Traditional neonatal care practices in Turkey
Özgür Alparslan, Department of Midwifery, Tokat School of Health, Gaziosmapaşa University, Taşlıçiftlik Yerleşkesi, TR-60250, Tokat, Turkey. Email: firstname.lastname@example.org; Yeltekin Demirel, Department of Family Medicine, School of Medicine, Cumhuriyet University, TR-58140, Sivas, Turkey, Email: email@example.com
Aim: The research was conducted as a descriptive and cross-sectional study in order to identify the traditional neonatal care practices applied by women in the 15–49 year age range.
Methods: The research sample comprised 263 married mothers aged 15–49 years living in the seven health center regions in Sivas city center and agreeing to participate in the study between 7 March 2008 and 30 April 2008. In data collection, a questionnaire form devised by the researchers on the basis of expert opinion was used. The data collected were assessed by computer by means of percentage analysis and χ2-tests.
Results: The traditional neonatal care practices for treatment of jaundice, rash, thrush, earache, swelling in the baby's chest (milk accumulation), falling of the umbilical cord, umbilical infection, eye crust, nail cut, and temperature were examined. The most frequently conducted traditional practices were identified as rubbing swollen nipples, “making the forties” (bathing the mother and neonate in a special ritual on the 40th day postpartum), salting, using holluk (sand-filled nappy), and swaddling the baby. It was found that the mothers with low levels of education applied traditional practices like swaddling, salting, holluk, and making the forties more frequently (P < 0.05).
Conclusion: According to the study findings, mothers practiced traditional applications at least once during neonatal care. It was observed that the lower the mother's educational level, the more frequent the traditional practices were applied. For this reason, neonatal healthcare services should be delivered by midwives/nurses or other healthcare workers.
For centuries, humankind has tended to carry out traditional practices to address health problems with an instinct to protect and sustain life. Therefore, the traditional practices, which are as old as human history, are samples of living history (Hotun & Coşkun, 1990) (Akın & Ozan, 1991; Okubagzhi, 1988).
The fact that traditional practices are still in use can be accounted for by acquired experiences as well as lack of available modern medical services in the region, lack of appropriate communication with the community, and preservation of the traditional structure in the region (Bahar & Bayık, 1985; Biltekin, Boran, Denkli, & Yalçınkaya, 2004; Polat, 1995). Extensive studies on this issue regarding Turkey in general are lacking. However, there are some studies investigating certain regions. These studies have demonstrated that traditional practices which may endanger neonates' health are still in practice (Akın & Ozan, 1991; Güleç, 2000). Some of these practices are beneficial for health while others are impractical or dangerous (Bahar & Bayık, 1985; Güleç, 2000). Traditional practices applied in the postpartum period, which are especially dangerous, may lengthen the neonate's recovery period, prevent effective uptake of treatment and result in disability, disorder, and even death. For example, traditional applications practiced on the belly may result in tetanus and infection, salting may result in rashes, swaddling may result in hip dysplasia, and using holluk (sand-filled nappy) may result in tetanus among others. Making the baby with jaundice drink its own urine, wiping the baby's mouth with a cat's tail in the case of thrush, dropping breast milk with added salt into the ear of the baby suffering from earache, dropping breast milk and lemon into the eye of the baby with eye crust, and wiping the baby's eye with a cloth washed with the baby's urine also exist (Güleç, 2000; Örsal & Kubilay, 2009). It is possible to add others to the list; nevertheless, even this list is enough to demonstrate the extent of the danger to neonatal health posed by traditional practices (Akın & Ozan, 1991).
One of the problems affecting child health in Turkey is the quality of the care given to the child. The quality of the care is determined by social, economic, and cultural factors. Nevertheless, it is stated that parents acquire information about childcare from their seniors and initially treat their children with traditional belief and practices; however, they take their children to the doctor when they understand that the child cannot recover (Eğri & Gölbaşı, 2007). Therefore, midwives/nurses are important in terms of educating the society about baby care and encouraging the mother to give good baby care (Dinç, 2005).
