Episode 168 Ramadan, it's ok to ask

Have you ever experienced a moment of cultural awakening, realizing that there's so much more to learn about the traditions of those around us? That's exactly what happened to me, Florence, after reading an enlightening tweet from the outstanding obstetrician Nisha Knot, which set me on a path to discover more about Ramadan and its effects on pregnancy. Join me on the OBSpod as I navigate my own journey of understanding, driven by the realization that many of the Muslim women we support in healthcare are observing this pillar of their faith. This episode is a heartfelt quest for knowledge, as I tackle the complexities of fasting during pregnancy without the guiding voice of an expert guest, but with the earnest desire to learn more and share that knowledge with you.

As we ponder the impact of fasting on expecting mothers and how this practice varies across the globe due to differences in daylight hours, I turn to a pivotal article that serves as an evidence-based guideline for obstetricians. This episode isn't just about sharing what I've learned; it's an invitation to engage in a more inclusive and informed maternity care conversation. I hope that by openly discussing my own educational gaps and curiosities, we can all feel empowered to ask questions and seek answers together. So whether you're a healthcare professional, a pregnant woman observing Ramadan, or simply someone intrigued by the intersection of culture and care, this episode is for you. Let's grow our understanding and become better allies to the diverse communities we serve.

Want to know more?
https://www.ajog.org/article/S0002-9378(23)00169-2/abstract
https://maternityandmidwifery.co.uk/fasting-in-ramadan-during-pregnancy-and-breastfeeding-a-personal-journey/
https://youtu.be/E2AceO2j2oc

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.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
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...

Episode Transcript

Florence (00:00):
Hello, my name's Florence.
Welcome to the OBSpod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife.
Maybe birth fascinates you, oryou're simply curious about what
exactly an obstetrician is.
You might be pregnant andpreparing for birth.

(00:21):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou want some fresh ideas and
inspiration.
Whichever of these is the caseand, for that matter, anyone
else that's interested, the OBSpod is for you.

(00:48):
Episode 168, ramadan.
It's okay to ask.
I am going to start by tellingyou I am not an expert on
Ramadan.
In fact, I know very littleabout it, and this is what
prompted this episode.
It all started when I saw atweet from Nisha Khot, a

(01:15):
fantastic obstetrician who usedto work with me but who is now
one of the vice presidents ofthe Australian and New Zealand
College of Obstetrics andGynaecology.
She lives and practices inAustralia.
She was highlighting an articlein the American Journal of

(01:36):
Obstetrics and Gynaecology aboutthe effects of Ramadan on
pregnancy.
This sparked something in mymind.
It made me think back to thereport which I helped contribute
to in a small way, by BaronessGohir Invisible Muslim women's

(02:03):
experience of maternity careInvisible.
It got me thinking.
In the UK, around six and a halfpercent of the population are
Muslim and whilst I don't workin an inner London, trust in
London.
I imagine the proportion ismuch higher.

(02:24):
Trust in London I imagine theproportion is much higher.
Therefore, year in, year out, Isee Muslim women during Ramadan
.
I must do, but if I think aboutthe conversations I've had with
those women, it's rare that itcrops up in the conversation.
So I had one of those momentswhere you suddenly realise your

(02:48):
level of ignorance and I put outa message on my Instagram and
Twitter because I thought Ican't possibly do an episode
about Ramadan because I don'tknow enough about it.
I need a guest because I don'tknow enough about it.
I need a guest.
I need a Muslim colleague orMuslim parent to come on and

(03:09):
tell me a bit about it.
But Ramadan is a month and ithas a time frame and whilst I
did get some excellent resourcesback, which I'm going to
mention in a moment from allycolleagues, I didn't get
anything back from any Muslimwomen themselves.

(03:29):
So I had a choice.
The end of Ramadan is in a weekand a bit's time.
Do I park it, leave it foranother year, because it's not
appropriate for me, a non-Muslim, to tell people about Ramadan.

(03:51):
Or do I take the approach ofTerri Gavin Jones, a wonderful
midwife who I talked to onepisode 136, all about cultural
curiosity?
Do I take Terri's approach andsay it's okay to ask?

