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Month: February 2017

Sealing Birth

Sealing Birth

I’ve been finishing up the requirements for a Sacred Pregnancy Belly Bind and Sealing course which I started years ago, but was never able to complete thanks to the birth of my second son, which threw me for a bit of a loop. Two years later I’m finally coming back to it again, and have been enjoying it very much. At the heart of the course are the skills needed to do a bengkung belly bind (pictured below), but the course is about more than just the physical binding itself. It’s also about learning how to create a sealing ritual to honour the birth and provide closure for the woman, as well as supporting her through her postnatal journey–both of which are sorely lacking in our modern world!

Pregnancy and birth is all about opening, on so many levels: opening yourself physically, opening yourself spiritually and emotionally, opening yourself up to the vulnerability of a new and powerful love, and opening yourself mentally and psychologically to the needs of another human being (and being willing to put those needs first). Our western culture is fairly good at discussing the physical opening that takes place (just go to any childbirth class or antenatal prep class and it will be all about the stages of labour and dilation and what happens to your body), somewhat good at acknowledging the mental and psychological opening that takes place (but better at focusing on the baby’s needs than on the mother’s needs), and generally not so good at the emotional or spiritual opening that’s going on. Antenatally, there is the tradition of the Baby Shower (very popular in the US, much less so in the UK), which revolves around gift-giving and providing for the material needs of the baby but tends to gloss over the emotional or spiritual needs of the mom and the transition she’s undergoing. A Mother Blessing, based loosely on a Navajo tradition known as a Blessingway, is a newer tradition that’s been growing in popularity and does a better job of filling the emotional and spiritual void by honouring the mother and her journey and showering her with love and blessings from her community. However, this still pertains mostly to the antenatal time period, and is focused on the birth itself. Overall, in our modern society, very little attention is given to providing closure for women, helping them to ground and center themselves again after such a transformative experience, and acknowledging their new role as a mother. That’s where a sealing ceremony comes in.

After an opening, it makes sense that there should be a closing. A woman needs to be sealed, on so many levels. Physically, her womb and pelvis and pelvic floor need to contract again, after softening and expanding and dilating. Her abdomen has to knit together once more after the diastasis recti muscles have literally come unzipped.  Her blood volume shrinks and her blood pressure may rise again (slightly–this is normal, and has nothing to do with the stress of having a newborn!).  On a chi/ energy/ prana level, she has to re-balance herself and find her own, singular energy rhythms again, after having adjusted to holding her own chi as well as that of her growing baby.  Emotionally, she has to adjust to the sudden emptiness inside of her, after having grown used to sharing her body and feeling the baby’s movements inside her for months and months.  And even more importantly, she has to adjust to being the only occupant of her body again, reclaiming herself as a single entity, and feeling the wholeness of herself once more. Spiritually, she is going through perhaps one of the biggest transitions of her life, from maiden to mother, with all of the new uncertainties, vulnerabilities and identity upheaval that contains. It’s a very big deal–SO much is happening on so many levels, but in our western culture there is no formal way to acknowledge or honour this process.

Many traditional cultures around the world have sealing ceremonies and traditions which are an important part of the postnatal process. In China, new mums are encouraged to stay in bed for the first 30 days and are fed “warming” foods, often with lots of ginger and bone marrow in them to help . In India and traditional Hindu cultures, women remain home with their new baby for the first 40 days to help promote breastfeeding and avoid infection (interestingly enough, it takes about 6 weeks for a woman to fully establish her milk supply, which may be the underlying reason for this), allowing family and friends to care for her while she learns to care for her baby.  Bengkung binding traces its roots to Malaysia, where it’s part of the traditional postnatal care offered to women. But of course, in modern America and the UK, there’s often very little room made for the woman’s transition during the postnatal phase. The focus is very much on the baby. The early weeks of the postnatal period involve trips to the paediatrician (in the US) or home visits by midwives and health visitors in the UK, checking the baby’s weight gain before finally discharging the mother/baby dyad from care around Day 10. Well-intentioned family members and friends encourage the mom to “get her life back” or “get her body back”, set up feeding schedules and routines for the baby and attend baby classes and postnatal groups as a way of socialising, all of which require the mum to leave the house with her newborn at a time when she’s not fully confident in her new identity yet, and often still overwhelmed by the transition and the round-the-clock needs of her baby.

