Wray, J

English

University of Salford Institutional Repository

4 April 2009 THE PRACTISING MIDWIFE ■ VOLUME 12 NUMBER 4Comment Julie WrayIt’s hard to imagine that throughout my1980s midwifery training there was nomention of  the ‘sex’ word other than inthe context of  pathology – in other words,disease and illness. The notion that sexualactivity is a healthy human function, thatcould be pleasurable and fun, was notmentioned or eluded to in any way. Rather, itwas presented in cloak-and-dagger setting,accompanied by the mantra: ‘No sex please,we're British’.Thus, my educational insights andlearning at the time were reduced to lookingat sex from the perspective of  sexuallytransmitted infections, sexual dysfunctionand psycho-sexual issues. This was a highlymedicalised and negative approach.Certainly it was unhelpful for enablingdiscussions with women, for whom the mereact of  childbirth meant that they had been,and possibly still were, sexually active. Thisinadequate handling of  educational mattersconcerning sex was due to both themidwifery tutors in the classroom andmidwives in practice, and is something Ihave always remembered. Yet at the time Iknew that this was an important aspect ofhealth and wellbeing, and that midwiveshad a responsibility and role to play. The standard ‘contraception chat’ that Ihad witnessed during the postnatal periodwas more often than not a rushed session atthe foot of  the bed, typically just prior totransfer home, or it was simply overlooked,based on the assumption that someone elsewould pick it up. To me, this was notsatisfactory and so, aware of  the knowledgegap I sought out relevant information andlearnt about sexual health – in its broadestsense – so that I could engage in meaningfuldiscussions with women as and whenrequired. As a starting point, I soonrecognised that a big factor was to helpwomen feel comfortable and at ease so that adialogue could unfold as naturally aspossible.A sensitive subjectThat said, I am more than aware thatdiscussing sexuality, sexual health andsexual activity can be difficult and evenembarrassing for women and midwivesalike. Sensitivity is required alongside anawareness of  the individual woman'scultural and social expectations. However,leaving concerns unmet followingchildbirth means that women and theirpartners may experience difficult situationsunsupported, with inadequate or noexplanation. In 2000, I was co-author (withAngie Benbow) of  a guideline on postnatalcare (RCM 2000). This was a first of  its kind,and we felt strongly that sexual healthshould be a key feature. To set a context andreinforce the normality of  sexual health wechose to cite the WHO (1986) definition ofsexual health: • A capacity to enjoy and control sexualand reproductive behaviour inaccordance with a social and personalethic• Freedom from psychological factorsthat inhibit sexual response andimpair sexual relationships• Freedom from organic disorders,diseases and deficiencies that interferewith sexual and reproductivefunctions. This definition remains useful and stillapplies in relation to contextualising sex andsexual health as a healthy human function. Furthermore, I am aware that despitenumerous health campaigns raisingawareness of  safe sex, safer sex and sex ingeneral, limited knowledge still prevails inBritish society, most notably among youngpeople, as highlighted within the teenagepregnancy policy framework (SocialExclusion Unit 1999). Following recentmedia coverage of  the newly publishedteenage pregnancy rates, which remainhigh (SEU 2009), I began to wonder aboutthe contribution that midwives make withinthis policy. Be it informing young peopleabout how and where to accesscontraception, ways to delay early sex andreduce the risk of  an unintended pregnancy,midwives can and should be participating inall of  these activities. Finally, I want to believe and, moreimportantly, be reassured that midwiferytraining addresses sex, sexual activity,sexuality and sexual health in a meaningfulway. In addition, I want to believe thatpractising midwives, as mentors andeducators, facilitate teaching and learningthat embraces good information anddialogue about sex. I also want to seemidwives sharing skills and ways of  being toenable discussions with women. Or does ‘Nosex please, we're midwives’ remain ourmantra? TPMJulie Wray is Senior Lecturer, School ofNursing, University of SalfordRCM (2000). Midwifery Practice in thePostnatal Period - Recommendations forPractice, London: Royal College ofMidwives. Social Exclusion Unit (1999). TeenagePregnancy, London: HMSO.WHO (1986). Concepts for Sexual Health.EUR?ICP?MCH521. Copenhagen: WorldHealth Organization.No sex please, we’re British midwivesDiscussing sexuality,sexual health andsexual activity can bedifficult and evenembarrassing forwomen and midwivesalikeDespite numeroushealth campaignsraising awareness ofsafe sex, safer sex andsex in general, limitedknowledge stillprevails in Britishsociety, most notablyamong young peopleTPM APRIL 2009/version7_TPM feb 08   20/05/2011  08:57  Page 4

No sex please, we're British midwives

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No sex please, we're British midwives

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