 Alright so we're getting to the main event now and I'm going to ask Jade to open her camera so we can welcome her and her amazing presentation. So I'll wait for a minute just to let her open her camera so we can properly welcome her to the IDM. There we are. Nihaal, thank you so much, Sheshi. So this is session four and we're very excited to welcome Jade Chengjian. Jade Chengjian taught midwifery at Wenzhou Medical University from 2007 to 2019 as the director of the midwifery program. Following a year at Yale studying direct entry midwifery she designed and facilitated the establishment of China's first undergraduate midwifery program at Wenzhou Medical University. Jade is also the leader of the Angel of Life for Africa training program which brings together NGOs in Ghana and Tanzania to provide training program for midwife's assistance and a model for integrating civil cooperation, medical professional technical support and enterprise participation. Prior to starting her doctoral studies, Jade's work mainly focused on curriculum development and promotion of higher education in midwifery in China. She is currently completing her PhD studies at Zhejiang University. Her research focuses on perinatal loss and cross-cultural comparisons of support following perinatal loss. Thank you so much. We are so honored to welcome you to the conference. Take it away and I'll hand you over the presenter rights. Good morning and good evening everyone. My name is Chengjian and I'm from Zhejiang University of China. I would like to say a thank you to Professor C.O. Javit for inviting me and thank you Dr. Jane Houston for helping me this presentation here. I will share my research, The Dole of Culture and Spirituality in Post-Askillber's Grave Healing of Braved Mudder in China. It is a qualitative research. As I know, I am the first person from China to give the presentation in this conference. Before I start the topic, I'd like to give you a brief introduce to the Chinese midwifery. Just to give you an idea, China has a population of over 1.4 million people. Yes, the unit is billion. Yeah, it's a huge number of the population. In 2022, we had 9.56 million births. It made 2022 the first year with negative population growth in China. Right now, China are facing a big challenge. The younger generation don't want to get married or have kids. So the government has came out a branch of policy to encourage having children. One such policy is improving the education level of midwives. Let me share a little bit about the midwife in China. Now, China has 183,000 midwives, but we also need about 200,000 more. Just like many countries, we need more midwives. This graph shows the number of midwives per 10,000 population, and this red color is China. Here, it has only four midwives for every 10,000 people. It's so small amount. You might already know about the one child policy in China. It's from the 80s, but the practice of midwifery in China was actually stopped in the 1960s. So, Chinese nurses and obstetricians took over the job of delivery babies. So, when the government saw that the birth rate was dropping and the one child policy was causing many social problems, they brought in the two child policy in 2015. These causes are high-pick in birth over two years period. It took over 40 years, it took over 50 years in 2017. Undergraduate midwifery program finally made a comeback in China. My university, the Venger Medical University, being one of the first group to re-establish this program, it is so lucky. But now, birth rate in China was dropping continuously, and then the set child policy has emerged. It was introduced in 2021. Midwifery in China has been growing super fast. Even though we still use the nurse-midwife model in China, universities are now in knowing students in legally recognized midwifery programs. There's still some work to do in improving midwifery education. We started to join the law to support early practice for midwives. And I'm very sure that midwifery in China is going to getting better and better. So now, let's get back to my presentation today. According to the World Health Organization, there are nearly two million steers each year. In 2019, the steers rate in China was about 5.54 per 1,000 total years. Steers is a heartbreaking and life-changing event. It made the one of their most emotionally-challenged grape experience. So that is show the international steers rate. Different cultural context might lead to different experience of steers. Right now, most of the grape care studies in medical literature came from Western and high income countries. There are not much data available from Asian. So in the Chinese cultural context, post-steers grape experience by mother may differ from the Western culture which exempt in their dominant in research. So the aim of my study is to explore the role of culture and spirituality in the grape among Chinese mothers following a steers. The method would took a constructionist approach and conducted a qualitative study using in-depth interview. A total of 28 mothers who had experienced a steers within their past year were interviewed by our chat interviewers. Then the researcher performed an inductive sematic analysis on their chance grapes. The scenes were identified. We carry out this study at a provincial public hospital. This hospital is in a modern city in Hanzhou with a diverse population including migrants from different regions of China. The hospital is the largest maternal and child health facility in the province. In 2020, the hospital has revenue delivery volume over 20,000 babies. We gathered our participants for October 2020 to May 2021. This is their inclusion and their exclusion criteria as follows. We use the purposeful sampling to include winning of different ages, education