Midwifery and Sexuality

Sam Geuens became a clinical sexologist by chance.  He started his University career studying Moral Sciences with a particular interest in semantics – the way people use words and play with their meaning.  Realising that sexuality and intimacy are full of semantic pitfalls and miscommunication,  he moved to clinical sexology after finishing his ethics degree.  He added psychotherapy and started working with people and couples experiencing various relationship and sexual difficulties.  He practised in the Netherlands and Wales before settling in Flemish institutionalised healthcare.Ever since he has been practising medical sexology within hospital settings.  Many hospitals did and do not yet have departments focused on treating sexual difficulties.  So he started outpatient sexology clinics at the hospitals in Herentals, Hasselt and Heusden-Zolder.  In this last one, he is still counselling patients/couples with various sexual problems.Working in this intersection of gynaecology, urology, psychiatry, and endocrinology has convinced him that our healthcare systems have a long way to go before taking people’s sexual health and well-being seriously.  Wanting to contribute to such a brighter sexual health future, Sam is active as a board member for both the Flemish Society for Sexology and the European Federation for Sexology, helping to get sexology and sexual health the attention it deserves in Flanders and the rest of Europe.Ten years ago, he entered midwifery in a rather suiting way.  He was standing in the hallway of his hometown’s maternity ward, having just become a father for the second time, when getting a phone call from the University’s head of midwifery announcing that he got a job lecturing their midwifery bachelor students.Since then, his primary focus has been training aspiring midwives at the PXL University College in Hasselt, Belgium, teaching them psychology and mental health related to reproduction & early childhood development, sexual health & well-being, communication & counselling skills and deontology & clinical ethics.  Aspiring midwives are always a thrilling and engaging bunch of students eager to learn and develop themselves.He hopes this new textbook on Sexuality & Midwifery can help colleagues to integrate sexuality into their midwifery programs, help practising midwives to take up the sexual well-being of their clients and educate his fellow sexologists on all matters regarding sexuality and childwish, pregnancy and young parenthood.At age five, when her brother was born, Ana Polona Mivšek decided to become a midwife when she had the privilege of meeting her mother’s birthing assistant.  It was precisely the year when midwifery education was abolished in Slovenia.  Without the opportunity to fulfil that dream, she went to the gymnasium.  In the last year, when she was deciding on her professional future, the government revived midwifery education, and the University of Ljubljana was accepting its first generation of midwifery students.  It felt as if she was called to become a midwife. In 2000 she graduated as the first bachelor of midwifery in Slovenia.  Though she got a job in the delivery room of a maternity hospital in Ljubljana, her curiosity was not yet satisfied, and she applied for an MSc in midwifery.  Since this was impossible in Slovenia, she headed to Scotland, where she met her mentor, an aspiring midwifery researcher who became her role model. A few years later, she began to teach at the University of Ljubljana, Faculty of Health Sciences, in the Department of Midwifery.  The following ten years were a hectic time - she became the head of the midwifery department, was the only midwifery teacher in Slovenia, was doing her PhD alongside her job, and in all this chaos, had a daughter.In her midwifery practice, she became increasingly aware that sexuality doesn’t get adequate attention.  After completing her doctorate in 2012, with her daughter growing up, her thirst for knowledge was reawakened, which led her to take a course in sexology and establish a subject, ‘Sexology in midwifery’, as part of the undergraduate midwifery study programme. In 2016, at the European Federation of Sexology conference in Dubrovnik, she spoke about the need for sexology in midwifery education and shared her experiences teaching this subject as an essential part of the midwifery curriculum.  There, meeting the co-editors, the seed of an idea for this book was planted.  It took a while - in midwifery terminology: during this “birthing process”, the editing team several times faced dystocia.  But midwives are patient and do not easily loose faith.  They are aware that good things take time to grow.  