a pseudonym was

employed for each participant. All collected data has been saved in a password-protected

computer and only us, the researchers, and our adviser have access to the data. One year

after the data gathering, all the data collected will be destroyed and deleted (see

Appendix F for the Ethics Approval form).

 43

Chapter 4

Results and Discussions

This chapter presents the data analysis and interpretation. The data we gather here

includes the themes of perinatal cultural beliefs and practices of women in Laguna,

Philippines. The interpretation and analysis of the researchers are also included in this

chapter. The statement of participant with their pseudonyms supports them.

Cultural Beliefs and Practices during Pregnancy

Three themes emerged upon analysis of the transcript on the cultural beliefs and

practices of women during pregnancy. It includes (1) protection of baby’s welfare, (2)

promotion of healthy pregnancy, and (3) safety against bad elements (see Figure 2).

Protection of baby’s welfare. Protection of baby’s welfare is defined as those

beliefs and practices of women and mothers that are focused on ensuring a good future to

the unborn child and keeping him/her from harm. It has three sub-themes namely: (1)

myths about food; (2) myths on activities; and (3) dietary undertakings with scientific

basis (see Figure 3).

Myths on food. Myths on food is defined as the beliefs and practices during

pregnancy on food consumption or abstinence that are believed to protect the fetus but do

not have any scientific basis. These myths include either promoting or avoiding certain

food with the thought of upholding for the welfare of the unborn child. Certain foods

were promoted so that the unborn child will develop a good skin complexion while other

foods are avoided to prevent twin pregnancy or fetal deformities. As shown in Figure 3,

these myths include: (1) avoid eating eggplant and promote eating turnip and young
 44

coconut to promote fair skin complexion of the fetus, (2) avoid twin foods to prevent twin

pregnancy, and (3) avoid eating crabs to avoid fetal deformities.

Figure 2

Themes of Cultural Beliefs and Practices during Pregnancy

Avoid eating eggplant and promote eating turnip and young coconut. The

participants believe that avoidance of eggplant, but consumption of turnip and young

coconut could promote development of fair skin of the fetus. Phebe, a 32-year-old

mother, said, “Ang una bawal po kumain ng talong kasi po nakakaitim daw ng bata.”

(First, eating eggplant should be avoided since it can cause the child to have dark skin).

Riza, a 27-year-old mother, also held the same belief. She stated, “Huwag daw ako

kakain ng talong kasi daw nakakaitim ng baby” (I should not eat eggplant because it can

cause the child to have dark skin). On the other hand, Jean, a 32-year-old postpartum,

mentioned, “[Kumain ako ng] buko at singkamas para maputi ang baby.” (I should eat

young coconut and turnip so that the baby will have fair skin).

The skin color or complexion of a child is deemed to have a strong influence on

the choice of food of mothers. The participants believe that having fair skin is attractive
 45

to others. It is thought that avoiding eggplant would prevent dark complexion of the child

while singkamas (turnip) or buko (young coconut) are consumed to promote fair and

smooth skin.

Figure 3

Theme 1: Protection of the Baby’s Welfare

 46

Fair skin is an advantage in many cultures. Some pregnant women may avoid

eating black foods to avoid the birth of an infant with a dark skin tone (Catherin et al.,

2017). India has similar beliefs about promotion of fair skin for baby. For them, skin

color of the baby was a priority. Fairer skin is attributed to increased physical

attractiveness and all efforts were taken by the parents to lighten the skin color (Catherin

et al., 2017). According to Yeasmin and Regmi (2013), pregnant women should eat more

fruits so their baby’s skin will be nicer and smoother. Further, in a survey conducted by

the Japanese, Filipino mothers moderately agreed that eating light-colored foods will

cause the baby to have a white complexion and others (Ocampo & Moriya, 1992).

Eating turnip and young coconut and avoiding eggplants to promote fair skin

complexion are myths since skin complexion is mainly determined by genetics (Rees,

2003). Although certain fruits and vegetables can help enhance baby’s skin during

pregnancy, making it radiant and healthy, the skin color is mainly determined by

genetics. Moreover, if a pregnant woman will avoid eggplant during her pregnancy, she

might miss some minerals found in this vegetable. According to Ipatenco (2017), eating a

serving of eggplant will supply the mother and the developing fetus with small amounts

of key nutrients. One serving of cooked eggplant delivers about three percent of the 15

milligrams of vitamin E the woman needs each day to support the formation of the baby's

red blood cells and muscles. Further, about two percent of the 600 micrograms of folic

acid needed by the pregnant mother is provided by this vegetable, which could reduce the

baby's risk of birth defects.

On the other hand, eating large amount of eggplant is not recommendable.

Various studies have found (Oshiro et al., 2008) that eggplants have significant amount
 47

of harmful chemicals such as nicotine, scopolamine, and atropine. It is found that nine (9)

kilograms of eggplant contain the nicotine of a cigarette stick. Hare (2017) article stated

that eggplant seeds, which are the tiny, grainy pieces inside the flesh of typical eggplants,

are unavoidable when eating the vegetable. They add texture and flavor, and they are

embedded in almost every bite. However, the insides of their seeds contain trace amounts

of nicotine — the substance primarily responsible for the addictive properties of

cigarettes. In the study of New England Journal of Medicine (Domino et al., 1993),

eggplant has the highest concentration of nicotine but according to the New York Times,

eggplant contains nicotinic acid, which has a similar molecular structure to nicotine, but

is not the same thing as nicotine, and does not have nicotine's addictive or stimulating

properties. The Times further states that the nicotinic acid in eggplant makes it an

excellent source of niacin, an essential vitamin for blood and brain function (Pelsue,

2017). Hence, eggplants can improve the nutrition of both the mother and the baby but

due to the significant amount of nicotine and other chemicals, which might cause bad

effects to their health, it is recommended to eat eggplants in moderation.

Some participants believe that eating fruits smooth in texture like young coconut

and turnip for smooth and fairer skin. This belief is a myth since genes mainly influence

the development of a fair skin of the fetus. However, eating nutritious foods have

properties that nourish the skin of both the mother and the baby (WholesomeBabyfood,

n.d.).

Avoid eating twin foods. Another belief during pregnancy is avoiding

consumption of twin foods like twin banana to prevent twin pregnancy. Myra, a 29-year-

old postpartum mother said, “Bawal ang kambal na saging, baka kambal din ang
 48

magiging anak.” (Avoid eating twin banana for it may cause to have twin baby). Lyka, a

35-year-old mother, said, “Bawal kumain ng kambal na saging baka maging katulad din

(sa pagbubuntis).” (Twin banana should be avoided; it can be the same in pregnancy).

The participants believe that eating twin food like banana will prevent having

twin pregnancy. In a survey among mothers in Ilocos sur, Philippines, mothers agreed

that the pregnant woman could avoid giving birth to twins if she will not eat twin fruit

like bananas (Bermio & Reoututar, 2017).

However, having fraternal twins occurs when two eggs are fertilized by two

sperms and identical twins when a zygote splits to form two embryos and is not

influenced by any food consumption. This myth has two explanations, some pregnant

women claim that twin bananas will lead to have to separate twins while other insist on

conjoint twin, which is a condition wherein twins are born with part of their bodies joint

together. However, this myth has no scientific evidence.

Avoid eating crabs. Another belief is the avoidance of crab in the diet of a

pregnant woman to avoid fetal deformities. Riza, a 27-year-old mother stated, “Huwag

din daw kakain ng mga alimango kasi daw baka yung baby ko ay kulang-kulang yung

parts.” (Do not eat crabs for it can cause my baby to have missing body parts).

The participant believes that by eating crabs, the child could develop fetal

deformities. According to a survey to Filipino Japanese mother, they agreed that pregnant

women would avoid eating crabs so that malformation of hands or feet will be avoided

(Ocampo & Moriya, 1992).

However, WHO (2016) defined congenital anomalies as structural or functional

anomalies that occur during intrauterine life. WHO explained that fetal development
 49

defects are multifactorial; it is caused by a combination of genes and environmental

exposures. In other words, a person can inherit a gene that increases sensitivity to an

environmental trigger. Examples include cleft lip or palate, certain heart defects, and

neural tube defects. On the other hand, environmental factors are exogenous birth defects

occur due to various teratogenic factors (industrial poisons, smoking, alcohol, viruses,

medicines and much more). Hence, it is not true that crabs can cause birth defects.

However, eating raw crabs causes an increased risk of food poisoning not only to

pregnant women but also in older adults and children (Nall, 2018). Further, crabs are rich

in a variety of vitamins and minerals, especially proteins, fatty acids, copper, zinc,

calcium, manganese, iron and many others (Arora, 2018), which are essential to maintain

pregnant women’s health as well as baby’s well-being throughout pregnancy.

Further, crabs are high in fat or omega 3 fatty acids that may help provide

protection from heart disease and aids brain development. Crabs are also rich in protein

and vitamins and minerals that boost our immune system (Arora, 2018). Therefore, this

belief is a myth since genes are mainly responsible to fetal development. Pregnant

women could miss nutrients that they are needed by avoidance of eating crabs.

Myths on activities. The second subtheme is the myths on activities. It is defined

as the promotion or avoidance of various activities that do not have scientific basis. It has

three sub-themes namely, (1) avoid exposure to “hamog” or dew (2) avoid looking at or

commenting about unpleasant things, and (3) avoid wearing jewelry (such as necklace) or

placing towel on the shoulders. (See Figure 3).

Avoid exposure to “hamog” or dew. According to the participants, avoiding

exposure to “hamog” or dew is important to prevent conceiving a sickly child. Myra, 29

 50

years old, said, “Bawal maserinohan kapag gabi at kapag pahapon ‘Yun ang sabi ng

matatanda kasi sisipunin, at saka yung bata sisipunin din” (I should avoid dew every

night and during dusk. Elders instruct us that it can cause colds to pregnant women as

well as to unborn child). In addition, Jazmine, a 23-year-old mother said, “Bawal

mahamugan…magiging sakitin ang anak ko.” (I should not expose myself to dew… my

child will become sickly).

Hamog is defined as “the moisture in the air that can be seen” (Tagalog

Dictionary, n.d). It can be translated as fog, mist, or dew. Jocano (1970) found in his

study that in going out in the afternoon, a pregnant woman must cover her head with a

piece of cloth in order to prevent the cold air (sareno) from entering at the crown of her

head else, she will have a blue baby.

Exposure to cool air or “hamog” does not directly cause illness. Colds are caused

by viruses and not by cold water or moisture. The best way to avoid getting a cold is by

avoiding exposure to infected people (Herrera, 2015). As midwives, we emphasized to

the mothers the importance of prenatal consultation, to guide them and have awareness of

possible consequences of their beliefs and practices. We also recommend following

precautionary measure to avoid getting viruses like proper hand washing.

Avoid looking at or commenting about unpleasant things. The participants believe

that it is important to avoid looking at or commenting about unpleasant thing to prevent

fetal deformity. Riza, 27-year-old postpartum, said, “Huwag din daw ako titingin sa mga

pangit na litrato, yung mga hindi kaaya-aya sa paningin at sa may mga kapansanan wag

ko daw titignan o lalaitin kasi daw magiging ganun din yung baby ko.” (I should not look
 51

at ugly pictures, those that look unpleasant, and people who have deformities. I should

not insult them so that my baby will not look like them).

The participant believes that by looking or commenting about unpleasant things

can contribute for having fetal deformities. Other studies have shown similar result on

avoidance of looking certain things that are believed to potentially have negative effects

in the fetus. In the study of Bermio and Reotutar (2017), they found that pregnant women

are discouraged from watching lunar eclipse because it will cause her to bear child with a

cleft lip. In addition, Chang et al., (2016) found that pregnant women should not watch

scary movies for it may cause pre-term labor.

The negative physical effect of looking at or commenting about unpleasant things

does not have scientific basis. Genes is responsible for the physical features of the child.

However, the mother’s mental state can affect the growing fetus.

Further, fetal deformities are found to be caused by various factors such as

genetics factors and variety of environmental injuries such as infections, radiation and

drug exposure during pregnancy. However, Sandman et al., (2011) have found out that

environment is very important to a growing fetus. Some effects are obvious, like in

smoking and drinking it is going to be devastating. As midwives, it is therefore

important to emphasize regular prenatal check-up so that pregnant women will be

assessed properly including their mental status.

