Recently I was interviewed on BFM 89.9 in their "Careers Unusual" segment about my job as a Doula. I guess its an unusual job - seeing as there are less than a handful of certified doulas here in Malaysia. I was excited to be on air, because there really is so much misconception about what a Doula actually is among doctors, nurses, hospitals and the general public.

Some think we are there to make medical decisions for the mother. This is completely untrue. We are non-medically trained professionals who provide emotional and physical support to the family throughout labour and birth.

We actually have quite a tough job - because on the one hand, we are employed by the mother and father, yet on the other hand we are in the hospital premises and in the delivery suite. So its really important to work well with the labour ward staff. The staff - nurses AND doctors - can view us as a threat if they don't understand what our role is.

And lately Pantia Bangsar has issued a directive for mothers wanting a doula at her birth to sign a notice of understanding which states the role of a doula at birth is questionable at best and "risky". 

Although the Ministry of Health has come up with the latest Mother Friendly Guidelines "Program Mesra Ibu" that clearly states mothers should have continuous support throughout labour and birth by a birth companion - be it her husband or a doula. It seems this is merely lip service. Many government hospitals still do not allow even husbands to be present with the birthing mother during labour and birth.

Some other misconceptions include:
Q1. Are doulas governed by a regulatory body?
A: We obtain training from the certifying body e.g DONA/ CBE/ AMANI and we are required to re-certify every year. This body is independent.

Q2. Do we attend homebirths?
A: Some do - but I don't anymore. Some certifying bodies e.g. DONA do not condone their doulas attending unassisted births

Q3. Are doulas employed by the mother or by the hospital?
A: We are independent and employed by the family, and therefore have to a duty to protect her space during labour and birth and do what is necessary in the labour room for mother to achieve the birth she wants - such as advocate for her choices.
HOWEVER we cannot completely disregard the hospital staff. In fact its very important for us to develop a good working relationship with them. This can sometimes be tricky to know when to advocate for mother and when to be flexible considering the individual circumstances.

Q4. Do doulas provide information to the family?
A: Yes definitely. We can provide the family with research and evidence-based information to enable the family to make an informed choice.

Anyway, have a listen to this podcast. It may shed some light on what the role of a doula is.

And please comment if you've any feedback or questions :)

I’m still reeling with oxytocin from a recent birth. It was a beautiful VBAC waterbirth!! I can't blog about it until I get permission from the mother. So I'm going to talk about my experience instead! haha..

This was my FIRST time doula-ing at Pantai Cheras. The hospital just began to offer waterbirths a couple of months ago. And this was the first time their delivery suite ever had an official doula present at a birth! So I was excited, but wasn't exactly sure what to expect – especially from the staff.  I had heard the waterbirth room was small... but really mothers have birthed in small buckets before..lol..so I wasn’t too concerned about that.

The mother was doing beautifully all throughout her labour and went to hospital only when it got really intense. So when we arrived at the hospital she was already in her ZONE - quiet, focusing inwards.

The environment in the delivery suite was rather busy and noisy - staff talking on the phone and to each other, rushing in and out of rooms. Just outside the waterbirthing room was a desk with a phone, so everytime the phone rang, we could hear it. The door to the room was a glass foldable door and not sound proof, so if it wasn't completely closed, we could hear the sounds of the nurses talking outside.

There was a flurry of activity as the mother entered the birthing room and tried to settle in. The pool was about a third way filled, but mom couldn't wait and immediately got in.  There were a number of nurses entering and leaving the room trying to fill up the pool and get the water to be the right temperature. To do this they had to drain some cool water out of the pool using a pump and fill it with hot water which they had to get from a thermopot outside of the room (in addition to hot water from a hose attached to the waterheater). So there were staff going in and out of the room frequently. The pool is a LaBassine pool, so it took some time to fill.