levels, gestational age, religion beliefs, and their previous briefment experience. We stopped recruiting when we reached the saturation for each scene. After identity let-cases through the hospital information system, we expand the purpose and the significance over the form, often inform the constant by taking into account the respondents' preference. Then we add the WeChat link in China We always use WeChat. It's like using the form, so we always use WeChat to connect other people. Then we discussed appropriate location with the models for in-person interview or online interviews through WeChat. Last five participants chose in-person interview and 23 chose online interview. There are 33 interviews was conducted in the study and in-person interviews were conducted with COVID precaution in place. Before the interviews, demographic data were collected. The recording was transcribed into a word script. Transcription has down word by word and the sentence by sentence. Demographic information of participants entered into the data sheet and stopped to excel. Patient-related data were de-identified and crept and capped by the researchers. We used the eye-pride text of the where and in vivo 12-8 with the study, the data were analysis through the broad clock, semantic analysis. This is a demographic information table. We collected the religion, gestational, weeks and previous brief experiment for the study and the figure shows the main thing in findings. The major thing is cultural impact on grave expression, cultural characteristic of experience and the significance in cultural and spiritual healing behavior and that is the substance. In these signs, I showed all of the main thing and the substance and some codes from the matters but due to the time constraints, I won't cover all the things but I will provide a few examples. I will introduce some substance. The restraint expression of grave. Some patients, some participants indicated that they were pursued to accept the view that the expression of silver's grave could be harmful to the health of their lost babies, their family or themselves. They reported their families used a taboo, customers arisen to discourage them from expression, their thought and feeling. This substance showed the silent grave. The silent grave is a common phenomenon in many cultures so I don't want to spend more about this thing. And another thing I would like to discuss most is their unattainable morning ceremonies. In our study, the hospital typically handled the disposal of babies remains only two mothers asked to take their babies home but no one actually did. This was because participants were unsure how to handle the remains and believe it was cultural, cultural taboo. They felt that a fetal after stillbirth might not be appropriate so they left the baby's body at the hospital to avoid cultural taboos. The practice recommended in Western Bremen Care guideline like holding a fetal as a master's of post-stillbirth healing does not appear to be achieved for Chinese mothers. Another thing I would like to talk is hospital policy as barrier. All mothers complained about the hospital did not have a policy to allocate separate rooms or space for women after stillbirth. They shared a room with the mother who had live babies. This made it so difficult to express their grave or discuss their loss. That became an additional barrier to graving and I will introduce other oriented self. Some mothers were more concerned with other husband with their husbands or family members feeling than their own. They were afraid that expressing their grave would trouble others with an unnecessary emotional burden and a negative feeling. They preferred to hide their emotion and pretend that the loss did not affect them too much or they had already moved on. This phenomenon knows the other oriented self. It is a very common phenomenon in China culture. I will introduce the, I will introduce that culture is a kongyuezi. Kongyuezi is a very special, it's a very special phenomenon in China because in China we have after a time we caught confinement, we caught confinement following a stillbirth. Participants use the term kongyuezi. Kong is mis-empty in Chinese and it's symbolized not only the loss of the baby but also the sub-connection between the mother and her baby. In China the post-partum confinement period we always see the seeding months. In Chinese pronunciation is juoyuezi. During this period the new mother rested at home for 30 to 42 days after giving birth and they have a lot of the restoration for their for the behavior like shut the window, can't open a door, can't take a shower, can't eat their cold food like this. And the mother thinks the confinement, the the month is not suitable for the mother without a live baby so they felt excluded from this experience which suggests their grief and their sadness. Another another thing is a cultural taboo on dealing with the seed baby possession. Some some stillborn babies belonging is a taboo when the mothers viewed this item as a lucky and unlucky and failed at giving them to other expectant mothers could bring misfortune. As a result they choose to dispose of all destroyed this item instead of passing them on to others or donating them under the under leasing the significant. Here I would introduce that scene seeking the meaning of the event. These these four scenes is more cultural and spirituality related with their with the behavior of their mothers. Some mothers shade some mothers shelled that they just can't stop thinking about the event about the event and this mind constantly returned to pen they've induced they've endured and they've tend to deflection try to find a meaning and a significant in what has happened throughout this process they've identified the