Avoid wearing jewelry or placing towel on the shoulders. Participants believe that

not wearing jewelry (such as necklace) or placing towel on the shoulders could prevent

cord coil. Edwill, 35-year-old married woman who is at 37 weeks of pregnancy, said,

“Yung pagsusuot ng kuwintas, [at] bracelet [ay] bawal, para hindi mapulupot yung
 52

pusod.” (Wearing necklace and bracelet is prohibited to avoid cord loop). Further, Jean, a

32-year-old mother, remarked, “Huwag daw maglalagay ng tuwalya sa balikat dahil

pupulupot daw ang pusod sa leeg.” (Do not place towel on the shoulder for it can cause

the umbilical cord loop).

There are similar studies that pregnant women believed that wearing anything

around the neck could cause cord coil. In the studies of Chang et al., (2016), they found

out the belief that wearing anything around the neck causes the umbilical cord to wrap

around the fetus.

Wearing jewelry or placing towel on the shoulders does not cause cord coil in

developing fetus. Random fetal movement, extra-long umbilical cord, or excess amniotic

fluid (Horsager-Boehrer, 2008) causes cord coiling. Further, Patil et al., (2013) explained

that the pattern of coiling develops during second and third trimesters, presumably due to

break in the cord (cord prolapse) and this coiling changes as pregnancy advances.

Dietary and activity undertakings with scientific basis. The last subtheme is the

dietary and activity undertaking with scientific basis. It is defined as promotion or

avoidance of certain food and activity to protect the unborn child’s welfare, which are

found to be clinically proven. This sub-theme has three categories namely, (1) promote

consumption of nutritious food, (2) avoid overeating, and (3) have light exercise and

early morning walk (see Figure 3).

Promote consumption of nutritious food. Promoting nutritious food consumption

for a healthy fetus is deemed important for the participants. Riza, a 27-year-old mother,

said “Dapat tama lang daw yung kinakain ko masustansya para sa’min ng baby ko

maging healthy.” (I should eat nutritious food for my baby’s health and mine).
 53

The participants believe that eating nutritious food is important during pregnancy.

In the study of Nierenberg (2018), they found out that eating nutritious food is the main

goal during pregnancy. They emphasized the importance of prenatal nutrition including

the five-food group (fruits, vegetables, lean protein, whole grains and dairy). In addition,

Turner’s (2017) study found that Cambodians believe that pregnant women should eat

food so they would be strong to deliver their baby. Furthermore, Catherine et al., (2015)

found out that most mothers agreed that green leafy vegetables, rice, less spice, bread,

ragi, jowar, groundnut powder, meats, eggs, fruits like apple, mosambi, and sapota

improve the health of mother and child. According to Indian beliefs, the antiemetic

properties of condiments like rasam, coriander powder, and red chilli powder were more

routinely consumed during first trimester. Chicken, mutton and green leafy vegetables are

thought to be galactogogues and are consumed ante-natally usually from second trimester

onwards, to ensure a bountiful supply of milk to the newly born. Ridge guard, rice, white

pumpkin, and green beans were considered to have cooling properties and were given to

majority of mothers during the antenatal period. Fish was particularly stressed upon with

regard to its ability to improve the intelligence of the baby. Closer to term certain food

practices like eating the meat of a lamb’s head was followed by few mothers. They

believed that this would help the newborn child attain head control earlier and achieve

motor milestones quicker.

Nutrition is vital in the development of both the mother and the baby. Mothers are

encouraged to eat a well-balanced diet throughout their pregnancy to improve the overall

health and welfare of the baby. The midwife’s response is encouraged to promote

nutrition and wellness to pregnant mothers in the community.

 54

Avoid overeating. Avoiding overeating is having moderation in food consumption

during pregnancy to prevent difficult childbirth. Jelai, a 24-year-old mother, stated, “At

saka dapat daw konti lang yung kakainin para hindi masyado lumaki yung bata at hindi

ka mahihirapan sa panganganak.” (And it was advised that I should eat less so that the

baby will not grow bigger that can cause difficult in delivery). In addition, Riza, a 27-

year-old mother, remarked, “Sinabi ni mama na huwag daw ako kumain ng kumain kasi

daw lalaki yung baby ko, mahihirapan daw ako manganak.” (My mother told me that I

should not eat a lot because my baby will become big; I might have a hard time giving

birth).

Indian women have similar beliefs. They are encouraged to increase the number

of meals, which is supposed to be of prime importance during the first and second

trimesters. It is considered to be quintesssential by most mothers for maternal and child

health. “Increased quantity of food is important during antenatal period as they need more

nutrition for themselves and the growth of the baby.” However, during the last trimester

food consumption is reduced to avoid abdominal distension (Catherin, et, al, 2015).

This belief and practice during pregnancy should be encouraged since excess

weight gain during pregnancy risks the mothers of pre-eclampsia, premature birth,

emergency caesarian section, and development of gestational diabetes (Hartley, 2015).

Difficulty in childbirth is associated with weight gain as it increases the likelihood of

larger newborns in pregnant women. The Institute of Medicine recommends that women

with a body mass index in the normal range (between 18.5 and 24.9) gain 25 to 35

pounds during the course of a pregnancy (Kaplan, 2015). Women who start out

underweight (with a BMI below 18.5) should put on 28 to 40 pounds while pregnant;
 55

women who are overweight should add 15 to 25 pounds and obese women should gain

only 11 to 20 pounds during their pregnancies. Midwives should advise pregnant women

to take precautions and monitor their weight during prenatal checkup to decrease their

chances of having difficulty during childbirth.

Have light exercise and early morning walk. Participants believe that light

exercise and early morning walk could hasten delivery. Phebe, a 32-year-old mother,

stated, “Nag e-exercise unang una po naglalaba as exercise at saka naglalakad-lakad

paggising sa madaling araw.” (I do exercise, like doing the laundry and walking upon

waking up at dawn).

Exercising regularly during pregnancy can improve health, reduce weight gain

risk and back pain, and make delivery easier (Miller, 2017). According to an article, not

every women should exercise like those with medical condition; those with heart disease,

restrictive lung disease, and incompetent cervix; those who have premature labor and

premature rupture of membranes; those with pre-eclampsia or pregnancy induced

hypertension; and those who have persistent second and third trimester bleeding and

placenta previa (Wood, 2010). As midwives, we advise the pregnant women to talk or

consult an obstetrician-gynecologist to make sure that they are qualified to exercise.

Protection of baby’s welfare is defined as beliefs and practices of women and

mothers that are focused on ensuring a good future to unborn child and keeping him/her

from harm. It has three sub-themes. First, myths about food is defined as the beliefs and

practices during pregnancy on food consumption or abstinence that are believed to

protect the fetus but do not have any scientific basis. Secondly, myths on activities is

defined as the promotion or avoidance of various activities that do not have scientific
 56

basis. Lastly, dietary and activity undertakings with scientific basis is defined as

promotion or avoidance of certain food and activity to protect the unborn child’s welfare

which found to be clinically proven.

As midwives, we want to emphasize the importance of prenatal checks to all

pregnant women, for us to guide and monitor the mother and baby inside them

throughout their pregnancy for better maternal and child outcome.

Promotion of healthy pregnancy. The second theme that was developed during

the data analysis is the promotion of healthy pregnancy. It is defined as the beliefs and

practices during pregnancy that promote wellness among pregnant women. It has three

subthemes namely, (1) myths on food and activities that hasten childbirth, (2) myths on

food and activities that prevent complications of pregnancy, (3) activities to prepare for

childbirth (see Figure 4).

Myths on food and activities that hasten childbirth. The first subtheme is the

myths on food and activities that hasten childbirth. It is defined as the beliefs and

practices on food and activities that are either encouraged or prohibited which do not

have scientific evidences. It includes three subthemes (1) drink rice water; (2) avoid

stepping over a rope; and (3) apply bigkis (see Figure 4).

Drink rice water. Participants believe that drinking rice water would hasten the

delivery of the fetus. Moneen, a 29-year-old mother, stated “...Pagdating mo daw ng six

months or seven months kukuha ka ng hugas bigas... tapos inumin mo sya ... para daw

mabilis lumabas yung baby” (When you reach about six to seven months [of pregnancy],

you should get rice water…then you drink it…to have a faster childbirth).
 57

A similar study found drinking rice water would make the childbirth easy. In the

study of Liamputtong et al., (2009), they found out that women in Thailand are advised

by older people to undergo magical shower which has been blessed by sacred word nam

mon to facilitate and easy and safe delivery. And every woman who are about to give

birth are given a cup of nam mon to drink and prevent rising childbirth blood rise to the

chest.

In getting enough fluids, drinking rice water for pregnant women is a safe way

(Cognac, 2017). Rice water is good for hydration and may affect the health of the

pregnant woman positively. As midwives, we encourage pregnant mothers to promote

health and wellness through eating nutritious foods to pregnant women as long as it does

not affect their overall health negatively. Rice is a source of energy. It is rich in vitamins

and minerals.

It also prevents constipation and contains neurotransmitter nutrients. Eating rice

in pregnancy helps improve brain developments and the baby’s cognitive function.

However, we advise to lessen the consumption of rice as it may cause to have weight

gain.

Avoid stepping over a rope. The participants believe that stepping over rope

should be avoided to prevent a prolonged or overdue pregnancy. Rosel, a 28-year-old

mother, remarked, “Tapos yung huwag lalaktaw sa lubid ng mga tali para hindi matagal

magbuntis.” (Then, do not step over a rope, to avoid being overdue).

There is a similar study that pregnant woman believes that stepping over rope can

cause prolonged pregnancy. According to the book “Multicultural clients: A professional

 58

Figure 4

Theme 2: Promotion of Healthy Pregnancy

 59

handbook for health care provider and social worker” by Lassiter (1995), walking

over the rope could result in delayed expulsion of placenta.

Further, Institute for Quality and Efficiency in Health Care (2008) stated that

longer pregnancy or overdue is sometimes determined by genetic disposition or

hereditary and stepping over ropes is not one of its causes as its cause is usually

unknown. The midwives advise the importance of regular prenatal check-up so that they

are monitored properly and may be referred to a higher facility if needed.

Apply “bigkis”. It is believed that the application of bigkis would hasten

childbirth. Weng, a 37-year-old mother, cited “…Yung bigkis ilalagay…ginagamit kapag

buntis…para madaling manganak.” (The cloth… worn during pregnancy could make the

delivery easy).

The participant believes that applying bigkis facilitates easy childbirth. Bigkis is a

thin cloth that wrap around the abdomen. Aeta women wear a piece of cloth (bigkis).

They believe that by wearing it, blood could be prevented from rising towards the heart.

This is worn all the time. It should not be too loose to prevent “bughat” which according

to them, is caused by air rising up towards the head. A month after giving birth, the Aeta

woman’s “bigkis” may be removed (Grey, 2016).

Applying cloths around the abdomen (bigkis) to ease and hasten childbirth is a

myth. Bigkis has no scientific evidence that it can help hasten childbirth. In fact, if the

bigkis is worn tightly, the women may have difficulty of breathing and it may affect the

baby inside the womb. As midwives, we suggest that they can practice their beliefs as

long as it may not cause harm to both mother and child.

 60

Myths on food and activities that prevent complications of pregnancy. The

second subtheme that emerged under the promotion of healthy pregnancy is myths on

food and activities that prevent complications of pregnancy. It is defined as the beliefs

and practices during pregnancy on food consumption and activities that are prohibited

which do not have scientific evidences. It includes five subthemes namely (1) avoid

pineapple consumption, (2) avoid running, (3) avoid soaking the body on water, (4) avoid

lifting heavy objects, and (5) avoid putting money on clothing (see Figure 4).

Avoid pineapple consumption. Women believe that avoiding the consumption of

pineapple during pregnancy could prevent miscarriage. Rina, a 30-year-old mother, said,

“Bawal kumain ng pinya kasi daw nakakalaglag ng baby.” (Pineapple should not be

eaten because it can cause miscarriage).

