After what can often be a nerve-wracking nine months, the thought of labour looms large for most of us. Caught up in a flurry of scans and antenatal appointments, it’s easy to get swept away on a medicalised path without necessarily considering whether it’s what is right for you and your baby – but is there another way which puts the mum-to-be in control? In low-risk pregnancies, the consensus among the global medical community is that a ‘natural’ birth – i.e. a vaginal delivery with little or no medical intervention – is the best option for a happy and healthy mum and baby. The idea of a labour without meds or minimal medical intervention might fill some women with fear, yet countless studies have shown that with the right guidance and support an empowering and even uplifting birth experience is possible.
Here in the UAE, the options for women seeking a back-to-basics birth experience have traditionally been limited, while at the same time, we have some of the highest caesarean section rates in the world. According to the most recent figures from the Dubai Statistic Centre (DSC), 41.2 per cent of births in the UAE happen through C-section -–compared to a global C-section rate of 18.6 per cent. The World Health Organisation recommends the ideal C-section rate be between 10-15 per cent.
Rising C-section rates are also breeding a lack of expertise in natural birth, according to Dr Amala Nazareth, secretary general of the Emirates Medical Association and specialist obstetrician and gynaecologist at Prime Healthcare Group,
She says: “The alarming trend is a result of a number of medical and legal factors. Obstetrics is all about the right decision-making but it is a dying art for fear of legal implications. And because deliveries are increasingly done through C-section, we are seeing a lot of problems, including perinatal morbidity [disease immediately before and after birth] and respiratory distress syndrome.”
For women hoping to have a ‘natural’ birth, the perception is still that this is a tough task in the UAE, says Lala Langtry-White, a Dubai-based doula and hypnobirthing specialist:
“I think women here are possibly made to feel that they are required to fulfil more criteria to be supported in vaginal birth than in other countries,” she says. “We base our choice of hospital and OB so much on recommendations from friends or social media, which is quite unusual, and the protocols vary greatly from hospital to hospital, and even doctor to doctor, without evidence to show they have a positive effect on birth outcomes.
"You should put at least as much time and effort into researching the sort of labour and birth you want as you put into looking up the type of stroller or car seat you buy."
“I also think that as a culture we naturally place our unwavering trust and care under the management of our doctor, often putting them on a pedestal. Instead I’d like to see more women putting themselves at the centre and ensuring that everyone surrounding them is there to support them in their personal desires for their pregnancy, birth and baby – I don’t know of any woman wanting anything other than what she considers the best for her baby.”
Nikki Oliver was a midwife at Dubai’s Al Zahra Hospital until earlier this year when she decided to devote herself full time to providing women with antenatal education and labour coaching. She agrees that a natural birth experience can be harder to achieve in the UAE. She says: “Having a natural birth here in the UAE is not always difficult. But in all honesty, it should be much easier than it is. I do know women face many barriers when they verbalise their birth preferences. The ‘natural’ births I have seen here have reinforced my belief in women’s bodies, mental strength and in normal midwifery care. Despite the high caesarean section rate, the majority of women in the UAE really strive for ‘normal’ deliveries.”
In the UAE, home birth is not a legal option for mums-to-be, and there is a lack of birthing centres without the traditional hospital setting, impacting the options for non-medicalised deliveries, contributing to C-section rates.
Lala believes there’s a shared responsibility in ensuring women avoid unnecessary surgical procedures.
She says: “Having a caesarean section has far greater impact than just the surgical risks and ramifications of the individual birth and associated healing time. In the short term it can affect the way a woman feels about her birth experience, especially with the dreadful ‘too posh to push’ stigma presuming caesarean birth is the ‘easy’ option – I can assure you it’s not!
“We live in a revenue-based birth climate which, if I’m being cynical, could be considered a major contributory factor. Added to that is the fact that there’s often pressure placed upon the rising demographic of families who fall into a ‘high risk’ category – such as those with diabetes, those who have conceived via IVF, those expecting multiples or older mothers – where there is often an obstetric preference for caesarean birth.”
Do your research
The first step in getting the birth you want is to arm yourself with knowledge, says Lala. “While it’s the responsibility of all birth professionals to advise, we as women need to take a more active role in our care and better educate ourselves on the evidence-based research about pregnancy and birth and rather than passively trusting an opinion – ask for it to be backed up with proper evidence before making an informed choice.
“One of the benefits of living in a culture of private healthcare is that we can choose the hospital and doctor we feel best supports our needs and desires for our birth. I would encourage women to do their own research; ask questions, work out and speak up for what is important to them.”
“One of the benefits of living in a culture of private healthcare is that we can choose the hospital and doctor we feel best supports our needs and desires for our birth."
Fellow Dubai doula and birth worker Yasmin AbuAyed agrees that it’s crucial for mamas-to-be to do their homework, putting in the preparation ahead of delivery day. “Generally it doesn’t cross our minds to question anything a medical professional tells us, or that we need to look in depth and research our own birth. But as things are, that’s exactly what you need to do if you want a satisfying experience. You should look into the birth at least as much as you research which stroller or car seat you want.”
Midwife Nikki Oliver says that choosing a doctor with a similar mindset to your own is key: “Having a doctor who fully supports your idea of birth and who trusts in and works closely with midwives is the first step on the journey to achieving your desired delivery.
“My advice for any couples wishing to seek support for their natural delivery is to thoroughly shop around well for a doctor. There are many facilities with water birth and hypnobirthing rooms, which is a fantastic step in the right direction, just ensure you feel comfortable with the staff in these units. A pool and some pretty lights does not a good facility make. The midwives will be crucial to achieving your positive birth experience and advocating for whatever birth preferences you have.”