Episode 179 Ramadan Special

Step into our enlightening conversation about the multi-faceted experience of Ramadan, particularly as it relates to pregnant women and the maternity care system. With insights from Muslim doctors Miss  Natasha Abdul-Aziz and  Dr Emma Wiley , we dive  into the spiritual and communal aspects of fasting during this holy month, discussing its potential impacts on health and wellbeing for expecting mothers. 

Ramadan is more than just abstaining from food; it is a time for renewal, reflection, and community. Join us as we uncover Quranic teachings that outline the importance of fasting and how flexibility applies regarding exemptions for pregnant women. 

This episode also sheds light on the disparities faced by Muslim women within maternity care. The insightful narrative of the 'Invisible' report reveals significant gaps in understanding and service provision, emphasising the need for culturally sensitive healthcare practices. 

Curiosity, compassion, and community spirit are woven throughout our discussion. Whether you're curious about the practices surrounding Ramadan, looking for ways to support a loved one, or seeking to understand how faith intersects with healthcare, this episode offers valuable insights. Tune in, engage with the content, and join us in promoting a more inclusive understanding of Ramadan and its meaningful impact during maternity care. Please remember to subscribe, share your thoughts, and leave a review!

Want to knowmore?

https://britishima.org/wp-content/uploads/2024/02/bima-ramadan-compendium-v1.2-3-1.pdf

https://britishima.org/wp-content/uploads/2024/02/ramadan-health-factsheet.pdf

With thanks to this clip sung beautifully by Omar Hisham Al Arabi

https://www.youtube.com/watch?v=i6zOA6OX34E

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
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Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

Chapters

• 0:00 Introduction to the Episode
• 9:30 The Importance of Ramadan in Islam
• 22:30 Fasting and Its Exemptions for Pregnant Women
• 35:15 Understanding the Balance: Health vs Faith
• 48:45 Community and the Spirit of Ramadan
• 1:02:30 Personal Experiences of Ramadan in Maternity Care
• 1:15:10 Addressing Disparities in Maternity Care
• 1:27:00 Conclusion and Zesty Takeaways

Transcript

Florence: 0:00

Hello, my name's Florence. Welcome to the OBSpod. I'm an NHS obstetrician hoping to share some thoughts and experiences about my working life. Perhaps you enjoy Call the Midwife. Maybe birth fascinates you, or you're simply curious about what exactly an obstetrician is. You might be pregnant and preparing for birth. Perhaps you work in maternity and want to know what makes your obstetric colleagues tick, or you want some fresh ideas and inspiration. Whichever of these is the case and, for that matter, anyone else that's interested, the OBS pod is for you. Episode 179 ramadan special. Today I'm very excited to follow up last year's ramadan episode. I decided it was okay to ask and I reached out to one of my colleagues, natasha, and she put me in touch with another consultant colleague, emma. So we're going to start with Natasha and Emma is going to join us part way through. We're going to have a great conversation about Ramadan and we're going to start with a bit of the Quran.

Natasha: 1:34

Surah Al-Fatihah. Shahr Ramadan al-Ladhi unzil fihi al-Qur'an hudan lin-Nasi wa bayinatim minal huda wal-Qurtaan Faman shahid minkum shahra fal yasum Waman kan baridhan anwala safari muqaddatun min ayyamin muqar.

Florence: 3:19

Surah Al-Fatihah it's so beautiful. You sent me that clip ahead of us chatting. Would you like to just explain to people what was being said?

Emma: 3:32

give us a translation yeah, that would be great. Thanks, um florence. So the verses you just listened to are a recitation of the qu, which, in the Islamic tradition, we consider to be a scripture revealed by God through the angel Gabriel to the prophet Muhammad that we accept as a prophet. And those particular verses are where the commandments we believe in our tradition come for fasting during the month of Ramadan. And what they say is for those of you who believe, we have prescribed fasting for you, as we prescribed it on the people before you for the purpose of you to be mindful of God. And if you think about it, fasting is prevalent across all the not just monotheistic traditions, but most religions. So you'll have the fasting of Lent in Christianity. You'll have the fasting on Yom Kippur in Judaism. There's fasting involved in worship in Hinduism and Jain religions so I think it's interesting that that's mentioned there. And then the verses go on to say the fasting is only for a few days, but if you're sick or on a journey, then you don't have to fast those days and you can make it up at another time. But if you're very ill or you're unable to make it up, then the option there is to feed a poor person because you're unable to engage with the fast.

