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Why the practice is done.

 

The beliefs of Ghanaian women regarding the fontanelle, the soft spot.

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Abstract:

Ninety-seven percent of the women saw the fontanelles and the sutures in the skull of the baby as holes and cracks that can cause damage. The treatment of hot water massage to the head heals those holes and cracks. Eighty-five percent of the women mentioned additional reasons for the practice, and they were the beauty and the strength of the baby. Only 61% of the women received warning against the practice in the maternity department and much less of them (27%) heard any explanation from the nurses. Ninety-one percent of these women (61% from the total interviewed women) thought that the explanation from the hospital was not relevant to their life. The most common behavior of the babies during the bath as was reported by the women was crying and sleeping. Both behaviors are not natural to babies in a normal bath, and they are the result of the damage of the heat that is applied on the head of the baby. 

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Thirty-three women were interviewed. They were 27 women who demonstrated the bath and the massage with the hot water on a doll, and 6 women whom we observed the way they bathed and massaged their babies. The women were from different tribes and locations in Ghana: The Ewe tribe in Volta Region in the east of Ghana, and different Akan tribes in Greater Accra Region in the central coast of Ghana and in Eastern Region which lies on the west side of the Volta River in the south center of Ghana. These women were asked the following questions in their mother tongue:

A.   What is the fontanelle or the soft spot?

B.   What will happen to the baby if he or she does not get the treatment of the hot water massage to the head?

C.    Do you know other reasons why there is the need for the massage of the head of a baby with hot water?

D.    What did they tell you in the hospital regarding the hot water massage to the head of a baby?

E.    Why do you continue to do the hot water massage to the head of your baby?

F.    What is the behavior of your baby during the hot water massage on his or her head?

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The answers of the women appear in the following table 1. On the left side of the table are the questions in red and under each question are the different answers or opinions in black. On the right side of the table are the percentages of women who held the opinion. They are arranged from left to right: The green numbers represent the percentages of women out of the 22 rural women. The olive-yellow numbers represent the percentages of women out of the 11 urban women. The black numbers are the total percentages out of the total rural and urban 33 women. The answers or opinions of the women are written by the order of popularity, from the lowest to the highest popular opinion for each question.

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Table 1: the opinions of the women regarding the massage of the head of a baby with hot water, and their reactions to the instructions given to them by the nurses in the hospital.

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Answers to questions A and B:

  • The anterior fontanelle is regarded by all as a hole that it should not be there for a long time, and must be closed, other wise a harm will come to the baby. 

  • The only woman who gave a correct explanation on the anterior fontanelle when referring to the “breathing” or the vibration movement of the skin covering the anterior fontanelle as the sign of the heart beats, was an uneducated elderly woman from the rural area.​

  • The main two reasons for massaging the head of a baby with hot water were:

   A. Majority of women (63.7 %) said that the baby will be sick, and the hot water prevents this sickness.

   B. Minority of the women (30.3 %) said that the fontanelles and the sutures in the skull of a baby will remain open if not massaged with hot water. We may assume that the 63.7% who are the rest of the women, thought that these gaps will be closed naturally. Six percent of the women said they do not know any reason for massaging the head of a baby with hot water.

The main difference between the rural and the urban women was that 40.9% of the rural women believed that the fontanelles and the sutures in the skull of a baby can not be closed naturally while only 9.1% of the urban women held that opinion.

During the interview, all the women said that since the delivery of a baby is not an easy process, there could be different kinds of wounds and holes in the head of the baby. They all feared that while these wounds and holes are in the head some damage could be caused to the baby. Not all the women thought that these wounds and holes would not be closed naturally.

Answers to question C:

  • There were two main secondary reasons for the massage with hot water:

1. Molding the shape of the head.

2. Strengthening the head and the body.

Answers to question D:

  • Majority of the women (60.6%) were warned by the nurses not to use hot water, however, only minority (27.3%) were given an explanation.

Answers to question E:

  • Majority of the women (81.8%) rejected the hospital advice because their daily life experiences showed them the opposite.

Their reasons were as follows:

  1.  No visible harm comes to the baby from the hot water but rather other benefits. 

  2. Some of the advice given in the hospital overlooked the conditions of life in the village. 

  • ·Only an insignificant number of the women (3% = one rural woman) gave a reason that involved supernatural powers such as “God gives wisdom” to reject the advice of the hospital.

  •  A small number of the rural women (9.1% = three women) followed the advice given in the hospital, and they reduced the temperature of the water they used in massaging the head of their baby.​

Answers to question F:

The three behaviors of the babies during the bath were:

  • The babies sleep during the bath was reported by 51.9% of the women.

  •  The babies cry during the bath was reported by 40.7% of the women.

  •  The babies are quiet during the bath was reported by only 7.4% of the women.

 Sleeping during a bath that includes massaging the head with hot water, rubbing the body with soap and water, and pouring water on the body is a very strange behavior. How can a baby sleep when there are such interventions in his or her state of comfortability? Surprisingly, it was the most common behavior reported by the women.

 Our observation of the daily bath of the babies gives explanations to these surprising finding.

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