Amish health care beliefs and practices in an obstetrical setting

Journal of Multicultural Nursing & Health, Fall 2002 by Lemon, Betty Spencer

In a variety of health care settings, nurses are caring for childbearing women and their families from the Amish culture. Accommodations for the Amish can be provided while still giving quality health care for the delivery and care of babies. A person's deeply held cultural religious views can profoundly impact the childbirth experience. This article describes a case study of an Amish family who had to transfer their newborn daughter to a neonatal intensive care unit and a visit to an Amish Birthing Center. Health care professionals working with the Amish must recognize and respect the role that culture plays in the health care practices of this population.

KEY WORDS: Amish; Amish Mutual Networks; Family Roles; Genetics; Prenatal Care; Birthing Center; Home Remedies.

Krieger (2001) usefully urge researchers to pay attention to the complexities of the pattering of health by culture, race, ethnicity and social class, for these patterns put our etiologic understanding to the test. In relation to child bearing, there are over 130,000 Amish in North America with the average Amish family having seven children, more than twice the mean of the America families (www.amish.net, 2002; Carlson, 2001). The Amish have doubled in population in the last decade (Good & Good, 1995). They are a conservative ethnic microcosm of the greater culture surrounding them but it appears that Amish mothers and their babies can utilize medical facilities without compromising their culture and/or religious beliefs. Accommodations for the Amish can be provided while still giving quality health care for the delivery and care of babies. A person's deeply held cultural religious view can profoundly impact the childbirth experience. Therefore, health care professionals working with the Amish must recognize and respect the role that culture plays in the health care practices of this population. This article describes a case study of an Amish family who had to transfer their newborn daughter to a neonatal intensive care unit as well as a family visit to an Amish Birthing Center.

CASE STUDY

The religious and cultural beliefs of the Amish culture have led to variations in health care practices that are different from main stream American culture. The Amish have a health care belief system that includes traditional remedies passed from one generation to the next. An opportunity to observe, care for, and learn about the Amish culture and life styles of this population occurred quickly one evening when our neonatal ICU received a transfer of a 24 hour old, 36 week gestation, 8 pound, six ounce female infant. This infant was delivered to a Gravida 14, para 13, 34 year old Amish mother who delivered at home and, because of birth asphyxia, the infant was taken to a nearby emergency room by a neighbor of the family who had a car. The family was without health insurance and was concerned about paying medical expenses associated with this baby's admission to the neonatal ICU. The biological and extended family visited frequently and brought in their own food in bags. The grandmother and neighbors would gather the children in the hospital waiting room to feed and entertain them while the mother would visit her baby daughter in the neonatal intensive care unit. The father visited on weekend. The family spoke Pennsylvania Dutch among themselves but used English in speaking with the health care providers. The children in the family were dressed like undersized replicas of their parents. They were in distinctive clothing that was subdued and devoid of any designs of flowers, figures or animals on the material. The little girls were in long dresses and head coverings, while the little boys were in trousers with suspenders. Some of the older boys wore broad-brimmed hats. All were very polite and well mannered. This Amish family appeared to come from another time, another place. In an instant the Amish family came into another world, the world of high tech health care. One may well surmise the "cultural - shock" of this encounter.

AMISH HERITAGE

The Amish are a conservative Protestant group who emerged after 1693 as a descendent of the Anabaptist movement that originated from Switzerland and spread to neighboring Germany. The Amish parted ways with the larger Anabaptist group, now known as the Mennonites, over a doctrinal dispute, (Hostetler 1993) and immigrated to America in the 17th & 18th century after experiencing religious persecution in Europe (Kraybill & Olshan 1994).

The diverse subgroups of the the Amish Culture have distinctive beliefs, values, and behaviors (Fine & Kleinman 1979). Today the Amish stand somewhere between the parent body, the Mennonites, and the four groups of Amish: Swartzentruber (ultra conservative), Andy Weaver (conservative), Old Order (conservative), and the New Order (less conservative). The New Order leads a more progressive path that diverged from the Old Order in 1968 (Blair & Hurst 1997). The New Order of Amish attempts to balance distinctive rituals and practices against accommodations. Over time the Amish have adapted to some change but at their own pace (Kraybill & Olshan 1994).