The experiences of postpartum hospital stay and returning home among Thai mothers in Australia

Length of stay after childbirth in India: a comparative study of public and private health institutions

Background

This paper discusses length of stay (LOS) following childbirth as an indicator of quality of postnatal care in health institutions. This research aims to describe LOS according to both vaginal and cesarean deliveries in public and private health care institutions in India, and to identify any association of LOS with postnatal care and post-delivery complications.

Methods

We use recently released nationally-representative data from the National Family Health Survey-4 (2015–16) and apply the Cox proportional hazard model to determine the factors associated with LOS at the health facility after childbirth during a five-year period preceding the survey.

Results

Overall, the average LOS after childbirth is 3.4 days; 2.1 days for vaginal deliveries and 8.6 days for cesarean section (CS) deliveries. Strikingly, half of the women are discharged within 48 h. Women who give birth in private hospitals have a more prolonged stay than those who give birth in public health facilities. For vaginal birth in public hospitals, one-fourth of the women are discharged with insufficient LOS as against only 19.2% women in private hospitals. LOS is significantly related to the cost of delivery only in the case of private facilities. Uneducated women belonging to lower wealth quintile households and those living in rural areas stay for a shorter duration for vaginal deliveries but for a longer duration in case of cesarean deliveries. Women who get four or more antenatal check-ups (ANC) done have a longer stay, while those who receive benefits under the Janani Suraksha Yojna (JSY) have a shorter stay. Another key finding is that women who are discharged on the same day report lower levels of postnatal care and a higher proportion of post-delivery complications.

Conclusion

The study concludes that early discharge has a negative association with maternal health outcomes, which has important program implications. Therefore, it is essential to maintain an adequate LOS at a facility after childbirth. We recommend that government programs should strengthen the JSY scheme not only to improve delivery care, but also to provide effective postnatal care by promoting sufficient LOS at facilities.

The influence of migration on women's satisfaction during pregnancy and birth: results of a comparative prospective study with the Migrant Friendly Maternity Care Questionnaire (MFMCQ)

INTRODUCTION

Approximately 21% of Germany's inhabitants have been born abroad or are of direct descent of immigrants. A positive birth experience has an effect on a woman's mental health and her future family planning choices. While international studies showed that immigrant women are less satisfied with their birth experience, no such study has been conducted in Germany until now.

METHODS

At our center of tertiary care in Berlin, with approximately 50% immigrants among patients, pregnant women of at least 18 years of age were offered participation in this study. A modified version of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) designed by Gagnon et al. in German, English, French, Spanish, Arabic and Turkish was used. We compared non-immigrant women to immigrant women and women with direct descent of immigrants. For certain analysis, the latter two groups were included together under the category "migration background".

RESULTS

During the study period, 184 non-immigrant, 214 immigrant women and 62 direct descendants of immigrants were included. The most frequent countries of origin were Syria (19%), Turkey (17%), and Lebanon (9%). We found a slight difference between groups regarding age (non-immigrants: mean 33 years versus women with any migration background: mean 31) as well as parity with more non-immigrants delivering their first child. No difference in the satisfaction with care was observed between immigrant and any migration background groups (p ≥ 0.093 in the two-sided Fisher's exact test). At least 75.8% of all participating women reported complete satisfaction with care during labor, birth and after birth. Interestingly, the level of German language proficiency did not influence the immigrant patient's satisfaction with care.

CONCLUSION

The study results show no difference regarding overall satisfaction with care during labor and birth despite a relevant language barrier. We are for the first time providing the MFMCQ in German and Turkish. Further future analyses on the impact of patient expectations on satisfaction with care will be conducted.

Traditional Postpartum Practices and Rituals: A Qualitative Systematic Review

Many cultures around the world observe specific postpartum rituals to avoid ill health in later years. This qualitative systematic review examined the literature describing traditional postpartum practices from 51 studies in over 20 different countries. Commonalities were identified in practices across cultures. Specifically, the themes included organized support for the mother, periods of rest, prescribed food to be eaten or prohibited, hygiene practices and those related to infant care and breastfeeding, among others. These rituals allow the mother to be ‘mothered’ for a period of time after the birth. They may have beneficial health effects as well as facilitate the transition to motherhood. In today's society, with modernization, migration and globalization, individuals may be unable to carry out the rituals or, conversely, feel pressured to carry out activities in which they no longer believe. The understanding of traditional postpartum practices can inform the provision of culturally competent perinatal services.

