Changing our birth culture

The recent construction of the new block of the Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital Women and Children’s Centre is evidence of the nation’s care towards fulfilling and strengthening the quality of health care in Brunei and in ensuring the welfare of the people of the country, in line with the Brunei Vision 2035. Alhamdulillah, as citizens, we are grateful for these blessings.

While we continue to strive for improvement for the betterment of our people, there is undoubtedly areas that needs to be re assessed. With this, we take in view of the developments of the birth / delivery culture in Brunei, specifically of a mother-baby centered, gentler births, to which, perhaps, very little can be said.

We do not have to look far to learn about childbirth. In the Quran, surah Maryam provides us a lesson and a glimpse into childbirth. When Maryam labored, she was advised  to drink (hydration ), eat dates (full of nutrients and provides energy) and implied that she was active. She was also called out to not grieve. Indeed, this surah implies that childbirth is an instinctive,  natural miracle, not a mere medical procedure.

Ask a mother who has delivered in our local health centres, this pattern could be described:

A healthy pregnant mother who has reached full term and has established true labor,  checks in the maternity ward. A medical staff does a vaginal check amongst others, to see which stage the mother is in. The mother would then be left to her own devices in an unfamiliar setting, sharing a ward with other anxious mothers. Once the mother has reached active labor, she is then ushered to the delivery room alone, where the medical staff would offer a pain relieving drug to the reluctant mother so she can rest and save her energy for the pushing stage. The mother then, falls in and out of sleep, drowsy with very little effect on the pain relief. Once she has reached the pushing stage, the father to be is then invited in to accompany the mother. The mother is instructed by the midwife to push, in addition to the routine episiotomy being done to the mother’s perineal tissues and in doing so, expedite the birth. If the mother is ‘lucky’ she will have 5, perhaps a dozen or so enthusiastic cheerleading interns by her bedside cheering her on.  After the baby is born, the after birth procedure often times does not afford the mother and baby the luxury of time, by which the umbilical cord is cut immediately and the baby whisked away to be checked despite the newborn’s cry for his mother.

In the 1800s or so, before birth became institutionalized,  laboring women all over the world, across cultures,  have been laboring in familiar surroundings, cocooned with love and support by their birth partners, in this case, in attendance of the residing midwife and the husband, or other close female relatives. Birthing mothers during that time are also assuming positions that are upright and where there is freedom of movement (evidence of this can be found in the book by GJ Witkowski, 1887, A history of childbirth of all people.)

Today, In most countries where a mother led birth culture is emphasized, this freedom of movement and encouraging mothers to be in an upright position as well as minimizing medical interventions has been revived.

In view of the current routine practices of our local hospitals in the maternity care, we wish to see less effective practices to be reviewed, and more mother empowering methods to be introduced and adopted.

  1. More childbirth education for the expectant parents. Do not stop at educating the parents on the availability of drugs available at the time of labor and birth. But also, educate the parents with what their birthing body is capable to do without unnecessary interventions. Birth must be taught to be seen as something that is empowering, natural and instinctive, not one that is sick and diseased that requires medical attention.
  2. Restricting visiting hours for husbands must be put in its proper place. The last (and damaging) thing a mother needs when she is in labor is to be left alone in unfamiliar surroundings. A mother needs to be around people she feels secure and safe with to encourage the progress of her labor.
  3. Procedure and routines done on the mother needs to get consent from the mother. Her wishes also needs to be respected. A mother needs to be aware of risks in medical interventions and not merely offered a drug because it is a routine. This is called making informed decisions and it NEEDS to be documented and not verbally expressed.
  4. A mother who has wishes to go through her labor and birth unmedicated needs to be heard and supported not just physically but also emotionally and spiritually – not by offering repeatedly of pain relief drugs that silences her and hinder her freedom of movement.
  5. Episiotomy is a surgical incision made in the tissues of the birth canal just before the baby is born. The World Health Organisation (WHO) states that  limiting the use of episiotomy has a number of benefits, ‘.. less.. trauma, less need for suturing and fewer complications…’ This medical procedure can cause trauma to the mother’s genital region and is considered a violation of woman’s human rights amongst natural childbirth advocates. Yet, this is  routinely done, unnecessarily, in our local hospital, even against the wishes of the mother.
  6. Employ updated, birthing props that can help and support the mother. Water tubs for the laboring mothers can provide natural and huge pain relief. In the Kingdom of Saudi Arabia where birth culture has conservative roots, a scene of change in the birth culture in AYA Hospital in Jeddah and in Al Salam hospital in Riyadh have already taken place, with its recent employment of laboring / birthing water tubs and other upright birthing tools. In our local hospital, mothers are very often left suffering in silence in hospital beds,  with  less effective pain medication that has rendered her passive, inarticulate and drowsy. A drugged mother is a mother who is disconnected with her natural and instinctive urges in labor. A mother who is not drugged works with her body, by assuming upright positions or side lying positions, by coached breathing, by utilizing her voice and also support from her birth partners.
  7. Our hospital’s birth plan needs to be a formal and comprehensive document and not merely 2 small pages that are asthetically pleasing. Every mother needs her birth plan to be heard, discussed and honored.
  8. There needs to be more lactation consultants in the country and more breastfeeding support and breast feeding education groups. While we appreciate and applaud the Health ministry’s move in giving away free breast pumps, let’s examine, and make more improvements to help the new mother and baby off to a good start in breastfeeding.

Many normal routines done on a mother are unnecessary. They are performed as a matter of protocol without assessing the need. In unfortunate cases, they leave a mother traumatized and emotionally scarred. Leading organisations like ACOG (American Congress of Obstreticians and Gynecologists ) and WHO (World Health Organisation) have removed many of these routines from the recommended list of protocols like episiotomy, immediate cord clamping, yet they are still done to the detriment of mothers today.

And while many mothers do need these medical interventions to save lives. There are a majority of mothers who can birth naturally and would want to.

It must also be said, that reviewing the current birth culture is not enough. Expecting mothers must be committed to work hard  during her pregnancy to prepare for her birth. This can be done by looking after her nutrition, a commitment to exercise, preparing mentally and spiritually and also by reading and educating herself on birth. Though by doing so does not guarantee a favourable outcome, it is in the expectant parents’ best interest and responsibility to prepare as they start their journey into parenthood and ultimately also in having confidence and trust in Allah’s timing and decree.

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