The cultural significance of Syrian refugees’ traditional childbirth and postpartum practices Nada Alnaji a,* , Bree Akesson b , Alma Gottlieb c a Graduate Studies, University of Nebraska Medical Center, USA b Faculty of Social Work, Wilfrid Laurier University, Canada c Department of Anthropology, University of Illinois at Urbana–Champaign, USA ARTICLE INFO Key words: Cultural practices Postpartum practices Refugees’ health ABSTRACT Problem: Childbirth and the postpartum period are critical times for both mothers and babies. Traditional cultural practices often play a significant role in providing support during this time. However, in exceptional circum- stances, such as those faced by refugees giving birth in disrupted social environments, these practices may be inaccessible, leading to emotional distress and delayed physical recovery. Aim: To explore the cultural significance of traditional motherhood practices in Syria that are still observed by some Syrian refugees in Lebanon. Methods: The study used a phenomenological approach and included in-depth interviews with eight Syrian mothers residing in informal settlements in Lebanon. Findings: Findings were organized around three themes: (1) Familial Support during the Postpartum Period, (2) Specific Cultural Practices during the Postpartum Period, and (3) Emotional Experiences during the Postpartum Period Discussion: Understanding these cultural practices is essential for developing culturally sensitive interventions that can improve wellbeing of refugee mothers. Introduction Around the world, positive support by kin and/or others during childbirth and in the postpartum period plays a significant role in the health and wellbeing of mothers and children (Davis-Floyd and Chey- ney, 2009). From an evolutionary perspective, human birth is more painful and is of a much longer duration than it is for other primates, due to the large human brain of the baby relative to the mother’s pelvis. As such, humans created a midwife role, usually performed by female kin, to assist a mother during birth and afterwards, until she regains her energy. This role played by female kin also helped in early cultural practices in the postpartum period (Davis-Floyd and Cheyney, 2009). Likewise, due to the longer period of dependence on adults for human children compared to all other mammals, humans evolved to foster care relationships between children and adult members of the family, espe- cially grandmothers (Pashos, 2017). As suggested by evolutionary the- ory, this relationship ensures that a mother is supported and can continue her livelihood practices while a grandmother and/or other adults care for her children. This line of research has led to the development of “the grandmother theory,” which posits the critical role played by grandmothers in human evolution (Pashos, 2017). Some recent research has shown that the presence of grandmothers improved fertility and survival rates of the daughter’s offspring, while this bene- ficial effect is decreased with the increase in geographic distance be- tween mothers and daughters (Engelhardt et al., 2019). We hypothesize that most early cultural practices in the postpartum period stemmed from this early evolutionary need and flourished to take varied forms in different geo-cultural settings. Today, most postpartum rituals include rest for the mother to encourage the recuperation process. In many Arab societies, women often stay in their parents’ or in-laws’ homes, where they are cared for by female relatives and supported by a dayet, a local midwife. The dayet assists with childbirth and continues to support the mother for several weeks postpartum, providing guidance on breastfeeding and infant care, while other female relatives take over household duties such as cooking and cleaning (Akesson, 2016). Forty days after giving birth, the mother is considered fully recovered from childbirth and can return to her house to resume her normal life (Fonte and Horton-Deutsch, 2005). These * Corresponding author. E-mail address: alnaji.nada@gmail.com (N. Alnaji). Contents lists available at ScienceDirect Midwifery journal homepage: www.elsevier.com/locate/midw https://doi.org/10.1016/j.midw.2024.104180 Received 27 November 2023; Received in revised form 15 August 2024; Accepted 6 September 2024 Midwifery 139 (2024) 104180 Available online 7 September 2024 0266-6138/© 2024 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.