March 5, 2025 • 48 mins
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.
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...
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
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.
Episode 179 ramadan special.
(00:55):
Today I'm very excited tofollow up last year's ramadan
episode.
I decided it was okay to askand I reached out to one of my
colleagues, natasha, and she putme in touch with another
consultant colleague, emma.
So we're going to start withNatasha and Emma is going to
(01:19):
join us part way through.
We're going to have a greatconversation about Ramadan and
we're going to start with a bitof the Quran.
Natasha (01:34):
Surah Al-Fatihah.
Shahr Ramadan al-Ladhi unzilfihi al-Qur'an hudan lin-Nasi wa
bayinatim minal hudawal-Qurtaan Faman shahid minkum
(02:35):
shahra fal yasum Waman kanbaridhan anwala safari
(03:16):
muqaddatun min ayyamin muqar.
Florence (03:19):
Surah Al-Fatihah it's so beautiful.
You sent me that clip ahead ofus chatting.
Would you like to just explainto people what was being said?
Emma (03:32):
give us a translation yeah , that would be great.
Thanks, um florence.
So the verses you just listenedto are a recitation of the qu,
which, in the Islamic tradition,we consider to be a scripture
revealed by God through theangel Gabriel to the prophet
Muhammad that we accept as aprophet.
(03:54):
And those particular verses arewhere the commandments we
believe in our tradition comefor fasting during the month of
Ramadan.
And what they say is for thoseof you who believe, we have
prescribed fasting for you, aswe prescribed it on the people
before you for the purpose ofyou to be mindful of God.
(04:19):
And if you think about it,fasting is prevalent across all
the not just monotheistictraditions, but most religions.
So you'll have the fasting ofLent in Christianity.
You'll have the fasting on YomKippur in Judaism.
There's fasting involved inworship in Hinduism and Jain
(04:40):
religions so I think it'sinteresting that that's
mentioned there.
And then the verses go on tosay the fasting is only for a
few days, but if you're sick oron a journey, then you don't
have to fast those days and youcan make it up at another time.
But if you're very ill oryou're unable to make it up,
(05:02):
then the option there is to feeda poor person because you're
unable to engage with the fast.
Then it says that the month ofRamadan is where the Quran was
revealed.
And that's very specificallywhy Ramadan is such a special
month for us, because we believethat it's when guidance came
(05:26):
once again to mankind.
It came before, obviously, withthe Psalms of David, the Torah
and other scriptures that weaccept.
So this is a reinforcement ofthat, and the whole month of
Ramadan is increasing yourunderstanding of the Quran.
(05:47):
That was revealed to improveyour relationship with God, but
also with people as well.
It says also in those versesagain that God doesn't want you
to go through hardship.
He wants ease for you.
So there's a lot of questionsabout why would you do this to
(06:08):
yourself, and I think that'saddressed there.
And he also wants us to begrateful.
And then the last verse that'sconnected to those is we believe
God says to us when people askyou about me, tell them that I'm
near and that I respond to thecall of anyone who prays to me.
(06:30):
So I'm asking them also torespond to the things that I ask
of them, so that you can berighteous and stay on the
straight path.
Florence (06:40):
Thank you so much.
That's a really helpful startfor our conversation, I think,
and I think so.
I started from a place ofcomplete ignorance.
I just thought Ramadan wasabout fasting and when I looked
into it last year a little bit,I started to understand much
(07:01):
more of the, started tounderstand much more of the
sense of community and breakingthe fast together each night and
it being a much morecelebratory sort of I was going
to say festival, but maybethat's not, I don't know if
that's the right word so more amore celebratory community event
(07:22):
than I had understood it to be.
I'd seen the fasting more, likeyou say, as a hardship and I
think and that may be in thisday and age a lot of us are not
used to the idea of fasting.
And I came to it last yearthinking this is awful.
(07:46):
Actually, in all these yearsI've had all these pregnant
women who are Muslim who everyyear are faced with this issue
about do they or don't they fastin Ramadan, and I have no idea.
And I came across some Americanguidance which kind of started
me on this, this journey.
Tell me a bit.
(08:06):
You just mentioned to me,before we started recording,
that there is some UK guidance.
Do you want to talk a bit aboutthat maybe?
Emma (08:15):
sure.
So I mean, I think, when we'retalking about religious guidance
, the Islamic tradition actuallyhas a really rigorous academic
tradition, and so you'll neverget opinions that don't come
with evidences behind them.
And that's one of the stricturesof the religion.
It's one of the ways that wepractice to ensure that we're
(08:37):
not diluting a message or goingby opinions.
But it's also a very lenientreligion and I think, when you
think back to the verses thatwere 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 aneasy path, you're not meant to
(08:59):
take the middle path.
If there's a hard path and aneasy path, you're not meant to
you know it's not a masochistictype of tradition.
There are exceptions to everyrule.
Now, I'm not a scholar, I'm notwhat we call a sheikh or an
alum, I don't have a degree.
There are, there are scholarswho do discuss and give verdicts
on an individual basis.
What, what I will tell you,from what I understand, is that
(09:25):
fasting and Ramadan is one ofthe five pillars of we call them
the five pillars of Islam.
It might help if I so.
In the Islamic tradition, thatthe five things that we consider
paramount are that you testifythat you believe in God and that
Hamid was his messenger, thatyou pray.
(09:46):
So that's Salah, that's fivetimes.
There's a five daily prayerritual which we can talk about,
which is essentially justrecentering yourself throughout
the day to see how are you, howare you interacting on a linear
level with the people around youand are you being mindful of
your responsibilities towardspeople.
(10:07):
And the third pillar, then, isfasting, and the exemptions to
that are if you are ill or ifyou are a traveler, and the
exemptions are if you go intothem.
It depends on the type ofillness, if it's temporary, if
(10:29):
it's permanent, and based onthat you would decide whether A
you can fast.
Is it safe to fast, or does itput 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 youfall into the category of the
seriously ill and so you feed apoor person instead?
Or do you have to make up yourfast afterwards, such as one
who's traveling, because weconsider a long travel hardship
as well?
We don't expect you to fastduring that time.
(11:01):
You also don't fast if you'remenstruating, because that's
considered an excessive hardship.
Yes, you make that up later.
In terms of whether you canfast in pregnancy it is.
There aren't large randomizedcontrol studies that tell us
100% this is safe or this isn'tsafe.
What we do know is that, intheory, the time when you might
(11:28):
be more cautious about fastingand again, I'm not a scholar,
but you might be more cautiousin your first trimester, which a
lot of people would find anoxymoron, they might have
thought actually, when I'mfarther along, it would be more
challenging.
But in the first trimester, weknow embryogenesis happens.
That's when the cells are comingtogether to form a baby, and
(11:51):
we'd want to avoid hypoglycemia,drops, your blood sugar for
long periods of time anddehydration to make sure that
that comes together properly yesthere's the option of
intermittent fasting, which hasbecome very popular in the
health community, where youmight consider I'm in the first
(12:12):
trimester and I don't want toput too much stress on this
developing a, so perhaps I'llfast one day and one day I won't
, and then you know.
That way we can feel a littlemore secure.
The studies, the case studiesand the few series that have
been done throughout the rest ofpregnancy.
(12:34):
The people went into itthinking oh, if you're fasting,
you're going to you'll bedelivering a low birth weight
baby, or you might deliver early, or they may be other risks,
and that hasn't been proven inany of the case series.
But again, it needs to be anindividualized decision.
(12:54):
It depends on you as a womanand what you feel you can manage
.
It's your body, it's yourchoice.
Florence (13:01):
Yes.
Emma (13:02):
It also depends on other factors.