Emma: 5:11

Then it says that the month of Ramadan is where the Quran was revealed. And that's very specifically why Ramadan is such a special month for us, because we believe that it's when guidance came once again to mankind. It came before, obviously, with the Psalms of David, the Torah and other scriptures that we accept. So this is a reinforcement of that, and the whole month of Ramadan is increasing your understanding of the Quran. That was revealed to improve your relationship with God, but also with people as well.

Emma: 5:55

It says also in those verses again that God doesn't want you to go through hardship. He wants ease for you. So there's a lot of questions about why would you do this to yourself, and I think that's addressed there. And he also wants us to be grateful. And then the last verse that's connected to those is we believe God says to us when people ask you about me, tell them that I'm near and that I respond to the call of anyone who prays to me. So I'm asking them also to respond to the things that I ask of them, so that you can be righteous and stay on the straight path.

Florence: 6:40

Thank you so much. That's a really helpful start for our conversation, I think, and I think so. I started from a place of complete ignorance. I just thought Ramadan was about fasting and when I looked into it last year a little bit, I started to understand much more of the, started to understand much more of the sense of community and breaking the fast together each night and it being a much more celebratory sort of I was going to say festival, but maybe that's not, I don't know if that's the right word so more a more celebratory community event than I had understood it to be.

Florence: 7:25

I'd seen the fasting more, like you say, as a hardship and I think and that may be in this day and age a lot of us are not used to the idea of fasting. And I came to it last year thinking this is awful. Actually, in all these years I've had all these pregnant women who are Muslim who every year are faced with this issue about do they or don't they fast in Ramadan, and I have no idea. And I came across some American guidance which kind of started me on this, this journey. Tell me a bit. You just mentioned to me, before we started recording, that there is some UK guidance. Do you want to talk a bit about that maybe?

Emma: 8:15

sure. So I mean, I think, when we're talking about religious guidance, the Islamic tradition actually has a really rigorous academic tradition, and so you'll never get opinions that don't come with evidences behind them.

Emma: 8:28

And that's one of the strictures of the religion. It's one of the ways that we practice to ensure that we're not diluting a message or going by opinions. But it's also a very lenient religion and I think, when you think back to the verses that were just said, if it says God doesn't want hardship for you, and the tradition in Islam is to take the middle path. If there's a hard path and an easy path, you're not meant to take the middle path. If there's a hard path and an easy path, you're not meant to you know it's not a masochistic type of tradition.

Emma: 9:03

There are exceptions to every rule. Now, I'm not a scholar, I'm not what we call a sheikh or an alum, I don't have a degree. There are, there are scholars who do discuss and give verdicts on an individual basis. What, what I will tell you, from what I understand, is that fasting and Ramadan is one of the five pillars of we call them the five pillars of Islam. It might help if I so.

Emma: 9:34

In the Islamic tradition, that the five things that we consider paramount are that you testify that you believe in God and that Hamid was his messenger, that you pray. So that's Salah, that's five times. There's a five daily prayer ritual which we can talk about, which is essentially just recentering yourself throughout the day to see how are you, how are you interacting on a linear level with the people around you and are you being mindful of your responsibilities towards people. And the third pillar, then, is fasting, and the exemptions to that are if you are ill or if you are a traveler, and the exemptions are if you go into them. It depends on the type of illness, if it's temporary, if it's permanent, and based on that you would decide whether A you can fast. Is it safe to fast, or does it put your health at risk to do so? Is it?

Speaker 4: 10:38

safe to fast or?

Emma: 10:39

does it put your health at risk to do so? B if you don't fast, do you fall into the category of the seriously ill and so you feed a poor person instead? Or do you have to make up your fast afterwards, such as one who's traveling, because we consider a long travel hardship as well? We don't expect you to fast during that time. You also don't fast if you're menstruating, because that's considered an excessive hardship. Yes, you make that up later. In terms of whether you can fast in pregnancy it is. There aren't large randomized control studies that tell us 100% this is safe or this isn't safe. What we do know is that, in theory, the time when you might be more cautious about fasting and again, I'm not a scholar, but you might be more cautious in your first trimester, which a lot of people would find an oxymoron, they might have thought actually, when I'm farther along, it would be more challenging. But in the first trimester, we know embryogenesis happens.

