I have a particular acquaintance who's an amazing businesswoman. She’s clever and beautiful and leads her family and community in ways I have so much respect for.
Every so often, though, she brings up something that just knocks me sideways.
Younger Ellie was a harsh with no time for anyone’s beliefs if they weren’t evidence based. When I was sixteen I was proudly reading Richard Dawkins and similar authors and loudly criticising everything.
I’ve now grown up a bit and understand a) I don’t know everything, no matter how many books I read b) being friends with people who think differently is a healthy, stretching experience.
But still – when it comes to pet psychics, the evil judgemental bit of me is thinking, oh, god, really?
It’s okay, I have a jokey relationship with this person and some of the things I do make her think I’m mad so we’re even.
Recently she’s started to go for vaginal steams, otherwise known as yoni steams. She feels they are making her periods lighter.
Based on this, I reflected on how midwives might discuss such a practice with clients, and learnt about my own prejudices and how best to cope with them.
If you haven’t come across vaginal steams, they’re a type of alternative medicine, or spa treatment, which involves sitting or squatting over steaming water infused with herbs. It’s claimed they’re good for reproductive organ diseases or issues, including fertility, but there doesn’t seem to be any evidence to back up these claims.
Some midwives I know like the idea as a nurturing activity for women and feel it's a historic practice that celebrates femininity.
Other professionals like gynaecologist Virginia Beckett, from RCOG and via the BBC, suggests the treatment is unlikely to be beneficial.
What is a midwife’s responsibility here?
Factors to consider:
· It's likely vaginal steaming will produce a placebo effect for some women.
· Placebos are very powerful
· But they work best when you’re not aware you’re getting a placebo
· Midwives have a responsibility to give evidence based information as per the NMC Code
· But they also have to respect client choice and there are cultural and spiritual needs to think about
My friend is completely genuine in feeling this treatment is helping her.
There is no formal evidence to show vaginal steams don’t work – but if we trust physiology we know that dilute herbs in steam absorbed by the vagina are unlikely to help with heavy periods.
It may be that the outcome of lighter periods is due to decreased inflammation and increased endorphins as placebos are known to cause these effects.
If my friend was your midwifery client, what would you do?
We have to be careful about validating treatments that aren’t evidence-based, but we also have to maintain good relationships.
After all, a good midwife/mother relationship is responsible for the amazing outcomes of continuous midwifery care.
It might be more simple to say ‘do whatever you feel is best’ but I’m not sure midwives can get off the hook that easily either.
Midwives sometimes work with women who are desperate for treatment to work, for instance, those having IVF.
Vaginal steams can be over £100 a treatment and some practitioners claim they can help with fertility issues. I think midwives have a responsibility to advocate for their clients in this situation, especially as this treatment could be recreated at home for not much.
The cleanliness of facilities and dangers of hot steam on delicate bits of our anatomy might be worth discussing too. I wonder what this treatment might do to the vaginal pH, as well, could it kill off some of the healthy bacteria perhaps?
It’s also a little concerning that in some countries vaginal steams are performed as women feel they need to 'tighten' their vagina to make sex better, or because they think their vaginas are inherently dirty. I'm a little afraid that vaginal steaming might be similar to waxing or douching - it's done because vaginas are presented as needing maintenance to stay clean when really they're very good at staying clean all on their own.
If women are booking steams because they think there’s something wrong with their normal physiology, that’s an issue.
If you pick up on this kind of belief, it's might be a prime opportunity to quote Ina May Gaskin when she says ‘Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.’
On balance I think that midwives can be supportive of vaginal steaming. Like any other choice, it's important to offer information. But women might feel a special connection with the practice, or simply enjoy it. If you've offered all the evidence, you've fulfilled your professional requirements.
After that, trusting women to make their own choices and being a good, kind, respectful person is the name of the game.