So potentially, you may havecomorbidities.
You know, maybe you're adiabetic, maybe you're intensive
, maybe you require to takemedications throughout the day.
So I think it's reallyimportant that we individualize
care, yes, and also that wesupport the woman's right to
(13:23):
choose yes.
If there is a situation wherewe're going to advise someone
one way or another, it comesfrom a purely medical basis,
where we say, okay, this wouldbe detrimental because actually
you're, you're unwell and thisway 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 antenatalclinic a few weeks ago actually
and it was really lovely becauseI was like, yes, I know, I know
what to say, I know I can tellher she's not going to do any
harm to her baby and it'sperfectly okay.
And she raised what you'd saidor what was in those verses of
(14:08):
the Quran about the extra days,which I'd never heard of before.
So she was like, yeah, I wantto fast and keep Ramadan because
I don't want to do all theextra days later when I've got a
new baby.
Yeah, that might actually bemore detrimental.
I've got to make it up that'san interesting point.
Emma (14:31):
so if you're lactating, if you're breastfeeding also and
the fasting reduces your abilityto breastfeed, then then you're
also exempt, okay yes.
In that time period.
But it can be quite daunting todo it outside of Ramadan
because you don't have thesupport and all this, you know,
really spirit of the communitythat you have during Ramadan.
Florence (14:56):
Yeah, and I think that's something I hadn't
understood until I started tolook into it last year and I
read a blog by a midwife who wassaying she found it really
difficult because if she wasn'tfasting then she wasn't part of
that community every eveningbreaking the fast and that
(15:17):
supportive cohesion thateverybody's doing it together,
and she felt very kind of leftout 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 ofreinvigorating your
relationship with God and otherpeople and having a chance to
examine yourself, almost like aboot camp, and saying, ok, if I
can do this, then for the restof the year I can do other hard
(15:49):
things, I can meet challengingsituations, and it's a time just
to be more mindful.
It's a time to spend also withcommunity, because often
together we'll sit and eat.
It's something that'srecommended to do together.
We also go for, you know,additional prayers at night.
(16:11):
You might think, oh, you dofive, how many more do you want
to do?
But the point of the nightprayers is that by the end of
the month you would have readthe entire quran all over again,
so that you've remindedyourself, almost like a
refresher course, like we wouldtake.
Uh, you know when, when we'reum, when we're looking at our
(16:32):
appraisals and our gmcregistration, 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, itcan feel like a challenge so,
just to be clear and summarize,what we're saying is that women
who are pregnant or lactating donot have to fast they're exempt
.
But they do have a choice ifthey want to fast, and we need
(17:04):
to individualize that advice andand they need to think about
the decision depending on theirparticular health issues and how
they feel, and that alternateday fasting might be an option,
or it might be an option not tofast in the first trimester and
to fast later on, and if you'renot going to fast, you can
(17:29):
either make the days up later oryou can feed someone in need as
an alternative.
I'm interested.
So you mentioned their prayersand I'm interested in this, both
in terms of Muslim staff aswell as Muslim well, I guess I
(17:55):
was going to say pregnant women,but anyone in a hospital.
Well, I guess I was going to saypregnant women, but anyone in a
hospital.
So I'm interested to know howyou feel supported or not
supported with praying, becauseI have in the past occasionally
come into the changing room andfound a colleague with their mat
(18:19):
out on the floor doing theirprayers and I felt awful that
I've walked in and disturbed inthe middle and whatever.
But equally, I felt that thefloor of the changing room is
really not an appropriate sortof space for them to be doing
that and and kind of.
(18:40):
But I hadn't really thoughtabout.
Well, what provision is therefor 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 usbecause 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 byemma, who's a consultant
colleague also, who's going togive her us her perspective on
working in the nhs as a muslim,but also, hopefully, sharing a
bit of your maternity experiencewith 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 heardof what we were just discussing
about the ability of staff orpeople 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 roomapproach, where we sort of have
one venue in the hospital, andthat's great, because I think,
consistently, you know, acrossthe board, hospitals do have a
facility.
I don't think I've ever workedin a hospital.
We haven't got somewhere quiet,you can go, and that's
fantastic, I guess.
(20:15):
The challenge, though, is thatI guess there's two groups in
this.
In terms of staff, you might beon a very busy shift and you
know the nhs is always busy soit's uh, it may take some time
to get to that location andparticularly if you're on the
other side of the hospital andin the winter months it can be
(20:36):
particularly challenging becauseyou've got to fit in three
within a working day, sort ofbetween nine and five, right.
So I worked out that it wouldtake me about an hour just
walking backwards and forwardsat one of my previous hospitals,
just in travel time in thewinter, and that's why people
generally want to pray on site.
Wherever they are, they sort ofneed a quiet space, and so the
the only quiet space is often,know, the changing rooms or
(21:01):
strange basements etc.
So I think it would be lovely,I think across the NHS, to think
about quiet spaces, and I thinkit's, you know, I think it
would be useful for a number ofdifferent people.
You know we talk, we have it forrelatives, don't we sort of
quiet rooms?
You know we have it forrelatives, don't we sort of
quiet rooms?
Certainly at the Marsden, whereI've been recently, they've got
(21:21):
lots of quiet rooms, you know,because it's appropriate for
that setting.
So people sort of need it fordebriefs, for quiet space if
you're sort of neurodivergent.
So it'd be lovely to kind ofthink 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 forthought.
Before you joined us, we werejust talking a bit about um
fasting or not fasting in ram,ramadan, in pregnancy, and the
idea of that it's notdetrimental to the baby, that
(22:05):
you are part of that sense ofcommunity and so on.
I don't know if you could shareanything with us from your
personal experience at allpersonal 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 guidancethat if you are pregnant, that
you're not obligated to fast,and particularly where you feel
that there will be a harm to thebaby.
So, for instance, um, when Iwas particularly first trimester
, both pregnancies, I definitelyfelt nauseous and and it was
worse if I didn't eat, um, sofor me my decisions were that I
(22:48):
wouldn't fast, you know,certainly during first trimester
.
You know that was a personaldecision, but it was also
bearing in mind the guidance.
I think other women do choose tofast and some people say that
it's worth trying and seeing andsort of seeing how you feel and
if it seems to go okay, thenyou can carry on or you should
(23:09):
try that first.
So I think both of the optionsare there.
I'm not sure in terms of howdefinitive the evidence is, sort
of either way.
So, and I think some peoplealso, they feel that if they're
not part of kind of Ramadanspirit, that kind of, they lose
out and they miss that elementof spirituality.
(23:30):
So a lot of Muslim women dochoose to fast during the month,
even though they might notabsolutely 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 thateveryone is trying to work on on
themselves, not just from thefasting, but you know everyone's
.
There was a joke I remember incollege where my friends would
be like it's Ramadan, askNatasha for money, she'll give
it to you.
(24:02):
Because you're trying to bemore generous, you're trying to
watch how you speak to people,you're trying to hold space for
them, you're trying to make surethat you're mindful, you want
to, you don't want to fall intolike 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 talkabout it actually and and I'm
definitely getting a sense of itbeing a really positive and
enjoyable time of year, which Ithink a lot of people that don't
(24:39):
know about it that's not anassumption 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 ofchemicals that are released, um,
that kind of give you that high.
I think you know, when I'veread 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 andobviously there's there's
almost two billion Muslims inthe world over various cultures.
They, you know, they rangeeverywhere and it's the second
largest religion in the world.
It's the fastest growingreligion in the world.
So you do, the fastest growingreligion in the world, so you do
find Muslims everywhere.
(25:21):
But if you're in a traditionalcountry where there is a Muslim
majority, it's definitely it'svery celebratory.