And of course, we’re getting it wrong again and again. For one thing, very few women are recovering from a peaceful or empowering birth in the first few weeks.  Most are having to process and contain experiences that ranged from disappointing to outright traumatic.  As a midwife and lactation consultant, part of my job is to listen to women’s birth stories. Often I’m visiting with women in the first few days or weeks after the birth, when the experience is still very raw and they’re still processing it. Asking them to share their story can sometimes open floodgates of emotion for them, particularly if the birth was traumatic to them. A big piece of my job is to give the woman time to tell her story, in her own words and at her own pace–not just to share the details of it for the purposes of collecting her medical history, but to give her a chance to debrief. Even if she’s already told all of her friends and family about her experience, there’s something different about the listening you do in the role of a birth worker. It’s important to give her space, without judgement, and to acknowledge her experience. Sometimes sharing her story will bring up questions about it that she didn’t even know she had, which I’m sometimes able to help answer (particularly if the question is about something technical), and sometimes not (but sometimes just being able to formulate a question for the first time is helpful). Other times she doesn’t have any questions, but will simply repeat something over and over again, usually until it’s acknowledged (and here, echoing the woman’s words back to her helps tremendously; she might say at 6 different points in the story that she hadn’t really wanted to be induced, and saying a statement like: “You really didn’t want to be induced” allows her to feel like she was heard). There are many counseling tips and tricks that you pick up along the way, such as active listening, asking open-ended questions, reflection, paraphrasing, summarising and clarifying etc. But the root of it, of course, is listening without judgement, and holding space for her to be or feel whatever is coming up for her. This is an important part of sealing a birth, and can be very healing for a woman.

Mothering is incredibly invisible and unappreciated in our society. In other cultures, mothers are respected and honoured on a fundamental level which we seem to be missing. So much of our identity comes from what we do professionally. Just think of a dinner party with new acquaintances where everyone is going around asking you about “what you do”. When I was not working professionally but rather staying home with my children, I would often respond to these types of questions with something like: “Oh, I’m just a mother right now” (JUST a mother…), or “Not much”.  Not much! As if the enormity of my daily work–caring for my children, nourishing them with my body when I was breastfeeding, preparing and cooking meals for them, running the household, doing laundry, cleaning, grocery shopping and a gazillion other domestic chores, but more than anything else teaching them *constantly* by my words and actions and attitudes–amounts to nothing much at all because at the end of the day I had very rarely achieved anything, at least anything that could be crossed off of a to-do list or recognized by the wider culture as important.  The work is repetitive, monotonous, lonely and under-valued, and in our culture it’s very low-status work. One has only to read a book like What Mothers Do by Naomi Stadlen to see the damage this lack of status inflicts on women on a daily basis. Here we are working our guts out, but the idea of a stay-at-home mother in our culture connotes the idea of not doing much of anything (but actually, this applies to any mother, because even working mums still have to come home from their paid job to begin their unpaid job of mothering, and are most likely only recognised for the work they do as part of paid employment). And we wonder why women are suffering from postnatal depression and anxiety in higher and higher numbers, or why modern women today are struggling as much as they are find their way.  The author of this article eloquently points out that perhaps feminism has let women down on this front. I agree with that, but I also think it’s part of a wider malaise in our society: raising children and parenting the future generation is not seen as important, meaningful work, and this is a problem.

Which brings us back to sealing birth…rather circuitously.  We need to get better and sealing birth for women. We can do this formally, through a ritual like the one Sacred Pregnancy has created (or something that we create on our own), or informally through birth debriefing, but at it’s very heart sealing a birth involves acknowledging the transition she’s been through, recognising the incredible work she has done and is currently doing–the work of giving birth, which is in itself a monumental achievement, but also the ongoing work of mothering–and honouring her for this. Sealing birth won’t elevate the status of motherhood overnight, or fix the many deficiencies in our culture, but it can definitely help to make a difference on an individual level to the woman herself. And every woman who feels supported, recognised and honoured as a mother will bring that confidence to her vital and incredibly important job of raising the next generation, and shaping our society in the process.

