Last week was probably THE busiest week of the year for me and the rest of the committee of The Gentle Birthing Group!

There was a huge Internatioal Conference called Women Deliver, held once every three years, that was held in Kuala Lumpur Convention Centre. It attracted thousands of participants from all over the world including government leaders, policymakers and NGO representatives from organizations such as UN and WHO. Internationally renowned figures such as Melinda Gates, Chelsea Clinton and Queen Mary of Denmark gave speeches at the conference; and also eminent figures in the birth world, such as Debra Pascali-Bonaro, Robbie Davis-Floyd and Ibu Robin Lim.

The weekend just before the conference, BIB Malaysia hosted the 2nd International Birth Without Borders (BWB) Conference, in which Robbie Davis-Floyd (meidcal anthropologist) and Debra Pascali-Bonaro (Birth Activist, Doula and chair of the International MotherBaby Childbirth Organization) were the main speakers. These are two prominent figures in the birth world and I was SO excited and SO grateful to be able to meet with both of them.

I myself was invited to present at a Forum during the Birth Without Borders Conference, as a representative of the Gentle Birthing Group Malaysia, and to represent the collective voice of Malaysian mothers. Other panelists included Consultant ObGyn, Dr Noraini from Sunway Medical Centre and Consultant ObGyn, Dr Haliza from Hospital Kuala Lumpur. I felt honoured and grateful to be invited to present amongst eminent figures at such an important conference.

In my presentation I showed video clips of mothers from the Gentle Birthing Group (GBG) telling their birth stories in their own words. Their stories told of how they were ill-treated during their births or given inaccurate information or how they were pressured into accepting unnecessary interventions. As these were first-hand accounts of mothers' experiences in birth, it did a good jon in informing the audience that many mothers are unhappy about the way they are treated in Malaysian hospitals during their births.

I thought it must be a difficult message to see, if I were a nurse or doctor, but it certainly had to be done. At first, the audience was silent and I noted an air of defensiveness from the other panelists, but as soon as I and the other members of the Gentle Birthing Group, who were seated in the audience, made it clear that we want to work together with the Ministry of Health and actually be part of the solution, the tone of the discussions became much less defensive and more productive all round. The conclusion was that medical professionals cannot turn a deaf ear to what mothers have to say, and so all parties agreed that it is in mothers and babies' interests that all parties work together in the spirit of mutual understanding for the health and safety of mothers and babies.

The whole Conference was charged with oxytocin, as the main speakers, Debra Pascali-Bonaro and Robbie Davis-Floyd, told it like it is to an audience full of medical professionals – how routine hospital procedures (much of which are still parcticed in Malaysian hospitals) impede the chances of the mother to experience a natural birth by a great amount; how many of them are actually NOT based on scientific evidence; how many other motives drive Obstetricians – including legal issues, conveniene and money. Each of the speakers brought to the conference their own strengths - Debra focused on the International MotherBaby Childbirth Initiative and the importance of doulas at birth, while Robbie Davis-Floyd talked from an anthropological perspective about childbirth and why we have gotten to the point we're at today. I found her talk about the difference between Technocratic, Humanistic and Holistic models of birth simply fascinating! And when she talked about power issues in birth and the centuries-old power struggle between man (Obstetrician) and woman (midwife and mother), the whole room (well, mostly the birth activists) gave her a standing ovation! Obstetrical medicine is a very recent phenomenon. Only in the past few hundred years, have men encroached upon the domain of childbirth, a historically female event – where females attended births and provided emotional support (midwives and doulas) to the mother. Fascinating! 

We were able to network with many parties and we definitely made headway in following-up with our relationship with the Ministry of Health. The GBG was invited by Dr Ravichandran, the head of the Obstetrical and Gynaecological Society of Malaysia, to work together with OGSM and Ministry of Health in improving birth in Malaysia. So this was a HUGE step forward for the GBG in our birth activism activities. I met midwives and nurses from Klinik Kesihatan who said "you know we have had a few women who birthed at home unassisted - at first we were against them, but now we realize we have to listen to them" ! :) These were good midwives who are just carrying out their jobs to the best of their abilities and to the best of their knowledge. The concept of Gentle Birth and HypnoBirthing were all new to them... they were curious! You could see it in their eyes!.. And many were willing to listen :)

I left the conference with a renewed vigour and a sense of awe by the work that these two strong amazing women do and how they contribute to the collective wealth and health of women and babies all over the world. My colleagues and I from the Gentle Birthing Group laughed, hugged and shed quite a few tears because it was so refreshing to be at a conference where the truth was spoken out loud and birth workers, mothers and medical professionals all gathered in the interests of mothers and babies! The conference only re-affirmed my belief in my work as a birth activist, and showed me that there is a MUCH bigger purpose for doing the work I do..It's not JUST birth. It has repercussions for women, babies and whole societies, nations and future generations in years to come.