Now, this book is sent out among midwives, to thosewho teach and those in practice.  Editors hope they are planting a seed that can improve midwifery care. Woet Gianotten is a Dutch retired physician and registered psychotherapist. His dream was to be a tropical doctor in Africa.  After graduating from Utrecht in 1967 as a physician, he spent a year in surgery and the tropical medicine course and moved to Gabon, West Africa, to work in a refugee camp with Biafran children.  His next job was in obstetrics in Rotterdam, where he, for several months, replaced the practice of a midwife in the Red Light district.  He then moved for three years to be the single doctor in a 110-bed upcountry mission hospital in Rubya, Tanzania. In addition to much work in surgery and obstetrics, he built a maternity unit and a mother and child clinic.  When asked to lecture in the school for nurses and midwives, he discovered the joy of teaching, which he has done ever since. With the help of a midwife student, he assisted his wife, Erna, at the birth of their second child.  Their third and last child was born in their home with nobody else.  He started training in gynaecology back in the Netherlands, hoping to return to Africa as a medical specialist.  However, after a year and a half, he had become so fascinated by the new fields of sexology and contraception that he quit gynaecology, a decision supported by his severe colour blindness.  Not being able to see someone turning pale or blue and not making a correct Apgar Score is a real handicap for a gynaecologist.  For a sexologist, however, it proved to be an asset since not being able to see the client blushing, one easily can continue asking difficult questions.With Africa still pulling, he moved again to Tanzania to work in medical care and public health at Kilombero hospital.  He built and started a family planning clinic and taught the midwivesto insert IUDs and run that clinic independently.Back in the Netherlands, he combined several jobs.  For 20 years, he worked in contraception and abortion care.  For 25 years, he worked in common sexology (where sexuality is not primarily influenced by disease or medical interventions).  He enrolled in psychotherapy training to better understand the non-physical connections and gradually ‘crossed the blood-brain barrier’.  For 15 years, he was intensely involved in sexual abuse in care and in an advisory role to the Dutch Ministry of Health.  His third job was as a senior lecturer in Medical Sexology at the Rotterdam and Utrecht University Hospitals.  In medical sexology, cancer, chronic diseases, physical impairment or medical interventions play an important role in sexual disturbances.  Having an extra eye for ‘unmet needs’, he was part of the development of oncosexology and gerontosexology and being under the wings of gynaecologynaturally introduced him to reproduction sexology.  In 2006, when obliged to retire from his University appointments, he was asked to continue in physical rehabilitation sexology.  Gradually he became a freelance national and international teacher and trainer in sexology.

• Preface.- Introduction to the Book and Module 1.- Sexuality redefined.- Relevant sexual anatomy, physiology and endocrinology.- How sex works.- The health benefits of sexuality.- Introduction to Module 2: ‘Nature taking its course’.-   Sexual aspects of getting pregnant (conception and preconception).- Sexual aspects of pregnancy.- Sexual aspects of labour and delivery.- Sexual aspects of post partum and the first year of young parenthood.- Sexual aspects of breast and lactation.- Sexual aspects of the female pelvic floor.- Introduction to Module 3.- Sexual aspects of fertility disturbances.-  Sexual aspects of  high-risk and complicated pregnancy.- Sexual aspects of labour / delivery induced trauma.- Sexual aspects of problems postpartum & in the first year of young parenthood.- Sexual aspects of problematic lactation.- Sexual aspects of pelvic floor disturbances.- Sexual aspects of  mental health disturbances in pregnancy & postpartum.- Sexual aspects ofphysical health disturbances in pregnancy & postpartum.- Introduction to Module 4.- Sexual aspects of contraception.- Sex aspects of pregnancy & pp in non-mainstream orientation.- Male experience(s).- Relevant (sexual) aspects of cultural differences.-  Sexual effects of trauma experience on pregnancy and labour.- Relevant aspects of female genital mutilation. Introduction to Module 5.- Talking sexuality.- Teaching and learning; skills.- Various sexual consequences of interventions in midwifery practice.- How sexual problems are managed (by other professionals).- Midwifery of the future; a widening field of competences.