Emma: 11:47

That's when the cells are coming together to form a baby, and we'd want to avoid hypoglycemia, drops, your blood sugar for long periods of time and dehydration to make sure that that comes together properly yes there's the option of intermittent fasting, which has become very popular in the health community, where you might consider I'm in the first trimester and I don't want to put too much stress on this developing a, so perhaps I'll fast one day and one day I won't, and then you know. That way we can feel a little more secure. The studies, the case studies and the few series that have been done throughout the rest of pregnancy. The people went into it thinking oh, if you're fasting, you're going to you'll be delivering a low birth weight baby, or you might deliver early, or they may be other risks, and that hasn't been proven in any of the case series. But again, it needs to be an individualized decision. It depends on you as a woman and what you feel you can manage. It's your body, it's your choice.

Florence: 13:01

Yes.

Emma: 13:02

It also depends on other factors. So potentially, you may have comorbidities. You know, maybe you're a diabetic, maybe you're intensive, maybe you require to take medications throughout the day. So I think it's really important that we individualize care, yes, and also that we support the woman's right to choose yes. If there is a situation where we're going to advise someone one way or another, it comes from a purely medical basis, where we say, okay, this would be detrimental because actually you're, you're unwell and this way and this way. Well, we have these worries, and then she can take that on board, hopefully.

Florence: 13:45

Yes, yeah, I had, bizarrely, the first time anyone had ever asked me in antenatal clinic a few weeks ago actually and it was really lovely because I was like, yes, I know, I know what to say, I know I can tell her she's not going to do any harm to her baby and it's perfectly okay. And she raised what you'd said or what was in those verses of the Quran about the extra days, which I'd never heard of before. So she was like, yeah, I want to fast and keep Ramadan because I don't want to do all the extra days later when I've got a new baby. Yeah, that might actually be more detrimental. I've got to make it up that's an interesting point.

Emma: 14:31

so if you're lactating, if you're breastfeeding also and the fasting reduces your ability to breastfeed, then then you're also exempt, okay yes. In that time period. But it can be quite daunting to do it outside of Ramadan because you don't have the support and all this, you know, really spirit of the community that you have during Ramadan.

Florence: 14:56

Yeah, and I think that's something I hadn't understood until I started to look into it last year and I read a blog by a midwife who was saying she found it really difficult because if she wasn't fasting then she wasn't part of that community every evening breaking the fast and that supportive cohesion that everybody's doing it together, and she felt very kind of left out almost.

Emma: 15:27

Yeah, I mean, it's such a beautiful time of year because the fast in Ramadan, obviously, you know. The first thing is it's sort of reinvigorating your relationship with God and other people and having a chance to examine yourself, almost like a boot camp, and saying, ok, if I can do this, then for the rest of the year I can do other hard things, I can meet challenging situations, and it's a time just to be more mindful. It's a time to spend also with community, because often together we'll sit and eat. It's something that's recommended to do together. We also go for, you know, additional prayers at night. You might think, oh, you do five, how many more do you want to do? But the point of the night prayers is that by the end of the month you would have read the entire quran all over again, so that you've reminded yourself, almost like a refresher course, like we would take. Uh, you know when, when we're um, when we're looking at our appraisals and our gmc registration, um, and it's useful in that way.

Florence: 16:37

And when you're out, when you're outside of that, doing it by yourself, it can, it can feel like a challenge so, just to be clear and summarize, what we're saying is that women who are pregnant or lactating do not have to fast they're exempt. But they do have a choice if they want to fast, and we need to individualize that advice and and they need to think about the decision depending on their particular health issues and how they feel, and that alternate day fasting might be an option, or it might be an option not to fast in the first trimester and to fast later on, and if you're not going to fast, you can either make the days up later or you can feed someone in need as an alternative. I'm interested. So you mentioned their prayers and I'm interested in this, both in terms of Muslim staff as well as Muslim well, I guess I was going to say pregnant women, but anyone in a hospital.

