Monday, May 30, 2011

Saudi Birth Culture

Picture from Aisha's original posting
I thought it worthwhile to repost this entire article, written by Aisha Al Hajjar. She is an American Muslim married to a Saudi man, living in Saudi Arabia. There are many similarities between the birthing culture in Saudi Arabia and the birthing culture in Kuwait- both highly medicalized, both seen primarily as a woman's event, and both set within the context of a highly authoritative doctor/patient relationship. However, I think there might be some differences (if you disagree, I'd love to hear your thoughts!) Kuwait women seem to have more autonomy and personal freedoms-especially the highly educated. I think given access to antenatal education and the correct information, they have the potential for having a very strong voice in the region. I think in general, Kuwait is an urban, open, and progressive society. There is a vibrant and growing green-friendly movement (especially among the younger generations) and a desire to be more aware of better health promoting practices. So, while I think it is useful to compare some of Aisha's commentary on Saudi birth culture to Kuwaiti birth culture, keep in mind that there are still MANY differences (like the picture at the top of the post- not something you would commonly see in Kuwait where I rarely see the niqab and where women would be much more likely to be sitting at a Starbucks than walking through some ancient ruins).

Originally posted on
Written by: Aisha Al Hajjar AAHCC

"“I hope you don’t mind,” my Saudi husband said to me, quite nonchalantly,  during my eighth month of pregnancy with our first child together, “but I don’t want to be with you at the birth.
What the heck?!?” I thought, while carefully searching words to express just how much I did mind!
In my culture, birth is a woman’s thing, you know.  Men don’t participate like they do in your country.”
I see,” I said, fighting back tears, as yet one more cultural difference that really matters crept up.
Such is the birthing culture in Saudi, subhan’Allah; a culture where most fathers seem to be little more than seed-planters in the childbearing process.  They are not expected to attend births and some doctors act as if the request for such a thing is absurd!  (Although a rare few are open to it.)
This was pretty hard to take, since I’m American, and in my country men are expected to attend the births of their children and most often times, even cut the cord!  I couldn’t even fathom that my husband would consider missing this important, once-in-a-lifetime event!
Interestingly, Saudi Arabia has a complex mix of tradition and technology.  This is as evident in the Saudi birthing culture as it is anywhere else in Saudi society.  We have the “tradition” of birth being a “woman’s thing,” set against the backdrop of modern technology medically “managing” birth.  Ironically, the “modern medical” theme has been copied from the American system.  But somehow they left out “father’s starting what they finish” by excluding them from the important part of emotionally and physically supporting mother’s in labor and birth.
In my opinion, Saudi would have been better off not following America’s lead in interfering in the natural process of birth as it was designed by the best of Creators, Allah (SWT).  This is evident in the alarming increase in Cesarean sections, 80% over a 10 year span![1] Much like my country, Saudi has become a place where medical interventions have become the norm and “natural birth” simply means “vaginal birth” rather than truly “non-medicated-natural.”
The trouble with this is that many women in Saudi are uneducated about their options in birth.  They are often times unprepared physically, emotionally, and mentally for birth.  Unfortunately, it’s rare that they are truly informed of the risks associated with modern medical interventions in birth.  For example, about one-fourth (23%) of women who opt for medical pain relief have complications and the medication (which is a narcotic, like cocaine) won’t even work for about 10%.[2] That’s not even mentioning the risks for the baby, who most mothers don’t realize have been proven to reach the unborn baby![3] Then there is the domino effect from the overuse of drugs to start (induce) or speed (augment) labor.  These drugs cause abnormally strong and frequent labor pains which often lead the mother to ask for the pain drugs noted above and often times lengthen the labor which ups the risk of forceps or vacuum extracting the baby out of her, if not Cesarean delivery.  Each of these interventions greatly increases the risks to both mother and child, prolongs healing time, and can cause lifetime injury or death at a far greater rate than natural-non-medicated birth for low-risk mothers.[2]
Complicating matters is the Saudi medical culture of dominance that still seems to reign over patients.  As one of the Saudi fathers-to-be in my childbirth classes explained, “It’s considered aib (shameful) to question your doctor, and second opinions are unheard of.”  From my point of view, this is a dangerous mix in a birthing climate that interferes way too much in a natural process and puts women at risk by discouraging childbirth education and informed decisions.
Speaking of “informed,” it’s important to note that there seem to be no “informed consent” laws here.  As stated by an American sister living in Saudi for many years, “The doctors here just take ownership of your body.  They don’t tell you what they are going to do or why.  You have no say in your health care once you come under their domain.
I’ve heard plenty of birth stories where unnecessary drugs have been injected without the woman’s prior consent.  Even more disturbing are the stories where invasive procedures have been employed as a matter of routine rather than need.  Of course these stories are also too common in my country where birth is over-medicalized. However, the difference is that women here don’t have access to quality childbirth education, are expected to blindly follow doctor’s orders, and the “care” they receive is simply the “luck-of-the-draw” since shopping around for the best doctor is “aib.”
I guess for locals it is less of a dilemma since they simply don’t know that the routines of medically managed birth are often times more harmful than helpful.  Husband’s don’t know their role as advocates and simply trust the doctors will take care of everything behind those closed doors.  But for foreign women, birthing in this climate is terrifying!
In fact, many expat women chose to leave Saudi for their birth, especially those whose husbands are also foreign.  For those who chose to stay, it’s usually a case of desperate searching for the most open-minded doctor they can find.  Often times they come to the disturbing realization that they will have to be strong advocates for themselves and their babies while carefully picking and choosing which battles to tackle and which to let go.  A few even travel the route of unassisted home birth,[4] since home-based midwifery care doesn’t seem to exist in Saudi.
Having said this, I am finding more inquires from conscious Saudis about childbirth education.  I’ve also found some encouraging professionals in the government and medical fields who are supportive of natural birth and education, alhamdulelah.  I’ve even been told that there rumblings of government programs in partnership with the Saudi Red Crescent working to revamp the system of maternity care.  I’d love to find out how to get involved with this work at the ground floor level, insha’Allah.
I’ve also been fortunate to be able to raise my voice through the Saudi Life venue, alhamdulelah.  This has led me to discover other natural childbirth advocates scattered across the country.  Networking together I have found that we all share a vision to drive change in the Saudi birthing culture, insha’Allah.
We pray for the day when childbirth education, involved fathers, professional labor companions, midwifery-led maternity care, and natural-non-medicated birth is the norm rather than the exception for all sisters of the Ummah.  We foresee a brighter future for the birthing culture when Saudi women become educated of their options and demand a gentler, more natural continuum of care, insha’Allah.
To address this I’m in the process of developing a culturally-sensitive childbirth education program, which will be called, “AMANI Birth” (Assisting Mothers for Active, Natural, Instinctive Birth) or اماني لالولادة الطبيعية in Arabic which means “Amani (Wishes) for a Natural Birth.”  I pray for support from the community at large and the day when an “AMANI Birth” is a household name for all expectant parents."