Some foods are also avoided to avoid miscarriage. Similar studies like that of

Wilde (2013) found that miscarriage is due to unfulfilled cravings of foods. In addition,

Washington (2015) found that pregnant women must avoid eating or even preparing

cooling foods, like ice cream, watermelon, bananas and mung beans among the Chinese

because such foods have too many yin qualities, and might cause a miscarriage.

Eating pineapple while pregnant does not cause miscarriage or early labor. No

scientific evidence supports that pineapple can be harmful during pregnancy (Marcin,

2016). Consumption of pineapple does not cause miscarriage or early labor to pregnant

women but rather gives additional intake of vitamin C. Mothers are advised to have a

balanced diet to provide good nutrition to the fetus inside the womb. A miscarriage is the

spontaneous loss of a pregnancy from conception to 20 weeks gestation. The most

common causes of miscarriage are chromosomal abnormality where the genetic material
 61

from the sperm and egg do not fuse together appropriately. Other causes are infection,

incompetent cervix, and abnormal uterus (Hill, 2011).

Avoid running. The participants believe that running should be avoided for it can

cause miscarriage. Jazmine, a 23-year-old mother said, “Bawal daw magtakbo ng

magtakbo kasi daw baka malaglag ang bata.” (They said running should be avoided

because if may cause miscarriage).

For those who have uncomplicated pregnancies, there is no harm in maintaining

exercise routine as running for it cannot cause miscarriage or hurt the baby (Burrel,

2018). Running and other associated activities do not cause miscarriage as long as the

mother is not in complicated pregnancies and when done in prescribed duration. Mothers

are encouraged to maintain an exercise routine for their fitness and preparation for the

delivery of the baby. The community is encouraged to promote fitness through exercising

to women with uncomplicated pregnancies.

Avoid soaking on water. Soaking on water when doing household chores is

believed to cause miscarriage. Jazmine, a 23-year-old mother, stated “Tapos ‘yan di ba

pag kunwari maglalaba ka huwag ka magbabasa, magbabad kasi malalamigan daw at

malaglag ang bata.” (And when you are doing the laundry do not soak yourself for you

might have miscarriage).

Some activities are avoided to prevent miscarriage. This finding is similar to the

study of Steward’s (n.d) that soaking in water at the temperature of 39-degree Celsius can

cause a drop in blood pressure, decreasing nutrient and oxygen supply and will most like

cause a miscarriage. Soaking in water at temperature not exceeding the prescribed

amount and time cannot be harmful to both the mother and the baby. Pregnant women are
 62

encouraged by the midwives to take a bath and refrain from soaking in water at

temperatures that exceed the prescribed amount to prevent miscarriage. The most

common causes of miscarriage are chromosomal abnormality where the genetic material

from the sperm and egg do not fuse together appropriately. The others are infection,

incompetent cervix, and abnormal uterus (Hill, 2011).

Avoid putting money on clothes. The fourth subtheme is to avoid carrying

anything on the clothes being worn by the pregnant women. The participants believe that

putting money on clothing is to be avoided because it can cause placenta previa and

dystocia. Moneen, a 29-year-old mother, said, “Masama rin daw yun ‘di ba tayo hilig

magkakandong… sa may damit kahit ano, kahit pera… kasi parang sunong daw kasi

yung inunan ng bata.” (It is harmful when you carry anything on your clothes, even

money...you might have placental previa).

There are some activities that are believed to avoid placenta previa and dystocia.

For instance, Owonikoko and colleagues (2017) found that women use safety pins that

are commonly used to fasten pieces of fabrics or clothing together and may help against

demon and protect the unborn child.

Placing money on clothes is a myth. There are no scientific studies that proved

that it really helps avoiding dystocia and placenta previa. Placenta previa cannot be

prevented, as pregnant women do not have control where the placenta connects with the

uterus (Millbrand, n.d.). Dystocia can happen during any vaginal birth, and it is

impossible to predict whether dystocia will happen. Mothers are allowed to conform to

their cultural belief as long as it does not affect their own welfare and the baby’s

negatively and without sacrificing their overall health.

 63

Activities to prepare for childbirth. The last subtheme in the promotion of healthy

pregnancy is the activities to prepare for childbirth. It is defined as the beliefs and

practices of women during pregnancies that are scientifically proven to promote a healthy

pregnancy by preparing themselves for childbirth. It includes three categories namely, (1)

avoid lifting heavy objects, (2) promote physical activity, and (3) have daily bath (See

Figure 4).

Avoid lifting heavy object. The third subtheme under the promotion of healthy

pregnancy is avoiding lifting heavy objects. It is believed that avoiding lifting heavy

objects can prevent miscarriage. Rina, a 25-year-old mother, said, “Bawal daw magbuhat

ng mabibigat baka malaglag.” (Lifting heavy objects is prohibited for it can cause

miscarriage).

Activities like carrying heavy objects can cause miscarriage. It is a common

belief, especially in Asian communities. Gonzales (2017) argued that lifting heavy

objects can weaken one’s body and put the pregnancy in danger.

The most common problems that can increase a woman’s risk of losing her baby

are chromosomal abnormalities, which account for the majority of failed pregnancies,

uterine abnormalities, incompetent cervix and infections (Gonzales). In addition, Stewart

(n.d.) stated that lifting objects frequently especially in jobs that require physical labor

may slightly elevate the risk of having a miscarriage or a baby with low birth weight. The

risk of miscarriage slightly increases for pregnant women who lift heavy objects more

frequently. Mothers are advised to avoid lifting heavy objects during pregnancy, and

rather just ask other family members and coworkers to do the lifting to avoid potential

miscarriage.
 64

Promote physical activity. The participants believe that physical activity should

be promoted to prepare for childbirth. Body movement is recommended to prepare for

childbirth. Riza, 27-year-old stated, “…Kailangan daw gumalaw galaw ako para daw

yung katawan ko eh maging handa kapag nanganak.” (…I need to move my body so that

I can be prepared in giving birth).

Maintaining physical activity in all phases of life especially during pregnancy

promotes health benefits. Hopkins (2019) stated that pregnancy is a recommended time in

maintaining a healthy lifestyle. Consistent body movements and physical activity during

pregnancy prepare the mother’s body for childbirth and promote health benefits. Mothers

are encouraged to maintain physical activity even at home to keep their fitness and health

and prepare their body for childbirth. However, pregnant women must consult their

midwives or physician before doing exercise, because there is some instance that

exercising during pregnancy could be harmful to you and the child.

Have daily bath. Daily bath is deemed important for pregnant women.

Phebe, a 32-year-old mother “Paliligo araw araw naman yun ay importante sa katawan

sa kalusugan ng katawan natin at lalong lalo na sa baby.” (Taking a bath everyday is

important for a healthy body and for baby’s welfare).

Daily bath is recommended to pregnant women. According to Valm (2019)

article, pregnant women should not take a bath that is hot enough to raise their core body

temperature to 38-39 degree Celsius (101-102°F) for more than 10 minutes. Exceeding

temperature 38-39 degree Celsius can cause a condition known as hyperthermia, a

condition in which the body absorbs more heat than it repels. Studies have linked a high

core body temperature, especially early in pregnancy, with neural tube defects like spina
 65

bifida. In addition, Philipps (n.d) found out that baths can decrease swelling in arms and

legs, increase amniotic fluids, and avoid premature contractions. Daily bath can be

beneficial to pregnant women with the right temperature and duration. Keeping in mind

the water temperature and length of the bath.

Promotion of healthy pregnancy is the second theme that was developed during

data analysis. It is defined as the beliefs and practices during pregnancy that promote

wellness among pregnant women. It has three sub-themes. (1) Myths on food and

activities that hasten childbirth are defined as beliefs and practices on food and activities

that are either encouraged or prohibited, which do not have scientific evidences. (2)

Myths on food and activities that prevent complications of pregnancy are defined as

beliefs and practices during pregnancy on food consumption and activities that are

prohibited and do not have scientific evidences. (3) Activities for healthy pregnancy are

the beliefs and practices of women during pregnancies that are scientifically proven to

promote healthy pregnancy.

For midwives, mothers are encouraged to believe what they want to as long as it

does not put their life and their baby’s in danger. In addition, we want to emphasize to

the mothers the importance of prenatal check-up for the better outcome of their

pregnancy.

Safety against bad elements. The third theme that emerged in the data analysis is

safety against bad elements. Safety against bad elements is defined as the beliefs and

practices during pregnancy that protect the pregnant woman and her fetus against

supernatural beings such as aswang, maligno, or titktik. Aswang is described as terrifying

vampire ghouls of the Philippines (Valdeavilla, 2018). Maligno / Engkanto is described

 66

as nature fairies and spirits. They are said to be angels who revolted with Lucifer against

the lord (Piccio, 2013). Tiktik is described as a bird that serves as a spotter for its aswang

master. The tiktik makes a loud sound “tik-tik-tik” chirp that serves as a warning. (Piccio).

As shown in Figure 5 it includes four subthemes, namely, (1) put salt on the

window, (2) apply calamansi juice on the abdomen, (3) place red cloth on the abdominal

area, and (4) keep a tail of a stingray.

Putting salt on the window. Placing salt at the window of a pregnant women

among is believed to avoid aswang, engkanto maligno, etc. Edwil, a 35-year-old mother,

stated, “At saka sa yung paglalagay ng mga asin sa mga bintana para daw hindi

aswangin.” (And you should put salt on the window so that the “aswang” will not come).

On the other hand, Weng, a 37-year-old mother mentioned “Tapos sa bahay naman

naglalagay ako ng bawang, asin at kalamansi sa may bintana, pangontra sa aswang.”

(Then at our house I put garlic, salt and calamansi on our window as an antidote against

aswang). Cristy, a 30-year-old mother, stated “At saka kapag matutulog na dapat

maglalagay sa may bintana ng bawang at asin para di lapitan ng aswang.” (And when I

am going to sleep, I put garlic and salt on the window to prevent coming of aswang).

Apply calamansi juice on abdomen. Applying calamansi juice on the pelvic area

of pregnant women is thought to keep the aswang, engkanto, or maligno away.

Rose, a 43-year-old mother said, “Bago ako lumabas o sakali ako lumabas

magbibiyak ako ng kalamansi yung katas ihahaplos ko sa puson ko kasi kapag hinaplos

mo daw sa puson hindi na makikita ng mga malign.” (Before I go or if I go out, I slice

calamansi then rub it on my hypogastric area so that bad elements will not see you).
 67

Figure 5

Theme 3: Safety Against Bad Elements

Some food spices that are found in our kitchen are believed to protect against bad

elements. Mothers should be protected from environmental harms that could also affect

the babies’ welfare and health especially from bad elements. Mothers are advised to

believe in what they want to as long as it does not affect their health and their baby’s

health, and their wellbeing is not harmed.

Place red cloth on the abdomen while sleeping. Placing red cloth on the abdomen

of a pregnant woman while sleeping is thought to avoid aswang, engkanto, or maligno.

Edwil mentioned, “At saka yung paglalagay ng telang pula sa ibabaw ng tiyan habang
 68

natutulog para malayo daw sa mga engkanto.” (Red cloth should be placed on the

abdomen while you are sleeping so that the engkanto will stay away).

Some of these beliefs have been documented few decades ago. Jocano (1970)

reported that pregnant women believed they must not use a white blanket or white

pillowcases because she will be attacked by the engkanto (supernatural beings).

Keep a tail of a stingray. Keeping stingray tail at home is thought to avoid tiktik.

Riza stated, “Yung buntot pagi, pang laban daw yun sa tiktik.” (The stingray tail could

fight against tiktik). On the other hand, Weng, a 37-year-old mother stated “At saka yung

buntot pagi dapat lagi mo dala yun kung lalabas pangontra aswang yun.” (And you

should always bring with you the stingray tail when you go out. It is an antidote against

aswang).

Filipinos use stingray tail to protect them from aswang (Valdeavilla). They also

use salt, garlic, and ginger as a weapon to ward off these terrifying creatures (which is

convenient considering those are key ingredients in Filipino cooking).

Safety against bad elements is the last theme. It is defined as beliefs and practices

during pregnancy that protect pregnant women and her fetus against supernatural beings

such as aswang, malign or tiktik.

