By a 'culturally competent midwifery education' do you mean one that provides the curriculum in a culturally congruent manner, to meet the needs of the ME woman studying midwifery, or that the ME midwife learns to provide culturally sensitive care to childbearing women and their families? Either way, the cultural aspects surrounding birth – both for midwives and for women, are intertwined. I believe the biggest consideration that must first be addressed is the fact that there is frequently very little understanding, or consideration (at least at the institutional level), of what childbearing women in the 'Middle East' (that’s a very big and diverse group!) actually want, or feel is important, as far as care and support surrounding pregnancy and birth. Secondly, by and large, my experience in two ME countries has been of a fairly medicalized, interventionist and authoritarian approach to birth, with midwives not really functioning with a lot of autonomy. Support of a normal physiologic birth process, providing woman centered care that is dignified, respectful and empowering, supporting autonomous evidence-informed decision making - these are all concepts that are being promoted internationally and by the ICM in the context of midwifery education and midwifery care – how do these ideas translate to the individual countries of the ME?

i do agree with Allende Wittmann, its a fact that we need to actually find out what the women want from their midwives. my concern was regarding the curriculum changes to be made in the midwifery programs in the middleeast , where cultural issues are to be incorporated into a developing new culturally competent midwifery curriculum.

As you know, cultural competence is a key concept in the ICM Essential Competencies for Basic Midwifery Practice 2010: "cultural sensitivity, including working with women and health care providers to overcome those cultural practices that harm women and babies”, but it would be helpful to have a framework for integration into the midwifery curriculum - I was surprised to find that the ICM hasn't created one. There are examples of stand-alone courses http://www.mercyinaction.com/distance-ceus/ but as a program outcome, I agree that it would be better to be threaded throughout the curriculum. Is this what you plan to develop?

(I am still pondering how we go about nurturing culturally competent midwives if we do not fully understand the culture of birth amongst the dominant population)

hi Allende Wittmann

i did study the taboos and beliefs during antenatal and postnatal period in Oman.to add on ,iam just planning to study the cultural practices of ME women before, during and after childbirth which would help us in understanding the exact practices and then suggest to incorporate those into the curriculum. thank you for suggesting examples.