A quiet revolution is gaining momentum across internet forums, pregnancy groups and maternity wards everywhere. While for years we have been taught by popular culture and well-meaning relatives that having a baby is by nature a painful experience to be approached with fear, social forces such as the Positive Birth Movement are insisting not only that birth can be a calm and happy experience, but even an enjoyable one. Alternative birthing techniques and methodologies once thought of as the sole dominium of hippies are slowly gaining mainstream approval.
But that’s not to say we’re all about to eschew Western medicine and give birth in fields. Alternative birthing techniques can be adopted to augment traditional hospital births; as part of a holistic birthing strategy; or on their own in the case of water births. The approaches have in common that theypromise a better outcome for everyone involved – Mum, Baby and Dad – and they offer women a sense of control over the birthing process.
They are designed to address factors that can sometimes negatively impact on a woman’s birth experience, including feeling inadequately prepared (emotionally, physically or intellectually), not having the procedures explained sufficiently during labour, having her wishes ignored, feeling isolated or detached from the experience, or just the stress resulting from medical interventions and having too many people in the hospital room.
Here we speak to experts in the UAE about hypnobirthing, enlisting the support of a doula, and water birthing, as well as mums who have tried these strategies in their second deliveries and found their experience more positive as a result.
Support from a doula
Andrea Allen from Dubai-based The Doting Doulas (www.thedotingdoulas.com) sums up the role of a doula as that of a non-medical birth supporter. She explains, “Our care is constant: from the time we arrive until after baby is born, your doula will stay and support you. Unlike the medical team, we don’t change shifts and we don’t have other women to support, so we are able to be there for you all of the time.”
Who should have a doula?
There’s a common misperception of a doula as a birthing partner for women who want to have an unmedicated birth. In fact, doulas offer their services regardless of which birthing path is chosen, and they do not take over the role of the husband but, instead, provide informational, emotional and physical (non-medical) support for pregnant women.
According to the international doula association Dona, “The doula advocates for the client’s wishes as expressed in her birth plan, in prenatal conversations, and intrapartum discussion, by encouraging her client to ask questions of her care provider and to express her preferences [but] the advocacy role does not include the doula speaking instead of the client or making decisions for the client.”
Another common misperception is that doulas are midwives, but Dona is quick to stress this is not the case, saying: “Doulas do not replace nurses or other medical staff. They do not perform clinical or medical tasks such as taking blood pressure or temperature, monitoring fetal heart rate, doing vaginal examinations or providing postpartum clinical care.”
What are the benefits?
Andrea points to a recent review of many studies from around the world, which has concluded that a doula’s support can be more effective than hospital staff, friends or family. Studies and reviews consistently demonstrate impressive benefits including:
50 per cent fewer caesarean sections
60 per cent fewer requests for epidurals
40 per cent reduction in the use of synthetic oxytocin for inductions or augmentations
30 per cent reduction in use of pain medication
25 per cent reduction in labour length
increased rates of breastfeeding at six weeks postpartum
higher self-esteem, less anxiety and less depression at six weeks postpartum.
How much will it cost?
Depending on experience, you should expect to pay between Dh3,000 and Dh6,000 for a doula. Andrea says this should include two prenatal education classes, birth support and two postnatal visits at home.
How much time is involved?
Andrea says, “Personally, I meet with Mum and Dad at least twice before birth. However, I also try to meet with Mum for a coffee at least once as well.”
Read the birth story of Kate Kikano, who gave birth with a doula, here
Hypnobirthing is as much a philosophy of birth as it is a method of birthing. “This philosophy is based on the belief that birth is a natural, normal and healthy function of the body and that a large number of women are able to experience birth calmly and without excruciating pain,” says Dubai-based hynotherapist Jasmine Collin.
There are various types of hypnotherapy available in the UAE, but probably the most well-known are the HypnoBirthing and EasiBirthing programmes.
Who will benefit from hypnobirthing?