You know, the lights go up andthe schedule changes and people
look forward to seeing theirfamily and just focusing, to
seeing their family and and justfocusing.
It's all, it's a.
It's like a mandated Well, it'sI wouldn't say mandatory
(25:48):
training, because that's quiteonerous, but it's.
It's like someone's forcing youto just stop.
Let's you know you're going amile a minute.
Just stop, just slow down, justremember why you're here.
You know, look at all the greatthings 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 whymost people I know, especially
(26:13):
as they get older, really lookforward 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, wekind of exchanged a couple of
emails and we mentionedInvisible, the report into
Muslim women's experiences ofmaternity care, which I had a
(26:45):
teeny tiny involvement in inreading some of the draft when
it was being written, and yousaid you contributed to.
So I don't know if you'd liketo talk a bit about that,
because that was to me veryshocking, 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 thedisparities between sort of
Muslim women within that sampleand some of the complications.
So yeah, there were, I thinkthere were interviews, but there
was also sort of a quantitativeelement to it.
I suppose it was the first timethat we'd seen that data
(27:31):
represented in that way.
And what was interesting aboutthe report was that it broke
down Muslim women by ethnicity.
So often there's a sort ofAsian other box, but it's then
dissect that further and look atdifferent, you know.
I mean, asia is a big continent, so look at the big, you know,
look at subcategories.
(27:52):
I was interested personally toget involved with it because I
had two babies and myexperiences were really
different.
I think with the first one Ihad an epidural and it ended up
sort of being quite medicalisedfrom that point in, whereas with
the second it was more sort ofa natural birth, kind of water
(28:15):
birth, etc.
So they were quite differentexperiences, although there were
some similarities, I guess, interms of the faith specific
parts.
You know, there were certainthings that were important, I
think, going in just the senseof kind of I guess dignity
feeling that I could cover,because I would normally be kind
(28:37):
of fully covered.
You know, I kind of have mybody covered, but you know, I'd
witnessed as a medical studentall of the births and the usual
various states of undress.
And yeah, there are certainkind of I guess rites that
follow after a baby's born thatI was keen to observe, some of
(28:59):
which were straightforward to doand 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 havehelped you with, with some of
those things?
Because I mean, when you saythat was harder, that makes me
think were we kind of puttingbarriers in place?
Speaker 4 (29:23):
I think it's to do with perspective.
So as a clinician, you know I'mkind of looking at it going.
Patient safety comes first andthat's sort of you can see that
in the, in the, in the care thatwas delivered.
You know that you need to havegood visibility, you need to
make sure that you're keepingmum and baby safe.
So if you need to undress acertain part to do that, then
(29:45):
that's clearly a sort ofclinical priority.
But there is a balance, Isuppose.
You know there were times whenit maybe wasn't strictly
essential that I be exposed,like my legs for instance, and
my priority would have beendifferent.
So what I did second time roundwas I actually employed a doula
(30:06):
, which is I guess you couldperceive that as a bit of a
luxury, although I think you canget doulas on a budget.
You can.
There are, there are optionsand I really found having an
advocate who I kind of freebriefed with my needs really
helped.
I really recommend and I think,particularly if you're from a
minority group, I think itreally helps to just have an
(30:27):
advocate kind of with you forsome of those elements.
She wasn't Muslim herself butbecause she was very attuned to
kind of my requirements, Isuppose, or as part of her role.
You know, it's holistic the waythat 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 knowyou as a person, it it doesn't.
It doesn't matter whetherthey're the same faith or
background or whatever it's.
It's understanding what'simportant to you, getting to
(31:04):
know that and then helping,helping you advocate that.
And you're right, you canaccess doulas um through doula
uk there there is.
There is some ability to accessum doulas even if you can't
afford a private doula.
But yes at the same time, itshould be that we should be able
(31:27):
to listen to you without,without a doula.
So that sort of makes me sadand I know.
When I read the invisiblereport, it the thing that struck
me was, I think, assumptions.
So there was quite a lot aboutwomen saying well, because of
(31:52):
the way I looked or the way Idressed, people made all this
the kind of trickle down of ofassumptions, rather than
actually asking you and talkingto 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 myselfsecond time round was should I,
who should I take with me?
Because I noticed that therewas quite difference and, and,
by the way, I'm talking aboutother trusts, southwest as a
(32:32):
whole but I noticed that therewas quite a difference in how I
was treated when I was with mymother, who's a sort of first
generation hijab wearing, youknow, arab woman, and when I was
with my husband, who is kind ofBritish, like me also, from the
same you know background, but aman number one, number two, you
(32:55):
know, british sounding.
It was very, very different.
And the times that I haveexperienced discrimination were
generally when I was with mymother and I you know if you
want your mother with you,because that's something you
know, as women sometimes we liketo have that kind of support.
To not be able to have thatbecause you fear being
(33:19):
discriminated against isactually quite sad During the
first.
So we ended up in theatre.
I was taken to theatre in a ina bit bit of a kind of rush, and
I just remember being in thistheater kind of yeah, not in a
very dignified positioncompletely stripped down.
There was a man wanderingaround in the background, even
(33:41):
though we kind of had theconversation that I didn't
necessarily want, you know if it, if it was at all possible to
avoid, and they said well, youknow it, an emergency, so we
have to go ahead.
So I accepted that and my mumwas with me during the first
baby.
She hadn't told me she was adoctor, which we later regret
(34:01):
and yeah, there was significantincivility.
Put it that way, she wasshouted at because she had
spotted an issue, a medicalissue, an acute issue, and she
was told to sit down repeatedlyand shouted at um.
So you know, it was difficultand we reflect on that and we
(34:25):
think that maybe she should havepulled the doctor card because
actually then she might havebeen respected.
Florence (34:31):
Gosh, I'm feeling really quite shocked.
I mean, I know I've read someof this stuff, but to hear you
say that like that, yeah, that'sreally awful, really awful.
Yeah, that, yeah, that's reallyawful, really awful, yeah.
(34:54):
And I and I know I remember inInvisible that report, I think
there was a story about someonewhose husband was an
anaesthetist and as soon as hesaid he was an anaesthetist,
everyone listened to this couple, but before that they didn't,
which sounds exactly like whatyou've just described with your
mother.
And yeah, if you want your mumwith you, of course, why
(35:15):
wouldn't you want your mum withyou?
I mean, yeah, of course thatmight be the person you would
turn to, and to feel that youcan't do that because that might
increase the discrimination andthe way people treat you badly,
that's that's awful.
Speaker 4 (35:33):
Yeah, but it certainly.
Yeah, it was certainly adifference in experience.
So I think second time round, Ithink, my husband appeared at
the end and it was all sort ofsmooth, everything he sort of
requested happened and it wasmuch 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 bizarrebecause it's not okay, but it's
also bizarre that we sometimesmake assumptions, I think, that
men are maybe more dominant inMuslim cultures, that women
(36:16):
could be subjugated, or there'smore misogyny, whereas what
we're then demonstrating is, ifyour mum's there with you, we're
going to treat you badly, butif your husband's there, we're
going to treat you well, whichis 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 ofdifferent things going on, but
certainly the the narrative ofthe last couple of decades of
the oppressed muslim woman hasbeen very hard to challenge,
(37:00):
simply because a woman choosesto 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 theremust be something, there must be
some sort of error in theirthinking.
These, these can't be thinkingfeeling intelligent human beings
(37:22):
, whereas an actual fact,obviously they're.
