In a multicultural society, culturally competent nursing
needs to be informed of the needs of patients from all
Nurses and midwives care for Amish women through
pregnancy and childbirth in a variety of settings,
including home births, birthing centres, and
hospitals. Health care professionals need to be
aware of and respect the ways the Amish culture
impacts on their health care practices.
Most Amish do not have any health insurance by
choice. The community supports those with serious
illness or accident, with a “prescribed, ritualistic
response to human tragedy” (Julia 1996), through
fundraising, and monthly contributions to a fund if
Amish and Mennonite are conservative
Protestant groups that developed after 1693
from the Anabaptist movement in
Switzerland. These groups believe in adult
baptism. There are subgroups in the Amish
culture that range from ultra conservative to
New Order. Amish adapt to changing
technology carefully, with much consideration
by the elders.
Amish women have an average of seven
children (Purnell and Paulanka,
1998). Children work on the farm performing
chores which ensures the survival of the
Consanguinity (relatives marrying relatives) in
the Amish culture results in a number of
recessive disorders, many of which are seen only
in the Amish population. Having a child with a
hereditary defect is accepted as God’s will, and
parents are not encouraged to stop having more
Babies are viewed as a gift from God, and
children are nurtured in preparation for eternal
life (Pumell 1998). Most couples do not use birth
control, and therapeutic abortions, amniocentesis
and other invasive techniques are not
acceptable. Distance and cost affect when
prenatal care begins and the number of visits
Mothers are generally in good health, well-
nourished, and complications of pregnancy
such as gestational diabetes and
hypertension are infrequent.
“Five week formula” is used for the last five
weeks of pregnancy, to tone and calm the
uterus, quiet the nerves, improve labour and
ease pain. This formula is also used for
menstrual disorders, morning sickness and
hot flashes. Herbs in the formula are red
raspberry leaves, butcher’s broom root, black
cohosh root, dong quai root, and squaw vine
Some Amish folk wisdom for pregnant
Walking under a clothesline – stillbirth
Crawl through a window or under a table –
umbilical cord around baby’s neck
Husbands may be present for delivery,
and there are no major taboos or
requirements for labour and delivery. The
women wear soft pastel-coloured gowns
when labouring. Other ladies in the
community assist the mother for about six
What is a Midwife?
The word "midwife" comes from Old
English and means "with woman”.
(Association of Ontario Midwives, 2008).
Midwives have helped women deliver
babies since the beginning of history.
References to midwives are found in
ancient Hindu records, in Greek and
Roman manuscripts, and even in the
Registered midwives are health
professionals who provide primary care
to woman and their babies during
pregnancy, labor, birth and the
What Do Midwives Do?
Provide complete course of low-risk
prenatal, intrapartum and postnatal care.
Screening and diagnostic tests
Assessment of risk and abnormal
Conduct normal vaginal deliveries.
Work in collaboration with other health
professionals and refer to specialists as
Attend births in the hospitals, birth
centres and at home.
During regularly scheduled visits midwives
Clinical examinations and routine tests of
pregnancy i.e. Blood work, ultrasounds etc.
Counselling & Education.
Between visits midwives provide:
24 hours a day call availability for questions,
labour/birth & emergencies.
Issues Affecting Midwives
Stereotypes of midwives(uneducated,
Misconceptions or misunderstanding
of the midwifery scope of practice and
Some Physicians fear regarding
litigation if involved in the care of a
Why do we need midwifery
The top 10 reasons:
(Adapted from Midwifery coalition of Nova Scotia)
Midwives are experts
Midwives promote the health of women and babies.
Midwifery is family-centred.
Midwifery is safe.
Midwives offer personalized care.
Midwives are flexible and accessible.
Midwives respect diversity.
Midwives are part of the health care team.
Midwifery care is a choice more families are making.
You Deserve it.
Contrasts between a Midwife
and an Obstetrician
Midwives tend to have a more holistic, natural
philosophy about childbirth, whereas
obstetricians are more likely to have a
medical perspective and view birth as a risk.
Midwives tend to spend more time with you
during labour and in prenatal visits than an
obstetrician, who may be in and out of the
birthing room until the final stages of pushing
Obstetricians are more likely than midwives
to use medical interventions such as
inductions, continuous monitoring,
episiotomies as well as recommend
Contrasts between a Midwife
and an Obstetrician Con’t
Obstetricians are trained as surgeons
and can do a caesarean, whereas a
midwife cannot perform major surgery.
Obstetricians can treat both low and
high-risk mothers but midwives can
see only low-risk patients.
Midwives, in some cases, practice in
birth centers or a homebirths in
addition to hospital births, unlike
obstetricians who practice only in a
The Ontario’s Ministry of Health recently
completed an evaluation of it’s midwifery
programme and found:
With Midwife Care With Physician
Improved breastfeeding rates (at
Reduced caesarean rates 12.7% 20.6%
Fewer operative vaginal
Fewer Episiotomies 7.2% 16.6%
Early hospital discharge <24
When having a baby in the hospital
your family doctor may refer you to an
The OB will handle every conceivable
medical aspect of your pregnancy,
labour, delivery and postpartum
If you are a high risk pregnancy you
will most likely be seeing an OB.
More than 90% of women see an OB
when they are pregnant
Tests that your Obstetrician will be
giving you during your pregnancy:
Prenatal blood test
This test will check your blood levels to
detect a pregnancy.
It tests the HCG level (human chorionic
gonadotropin) in your blood. This should
double every day to detect a normal
16 – 18 weeks of your pregnancy your
OB will give you another blood test to
-enhanced AFP- Alpha-fetoprotein
- this can show a risk of an abnormality
of the fetus.
Or absence of all or part of the fetal brain
Can diagnose a high % of anencephaly
and spina bifida cases.
Low level of MSAFP could indicate down
can be done according to your OB’s
preference starting at 6 weeks
can also have one at 18-20 weeks to look for
any abnormalities in the fetus
Glucose Tolerence Test (diabetes test)
screened between 25th and 28th weeks
you take a non-carbonated bottle of a
sweetened beverage to drink 1 hour before
the blood test
At every doctors appointment your OB
will take your blood pressure, your
weight, check the size of your uterus and
answer any questions or concerns you
By the 42 week of your pregnancy (if you
already haven’t had the baby) then the
OB will discuss whether he/she will
induce you into labour.
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