Immediately after the BWB conference, was the Women Deliver Conference where key figures from renowned institutions across the world came together. We were fortunate to attend and listen to such important people speak such as Francis, the president of the International Confederation of Midwives, Queen Mary of Denmark, and other eminent figures talk about the state of women and girls all around the world today. Ibu Robin Lim (CNN Hero of the Year) also was invited to speak. It was a great opportunity for me and my colleagues from the Gentle Birthing Group to network with relevant organizations to put forth our cause. I met many wonderful people there who I hope to be in touch with for future projects with the GBG. The conference itself I thought was alright. I did learn quite alot. However, the entrance fees was very high and it was definitely not affordable to independent midwives who work the most with mothers and babies. Many ministries from around the world sent representatives, and there were many Obstetricians there, but the main theme I felt was still about institutionalizing birth - about getting women to the hospital and "adequate care" and reducing maternal mortality, etc - but as Robin Lim poignantly pointed out - there was nothing about food quality - and about addressing malnutrition in countries. How can we talk about gentle birth, when mothers are malnourished?? Its not possible. There really should have been more talks addressing the causes of undernourishment of women and children leading to dangerous complications and deaths. However, it was good that the International Confederation of Midwives were represented and were able to put forth their case. Debra also put forth her case for Respectful Maternity Care. Hopefully all these issues will be taken into consideration when the next Millennium Development Goals are drawn up in 2015.

After the conference, we spent half a day with Debra and Ibu Robin just chatting! The day after that, the GBG hosted a talk where Ibu Robin addressed a crowd of about 40 mothers and fathers at Chayo Studio before she went home to Bali. I was only able to stay for the first half of the talk, but it was full of love, hugs and tears of happiness :)

It was such a memorable 10 days. I am so grateful and feel so blessed that everything worked out well – and I was so grateful I managed to squeeze in an intensive HypnoBirthing class and also attend a beautiful homebirth (more about that later;) !

Alhamdulillah! Feeling very blessed! And now, returning from a 5-day vacation with my girls, I'm excited to get back into gear! Allah make it easy for me and bless our work and give us barakah in the work we do to make birth better for mothers and babies in Malaysia. Ameen.

MashaAllah , SubhanAllah. I still smile to myself thinking of the events of this past Saturday. I was privileged to attend a home unassisted birth of a first time mother. I had missed a few births in the past few months because of home commitments and other issues, but somehow this birth was perfect timing. In fact, I was supposed to have a class that morning, but the mother had to cancel because she was not feeling well.

I got up in the morning thinking it would be an uneventful day, relaxing with my kids. My phone had gone flat in the night and so I charged it and got this mama's SMS at 7am, when she had already texted me at 6am. I rushed to get my kids fed and left them at my mother's house. Her husband was texting me to hurry as he was excited:) "No stop in surges for last 30 mins. Sorry to rush you".

When I got there, mom was on all-fours on her bed riding her surges. Rocking her body back and forth in silence. Her waters had released at 4am and apparently she had wanted to drive herself from her mother's house to her house to birth, but her husband didn't allow it. *chuckle*

I knelt by her to let her know I was there. She acknowledged my presence and returned to attending to her surges. She was quiet, breathing through her surges. She would occasionally scrunch her eyebrows and her fists and moan. 

We reminded her to relax and release the tension in her body. "How do I do that?" she asked. "Smile" I ventured. And soon enough she started to relax.

"I'm comfortable in this position but my hands are tired". So we piled a heap of pillows against the headboard of the bed and she leaned on it, slightly elevated. This seemed to be her position of choice.

Her surges started to patter out and not long after, the tip of baby's head could be seen. Dad was excited by the sight and rushed to get towels. Mom's sister arrived to give support. Mom was still on all-fours breathing and smiling between surges. 


"But every time I relax I can feel his head go back in".  

"That's fine", we said smiling quietly, excited at this point. 