(04:11):
So I thought I'd bite thebullet, I'd do an episode on
Ramadan because otherwise thisyear will have been missed and
it's okay for me to ask and it'sokay for me to say I'm ignorant
, and I very much hope thatsomeone listening to this
somewhere it will spark somethoughts and maybe next year,

(04:33):
when Ramadan comes around, wecould record an episode together
.
So, in my little quest toexplore Ramadan, what have I
learnt?
Well, I'm going to start withthat article and I will put a
link in the show notes, but youmay need an institutional login

(04:57):
to be able to access the wholething.
So the article is calledRamadan, fasting and Pregnancy
an evidence-based guideline forthe obstetrician.
The article starts by tellingus what Ramadan is.
Telling us what Ramadan is.
It consists of refraining fromsmoking, food, including chewing

(05:21):
gum, and medication, and drink,including water, and refraining
from sexual activity from dawnuntil sunset for a month.
At sunset, Muslims areencouraged to break their fast
iftar with electrolyte rich andnutrient rich food and eat a
healthy early breakfast, suhoor,before the next dawn.

(05:43):
I knew already that Ramadan wasa lunar month and therefore
moves around the year, and inthe northern hemisphere this is
relevant because it means thehours of fasting can be
significantly longer.
If you live near the tropics,from dawn until dusk is likely

(06:03):
to be roughly a 12-hour period,whereas for those of us in the
northern or southern hemisphere,depending on the time of year,
muslims may be fasting for up to16 or more hours.
Because Ramadan lasts for amonth and obviously pregnancy is

(06:24):
nine months, it is very likelythat Ramadan will fall at some
point during a woman's pregnancyand therefore many Muslim women
will have a dilemma about whatthey do during Ramadan.
Before I go any further, Ithought I needed to explore

(06:46):
what's the point of Ramadan, andthat sounds a bit rude, but I
understand fasting, but fastingfor a month in this way.
I didn't really appreciate andunderstand what that might mean
or why you might want to do.
That.
Links, in particular, anaccount by a wonderful midwife,

(07:24):
fatima Mohameid, about thedilemma she had personally in
whether to fast in pregnancy ornot.
What she outlines in heraccount is that it wasn't just
about the fasting.
It was about the spirituality,the sense of community and

(07:45):
re-energising willpower thatthis month of Ramadan brought,
and I think that's something Ihadn't really understood, that
it's not a suggestion that onemust fast and that's all there
is to it.
It's a much broader culturaland spiritual event in which

(08:09):
one's involved.
The whole community is behavingin this way together.
Whole community is behaving inthis way together, and she
talked about the difficulty offasting contrasted with the
difficulty of suddenly not beinginvolved in that strong sense
of community and spiritualitythat was going on around her.

(08:33):
She also talks about the factthat she'd fasted every Ramadan
from the age of 11.
And I think that's something weneed to consider that this is
something women have done everyyear for a very large part of

(08:55):
their life, and suddenly beingfaced with the dilemma about
what to do and whether or notit's safe to fast is a massive
challenge.
Dr Jenny Hall also sent me alink to one of her Matt Flick
hour talks, also given by Fatima, and through that I learned

(09:20):
that fasting is one of the fivepillars of Islam.
I know I sound terriblyignorant, but I hadn't
understood that either.
So the fast of Ramadan is verycentral to the five pillars of
Islam that make one a Muslim.

(09:41):
This has made me realise allthese missed opportunities.
I've had to talk to people aboutRamadan, and I'm not just
talking about parents and womenI see in my clinic, but my
colleagues.
I have a number of Muslimcolleagues every year and I do

(10:08):
know they're fasting, usuallybecause I'm at pains to try and
make sure that the doctorsworking with me are having
breaks, or people around memidwives and support workers are
getting drinks, and I willoffer to get people coffee and I
will check whether people havehad some sort of lunch break and
eaten, and sometimes I get theresponse no, I don't want coffee

(10:34):
, I'm fasting, or I don't needto go for lunch, I'm fasting,
and I accept that and move onInstead of which.
Maybe I should be a bit morecurious.
Maybe I should be asking them abit more about that.
Maybe I could say tell me a bitabout that, educate me.

(10:56):
But I don't, and I think partof that is I'm worried about
being nosy, I'm worried aboutbeing obtrusive and worried
about being obtrusive, or Ithink I should know.
Perhaps we don't talk to peopleenough about their different

(11:16):
cultures and ask questions.
Just this weekend I had awonderful conversation on the
bus with a group of guys whowere getting ready for IFTA, and
the only reason we struck up aconversation is we had our dog
with us and our dog was sniffingtheir various bags of shopping

(11:40):
on the bus and it turned outthere was fish in the bags for
Iftar.
They were going off to cook andcelebrate the end of that day's
fast.
So, having given you a littlebit of an overview of what is
Ramadan and hopefully somepersonal perspectives from the

(12:06):
lovely Fatima and the resourcesI've been signposted to, what is
the impact on pregnancy?
And for that I'm going toreturn to this article.
In the American Journal ofObstetrics and Gynaecology they