[1] Ba'aqeel HS. Cesarean delivery rates in Saudi Arabia: A ten­ year review. Ann Saudi Med 2009;29:179-83

[2] International Federation of Gynecology and Obstetrics: Fish can't see water: the need to humanize birth, Marsden Wagner, MD, MSPH

[3] Anesthesiology 29:951

[4] Arab News:  Many women don't give birth in hospitals, Arjuwan Lakkdawala

©2011, All Rights Reserved  (All writings are the original work of Aisha Al Hajjar and are based on her personal research, experiences, and opinions; they do not necessarily reflect the views of any association, or this publication.)


  1. Wow, this is so interesting, Sarah! I love your blog, and this post in particular emphasizes how progressive the US is, in some ways. I thought the medical culture here was authoritarian and prescriptive, but it's definitely all relative. I'm feeling grateful for the freedoms that do exist here, and the growing culture of midwifery and acceptance of homebirth...
    Thank you!

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  2. Thanks for your comment Laura. Yes, it is all relative. I wonder where the rest of the world would be without the midwifery witch-hunt back in the early 1900s. Hopefully we can use the knowledge and appropriate technology gained over the last 100 years in an appropriate way, while still returning to a much more mother-centered birth culture. Homebirth in the US still has a long ways to go...but I am optimistic. The more women know about their options and advocate for themselves, the better our health care system will become (especially with mothers like you raising their voice) :) Thanks again, Laura!

  3. Salam alaikum, Sarah,

    I just stumbled upon your post, masha'Allah. Unfortunately, Saudi and Kuwait (and others) have followed the United States' obstetric model of maternity care. But worse is the authoritarian medical dominance found here.

    There are gems out there though. It's really interesting, actually, that there is such a big gap between really natural and patient-friendly care and really authoritative with over use of interventions. Having said that, we are left with a hit-or-miss situation. This is terrifying when you consider the culture shuns second opinions!

    When I discover a gem I become a huge advocate and refer everyone I come in contact with to go to him/her, regardless of insurance coverage. Some things are worth paying out of pocket for and a good birth experience is one of them!

    Thanks for sharing my article. :)

    Best regards,

    -Aisha, Natural Mom

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