The nurses were trying to get the CTG machine strapped on to mother’s abdomen and at just the right spot to be able to get a good reading. This was a wireless CTG machine - the FIRST ever being used in Malaysia as far as I know. The nurses tried to get mother to lie back, but she couldn't. The only comfortable position for her was leaning forward onto the side of the pool. At one point, there were three nurses hovering around the mother - one trying to drain water from the pool, and another two adjusting the CTG machine on mother's tummy.  Mother shifted uncomfortably and was visibly annoyed. I felt slightly helpless at this point - should I say something? I didn't think it was a good idea to say anything just yet because we had just arrived, and I didn't want to turn the staff off working with doulas ever again. Lol. So instead, I focused my efforts on mother and trying to get her into her zone again with massages and hypnosis. I silently prayed that the fuss would soon settle.

After several subtle attempts by me to get the nurses to leave the room and quiet down and close the door, the activity died down and it was quiet at last.  Father joined us after some administrative work and the two of us worked to make Mom as comfortable as possible, and protect her space.

Every so often the CTG machine would beep and disturb the silence. I was SO grateful for this GREAT tool that enables mother to move around freely in the tub, but at the same time, I was cursing it under my breath!! I knew though that it was important for the staff to get a good 20-minute strip reading especially with a VBAC Mom, so I just had to bite my lip and hoped Mom could endure the hassle just a little bit longer. It took quite awhile to get it at exactly at the right spot, and even then the reading would only last a few minutes before the trace went off again.

I can't give too much away about the birth story (hope the mother writes her story soon!) but Dr Tan arrived after a few hours. She did one final adjustment to the CTG and it stuck! Hah! (Dr’s touch ;) )

Mom was left alone for a few more hours, and before long, baby finally made her slippery entrance into the pool and was placed onto Mom’s chest. Tears and words of joy all round! Mom was incredulous!

It really was a beautiful birth - the star of the show of course was mother - and I really can't wait for her to write her birth story. But as far as the staff at Pantia Cheras is concerned - they were really great! Two thumbs up for effort – most definitely!! They had never really been exposed to a doula and other requirements of HypnoBirthing mothers apart from taking the lead from Dr Tan (who is a HypnoBirthing Practitioner herself) ..but they had positive attitude about supporting the mother and father, and this speaks volumes. 

Pantai Cheras had 6 waterbirths prior to this one, but I was glad and relieved that the staff accepted and acknowledged my presence and my role and were willing to cooperate!  Of course things could have been much better with staff being more respectful of the mother's needs for privacy, quiet and getting informed consent before carrying out things like taking her temperature or taking her blood pressure, etc., but this can all be learnt in time.


Dr Tan really has to be given most credit. She really is one of those rare ObGyns who is willing to stick up for what is right, rather than what the system dictates, and because of this many mothers have been able to enjoy undisturbed births in medicalised settings.

I’m excited for mothers who will birth in the future- especially for mothers who will birth in Pantai Cheras. With more training of staff on the needs of HypnoBirthing/ natural birth mothers, I can see much improvement in catering to natural birth mamas.. and who knows, maybe one day Pantai Cheras will be a hub for natural birth mamas to go to. And there are already plans for training in the near future!!

So in short, I HIGHLY recommend considering waterbirth @ Pantai Cheras :)

BUT of course, as with all other hospital births, the mother herself has to be extremely mentally and emotionally prepared. This mother ROCKED her birth and I'm sure many more mothers will in the future inshaallah, with the growing awareness about natural birth.

I'm so excited to finally find the time to sit and blog about this beautiful birth. About a month ago I attended an unassisted birth of a young mother and father. This was their third baby, and masyaAllah they have such a cute little family. 
A few days before she birthed, Mom was PMing me and ready to birth her baby. At 42weeks and 1 day, I received a text from her in the morning saying she started feeling her surges. I had a class that day and a talk by Ibu Robin in the afternoon. 