Florence: 17:58

Well, I guess I was going to say pregnant women, but anyone in a hospital. So I'm interested to know how you feel supported or not supported with praying, because I have in the past occasionally come into the changing room and found a colleague with their mat out on the floor doing their prayers and I felt awful that I've walked in and disturbed in the middle and whatever. But equally, I felt that the floor of the changing room is really not an appropriate sort of space for them to be doing that and and kind of. But I hadn't really thought about. Well, what provision is there for five times a day to go and do your prayers if you want to?

Emma: 18:48

yeah, it's the same.

Florence: 18:50

I guess, if you're admitted as a as a patient uh, it's a.

Emma: 18:57

It's a great observation. I'm so glad emma's joined us because she's done a lot of work around this excellent, emma.

Florence: 19:02

I'm just going to introduce you to everybody. So we've just been joined by emma, who's a consultant colleague also, who's going to give her us her perspective on working in the nhs as a muslim, but also, hopefully, sharing a bit of your maternity experience with us.

Speaker 4: 19:24

Hi, hi, it's lovely to be here. Thank you for coming. Yeah, no, it's my pleasure. Yeah.

Florence: 19:32

So we were just talking about praying. I don't know how much you heard of what we were just discussing about the ability of staff or people admitted as as patients, either in pregnancy or or not, um to fulfill their five times a day prayer.

Speaker 4: 19:54

I guess you know, classically, we've gone for the sort of multi-faith room approach, where we sort of have one venue in the hospital, and that's great, because I think, consistently, you know, across the board, hospitals do have a facility. I don't think I've ever worked in a hospital. We haven't got somewhere quiet, you can go, and that's fantastic, I guess. The challenge, though, is that I guess there's two groups in this.

Speaker 4: 20:20

In terms of staff, you might be on a very busy shift and you know the nhs is always busy so it's uh, it may take some time to get to that location and particularly if you're on the other side of the hospital and in the winter months it can be particularly challenging because you've got to fit in three within a working day, sort of between nine and five, right. So I worked out that it would take me about an hour just walking backwards and forwards at one of my previous hospitals, just in travel time in the winter, and that's why people generally want to pray on site. Wherever they are, they sort of need a quiet space, and so the the only quiet space is often, know, the changing rooms or strange basements etc. So I think it would be lovely, I think across the NHS, to think about quiet spaces, and I think it's, you know, I think it would be useful for a number of different people.

Speaker 4: 21:14

You know we talk, we have it for relatives, don't we sort of quiet rooms? You know we have it for relatives, don't we sort of quiet rooms? Certainly at the Marsden, where I've been recently, they've got lots of quiet rooms, you know, because it's appropriate for that setting. So people sort of need it for debriefs, for quiet space if you're sort of neurodivergent. So it'd be lovely to kind of think about, you know, could we have a little bit more of that, places where people can kind of stop?

Florence: 21:42

and decompress a bit closer to where they work. Yeah, thank you. That's really useful food for thought. Before you joined us, we were just talking a bit about um fasting or not fasting in ram, ramadan, in pregnancy, and the idea of that it's not detrimental to the baby, that you are part of that sense of community and so on. I don't know if you could share anything with us from your personal experience at all personal experience at all, yeah, so, um, I suppose I've.

Speaker 4: 22:24

I guess there's different opinions on it and it depends on the person as well. So there certainly is guidance that if you are pregnant, that you're not obligated to fast, and particularly where you feel that there will be a harm to the baby. So, for instance, um, when I was particularly first trimester, both pregnancies, I definitely felt nauseous and and it was worse if I didn't eat, um, so for me my decisions were that I wouldn't fast, you know, certainly during first trimester. You know that was a personal decision, but it was also bearing in mind the guidance.

Speaker 4: 22:56

I think other women do choose to fast and some people say that it's worth trying and seeing and sort of seeing how you feel and if it seems to go okay, then you can carry on or you should try that first. So I think both of the options are there. I'm not sure in terms of how definitive the evidence is, sort of either way. So, and I think some people also, they feel that if they're not part of kind of Ramadan spirit, that kind of, they lose out and they miss that element of spirituality. So a lot of Muslim women do choose to fast during the month, even though they might not absolutely have to.

