Cultural Competence & Birth Work

We hear this term quite often, “cultural competence” but what does it really mean to be culturally competent?  What does it mean on an individual level and what does it mean in the area of maternal health?  Well let’s break down the definition of culture and competence.  According to Boston University, culture is defined by “all the ways of life including arts, beliefs and institutions of a population that are passed down from generation to generation.” Culture has been called “the way of life for an entire society.”  “As such, it includes codes of manners, dress, language, religion, rituals, art, norms of behavior, such as law and morality, and systems of belief. (Boston University, 2016).”  A simpler definition and the one we likely are more familiar with can be found in Merriam-Webster’s Dictionary which reads; “the customary beliefs, social forms, and material traits of a racial, religious, or social group” also: “the characteristic features of everyday existence (such as diversions or a way of life) shared by people in a place or time.”  Again from Webster’s let’s look at the definition of competence which reads; “having the necessary ability, knowledge, or skill to do something successfully.”

Based on these definitions we know culture is vast, it is complex it can vary from generation to generation, person to person, family to family, it encompasses all of the ways people move through life.  With that in mind how much time and effort does it take to be culturally competent?  How much time does it take to “have the ability, knowledge or skill to successfully work with the customary beliefs, social forms, and material traits of a racial, religious, or social group; understanding the characteristic features of everyday existence shared by people in a place or time?”  When we look at if from this perspective, I think we can come to understand that it takes some time.

Cultural competency begins with individuals first acknowledging their own culture, beliefs, social norms.  Think about what it is about your culture that you appreciate, the language, the origins, the social norms, food, festivities, the rituals and the traditions.  Then think about the stereotypes that have been associated with your particular culture, have you been considered people who are lazy, cheap, excessive drinkers, unstable, or racist.  What have these stereotypes cost you?  Have they caused you or your family pain, discomfort, lost opportunities?  Have they made you feel insecure, uncertain or unsafe in certain spaces?

Now imagine that you are in the vulnerable space of pregnancy and you have to navigate systems of care with the weight of the responsibility of your culture, you want to keep your traditions, you want to care for your family and new baby with your values at the forefront.  The problem is the systems you have to navigate are riddled with the stereotypes associated you’re your culture, people are implicitly biased and treat you indifferently and they don’t even know it. However, you know it, you have that feeling in your gut that familiar pain that has no voice.  Maybe you can’t put into words, but you can feel in the core of your being.  Now try and have the best birth experience possible! Is it possible to have the best birth experience without culturally competent providers and birth workers?  If we don’t understand the importance of cultural competence, it is impossible to give someone the best possible care.

Cultural competence is being aware enough to not be afraid to learn and honor the culture of others, learn their morals, values, belief systems and pain.  Realizing that understanding another person’s culture takes nothing away from our own.  Cultural competency is not just wearing a T-shirt that says I support the LGBTQIA+ community or putting a sign in your office that says “this is a safe space.”  While these gestures are commonplace, they are not enough to combat the harm from implicit bias and incompetent birth work.  You see cultural competence is an ethical standard.  It is not just about our behavior it is also about our beliefs across systems and frameworks. It is the ability to care enough to study and work across all or a variety of cultures. It never gets old and we never arrive at its conclusion, cultural competence begins with awareness and with each client we serve from a different culture our competency grows.

It is impossible to be culturally competent and not expose ourselves to other cultures. It is not just the acknowledgment of one culture at a particular time of year or asking a particular group to explain their culture.  Now there is a space for curiosity but follow it with empowerment validation and lifelong learning.

As a doula and doula trainer we spend lots of time talking about comfort measures, advocacy, interventions, pain management and birth plans.  All of these concepts are great but a culturally incompetent provider, or doula no matter how many trainings we’ve taken or information we have can ruin how someone experiences their birth.  So consider this a call to action, a chance to re-think and reflect on our influence in the birthing community.  Working on our cultural competence can make all the difference in how we approach clients.  Because, unless we are continuing to learn about other cultures with intention, it is impossible to give someone the best possible care.


About the Author

Karen M. Peterson owner of KMP Doula Service has over 30 years of experience working with women, children and families. She is a faculty doula trainer for CAPPA, a certified labor and certified postpartum Doula (CAPPA), a certified lactation counselor, a safe sleep ambassador, and a certified child passenger safety technician.

Karen believes that the birthing space is a sacred one and feels privileged to help birthing people along their journey. Karen loves birthwork because it is a place where everyone involved becomes someone new. Karen supports healing, health equity, and the rights of childbearing people. Karen has great relationships with community based organizations and is connected to many referral services. She is a wife, mother and grandmother with a blended family of 8 children and 13 grandchildren.

She holds a BSED from West Chester University and has taught every grade level from K-12. Karen spent 12 years educating pregnant and parenting teens and prior to that she was a foster parent to teenage mothers. Karen is the former program director for the Pettaway Pursuit Foundation’s Doula by My Side Program and former interim program manager for Daddy University’s Paternal Involvement Initiative and Doula 4 Dads Program. Karen is the former founder & executive director of non-profit Women of Harmony, Inc.

Currently Karen is the Healthy Start case management coordinator and supervisor for the Doula Supplement program under The Foundation for Delaware County. Karen is a member of the Delaware County Breastfeeding Coalition and a graduate student at Widener University receiving a masters in clinical social work. Karen can be reached by phone or email at 610-809-1487 or Karen loves her family, teaching and self care by way of travel, dining, swimming and yoga.

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