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.

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 :)