Looking back, I think that I was very lucky in that I was able to seal my first birth pretty well. While I never had a formal ceremony done, I was lucky to have had a very empowering birth experience (I’ll get my two birth stories posted soon) and I happily recounted my birth story over and over and over to whoever would listen. I felt like superwoman–I felt like I could do anything, after having given birth! There was something about repeating it again and again, something in the telling of the story, that helped make it real for me, and helped me gain closure on it. The telling of it and the closer helped to translate the confidence I felt about my birth into a growing confidence I felt about my new role of as a mother (Breastfeeding? Pshaw! OF COURSE I can breastfeed. I just gave birth after all–I can do anything!) I also had loads of support and help from friends and family in the first few weeks after my first birth, which made it a relatively smooth transition. With my second birth, this wasn’t the case. Even though the birth itself was wonderful, joyous and empowering, the postnatal period became incredibly stressful due to a medical emergency with my 5 day old son, which threw everything off kilter. Also, since it was the second time around, my expectation was that of course I would be able to manage it, just like I had with my first…but in reality, I found the transition from one child to two children incredibly difficult!  And perhaps not surprisingly, I suffered from postnatal depression with my second son (again, I’ll share the story on here sometime soon). I think sealing is crucially important part of the birth experience. Was your own birth sealed? And if so, how was this accomplished?

 

Bengkung belly binding

 

 

Day One and Two: Full on!

Day One and Two: Full on!

Hello lovely readers: guess what? I’m in midwifery school again! And trust me, I never thought re-qualifying was going to be a walk in the park, but these last two days have been a pretty brusque reminder to just how intense this is going to be. And I know I’m capable (and thankfully, a lot of it will be familiar, at least), but man–here we go!

Yesterday was a general orientation to the program: the course requirements, the timetable, our first assignments. Thursday is a day-long orientation to the library, where I suspect we’ll be spending *a lot* of our time. We’ve received an independent study guide, a workbook on medications and abbreviations and prescribing in labour, and an inch-thick workbook on reproductive physiology, plus some fervent warnings to keep up with the work and not let it pile up. Right! We also spent yesterday and today working in small groups, getting to know each other, and discussing the role of the midwife and the principles of midwifery care, which is always nourishing and enriching work.

The class itself is fabulous–there are 28 of us in total, ranging in ages from 18 and fresh out of sixth form (sort of the UK high school equivalent) through late 40s with teenager children, all from very diverse cultural and social backgrounds, and with a myriad of reasons for wanting to be midwives. I was very relieved to discover that I’m not the only mature student, by a long shot, and not the only mother going back to university with children at home. In fact, most of the other mothers in my class have three children rather than just two, and a few of them even have four children (and one with a set of twins), so if they can do it (superwomen!), I can too. I made a comment along the lines of “wow, how do you do it?” to a mum of four in my class, and her response was “You just have to get super organised.” Right! Wise words; that is definitely the plan! We’re still just getting to know each other, but everyone seems very friendly and welcoming so far, and I suspect that the wonderfully stressful bonding experience we’re all about to go through will ensure some lifelong friendships. I still think of my midwifery school friends from my US qualification with such love and warmth, and even though most of us don’t talk or hang out much any more, I still feel like many of them are my sisters as much as friends and colleagues, and the feeling hasn’t faded through the years, despite the distance and limited contact (mostly through facebook these days). So there is definitely something to be said for midwifery school friends!