Florence (37:25):
Incredibly, everyone has value and everyone has the
right to choose how they expressthemselves with their body,
their clothing I'd like to askyou about what you said about
male staff, because this issomething we do talk about quite
a lot at work and last yearwhen we ran a maternity workshop
(37:50):
, really trying to focus on theexperience of women from
different ethnic backgrounds,and one of the things that came
up was if a Muslim woman asks tohave minimized male staff will
(38:12):
go well, you know that's notokay.
But if a woman who's beensubject to sexual abuse or abuse
in the past, everyone will go.
Oh yeah, that's of course, youknow it's it's.
It's like two completelydifferent responses to the same
(38:36):
request well, it's about what'sculturally 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 10years ago but you know, I've
seen the trajectory, I've seenthe course of the misinformation
that's been spread aboutimmigrants and beliefs,
(39:01):
practices, ways, how they'revery different from us.
The whole othering of any groupof people, I think, is always
going to lead to lot of ourwonderful, kind, intelligent,
otherwise well-roundedcolleagues and friends may not
(39:22):
understand that they have thisbias and may be offended if you
flag it and say you know, I feelthis 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 ratherthan, um, you know a woman with
a personal preference and, andsuddenly there's a, there's a
(39:46):
bit of a disconnect, um, and butthat's because of what we?
We are constantly fed um by themedia, politicians, by world
events, and it's hard tocontinually have to challenge
that.
Speaker 4 (40:00):
And that's where you know the concept of this
exhaustion from continuallyfighting microaggressions can
come from yeah, yeah, I guessthat explains it and I think, um
, the other thing I think isquite interesting.
I mean, I would like tounderstand why there are these
health disparities, and my gutfeeling is that you need to be
(40:25):
in a sort of calm and happystate in order to give birth
effectively.
And when we say no to people'sfaith preferences, like, I think
, as clinicians clinicians we'retrained sort of ideas concerns,
expectations, so we're used tothat framework.
But as soon as you insert faithinto that framework, suddenly
we you know we struggle withthat.
(40:46):
But when we don't consider howa woman who is going to give
birth wishes to deliver, I don'tthink that things work as
smoothly.
Um, I don't think the birthprocess goes as smoothly.
I don't think you feel asrelaxed, and then I think the
complications come from that.
(41:06):
Yeah, I think, particularlywith the second time around,
that was my, my feeling.
Yeah, there's just, there'ssomething in it.
It's a bit like how you can'tsleep if you're stressed.
To deliver a baby, you need tobe in that kind of calm and
relaxed state and you need to besurrounded 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, comeinto triage.
Pick up the phone, come intotriage.
Everything stops becausethere's something in an
environment with bright lights,strange people, not just because
their body's gone.
Is this a safe place for me?
(41:47):
So it totally, I totally agree,and that also kind of made me
think a little bit about choicesof place of birth.
So I know my colleague, francesRivers, who's our consultant
midwife, has done some workabout women from different
(42:07):
ethnic backgrounds makingchoices about things like home
birth or birth centre.
That may, I might, be the rightplace for them, or they might
not, depending on how theirpregnancy's been, but less women
from different ethnicbackgrounds being aware that
(42:28):
those choices are there and aresuitable 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 thehospital?
Florence (42:42):
Yes, and also less awareness of birth centre.
So you know, if you have anuncomplicated, straightforward
pregnancy, actually giving birthon a midwifery-led birth centre
is better.
It's safer.
Speaker 4 (43:04):
Like you say, less complications.
Yeah, yeah, that's reallyinteresting.
I mean, I felt it veryviscerally because I remember
with my second birth, uh, I hadthis lovely team up until the
shift change, and we were doingthe kind of natural things.
So we had the kind of candles,you know, not naked flame, but
you know the soft candles, andwe had all the kind of
(43:24):
aromatherapy and it was lovelyand the midwife, I think she was
very experienced, very calming.
And then suddenly there was ashift change and I was moved to
a much brighter unit andsuddenly all the kind of the
blind blinds went up and it wasa completely new team.
And then everything, as you say,it slowed down and they were
(43:45):
really perplexed.
In fact, they said to me listen, you've got this many hours to
give birth and then, if itdoesn't happen, then we're going
to have to sort of move youback.
And I thought I feel like thisis a process you can't really
rush.
So you know, everything sloweddown and they were all a bit
perplexed.
Why is it all slowed down?
I was thinking.
Well, I know why.
You know, I just don't feelcomfortable anymore.
And we ended up this is alittle bit naughty perhaps, but
(44:07):
it worked.
We ended up in a bathroom.
I was moved back to theantenatal unit because things
weren't moving properly and Iwasn't given any pain relief,
because that's what happens andwe ended up in a bathroom
because I wanted this waterbirth and I was with the doula
and then I was relaxed and I wasaway from everybody and that
suddenly, when everythingstarted happening and I probably
(44:28):
had no an hour or two, justthat feeling of calm and
seclusion and kind of where Iwanted to be, then suddenly it
all happened and they werereally shocked.
You know that how quickly itdeveloped when we went back and
you know I was delivering withina short time.
So, yeah, definitely.
Florence (44:45):
Of course you were.
That's fantastic.
I'm aware I'm taking up yourprecious, precious time in an
evening.
Are there other things youthink we should talk about?
Emma (45:03):
I think that you've you've come with some really great
questions that are reallyrelevant.
Um, and personally I'm justreally glad that you opened the
conversation.
I loved that you reached outand you've been so kind and so
open to hearing about differentfaith experiences and it's gone
(45:27):
a huge way just even making me,as your colleague, feel seen and
heard.
There's this concept ofbringing your whole self to work
and being psychologically safe,and you know there's a.
We just don't talk about thesethings because sometimes you
don't know how it'll be received, whether you have unconscious
(45:48):
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 responseand for you to introduce me to
Emma as well.
She's fantastic, isn't she yeahyeah, absolutely, and I think,
because I feel like why have Ileft it till now in terms of,
you know, I would know Ramadanwas kind of vaguely going on,
(46:14):
because I would go to the coffeeshop and go, you know, to
people do you want a coffee?
And they go, no, I'm fasting.
And I would never use that asan opportunity to open up the
conversation, which feels reallybad 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 lastyear and I liked the way that
you almost bookmarked it andkind 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 youacknowledge it if you're not
sure and if you don't kind ofknow what to ask and where to
(46:58):
start?
I think it was really importantand I think I always describe
this sort of conversation as abit like a two-way dance, like
somebody's got to lead,somebody's got to invite and
then and then you can then feelcomfortable enough to talk about
it.
So I think, it is reallyimportant.
We do kind of honor it and andare 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 youprobably know I normally end
with a kind of zesty bit of thebit I want people to remember.
So I think that might be.
That might be.
The zesty bit is be curious andtry and invite your colleagues
and try and talk to women you'reseeing and try and open up the
(47:40):
conversation a bit more.
Do you think?
Emma (47:43):
Definitely.
I mean the more we know abouteach other, just as people
humanises people, yes, and thenwe're able to treat each other
with kindness and respect, whichis all I think anyone wants as
a patient, as a colleague, as aperson.
Florence (47:58):
Yeah, no, that's really lovely.
Yeah, I'm so grateful to youboth for coming back and going
yes, let's do it and fitting itin in your evening, because I
really did kind of feel like, no, I don't want another year to
pass without trying to learn abit more and have a bit more
(48:20):
conversation.
So thank you very much, Ireally appreciate it.
Emma (48:24):
Thank you.
Florence (48:25):
Lovely to meet you, Emma.
Thank you so much for giving upyour time.
Lovely to see you, natasha, andI'll hopefully see you soon,
thank you.
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.
Episode 179 ramadan special.
(00:55):
Today I'm very excited tofollow up last year's ramadan
episode.
I decided it was okay to askand I reached out to one of my
colleagues, natasha, and she putme in touch with another
consultant colleague, emma.