A few relaxing surges later, baby's head slowly emerged, almost all the way.. and then stopped just at the lips, like a turtle-neck sweater that didn't come down all the way.

Time stood still. 

Dad steadied his hands under baby's head.

"Mancungnya hidung dia!" 

Dad and aunty couldn't contain their excitement.

Another smile from mom..

After a couple more surges, baby slithered out wearing his cord around his wrist and with his hands against his chest... as if making du'a :) SubhanAllah.

Dad received baby, and after mom turned around and sat back down, Dad put baby on her chest.

What a beautiful moment.

We helped mom take her shirt off for skin-to-skin with baby. Then her sister and I left the room to let the new family bond and enjoy their magical moment together.

The mother was ecstatic and incredulous. Baby was alert and taking in his new world with bright eyes. They were both tired and enjoyed a good sleep. I left soon after and learned that the placenta came a few hours after that. 

Mother went to the clinic at night and got a few stitches (which she didn't appreciate) and was so happy and grateful for her beautiful birth and baby.

Alhamdulillah ala kullihaal! What awesomeness HE creates everyday in birth, through the simplest yet most profound moments.

I don't usually blog about the births I attend, because its the family's story to tell and not mine.. but it would be a shame not to share the sheer awesomeness of it.. plus mom gave permission.. hehe.

Congratulations and Mabrook to the amazing mother and father! May your son be the coolness of your eyes, and may you live to tell this wonderful tale to his children :)


Note: I do not promote unassisted cildbirth. This family decided they wanted an unassisted childbirth because they believed that it was the best for them. They are well-researched and informed and they made and informed decision. They were going to birth unassisted anyway, whether anyone was with them or not. I was just a companion.

Just recently one of the moms in my class related what her doctor told her when she asked if her baby could delay getting a Vitamin K shot at birth. The doctor told a story of a mom under his care who refused to immunize her newborn with Vitamin K and the child suffered brain hemorrhage as a result, and his skull had to be drilled into for operative surgery. 
I was surprised at this, not of the story, but of the fact that her doctor told it to this mother with such vividness and detail. 

For all intents and purposes, the mother was trying to make an informed decision about her baby's well-being. By telling her the story the doctor was not helping her make an informed decision. In fact, he was scaring her into complying with hospital practices. What he should have done was given her information about the benefits and risks of Vitamin K injection at birth, (This is a good one for example http://drbenkim.com/vitamin-K-shot-baby.html) and if he really needed, he could have mentioned he had seen cases of brain hemorrhage before. But to tell the story the way he did, it was clear he was trying to scare her. It is downright unprofessional, and something no doctor should do. In any case, it would be the pediatrician's jurisdiction when it comes to newborn immunization, not an ObGyn. 

When I was pregnant with my first, I would be ready with a long list of questions to ask my ObGyn at each antenatal appointment- about whether I could birth in different positions, about whether I'd be given enemas, episiotomies on routine, about her induction practices, etc.. But every time I tried to bring up the topic with her, she'd hush me with a wave of her hand and start throwing me statistics about deaths in births. She'd say things like "Did you know, every year, 7 babies die in childbirth?" ... and I would be left re-considering what I was asking of her, whether it really was too much to ask. I have since learned that it is definitely not too much to ask. In fact, I didn't ask enough. I should have insisted she make known her c-section rates (she also waved this question off with a vague "well it depends, sometimes 20%, sometimes 50%" ??!?), her induction rates, her episiotomy rates, and many more. And I was also in a system that supported this kind of disclosure (in Australia its mandatory that doctors and hospitals be transparent about these data).

My point is, scaring pregnant women by telling them stories of maternal or infant death or injury is an extremely unprofessional and irresponsible way for doctors to get women to do what they want you to do. Under no circumstances should a doctor resort to these scare tactics if he is a true professional... because this can have devastating effects on the psyche of the mother. In many cases the mother is left feeling unsure and insecure about her body's ability to birth naturally.

Families have a right to make informed decisions about their baby's births and care in the immediate post partum period. Sadly this is NOT supported in many hospitals or with many doctors in Malaysia today. Many doctors will order prenatal tests, prescribe drugs without bothering to explain to parents about why they think this is needed or bother even getting their consent.

Before families make decisions, remember you have the right to know "BRAIN": - 
 B - What are the benefits of a particular procedure?
 R - What are the risks involved?
 A - Are there any alternative courses of action/ options that we can explore / consider?
 I - What is my gut instinct?
 N - What if I don't do anything and let nature take its course?