After class I rushed to her house. Apparently, the night before she felt intense surges after she nursed her second boy. She didn't get much sleep and was tired. She was doing well though; breathing beautifully through her surges. Her surges were long, but irregular. I stayed for a while during which she ate some lunch, then she told me to go to the talk as she felt it was still some time to go. I suggested for her to rest, and then to try going on hands-and-knees to help baby get into a more encouraging position. I left for the talk, but didn't stay long as her hubby texted to come around 4pm. 
I went to see her and when I entered the room, I noted the scent of amniotic fluid in the air. Mom was doing beautifully - relaxed and doing slow breathing through her surges, lying semi-reclined on the bed. 
She was starting to lose her patience though. "When is baby going to come?" 
"Sometimes babies have a mind of their own" I said. 
She half-smiled.

There was one point when Mom stood up and leaned forward against her husband and started to sway her hips from side-to-side. Her husband was supporting her and kissing her and holding her, and they were in a little dance together moving baby down and out.

Probably the most memorable part of the birth was when Dad kept doing light touch massage up and down Mom's arms and talking in a little girl's voice - meant to mimic their three  year-old daughter. "Nuha works", Mom whispered.. and so Dad continued to do all the impressions of their daughter, Nuha, in all situations imaginable. "Mama, Nuha ada dress!", "Its a dinosaur!". I smiled at the dedication of this couple to each other and their determination to have the most peaceful birth. "Please Allah make it easy for them," I silently prayed.

Mom then went into the toilet and cleared her bowels. After awhile she got up and went into the room and squatted at the foot of the bed. Her instinct was telling her to squat the baby out... some primal noises coming from her.. Soon she became tired. And so she moved to the bed. Dad was there by her side every step of the way - telling her he's there for her, massaging her, wiping the sweat from her face.

Not long after, Mom began to voice her doubts "I don't think I can do this"; "They'll have drugs at the hospital"

Dad and I looked at each other.

"It seems very close" I said.

"I want to go to the hospital!" she said.

"Ok, the best thing is you might birth in the car... shall we get you dressed?"

Mom seemed to change her mind at the mention of getting dressed.

Azan Maghrib was heard, and a peaceful feeling filled the room. Dad and I took turn to say our prayers and be with Mom.

Mom was starting to grunt and make guttural sounds that filled the room. Dad and I held each of Mom's legs up during the surges, as the expulsive surges were taking over her body.


Silence... Calm... Dad lovingly holding Mom while Mom gave into her body's urges.

"I can see the head!" Dad said incredulously with a big grin.

"Really??" Mom said, not believing.

"He's got curly hair!" I smiled.

"Aghhhh!" One last primal sound from Mom and baby's head slowly crowned and was born.

Dad looked at his baby's head being born in sheer awe.

And then another "aggghhh!" and the body rotated to allow the shoulders to come through.

Baby had a nuchal cord. With the next surge, baby's body came out only slightly further and the cord became tighter. So I motioned to Dad to unwind the cord, and when he did, baby started to sputter.

One last surge and baby's body was out.

"Alhamdulillah!" Mom said, visibly relieved.

Dad received baby and slowly put baby on Mom's chest. 

A big smile on Mom and Dad's faces as they gazed at their new baby. Mom looking so refreshed and ecstatic! ...quite the opposite from just a few minutes before ;). 

I left the family alone to bond and enjoy their special moment.

They were chatting when I returned, and I could sense the feeling of pride, gratefulness and joy! 

Alhamdulillah! Allah is the best of architects! A family is born again :)

The placenta came not long after when Mom sat on the toilet bowl. We fed Mom dates and honey so that she would regain some of the energy she expended.

I left feeling warm and fuzzy..

"Thank you Nadine. I don't know what would have happened if you weren't there" came a text from Dad after I had left. I chuckled to myself. I find it so funny when couples say this to me.. because I know I didn't do anything.

Mabrook to the amazing mother, father and baby team who did so beautifully! Nik Umar is so lucky to have such wonderful parents such as yourselves. May he be anak solehah and be the coolness of your eyes. Ameen.

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.

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.

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