Tomorrow is our orientation to our clinical site. My first rotation will be community midwifery, which is an area I’m very excited to learn more about, as it doesn’t exist in the United States. At all. In fact, the UK’s commitment to community midwifery is a bit of a rarity even among European countries, and is very exciting. My limited understanding of it so far (I’m sure I’ll have a much better grasp of it in the weeks and months to come) is that community midwives are responsible for delivering midwifery care in womens’ homes. This includes providing home births, of course (which is my particular love, and where I want to be practicing when I finally graduate again), but the more remarkable feat of community midwifery is that here in the UK, ALL women (even those who delivered in hospitals) are given follow-up postnatal care by a midwife in the comfort of their home, usually 1-2 days after returning from the hospital, then again around Day 5-6 postnatally, and finally one more time around Day 10 when the woman and baby will finally be discharged from midwifery care. Let me say that again, because it still sounds so incredible to me: a midwife will come to your *house* in the first few days and weeks after you give birth, check your bleeding, help with breastfeeding, weigh the baby, perform the newborn screen etc. etc., and this is not some extra, luxury service for wealthy clients with private insurance, but ROUTINE POSTNATAL CARE.  In the US, postnatal care generally looks like this: you give birth, you’re seen in the hospital by a midwife or OB on postnatal Day 1- Day 2 (which is usually when you’re discharged if you’ve had a vaginal delivery; usually Day 3-4 if you’ve given birth by cesarean), and then…that’s it. Your next postnatal visit is booked for 6 weeks later. And to a new mom with a newborn baby, the chasm between Day 2 and 6 weeks might as well be the Grand Canyon. SO much happens during those first 6 weeks–so many questions, such a steep learning curve–and you’re basically on your own for most of it (unless there’s a rare complication that would necessitate an earlier visit). Add to this the fact that many women in the US are also expected to return to work around 6 weeks, and maybe it begins to sink in just a little bit how cruel and inadequate the US maternity leave/ postnatal care system is.

Which isn’t to say that UK postnatal care is perfect.  In fact, most of the complaints I’ve heard since I’ve been working as a lactation consultant here for the past 3 years is that postnatal care isn’t nearly supportive enough, and that the advice about breastfeeding in particular can be very inconsistent. Also, one of the reasons community midwifery follow-up happens so quickly here is because many women are being released from the hospital within 6-24 hours after giving birth, which can also be very disorientating and stressful, for first-time moms in particular, I think.

In any case, I am very excited about working in the community initially–and I’m even hopeful that I might be able to attend a home birth, if I’m lucky. Fingers crossed! But our clinical rotation is still 8 weeks from now, and first…there’s a whole lot of reproductive physiology to review.

Breastfeeding News Roundup

Breastfeeding News Roundup

Breastfeeding has been in the news a lot the last few weeks. Here’s a quick roundup of some of the most interesting and exciting new articles regarding our first food, and why it’s so important.

First, a viral post about the microbiology research of a Vicky Green, a Biosciences student at South Devon College, who demonstrated the power of breastmilk by placing it in petri dishes cultured with some of the nastiest bugs around, including MRSA and E. coli. In the picture in the link, you can actually see clear rings surrounding each drop of breastmilk on the petri dish where the bacterial growth was halted by the breastmilk proteins. What’s even more remarkable is that she’s using the breastmilk from a mum nursing a 15 month old and a mum nursing a 3 year old, which just goes to show that breastfeeding DOES continue to play an important and vital role in nourishing our children and providing optimal health for them well past the first 6 months of life. Unfortunately, as an IBCLC, I hear all too often from clients that they were told by a (presumably well-meaning) GP or Health Visitor that there’s no benefit to nursing a baby past 6 months. Absolute nonsense, as this research so clearly demonstrates! And who knows, perhaps the protein in breastmilk will hold the key to defeating bacteria like MRSA in the future.