Culturally and linguistically diverse women

The proportion of women from culturally and linguistically diverse backgrounds is growing in Australia. Synthesising existing evidence concerning the views and experiences of these women in accessing sexual and reproductive health care is crucial to future policy and service development. A systematic review of scientific articles and grey literature published in English between 1990 and 2015 was conducted to identify the barriers and facilitators in accessing sexual and reproductive health care in Australia experienced by culturally and linguistically diverse women. The search strategy covered seven electronic databases (ProQuest, PubMed, EMBASE/Elsevier, SCOPUS, PsycINFO, CINAHL and Infomit) and websites. Thematic analysis methodology was used to analyse and interpret the data extracted from individual studies. From the 1401 potentially relevant articles identified, 22 articles that represent the views and experiences of 1943 culturally and linguistically diverse women in accessing sexual and reproductive health care in Australia were reviewed. The main barriers and facilitators identified were grouped into three major themes. These include personal level experiences of accessing health care, women's interaction with the healthcare system and women's experience with healthcare providers. Implications for clinical practice and future research are discussed based on the findings of the review.

Immigrant and non-immigrant women's experiences of maternity care: a systematic and comparative review of studies in five countries

BACKGROUND

Understanding immigrant women's experiences of maternity care is critical if receiving country care systems are to respond appropriately to increasing global migration. This systematic review aimed to compare what we know about immigrant and non-immigrant women's experiences of maternity care.

METHODS

Medline, CINAHL, Health Star, Embase and PsychInfo were searched for the period 1989-2012. First, we retrieved population-based studies of women's experiences of maternity care (n = 12). For countries with identified population studies, studies focused specifically on immigrant women's experiences of care were also retrieved (n = 22). For all included studies, we extracted available data on experiences of care and undertook a descriptive comparison.

RESULTS

What immigrant and non-immigrant women want from maternity care proved similar: safe, high quality, attentive and individualised care, with adequate information and support. Immigrant women were less positive about their care than non-immigrant women. Communication problems and lack of familiarity with care systems impacted negatively on immigrant women's experiences, as did perceptions of discrimination and care which was not kind or respectful.

CONCLUSION

Few differences were found in what immigrant and non-immigrant women want from maternity care. The challenge for health systems is to address the barriers immigrant women face by improving communication, increasing women's understanding of care provision and reducing discrimination.

"Being flexible and creative": a qualitative study on maternity care assistants' experiences with non-Western immigrant women

BACKGROUND

Several studies conducted in developed countries have explored postnatal care professionals' experiences with non-western women. These studies reported different cultural practices, lack of knowledge of the maternity care system, communication difficulties, and the important role of the baby's grandmother as care-giver in the postnatal period. However, not much attention has been paid in existing literature to postnatal care professionals' approaches to these issues. Our main objective was to gain insight into how Dutch postnatal care providers--'maternity care assistants' (MCA)--address issues encountered when providing care for non-western women.

METHODS

A generic qualitative research approach was used. Two researchers interviewed fifteen MCAs individually, analysing the interview material separately and then comparing and discussing their results. Analytical codes were organised into main themes and subthemes.

RESULTS

MCAs perceive caring for non-western women as interesting and challenging, but sometimes difficult too. To guarantee the health and safety of mother and baby, they have adopted flexible and creative approaches to address issues concerning traditional practices, socioeconomic status and communication. Furthermore, they employ several other strategies to establish relationships with non-western clients and their families, improve women's knowledge of the maternity care system and give health education.

CONCLUSION

Provision of postnatal care to non-western clients may require special skills and measures. The quality of care for non-western clients might be improved by including these skills in education and retraining programmes for postnatal care providers on top of factual knowledge about traditional practices.

Transnational Migration and Global Health: The Production and Management of Risk, Illness, and Access to Care

Globalization, including the global flows of people, is clearly linked to disease transmission and vulnerability to health risks among immigrant populations. Anthropological research on transnational migration and health documents the implications of population movements for health and well-being. Studies of immigrant health reveal the importance of the social, political, and economic production of distress and disease as well as the structures and dynamics that produce particular patterns of access to health services. This review points to underlying political, economic, and social structures that produce particular patterns of health and disease among transnational migrants. Both critical and phenomenological analyses explore ideas of alterity and community, which underlie the production and management of immigrant health. Research on immigrant health underscores the importance of further attention to policies of entitlement and exclusion, which ultimately determine health vulnerabilities and accessibility of health care.