So we're going to start withNatasha and Emma is going to
(01:19):
join us part way through.
We're going to have a greatconversation about Ramadan and
we're going to start with a bitof the Quran.
Natasha (01:34):
Surah Al-Fatihah.
Shahr Ramadan al-Ladhi unzilfihi al-Qur'an hudan lin-Nasi wa
bayinatim minal hudawal-Qurtaan Faman shahid minkum
(02:35):
shahra fal yasum Waman kanbaridhan anwala safari
(03:16):
muqaddatun min ayyamin muqar.
Florence (03:19):
Surah Al-Fatihah it's so beautiful.
You sent me that clip ahead ofus chatting.
Would you like to just explainto people what was being said?
Emma (03:32):
give us a translation yeah , that would be great.
Thanks, um florence.
So the verses you just listenedto are a recitation of the qu,
which, in the Islamic tradition,we consider to be a scripture
revealed by God through theangel Gabriel to the prophet
Muhammad that we accept as aprophet.
(03:54):
And those particular verses arewhere the commandments we
believe in our tradition comefor fasting during the month of
Ramadan.
And what they say is for thoseof you who believe, we have
prescribed fasting for you, aswe prescribed it on the people
before you for the purpose ofyou to be mindful of God.
(04:19):
And if you think about it,fasting is prevalent across all
the not just monotheistictraditions, but most religions.
So you'll have the fasting ofLent in Christianity.
You'll have the fasting on YomKippur in Judaism.
There's fasting involved inworship in Hinduism and Jain
(04:40):
religions so I think it'sinteresting that that's
mentioned there.
And then the verses go on tosay the fasting is only for a
few days, but if you're sick oron a journey, then you don't
have to fast those days and youcan make it up at another time.
But if you're very ill oryou're unable to make it up,
(05:02):
then the option there is to feeda poor person because you're
unable to engage with the fast.
Then it says that the month ofRamadan is where the Quran was
revealed.
And that's very specificallywhy Ramadan is such a special
month for us, because we believethat it's when guidance came
(05:26):
once again to mankind.
It came before, obviously, withthe Psalms of David, the Torah
and other scriptures that weaccept.
So this is a reinforcement ofthat, and the whole month of
Ramadan is increasing yourunderstanding of the Quran.
(05:47):
That was revealed to improveyour relationship with God, but
also with people as well.
It says also in those versesagain that God doesn't want you
to go through hardship.
He wants ease for you.
So there's a lot of questionsabout why would you do this to
(06:08):
yourself, and I think that'saddressed there.
And he also wants us to begrateful.
And then the last verse that'sconnected to those is we believe
God says to us when people askyou about me, tell them that I'm
near and that I respond to thecall of anyone who prays to me.
(06:30):
So I'm asking them also torespond to the things that I ask
of them, so that you can berighteous and stay on the
straight path.
Florence (06:40):
Thank you so much.
That's a really helpful startfor our conversation, I think,
and I think so.
I started from a place ofcomplete ignorance.
I just thought Ramadan wasabout fasting and when I looked
into it last year a little bit,I started to understand much
(07:01):
more of the, started tounderstand much more of the
sense of community and breakingthe fast together each night and
it being a much morecelebratory sort of I was going
to say festival, but maybethat's not, I don't know if
that's the right word so more amore celebratory community event
(07:22):
than I had understood it to be.
I'd seen the fasting more, likeyou say, as a hardship and I
think and that may be in thisday and age a lot of us are not
used to the idea of fasting.
And I came to it last yearthinking this is awful.
(07:46):
Actually, in all these yearsI've had all these pregnant
women who are Muslim who everyyear are faced with this issue
about do they or don't they fastin Ramadan, and I have no idea.
And I came across some Americanguidance which kind of started
me on this, this journey.
Tell me a bit.
(08:06):
You just mentioned to me,before we started recording,
that there is some UK guidance.
Do you want to talk a bit aboutthat maybe?
Emma (08:15):
sure.
So I mean, I think, when we'retalking about religious guidance
, the Islamic tradition actuallyhas a really rigorous academic
tradition, and so you'll neverget opinions that don't come
with evidences behind them.
And that's one of the stricturesof the religion.
It's one of the ways that wepractice to ensure that we're
(08:37):
not diluting a message or goingby opinions.
But it's also a very lenientreligion and I think, when you
think back to the verses thatwere 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 aneasy path, you're not meant to
(08:59):
take the middle path.
If there's a hard path and aneasy path, you're not meant to
you know it's not a masochistictype of tradition.
There are exceptions to everyrule.
Now, I'm not a scholar, I'm notwhat we call a sheikh or an
alum, I don't have a degree.
There are, there are scholarswho do discuss and give verdicts
on an individual basis.
What, what I will tell you,from what I understand, is that
(09:25):
fasting and Ramadan is one ofthe five pillars of we call them
the five pillars of Islam.
It might help if I so.
In the Islamic tradition, thatthe five things that we consider
paramount are that you testifythat you believe in God and that
Hamid was his messenger, thatyou pray.
(09:46):
So that's Salah, that's fivetimes.
There's a five daily prayerritual which we can talk about,
which is essentially justrecentering yourself throughout
the day to see how are you, howare you interacting on a linear
level with the people around youand are you being mindful of
your responsibilities towardspeople.
(10:07):
And the third pillar, then, isfasting, and the exemptions to
that are if you are ill or ifyou are a traveler, and the
exemptions are if you go intothem.
It depends on the type ofillness, if it's temporary, if
(10:29):
it's permanent, and based onthat you would decide whether A
you can fast.
Is it safe to fast, or does itput 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 youfall into the category of the
seriously ill and so you feed apoor person instead?
Or do you have to make up yourfast afterwards, such as one
who's traveling, because weconsider a long travel hardship
as well?
We don't expect you to fastduring that time.
(11:01):
You also don't fast if you'remenstruating, because that's
considered an excessive hardship.
Yes, you make that up later.
In terms of whether you canfast in pregnancy it is.
There aren't large randomizedcontrol studies that tell us
100% this is safe or this isn'tsafe.
What we do know is that, intheory, the time when you might
(11:28):
be more cautious about fastingand again, I'm not a scholar,
but you might be more cautiousin your first trimester, which a
lot of people would find anoxymoron, they might have
thought actually, when I'mfarther along, it would be more
challenging.
But in the first trimester, weknow embryogenesis happens.
That's when the cells are comingtogether to form a baby, and
(11:51):
we'd want to avoid hypoglycemia,drops, your blood sugar for
long periods of time anddehydration to make sure that
that comes together properly yesthere's the option of
intermittent fasting, which hasbecome very popular in the
health community, where youmight consider I'm in the first
(12:12):
trimester and I don't want toput too much stress on this
developing a, so perhaps I'llfast one day and one day I won't
, and then you know.
That way we can feel a littlemore secure.
The studies, the case studiesand the few series that have
been done throughout the rest ofpregnancy.
(12:34):
The people went into itthinking oh, if you're fasting,
you're going to you'll bedelivering a low birth weight
baby, or you might deliver early, or they may be other risks,
and that hasn't been proven inany of the case series.
But again, it needs to be anindividualized decision.
(12:54):
It depends on you as a womanand what you feel you can manage
.
It's your body, it's yourchoice.
Florence (13:01):
Yes.
Emma (13:02):
It also depends on other factors.
So potentially, you may havecomorbidities.
You know, maybe you're adiabetic, maybe you're intensive
, maybe you require to takemedications throughout the day.
So I think it's reallyimportant that we individualize
care, yes, and also that wesupport the woman's right to
(13:23):
choose yes.