And speaking of nursing babies beyond infancy, Tamara Ecclestone recently posted a lovely photoshoot of herself nursing her 2 year old daughter Sophia and just about broke the internet in terms of controversial backlash, as people reacted so negatively to the photos that she was actually forced to defend her decision for posting the photos in the first place. Which honestly is just a very sad state of affairs. Also, the BBC article linked above doesn’t provide 100% accurate information. UK guidelines for breastfeeding are in line with WHO guidelines, and state that babies should be breastfed exclusively for six months and then continue to be breastfeed for a minimum of 2 years OR BEYOND, in addition to the food they’re eating. For the record, the right time to wean is whatever feels right for mom and baby, but the biological norm for our mammalian species is to breastfeed for anywhere from 2-3+ years, and as with all phases of growth or development, there’s a huge range of normal in terms of the right time to wean depending on the mother and baby dyad. It’s irresponsible to suggest that the UK guideline only encourages breastfeeding for the first 6 months. As for the controversy, unfortunately that’s nothing new. People are often outraged by the thought of breasts being used for purposes *other* than sexual, and sadly we hear of stories all the time of women being shamed for nursing in public, or told to use the toilet instead. And not surprisingly, most likely due in part to these cultural perceptions, the UK has one of the worst rates of extended breastfeeding of any developed nation in the world–even lower the the US’ rate of extended breastfeeding, which is quite surprising given that women in the UK routinely have 6 months of maternity leave (and often a year) compared to women in the US who often receive a scanty 6 weeks, if they’re lucky enough to receive anything at all. Clearly there’s still A LOT of room for improvement, and personally, as someone who’s still nursing her own two year old, I applaud Tamara Ecclestone’s decision to share her beautiful photos, which is an important part of how we can begin to normalize breastfeeding in the first place. The Milk Meg also has a wonderful article on this entitled: 9 Reasons my child is not “too old” to breastfeed.

And finally, this is a fascinating article by Kathleen Kendall-Tackett, IBCIC (who I saw at the LCGB conference last year, and is a fantastic speaker), discussing all of the ways that breastfeeding doesn’t just provide the optimal food for our babies, but also provides the best emotional and neurological foundation for their mental health. Breastfeeding encourages responsive parenting, promotes sleep (which in turn supports better parenting, as well as lowering the risk of postnatal depression–and breastfeeding is an independent factor for reducing maternal depression as well, regardless of sleep). Breastfeeding also promotes nurturance, attachment and bonding. As I often tell clients, breastfeeding is 10% about the FOOD we’re feeding our babies (and what incredible food it is!) and 90% about THE MANNER in which we’re feeding our babies, setting them up for healthy brain growth, emotional processing and psychological attachment in addition to optimal nutrition.

It’s ALL Happening: Midwifery Seminar, Timetables, Bursary Approved!

It’s ALL Happening: Midwifery Seminar, Timetables, Bursary Approved!

It’s all starting to get very, very real! I went to my new university on Friday to attend a midwifery seminar, which they hold every 6 months or so. It was a fantastic morning listening to some very interesting speakers and topics (I’ll give you a run-down below). I also received my student timetable for the first year of the course (let’s just say….lots and lots of work ahead, and very few holidays), and yesterday I also got a notice from the NHS that my fees-only bursary has been approved. What a huge relief that is! And for the record, I am an incredibly lucky student, as I am part of THE VERY LAST COHORT of incoming midwifery students who will be eligible to receive an NHS bursary. Starting in Aug. 2017, all incoming midwifery and nursing students will have to pay for their education (to the tune of 9,000 GBP per term), whereas if you are lucky enough to begin your education under the old scheme (as I am), your fees will be covered for your entire course (i.e. 3 years worth of education). As you can imagine, there are a lot of organizations (most notably, the RCM and RCN) which were quite distressed about this change, as it may limit the numbers of incoming student nurses and midwives and destabilize the future of maternity care in the UK. I am not entirely convinced about this, as midwifery and nursing education has ALWAYS been paid for by students in the US, without detrimental effects on the number of students choosing to enter these professions (but obviously coming out with lots and lots of student debt at the end of their education, which isn’t necessarily a good thing at all). In any case, though, as an American student approaching midwifery education here in the UK, I must admit that I am absolutely floored (flabbergasted! Amazed! Delighted!) that my education will be covered by the NHS, as I would never in a million years dream of free tuition in the States for any degree. It feels completely surreal to me, especially as I spent years and years paying off my student debt from my US midwifery and nursing education. And I am counting my lucky stars that I am slipping in just under the wire and will have my fees covered, but at the same time saddened that this incredible system–a system that values a student’s time and energy, and understands that properly educated professionals require investment–is being dismantled.