A patient perspective in research on intercultural caring in maternity care: A meta-ethnography

The aim of this study is to explore and describe a patient perspective in research on intercultural caring in maternity care. In total, 40 studies are synthesized using Noblit and Hare's meta-ethnography method. The following opposite metaphors were found: caring versus non-caring; language and communication problems versus information and choice; access to medical and technological care versus incompetence; acculturation: preserving the original culture versus adapting to a new culture; professional caring relationship versus family and community involvement; caring is important for well-being and health versus conflicts cause interrupted care; vulnerable women with painful memories versus racism. Alice in Wonderland emerged as an overarching metaphor to describe intercultural caring in maternity care. Furthermore, intercultural caring is seen in different dimensions of uniqueness, context, culture, and universality. There are specific cultural and maternity care features in intercultural caring. There is an inner core of caring consisting of respect, presence, and listening as well as external factors such as economy and organization that impact on intercultural caring. Moreover, legal status of the patient, as well as power relationships and racism, influences intercultural caring. Further meta-syntheses about well-documented intercultural phenomena and ethnic groups, as well as empirical studies about current phenomena, are suggested.

Traditional practices, beliefs and uses of medicinal plants in relation to maternal–baby health of Criollo woman in central Argentina

OBJECTIVE

to present information on traditional practices and medicinal uses of plants for treating health diseases related to the reproductive cycle of Criollo women living in the hills of the province of Córdoba; and to interpret these uses in the context of this population's folk medicine.

DESIGN

data were collected during several field trips to the study area based on the guidelines of a research project that included ethnographic and ethnobotanical aspects of the study area.

SETTING

a rural community of central Argentina.

PARTICIPANTS

a total of 62 peasants were interviewed on the basis of a semi-structured system. Repeated open and extensive interviews were also undertaken with seven women who had previously worked as midwives in areas of difficult access.

FINDINGS

this study found that 12 different female diseases and complaints are treated using a total of 48 plant species belonging to 27 botanical families, with 71 different medicinal uses. The traditional beliefs and practices associated with maternal-baby health care in rural areas highlights the existing combination of principles reformulated from humoral medicine, the use of analogical reasoning, and ontological and functional interpretations of morbid processes. The principle of Hypocratical opposition and hot-cold categorisation are significant criteria that rule over the practices of mother and child health care during birth and puerperium.

IMPLICATIONS FOR PRACTICE

consequences of traditional knowledge on the health care of peasant women are discussed, based on the analysis of traditional practices from a peasant's point of view.

The Meanings and Experiences of Cesarean Birth Among Cambodian, Lao and Vietnamese Immigrant Women in Australia

We examined the experience of cesarean birth among 67 Cambodian, Lao and Vietnamese women who are now living in Melbourne, Australia, based on a larger ethnographic research project on childbearing, childrearing and motherhood among Southeast Asian women in Australia. We found a range of responses in the discourses of the women: some women preferred cesarean birth, but others resisted it. Women's social construction of their feelings stemmed from three interpretive frameworks: trust in medical knowledge, expectations (personal ideology of reproduction and motherhood) and communication with an understanding of their caregivers' preferences (as opposed to choice). Our findings have ramifications for health care providers working in multicultural settings. An effective dialogue between women and their health caregivers is required to keep the cesarean section rates down. In the case of immigrant women in a multicultural society like Australia, it is not the passive receipt of information but a two-way communication with adequate interpreter support that will lead to informed choice, fewer cesarean births, more satisfaction and less regret.

When giving life starts to take the life out of you: women's experiences of depression after childbirth

OBJECTIVE

To capture the missing voices of mothers who are suffering postnatal depression.

DESIGN

Qualitative methodology using in-depth interviews.

SETTING

Melbourne, Victoria, Australia.

PARTICIPANTS

10 women who had been clinically diagnosed and admitted to a large hospital mother and baby unit in Australia.

FINDINGS

Stigma is frequently attached to women who are unhappy after the birth of their child, because they are not coping with the demands of motherhood or do not instantly bond with, and love, their baby. As a result, postnatal depression can be a terrifying and isolating experience for women. It is also a complex illness with varying degrees, reasons for onset and medical treatments.