Jasmine, who is also a hypnotherapist and co-founder of Love Parenting UAE (www.loveparentinguae.com), says that while most clients choose hypnobirthing because they want a more calm and natural birth with low or no medical interventions or drugs, it’s also ideal for any couple looking for knowledge and tools to help them enjoy their pregnancies and to have a positive birthing experience, no matter what path their birthing takes. She says, “Women who are particularly fearful of birth benefit greatly as they are invited to explore where that fear has come from and release it before the birth so that they can remain relaxed during the birth and let their bodies do what nature designed them to do.”
What are the advantages for mums?
Jasmine says, “It teaches women to relax their minds and connect with their innate birthing instincts.
It helps them let go of any fears or limiting thoughts that might hinder their body’s natural ability to give birth and to enjoy their pregnancy.”
Statistically, it’s been shown that women who use HypnoBirthing, tend to have shorter and more comfortable labours and births. Jasmine points out they have less need for inductions and interventions, including episiotomy, medication or surgical birth.
They use fewer drugs or no drugs at all, which means less risk of side effects for the mother and baby. She adds that mothers are usually more awake and energised after the birth and have a more satisfying experience with faster recovery rates.
An unexpected advantage is that HypnoBirthing techniques can even help women in their everyday lives.
As Jasmine reports, “I’ve had people pass their driving tests and get over their fears of presenting to large groups using some of the relaxation and breathing techniques that we use in HypnoBirthing.”
What are the advantages for dads?
In hypnobirthing, husbands are encouraged to practise with their wives, therefore they, too, are well prepared. Jasmine explains that men benefit by gaining knowledge and confidence about their role during pregnancy and birth – from keeping mum relaxed to interacting confidently with hospital staff. It also enhances bonding with their baby, which starts during pregnancy and continues through birth and beyond.
Are there any advantages for the baby?
Jasmine says that there are plenty of benefits for Baby too – while Mum is relaxing and feeling positive during her pregnancy, her baby is feeling that too. “HypnoBirthing babies also have a reputation for being alert, easygoing and content.”
She points out that, because their births tend to be shorter, calmer and with less trauma, they have high levels of alertness at birth and sleep and nurse well due to fewer drugs in their systems. Having a confident and relaxed mother who is readily available mentally to connect with them at birth enhances mother-baby bonding and attachment.
Jasmine’s HypnoBirthing programme involves five three-hour classes held over a five-week period, totalling 15 hours of tuition. Parents-to-be can join a group or request private classes.
In addition, there are support materials and audios for home practice. “You are conditioning your mind and body to respond with calm and relaxation and this involves repetition, so there is a commitment needed for home practice. Mums should practise the techniques daily (it will take around an hour) and couples are encouraged to practise together three or four times a week for 30 minutes each” Jasmine explains.
The ideal time to start the five-week set of classes is between 26 and 32 weeks of pregnancy to allow plenty of time to practise the techniques, but any time between 20 and 35 is all right too.
The classes focus on breathing, relaxation, affirmations, visualisation and self-hypnosis. Jasmine says, “Parents come away from the classes with a toolbox of techniques that they can call upon during labour and birth. All of them are designed to enable the mother to enter a state of deep relaxation, to maximise the release of endorphins and oxytocin and to assist all the normal and natural functions of the body during birth. In the classes, we focus not just on the techniques, but on a couple’s beliefs and fears about birthing and parenting, with the aim of replacing old limiting thoughts and beliefs with positive and empowering ones.”
While classes are designed with dads in mind so that parents can prepare for the birth of their child together, if they can’t make it to all of the classes or the birth, it’s not a problem, says Jasmine. “Mums can come with someone else or by themselves and the programme can be adapted accordingly.”
How much will it cost?
Jasmine’s group classes are Dh2,200, while private classes are Dh3,500. Both prices include all materials, books, audios and ongoing support during pregnancy and beyond.
Water birthing is relatively new to the UAE, introduced by Dubai’s Al Zahra Hospital (www.azhd.ae). It hosted its first water birth in July 2015 and has now witnessed
50 of these births. We spoke to two senior members of the hospital staff – Sally Hunter-Madubuko the senior women’s health manager and midwife; and Anne Willoughby, the senior charge midwife and water birth lead midwife – about the advantages and what to expect.