Emma: 23:42

I said it's a lot of team spirit it's a it's it's really hard to describe, but it's uh, it's such a great, uh, great time, because you know that everyone is trying to work on on themselves, not just from the fasting, but you know everyone's. There was a joke I remember in college where my friends would be like it's Ramadan, ask Natasha for money, she'll give it to you. Because you're trying to be more generous, you're trying to watch how you speak to people, you're trying to hold space for them, you're trying to make sure that you're mindful, you want to, you don't want to fall into like the little white lies, and all of that is a part of fasting.

Florence: 24:18

Um, and it, yeah, it's just such a great experience it's lovely to hear you talk about it actually and and I'm definitely getting a sense of it being a really positive and enjoyable time of year, which I think a lot of people that don't know about it that's not an assumption we would would make yeah, I think.

Speaker 4: 24:46

I think they would sometimes like the science of fasting as well. I think there are kind of chemicals that are released, um, that kind of give you that high. I think you know, when I've read about, I think there's so much more now literature on it.

Emma: 25:01

I think that if you, uh, have ever spent any time in a, in a Muslim majority country and obviously there's there's almost two billion Muslims in the world over various cultures. They, you know, they range everywhere and it's the second largest religion in the world. It's the fastest growing religion in the world. So you do, the fastest growing religion in the world, so you do find Muslims everywhere. But if you're in a traditional country where there is a Muslim majority, it's definitely it's very celebratory. You know, the lights go up and the schedule changes and people look forward to seeing their family and just focusing, to seeing their family and and just focusing.

Emma: 25:38

It's all, it's a. It's like a mandated Well, it's I wouldn't say mandatory training, because that's quite onerous, but it's. It's like someone's forcing you to just stop. Let's you know you're going a mile a minute. Just stop, just slow down, just remember why you're here. You know, look at all the great things you've got, appreciate the things you've been given, understand not everyone has the things that you've been given. Reconnect with your compassion, your spirituality. So, yeah, I think that's why most people I know, especially as they get older, really look forward to Ramadan coming. I certainly do, because I think, oh yeah, I just, I need that reset, you know.

Florence: 26:23

Well, that sounds lovely. I'm now feeling quite envious. You can do this, emma. In preparation for today, we kind of exchanged a couple of emails and we mentioned Invisible, the report into Muslim women's experiences of maternity care, which I had a teeny tiny involvement in in reading some of the draft when it was being written, and you said you contributed to. So I don't know if you'd like to talk a bit about that, because that was to me very shocking, very shocking reading.

Speaker 4: 27:06

There was a lot in that report't there and I think I was really struck. There was a table, I think, that showed some of the statistics in terms of the disparities between sort of Muslim women within that sample and some of the complications. So yeah, there were, I think there were interviews, but there was also sort of a quantitative element to it. I suppose it was the first time that we'd seen that data represented in that way. And what was interesting about the report was that it broke down Muslim women by ethnicity. So often there's a sort of Asian other box, but it's then dissect that further and look at different, you know. I mean, asia is a big continent, so look at the big, you know, look at subcategories.

Speaker 4: 27:52

I was interested personally to get involved with it because I had two babies and my experiences were really different. I think with the first one I had an epidural and it ended up sort of being quite medicalised from that point in, whereas with the second it was more sort of a natural birth, kind of water birth, etc. So they were quite different experiences, although there were some similarities, I guess, in terms of the faith specific parts. You know, there were certain things that were important, I think, going in just the sense of kind of I guess dignity feeling that I could cover, because I would normally be kind of fully covered. You know, I kind of have my body covered, but you know, I'd witnessed as a medical student all of the births and the usual various states of undress. And yeah, there are certain kind of I guess rites that follow after a baby's born that I was keen to observe, some of which were straightforward to do and others were a little bit harder harder.

Florence: 29:12

Do you think there are things that you'd wish that the staff knew that might have helped you with, with some of those things? Because I mean, when you say that was harder, that makes me think were we kind of putting barriers in place?

Speaker 4: 29:23

I think it's to do with perspective. So as a clinician, you know I'm kind of looking at it going. Patient safety comes first and that's sort of you can see that in the, in the, in the care that was delivered. You know that you need to have good visibility, you need to make sure that you're keeping mum and baby safe. So if you need to undress a certain part to do that, then that's clearly a sort of clinical priority. But there is a balance, I suppose.