And you also have the right to a second opinion. 

The more families make known their request for less biased, more accurate, evidence-based and complete information, the more the maternal health community will take note and perhaps some improvement can come about. 

Yay! Really excited that an article of mine got published in OnIslam.net!

Here's the link http://www.onislam.net/english/family/moms-and-dads/457732-childbirth-gentle-initiation-into-motherhood-.html

My firstborn turned 5 a few days ago. A bitter sweet event for me. The baby days of my chubby cherub are gone forever.. The one chance to lay the foundation right...gone!! ekkk..

So before I get over emotional, I'm so grateful that I even got the chance to ever become a mom.. Sarah Ayesha has been a teacher to us in many ways.. Alhamdulillah. Hope and pray that I did right by her and fulfilled the tryst accorded to me.. Du'as for our family is very much appreciated thanks :)

Let's hug our little ones today!

How exciting that there are more and more studies being done about the effects of pregnant and laboring women's emotional and mental states on birthing outcomes. This particular study finds that women who fear birth have longer labors. 

http://thechart.blogs.cnn.com/2012/06/27/fearing-childbirth-may-prolong-labor/

http://www.cbsnews.com/8301-504763_162-57463127-10391704/women-who-fear-childbirth-have-longer-labor-times-study-finds/ 

Researchers at Akershus University Hospital in Norway found women who feared giving birth were in labor for 1 hour and 32 minutes longer, on average, than those who had no fear. 

"I'm glad there's now evidence to say that," Fischbein said, "but it's obvious." 

...duh...

According to the study, women who are fearful of labor and birth have longer labors and are more likely to need emergency c-section and assisted delivery (vaccum/ forcep extraction). 

Now, is that really a wonder? 

Grantly-Dick Read, in the early twentieth century, talked about how fear affects the effective working of the uterine muscles. Go back to the earliest times - the fathers of the Grecian school of medicine - Hippocrates and Aristotle -talked about the importance of the woman's emotional state, and the mind-body connection in labor and birth. Even the Qur'an tells us the story of Maryam r.a. and how she was told by Allah swt "not to grieve" and to delight in the sustenance (dates and water) that He provided. 

And yet, modern medicine is just recently becoming interested in how our emotional and mental states affect our physical, biological states. It has been so focused on treating the body in isolation and as separate and independent of our mind and spirit. 

Indeed it is an exciting time.. as Elena Tonetti says "We are approaching an era where science and spirituality are converging.."
Hear hear.

Huh..
Interesting study of the title above -- comparing women's attitudes towards birth with birthing outcomes and experiences.

http://7thspace.com/headlines/415452/the_influence_of_womens_fear_attitudes_and_beliefsof_childbirth_on_mode_and_experience_of_birth.html

 "Conclusions: In this study three clusters of women were identified. Belonging to the 'Fearful'cluster had a negative effect on women's emotional health during pregnancy and increased the likelihoodof a negative birth experience. Both women in the 'Take it as it comes'and the 'Fearful'cluster had higher odds of having an elective caesarean compared to women in the 'Selfdeterminers'. Understanding women's attitudes and level of fear may help midwives anddoctors to tailor their interactions with women."

 

I stumbled upon this interesting article yesterday about how Hypnosis is occasionally used in medical settings to help patients dissociate themselves from pain and minimize their need for anesthesia. The article is written by two Australian anesthetists.http://theconversation.edu.au/explainer-how-does-hypnosis-relieve-pain-7060 
 
For years before pharmacological anesthesia came about, patients underwent surgical procedures while under hypnosis. In present day hospital settings, patients may feel overwhelmed by external situations, such as the stress of the hospital environment, and become more vulnerable and responsive to suggestions given by their doctor. So the doctor's suggestion can function as a hypnotic suggestion - if he says "this will hurt" - the patient actually feels increased pain; alternatively, if he says "relax it will be fine", the patient feels less pain.

As a woman who has birthed twice and having been involved in the birth community for some years, this is so true when it comes to birth. The birthing woman's senses are extremely heightened. She is focused inwards and yet at the same time suggestions/ comments from others, especially her care-provider (whom she usually holds in high regard) can affect her tremendously. If her husband or Birth Companion, says positive things to her such as "Relax, Trust your Body", this can have a soothing and calming effect on her mind AND her body. If on the other hand, her nurse or doctor asks "Do you feel any pain? Would you like an epidural?"---- this will also affect her, but in adverse way. She may not have felt any pain prior to this, but once the reference to pain and drugs is mentioned, she starts to believe that she is meant to feel pain, and then she actually WILL. She then takes on the role of "helpless patient" and may ultimately unwittingly give up control of making decisions in her birth to her care-providers.