(12:27):
did a literature review lookingat the studies on fasting during
Ramadan and pregnancy to lookat maternal and fetal outcomes.
Interestingly, they foundlittle to no clinical
significant effect of fasting onneonatal birth weight or
preterm delivery.
They commented that fastingduring Ramadan had mainly been

(12:51):
associated with signs andsymptoms of maternal fatigue and
dehydration, with a minimaldecrease in weight gain, and
there was conflicting data aboutthe association of gestational
diabetes and insufficient dataon maternal hypertension, of
gestational diabetes andinsufficient data on maternal

(13:11):
hypertension.
They say that literature on thelong-term effects of fasting on
offspring suggests possibleadverse effects but that really
more data is required.
And it concludes that incounselling patients,
obstetricians should be preparedto discuss the nuances in the
data and demonstrate culturaland religious awareness and
sensitivity to foster a trustingrelationship between women and

(13:37):
their providers.
And then in the paper theyinclude a framework just to kind
of suggest how you might dothat, just to kind of suggest
how you might do that.
It suggests putting up postersin the antenatal clinic and it
describes being aware whenRamadan falls, asking women if

(14:02):
they plan to fast, usingopen-end, respectful questions
such as what are your thoughtsabout fasting during Ramadan?
Do you have any concerns?
It kind of says the obviousthings like being non-judgmental
, understand the importance offasting during Ramadan.
It talks about shared decisionmaking and individualised

(14:26):
recommendations, so providingsome medical recommendations
based on clinical experience andthis paper on the actual
outcomes.
And it talks about talking towomen about increased symptoms
of maternal fatigue anddehydration and therefore is

(14:51):
reasonable for providers torecommend against prolonged
fasting while pregnant but notto give what they call blanket
prohibitions against fasting,given that there isn't strong
evidence against fasting, giventhat there isn't strong evidence

(15:12):
.
Then it talks about supportingpregnant women who choose to
fast and how they might minimisethe impact thinking about
healthy exercise, sleep,nutritious bedtime, snacks and
breakfast and how to make surethat in the hours they are
eating, they're getting a good,balanced diet.

(15:33):
They also talk about discussingwith women what signs and
symptoms might mean thatbreaking the fast is necessary
and possibly offering someadditional antenatal visits to
increase monitoring of the womanand her baby.

(15:54):
And then it also talks aboutsupporting pregnant women who
are observing Ramadan but notfasting.
So it's a really helpful box ofthought-provoking stuff and I
will put a picture of it on myInstagram because I think, even

(16:18):
if you do nothing else, thenthat could be really helpful in
opening up conversation.
What's my zesty bit?
I think for me, the take-homemessage is very much not being
afraid to open up a conversationabout Ramadan when I see Muslim
women and I'm going to try andput that into effect this year

(16:42):
very much with the awareness ofit's okay to ask and also maybe
be a bit more curious with myMuslim colleagues.
If you're pregnant andlistening to this and you're
Muslim, then I think the same istrue don't be afraid to talk to

(17:05):
your midwife or obstetricianabout fasting and Ramadan and
what you are or aren't doing,but, most importantly, know that
it doesn't seem like this ishaving a negative impact on the
growth and development of yourbaby and a healthy pregnancy for

(17:27):
you the growth and developmentof your baby and a healthy
pregnancy for you.
But you may experience somesymptoms of being particularly
tired or dehydrated.
So bear that in mind.
And my final zesty bit is Iwould absolutely love it if
someone listening to this who isMuslim, who is or who has

(17:51):
experienced Ramadan in pregnancygot in touch and would be
willing to come on the podcastand talk to me about it, ready
for next Ramadan.
I very much hope you found thisepisode of the OBS pod
interesting.
If you have, it'd be fantasticif you could subscribe, rate and

(18:16):
review on whatever platform youfind your podcasts.
As well as recommending the OBSpod to anyone you think might
find it interesting, there'salso tons of episodes to explore
in my back catalogue fromclinical topics, my career and
journey as an obstetrician andlife in the NHS more generally.

(18:38):
I'd like to assure women I carefor that I take confidentiality
very seriously and take greatcare not to use any patient
identifiable information unlessI have expressly asked the
permission of the personinvolved on that rare occasion

(18:59):
when it's been absolutelynecessary.
If you found this episodeinteresting and want to explore
the subject a little more deeply, don't forget to take a look at
the programme notes, where I'veattached some links.
If you want to get in touch tosuggest topics for future

(19:21):
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(20:05):
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