If there is a situation wherewe're going to advise someone
one way or another, it comesfrom a purely medical basis,
where we say, okay, this wouldbe detrimental because actually
you're, you're unwell and thisway 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 antenatalclinic a few weeks ago actually
and it was really lovely becauseI was like, yes, I know, I know
what to say, I know I can tellher she's not going to do any
harm to her baby and it'sperfectly okay.
And she raised what you'd saidor what was in those verses of
(14:08):
the Quran about the extra days,which I'd never heard of before.
So she was like, yeah, I wantto fast and keep Ramadan because
I don't want to do all theextra days later when I've got a
new baby.
Yeah, that might actually bemore detrimental.
I've got to make it up that'san interesting point.
Emma (14:31):
so if you're lactating, if you're breastfeeding also and
the fasting reduces your abilityto breastfeed, then then you're
also exempt, okay yes.
In that time period.
But it can be quite daunting todo it outside of Ramadan
because you don't have thesupport and all this, you know,
really spirit of the communitythat you have during Ramadan.
Florence (14:56):
Yeah, and I think that's something I hadn't
understood until I started tolook into it last year and I
read a blog by a midwife who wassaying she found it really
difficult because if she wasn'tfasting then she wasn't part of
that community every eveningbreaking the fast and that
(15:17):
supportive cohesion thateverybody's doing it together,
and she felt very kind of leftout 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 ofreinvigorating your
relationship with God and otherpeople and having a chance to
examine yourself, almost like aboot camp, and saying, ok, if I
can do this, then for the restof the year I can do other hard
(15:49):
things, I can meet challengingsituations, and it's a time just
to be more mindful.
It's a time to spend also withcommunity, because often
together we'll sit and eat.
It's something that'srecommended to do together.
We also go for, you know,additional prayers at night.
(16:11):
You might think, oh, you dofive, how many more do you want
to do?
But the point of the nightprayers is that by the end of
the month you would have readthe entire quran all over again,
so that you've remindedyourself, almost like a
refresher course, like we wouldtake.
Uh, you know when, when we'reum, when we're looking at our
(16:32):
appraisals and our gmcregistration, 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, itcan feel like a challenge so,
just to be clear and summarize,what we're saying is that women
who are pregnant or lactating donot have to fast they're exempt
.
But they do have a choice ifthey want to fast, and we need
(17:04):
to individualize that advice andand they need to think about
the decision depending on theirparticular health issues and how
they feel, and that alternateday fasting might be an option,
or it might be an option not tofast in the first trimester and
to fast later on, and if you'renot going to fast, you can
(17:29):
either make the days up later oryou can feed someone in need as
an alternative.
I'm interested.
So you mentioned their prayersand I'm interested in this, both
in terms of Muslim staff aswell as Muslim well, I guess I
(17:55):
was going to say pregnant women,but anyone in a hospital.
Well, I guess I was going to saypregnant women, but anyone in a
hospital.
So I'm interested to know howyou feel supported or not
supported with praying, becauseI have in the past occasionally
come into the changing room andfound a colleague with their mat
(18:19):
out on the floor doing theirprayers and I felt awful that
I've walked in and disturbed inthe middle and whatever.
But equally, I felt that thefloor of the changing room is
really not an appropriate sortof space for them to be doing
that and and kind of.
(18:40):
But I hadn't really thoughtabout.
Well, what provision is therefor 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 usbecause 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 byemma, who's a consultant
colleague also, who's going togive her us her perspective on
working in the nhs as a muslim,but also, hopefully, sharing a
bit of your maternity experiencewith 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 heardof what we were just discussing
about the ability of staff orpeople 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 roomapproach, where we sort of have
one venue in the hospital, andthat's great, because I think,
consistently, you know, acrossthe board, hospitals do have a
facility.
I don't think I've ever workedin a hospital.
We haven't got somewhere quiet,you can go, and that's
fantastic, I guess.
(20:15):
The challenge, though, is thatI guess there's two groups in
this.
In terms of staff, you might beon a very busy shift and you
know the nhs is always busy soit's uh, it may take some time
to get to that location andparticularly if you're on the
other side of the hospital andin the winter months it can be
(20:36):
particularly challenging becauseyou've got to fit in three
within a working day, sort ofbetween nine and five, right.
So I worked out that it wouldtake me about an hour just
walking backwards and forwardsat one of my previous hospitals,
just in travel time in thewinter, and that's why people
generally want to pray on site.
Wherever they are, they sort ofneed a quiet space, and so the
the only quiet space is often,know, the changing rooms or
(21:01):
strange basements etc.
So I think it would be lovely,I think across the NHS, to think
about quiet spaces, and I thinkit's, you know, I think it
would be useful for a number ofdifferent people.
You know we talk, we have it forrelatives, don't we sort of
quiet rooms?
You know we have it forrelatives, don't we sort of
quiet rooms?
Certainly at the Marsden, whereI've been recently, they've got
(21:21):
lots of quiet rooms, you know,because it's appropriate for
that setting.
So people sort of need it fordebriefs, for quiet space if
you're sort of neurodivergent.
So it'd be lovely to kind ofthink 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 forthought.
Before you joined us, we werejust talking a bit about um
fasting or not fasting in ram,ramadan, in pregnancy, and the
idea of that it's notdetrimental to the baby, that
(22:05):
you are part of that sense ofcommunity and so on.
I don't know if you could shareanything with us from your
personal experience at allpersonal 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 guidancethat if you are pregnant, that
you're not obligated to fast,and particularly where you feel
that there will be a harm to thebaby.
So, for instance, um, when Iwas particularly first trimester
, both pregnancies, I definitelyfelt nauseous and and it was
worse if I didn't eat, um, sofor me my decisions were that I
(22:48):
wouldn't fast, you know,certainly during first trimester
.
You know that was a personaldecision, but it was also
bearing in mind the guidance.
I think other women do choose tofast and some people say that
it's worth trying and seeing andsort of seeing how you feel and
if it seems to go okay, thenyou can carry on or you should
(23:09):
try that first.
So I think both of the optionsare there.
I'm not sure in terms of howdefinitive the evidence is, sort
of either way.
So, and I think some peoplealso, they feel that if they're
not part of kind of Ramadanspirit, that kind of, they lose
out and they miss that elementof spirituality.
(23:30):
So a lot of Muslim women dochoose to fast during the month,
even though they might notabsolutely 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 thateveryone is trying to work on on
themselves, not just from thefasting, but you know everyone's
.
There was a joke I remember incollege where my friends would
be like it's Ramadan, askNatasha for money, she'll give
it to you.
(24:02):
Because you're trying to bemore generous, you're trying to
watch how you speak to people,you're trying to hold space for
them, you're trying to make surethat you're mindful, you want
to, you don't want to fall intolike 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 talkabout it actually and and I'm
definitely getting a sense of itbeing a really positive and
enjoyable time of year, which Ithink a lot of people that don't
(24:39):
know about it that's not anassumption 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 ofchemicals that are released, um,
that kind of give you that high.
I think you know, when I'veread 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 andobviously there's there's
almost two billion Muslims inthe world over various cultures.
They, you know, they rangeeverywhere and it's the second
largest religion in the world.
It's the fastest growingreligion in the world.
So you do, the fastest growingreligion in the world, so you do
find Muslims everywhere.
(25:21):
But if you're in a traditionalcountry where there is a Muslim
majority, it's definitely it'svery celebratory.
You know, the lights go up andthe schedule changes and people
look forward to seeing theirfamily and just focusing, to
seeing their family and and justfocusing.
It's all, it's a.
It's like a mandated Well, it'sI wouldn't say mandatory
(25:48):
training, because that's quiteonerous, but it's.