Mothers should be protected from harm especially when they are sleeping as the

mother’s health is directly affecting the babies. Mothers are advised to believe in what

they want to as long as it does not affect their health and their baby’s health as well as

their own comfort. In addition, we must respect and be aware to our differences when it

comes to our cultural norms.

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Cultural Beliefs and Practices during Childbirth

This section discusses the cultural beliefs and practices of women in labor and

childbirth. It has two themes that include (1) facilitating factors in childbirth and (2)

promotion of comfort during childbirth (See Figure 7).

The first theme in cultural beliefs during childbirth was facilitating factors in

childbirth. It is defined as beliefs and practices that are thought to hasten the delivery of

the fetus. Under this theme are two sub-themes namely (1) physical and socio-spiritual

preparedness and (2) myths on food that promote labor and expel sumilim (placenta

previa) (see Figure 8). The second theme in cultural beliefs during childbirth is the myths

on activities. It is defined as beliefs and practices of women during labor that the mothers

believed that it has assurance for successful and comfortable childbirth. It includes (1)

myths to promote labor and hasten childbirth and (2) myth to lessen labor pain.

Facilitating factors in childbirth. Facilitating factors in childbirth is the first

theme that emerged in cultural beliefs and practices during labor and childbirth. It is

defined as beliefs and practices that are thought to hasten the delivery of the fetus. Under

this theme are two sub-themes namely (1) physical and socio-spiritual preparedness and

(2) myths on food that promote labor and expel sumilim (placenta previa).

Physical and socio-spiritual preparedness. Physical preparedness is defined as

the beliefs and practices that women perform during the active stage of labor. These

activities include (1) taking a bath, (2) praying, (3) having a companion during labor, and

(4) promoting physical activity. (See Figure 8)

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Figure 6

Summary of Cultural beliefs and Practices during Pregnancy

 71

Figure 7

Themes of the Cultural Beliefs and Practices during Childbirth

Taking a Bath. The participants believe that taking a bath should be encouraged

during labor to feel fresh and to help activate labor. Geraldine, a 35-year-old mother

stated, “Ako noon yung first baby ko [noong] nilabasan ako kahit bahid ng dugo [ay]

naligo na ko, tuloy tuloy na yung sakit ng tiyan ko pang pa-active yung pagligo.” (With

my first born, when I saw some vaginal discharge, I took a bath and the labor pain

continued because bathing can activate labor). Cristy, a 30-year-old mother, stated

“Kapag nakaramdamn na ko ng pananakit ng tiyan yung parang nagle-labor, maliligo

na ko para maginhawa sa pakiramadam at magtuloy ang labor.” (When I feel the

abdominal pain, like I am on labor already, I take a bath for me to feel fresh and the labor

will continue).

Some activities are done to activate labor and feel fresh. Bath and shower are

ancient treatment for many painful ailments and are rapidly growing in acceptance as

palliative in labor (Simkim, 1995). It is suggested that bath has a relaxing, reassuring and

analgesic effect which provides favorable conditions for a satisfactory delivery even in

pathological cases. A mother is encouraged to take a bath as taking a bath enables women

to master the pain and also to relax and to find comfort in reassuring figures such as their

partners and their mothers and become more responsive to their baby (n.d.,1987).
 72

Figure 8

Theme 1: Facilitating Factors in Childbirth

Pray. Praying is defined as a belief and practice of women reaching our God

through prayer to protect and guide them for safe delivery. It helps the mother to have a

safe delivery. Geraldine said that “Tapos sasamahan mo na din ng dasal.” (And then you

include prayers). Edwil stated that “…nung nandun naman ako sa loob ng pa-anakan

dasal ako ng dasal para sa kaligtasan namin ng baby.” (… when I was inside the

delivery room, I prayed and prayed for our safety).

Palacio’s (2014) study put forth that mothers practice delivery in health facility or

birthing clinic and pray to ask God' help for a safe delivery. In addition, Routledge (2018)
 73

stated that recent behavioral science experiments suggest that prayer helps people focus

their attention. In one study, research participants with varying levels of religiosity

completed cognitive tasks that assess attention. After finishing these tasks, they were

instructed to bring to mind one concern in their lives. One group of participants was then

asked to spend ten minutes praying about that concern. Another group was asked to

spend ten minutes thinking about that concern. A final group spent that time working on a

puzzle. Then they repeated the attention tasks. Researchers looked for changes in their

performance and found that among highly religious individuals, praying about a life

concern, compared with thinking about it or being distracted with a puzzle, improved

cognitive performance. No differences were observed among the less religious. These

findings are consistent with the researchers’ proposal that prayer frees up cognitive

resources needed to focus on mental tasks by reducing the extent to which people are

distracted by negative emotions.

As midwives, we recommend that the patient pray and seek guidance and help

from God. Childbirth is a time to grow the relationship to God, the use of religious beliefs

and rituals is powerful coping mechanisms that woman can do during childbirth (Callister

& Khalaf, 2010).

Have a companion during labor. Having a companion during labor is defined as

beliefs and practices that what a companion does during labor and childbirth can either

hasten delivery, can contribute to delay or cause difficulty giving birth. Myra, a 29-year-

old mother, said, “Bawal sa pintuan ang mga tao kasi mahihirapan manganak.” (People

are told not to stay on the doorway for it can cause difficult childbirth).
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It is also believed that prohibiting the loved one can lessen the possible stressors

that mothers experience, especially during labor. Geraldine said, “Tapos yung kapag

nakikita mo yung asawa ng nagla - labor matagal pa din lumabas yung bata pwede rin

yung asawa nya e paalisin mo rin dun sa pinto hangga’t hindi nakakaraos, para di rin

matagal mag labor yung buntis.” (Then when you see that the wife who is in labor has

not delivered the baby yet, you can ask her husband to go or stay away from the door

until his wife successfully delivers their child, so that the labor will not be long)

Companions can either help hasten childbirth or cause delay or difficulty in giving

birth. In the study of Bermio and Reoututar (2017), guests are prohibited to stand too near

or at the door and at the stairs to prevent complications in labor. On the contrary,

according to Salehi et al., (2016), the presence of husbands during labor decreased the

anxiety of mothers during delivery. This intervention is encouraged during childbirth.

Husband’s presence can have positive impact to the health of the mother during labor by

decreasing their anxiety.

Promote physical activity. The participants believe that physical activities, such as

ambulation and walking up and down the stairs, are encouraged to facilitate engagement

and fetal descent. Phebe, a 32-year-old mother, said “Akyat baba sa hagdanan para

mabilis bumaba yung bata isang hagdan mga limang beses pabalik balik.” (I walk up

and down the stairs so that the baby will descend faster. In the stairs, do it around five

times).

Ambulation may help in fetal descent. In the study of Bermio and Reoututar,

women are encouraged to walk during labor to facilitate descent of the head of the fetus.

In adddition, Bloom and colleagues (1998) conducted a randomized trial of walking

 75

during active labor to determine whether it altered the duration of labor or other maternal

or fetal outcome. But the finding revealed that walking does not shorten labor or reduce

the woman's discomfort. Cameron (2006) suggested that the possible efficacy of

ambulation in labors requiring augmentation, provided that adequate monitoring

surveillance is maintained. Ambulation during the first stage of labor may be safe but

considering the available evidence it cannot be recommended as an effective intervention

to reduce duration of the first stage of labor (Souza et al., 2006). We encourage

ambulation as long as it has permission from their attending physician or midwives.

Myths about food that promote labor and expel “sumilim” (placenta). Myths

about food that promotes labor and expel sumilim are defined as beliefs and practices of

women during labor and childbirth that help women to hasten delivery without any

scientific basis. It includes (1) drinking brewed balimbing and onion, (2) eating raw egg

and lady finger, and (3) drinking calamansi juice and rice water (See Figure 8).

Drink brewed “balimbing” and onion. The participants believe that brewed

drinks could help expel sumilim. Riza stated that “Nilagang balimbing yun, para daw

lumabas yung sumilim.” (Brewed balimbing fruit could remove the sumilim ([placenta]).

Jazmine mentioned, “Sabi nila kumain daw ng sibuyas tagalog para daw mabilis

lumabas kung may sumilim.” (They say native onion could promote faster expulsion of

the sumilim [placenta]).

There is a similar study about herbs decoction that facilitate childbirth. In the

study of Chang, and colleagues (2016), many Filipinos believed that drinking medicinal

herbs like boiled ginger helps reduce labor pains. In addition, in Jocano’s (1970) study,
 76

women in Laguna are usually given a medicinal drink composed of a part of balimbing

bark and leaves of sulasi (a kind of sea weeds).

Participants believed that by drinking brewed drinks placental expulsion happen

easily. This is a myth because placental expulsion happens during third stage of labor.

When the uterus contracts, the placenta separates from the uterine wall and is delivered

vaginally.

Further, according to the article of Kochrekar (2019), balimbing is rich in

vitamins, minerals and others nutrients and it also provides healthy stamina during

pregnancy; while Arora’s (2018) article suggests that onions are beneficial to pregnant

women as long it is consumed in moderation. Onion has antioxidant, anti-cholesterol,

anti-cancer, and anti-inflammatory properties and protects the pregnant women from

many fatal diseases. It is also high in vital nutrients like carbohydrates, minerals,

vitamins, and fibers. It contains essential folic acid that is an excellent source of calcium,

iron, magnesium, sulfur etc., which help in regulating the growth of new cells. Moreover,

these are rich in quercetin which imparts protection against many common maladies like

flu or common cold etc. Its nutritional facts have helped in safeguarding the women from

low sugar levels and promote the healthy growth of the baby and the mother. For

midwives, the health of mother and baby should be continually monitored. Mothers are

allowed to follow their beliefs and practices as long as it does not cause harm to them.

Drink calamansi juice and rice water. It is believed that it aids in hastening

childbirth. Rina said, “Meron yung pag-inom ng kalamansi juice kasi daw pampabilis

lumabas ng baby.” (There is some advice to drink calamansi juice to speed up giving

birth).
 77

A similar study shows that there are different drinks that help hastening

childbirth. According to the study of Chang et al., (2016), Filipino women believed that

ginger and coconut oil help facilitate delivery and reduce labor pain. This is a myth for

there is no scientific evidence that calamansi juice helps in delivering the baby easily.

However, calamansi has numerous health benefits but it should not be consumed in

excess during pregnancy as it is citrus juice that may cause heartburn, stomach cramps,

indigestion and diarrhea if consumed in excess.

Rice water is also believed to hasten childbirth. It is defined as the beliefs and

practices that help promote speedy childbirth. Moneen told us “...pagdating mo daw ng

six months or seven months kukuha ka ng hugas bigas... tapos inumin mo sya ... para daw

mabilis lumabas yung baby.” (When you reach six to seven months age of gestation, you

have to get rice water, and then drink it for the baby to come out easily).

Agyei (2007) suggested combining rice water with oats, porridge, bread, roasted

ground nuts, fruit and other items to increase nutrition. Moreover, drinking rice water is

recommended for it can help with nausea, diarrhea, and rehydration after illness. This is a

myth because raw or uncooked rice may contain a high amount of pesticide and

chemicals which are not good for health of the mother and baby (Tian, 2018). However,

as midwives, we advise the pregnant women to be well hydrated to lessen possible illness

and complications and we recommend that the family prepare their food properly and

wash it thoroughly before using.

Eat raw egg and “okra” (lady finger). The participants believe that raw egg

could help hasten delivery. Rose said, “Sa pagla-labor, papainumin ka daw ng itlog na

native para mabilis daw ang paglabas ng bata.” (During labor, you will be asked to take
 78

in native egg to speed up delivery). Moreover, Phebe said, “At saka okra para mabilis

manganak.” (Also, lady finger [should be consumed] to speed up childbirth).

Participants believed that eating raw eggs and vegetables helps in childbirth. This

is a myth as there is no scientific basis. In the study of Bermio and Reoututar (2017),

women are encouraged to drink a fresh native egg as it is as source of energy to deliver

the baby easily. Further, Palsdottir (2016) noted that even if the eggs are cooked or raw it

is extremely nutritious. The participants’ belief is a myth as there is no scientific basis

that eggs could hasten childbirth, Eggs are rich in high quality protein, healthy fats,

vitamins, minerals, eye-protecting antioxidants and various other nutrients. However,

eating raw eggs raises concerns about the risk of Salmonella infection. That is why we

advise expectant mothers to eat cooked eggs rather than raw.

