Pregnancy and labour are supposed to be natural and normal events. They provide woman with unique opportunity to learn about her body and soul. Woman experiences changes in all aspects of her life as the pregnancy progresses and thus she can experience transformation into intuitive, relaxed and receptive mother. She is given a chance to find out how powerful and competent she is by faciliating to bring a new life to this world.
THERE was a time when birth belonged to women. This was a time where they labored at home and chose only their dearest, most trusted companions to accompany them during their journey. Modesty and privacy were respected, masha’Allah. In days of old, midwifery was the common model of care and doctors were only invited in for major complications or difficulties.
Midwifery, as a profession, evolved and was passed down from generation to generation. These were women who were skilled in handling most complications. But they also possessed a certain art in the gentle and patient way that they approached a woman in labor. The women who served as midwives did so out of sisterly love and a true passion to ease the hardships of birth.
Our beloved Prophet (sallallahu alayhi wa sallam) said,“Whoever relieves his brother [or sister] of a hardship from the hardships of this world, Allah shall relieve him of a hardship from the hardships of the Day of Judgment. And whoever makes things easy for a person in difficulty; Allah will ease for him in this world and the Next. And whoever conceals (the faults of) a Muslim, Allah will conceal him in this world and the Next. Allah is forever aiding a slave so long as he is in the aid of his brother.”[Sahih Muslim, al-Tirmidhi, Ibn Majah and others]
The field of obstetrics was formally introduced over four centuries ago. With it came an abundance of men. These were not male companions or maharm (close male relatives); they were strangers with medical training. But they didn’t take over birth right away.
In Ina May’s Guide to Childbirth, renowned American midwife, Ina May Gaskin, explores textbook entries about childbirth in American obstetrics prior to the current hospital birthing era. She looked at texts of old and found that obstetricians were taught to wait outside the laboring women’s bedroom door until summoned in by the nurse or midwife in attendance. According to her research, there is evidence in these writings that teach about the importance of modesty in the labor and birth process. Doctors of that time respected the woman’s need to labor and birth in private and only entered if there was a true need to do so. In fact, they keenly understood how the unwelcomed or rushed presence of a male observer could actually stall or shut down even an active labor.
Over the years, the obstetric model of care took over birth in the United States and many other regions of the world, including Saudi Arabia. Birth moved out of the home and into the hospital and the sisterly model of midwifery care was greatly diminished, and in some areas, completely lost. Sadly, the importance of birthing modesty is often times overlooked in a hospital setting. This can be particularly troubling in Saudi Arabia, where modesty is ingrained in the culture and deen (religion).
Skill of Modern Day Midwives
American actress and natural birth advocate, Ricki Lake, produced an amazing documentary, The Business of Being Born. This film is a very poignant comparison of the care given by modern day midwives as compared to hospital-based obstetricians. I want to mention a few points that really stood out to me.
When birth moved to the hospitals, midwives were mostly left behind. Consequently, the public opinion of midwifery care was greatly damaged. Women began to fear birth and the false beliefthat “birth could only safely takeplace in the hospital setting under the care of an obstetric surgeon” set in.
Observing the modern-day midwife in the film taught me a few things about midwifery care in general. I gained a heightened respect for the profession and realized that these women are highly trained, skilled professionals. They are capable of recognizing, diagnosing, and handling most complications that arise in pregnancy and childbirth. They are skilled in natural birth and are equally able to assess which cases truly should be handled in a hospital setting with an obstetric surgeon. They carry quite a load of equipment and medications with them to the birth and are thus quite prepared to handle most emergencies. In fact, they have much of the same equipment in tow as a hospital, unless a surgery is needed (including medication and equipment for postpartum hemorrhage and neonatal resuscitation). Frankly, they are more adept at the art of birthing than most obstetricians…unless a surgical procedure is truly warranted (which is far less often than is currently done).