It's like someone's forcing youto just stop.
Let's you know you're going amile a minute.
Just stop, just slow down, justremember why you're here.
You know, look at all the greatthings 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 whymost people I know, especially
(26:13):
as they get older, really lookforward 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, wekind of exchanged a couple of
emails and we mentionedInvisible, the report into
Muslim women's experiences ofmaternity care, which I had a
(26:45):
teeny tiny involvement in inreading some of the draft when
it was being written, and yousaid you contributed to.
So I don't know if you'd liketo talk a bit about that,
because that was to me veryshocking, 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 thedisparities between sort of
Muslim women within that sampleand some of the complications.
So yeah, there were, I thinkthere were interviews, but there
was also sort of a quantitativeelement to it.
I suppose it was the first timethat we'd seen that data
(27:31):
represented in that way.
And what was interesting aboutthe report was that it broke
down Muslim women by ethnicity.
So often there's a sort ofAsian other box, but it's then
dissect that further and look atdifferent, you know.
I mean, asia is a big continent, so look at the big, you know,
look at subcategories.
(27:52):
I was interested personally toget involved with it because I
had two babies and myexperiences were really
different.
I think with the first one Ihad an epidural and it ended up
sort of being quite medicalisedfrom that point in, whereas with
the second it was more sort ofa natural birth, kind of water
(28:15):
birth, etc.
So they were quite differentexperiences, although there were
some similarities, I guess, interms of the faith specific
parts.
You know, there were certainthings that were important, I
think, going in just the senseof kind of I guess dignity
feeling that I could cover,because I would normally be kind
(28:37):
of fully covered.
You know, I kind of have mybody covered, but you know, I'd
witnessed as a medical studentall of the births and the usual
various states of undress.
And yeah, there are certainkind of I guess rites that
follow after a baby's born thatI was keen to observe, some of
(28:59):
which were straightforward to doand 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 havehelped you with, with some of
those things?
Because I mean, when you saythat was harder, that makes me
think were we kind of puttingbarriers in place?
Speaker 4 (29:23):
I think it's to do with perspective.
So as a clinician, you know I'mkind of looking at it going.
Patient safety comes first andthat's sort of you can see that
in the, in the, in the care thatwas delivered.
You know that you need to havegood visibility, you need to
make sure that you're keepingmum and baby safe.
So if you need to undress acertain part to do that, then
(29:45):
that's clearly a sort ofclinical priority.
But there is a balance, Isuppose.
You know there were times whenit maybe wasn't strictly
essential that I be exposed,like my legs for instance, and
my priority would have beendifferent.
So what I did second time roundwas I actually employed a doula
(30:06):
, which is I guess you couldperceive that as a bit of a
luxury, although I think you canget doulas on a budget.
You can.
There are, there are optionsand I really found having an
advocate who I kind of freebriefed with my needs really
helped.
I really recommend and I think,particularly if you're from a
minority group, I think itreally helps to just have an
(30:27):
advocate kind of with you forsome of those elements.
She wasn't Muslim herself butbecause she was very attuned to
kind of my requirements, Isuppose, or as part of her role.
You know, it's holistic the waythat 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 knowyou as a person, it it doesn't.
It doesn't matter whetherthey're the same faith or
background or whatever it's.
It's understanding what'simportant to you, getting to
(31:04):
know that and then helping,helping you advocate that.
And you're right, you canaccess doulas um through doula
uk there there is.
There is some ability to accessum doulas even if you can't
afford a private doula.
But yes at the same time, itshould be that we should be able
(31:27):
to listen to you without,without a doula.
So that sort of makes me sadand I know.
When I read the invisiblereport, it the thing that struck
me was, I think, assumptions.
So there was quite a lot aboutwomen saying well, because of
(31:52):
the way I looked or the way Idressed, people made all this
the kind of trickle down of ofassumptions, rather than
actually asking you and talkingto 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 myselfsecond time round was should I,
who should I take with me?
Because I noticed that therewas quite difference and, and,
by the way, I'm talking aboutother trusts, southwest as a
(32:32):
whole but I noticed that therewas quite a difference in how I
was treated when I was with mymother, who's a sort of first
generation hijab wearing, youknow, arab woman, and when I was
with my husband, who is kind ofBritish, like me also, from the
same you know background, but aman number one, number two, you
(32:55):
know, british sounding.
It was very, very different.
And the times that I haveexperienced discrimination were
generally when I was with mymother and I you know if you
want your mother with you,because that's something you
know, as women sometimes we liketo have that kind of support.
To not be able to have thatbecause you fear being
(33:19):
discriminated against isactually quite sad During the
first.
So we ended up in theatre.
I was taken to theatre in a ina bit bit of a kind of rush, and
I just remember being in thistheater kind of yeah, not in a
very dignified positioncompletely stripped down.
There was a man wanderingaround in the background, even
(33:41):
though we kind of had theconversation that I didn't
necessarily want, you know if it, if it was at all possible to
avoid, and they said well, youknow it, an emergency, so we
have to go ahead.
So I accepted that and my mumwas with me during the first
baby.
She hadn't told me she was adoctor, which we later regret
(34:01):
and yeah, there was significantincivility.
Put it that way, she wasshouted at because she had
spotted an issue, a medicalissue, an acute issue, and she
was told to sit down repeatedlyand shouted at um.
So you know, it was difficultand we reflect on that and we
(34:25):
think that maybe she should havepulled the doctor card because
actually then she might havebeen respected.
Florence (34:31):
Gosh, I'm feeling really quite shocked.
I mean, I know I've read someof this stuff, but to hear you
say that like that, yeah, that'sreally awful, really awful.
Yeah, that, yeah, that's reallyawful, really awful, yeah.
(34:54):
And I and I know I remember inInvisible that report, I think
there was a story about someonewhose husband was an
anaesthetist and as soon as hesaid he was an anaesthetist,
everyone listened to this couple, but before that they didn't,
which sounds exactly like whatyou've just described with your
mother.
And yeah, if you want your mumwith you, of course, why
(35:15):
wouldn't you want your mum withyou?
I mean, yeah, of course thatmight be the person you would
turn to, and to feel that youcan't do that because that might
increase the discrimination andthe way people treat you badly,
that's that's awful.
Speaker 4 (35:33):
Yeah, but it certainly.
Yeah, it was certainly adifference in experience.
So I think second time round, Ithink, my husband appeared at
the end and it was all sort ofsmooth, everything he sort of
requested happened and it wasmuch 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 bizarrebecause it's not okay, but it's
also bizarre that we sometimesmake assumptions, I think, that
men are maybe more dominant inMuslim cultures, that women
(36:16):
could be subjugated, or there'smore misogyny, whereas what
we're then demonstrating is, ifyour mum's there with you, we're
going to treat you badly, butif your husband's there, we're
going to treat you well, whichis 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 ofdifferent things going on, but
certainly the the narrative ofthe last couple of decades of
the oppressed muslim woman hasbeen very hard to challenge,
(37:00):
simply because a woman choosesto 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 theremust be something, there must be
some sort of error in theirthinking.
These, these can't be thinkingfeeling intelligent human beings
(37:22):
, whereas an actual fact,obviously they're.
Florence (37:25):
Incredibly, everyone has value and everyone has the
right to choose how they expressthemselves with their body,
their clothing I'd like to askyou about what you said about
male staff, because this issomething we do talk about quite
a lot at work and last yearwhen we ran a maternity workshop
(37:50):
, really trying to focus on theexperience of women from
different ethnic backgrounds,and one of the things that came
up was if a Muslim woman asks tohave minimized male staff will
(38:12):
go well, you know that's notokay.