IMPLICATIONS FOR PRACTICE

In this study, we have captured the emotions and feelings of women first hand, allowing us and health-care practitioners who are treating women to truly understand this debilitating illness. It is hoped that, in making the wider community aware of depression after childbirth, fewer women will suffer in silence.

The education of health practitioners supporting breastfeeding women: time for critical reflection

The protection, promotion and support of breastfeeding has now become a major international priority as emphasized in the Global Strategy for Infant and Young Child Feeding. Health practitioners, such as midwives, nurses and doctors, have a key role to play in providing support to breastfeeding women. This paper provides a critical discussion of educational requirements of health practitioners to equip them for their supportive role. The effective integration of embodied, vicarious, practice-based and theoretical knowledge requires opportunities for deep critical reflection. This approach should facilitate personal reflection and critical engagement with broader socio-political issues, thus allowing for collective understandings and change. Practitioners also need to understand breastfeeding as a biopsychosocial process that is dynamic, relational and changes over time. Recommendations are outlined with regards to multidisciplinary undergraduate education; mentorship schemes with knowledgeable role models supporting student practitioners; involvement of voluntary and peer supporters; post-registration education; setting of national standards for breastfeeding education; tailored education for specific groups; designated funding; and involvement of breastfeeding specialists.

A critical ethnographic study of encounters between midwives and breast-feeding women in postnatal wards in England

OBJECTIVE

To explore the nature of interactions between midwives and breast-feeding women within postnatal wards.

DESIGN

A critical ethnographic study using participant observation and focused interviews.

SETTING

Two maternity units in Northern England, UK.

PARTICIPANTS

61 postnatal women and 39 midwives.

FINDINGS

The interactions between midwives and women were encompassed by the global theme of 'taking time and touching base'. However, most encounters were characterised by an absence of 'taking time' or 'touching base'. This related to midwives' experiences of temporal pressure and inability to establish relationality with women due to their working patterns. The global theme was underpinned by five organising themes: 'communicating temporal pressure'; 'routines and procedures'; 'disconnected encounters'; 'managing breast feeding'; and 'rationing information'.

KEY CONCLUSIONS

The organisational culture within the postnatal wards contributed to midwives experiencing profound temporal pressures and an inability to establish relationality with women. Within this context, the needs of breast-feeding women for emotional, esteem, informational and practical support were largely unmet.

IMPLICATIONS FOR PRACTICE

Transformative action is required to dramatically reorganise the provision of hospital-based, postnatal ward midwifery care in parts of the UK. This should include a re-conceptualisation of caring time, with recognition that midwives need sufficient time in order to give time to others. This, in turn, requires recognition that caring time is cyclical and rhythmical, allowing for relationality, sociability, mutuality and reciprocity. The midwifery staffing structure in postnatal wards needs to be reviewed, as it is unacceptable to midwives and service users for staff to be rapidly relocated according to other demands within the institution. Most radically, it is argued that now is the time to reconsider the suitability of the hospital as the place and space within which women commence their breast-feeding journey.

Thai nurses' beliefs about breastfeeding and postpartum practices

Cultural beliefs are important determinants of health care behaviours. Nurses have an important influence on infant feeding decisions and maternal postpartum care, but little is known about the extent to which their practice is influenced by traditional beliefs and/or recent innovations driven by evidence-based research. The aim of this study was to investigate Thai nurses' traditional beliefs about breastfeeding and related postpartum care, and their impact on nursing practice. A survey of 372 nurses working in hospitals and health services in Ubon Ratchathani, Thailand was undertaken. Questionnaire items were developed from a review of the literature and exploratory interviews with Thai women. Descriptive statistics were used to represent the incidence of particular beliefs and behaviours. Chi-square analyses were conducted to determine relationships between demographic characteristics and traditional beliefs and practices. There were discrepancies between nurses' beliefs and contemporary evidence-based practices. Many nurses supported traditional Thai postpartum practices such as food restrictions and encouraging hot baths. Some traditional beliefs supported by nurses may be detrimental to women and babies such as "lying by fire", discarding of colostrum, and giving boiled water to neonates. Only half the nurses reported that they encouraged mothers to breastfeed immediately following birth. The study was undertaken in the North-East of Thailand, where the population is known to have strong belief systems. Reliability and content validity of the tool would be enhanced through replication studies and qualitative investigations of other breastfeeding issues. There is a need for professional development strategies such as peer review and mentoring to address inadequate knowledge and outdated practices of some health professionals, as well as continuity of care models to assess quality care outcomes that are culturally appropriate.