Okra or lady finger helps promote healthy pregnancy because it is rich in vitamin

A, B vitamins (B1, B2, B6), and vitamin C, and traces of zinc and calcium, which makes

it an ideal vegetable to eat during pregnancy (Borreli, 2015). Okra also serves as a

supplement for fiber and folic acid. Folic acid helps prevent birth defects like spina bifida

and fiber can help stop constipation during pregnancy. That is why we suggest that before

trying any food, herb or supplement to help bring on labor, women should talk with their

practitioner and get his or her approval. But we also want to support those individualized

beliefs, values and practices that are either beneficial or harmless and modify those that

are harmful.

Promotion of comfort during childbirth. Promotion of comfort during

childbirth is the second theme in the beliefs and practices during childbirth. It is defined

as beliefs and practices of women during labor that have assurance for successful and
 79

comfortable childbirth. It includes (1) myths to promote labor and hasten childbirth and

(2) myths to lessen labor pain (see Figure 9).

Myths to promote labor and hasten childbirth. The participants believed that there

are certain activities that promote labor. It is defined as beliefs and practices of women

that facilitate their labor and childbirth without any scientific basis. These activities

include (1) applying saliva to the umbilical area, and (2) putting garlic and bigkis to the

umbilical area (see Figure 9).

Apply saliva to the umbilical area. The participants believe that saliva could

hasten childbirth. Geraldine said, “Kung kasama mo sana yung nanay mo e palalawayan

mo sana yung pusod ko makakaginhawa sa pagla-labor yun, pampabilis din yun,

naranasan ko rin yun, ginawa ko na yan sakin wala syang kahirap hirap.” (If you are

with your mother, you can ask her to put saliva on your navel. It can relieve the labor

pains and can speed up delivery. I experience that and that’s what I’ve done and it is

really easy for me to give birth).

There are activities that participants believed will help them to have easy

childbirth. But these beliefs are a myth as there are no scientific evidences that it really

helps hasten childbirth. The support from other people especially from family members is

important in promoting comfort to a mother in labor. People, especially female family

members in particular, commonly attend the birth (Wilde, 2019).

Put garlic and “bigkis” on umbilical area. The participants believed that bigkis and

garlic could promote labor and hasten childbirth. Cristy said “Sabi naman ng nanay ko

ung bigkis daw isuot at lagyan ng bawang para mag labor na at mabilis manganak.”
 80

(My mother told me to wear a bigkis with garlic on it to activate labor to deliver child

easily).

This participants’ belief is a myth, there are no evidences that bigkis and garlic

help promote labor and hasten childbirth. There are signs when pregnant women are

about to give birth. First is when lightning take place (fetal descent) with mucus plug and

when cervix is dilated and becomes effaced once the contraction begins. Second is when

the cervix is fully dilated and fetal expulsion follows. Third is when the placenta is

delivered (Stöppler, 2018). However, according to Laelago (2018), garlic aids in

enhancing a woman’s immune system, and that will in turn help women to have a healthy

pregnancy and a healthy baby. So, we suggest that the primary motives for using herbal

medication during pregnancy, labor and after delivery were to boost general health ease

and accelerate labor and clean the womb respectively. In addition, Duley and Meher

(2006) stated that

Figure 9

Theme 2. Myths about activities that Promote Comfort

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garlic has a property that can lower blood pressure, so it may have a role in helping

reduce the risk of pre-eclampsia.

Myth to lessen labor pain: Scratching the pregnant abdomen on the wall. It is

defined as beliefs and practices of women without scientific evidence that help alleviate

the pain during labor. Specifically, the participants believed that scratching on the wall

may lessen their pain during labor (see Figure 9). Participants believed that by doing that

labor pain would be lessened. April said, “Tapos yung tiyan ikakaskas sa pader para

mabilis ang panganaganak at sasabihing sayo ang sakit sa akin ang ginahawa ganon.”

(And rub your abdomen on the wall to speed up delivery and the pain will be relieved).

The participants believed that by scratching the abdomen will lessen the labor

pain. This belief is a myth as is does not have scientific evidence that proves it will really

alleviate the pain. But there are some studies like that of Bermio and Reoututar (2017) in

which 1.5 % of pregnant mothers in Ilocos Sur believed that rubbing the abdomen into a

wooden post will deliver the baby easily. In addition, Chang, and colleagues (2016)

stated that by rubbing the abdomen with boiled ginger, the labor pain will be reduced. As

midwives, we allow the mother to practice their beliefs on facilitating delivery as long as

it does not endanger them.

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Figure 10

Summary of Cultural Beliefs and Practices during Childbirth

 83

Cultural Beliefs and Practices during Postpartal Period

There are two themes that emerged in the cultural beliefs and practices of women

in postpartum during our data analysis. It includes (1) food and activities that promote

maternal welfare and (2) myths on food and activities that promote the child’s welfare

(see Figure 11).

Foods and activities that promote maternal welfare. This is the first theme that

emerged on cultural beliefs and practices during postpartal period. It is defined as beliefs

and practices of women in postpartum period that focus on ensuring the mother’s

wellness. It is divided into five sub themes, namely, (1) food and activities that promote

strength; (2) myths on food that promotes involution and low blood pressure; (3) myths

on food and activities that prevent binat; (4) myths on foods that promote perineal

healing; and (5) myths on activities that promote heat and cold balance (see Figure 12).

Figure 11

Themes for the Cultural beliefs and Practices during Postpartal Period

Food and activity that promote strength. This is the first sub-theme that emerged

in the beliefs and practices during postpartal period in promotion of maternal welfare. It
 84

is defined as the beliefs and practices of women during postpartum about food and

activities that help recover their strength. It includes (1) eating soup, (2) eating green

leafy vegetables and coconut dishes, and (3) resting (see Figure 12).

Eat soup. Eating soup was believed by the participants as source to renew their

strength and improving their milk production. Riza, a 27-year-old mother, said, “Sa

pagkain wala namang ipinagbabawal, yung mga gusto lang nila ipakain sakin noon eh

kahit anong masasabaw, para daw maganda sa pakiramdam tapos makatulong din sa

paggagatas.” (In food, there is nothing prohibited. What they offer me then were

anything with soup so that I, would feel better and that it can improve milk production).

According to the study of Bermio and Reoututor (2017), the 4.02 mean rating of

women who have given birth were given a hot soup and nutritious foods to eat so they

can make the most nourishing milk. In addition, Chang et al., (2016) recommended that

the postpartum women eat Lugaw (rice porridge) for lactation. Mothers are advised to eat

food that are nutritious to improve their health. However, hot soups can be served with

precaution to keep the mouth from burning.

Eat green leafy vegetable and coconut milk dishes. The participants believed that

leafy vegetable and coconut milk dishes could overcome the stress brought about by

giving birth. Rose, a 43-year old mother said, “Yung kalimitan ipinapakain sakin ay yung

masasabaw gaya ng talbos ng ampalaya o kaya talbos ng kamote yung mga masasabaw

at saka yung may mga gata ok lang din para mabilis bumalik yung lakas ng nanay.” (The

food they always offer to me is soup with leafy vegetables like bitter melon and sweet

potato leaves and those foods with coconut milk to recover the strength).
 85

In the study of Raven and colleagues (2007) postpartum women are encouraged to

eat more food after birth. In addition, in the study of Fadzil (2016) mothers are advised to

eat green leafy vegetables, garlic, shark’s meat, black dhal pudding, and boiled fenugreek

seeds to increase milk production. As midwives, we advise mothers to eat healthy foods

such as green leafy vegetables as guided by healthcare professionals.

Rest. The participants believed that resting helps in bringing back their strength.

Riza, a 27-year-old mother said “Sabi sa bahay lang, magpapahinga ka isang buwan,

nasa bahay ka lang kailangan wala ka gagawin gawaing bahay parang papahinga ka

lang para daw bumalik lahat yun dati mong lakas.” (They told me they I need to stay at

home, rest for one month and should not do any household chores and stay at rest to

recover the strength).

In similar study, Malay women remain at home during the postpartal period. They

have confinement period of at least 40-44 days or six weeks to recover form childbirth

stress (Dennis, et.al, 2007). Further, Chinese women have the same resting tradition

called zou yue or doing the month (Dennis, et.al). Rest is important for mothers in

postpartum to restore their overall health. Mothers are encouraged to restore their general

health and heal their wounds from childbirth through rest.

Myths on food and activity that promote involution and low blood pressure. This

the second sub theme that emerged in food and activities that promote maternal welfare.

It is defined as beliefs and practices of women during postpartal period that help regulate

blood pressure and uterus back to normal. It includes (1) hilot (massage) and (2) avoiding

jackfruit and katuray (see Figure 12).

 86

“Hilot” (Massage). The participants believed that massage could bring back the

abdomen in normal size after delivery. Rose, 43-year-old mother, said “Magpapahilot ka

na para bumalik na sa ayos yung matris mo para bumalik yung lakas mo at ayung ayos

ng matris mo at saka yung lamig mawawala rin.” (You should have a massage for your

uterus to go back to normal, for you to regain strength, and the cold will be removed).

A similar study has shown that abdominal massage is performed so that retained

blood and blood products will be expelled (Bermio & Reoututar, 2017). In addition,

Filipino Ethnicity and Background (n.d.), stated that postpartum women may be

massaged with coconut oil, to restore their lost health, expel blood clots from the uterus,

return the uterus into a normal position, and promote lactation. However, Thai women are

being massaged by well-trained spiritual healers for maintenance of body’s energy

(Prangthip, 2010). Massage can be helpful in promoting blood flow to the area where the

massage is applied. It is still encouraged to them as long as it has no harmful effects to

mother and baby.

Avoid eating jackfruit and katuray vegetable. Participants have believed that

jackfruit and katuray vegetables when avoided will prevent having low blood pressure.

Geraldine said, “Bawal kumain ng langka saka yung katuray na gulay…, pampababa yun

ng dugo.” (You should not eat jackfruit and katuray…they decrease the blood pressure).

Some women believed that consumption of jackfruit during pregnancy causes

miscarriage, but it has no scientific basis. This belief has been existing for decades in the

Southern Philippines. In the study of Jocano (1970), a mother was being instructed to

avoid bananas, jackfruit, young coconuts, guavas, and papayas because these foods were

believed to cause binat or relapse.

 87

Jackfruit is a good source of folate, thiamine, niacin, riboflavin and even vitamin

C and vitamin A, which makes it a healthy choice. It also contains a number of minerals

such as manganese copper, potassium, iron, and calcium. More importantly, it

contains very less amount of saturated fats, cholesterol, and sodium. The fiber present in

jackfruit plays a vital role in stimulating digestion, and the absence of sugar makes it a

great choice for women with gestational diabetes. While according to the health benefits,

katuray or Sesbania has a benefit to lower blood pressure and help keep arteries flexible,

supports normal fetal development, beneficial for skin, boosts immunity, and prevents

Alzheimer’s disease, migraine, and weakness. The health benefits of Sesbania make it an

important constituent of any diet. Eating jackfruit and katuray is still recommended but in

moderation.

Myths on food and Activities that prevent “binat”. This is the third sub-theme

that emerged during data analysis on the beliefs and practices during the postpartal

period. It is defined as a beliefs and practices about food and activities that are

discouraged in order to avoid binat. Binat is a term used when someone is getting illness

again before you can fully recover (Tagalog dictionary, n.d.).

This sub-theme includes (1) food that prevent binat: avoiding fish like tulingan

and malansa, and (2) in activity, avoiding shouting and lifting heavy object.