Speaker 4: 29:52

You know there were times when it maybe wasn't strictly essential that I be exposed, like my legs for instance, and my priority would have been different. So what I did second time round was I actually employed a doula, which is I guess you could perceive that as a bit of a luxury, although I think you can get doulas on a budget. You can. There are, there are options and I really found having an advocate who I kind of free briefed with my needs really helped. I really recommend and I think, particularly if you're from a minority group, I think it really helps to just have an advocate kind of with you for some of those elements. She wasn't Muslim herself but because she was very attuned to kind of my requirements, I suppose, or as part of her role. You know, it's holistic the way that doers look after people.

Florence: 30:43

Yes. I found that really helpful, actually, yeah yeah, I can see that in terms of getting to know you as a person, it it doesn't. It doesn't matter whether they're the same faith or background or whatever it's. It's understanding what's important to you, getting to know that and then helping, helping you advocate that. And you're right, you can access doulas um through doula uk there there is. There is some ability to access um doulas even if you can't afford a private doula.

Florence: 31:21

But yes at the same time, it should be that we should be able to listen to you without, without a doula. So that sort of makes me sad and I know. When I read the invisible report, it the thing that struck me was, I think, assumptions. So there was quite a lot about women saying well, because of the way I looked or the way I dressed, people made all this the kind of trickle down of of assumptions, rather than actually asking you and talking to you, and who are you, emma, as a person?

Speaker 4: 32:10

yes, yeah, and it's interesting because one of the questions that I asked myself second time round was should I, who should I take with me? Because I noticed that there was quite difference and, and, by the way, I'm talking about other trusts, southwest as a whole but I noticed that there was quite a difference in how I was treated when I was with my mother, who's a sort of first generation hijab wearing, you know, arab woman, and when I was with my husband, who is kind of British, like me also, from the same you know background, but a man number one, number two, you know, british sounding. It was very, very different. And the times that I have experienced discrimination were generally when I was with my mother and I you know if you want your mother with you, because that's something you know, as women sometimes we like to have that kind of support. To not be able to have that because you fear being discriminated against is actually quite sad During the first.

Speaker 4: 33:25

So we ended up in theatre. I was taken to theatre in a in a bit bit of a kind of rush, and I just remember being in this theater kind of yeah, not in a very dignified position completely stripped down. There was a man wandering around in the background, even though we kind of had the conversation that I didn't necessarily want, you know if it, if it was at all possible to avoid, and they said well, you know it, an emergency, so we have to go ahead.

Speaker 4: 33:50

So I accepted that and my mum was with me during the first baby. She hadn't told me she was a doctor, which we later regret and yeah, there was significant incivility. Put it that way, she was shouted at because she had spotted an issue, a medical issue, an acute issue, and she was told to sit down repeatedly and shouted at um. So you know, it was difficult and we reflect on that and we think that maybe she should have pulled the doctor card because actually then she might have been respected.

Florence: 34:31

Gosh, I'm feeling really quite shocked. I mean, I know I've read some of this stuff, but to hear you say that like that, yeah, that's really awful, really awful. Yeah, that, yeah, that's really awful, really awful, yeah. And I and I know I remember in Invisible that report, I think there was a story about someone whose husband was an anaesthetist and as soon as he said he was an anaesthetist, everyone listened to this couple, but before that they didn't, which sounds exactly like what you've just described with your mother. And yeah, if you want your mum with you, of course, why wouldn't you want your mum with you? I mean, yeah, of course that might be the person you would turn to, and to feel that you can't do that because that might increase the discrimination and the way people treat you badly, that's that's awful.

Speaker 4: 35:33

Yeah, but it certainly. Yeah, it was certainly a difference in experience. So I think second time round, I think, my husband appeared at the end and it was all sort of smooth, everything he sort of requested happened and it was much more straightforward. So, yeah, yeah, it's pretty sad.

Florence: 35:51

Yeah, and that's also. I'm thinking that's bizarre. I mean, obviously it's bizarre because it's not okay, but it's also bizarre that we sometimes make assumptions, I think, that men are maybe more dominant in Muslim cultures, that women could be subjugated, or there's more misogyny, whereas what we're then demonstrating is, if your mum's there with you, we're going to treat you badly, but if your husband's there, we're going to treat you well, which is exactly that misogyny. That's so. I'm just struggling. My brain's a bit blown by that.