It is well known that the most traditional method of swaddling neonates is laying them on heated soil entitled “höllük” and has been practiced in Anatolia for centuries. Holluk is the operation of sifting and drying clayed soil and putting it under the baby (Biltekin et al., 2004; Özen & Özgör, 2006). When holluk is applied after warming, it keeps the baby's bottom dry for a longer period due to its absorbing power and thus frequent nappy replacements become unnecessary. In Sivas culture, the belief that “a child grown without sand will not be able to hold his urine, will have hemorrhoids, get ill frequently, get cold and have knee pain” is common (Bahar & Bayık, 1985). Holluk sand is the most important cause of neonatal tetanus in neonates (Güleç, 2000; Özen & Özgör, 2006).
In many parts of Turkey, mothers swaddle their babies tightly in order to keep them warm or so that babies can be strong, have beautiful legs, or just sleep well (Bahar & Bayık, 1985; Özyazıcıoğlu & Polat, 2004; Platin & Khorshid, 1994; Polat, 1995). Swaddling is quite common in Turkey. Babies whose arms and legs are tied and unable to move freely feel uncomfortable, cry, and are restless. In addition, the practice may induce hip dislocation in babies with a congenital predisposition to the disorder. For these reasons, swaddling can be considered harmful to infant health.
In Turkey, newborn babies are covered in a yellow cloth as it is thought to prevent jaundice (Çetinkaya, Özmen, & Cambaz, 2008; Örsal & Kubilay, 2009; Özyazıcıoğlu & Polat, 2004). In the Sivas region, traditionally the baby is bathed in golden water, dressed in yellow clothes, a sublingual part of the baby is cut, the head is covered with a yellow cloth, the baby is fed dog feces, carried to the jaundice tekke (Islamic lodge), the ear or forehead are scratched and bled, or yellow-footed chicken is cooked and the baby either eats it or drinks its water (Bahar & Bayık, 1985; Polat, 1995). It is believed that yellow fabrics used to cover babies for the first 4 days of life prevent or cure jaundice (Bayat, 1987; Biltekin et al., 2004; Özkan & Khorshid, 1995).
According to Anatolian beliefs, the reasons for neonatal disorders are jealousy of others, the “evil eye”, and magic (Kahriman, Topbaş, & Çan, 2011; Özsoy & Katabi, 2008). If the mother and child get ill when they are alone and indoors within the first 40 days postpartum, this event is named “puerperal fever”, during which the baby becomes weaker, ill, and disabled, or a superstitious creature called “the red woman”, kırk basması, kırk karışması or loğusa basması takes the baby's lung and carries it away. It is widely believed that some living or non-living things harm lactating women and 40 day old babies (Bahar & Bayık, 1985; Çetinkaya et al., 2008). In order to avoid kırk basması, lactating women hug each other, pets like cats and dogs are not allowed in lactating women's rooms, and the Koran, needles, a piece of bread, a broom or instruments made, of iron are left near babies to help them avoid contracting diseases during lactation (Arısan & Günay, 1995; Bahar & Bayık, 1985; Çakmak, Melikşah, Zeyrek, Ataş & Karazeybek, 2009; Geçkil, Şahin, & Ege, 2009; Kahriman et al., 2011; Naskali & Şen, 2004; Özsoy & Katabi, 2008). Due to these beliefs, the baby is not left alone and is bathed on the 20th and 40th days postpartum and sent to the hodja (Muslim clergyman). Babies reaching 40 days of age are described as having “passed the 40 mark” and are now able to survive and become acquainted with the world. The mothers are also perceived as having their womanhood restored. For that reason, passing the 40 mark is important for both baby and mother, and cleaning in that period takes place in a manner different to normal cleaning. Forty wheat grains and 40 stones are added to 40 spoons of water and poured over the baby's head and then into the street, and the Koran and prayers are read (Çakmak et al., 2009; Kahriman et al., 2011; Naskali & Şen, 2004; Özsoy & Katabi, 2008).