Avoid eating tulingan fish and other food that is malansa. Fish and other foods

that are malansa (rammish) are avoided in order to prevent binat or getting illness,

bleeding and delayed wound healing. Moneen, a 29-year-old mother, stated, “Sa pagkain

po after manganak bawal po yung tulingan. Di ko po alam kasi nakakabinat daw po

yun.” (After giving birth, you should not eat fish like tulingan. I don’t know because they
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say it can cause binat). Phebe stated, “Tapos bawal kumaen ng malalansa, gawa ng di pa

daw tuyo yung sugat at baka matagal matuyo yung pusod ng bata.” (Then, avoid eating

malansa, because the wound is not dry yet and the healing of umbilicus may be longer).

Figure 12

Theme 1. Food and Activities that Promote Maternal Welfare

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In the study of Ocampo and Moriya (1992), mothers are advised to avoid eating

milkfish for it will make the mother feel ill. In addition, Prangthip’s (2010) study shows

that the Malay believed that bias (certain kind of fish) must not be consumed because it is

known to cause digestive disorder and postpartum hemorrhage in women. However, this

is a myth as it does not have evidence to prove that fish causes the person to be sick.

Some types of fish can affect pregnant mothers in a bad way. Mothers are

encouraged to consult physicians and other experts in the field for the types of food

especially the kind of fish that they must avoid.

Avoid shouting and lifting heavy objects. The participants believed that shouting

and lifting heavy object should be avoided to prevent binat. Rosel mentioned,

“Nakakabinat daw po yun magbuhat ka ng mabigat.” (Binat can be caused by lifting

heavy objects). Geraldine stated, “At saka bawal ka muna magsisisigaw, nakaabinat din

iyon.” (And avoid shouting; it will cause binat).

Carrying heavy objects and shouting are activities that could increase intra-

abdominal pressure and are thought to cause binat. However, these activities have not

been found to have any adverse effect but there is a risk of having uterine prolapse if

some women have weak connective tissue because of their genes. The risk factor is

childbirth, age and weight, and the prevention of having uterine prolapse is Kegel

exercise or regular pelvic floor exercise (Koch, et.al, 2018).

During postpartal period, rest is vital to avoid binat. In the Philippines, to prevent

a woman on her immediate postpartal period from experiencing binat, it is a common

practice that a relative is the one in-charge of doing housework (Cabigon, 1996). Mothers

are advised to practice their beliefs as long as it will not affect their health status.
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Myths on food that promote perineal healing. This is the fourth sub-theme that

emerged in postpartal period. It is defined as the beliefs and practices of women in

postpartum who believed that food may affect the wound healing of a mother who have

given birth. It includes (1) avoiding eating foods that are malansa (rammish); (2)

avoiding eating banana blossom; and (3) avoiding eating taro (see Figure 12).

Avoid eating foods that are “malansa” (rammish). The participants believed that

foods that are considered malansa (rammish or fishy) must be avoided to improve wound

healing. Geraldine, a 35-year-old mother says “Ako binawalan kasi ako kumain ng

malansa. Nakakatagal daw yun ng pag galing ng sugat.” (I was told to avoid eating

malansa. It can delay wound healing).

The women believed that there are foods that may cause delayed wound healing.

A similar study has found out that the Malay believed that bias (certain kind of fish) must

not be consumed because it is known to cause digestive disorder and postpartum

hemorrhage in women (Prangthip, 2010).

This belief is a myth as it does not have scientific evidence that fishy food has

effects on wound healing. Regeneration and tissue repair process consist of a sequence of

molecular and cellular events, which occur after the onset of tissue lesion to restore the

damage tissue (Gonzales et al., 2016). There are stages of wound healing and it occurs in

dynamic process. First, is the inflammatory stage, which takes place after the tissue injury

happen. Second is proliferative stage. It diminishes the lesion tissue and is responsible for

closure of lesion itself. Third stage is remodeling stage, which starts after two to three

weeks on set of lesions and can last for a year or more. It is responsible for the recovery

of tissue. Postpartum mothers are encouraged to consult experts in the field for the types
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of food especially fishes that they have to avoid for it can sometimes cause allergy and a

midwife assist them on how to care for their perineal area for proper healing of perineum.

Avoid eating banana blossom. Participant believed that banana blossom causes

delay in wound healing and foul smell discharged. Jelai, said, “Bawal daw kumain ng

puso ng saging para di ka daw duguin.” (They say eating banana blossom should be

avoided to prevent bleeding).

This is a myth for there is no scientific study that proves it. However, banana

blossom contains vitamin A, B, C, E, fiber, thiamin, niacin, and pantothenic acid. It is

also packed with calcium, magnesium, phosphorous, copper, manganese, iron, potassium,

zinc, protein and carbohydrates. It has antibacterial, antimicrobial, anti-cancer, antiviral,

anti-inflammatory, and antioxidant properties that help fight free radicals that have

negative effects on the body (Agustin-Bunch, 2018). Mothers are not discouraged from

eating foods that may be nutritious to them but should be guided for it may have other

effects from what they are perceived to be.

Avoid eating gabi (taro). The participants believed that eating taro should be

avoided for it can cause skin itchiness. Jelai, a 24-year-old mother, said, “Bawal daw

kumain ng gabi, kasi ung gabi daw makati gawa sa pusod daw ng bata.” (They say

eating taro should be avoided for it can cause itchiness on umbilicus of the baby).

Participants believed that there is food associated for having skin pruritus. In the

study of Bermio and Reoututar (2017), mothers are told to avoid taro roots because these

will make the infant's navel itchy. However, mothers will deprive herself of getting the

nutrients of taro. It is rich in nutrients, which include potassium, calcium, magnesium,

phosphorus, folate, and fiber. Mothers are not discouraged from eating foods that may be
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nutritious to them but should be guided for it may have other effects from what they are

perceived to be.

Myths on activities that promote heat and cold balance. It is defined as beliefs

and practices of postpartum woman that should be discouraged or encouraged to promote

heat and cold balance. It includes (1) avoiding drinking cold fluid; (2) bathing with herbal

decoction; (3) dressing to cover the whole body; and (4) avoiding cold air.

Avoid drinking cold fluids. Cold drinks should be avoided. It can cause lamig to

enter due to open cervix. Lamig is explained as having extreme feeling of colds and can

cause illness. Rose said, “Bawal uminom ng malamig kasi bagong panganak ka, tapos

ang matris daw eh bukas susuutan ng lamig.” (Avoid drinking cold water after giving

birth because the cervix is still open and cold air will go in).

A similar study shows that heat and cold balance is being used to recover from

birthing process. In the study of White (2004), women who have given birth lost their

heat in birthing process, which needs to be restored. That is why women should be

protected against cold air and wind. This is also the reason for women to be covered up

immediately after birth. We allow mothers to practice their norm during postpartal period

as long as it would not affect their health status.

Bathe with herbal decoction. Bathing with decoction of herbs should be done 10

days after giving birth. In hygiene of postpartum, women are taught to bathe after 10 days

with decoction of herbal plants (sambong, sampaluk-sampalukan, kalamyas, pito-pito,

bayabas). Lyka, a 35-year-old mother, stated, “…isang linggo bago maligo para hindi

mabinat.” (One week before taking a bath to avoid binat).

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Chang et al., (2016) said that postpartum women must avoid taking a bath for 10

days after giving birth because it can cause ill health and rheumatism in old age.

However, in many cultures, specific bathing restrictions or prohibitions exist, some of

which relate to the ‘hot’ and ‘cold’ beliefs already described (Dennis et al., 2007). For

instance, cold baths or showers are often strictly prohibited to avoid blood clots, sore

bones and joints, and an itchy body.

Dress to cover the whole body. The participants believed that wearing long dress

to cover the body prevent them from getting illness. Postpartum women are encouraged

to cover up to prevent getting colds and illness. Riza mentioned, “Kapag lumabas

…kailangan dapat nakabalot ka meron kang sombrero, naka-shirt ka, nakapajama at

medyas para daw di ka pasukan ng lamig.” (When you go out, you should be covered,

wearing a cap, t-shirt, pajamas, and socks so that the cold air will not come inside).

According to maternal and child care among the Tagalogs in Bay, Laguna, Philippines in

Jocano’s (1970) study, the postpartum women must be protected from cold wind, rest

completely, and stay inside the house for 30 to 40 days after delivery. This will help her

heal and keep “cold” or “wind” from getting inside her body. Pregnant women are

advised to wear appropriate clothing that will benefit their pregnancy.

Avoid cold air. Participants’ believed that cold air could enter the body and make

the mother sick. Cristy said, “Bawal ang electric fan o mahanginan, para hindi pasukan

ng lamig at sumakit ang ulo.” (Avoid electric fan or being exposed to cold air to avoid

entry of cold air causing headache). This is a myth; the participant was told to avoid cold

air to avoid headache; but there is no scientific basis for that.

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In a similar study of Garner and colleagues (2007), the mothers believed that

when mothers go out and get exposed to cold wind, the air will enter their body and cause

illness. Mothers who have given birth are advised to stay at home and rest to recover their

strength lost during childbirth.

Myths on food and activities that promote the child’s welfare. This is the

second theme that emerged in cultural beliefs and practices during the postpartal period.

It is defined as beliefs and practices of postpartum women that are either promoted or

discouraged that aimed to promote the child’s health. However, these activities are

without any scientific evidence. There are two sub-themes namely (1) myths on food to

prevents stomachache on infant and (2) myths on activities that promote intellectual

health (see Figure 13).

Myths on food that prevents stomachache on infant. This is the first sub theme

that we get during our data analysis on cultural beliefs and practices during postpartal

period. It is defined as the beliefs and practices of postpartum mothers that are taught to

be avoided for the baby’s health. It includes (1) avoiding, eating sour food and (2)

avoiding eating rice cake.

Avoid eating sour food. The participants believed that sour food affects baby’s

stomach through breastfeeding. Geraldine stated, “Ako binawalan kasi ako kumain ng

maasim, baka madede ng bata sumakit tiyan ng baby pagnadede.” (I was told not to eat

sour food otherwise; the baby will have stomachache).

This is a myth as there is no evidence that a mother could transfer stomachache to

infant thru breastfeeding. We know that sour food causes acid-related disease when

consumed in excess, so we advise the mother to consume it moderately. Postpartum and

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nursing mothers are advised to eat food that is nutritious for lactation and for the overall

health of mother.

Figure 13

Theme 2. Myths on Food and Activities that Promote Child's Welfare

Avoid eating rice cake. Rice cakes are also avoided to prevent heaviness on

baby’s stomach. Jelai explained, “Bawal din ung malagkit kasi mabigat daw sa tiyan

kung mag papadede ka madede raw ng bata.” (You should not eat rice cakes for it can

cause heaviness on the stomach of the baby). The mother must refrain from eating tutong

(crisp brown layer of cooled rice) to ensure the immediate ejection of the placenta. Eating

improperly cooked or even some types of rice can cause heaviness on both the mother

and the baby’s health. The mother must not eat uncooked rice or banana inflorescence,

known as puso, the baby inside her womb will have skin ailments.

Myth on activity that promotes intellectual health. This is the second sub-theme

of theme 2 (i.e., food and activities that promote child’s welfare) which includes the

belief and practice of postpartum women that are taught to do after delivery which

promotes intellectual health. This activity includes burying the placenta.

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Bury the placenta with a dictionary, paper, and pencil. The participants believed

that by burying the placenta with school essentials such as a dictionary, paper, and pencil,

their child will become intelligent. Riza remarked, “Pagkapanganak, yung inunan

kailangan ipapabaon mo agad dun sa asawa mo doon sa tabi ng bahay nyo sa may

pintuan para hindi daw maging layas yung anak mo paglaki, kaya ibabaon dun sa

malapit sa inyo.” (After giving birth, the placenta should be buried by your husband

beside your house, near the door, so that your child will not always go out when he or she

grows up. So, it should be buried near you).

A similar study shows that burying the placenta has impact on the future of the

child. In the study of Sharma et al., (2016), Gurung women commonly bury the placenta

at the foot of a tree, while the Newari and Tamang bury it at a junction or under the road.

It is believed that the child’s future health is linked to the method of disposal of the

placenta. However, this is a myth as there are no evidence that burying placenta affects

the future of the child.