Emma: 36:38

Really, it's, it's hard, yeah, to unpack discrimination in in its various forms. There's probably a couple of different things going on, but certainly the the narrative of the last couple of decades of the oppressed muslim woman has been very hard to challenge, simply because a woman chooses to retain her locus of control and to privatize her sexuality. Um, and there are, you know, there are people who who then argue that, um, or that there must be something, there must be some sort of error in their thinking. These, these can't be thinking feeling intelligent human beings, whereas an actual fact, obviously they're.

Florence: 37:25

Incredibly, everyone has value and everyone has the right to choose how they express themselves with their body, their clothing I'd like to ask you about what you said about male staff, because this is something we do talk about quite a lot at work and last year when we ran a maternity workshop, really trying to focus on the experience of women from different ethnic backgrounds, and one of the things that came up was if a Muslim woman asks to have minimized male staff will go well, you know that's not okay. But if a woman who's been subject to sexual abuse or abuse in the past, everyone will go. Oh yeah, that's of course, you know it's it's. It's like two completely different responses to the same request well, it's about what's culturally accepted, isn't it?

Emma: 38:40

And I think the culture, especially if you look at the I can't speak to before Brexit. I only arrived in England 10 years ago but you know, I've seen the trajectory, I've seen the course of the misinformation that's been spread about immigrants and beliefs, practices, ways, how they're very different from us. The whole othering of any group of people, I think, is always going to lead to lot of our wonderful, kind, intelligent, otherwise well-rounded colleagues and friends may not understand that they have this bias and may be offended if you flag it and say you know, I feel this is coming from a place of unconscious bias. Or let's change the situation, like you said, and say it's a sexual assault survivor rather than, um, you know a woman with a personal preference and, and suddenly there's a, there's a bit of a disconnect, um, and but that's because of what we? We are constantly fed um by the media, politicians, by world events, and it's hard to continually have to challenge that.

Speaker 4: 40:00

And that's where you know the concept of this exhaustion from continually fighting microaggressions can come from yeah, yeah, I guess that explains it and I think, um, the other thing I think is quite interesting. I mean, I would like to understand why there are these health disparities, and my gut feeling is that you need to be in a sort of calm and happy state in order to give birth effectively. And when we say no to people's faith preferences, like, I think, as clinicians clinicians we're trained sort of ideas concerns, expectations, so we're used to that framework. But as soon as you insert faith into that framework, suddenly we you know we struggle with that. But when we don't consider how a woman who is going to give birth wishes to deliver, I don't think that things work as smoothly.

Speaker 4: 40:59

Um, I don't think the birth process goes as smoothly. I don't think you feel as relaxed, and then I think the complications come from that. Yeah, I think, particularly with the second time around, that was my, my feeling. Yeah, there's just, there's something in it. It's a bit like how you can't sleep if you're stressed. To deliver a baby, you need to be in that kind of calm and relaxed state and you need to be surrounded by people who are supportive of you.

Florence: 41:27

Yeah, I completely agree and there's lots of evidence around that in terms of, you know, women contracting at home pick up the phone, come into triage. Pick up the phone, come into triage. Everything stops because there's something in an environment with bright lights, strange people, not just because their body's gone. Is this a safe place for me? So it totally, I totally agree, and that also kind of made me think a little bit about choices of place of birth. So I know my colleague, frances Rivers, who's our consultant midwife, has done some work about women from different ethnic backgrounds making choices about things like home birth or birth centre. That may, I might, be the right place for them, or they might not, depending on how their pregnancy's been, but less women from different ethnic backgrounds being aware that those choices are there and are suitable for them and are potentially safer for them.

Speaker 4: 42:38

So, less aware of home birth as an option is it that people default to the hospital?

Florence: 42:42

Yes, and also less awareness of birth centre. So you know, if you have an uncomplicated, straightforward pregnancy, actually giving birth on a midwifery-led birth centre is better. It's safer.