The nurse/midwife should take these issues into account when meeting the needs of the individuals in the postpartum period on account of the effects of cultural values, beliefs, and attitudes on the baby's health. Awareness of the individuals' traditional beliefs and practices will be instructive in terms of identifying the priorities in the healthcare services presented to families.
The present study aimed to identify the traditional practices applied by women aged 15–49 years in neonatal care, support beneficial practices, and prevent the negative effects of dangerous practices on the baby's health.
The present study was conducted as a descriptive and cross-sectional study (between 7 March 2008 and 30 April 2008) by selecting seven health center regions out of 20 by means of the cluster sampling method. The extent of the research was 32,471 women aged 15–49 years living in the health center regions. The research sample was calculated by means of a formula used for analyzing the incidence frequency in a condition whose universe is certain and each health center was accepted as a cluster. The number of women from each health center to be included in the sample was calculated in proportion with the number of women in each layer. The streets in the districts of each health center were numbered according to a numbering system. The researchers accepted each street as a cluster, determined a certain number of streets from these clusters, and took even and odd numbered houses in the streets together in order to maintain heterogeneity. The women in the 15–49 year age range living in the selected houses were informed about the aim of the research and 263 women who agreed to participate were included in the sample after their informed consent was taken.
The data were collected via a questionnaire form prepared on the basis of related published work (Güleç, 2000; Polat, 1995). The questionnaire form was constructed in order to identify the traditional practices towards neonatal care and piloted with 30 women aged 15–49 years with at least one child. Following the pilot study, the questions were found to be comprehensible and thus were administered. The questionnaire comprised 32 questions, nine of which were related to identifying the women's sociodemographic features and 23 to identify their traditional practices in baby care.
Because an ethics committee was not present prior to the application, the permission was obtained from the directorate of health. Informed consents were obtained from the women willing to participate in the study, and the application phase started.
The data collected via face-to-face meetings were evaluated in the SPSS program (version 13; SPSS, Chicago, IL, USA) by means of χ2-tests. P < 0.05 was considered statistically significant.
Of the 263 women who participated in the questionnaire, 27.8% were 33–38 years old (mean, 36.44 years); 58.9% (n = 155) had primary school education; and 97.3% (n = 256) were housewives. As stated by the women, 81.4% (n = 214) had a nuclear family structure and 72.2% (n = 190) were of medium level economic status and 94.3% (n = 248) had health insurance.
Of the women, 17.5% (n = 46) had been married for 6–10 years, and 73.8% had 1–3 children. Regarding practices, 10.3% (n = 27) of the women stated they poured powder over the neonate's belly in order to make the cord fall faster, 7.2% (n = 19) tied the belly with a rope, and 1.5% (n = 4) put a buttered cloth over the neonate's infected belly. In addition to these, 16.3% (n = 43) of the women stated that they applied sweets to their nipples to encourage feeding, and 1.9% (n = 5) reported having the neonate breastfed by other women when it did not attach to their breast. For jaundice, 22.5% (n = 16) of the women stated that they covered the baby's face with a yellow scarf, 9.9% (n = 7) fed the baby with yellow-footed chicken without adding salt, and 2.8% (n = 2) kept the baby's urine in a cup and made the baby drink it. For rashes, 33.2% (n = 61) of the women explained that they applied powder to the neonate, and 27.2% (n = 50) applied olive oil. For thrush, 17.7% (n = 26) reported that they wiped the baby's mouth with clear water, and 10.9% (n = 16) reported pressing the thrush regions with their fingers. For earache, 25.7% (n = 27) of the women poured breast milk and salted water into baby's ear. For high temperature, 26.2% (n = 69) reported that they wiped the baby's body using water with vinegar. To make the neonate's breasts smaller, 66.2% (n = 174) of the women rubbed the baby's swollen nipple, while 44.9% (n = 118) salted the baby's body so that it would not smell of sweat, 60.8% (n = 160) washed the baby with salted water containing rice for which prayers were read on the 40th day postpartum (“making the forties” = kırk çıkarma), and 29.3% (n = 77) used holluk and swaddling.