According to the study of Oommen (2014) intelligent quotient is mainly determined by

genetics but there are also non-genetic factors that influence the intelligence of a person

(i.e., modifiable environmental factors like education, premature birth, nutrition,

pollution, drug and alcohol abuse, mental illnesses, and diseases can have a influence on

an individual’s IQ). But we respect every people beliefs and practices. We are here to

guide and teach them to avoid the possible consequences of those beliefs they are

practicing.
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Figure 14

Summary of Cultural Beliefs and Practice during Postpartal Period

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Chapter 5

Summary of Finding, Conclusion, and Recommendations

This chapter presents the summary of findings, the conclusions, and the

recommendations found in this study.

Summary of Findings

This study focused on the perinatal beliefs and practices of women in Laguna,

Philippines. Perinatal beliefs include their beliefs and practices during the prenatal,

childbirth, and postpartal period.

There are three themes that emerged regarding the beliefs and practices of women

during pregnancy, which includes protection of baby’s welfare, promotion of healthy

pregnancy, and safety against bad elements. Protection of baby’s welfare is the first

theme in cultural beliefs and practices during pregnancy. It is defined as beliefs and

practices of women and mothers that are focused on ensuring a good future to unborn

child and keeping him/her from harm. Protection of baby’s welfare has three sub-themes

namely (1) myths on food which is defined as the beliefs and practices during pregnancy

on food consumption or abstinence that are believed to protect the fetus but do not have

any scientific basis; (2) myths on activities which are the promotion or avoidance of

various activities that do not have scientific basis; and (3) dietary and activity

undertakings with scientific basis which is defined as promotion or avoidance of certain

food and activity to protect the unborn child’s welfare, which are found to be clinically

proven. All of these themes have their own sub-sub themes.

Promotion of healthy pregnancy is the second theme that was developed during

data analysis. It is defined as the beliefs and practices during pregnancy that promote
 99

wellness among pregnant women. It has three sub-themes (1) myths on food and

activities that hasten childbirth which it is defined as beliefs and practices on food and

activities that are either encouraged or prohibited and do not have scientific evidences;

(2) myths on food and activities that prevent complications of pregnancy, defined as

beliefs and practices during pregnancy on food consumption and activities that are

prohibited which do not have scientific evidences; and (3) activities to prepare for

childbirth, which are defined as the beliefs and practices of women during pregnancies

that are scientifically proven to promote healthy pregnancy. All of these have their own

sub-sub themes.

Safety against bad elements is the third theme that emerged on the beliefs and

practices of women during pregnancy. It is defined as the beliefs and practices during

pregnancy that protect a pregnant woman and her fetus against supernatural beings such

as aswang, maligno or tiktik. It has four sub-themes (1) putting salt on the window;(2)

applying calamansi juice on the abdomen; (3) placing a red cloth on the abdomen; and (4)

keeping a stingray tail.

In cultural beliefs and practices of women during labor and childbirth there are

two themes that emerged. It includes facilitating factors in childbirth and promotion of

comfort during labor and childbirth. Facilitating factors in childbirth is defined as beliefs

and practices of women or mother that are thought to hasten the delivery of the fetus.

Under this theme are two sub-themes: (1) physical and socio-spiritual preparedness and

(2) myths about food that promotes labor and expel sumilim (placenta). Promotion of

comfort during labor and childbirth is defined as beliefs and practices of women during

labor that give the mother assurance of successful childbirth.

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In postpartum cultural beliefs and practices of women, two themes emerged. It

includes food and activity that promote maternal welfare and food and activity that

promote child’s welfare. Food and activity that promote maternal welfare is defined as

beliefs and practices of women in postpartum that focus on ensuring the mothers’

wellness. Food and activity that promote maternal welfare are divided into five sub-

category namely, (1) food and activities that promote strength; (2) myths on food and

activities that promote involution and low blood pressure; (3) myths on food and activity

that prevent binat; (4) myths on foods that promote perineal healing; and (5) activities

that promote heat and cold balance.

Food and activities that promote child’s welfare, the second theme on postpartum

cultural beliefs and practices of women, is defined as beliefs and practices of postpartum

women that are discouraged and encouraged to promote child’s health. It has two sub-

themes namely: (1) food and activities that promote child’s welfare; and (2) myths on

activities that promote the child’s intellectual health.

Conclusions

The participants’ cultural beliefs and practices during the perinatal period is

focused on promoting the welfare of both the mother and the unborn child. Many of these

beliefs and practices have no scientific evidence. In cultural beliefs and practices during

pregnancy, the mother’s focus is on the safety and wellness of her unborn child during

pregnancy. During childbirth, the main priority of mother’s beliefs and practices is to

have safe and successful childbirth while in postpartal period, it is in the assurance of

good health of her child.

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Recommendations

Pregnant and Postpartal women. For pregnant women it is recommended that

regular prenatal and postpartal consultation be conducted to monitor her personal health

status and the fetus inside her.It is vital that they will practice good judgment on the

cultural beliefs and practices that are handed over them since there are beliefs and

practices that are not based on scientific evidence.

Community. For the community people it is recommended that that every time

they do something new to the pregnant mother, she should seek the advice of the expert.

We, the researchers want the community to determine which beliefs and practices are

harmful to the mother and the baby and guide her to do it correctly.

Midwives. Midwivers should guide and educate their patients regarding maternal

and child health. They should correct them and guide them not to do the harmful beliefs

and practices they have.

Midwifery students. Midwifery students are encouraged to develop awareness on

every woman’s differences in culture and to be the one to promote wellness of women

throughout the pregnancy by providing proper guidance on avoiding the beliefs and

practices that may be harmful to them.

Municipal Health Officer. We recommend the MHO to conduct regular

educational teaching to women in their respective town to promote perinatal practices

that are based on clinical evidence as well as increase awareness to the new trends

regarding maternal and child care.

Researchers. It is recommended that they conduct a quantitative research that

will determine a more generalized perspective on the beliefs and practices during the
 102

perinatal period. Also, we recommend to the future researchers to focus on one town for

another qualitative research.

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 113

Appendix A

Informed Consent (English)

Manila Adventist College

San Juan St., Pasay City 1300

This information consent form is for the pregnant women or women who have
just given birth who are being invited to participate in our research. The title of our
research project is “PERINATAL CULTURALBELIEFS AND PRACTICES OF
WOMEN IN LAGUNA, PHILIPPINES.”

PART I. INFORMATION SHEET

We, the students of Manila Adventist College, are doing a research on perinatal
cultural beliefs and practices of women in Laguna. We invite you to be part of our
research. You don’t have to decide today whether you want to or not to participate.
Before you decide, you can talk to anyone you feel comfortable to talk about the
research.

Purpose of the Study

This study aims to identify the cultural beliefs and practices of women during
pregnancy, labor and childbirth and few weeks after giving birth. Giving attention to the
beliefs and practices of women will help us gain knowledge and understanding about
practices. In addition, through this study we will be able to identify various beliefs and
practices that may be harmful to you and to your unborn child.

Type of Research Methodology

This research involves in-depth interview among women and mothers about their
cultural beliefs and practices.

Participant Selection
We are inviting at least ten pregnant mothers, postpartum mother not greater than
one month, resident of Laguna and willing to participate to in our research project.

Voluntary participation
It is your choice whether you want to participate or not. Whether you participate
or not, we will give you a feedback about our research. You may change your mind later
and stop participating even if you agreed earlier.
 114

Procedures
We are asking you to help us learn more about cultural beliefs and practices in
your community. We are inviting you to take part in this research project. If you accept,
you will be asked to be part in our group discussion about the cultural beliefs and
practices of women regarding pregnancy, childbirth, and postnatal care.
For the participant in an interview you will be guided by the interviewer. During
the interview, I or another interviewer will sit down with you in a comfortable place at
the Rural Health Center. If it is better for you, the interview can take place in your home
or a friend's home. If you do not wish to answer any of the questions during the
interview, you may say so and the interviewer will move on to the next question. No one
else but the interviewer will be present unless you would like someone else to be there.
The information recorded is confidential, and no one else but researchers will have access
to the information documented during your interview. The entire interview will be tape-
recorded, but no-one will be identified by name on the tape. The tapes will be destroyed
after a year from the start of the study.

Interview guide questions

Here are the sample questions that we will be asking you.
1. While you were pregnant (Now that you are pregnant- for currently pregnant
women) what are the things that you believe women should or should not do
during pregnancy?
2. What are the things that you do/practice or do not do/practice during pregnancy?
3. While you were pregnant (when you will give birth) what are the things that you
believe women should or should not do during labor and childbirth?
4. What are the things that you do/practice or do not do/practice during labor and
childbirth?
5. What are your beliefs that women should or should not do after giving birth?
6. What are your practices that women should or should not do after giving birth?
7. Is there anything else that you would like to add that we haven’t asked?

Duration
The interview will be about one (1) to one and a half (1.5) hour. However, the
whole research process takes place over a couple of days or weeks. During that time, it
may be necessary for us to come back at your house for further interview. Also, after we
transcribe the interview, we will return to you and give a copy of the transcription for you
to review and give your approval. Before going to your house or venue we will give you
a short notice that we will come.

Benefits
If you participate in this research, you are giving a chance to inform people about
the current beliefs and practices during pregnancy, childbirth and few weeks after giving
birth. And perhaps you may even save lives by identifying those practices that maybe
harmful to the mother and unborn baby.
 115

Confidentiality
With this research, it is possible that others in the community are aware that you
are participating. We will not be sharing your identity in this research. The information
that will be collected during our research project will be kept confidential. Any
information about you will have a code instead of your name. Information about you will
be put in the safe place that only us, the researchers, and our thesis advisor will have an
access. It will not be shared with anyone else who are not part of the research project.

Sharing the result

The knowledge that we get from doing this research will be shared with you
before it is made to the public. Confidential information will not be shared. After these,
we will publish the result in order that other people may learn from our research.

Right to refuse or withdraw

You do not have to take part in this research if you do not wish to do so. You may
also stop participating in the research at any time you want to do so. It is your choice and
all your rights will still be respected.

Who to contact?
If you have any questions you may contact us now or even after the study has
started. If you wish to ask question later, you may contact any of the following:

This proposal has been reviewed and approved by Manila Adventist College
Ethics Research Committee. A committee task is to make sure that research participants
are protected from harm. If you wish to find more about the Ethics Review Committee,
contact the research team.

Contact details of Ethics Review Committee members:

Dr. Linda-Lim Varona, [email protected]
Dr. Nestor C. Rilloma, [email protected]
Dr. Bibly Macaya, [email protected]
Dr. Maria Carmela L. Domocmat, [email protected]
Atty. Silvino Sumagaysay, [email protected]
Dr. Wealthy C. Estada, [email protected]

PART II. CERTIFICATE OF CONSENT

I have read the following information, or it has been read to me. I have the
opportunity to ask question about it and any question that I have asked have been
answered to my satisfaction. I consent voluntarily to participate as a participant in this
research.
Printed Name of Participant: __________________________________________
Signature if the Participant: ___________________________________________
Date: ______________________________________________________________
(Day/ Month / Year)
 116

We have read out the information sheet to the potential participant and to the best
of our ability make sure that the participant understands the following will be done:
1. The importance of this research in all women.
2. The participants understand what they do in this research.
3. The participants understand their rights the research.
I confirm that participant was given the opportunity to ask about the study, and all
the question asked by them have been answered correctly and to the best of our ability.
We confirm that individual has not been coerced into giving consent, and the consent has
been given voluntarily.

A copy of INFORMED CONSENT FORM HAS BEEN PROVIDED TO THE

PARTICIPANT.
Printed name of Researcher: ________________________________________________
Signature of the Researcher: ________________________________________________
Date: ________________________________________________________________
(Day / Month / Year)

Appendix B

Informed Consent (Filipino)

Manila Adventist College

 117

San Juan St., Pasay City 1300

Itong “Informed Consent Form” ay para sa mga nagdadalangtaong babae o

babaeng kapapanganak pa lang na iniimbitahan para makilahok sa nasabing pananaliksik.
Ang pamagat ng aming proyektong pananaliksik ay “PERINATAL CULTURAL
BELIEFS AND PRACTICES OF WOMEN IN LAGUNA PHILIPPINES.”