Who is a water birth suitable for?
Generally, if you are healthy and between 37 and 42 weeks pregnant; have experienced a normal pregnancy with no serious medical conditions or complications; and any previous labours have been completely normal, you are suitable to use water for labour and/or birth, say the Al Zahra midwives. They add that labour should also start spontaneously.
What are the advantages?
According to Sally and Anne, the many benefits include less painful contractions; shorter labour; less need for pain relief and for drugs that accelerate labour such as oxytocin; and a more gentle birth for the baby. The relaxing effect of warm water helps produce endorphins – promoting the body’s natural pain-relief mechanism. In addition, a birthing pool supports 75 per cent of a labouring woman’s weight, allowing her to feel buoyant and comfortable. Mobility is easier, thus conserving a woman’s energy for labour. Water also helps to relax the pelvic floor muscles and soften the perineum, thus reducing the risk of tearing.
Sally adds that women are more likely to achieve a natural birth; have the feeling of being in control; and have a more enjoyable labour experience.
What are the risks?
According to the Al Zahra midwives, for a healthy woman with an uncomplicated term pregnancy, complications are seemingly rare. “A concern for some people is that the baby will breathe while still under the water – this is highly unlikely as there are many mechanisms that prevent this from happening, one of which is ensuring the baby’s head is totally submerged during delivery to prevent the breathing reflex from starting until the head is clear of the water,” explains Sally. She points out that research suggests that for healthy women with straightforward pregnancies and in full-term labour (after 37 weeks gestation) using water for labour and birth is as safe as for a land birth.
Sally and Anne say a woman should continue to see her doctors as a routine course of antenatal care, and that classes providing breathing and relaxation techniques are advisable, but otherwise, nothing additional is required as this is a normal labour and birth.
Sally explains the process: “As the birth approaches, you will know whether you wish to birth in the pool; some women prefer to birth their baby out of the water. Your baby will be allowed to birth with no one touching you, and you will be supported with verbal guidance from your midwife or doctor. You, your midwife or your doctor will raise your baby gently to the surface, head first. Your baby will then start to breathe. Once the baby has been born, his or her head must not go back into the water.” She adds,“Babies born in water tend to have their eyes open and be very calm. Sometimes the baby may take a short time to become pink. This is because the birth has been very gentle and is normal.”
As for when the best time is to enter the pool, the Al Zahra midwives say there is not enough evidence about this, but they believe it is when the labour is established.
Al Zahra does a short admission trace of the baby’s heart rate before entering the pool. Midwives will also regulate the water temperature so that the mother is comfortable. They will check the mother’s temperature, the water and the room temperature every hour in labour, and the water temperature every 30 minutes before the birth.
“If you require gas and air (Entonox) this can be used in the pool. However, if you need a pain-relieving injection or an epidural you will need to leave the pool. If you have already had a pain-relieving injection, four hours should lapse before getting into the pool.
“To maintain the benefits of labouring in water, we will try to create a calm, unhurried and relaxed atmosphere.” says Sally. “We will encourage you verbally when necessary and disturb you as little as possible at other times.”
But they will need to listen to the baby’s heart rate and regularly check the mother’s temperature, pulse and blood pressure.
The mother will be supported in labour by a midwife, her birth partner and her doctor. Your OBGYN must be present at the birth of your baby.
What should I wear?
“It is important that you feel relaxed and in control during labour so the choice of what you wear is entirely up to you,” explains Anne.
“Some women like to be naked when they give birth and find clothing gets in the way, being naked also allows skin-to-skin contact to take place straight away. Others feel more comfortable if they are wearing a T-shirt or bikini top which covers their body.
“You may want to bring a dressing gown or large towel from home because you can become cold very quickly if you need to leave the pool for any reason.” (You can choose to leave the pool at any time during labour – for example, to use the toilet – except when the baby’s head is about to deliver.)
How much does it cost?
There is minimal additional financial outlay; if you are labouring in the portable pools the charge of Dh360 for the pool liner. If you are delivering in the water birth/hypnobirthing room there is an additional Dh1,000 charge.