Some of the traditional neonatal care practices applied by women aged 15–49 years in terms of age groups are presented in Table 1. It was found that 25% of the women aged 15–20 years, 19.2% aged 33–38 years, 43.4% aged 39–44 years, and 61.2% aged 45–50 years applied holluk, while only 10.7% of the women aged 21–26 and 27–32 years did likewise. According to these data, a significant difference was found between the holluk practice and age (P = 0.000, χ2 = 46.9).
Table 1. Distribution of traditional practices applied by women according to age
|Lying in soil (holluk = sand-filled nappy)|
| Yes||1 (25)||3 (10.7)||6 (10.7)||14 (19.2)||23* (43.4)||30* (61.2)||77 (29.3)|| P = 0.000|
| No||3 (75)||25 (89.3)||50 (89.3)||59 (80.8)||30 (56.6)||19 (38.8)||186 (70.7)||χ2 = 46.9|
|Swaddling|| || || || || || || || |
| Yes||4 (100)||24 (85.7)||37 (66.1)||61* (83.6)||49* (92.5)||46* (93.9)||221(84)|| P = 0.001|
| No||0 (0)||4 (14.3)||19 (33.9)||12 (16.4)||4 (7.5)||3 (6.1)||42 (16)||χ2 = 20.6|
|Making the forties†|| || || || || || || || |
| Yes||3 (75)||17 (60.7)||35 (62.5)||41 (56.2)||38 (71.7)||30 (61.2)||164 (62.4)|| P = 0.624|
| No||1 (25)||11 (39.3)||21 (37.5)||32 (43.8)||15 (28.3)||19 (38.8)||99 (37.6)||χ2 = 3.49|
Swaddling was practiced by 100% of the women aged 15–20 years, 85.7% aged 27–32 years, 66.1% aged 33–38 years, 92.5% aged 39–44 years, and 93.9% aged 45–50 years. According to these data, the difference between the mother's age and swaddling was found to be significant (P = 0.001, χ2 = 20.6) (Table 1).
Making the forties was practiced by 75% of the women aged 15–20 years, 60.7% aged 21–26 years, 62.5% aged 27–32 years, 56.2% aged 33–38 years, 71.7% aged 39–44 years, and 61.2% women aged 45–50 years. According to these data, the relationship between making the forties and mother's age was found to be insignificant (P = 0.624, χ2 = 3.49) (Table 1).
The relationship between educational level and swaddling, holluk use, salting, rubbing swollen chest, and making the forties was found to be significant (P < 0.05). As the educational level increased, a decrease was observed in the number of women applying these practices (Table 2).
Table 2. Distribution of traditional practices applied by women aged 15–49 years in terms of educational level
|Swaddling|| || || || || || || |
| Yes||22 (100.0)||140 (90.3)||29 (80.6)||27* (64.3)||3* (37.5)||221 (84.0)|| P = 0.000|
| No||0 (0.0)||15 (9.7)||7 (19.4)||15 (35.7)||5 (62.5)||42 (16.0)||χ2 = 34.19|
|Salting|| || || || || || || |
| Yes||16* (72.7)||72 (46.5)||16 (44.4)||14 (33.3)||1 (12.5)||119 (45.3)|| P = 0.012|
| No||6 (27.3)||83 (53.5)||20 (55.6)||28 (66.7)||7 (87.5)||144 (54.7)||χ2 = 12.9|
| Holluk (sand-filled nappy)|
| Yes||17* (77.3)||48 (31.0)||8 (22.2)||4 (9.5)||0 (0.0)||77 (67.3)|| P = 0.000|
| No||5 (22.0)||107 (69.0)||28 (77.8)||38 (90.5)||8 (100.0)||186 (36.7)||χ2 = 36.78|
|Making the forties†|
| Yes||11 (50.0)||109* (70.3)||19 (52.8)||22 (52.4)||3 (37.5)||164 (62.4)|| P = 0.028|
| No||11 (50.0)||46 (29.7)||17 (47.2)||20 (47.6)||5 (62.5)||99 (37.6)||χ2 = 10.91|
In every culture, babies, who are the most valuable living things for the continuation of humankind, are directly affected by the family's economic, cultural, and general health status (Başer, Mucuk, Korkmaz, & Seviğ, 2006). The baby's health is also influenced by the caregiver's interest, attitudes, and behaviors (Akın & Ozan, 1991; Demirezen, 2009).
