The religious and cultural beliefs of the Amish, have led to variations in health care practices that are different from main stream American culture. The Amish believe in simple lifestyles and being “separate from the world,” this is hallmark for the Amish. They don’t use modern conveniences that we do, such as electricity, computers, cars, and phones. They travel by horse and buggy, and grow their own gardens and raise their own cattle for food/milk. Their days are filled with hard work and simple pleasures.
Babies are a welcomed gift in the Amish culture and are viewed as a blessing rom God. They believe the # of children they have should be left in God’s hands, this is why it’s forbidden to use birth control, because it would interfere with God’s will. Amish families tend to be large; 6-10 kids is common, and occasionally there are families with up to 20 children born to one mother. When a woman gets pregnant; therapeutic abortions, amniocentesis, and other invasive prenatal diagnostic testing (that some of us may use) is not acceptable.
They are happy “to take what God gives them. ” The Amish usually have homebirths or give birth at birthing centers with a midwife. The only time they do hospital births, is when there is risk to the mother or the child. At the hospitals, routine interventions of labor and delivery are not used. IVs are available, but optional. Fetal heart rate monitoring is done intermittently by doppler. Amish women usually labor quietly while husbands support them by rubbing their backs, cooling them with hand fans, and holding their hands.
Labor tends to be shorter than average and happen peacefully with controlled pushing. Most mothers breastfeed and are anxious to feed the baby after elivery, but some produce no breastmilk at first, because of the huge workload and stress of a large family, and can’t feed the baby until the next day. So in the mean time, they give the baby things like jello water or watermelon seed tea, which is supposed to be good for preventing jaundice. Also, they usually don’t pick out names before the delivery; they wait and see “who the baby looks like” before they name him/her.
Amish folk wisdom is also an integral part of their prenatal practices, such as walking under a clothes line will result in still birth, or crawling through a window or nder a table will cause the umbilical cord to be wrapped around the baby’s neck. Complications such as pregnancy-induced HTN and diabetes (which is higher in Americans) is low in the Amish culture, most likely due to the well-nourished state of the mom, because she eats home-cooked and self-preserved foods (instead of fast food, which is convenient for us.
The greatest risk factor for the pregnant women is development of painful varicose veins because of all the heavy work they do. In preparing for the childbirth process, a 5 week formula is sometimes used in the ast 5 weeks of pregnancy to tone and calm the uterus, quiet the nerves, ease pain, and help make labor easier and on time. This formula has also been known to help with menstrual disorders, morning sickness, and hot flashes. It has been passed down from one generation to the next. This formula consists of 5 herbs including:
1. Red Rasberry leaves: relieves nausea and pain in labor. 2. Butcher’s Broom Root: this herb is used for hemorrhoids, varicose veins, and thrombosis. 3. Black Cohosh Root: relieves spastic muscles, dilates peripheral blood vessels, and helps reduce B/P. These actions help the terus and other muscles during labor. 4. Dong Quai Root: it is an anti-inflammatory and diuretic effect and helps to treat swelling prior to labor. During labor it eases smooth muscle contractions and gives a general sedative effect. 5. Squaw Vine Root: Used to prepare the uterus for childbirth and speed up delivery and encourage regular contractions. It has an antispasmodic action. (This is about the only pain relief/ medications that they use to help with pregnancy/delivery, besides maybe Tylenol. )
A person’s life philosophy and religious views profoundly impact the childbirth and parenting experience. Having a positive attitude toward the birthing process, a healthy lifestyle, and adequate support makes childbirth a better experience for the patient.
Some nursing interventions that could be used; since varicose veins are the greatest complication for pregnant Amish women (from all of their house work and laundry they do), I would remind her that she should take frequent rest periods from standing and elevate her legs. Maybe if she has older children, they could do some of the house work while mom rests. I would remind her that medication is available for pain relief if she chooses to accept it. I would provide her and her family a warm and comfortable environment, to make them feel at home.
I would also encourage the family to bring in home-cooked meals to help her and her husband feel at home. After delivery, if the mother started to feel too tired, and needed some rest I would care for the baby for short periods of time, and help with diaper changes and baths. As I mentioned before, the mother sometimes can’t lactate at first and isn’t able to feed the baby, so as a nurse I would offer bottles of formula to her so she could feed the baby until shes able to produce er own breastmilk (whether she accepted it or not would be up to her and her husband).
The only time an Amish woman gets to rest is right after she has the baby, so the families usually have a “helper” around for 6 weeks to care for the other children, clean, cook, and do laundry. So before the family leaves the hospital/birthing center, I would make sure they had someone lined up to help them out for at least 6 weeks after birth. I would also make sure she, as well as the family, understands instructions and reasons why interventions are offered.