The natural way
THE birthing process is nothing short of a miracle. It is a process that not only impacts the mother and child physiologically, psychologically and emotionally but also the many individuals who are involved.
Malaysia has achieved a 98% safe delivery rate since 2009, which is on par with many developed nations, thanks to improved medical infrastructure and well-trained obstetricians and gynaecologists (OB/GYN).
There seems to be growing awareness among mothers to opt for alternative delivery methods that often come under the umbrella of natural birthing and home birthing.
Although there is no available data on safe delivery rates by alternative birthing methods, there is much promotion and talk among various natural birthing support groups, organisations, advocates and even on online forums, suggesting a growing trend.
For the purpose of this article, natural birthing is defined as vaginal childbirth without routine medical interventions, including the use of epidural anaesthesia and painkillers.
Many of these birthing options usually take place at home under the care and service of a midwife, delivery assistant, doula (professional birthing companion) or even medical personnel.
A matter of choice
Although mothers have the right to decide their childbirth and delivery method, consulting an OB/GYN is crucial before making any decision.
“Natural childbirth may be suitable for mothers who are categorised as low risk, without any problems in their previous pregnancy and delivery. Her current pregnancy should be without any risk and with no expected complications during labour,” says Dr Bavanandan Naidu, obstetrics and gynaecology consultant and maternal foetal subcommittee chairman at Obstetrical and Gynaecological Society of Malaysia.
He adds that expecting mothers and fathers should talk to their OB/GYN about going through natural childbirth in a hospital setting and get educated on the different delivery practices by attending classes and courses together as well as learn natural pain management techniques.
Advocates for natural birthing often promote that with effective methods and techniques, mothers who are in childbirth will experience less pain and discomfort and even enjoy the childbirth process. Advocates also say that natural birth is beneficial for both mother and child.
“When a healthy mother has a natural birth, her body releases hormones during labour that prepare the mother physically as well as psychologically for the great task of mothering her newborn.
“Although it is hard work, her body naturally releases the hormones needed to withstand the intense sensation of labour,” says Nadine Ghows, hypnobirthing childbirth educator, doula and breastfeeding peer counsellor at Gentle Beginnings Malaysia for the past six years.
According to Ghows, midwives are medical care providers who can identify when there is a medical emergency and know when to refer to an OB/GYN while a doula is a professional birth companion who provides emotional and informational support to the family but is not able to make decisions for them.
“She usually accompanies the mother throughout her labour in the hospital. She is not medically trained and, therefore, is unable to recognise a medical emergency. That is why she attends to births at hospitals where medical professionals who are able to identify emergency cases and render medical help are present,” she adds.
Many developed countries such as the United Kingdom, the United States and other nations in Europe are champions of natural childbirth so much so that it is now a subculture within some communities. In fact, 25% of births in the Netherlands are conducted at home with a qualified midwife.
Additional data from the aforementioned nations show that home births have high vaginal delivery rates with C-section rates (in case of an emergency) of less than 10%, low morbidity, reduced healthcare cost, low intrapartum and neonatal death rates.
It is important to note that these countries have well-trained and certified delivery experts who are able to assist in natural child birthing at home and are able to deal with complications in the case of an emergency.
Ensuring safety
Natural birth has never been short of debate here in Malaysia. Simply put, there is a question of whether the country has adequate professionals and infrastructure to conduct natural births safely.
There have been reports of complications during natural and home births due to delayed medical intervention. This has caused various issues, including the Health Ministry questioning the safety of natural birthing alternatives as well as the people that are in contact with the mother during delivery.
“There is a need for intervention when the progress of labour is delayed, when there is an evidence of foetal distress or there is postpartum haemorrhage or bleeding. Avoiding immediate medical attention poses a risk of poor neonatal outcome or a risk of major obstetric haemorrhaging,” says Dr Bavanandan.
In light of unwanted incidences, the Health Ministry has put a ban on water birthing since July last year, including those offered in private medical centres. The ministry has assured that once a proper guideline has been set, the ban will be lifted.
“The Health Ministry is in the final stages of finalising the guidelines on water birthing. These guidelines have been prepared by the Health Ministry as well as the private sector. This is to ensure that the birthing process is safe for the mother, baby and the obstetrician,” says Dr Ravichandran, who is currently president of the Obstetrical and Gynaecological Society of Malaysia.
In a response to an open letter dated June 5, 2015 published in a local online news agency, director general of health Datuk Dr Noor Hisham Abdullah said on his official blog that the Health Ministry takes the advocacy of natural and home birthing seriously especially when it comes to the safety of mother and child.
He also said that births not conducted by an OB/GYN should be conducted by registered midwives under the Midwives Act 1966.
The local Confidential Enquiry into Maternal Deaths (CEMD) and Maternal Death Surveillance and Response (MDSR) findings also indicate that midwifery training is lacking and the Government has introduced Advanced Diploma in Midwifery to improve delivery healthcare in Malaysia, thus providing more birthing options for mothers.
“Attending to home deliveries is par the training for our midwives in their Advanced Diploma in Midwifery course.
“In the Health Ministry’s Perinatal Care Manual 3rd Edition, there is clear flowchart on how to handle home deliveries.
“However, it must be understood that the Health Ministry encourages facility-based deliveries,” says Dr Ravichandran.
He adds that there is a need for more trained staff to allow for home deliveries upon request.
Despite increasing the number of midwifery trained nurses, there is still a shortage of staff and the Health Ministry is currently addressing this issue.
In addition to this, medical professionals including OB/GYN and midwives can be held responsible for any complication that could arise from any delivery where there is no timely medical intervention and jeopardises the safety of mother and child.
Hence, it is crucial for expecting mothers and their partners to ensure that the right professionals are available during their natural birthing process.
Joint effort
In addition to working together with natural birthing advocates and professional healthcare providers, Dr Noor Hisham’s response also states the Health Ministry has had discussions with advocates and medical professionals in providing safe birthing methods for Malaysian mothers.
Ghows believes that home birth is a viable option for many expecting mothers as long as there are adequate emergency response infrastructure and facilities as well as qualified medical professionals willing to supervise home births.
“A system’s ability to offer the options of home birth would depend on its ability to provide thorough and holistic antenatal care of the mother throughout her pregnancy and birth including education and follow-ups on nutrition, exercise, and emotional and psychological well-being of the mother,” she says.
Dr Bavanandan also says there may be hope for improved home birth care soon with the guide and aid from the Health Ministry.
“As for now, there are no formal guidelines for home birthing in Malaysia but I believe it is at the final stage of preparation,” he says.
There is still some way to go before Malaysia is competent in handling natural births, including those conducted at home.
“Government bodies, the Obstetrical and Gynaecological Society of Malaysia, the Malaysian Nursing Board, private midwifery colleges, private practitioners and other organisations can work together by having an open dialogue every few months to listen and understand the concerns and needs of each party.
“Only through dialogue and discussion are we able to understand each other and provide mothers and families with birthing options that are safe as well as evidencebased,” concludes Ghows.
Mothers and mothers-to-be can speak to their doctors about delivery without epidural anaesthesia and painkillers if they have been given the green light and have had a safe pregnancy.
Options are always a good thing. However, mothers-to-be need to be well educated and make informed choices when it comes to birthing methods.
Keep your OB/GYN a part of the process every step of the way as their medical advice is vital to ensure a safe and joyous birthing process.