spiritual as a key factor in helping them seek answers. When other ways haven't provided them with the closure they need they believe life spiritual spirituality might offer the ultimate answer to their profound loss and another important something is accepting and reconciling with the with the event. Some of the mothers believed that their own habits or their behavior might have directly or indirectly lead the silvers or that they didn't recognize warning signs in time to save the baby to deal with the guilt to deal with the guilty. Some mothers have tended to spiritual practice as the way to let go of their feeling of brand and focus on positive actions for a better outcome. In context of Chinese spiritual they attribute the cause to fate which is believed to be predetermined by a higher power and it cannot be changed. However, they also express spiritual concepts like recognition giving them hope that the babies might return to this world and be reborn into a better family. This helps them accept we reconcile with their loss ultimately find the peace. Some participants some participants who were previously assisted in the region found themselves turning to religion after their loss. They studied performing goodies hoping to gain merit and a virtue for a better future. They also they also doped into philosophical and religion books exploring concepts of life and death and found comfort through spiritual activities. This demonstrates how a steward's experience can change one's spiritual or religion space. On the other hand some mothers who were already religions before the loss became skeptical of their faith. They feel betrayed after engaging in faith-related activities during pregnancy like praying for a health child but only to experience the opposite outcome. This lead to a decline in their confidence in their faith. This study is one of the few that described the influence of of chinese of chinese culture on brave expression. Expression as well as the low of chinese culture and the spirituality in women's post-loss healing after her steward's. The study showed that some customers' social norms politics, the policy and the rules and the spiritual of the faith life and death might contribute to the pathways to adaptive to brave men in chinese society. Some cultural practice facilitated this connection and the detachment from their steel bone babies and their event. Influence by chinese believe about life and death. Some mothers believed that detaching from the negative past could lead to a positive future. Additionally, traditional belief detected that a deceased baby could only reignite if unbound by its previous family. The study highlights the influence of medical culture policies and their interaction between brain models and their health care provided in china on post-steward's brave experience. The spiritual pathway is a multifaceted aspect of grave coping with both supportive and challenge effect on brave models and conclusion summarized chinese culture and the spiritual has various influence in brave the mother's grave exploration and their post-steward's healing process. This research demonstrated some specific aspect of spiritualality that contribute or hinder to the braving process and the different roles of chinese culture and spiritual spirituality in individuals. It could develop the culturally sensitive interventions and the support systems assisting models in navigating grave and healing. Future longitudinal studies could be undertaken to explore in deeper influence of chinese culture and spirituality over time in the different stages of grave healing after stillbirth and this study may help health care workers and their brave mother with stillbirth not only in china but also in country with chinese migrants to understand stillbirth's healing behaviors and provide different perspectives on life and thus view and values as well as different behavior and thought orientations when coping with stillbirths in cultural contexts other than western world. So that's all for my presentation thank you for your attention and do you have any questions i'm very happy to answer the questions thank you well thank you so much jade that was very moving and a fantastic presentation and dr jevett in the chat says can you tell us if you've tried an educational program for midwives to give women time to see the baby after stillbirth jade did you get that question for me yeah uh now uh in our research group we have another group to uh to establish their education for their for the nurse and midwives and uh because in china our nurse and midwives they do not have a awareness to to give uh give suggestion to the uh to the mothers to to see the baby or hold the baby so uh we need to educate them and have and have chance them to give the opportunity to the mothers could to see baby or holding the baby and i think the mother they um they have a they have a right and our midwives have a responsibility or both to give their give their opportunity to choose yeah if they want to see or if they want to hold the babies but now in my research when i ask their mother if they want to see or hold their baby um until now uh in my research most of mothers they don't want to they don't want to hold or they don't want to see and there are some of them they they do not have or they don't know if they could see or they could hold so uh might be in the future uh we we could do some research for for about that yeah thank you and then just to read two comments to you and one from uh selene says this is surely important and it's so heartbreaking for the lived experience of these women and then these customs are so different from what we were taught 40 years ago in the united states this is important for all of us to know when we're caring for