Traditional postpartum practices among Thai women

BACKGROUND

Culture is often related to notions of well-being, illness, healing and health that inform individuals in their day-to-day activities. The postpartum period is noted for traditional practices related to rest, healing and the consumption of food and drinks, but a contemporary view of these practices is needed.

AIMS

To gain an understanding of the traditional practices that Thai women follow in relation to postpartum care and the rationales underpinning such practices.

METHODS

This descriptive study surveyed 500 Thai women living in Ubon Ratchathani, Thailand and attending their first postpartum hospital clinic appointment. A self-completion questionnaire was specially developed and pilot tested, and then administered to women attending the clinic.

DATA ANALYSIS

Descriptive statistics were used in relation to the incidence of particular behaviours. Chi-square analyses were conducted to determine relationships between demographic characteristics and traditional practices.

RESULTS

The majority of Thai women adhered to traditional postpartum practices related to the notion of regaining 'heat'. These included 'lying by fire', food restrictions, taking hot baths and consuming hot drinks. Other activities involved not exposing the body to heat loss by keeping covered, not shampooing the hair, avoiding the wind and sexual abstinence. Younger, less educated, primiparous women were more likely to report traditional practices. Mothers and mothers-in-law were most influential in recommending these behaviours.

CONCLUSIONS

Traditional postpartum practices are still dominant in contemporary Thai culture and are perpetuated by close female family relatives. Health professionals need to be aware of clients' culture and consider the extent to which professional care complements the mothers' traditional beliefs. Nurses need to educate women about the benefits of contemporary postpartum care and to provide strategies to help them to integrate their beliefs and the practices recommended in contemporary health care practice.

The cultural and social meanings of childbearing for Chinese and Scottish women in Scotland

OBJECTIVE

to analyse the meanings that women gave to their childbearing experiences in order to provide some useful insights as to how their experiences might be improved.

SETTING

maternity units in Scotland.

DESIGN

four semi-structured interviews with each of ten Chinese and ten Scottish women in their own language; and unstructured interviews with 45 health workers, women's relatives and their friends.

FINDINGS

having children was meaningful to Scottish and Chinese women in Scotland in different ways which were related to their social positions, beliefs and practices involved and the change in social status on the birth of a child. Different meanings demanded different coping strategies in healthy childbearing. Scottish women took greater interest in their sense of control over their childbearing. Some Chinese women were experiencing more extensive cultural conflicts and changes as they tried to identify with the new culture, while the others were experiencing gradual changes over a period of time consciously or unconsciously. Both Chinese and Scottish women in the study were in a struggle between autonomy and control over their childbearing--between the mind and the body.

CONCLUSION

childbearing is socially shaped and culturally specific. Maternity services need to consider ways in which cultural sensitive care can be provided to women in a multi-ethnic modern society.

Choice and control as experienced by Chinese and Scottish childbearing women in Scotland

OBJECTIVE

to provide some insights as to how women's childbearing experiences might be improved.

DESIGN

a qualitative comparative approach.

SETTING

maternity units in Scotland.

METHOD

two case comparison, four tape-recorded semi-structured interviews with each of ten Chinese and ten Scottish women, and one unstructured interview with 45 health workers, women's relatives and friends. This study was set against the background of existing literature and the author's personal experience as a midwife in both Chinese and Scottish societies and as a Chinese mother having her first baby in Scotland.

FINDINGS

the issues of 'choice' and 'control' in childbearing regulated the social relationships between women, women's bodies, their babies, health workers, obstetric technology and the wider social context. Although the Chinese and Scottish women under investigation were in Scotland, their different cultural backgrounds gave them different expectations, choices and experiences. These differences are further examples of the social and cultural construction of choice and control.

CONCLUSION

'choice' and 'control' offered some new dimension for the women to achieve; for the health workers and society to facilitate a new dynamic and stimulating childbearing experience. Women's bodies' cues, their babies and their feeling of being in control could be important in the management and their experience of care.

Parents' experience of early discharge from hospital after birth in Sweden

OBJECTIVE

to investigate the factors that influence the experience of mothers and fathers when they have chosen to return home, earlier than is the normal routine, following the birth of their baby.