In a study by Başer et al. (2006), it was observed that parents needed the highest amount of information and support in neonatal care for issues such as bathing; rash; parasites; mouth, eye, belly and chest care; jaundice; removing gas; and handling temperature. To solve these problems, parents apply some of the traditional practices they have learned from the environment and other family members have used with their children (Başer et al., 2006). In this study, it was observed that mothers applied at least one traditional practice in daily baby care to solve health problems. The most frequent traditional practices included rubbing swollen chest, making the forties, salting, holluk, swaddling, wiping the body using water with vinegar, wiping clustered eyes with cooled strong tea, and pouring salted breast milk into aching ears. The findings of this study are in line with that of others (Akın & Ozan, 1991; Arısan & Günay, 1995; Bahar & Bayık, 1985; Biltekin et al., 2004; Hotun & Coşkun, 1990; Öncel, 2009; Özen & Özgör, 2006; Polat, 1995).
In this study, it was found that 29.3% of the women swaddled their babies after wrapping them in holluk. Biltekin et al. (2004) found that 74% of the mothers swaddled their babies so that their legs should be beautiful. In this study, the traditional practice of swaddling was similar to that reported in Dinç (2005). The negative role of swaddling in hip problems in thousands of children each year is well-known and constitutes an important cultural problem in Turkey. In children, the joints and ligaments are loose, and therefore the tendency towards dysplasia increases (Çalışkan, 2004). Ethnic variation in the prevalence of hip dysplasia and dislocation in unscreened populations has been reported, with notably higher rates in Japanese, Turkish, Amerindian, and Lapp populations (Kutlu, Memik, Mutlu, Kutlu, & Arslan, 1992; Mahan & Kasser, 2008; Van Sleuwen et al., 2007). It is observed that mothers who practice holluk and swaddle are older in comparison with others and have lower levels of education. Educational level was also found to influence the practices (P < 0.05). Laying the neonate in holluk and swaddling were detected more in the illiterate group. It could be argued that older women raised their babies in the traditional way through the information and methods they learned from their parents and thus used traditional methods more frequently because they had a lower level of education. In this study, similar results were obtained to that of Dinç (2005), Geçkil et al. (2009); while Bahar and Bayık (1985) did not find that education and age were significant, which was not in line with the findings of this study. Holluk sand is the most important cause of neonatal tetanus in neonates (Güleç, 2000). Holluk and swaddling can be said to be traditional practices affecting the baby's health negatively. The holluk practice is a dangerous application which may lead to infection in the baby. Nurses and midwives should educate new mothers about contemporary best practices for baby care in the postnatal period (Akın & Ozan, 1991; Hotun & Coşkun, 1990; Öncel, 2009; Örsal & Kubilay, 2009).