families from china and then another question in the chat is there a taboo for nurses and midwives to help the mother with the baby that has died so is there any kind of cultural things that we should really be aware of like for helping bereaved families if you could respond sorry taking all my paper of pictures yeah yeah sorry so dr jevitt said is it taboo like is it is it not a good thing uh for nurses and midwives should like what are your suggestions should they try and help is there is there like a cultural uh issue if nurses and midwives are trying to help the mother with the baby and that has died for the nurses and midwives like how how is that viewed in in chinese culture is it unlucky so is she saying is it unlucky for nurses and midwife to help mother when they've had a stillbirth you mean there uh yeah some um some nurse and midwives um might be not saying it's unlucky um but um like might be uh some some nurse and midwives but when they face that situation uh because uh they do not get a chaining for for this kind of field and they don't they don't know how to deal with that situation and sometimes they like cope with that uh cope with stillbirths according by themselves like they leverage their article literature from western countries um and there are sometimes they they are decided by themselves and they are i invite i also invited some midwives in china and their uh the younger midwives they said they don't know because because they do like some midwives it because they're too young they do not have their own children they do not have their own kid so they don't know how to deal with that situation some uh most of the time they escaped yeah they say nothing for the for the women with stillbirth and they escaped that kind of situation and they they might be hurt and they're also um my students my students when they have practice in their um in the hospital they also face um that situation with stillbirth and they have some trauma for that but in china now we do not have any um any knowledge in the test book and there are no any and training program for that how to deal with the stillbirths so i think we we need to match for that part and then we've got a comment a couple of comments um uh yan wong says i think there's no taboo in china but some nurses may or midwives may think this is not lucky uh sherry says learning about bad luck of keeping or passing on the possessions was great to learn and says great findings what is the way forward to help these women and then steel says secondary trauma for nurses and midwives who haven't been given information to help the mother so um we can probably just if you want to um maybe give us a little summary and then we'll start to close the session jade great session i saw one yang yang wang said i think less has no taboo i i i think uh i'm i'm confirmed um maybe her meaning is no taboo in hospital but it is taboo in the for the family yeah or she's my students yeah she's walking for many years and there is no taboo i think is no taboo in our hospital but it's also a taboo for the family so i correct it and uh yeah sorry what your questions again thank you i think it was just talking really about um you know for um folks from different cultures like you know where i live probably where you live it's very diverse so i think i think that dr jevits point was that having this information is really helpful because when you're from different culture it can be quite different if people have different beliefs um about stillbirth so i think i think that was the main point um yes yes i think uh different culture have different outcome and to um influence different reaction and behavior um so uh you know uh china china have a lot of the the the cultures like uh like chinese immigrants they living in the western country you you could see a lot of cultural from china so um yeah thank you yes so um for the stillbirths yes we also um have a lot of cultural influence that and for another part is we we know uh sometimes we know have the others uh like a social norm uh uh um ordinary social norm for special for the stillbirths so that may be uh that may be due to um maybe a result in the matter they do not have a knowledge to know how to deal with that situation because they do not have a rule based in the chinese traditional cultures like how to hold the funeral and if they they need to get their baby's body back and um if they they need to um to to write the baby's name under my uh under tombstone you know in china we have a tombstone they have some some offspring's names but there are stillbirths baby they do not have a name in their in the tombstone that is the taboo also in china yeah it's so different but you've actually you you know you've brought us into your culture so so eloquently and beautifully today and there's there's some wonderful comments um uh thank you so much jade it's so brave to present to the language that you don't speak every day you've made our our midwifery world a little closer thank you so much for joining today and glad you're representing uh we have 400 000 chinese in british columbia and four mandarin speaking midwives saline says very informative and uh sensitive presentation thank you and yan wong uh sends roses sends flowers so thank you so much shixi it it was really fantastic presentation um so much to learn as someone that's very has experienced very close perinatal uh stillbirth loss um i so appreciate you um bringing this um and we want to say thank you uh from the idm uh so much and uh to all of you and let me put all the links in the chat oh i need to if you can serve fish oh yeah make a selfie right now selfie could you could you move a little bit forward my line i want to all right yeah there we go awesome your way yeah thank you all right