The Difference in Pain Perception Between Jewish and Arab Women During Child Birth in Israel

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Table of Contents

Background
The study
The Results
Comparison of pain expression and pain relief usage
Discussion
Relevance to the nursing practice
References

Background

The way a woman handles a birth is determined on a large part by her cultural background, and cultural values are present in every aspect of the gestation and the parturition and determine the way she will conduct herself in the run-up and during the parturition [Callister et al. 1999; Cassar 2006].

In regards to the matter of perception and expression of pain, previous studies have suggested that Arab women expressed pain more than Jewish women [Weisenberg and Caspi, 1989]. However, the other studies have suggested that the expression of pain during delivery may not be a reliable indicator of the intensity of pain the patient is feeling; this may stem from cultural beliefs that condemn the expression of pain during delivery as a sign of weakness [Harrison, 1991].

Further studies suggested that the estimation of the intensity of pain that the patient is feeling by the obstetric team may be influenced by the ethnicity of its members; for example, Jewish obstetric practitioners were shown to estimate that Bedouin women intensity of pain was less than that of Jewish women [Sheiner, et al, 1999].

In regards to the judgment on the amount and type of pain-relieving medication to be used, other factors in addition to the ethnicity of the patient come into play; this includes the age and the parity of the patient, level of education and secularism, and the patients demand epidural anesthesia [Sheiner, 2000].

The study

The study was carried out as part of a larger study of the cultural aspects surrounding childbirth among Arab and Jewish women in Israel [Rassin, et al, 2009]. The study involved filling out a 45 questions form which was specifically designed and covered the scope of the study.

The participants were from Arabic and Jewish ethnicity but were all of the Israeli nationality; a total of 126 participants were chosen with each group being represented by 63 participants. The participants were engaged within the first three days post-partum and recruited into the study after agreeing to fill the questionnaire. The study was carried out in one of the largest hospitals in Israel between October 2006 and May 2009.

The Results

In regards to pain, the parameters of analysis included verbal expressions of pain ranging from moaning to yelling. Data was also analyzed in regards to the type of pain relief medication administered between the two groups.

Comparison of pain expression and pain relief usage

Parameter	Jewish origin %	Arab origin %
Reported verbal pain expression Moans and crying Moans and yelling
	63.5% (40)	42.85% (27)
	36.5% (23)	57.14% (36)
Pain relief Epidural anesthesia Pethidine/promethazine None
	57.14% (36)	17.46% (11)
	19.04% (12)	52.38% (33)
	23.81% (15) 30	15% (19)

Source; Rassin, et al, 2009

From the tabulated results, it is clear that more of the Jewish women expressed pain by moaning and crying; and most of the Arab women expressed pain by moaning and yelling. There was also a significant difference in the type of pain-relieving medication the women opted for; with more of the Jewish women being given more epidural anesthesia and the Arabic women, more promethazine and pethidine compared to the respective opposite.

Discussion

The clinician’s decision to administer a pain-relieving medication during parturition is determined by the estimation of the intensity of pain that the woman is feeling at the time. On the other hand, the expression of pain on the run-up to the actual delivery is affected by the cultural beliefs and practices of the patient and may not be an accurate method of estimating the intensity of pain.

This may be the reason why the clinicians are opting to give the Jewish women the more effective epidural anesthesia to pethidine and promethazine as they may express more pain at the beginning of parturition; therefore end up having a less painful experience as the process progresses; as shown by the less pronounced.

On the other hand, the Arab women may be bound by practices that frown on the expression of pain (as seen among the Bedouins) at the onset of parturition leading to an underestimation of the intensity of pain by the obstetric team thus explaining the administration of promethazine and pethidine; as the process progresses the intensity of pain in the Arab patient will be significantly more than that in the Jewish patient; thus resulting in more pronounced vocalization comparatively.

Relevance to the nursing practice

The understanding of the culture of the various ethnic groups who visit a hospital for various reasons is essential for the effective delivery of nursing services to these patients. This would make the stay of the patient in the hospital less stressful.

In regards to the perception of pain among the women of different ethnicities during childbirth and the reaction of the obstetric team in the management of this pain, it is important for the caregiver to have at least basic knowledge of the possible reaction of the patient to the pain of delivery.

This would enable the medical team to avoid stereotyping the patient based on the ethnicity of the patient; making the experience even more stressful.

References

Callister, L.C., Semenic, S. & Foster, J.C. (1999) Cultural and spiritual meanings of childbirth: orthodox Jewish and Mormon women. Journal of Holistic Nursing, 17, 280–295.
Cassar, L. (2006) Cultural expectations of Muslims and orthodox Jews in regard to pregnancy and the postpartum period: a study in comparison and contrast. International Journal of Childbirth Education, 21 (2), 27–31.
Harrison, A. (1991) Childbirth in Kuwait: the experiences of three groups of Arab mothers. Journal of Pain and Symptom Management, 6, 466–475.
Rassin M., Klug E., Nathanzon H., Kan A. & Silner D. (2009): Cultural differences in child delivery: comparisons between Jewish and Arab women in Israel. International Nursing Review 56, 123–130.
Sheiner, E., et al. (1999) Characteristics of parturients who choose to deliver without analgesia. Journal of Psychosomatic Obstetrics and Gynaecology, 20, 165–169.
Sheiner, E., et al. (2000): Overestimation and underestimation of labor pain. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 91 (1), 37–40.
Weisenberg, M. & Caspi, Z. (1989): Cultural and educational influences on pain of childbirth. Journal of Pain Symptom Management, 4 (1), 13–19.

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