I’ve chosen to compare Saudi Arabian midwifery to American and European because of similar economic status and level of infrastructure development. When I discuss midwifery in these regions I’m referring to highly skilled and trained professionals. Their level of education is typically at the university level with regards to their midwifery training. They are true medical experts who have invested a great deal of time and study to their work.
In the States, most midwives work either in home-based practice or in stand-alone birth centers. However the laws relating to licensure and the practice of midwifery varies from state to state. There are also hospital-based midwives who work side-by-side with obstetricians. They typically carry the low-risk caseload of their obstetric peer. Regardless of the model of practice, midwives handle a relatively few number of births (+/- 5%).
In Europe, many countries employ the midwifery model of care. Women rarely see an obstetrician during their pregnancy. If obstetric care is utilized, it is due to some complication or problem in the pregnancy, labor, or birth. Midwives typically are assigned to home births or are hospital-based. Regardless of birthplace, midwives exclusively handle the majority of the births in Europe (+/- 75%).
Interestingly, Europe has far better outcomes in terms of maternal and neonatal mortality than the United States. According to www.midwifeusa.com: “The World Health Organization (WHO) states that the preferred location for most births is outside the hospital, either at home or in a birthing center, and that out-of-hospital birth should be implemented and maintained as the basic standard for all midwifery education and training programs.”
Modern Midwifery in Saudi Arabia
I’ve been told that it is illegal for any medical professional to attend a birth outside of the hospital. However, this is only hearsay, as I haven’t looked into the specifics of the law myself. But assuming this is true, home and/or birth center midwifery care simply aren’t options today. In fact, the Saudi model of maternity care most closely mirrors that of the United States. Considering the low ranking of the United States amongst developed nations in consideration of maternal and neonatal outcomes, this is really not the best model to copy, in my opinion.
Alhamdulillah, we do have hospital-based midwives here. But what I find is that many of them function more as obstetric nurses than as autonomous midwives. That is midwives:
don’t usually preside over the woman’s care
don’t deliver babies
typically work under direction of obstetricians
usually only carry out doctor’s orders without much decision-making authority
There are, however, a few true practicing hospital-based midwives in our midst, masha’Allah. These are typically European, South African, or Canadian trained. They may also come from the American home or birth center midwifery model.
Unfortunately, the hospitals that allow midwives to lead maternity care and actually act as the birth attendant for women who ask for it are few and far between. Often times this aspect of service is not well-known. But they are the true gems of the current birthing era.
However, even within those hospitals, births are still primarily attended by obstetricians. This is due mostly to the public opinion and false belief that “birth could only safely take place in the hospital setting under the care of an obstetric surgeon.”
Shift of Care
I have heard of the progressive research of Saudi government consultants and regulators into the successes and safety of the midwifery model of care. Unfortunately, I have not been privy to much of this information as it comes to me primarily as hearsay from Arabic news articles (which I can’t personally read). But I am hopeful and confident in the government’s concern for the safest and most practical care for our women and babies.
I pray that this article supports the already existent work towards an in-depth review of the worldwide data regarding natural birth and midwifery. I am quite confident that when the powers-that-be are able to review such information, they will naturally come to the conclusion that a responsible move is warranted from the U.S. obstetric model to the proven and superior midwifery model of our European counterparts. I personally support any such research and would be excited to participate in the behind-the-scenes work to build the needed infrastructure.
I pray that any such efforts are guided and blessed and that significant findings are reached to support natural birth and the midwifery model of care. From that point, our birthing culture will shift to emphasize such evidences in the education of birthing professionals and expectant women,insha’Allah. In this way, public opinion will be positively influenced with regards to the importance of natural birth and the professional and preferred care provided by midwives, with obstetricians continuing to provide support for the rare cases of severe complication.
1 Gaskin, I. M. (2003), Ina May’s guide to childbirth. USA:Bantam Books.
2 Lake, R. P. (2008), Video Documentary:The business of being born. USA:Epstein.