title: Childbirth traditions and cultural perceptions of safety in Nepal: critical spaces to ensure the survival of mothers and newborns in remote mountain villages.
abstract: OBJECTIVE
  to uncover local beliefs regarding pregnancy and birth in remote mountainous villages of Nepal in order to understand the factors which impact on women's experiences of pregnancy and childbirth and the related interplay of tradition, spiritual beliefs, risk and safety which impact on those experiences.
  
  
  METHODS
  this study used a qualitative methodological approach with in-depth interviews framework within social constructionist and feminist critical theories.
  
  
  METHODS
  the setting comprised two remote Nepalese mountain villages where women have high rates of illiteracy, poverty, disadvantage, maternal and newborn mortality, and low life expectancy. Interviews were conducted between February and June, 2010.
  
  
  METHODS
  twenty five pregnant/postnatal women, five husbands, five mothers-in-law, one father-in-law, five service providers and five community stakeholders from the local communities were involved.
  
  
  RESULTS
  Nepalese women, their families and most of their community strongly value their childbirth traditions and associated spiritual beliefs and they profoundly shape women's views of safety and risk during pregnancy and childbirth, influencing how birth and new motherhood fit into daily life. These intense culturally-based views of childbirth safety and risk conflict starkly with the medical view of childbirth safety and risk.
  
  
  CONCLUSIONS
  if maternity services are to improve maternal and neonatal survival rates in Nepal, maternity care providers must genuinely partner with local women inclusive of their cultural beliefs, and provide locally based primary maternity care. Women will then be more likely to attend maternity care services, and benefit from feeling culturally safe and culturally respected within their spiritual traditions of birth supported by the reduction of risk provided by informed and reverent medicalised care.
authors.affiliation: 7 Dobies Court, Westmeadows, VIC 3049, Australia. Electronic address: sabitrakaphle@gmail.com.
authors.forename: Sabitra
authors.initials: S
authors.lastname: Kaphle
authors.forename: Heather
authors.initials: H
authors.lastname: Hancock
authors.forename: Lareen A
authors.initials: LA
authors.lastname: Newman
mesh_terms: D000328:Adult; D065246:Culturally Competent Care / Q000458:organization & administration; D003469:Culture; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007229:Infant Welfare / Q000208:ethnology; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000379:methods / Q000458:organization & administration; D008429:Maternal Welfare / Q000208:ethnology; D008880:Midwifery / Q000379:methods*; D009390:Nepal; D036801:Parturition / Q000208:ethnology*; D011247:Pregnancy; D018570:Risk Assessment; D012424:Rural Population
keywords: Childbirth; Culture; Nepal; Safety