Speaker 4: 43:04

Like you say, less complications. Yeah, yeah, that's really interesting. I mean, I felt it very viscerally because I remember with my second birth, uh, I had this lovely team up until the shift change, and we were doing the kind of natural things. So we had the kind of candles, you know, not naked flame, but you know the soft candles, and we had all the kind of aromatherapy and it was lovely and the midwife, I think she was very experienced, very calming. And then suddenly there was a shift change and I was moved to a much brighter unit and suddenly all the kind of the blind blinds went up and it was a completely new team.

Speaker 4: 43:42

And then everything, as you say, it slowed down and they were really perplexed. In fact, they said to me listen, you've got this many hours to give birth and then, if it doesn't happen, then we're going to have to sort of move you back. And I thought I feel like this is a process you can't really rush. So you know, everything slowed down and they were all a bit perplexed. Why is it all slowed down? I was thinking. Well, I know why.

Speaker 4: 44:01

You know, I just don't feel comfortable anymore. And we ended up this is a little bit naughty perhaps, but it worked. We ended up in a bathroom. I was moved back to the antenatal unit because things weren't moving properly and I wasn't given any pain relief, because that's what happens and we ended up in a bathroom because I wanted this water birth and I was with the doula and then I was relaxed and I was away from everybody and that suddenly, when everything started happening and I probably had no an hour or two, just that feeling of calm and seclusion and kind of where I wanted to be, then suddenly it all happened and they were really shocked. You know that how quickly it developed when we went back and you know I was delivering within a short time. So, yeah, definitely.

Florence: 44:45

Of course you were. That's fantastic. I'm aware I'm taking up your precious, precious time in an evening. Are there other things you think we should talk about?

Emma: 45:03

I think that you've you've come with some really great questions that are really relevant. Um, and personally I'm just really glad that you opened the conversation. I loved that you reached out and you've been so kind and so open to hearing about different faith experiences and it's gone a huge way just even making me, as your colleague, feel seen and heard. There's this concept of bringing your whole self to work and being psychologically safe, and you know there's a. We just don't talk about these things because sometimes you don't know how it'll be received, whether you have unconscious bias. So I've really appreciated this, thank you oh it's.

Florence: 45:52

It's such a pleasure and it was so lovely to get your really enthusiastic response and for you to introduce me to Emma as well.

Florence: 46:00

She's fantastic, isn't she yeah yeah, absolutely, and I think, because I feel like why have I left it till now in terms of, you know, I would know Ramadan was kind of vaguely going on, because I would go to the coffee shop and go, you know, to people do you want a coffee? And they go, no, I'm fasting. And I would never use that as an opportunity to open up the conversation, which feels really bad now in retrospect, because that was the perfect opening, wasn't it? To have a conversation.

Speaker 4: 46:35

I was going to say I really liked, because I was listening to your podcast last year and I liked the way that you almost bookmarked it and kind of like, well, I don't have somebody here this year, yeah, but it's okay to ask, like I think. I think that's the hard thing, isn't? It is sort of um is, how do you acknowledge it if you're not sure and if you don't kind of know what to ask and where to start? I think it was really important and I think I always describe this sort of conversation as a bit like a two-way dance, like somebody's got to lead, somebody's got to invite and then and then you can then feel comfortable enough to talk about it.

Speaker 4: 47:12

So I think, it is really important. We do kind of honor it and and are okay with asking, even if they don't know.

Florence: 47:18

So I think, yeah, that's so I was gonna say, if you listen to it, you you probably know I normally end with a kind of zesty bit of the bit I want people to remember. So I think that might be. That might be. The zesty bit is be curious and try and invite your colleagues and try and talk to women you're seeing and try and open up the conversation a bit more. Do you think?

Emma: 47:43

Definitely. I mean the more we know about each other, just as people humanises people, yes, and then we're able to treat each other with kindness and respect, which is all I think anyone wants as a patient, as a colleague, as a person.

Florence: 47:58

Yeah, no, that's really lovely. Yeah, I'm so grateful to you both for coming back and going yes, let's do it and fitting it in in your evening, because I really did kind of feel like, no, I don't want another year to pass without trying to learn a bit more and have a bit more conversation. So thank you very much, I really appreciate it.

Emma: 48:24

Thank you.

Florence: 48:25

Lovely to meet you, Emma. Thank you so much for giving up your time. Lovely to see you, natasha, and I'll hopefully see you soon, thank you.