I met a few of the students who will be in my course, though, as well as a few of the professors, and everyone was incredibly kind and welcoming. I even met a third year student who gave me her phone number (unprompted by me!) and told me that I could get in touch with her at any point if I needed help. What a kind thing to do, and such a wonderful example of mentoring.  All of it seems very encouraging, and is making me think (again!) that I’ve chosen the right university to study at. The atmosphere was warm, the students were engaged, and the questions being asked were perceptive, smart and on-point. I am very excited about learning here!

The first speaker at the seminar was the one and only Professor Cathy Warwick, CEO of the Royal College of Midwives (and how fantastic that she’s speaking at conferences at my university??). Her presentation was on the importance of challenging the status quo in order to better deliver personalised care to each woman, which is a core value reflected in the National Maternity Review’s Better Births policy, but is not always easy to implement when a woman’s desires for her birth clashes with the institutionalised norm. She discussed many of the common situations where care is provided based on ritual (i.e. we do it this way because we’ve always done it this way), rather than evidence of best practice (examples of these sorts of non-evidence based rituals include transferring women between wards in a wheelchair when they’re perfectly capable of walking, not allowing fathers to stay overnight in early labour, routine use of external fetal monitoring on admission, transferring women from birth settings in an ambulance regardless of the reasons for the transfer etc. etc.) Prof Warwick pointed out that delivering personalised care presents big challenges for midwives on a systemic level, but that in many situations massive system changes aren’t needed. She spoke, for example, about how you can begin as simply as removing the word “allowed” from your vocabulary (something I can 100% get behind). The woman in labour is the one in charge of her birth. As midwives, it’s our job to support and empower her, but ultimately she should be the one making decisions (in collaboration with her midwife and birthing team). Telling a woman she isn’t “allowed” to do something goes against this sentiment. Ideally, a woman should be able to do whatever she likes in labour and on the ward (within reason), so long as the risks and benefits of her choices have been fully explained to her and she has been given the opportunity to make an informed decision. It’s HER birth, after all. Prof Warwick also pointed out that in some cases, women are labeled as “birthing outside of guidelines” as if they are stubborn and intractable and taking unnecessary risks with their babies, when in fact they are successfully advocating and demanding the type of birth experience they want and are legally entitled to. A better question is: how do we support women who challenge birth conventions/ norms of institutions, and choose to birth outside of these norms? As a strong advocate for home birth, this is something I have encountered many times before, and something that independent midwives facilitate, as many women who choose independent midwifery care are doing so because the institutionalised care offered to them was not in sync with what they desired for their birth. (And I must admit, I found it incredibly encouraging to be hearing this from the CEO of the RCM, especially in light of the recent difficulties imposed on Independent Midwives by the NMC). Safety and risk is perceived differently by every woman, after all; what feels safe to one woman could feel like the definition of risk to another. Prof Warwick also spoke about the need for not only continuity of care, but continuity of carer, and was quite adamant that figuring out how to deliver this type of continuity is something that can only be done by midwives (and that most likely the way forward will be different for each individual midwife, in terms of case-loading v. shift work v. shared call), and that midwives need to be given the power and flexibility to find their own solutions.

