Andrea Altomaro on why it's important to talk about bodies and health in a way that is open and honest.

Editor’s Note: The opinions expressed in this blog post are solely those of the author.
Spoiler Alert: This post discusses events in Call the Midwife Season 7 Episode 6.

This week, we saw Lucille and Valerie preparing for their Health and Relationship class. This was a special class for girls age 16 and over, with parental permission, where they could learn about their bodies, menstrual cycles, and reproduction. Valerie had been teaching the class previously, and now Lucille was about to join her. I absolutely love the idea of a class to discuss the body and reproductive health, although I am thankful that the basics are generally taught a little earlier these days. With the average age of menarche (the first menstrual cycle) around 12 years old, I feel like it is important for young girls to understand how the body works before this important milestone.

The concept of the female body is discussed rather often these days, but I’m not certain that it’s talked about in the correct light.

Many people don’t realize that Certified Nurse Midwives provide care for adolescents as well as women of reproductive age, and up through menopause and the post-menopausal period. Some of my favorite visits are with younger teens, talking to them about their bodies, normal life cycle events like menstruation, and of course, sex. I’ve gotten out a mirror and showed young women their own anatomy. A gynecological appointment does not have to be scary, painful, or shameful. It can be a wonderful time to ask any questions about your body, health, and sex, and there is never any judgment. Much like Valerie, I am a firm believer that sexual and reproductive health should be talked about honestly, openly, and regularly. Although I have two sons, we talk about bodies regularly, and always use the correct anatomical name for our body parts. I’ll never forget when I was pregnant, and my then-two-year-old exclaimed loudly while walking through Target that “babies are born out the vagina!”

The concept of the female body is discussed rather often these days, but I’m not certain that it’s talked about in the correct light. There is the constant debate over women’s reproductive rights. There are discussions about what kind of information is appropriate for sex education classes, like Valerie and Lucille’s class. There is a LOT of talk about what the “ideal” woman’s body should look like. Then, there’s the way that women talk about their own bodies. Far too often, young women are exposed to an older woman (sometimes a mother, grandmother, sister, or friend) criticizing their own body; we learn to look in the mirror and pick apart our “flaws”. Too round and soft here, cellulite there. Hips too wide, breasts too small. I remember reading somewhere that the majority of young girls have been on their first diet by the age of eleven. Let that sink in--by the young age of eleven, we have decided that our bodies are not beautiful the way they are, and we must change them.

I can admit, I was the same way growing up. I was always the chubby kid, and I was teased because of it. I remember coming home crying when I was six or seven because my neighbor called me “husky”. I don’t ever remember my mother talking badly about herself, but sometimes it’s not always overt negative self-talk. Sometimes it’s not mentioned directly in front of our children, but they are listening anyway. Sometimes it’s the nonverbal assessment of ourselves in the mirror. It can be the disappointment when something doesn’t fit, or doesn’t fit the way we think it should. Sometimes it’s the constant bombardment of magazine images and articles, promising a “summer body” or “how to lose those stubborn 10 pounds”. In the age of social media, it’s also very noticeable in the fitness accounts on Facebook and Instagram; there are “before and after” photos, and advertisements for products promising to help you drop a few pounds quickly. I’ve seen Facebook groups for kids as young as middle school rating girls as “hot or not”. There is an immense amount of societal pressure for girls to fit the ideal beauty standard from a young age. I think I was probably around 10 years old the first time I thought that I needed to lose weight.

As damaging as social media can be these days to young women and their perception of themselves, there is also a large body positivity movement growing and gaining momentum. I was introduced to this concept first by the 4th Trimester Bodies Project. The 4th Trimester Bodies Project celebrates “the uncensored beauty of motherhood.” It is a photodocumentary project by Ashlee Wells, where she captures photos of female-bodied parents, usually with their children. All of the photos are black and white, but otherwise are unretouched, and the participants are photographed in their underwear. No photoshop, no angles, no “hold your arm like this and tilt your chin up so you look thinner”! Just a beautiful, captured moment of parents and their children, celebrating what our bodies have gone through during this life and journey to parenthood.

I had the privilege of participating in the 4th Trimester Bodies Project in Detroit this past March. It was a hugely empowering experience for me, definitely exhilarating and but also nerve-wracking. I’d be lying if I didn’t tell you that I tried on my underwear and bra in the mirror quite a few times before that morning, and not all of my thoughts were positive in nature. Body positivity is something that I’ve been working on for a long time, but more sincerely since the birth of my first son in 2014. I want my children to grow up seeing all body types and understanding that all bodies are normal and beautiful. I change in front of my children often and I try to be very careful about the words I choose when talking about myself. I exercise regularly, and we talk about how I love feeling strong and healthy. As of the beginning of this year, I have adopted a plant-based vegan diet to help fuel my body in a healthy way, without harming other living beings. Of course, I’m not perfect. When my kids aren’t around, I definitely pick myself apart some days. It can be the stretch marks on my stomach or the 10ish pounds I would still love to lose, getting caught up in the negative self-talk still happens much more than I would care to admit.

I would love if our generation is the one who actively works to end the idea of the “perfect female body.” I can imagine young children growing up with parents/mothers who embrace their own bodies, who celebrate and love every part of themselves. I think with constant enough communication to our children about loving our bodies, we will eventually start to believe ourselves. Positive affirmations and expressing gratitude for what our bodies do for us is definitely one way to start. Talking about the body’s normal events, like menstruation, birth, and lactation to truly understand how the body works is another huge step toward self-love. These normal life events are often talked about in a hushed manner, spoken about in a low voice behind closed doors. We learn to be ashamed of our menstrual cycles, our stretch marks, or our body hair. When I’m caring for a woman, albeit young or older, we talk about bodies and health in a way that is open and honest, never shaming. I love to think that as a midwife, I am helping in some small way to normalize the female body.

Andrea Altomaro (MS, RN, CNM) has been nurse-midwife for the past three years and is currently working for the Henry Ford Health System. Before becoming a midwife, she worked as a nurse in the emergency department and also in labor and delivery.
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