Applying dry coffee, olive oil, rotten tree powder, myrtle, sugared fat, hellebore, black sesame, and burnt cloth over the belly until the umbilical cord falls are other frequently used traditional practices (Akın & Ozan, 1991; Arısan & Günay, 1995; Çalışkan, 2004; Hotun & Coşkun, 1990; Okubagzhi, 1988; Öncel, 2009; Polat, 1995). The practices of covering the belly with a turban, pouring holluk soil on the belly, bathing the baby until the cord falls, and tying it with a rope reported in this study do not correspond to those found in the published work (Biltekin et al., 2004; Çalışkan, 2004; Eğri & Gölbaşı, 2007; Örsal & Kubilay, 2009; Özen & Özgör, 2006). In addition, although practices of covering the belly with cooked onion and raw halva (a Turkish dessert) are carried out in the Sivas region, mothers in the present study did not apply them. These practices applied over the umbilical cord may lead to tetanus by contaminating the belly (Emeribe & Akah, 2011; Özen & Özgör, 2006; Quddusa, Lubyb, Rahbarc, & Pervaizd, 2002). Previous research also demonstrated that postnatal babies experienced belly problems like umbilical infection and that these were caused by the mother's ignorance in baby care (Biltekin et al., 2004; Dinç, 2005; Eğri & Gölbaşı, 2007; Emeribe & Akah, 2011; Öncel, 2009; Vural & Akan, 1995; Wong & Eaton, 2001). Nurses and midwives should train new mothers about umbilical cord care (Güleç, 2000).
According to Argentinean and Anatolian beliefs, the reasons for neonatal disorders are jealousy of others, the “evil eye”, and magic (Martinez, 2008; Özsoy & Katabi, 2008). In the present study, 60.8% of the women were reported to apply these beliefs to care of their babies, and as the educational level decreased, these beliefs and consequent practices became more frequent (P < 0.05). On the other hand, the women's age was not found to correlate with the practices (P > 0.05). This belief could delay medical treatment for infections and dehydration.
Salting aims at preventing the baby from smelling, but may lead to pain, rashes, and spoiling of skin integrity because of the sensitivity of the skin (Karayağız & Öztürk, 2008). In the present study, the salting rate of the babies was found to be 44.9%. As the women's educational level increased, the rate of salting decreased, and the difference was found to be significant (P < 0.05). Considering these research findings, the mothers were found to practice salting less frequently in comparison with others (Güleç, 2000; Örsal & Kubilay, 2009). In the present study, the reasons why this practice was less frequently applied can be determined as the increasing transition from large to nuclear families, decrease in the authority of the elderly, and the increase in reaching available health services.
The traditional health practices correspond with the cultural elements of the public perfectly. Making use of traditional services is easier than making use of modern services. Traditional practices are preferred due to the fact that they have a spiritual dimension, no waiting time, no necessity for making appointments, easier availability, and lower service cost (Güleç, 2000; Kahriman, 2007; Karayağız & Öztürk, 2008; Özyazıcıoğlu, 2009). In studies conducted in Turkey, it was observed that women traditionally applied certain practices to prevent or treat jaundice (Akın & Ozan, 1991; Çalışkan, 2004; Engle, 1999; Örsal & Kubilay, 2009; Özyazıcıoğlu, 2009). In this study, it was found that the mothers applied similar practices in general, and 2.8% made the baby drink its own urine, which is an unhealthy practice. A positive study finding was that the traditional invasive and dangerous practices like cutting the baby's hard palate and back of the ear, and scratching the forehead were not practiced by the participants (Polat, 1995). While practices like covering the baby with cloth does not pose a danger to health, other practices may hinder the realization of early diagnosis and treatment. The obtained findings were found to be higher than those of Eğri and Gölbaşı (2007) and Kahriman (2007); they were a little higher than those of Çakmak, Melikşah, Zeyrek, Ataş and Karazeybek (2009) and lower than those of Şenol, Ünalan, Çetinkaya, and Öztürk (2004) (%8.9). This condition may stem from the regional differences.
Although thrush is a frequently seen problem which negatively affects the baby's health, parents try to treat it with practices different from traditions (Kahriman, 2007; Vural & Akan, 1995). In the present study, 15.7% of the mothers were found to press the baby's mouth with their fingers and wipe the mouth with the mother's hair in the case of canker. The study findings showed no similarity to the traditional practices reported by Kahriman (2007) and reported slightly higher rates in comparison with those of Eğri and Gölbaşı (2007).