The next speaker was Margaret Nyudzewira, a public health advocate and co-founder of the charity CAME Women and Girls Development Organisation (CAWOGIDO), who spoke to us about breast ironing. While I’ve been aware of the dangers of Female Genital Cutting (FGC, or Female Genital Mutilation, FGM) for years, and have encountered it a few times as a midwife in Brooklyn, the practice of breast ironing is fairly new to me. Strangely enough, I first learned about it just a few weeks ago when a midwife friend posted a link to a photographer’s riveting portraits of women and girls who’ve experienced breast ironing.  The practice involves using a tight elastic band, pestle, ladle, hot stone, shell, or even hot seeds or heated leaves, to massage and flatten developing breast tissue on young girls, and can lead to many serious medical complications, including chronic pain, scalding, burns, infections, cysts, abscesses, tissue damage, the inability to breastfeed, and of course psychological trauma. Breast ironing is most often done by the girl’s mother (but can also be done by a grandmother, aunt, or tribal practitioner), and comes from a place of love, or more specifically, fear for loved ones–fear of unwanted sexual attention directed towards their daughters, fear of rape or sexual assault, or fear that early marriage or teen pregnancy could education and curtail opportunities.  And similar to FGC, this practice doesn’t occur only in Central and West Africa, but in the UK (and the US) as well (although the numbers are difficult to track, and very few studies have been done on the rates of breast ironing in the UK). In Cameroon, 50% of girls on the coast, and 24% of girls nationwide, experience breast ironing.

But one of the things that struck me the most was when Ms. Nyuydzewira said quite emphatically: “It is NOT part of our [Cameroonian] culture to harm girls and young women.” And that is absolutely true. While the practice of breast ironing itself is brutal and debilitating, it’s really important to keep in mind that the practice and the culture are not exactly one and the same. As a (white) midwife approaching a cultural practice like this (which runs counter to my own beliefs, and feels very foreign to my own cultural upbringing), I think it’s crucial to come from a place of support rather than a place of judgement.  This is one of the reasons I have come to call it Female Genital Cutting over the years, rather than Female Genital Mutilation (which has our cultural judgement baked into the very name itself) or Female Genital Circumcision (which to me seems to condone the practice, on some level, and also equates it in the mind with male circumcision, which is a false equivalence), especially when I’m discussing it with women/ patients directly (I understand that more generally, in health policy and research, it is more often referred to as FGM). Some women brought up in cultures which practice female genital cutting, for example, may view FGC as no more strange to them than piercing bellybuttons or lips or eyebrows is to us, even if the implications, the actual act itself and the repercussions of it can be much more damaging to them than a bellybutton piercing.  When viewed within their culture, it may be seen as a mark of belonging and identity, a much anticipated rite of passage, a way of fitting in, a symbol of their womanhood, a manifestation of their virtue and honor, and on its most basic level, the way that vaginas are supposed to look–beautiful, even, to their eyes. On a personal level, I disagree with these assertions and find FGC abhorrent, but as an outsider to these cultures, I can’t approach a woman by telling her that she’s been mutilated as the starting point for any future conversations with her–that will immediately close her off to me and only serves to project my own cultural bias over her own.  Instead, gentleness and sensitivity is needed more than anything else. Rather than imposing my own viewpoint, I would have to elicit the woman’s own views on the topic first, and use that as the starting point for whatever would be most useful to her moving forward: education and resources if desired, medical care if needed, mental health referrals if she feels depressed or traumatised by her experience, or silence and non-judgement if she views it in a positive or neutral light (and should this viewpoint ever change, I can then step in at that point with whatever help or support is most appropriate at that time).  To me, this gets to the very heart of my own personal philosophy of midwifery care: LISTEN to women, and DON’T JUDGE. In any case, now that breast ironing is also on my radar, I will be more alert to it if/ when I ever encounter it, and in a much better place to offer sensitive care on this very complex issue. Overall, it was a difficult and disturbing presentation to listen to, but I’m glad that it was part of the seminar, as these things are really important to think about in advance of encountering them!

There were two other speakers at the seminar: Debra Sloam, Midwife and Infant Feeding Specialist from Frimley NHS Foundation Trust, who spoke about her MSc research on student midwives’ attitudes towards offering breastfeeding assistance (as suspected, I will most likely have a lot more time to help women breastfeed as a student than I will as a working midwife), and Dr. Kim Russell from the University of Nottingham, who discussed her action research on challenging midwifery barriers (real and perceived) to facilitating water births on the wards.  These were both interesting and engaging presentations, and I’m really glad I was able to attend the seminar.

Two more weeks until classes start!