But if a woman who's beensubject to sexual abuse or abuse
in the past, everyone will go.
Oh yeah, that's of course, youknow it's it's.
It's like two completelydifferent responses to the same
(38:36):
request well, it's about what'sculturally 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 10years ago but you know, I've
seen the trajectory, I've seenthe course of the misinformation
that's been spread aboutimmigrants and beliefs,
(39:01):
practices, ways, how they'revery different from us.
The whole othering of any groupof people, I think, is always
going to lead to lot of ourwonderful, kind, intelligent,
otherwise well-roundedcolleagues and friends may not
(39:22):
understand that they have thisbias and may be offended if you
flag it and say you know, I feelthis 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 ratherthan, um, you know a woman with
a personal preference and, andsuddenly there's a, there's a
(39:46):
bit of a disconnect, um, and butthat's because of what we?
We are constantly fed um by themedia, politicians, by world
events, and it's hard tocontinually have to challenge
that.
Speaker 4 (40:00):
And that's where you know the concept of this
exhaustion from continuallyfighting microaggressions can
come from yeah, yeah, I guessthat explains it and I think, um
, the other thing I think isquite interesting.
I mean, I would like tounderstand why there are these
health disparities, and my gutfeeling is that you need to be
(40:25):
in a sort of calm and happystate in order to give birth
effectively.
And when we say no to people'sfaith preferences, like, I think
, as clinicians clinicians we'retrained sort of ideas concerns,
expectations, so we're used tothat framework.
But as soon as you insert faithinto that framework, suddenly
we you know we struggle withthat.
(40:46):
But when we don't consider howa woman who is going to give
birth wishes to deliver, I don'tthink that things work as
smoothly.
Um, I don't think the birthprocess goes as smoothly.
I don't think you feel asrelaxed, and then I think the
complications come from that.
(41:06):
Yeah, I think, particularlywith the second time around,
that was my, my feeling.
Yeah, there's just, there'ssomething in it.
It's a bit like how you can'tsleep if you're stressed.
To deliver a baby, you need tobe in that kind of calm and
relaxed state and you need to besurrounded 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, comeinto triage.
Pick up the phone, come intotriage.
Everything stops becausethere's something in an
environment with bright lights,strange people, not just because
their body's gone.
Is this a safe place for me?
(41:47):
So it totally, I totally agree,and that also kind of made me
think a little bit about choicesof place of birth.
So I know my colleague, francesRivers, who's our consultant
midwife, has done some workabout women from different
(42:07):
ethnic backgrounds makingchoices about things like home
birth or birth centre.
That may, I might, be the rightplace for them, or they might
not, depending on how theirpregnancy's been, but less women
from different ethnicbackgrounds being aware that
(42:28):
those choices are there and aresuitable 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 thehospital?
Florence (42:42):
Yes, and also less awareness of birth centre.
So you know, if you have anuncomplicated, straightforward
pregnancy, actually giving birthon a midwifery-led birth centre
is better.
It's safer.
Speaker 4 (43:04):
Like you say, less complications.
Yeah, yeah, that's reallyinteresting.
I mean, I felt it veryviscerally because I remember
with my second birth, uh, I hadthis lovely team up until the
shift change, and we were doingthe kind of natural things.
So we had the kind of candles,you know, not naked flame, but
you know the soft candles, andwe had all the kind of
(43:24):
aromatherapy and it was lovelyand the midwife, I think she was
very experienced, very calming.
And then suddenly there was ashift change and I was moved to
a much brighter unit andsuddenly all the kind of the
blind blinds went up and it wasa completely new team.
And then everything, as you say,it slowed down and they were
(43:45):
really perplexed.
In fact, they said to me listen, you've got this many hours to
give birth and then, if itdoesn't happen, then we're going
to have to sort of move youback.
And I thought I feel like thisis a process you can't really
rush.
So you know, everything sloweddown and they were all a bit
perplexed.
Why is it all slowed down?
I was thinking.
Well, I know why.
You know, I just don't feelcomfortable anymore.
And we ended up this is alittle bit naughty perhaps, but
(44:07):
it worked.
We ended up in a bathroom.
I was moved back to theantenatal unit because things
weren't moving properly and Iwasn't given any pain relief,
because that's what happens andwe ended up in a bathroom
because I wanted this waterbirth and I was with the doula
and then I was relaxed and I wasaway from everybody and that
suddenly, when everythingstarted happening and I probably
(44:28):
had no an hour or two, justthat feeling of calm and
seclusion and kind of where Iwanted to be, then suddenly it
all happened and they werereally shocked.
You know that how quickly itdeveloped when we went back and
you know I was delivering withina short time.
So, yeah, definitely.
Florence (44:45):
Of course you were.
That's fantastic.
I'm aware I'm taking up yourprecious, precious time in an
evening.
Are there other things youthink we should talk about?
Emma (45:03):
I think that you've you've come with some really great
questions that are reallyrelevant.
Um, and personally I'm justreally glad that you opened the
conversation.
I loved that you reached outand you've been so kind and so
open to hearing about differentfaith experiences and it's gone
(45:27):
a huge way just even making me,as your colleague, feel seen and
heard.
There's this concept ofbringing your whole self to work
and being psychologically safe,and you know there's a.
We just don't talk about thesethings because sometimes you
don't know how it'll be received, whether you have unconscious
(45:48):
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 responseand for you to introduce me to
Emma as well.
She's fantastic, isn't she yeahyeah, absolutely, and I think,
because I feel like why have Ileft it till now in terms of,
you know, I would know Ramadanwas kind of vaguely going on,
(46:14):
because I would go to the coffeeshop and go, you know, to
people do you want a coffee?
And they go, no, I'm fasting.
And I would never use that asan opportunity to open up the
conversation, which feels reallybad 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 lastyear and I liked the way that
you almost bookmarked it andkind 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 youacknowledge it if you're not
sure and if you don't kind ofknow what to ask and where to
(46:58):
start?
I think it was really importantand I think I always describe
this sort of conversation as abit like a two-way dance, like
somebody's got to lead,somebody's got to invite and
then and then you can then feelcomfortable enough to talk about
it.
So I think, it is reallyimportant.
We do kind of honor it and andare 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 youprobably know I normally end
with a kind of zesty bit of thebit I want people to remember.
So I think that might be.
That might be.
The zesty bit is be curious andtry and invite your colleagues
and try and talk to women you'reseeing and try and open up the
(47:40):
conversation a bit more.
Do you think?
Emma (47:43):
Definitely.
I mean the more we know abouteach other, just as people
humanises people, yes, and thenwe're able to treat each other
with kindness and respect, whichis all I think anyone wants as
a patient, as a colleague, as aperson.
Florence (47:58):
Yeah, no, that's really lovely.
Yeah, I'm so grateful to youboth for coming back and going
yes, let's do it and fitting itin in your evening, because I
really did kind of feel like, no, I don't want another year to
pass without trying to learn abit more and have a bit more
(48:20):
conversation.
So thank you very much, Ireally appreciate it.
Emma (48:24):
Thank you.
Florence (48:25):
Lovely to meet you, Emma.
Thank you so much for giving upyour time.
Lovely to see you, natasha, andI'll hopefully see you soon,
thank you.
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Welcome to Bookmarked by Reese’s Book Club — the podcast where great stories, bold women, and irresistible conversations collide! Hosted by award-winning journalist Danielle Robay, each week new episodes balance thoughtful literary insight with the fervor of buzzy book trends, pop culture and more. Bookmarked brings together celebrities, tastemakers, influencers and authors from Reese's Book Club and beyond to share stories that transcend the page. Pull up a chair. You’re not just listening — you’re part of the conversation.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com