It was seen that the participants used a mixture of salted breast milk and rabbit fat and puffed tobacco for earaches. These traditional practices showed similarity to those reported in Polat (1995). There are also some studies reporting similar practices in the Turkish region of Kars, (4.8%) among others (Arısan & Günay, 1995; Özyazıcıoğlu, Polat, & Bıçakcı, 2010).
As for the finding of this study, mothers applied salting, holluk and powdering to their children who had rash. These traditional practices are in line with those of others (Kahriman, 2007; Örsal & Kubilay, 2009; Özyazıcıoğlu, 2009) and they do not contribute to the baby's recovery; on the contrary, they may cause infections by spoiling the skin integrity and threaten the child's health (Özyazıcıoğlu et al., 2010).
The eye is a highly sensitive organ and traditional treatments may negatively affect the baby's sight and general health condition. The traditional practices in this study were wiping the eye with strong cool tea, dropping in of breast milk, and squeezing lemon into the eye. Although dangerous practices like dropping in the child's urine or drawing lines on the eyelids with a needle sooted by candles are traditional practices in Sivas, they are not reported in the present study, which is a positive finding (Polat, 1995). This may result from the higher educational level of the mothers.
When the baby's temperature increases, the families may be frightened and apply faulty practices because of this fear. In studies conducted in Turkey, it was reported that children were covered tightly in order to decrease the temperature, made to sweat, made to drink tea with lemon or chamomile, that a mixture of olive oil, aspirin, lemon water, and black pepper was applied to the body and prayers were read, and that the body was wiped using water with vinegar, among others (Arısan & Günay, 1995; Çetinkaya et al., 2008; Kalaca, Harmancı, Kalaca, & Kuşcu, 2006; Örsal & Kubilay, 2009). As for the present study, only 3% of the mothers were found to cover their babies. This low rate of putting the baby at risk might have been affected by the mother's educational level and is highly pleasing.
One of the most frequent practices applied by mothers in daily care is applying milk over the baby, cutting the nails when they are 2–3 months old, or after making the forties. In Turkey, in studies of traditional baby care practices, similar results were obtained (Akın & Ozan, 1991; Eğri & Gölbaşı, 2007).
According to Sivas beliefs, the baby's nails should be cut when it scratches its face, when it can get money from his father's pocket, or when it reaches the age of 1 year (Polat, 1995). The findings of this study are in line with those of Polat's (1995) regional findings. This indicates that traditional practices are still transferred to young parents and it is essential that nurses and midwives should train the candidate mothers well.
CONCLUSION AND RECOMMENDATIONS
The most frequent traditional practices applied by women are rubbing swollen nipples, making the forties (bathing), salting, holluk, and swaddling. Also, wiping the baby's body using water with vinegar when it has a high temperature, wiping the eye with cooled strong tea when it has clustering, and pouring salted breast milk into the aching ear are other frequently applied practices in the solution of health problems. The most frequent daily baby care practices include applying breast milk to the baby's face so that it can become more beautiful and cutting nails at 2–3 months or after making the forties. There is a negative correlation between the educational level and applying traditional practices.
It is recommended that midwives and nurses identify the traditional beliefs and practices of the region they are serving, take into account the effects of culture on health, and decide on intervention strategies. The health workers should inform mothers about the issue, encourage them to make appropriate choices, and raise their awareness about the results of traditional practices and the side-effects.
The authors are grateful to all the mothers who participated in this study. The authors would like to thank midwives Sevda Aslantaş, Pınar Koç, Gülbahar Çakmak, and Tuğba Öniz for data collection. This article was presented as a poster in the 6th Lokman Hekim History of Medicine Days, on 27–30 May 2009 in Antakya, Turkey.