So what can we do?
1) Choose your careprovider VERY carefully

This is a major decision you'll make that may determine your chances of having a gentle birth. Interview your doctor, and observe the way he/ she talks to you and treats you. Does he come from a very cautious viewpoint about birth? Is his philosophy - birth needs to be helped by medicine? Or is he happy to let nature take its course? Usually mothers are very instinctual and can tell if doctor is just stringing her along or if he really intends to honor her wishes for a gentle natural birth.

2) In your birth preference sheet, state that you would appreciate that labor ward staff to refrain from any references to pain or drugs in the birthing room, and communicate this to your care-provider

Depending on your doctor, he may or may not have control over this. If he is known to be  a pro-natural doctor, the nurses and midwives may be used to his style of working and refraining from suggestions of medical help to his patients. Other times, its hit-and-miss - it will depend on which nurse or midwife is on duty on the day.

2) Do research about your intended place of birth well before your EDD.

Find  out the attitudes of the staff in the labor ward. This will tell you alot about what their philosophy is - Do they rush to administer drugs to you to help labor along? Do they encourage natural means of managing labor? e.g. Do they encourage you to utilize hot showers, walking, changing positions, etc? 

3) Hire a Doula
 
A Doula is a professional birth companion that supports the family emotionally and physically. Trained Doulas know the ins and outs of hospital policies and procedures and can provide the family with information for them to make informed decisions. 

4) Father/ Birth Companion needs to protect mom's space

Birthing naturally in a hospital takes a lot of effort and preparation. The hospital is a huge system which has many policies and procedures in place to ensure things flow smoothly from a medical, legal as well as business aspect. The woman birthing without any intervention in the hospital is an EXCEPTION to the rule, not the norm. So it takes a lot of effort and preparation on her part. On birthing day, the father or Birth Companion needs to be vigilant about protecting mom's privacy and space. This certainly can be done - however,  it takes assertiveness, firmness and a little bit of ingenuity :)

When I first heard of HypnoBirthing, it was during my first pregnancy and someone mentioned it in an online Islamic forum I was in. She said it was haram (not allowed in Islam). I was a little curious, but I didn't explore further as I had already signed up for independent childbirth classes with Choices in Childbirth in Melbourne. When I got back to Malaysia and read up more about HypnoBirthing mostly from Soo Wai Han's website, I reflected on my birth experience and realized that indeed I was under hypnosis. I was doing my Childbirth Education course with Childbirth International at the time, so I didn't pursue HypnoBirthing any further. 

After I birthed my second child unassisted at home, Wai Han and I became close friends as we discovered we shared the same passion for childbirth. She urged me to take the practitioner course so that I could give classes. At first I was hesitant because I wasn't sure if it was allowed Islamically. However I checked with a trusted Ustaz and he said that if it helps people it is generally allowed. And so I registered myself ...Best decision I ever made! The course taught me, in many ways, things that I ALREADY KNEW, but couldn't quite put a finger on or access easily. The principles are so simple and basic, yet we tend to overlook them. Now I use HypnoBirthing techniques in my everyday life and use the principles in any situation. 

Here's a great article (albeit slightly old one) in TIME about HypnoBirthing. http://www.time.com/time/connections/article/0,9171,1101040301-593553,00.html

Wow. How long has it taken me to create a post here huh? Truth is.. I have lots of ideas and energy when it comes to birth.. but not so much when it comes to blogging. Am not a blogger by nature.. but this skill can be honed I'm hoping. Anyway, just a prelude as to what's to come - I like photos of birth. A picture speaks a thousand words right? So I think that's what I'll do.. I'll share with you some inspiring pictures/ photos/ posters which I love and that can be the focus of the post! Wish me luck on my blogging adventure!

This particular poster is awesome. Someone (a fellow birth junkie) created it and shared this on facebook, and I'm sharing it with you here :) ...Something so fundamentally simple, yet so difficult to grasp by most people today. This would make a great poster for your birthing room/ nest... I'd like to see this poster up in ObGyn's offices/ hospital labour wards!