DESIGN

a qualitative study, using open interviews, was undertaken. The text of the transcripts was coded and categorised according to the grounded theory method using constant comparative analysis.

SETTING

interviews were carried out with 12 parents, six mothers and six fathers, individually in their own homes. They had all left a maternity/family ward at the Helsingborg Hospital in southern Sweden within 26 hours of birth whereas the normal discharge time is 72 hours.

MEASUREMENTS AND FINDINGS

'a sense of security' was the core category. Achieving a sense of security linked to informed choice for early discharge appeared to be dependent on the following categories: (l) the midwives' empowering behaviour; (2) affinity within the family; (3) the parents' right to autonomy/control; (4) physical well-being. There appears to be an inner connection between each of these categories.

KEY CONCLUSIONS

the midwife's empowering behaviour supports the parents' sense of security and encourages their informed choice of earlier discharge after birth. When the mothers' and babies return home it strengthens the affinity within the family and the father's sense of participation.

Incorporating cultural diversity in randomised controlled trials in midwifery

The randomised controlled trial is currently the 'gold standard' that guides health-care practices. The implementation of new models of midwifery care often relies on results from randomised controlled trials. However, many randomised controlled trials exclude women who do not speak English or are designed in such a way that cultural diversity is not facilitated. This can mean that the sample is not representative of the population from which it was drawn or to which it will be applied. Culturally diverse representation can be achieved through a number of strategies. These include utilising health-care interpreters, ensuring materials are translated into common community languages and engaging the local community. These strategies can be used to ensure that the sample in a randomised controlled trial is culturally and linguistically diverse, and representative of the community. We have conducted a randomised controlled trial of a community-based model of midwifery providing continuity of care in a culturally diverse population. A number of issues in the conduct of a trial within a culturally diverse society are discussed in this paper. The trial will be used to illustrate some of the strategies used to ensure that the sample represented the population from which it was drawn.

Nyo dua hli--30 days confinement: traditions and changed childbearing beliefs and practices among Hmong women in Australia

OBJECTIVE

To examine traditional and changed beliefs and practices related to the puerperium of Hmong women in Melbourne, Australia.

DESIGN

An ethnographic study of reproductive health among Hmong women in Australia.

SETTING

Melbourne Metropolitan Area, Victoria, Australia.

PARTICIPANTS

27 Hmong women, three shamans, two medicine women and one magic healer who are now living in Melbourne.

FINDINGS

In the Hmong tradition, the first 30 days after birth is seen as the most dangerous period for a new mother. There are several beliefs and practices which women must observe in order to regain strength and avoid poor health in the future. Lying near the fire in the first three days is one such belief. The woman's body during the puerperium is considered polluted. Hence, there are several rules to restrict the woman and the substance of her body. It appears the Hmong continue to observe their post-birth confinement practices regardless of their new environment. Most women mentioned that this is to avoid ill health and misfortune in the future. There are only a few customs which they have to modify due to changes in their living situations in a new country.

IMPLICATIONS FOR PRACTICE

Hmong cultural beliefs and practices concerning the puerperium in particular, and childbearing in general, have specific implications for midwifery care. Since midwives will continue to encounter many traditional beliefs and practices of the Hmong when providing birthing care to Hmong women, it is essential that their cultural beliefs and practices be taken into account. This will not only help to avoid misunderstanding, but also result in culturally appropriate and sensitive care for immigrant women.

Baby, souls, name and health: traditional customs for a newborn infant among the Hmong in Melbourne

In this paper, I discuss childrearing beliefs and practices in Hmong culture. In particular I focus on issues related to souls and ceremonies for a newborn infant in Hmong society. The Hmong believe that each living body has three souls. For a newborn infant, the first soul enters his or her body when he or she is conceived in the mother's womb. The second soul enters when the baby has just emerged from the mother's body and taken its first breath. The third soul, however, will have to be called on the third morning after birth, as will be discussed in this paper. If all three souls are secured in the infant's body, he or she will be healthy and hence thrive well. On the contrary, the infant may become ill and eventually die if all three souls do not reside in his or her body. This, therefore, makes a soul calling ceremony on the third morning after birth essential in Hmong culture. I will show that for Hmong society to survive, the Hmong strongly adhere to their cultural beliefs and practices related to a newborn infant. These beliefs and practices tie the Hmong with not only their family and their society at large, but also the supernatural world.