PART I. INFORMATION SHEET

Kaming mga mag- aaral ng Manila Adventist College ay kasalukuyang

gumagawa ng pananaliksik ukol sa “Perinatal Cultural beliefs and practices of women in
Laguna”. Iniimbitahan naming kayong maging bahaging pananaliksik na ito. Hindi ninyo
kinakailangan magdesisyon ngayon kung nais ninyo man o hindi na lumahok. Bago kayo
magdesisyon, maaari ninyong kausapin ang kahit sino sa amin na inakala ninyong
magiging komportable kayo ukol sa pananaliksik na ito.

Layunin ng Pag- aaral

Itong pag-aaral ay may layunin na matukoy ang kultura ukol sa paniniwala ang
pagsasanay ng mga kababaihan sa panahon ng kanilang pagbubuntis. Sa pagbibigay ng
pansin sa ganitong kaugalian at paniniwala ng mga kasabihan ay makakatulong sa amin
na maunawaan at malaman ito. Karagdagan pa dito, mula sa pag aaral nito matutukoy
naming ang iba’t- ibang paniniwala at gawi na maaring makasama sa inyo at sa sanggol
sa inyong sinapupunan.

Uri ng Metodolohiya ng Pananaliksik

Itong pananaliksik na ito ay kinasasangkutan ng kalaliman ng panayam sa mga

kababaihan at mga nanay ukol sa kultural na paniniwala at kasanayan.

Pagpili ng Kalahok

Inaanyayahan naming ang lima (5) hanggang anim (6) na babae o yung mga
nanay na nakaranas ng kalungkutan pagkapanganak na hindi hihigit sa isang buwan na
naninirahan sa Laguna at nakahanda na lumahok sa bawat FGD.
 118

Iniimbitahan ang kahit na sampu (10) nagdadalangtaong mga ina, mga inang
nakaranas ng kalungkutan na di hihigit sa isang buwan na nakatira sa Laguna na handing
lumahok sa aming proyektong pananaliksik.

Boluntaryong Pakikilahok

Sarili ninyong kagustuhan ng paglahok o kahit na hindi kayo lumahok bibigyan

naming kayo ng katugunan ukol sa amin pananaliksik at pagkatapos maari ninyong
baguhin ang inyong isip at huminto sa paglahok kahit na kayo pumayag na.

Pamamaraan

Hinihiling naming sa inyo na tulungan kami na matutuhan ang tungkol sa

kulturang paniniwala at kasanayan sa inyong komunidad. Banayad naming kayong
iniimbitahan na makilahok sa proyekto ng pananaliksik kung tatanggapin ninyo,kayo ay
hihilingin na makibahagi sa talakayan ng grupo ukol sa pamaniniwala ng kultura at
kasanayan ng mga babae ukol sa pagdadalang tao, pag-anak ng bata at pangangalaga
pagkatapos manganak. Para sa sa pangkat ang talakayan ito ay gagabayan ni Bb. Mhacy
Mae Sipat ang tagapangasiwa na sisiguruhing kayo ay komportable. Tatanungin naming
kayo tungkol sa paniniwala ng ating kultura at kasanayan at bibigyan kayo ng oras para
ibahagi ang mga nakaugaliang iyon na ginagawa ninyo o naranasan. Ang talakayan ay
magaganap sa isang silid at walang ibang tao kundi iyong may bahagi ng at iyong
tagapangasiwa ay nandoon din para sa talakayan. Ang buong talakayan ay gagamitan
tape recorder subalit walang sino man ang babanggitin sa nasabing tala. Ang mga
impormasyong naitala ay kompedensyal, at walang sino man ang magkakaroon ng daan o
susi dito maliban sa mananaliksik. Ang mga tape ay sisirain pagkatapos ng ilan taon
pagkatapos masimulan ang pananaliksik.

Gabay na Panong para sa Panayam

Ito ang mga halimbawa na katanungan na maaring itanong.

1. Sa panahon ng iyong pagdadalangtao (na ngayon na ikaw ay nagdadalangtao para sa

mga babaeng na ngayon ay nagdadalangtao) Ano ang mga bagay na pinaniniwalaan mo
na hindi dapat o dapat gawin ng babae habang siya ay nagdadalangtao?

2. Ano ang mga bagay na kaugalian mong di gawin at ginagawa mo sa panahon ng iyong
pagbubuntis?

3. Noong ikaw ay nagdadalangtao (nang manganganak ka na) Ano ang mga bagay na
pinaniniwalaan mo na hindi at dapat gawin ng babae sa panahon ng kanyang paglelabor
at panganganak na?
 119

4. Ano ang mga bagay na nakasanayan mo ng gawin o mga bagay na di mo isinasagawa

sa panahon ng paglelabor at pagnanganak na.

5. Ano ang iyong mga paniniwala na dapat ginagawa at di ginagawa pagkatapos

magsilang?

6. Ano ang mga nakasanayan ng gawin ng mga babae ang hindi at dapat ginagawa
pagkatapos manganak? Mayroon ka bang nais na idagdag na mga bagay na di naming
maitanong?

Tagal

Ang talakaya ng pangkat ay tatagal lamang ng isa (1) hanggang isa’t kalahating
(1.5) oras. Ganon pa man ang kabuuan ng proseso ng pananaliksik ay magaganap ng mga
ilang araw o linggo. Sa mga panahong iyan kinakailangan sa amin na bumalik sa iyo para
sa karagdagang panayam o sa mga paglilinaw din. Pagkatapos naming salinin ang
panayam, bibigyan naming kayo ng kopya ng pagsasalin para sa inyong pagrerebyu at
pag-abruba. Bago pumunta sa inyong bahay o sa ibang lugar ay bibigyan naming kayo ng
maiksing paunawa na kami ay darating.

Benepisyo

Kung kayo ay lalahok sa pananaliksik na ito bigyan ninyo ng pagkakataon na

ipaalam sa tao ang tungkol a kasalukuyang paniniwala at kaugaliang gawin sa panahon
ng pagbubuntis, pagkapanganak at makailang linggo pagkatapos manganak. At marahil
maari ninyo pang maisalba ang mga buhay sa pamamagitan ng pagtukoy ng mga
nakagawian ng gawin na maaring masama sa mga nanay at sa mga di pa naipapanganak
na sanggol.

Pagiging Kumpedensyal

Sa pamamagitan ng pananaliksik na ito, posibleng ang ibang mga kumunidad ay

buksan ang kamalayan na kayo ay makibabahagi. Hindi naming ibubunyag ang inyong
pagkakakilanlan sa pananaliksik na ito. Ang mga impormasyong makukuha naming sa
panahon ng aming pananaliksik ay mananatiling kumpidensyal lahat ng impormasyong
ukol sa inyo ay may palahudyatan kayo sa inyong pangalan. Ang impormasyong nauukol
sa inyo ay ilalagak sa ligtas na lugar na tanging kami lang ng mga mananaliksik at ang
aming tagapayo sa tesis ang magkakaroon ng daan dito. Hindi ibabahagi kahit kanino na
di kabahagi sa proyektong pananaliksik na ito.

Pagbahagi ng Resulta

Para sa kaalaman na nakuha naming sa pagsasagawa ng pananaliksik na ito. Ito ay

ibabahagi sa inyo bago isagawa sa publiko. Lahat ng kumpidensyal ay hindi ibabahagi.
 120

Pagkatapos nito ay ihahayag namin ang resulta upang ang mga ibang tao ay matuto sa
pananaliksik.

Karapatang Tumanggi o Umurong

Hindi mo kinakailangang makibahagi sa pananaliksik na ito kung ayaw ninyo.

Maari rin kayong umurong sa pakikilahok sa anumang oras ninyo naisin. Ang inyong
desisyon at lahat ng karapatan ay igagalang.

Kanino makikipag-ugnayan

Kung mayroon kayong katanungan sa pananliksik na ito maari kayong makipag

ugnayan kina:

Itong proposal na ito ay inaprubahan ng Manila Adventist College ETHICS

RESEARCH COMMITTEE of the School kung mayroon kayong tanong ukol sa ERC na
kontakin lang po ang pangkat ng mananaliksik.

Dr. Linda-Lim Varona, [email protected]

Dr. Bibly Macaya, [email protected]

Dr. Maria Carmela L. Domocmat, [email protected]

Atty. Silvano Sumagaysay, [email protected]

Dr. Wealthy C. Estrada, [email protected]

Part II. Katibayayan ng Pagpayag

Nabasa ko ang lahat ng impormasyon o nabasa sa akin. Nagkaroon ako ng

pagkakataon na makapagtanong ukol dito at ang bawat tanong ko ay nasagot naman ng
may kasiyahan. Pinahihintulutan ko nang kusa ang paglahok bilang kalahok dito sa
pananliksik na ito.

Pangalan ng Kalahok: _____________________________________________________

Lagda ng Kalahok: ________________________________________________________

Petsa: __________________________________________________________________

Nabasa naming ang papel ng impormasyon sa mga potensyal na kalahok sa abot

ng aming makakaya at sinugarado namin na ang bawat kalahok ay nauunawaan na ang
mga sumusunod ay gagawin.
 121

1. Ang kahalagahan ng pananaliksik na ito sa bawat babae.

2. Ang mga kalahok ay naunawaan kung ano ang ginawa sa pananaliksik na ito.

3. Ang mga kalahok ay naunawaan ang kanilang karapatan sa pananaliksik na ito.

Kinukumpirma ko na ang kalahok ay nabigyan ng pagkakataon na

makapagtanong ukol sa pag aaral na ito, At ang lahat ng katanungan ay nasagot nang
tama sa abot ng aming makakaya. Kinukumpirma namin na ang bawat indibiduwal ay
hindi pinilit sa pagbigay ng pahintulot at ang pahintulot ay binigay ng kusa.

Ang kopya ng pormularyong INFORMED CONSENT ay pinagkaloob sa kalahok.

Pangalan ng
Nananaliksik:____________________________________________________________

Lagda ng Nananaliksik:____________________________________________________

Petsa:___________________________________________________________________
 122

Appendix C

Interview Guide

Research Question Interview Question

What are the participant’s 1. While you were pregnant (Now that you are
prenatal cultural beliefs pregnant- for currently pregnant women) what
and practices? are the things that you believe women should or
should not do during pregnancy?
2. What are the things that you do/practice or do not
do/practice during pregnancy?

What are the participants’ 1. While you were pregnant (when you will give
cultural beliefs and birth) what are the things that you believe women
practices regarding should or should not do during labor and
childbirth? childbirth?
2. What are the things that you do/practice or do not
do/practice during labor and childbirth?
What are the participants’ 1. What are your beliefs that women should or
postnatal cultural beliefs should not do after giving birth?
and practices? 2. What are your practices that women should or
should not do after giving birth?
1. Is there anything else that you would like to add
that we haven’t asked?
 123

Appendix D

Gabay na Katanugan

Research Questions Interview Questions

Ano ang kultural na paniniwala at 1. Nang ikaw ay nagdadalangtao (ngayong
nakasanayang gawin ng mga kalahok ikaw ay buntis-para sa kasalukuyang
ukol sa pre-natal? nagdadalangtao) Ano ang bagay na
pinaniniwalaan mo na dapat at di dapat
gawin ng babae sa panahon ng kanilang
pagbubuntis?
2. Ano ang mga bagay na nakasanayan at
di mo nakasanayang gawin sa panahon
ng pagdadalangtao?
Ano ang paniniwalang kulturang at 1. Habang ikaw ay buntis (kapag
nakasanayang gawin ng kalahok ukol sa manganganak) Ano ang mga bagay na
panganganak? pinaniniwalaan ng babae na dapat at hindi
dapat gawin sa panahon ng pagle labor at
pagkapanganak.
2. Ano ang mga bagay na nakasanayang
mong gawin at di mo nakasanayan?
Ano ang paniniwalang at nakagawian na 1. Ano ang iyong paniniwala na dapat
ng kalahok ukol sa “postnatal care” o gawin at di dapat gawin ng babae
pangangalaga pagkatapos manganak? pagkatapos manganak?
2. Ano ang iyong nakasanayang gawin na
sa tingin mo na dapat gawin at di dapat
gawin pagkatapos gawin?
3. Mayroon ka bang gustong idagdag na
hindi naitanong?
 124

Appendix E

Correspondence