Wednesday, January 16, 2013

Psst......Three Things They Didn't Teach You in Medical School

I will admit. My experience working as a childbirth educator and doula in Kuwait has often times been frustrating. My purpose is to educate, empower and support mothers to birth in a way that is both healthy and satisfying. Unfortunately, there are many practices in Kuwait that make this difficult. Don't get me wrong ~ the doctors and nurses in Kuwait are well trained surgeons and medical care providers. But they were educated, trained, and continue to operate in a pathological system that focuses on the failures of the human body and the need for human intervention to correct them. That's why so many doctors here in Kuwait look at a mother's birth plan with a mixture of incredulity and either tolerance or derision. The type of birth that many of these mother's want is so different from the way doctors have been taught to deliver babies here in Kuwait. So in an effort to help doctors understand those of us from a more holistic and community health background better, here are three principles I don't think they taught you in medical school.

Women's Bodies Were Designed to Grow Life & Give Birth to that Life

The whole process of pregnancy and birth include a delicate orchestra of hormones and events far more complicated and fine tuned than anything man could ever create. Women have been giving birth for thousands of years. Humanity would not have survived if there were any inherent flaws in the process. And no ethnicity or race is better designed for birth than another. We have all evolved to this point because of our ability to birth. There are very few inherently deficient pelvises or pelvic floors, more often ineffective birthing positions. There are very few "dysfunctional uteruses" that fail to progress that wouldn't be resolved by the elimination of artificial time limitations and dysfunctional birthing environments.

There are some women born with complications and challenges: deformed pelvises, uterus's that don't work properly, conditions that make certain moms high risk. For these women I am so grateful for well trained doctors (it is very likely that my sister would not be here today without this kind of advanced obstetrical care). In these circumstances, I am grateful for doctors who detect and try to prevent complications or who deal with emergency complications that happen unexpectedly. In these situations, doctors serve as a safety net for mothers. But that doesn't mean doctors should be orchestrating the process of birth for every other healthy and normal mother. But if things are going well, it is better to stand back and leave well alone. Except for a very rare number of cases, the danger of childbirth in the past can be attributed to unsanitary conditions and disease (not any flaw with the natural design of birth). We are so thankful that advanced obstetrics are available for the small number of women with rare childbirth complications; but in the majority of cases, birth is designed to progress normally and optimally with no or minimum interventions.

Pain is Not the Same as Suffering

Medical Schools teach doctors to view pain as a symptom of something wrong. They are trained to treat or alleviate pain and suffering, for which we are all grateful! But what they are not taught is that the pain in childbirth is different than the pain caused by an illness. Pain (there are many women who would choose to use a different word to describe the intense feeling of contractions, such as surges or waves) in childbirth is normal, healthy, and has a purpose.

The pain women feel in childbirth is directive: it encourages them to move throughout labor into positions that best help the baby progress down through the birthing canal. Positions that make a mother more uncomfortable during labor than others (like lying on your back on a bed) are less effective for the progress of birth. If women are allowed to respond to and move into positions that are more comfortable and satisfying, they will also be able to help their labor progress more effectively.

The pain women feel in childbirth is also intermittent. In a twelve hour labor, with an average of 60-second contractions every 3 minutes, a laboring mother only spends 3 hours in pain. Nature designed the rest of the time in between contractions for mothers to rest and gather strength. Creating a supportive environment helps mothers to relax and fully take advantage of these resting periods.

The challenges women face in a normal and healthy childbirth, including pain, self-doubt, discouragement, or exhaustion are a part of her rite of passage into motherhood, and come hand-in-hand with her feelings of awe, triumph, confidence, power, and capability that she will need to help her be the best mother she can be for her new baby. She does not need to be rescued from her experience. She needs those around her to believe in, support, and encourage her to birth her baby the way she wants to.

Science is not static or dogmatic.

Don't stop learning when you finish medical school, or even after you have been practicing medicine for 20 years! Stay current and up to date with the newest research designed to inform and shape your obstetric practices. According to the World Health Organization, many doctors are not basing their obstetric practices on current scientific research:

“….Evidence-based maternity care uses the best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and to facilitate optimal outcomes in mothers and newborns. Although the field of pregnancy and childbirth pioneered evidence-based practice, resulting in a wealth of clear guidance for evidence-based maternity care, there remains a widespread and continuing underuse of beneficial practices, overuse of harmful or ineffective practices, and uncertainty about effects of inadequately assessed practices. …

New scientific studies or ancient wisdom may challenge your cultural or social norms, challenge what you may have learned from a previous text book, or challenge even your own experiences ~ but that does not make them untrue. Be open to different ways of doing things. If you don't know how to do something (deliver a baby in positions other than with the mother in stirrups, support an intact perineum rather than cutting routine episiotomies, use intermittent fetal monitoring rather than continuous) find someone who does and learn! You will be respected more ~ not less.

Hope for Maternity Care in Kuwait

A few weeks ago I attended a birth at Royal Hayat with a first time mother. I could tell that many of the mother's requests on her birth plan were foreign to her doctor, Dr. Mona. But she respected and supported this mother and her wishes during the birth. She was open to trying something different. When the mother wanted to deliver on her hands and knees Dr. Mona was concerned, because she had never delivered a baby in that position. We found a compromise that both mom and doctor were comfortable with: what was really important to the mom was to be in an upright position (off her back and out of the stirrups) and to prevent an episiotomy and minimize natural tearing. We worked together to find a squatting position that both mom and doctor felt comfortable with, Dr. Mona supported the mother's perineum patiently while the mom slowly breathed her baby down (at her own pace), and mom was given her baby skin to skin after the birth for two hours of uninterrupted bonding time.

Dr. Mona initially wanted to give the mom a routine injection to prevent heavy bleeding after the birth. However, after the mother reiterated how important it was for her to have a completely natural birth and expressed her confidence in her body's ability to contract normally if she was allowed skin to skin and breastfeeding time with her baby (a process that creates the natural hormones needed for the uterus to contract after birth), Dr. Mona respected this mother's wishes. Dr. Mona never used scare tactics or coercion to convince the mother to do things her way; she never belittled the mother's wishes or opinions because she wasn't a medically trained doctor. She was supportive, open-minded, and respectful. So, Thank You Dr. Mona for giving me hope for the future of birth in Kuwait. I am happy to refer any mothers in Kuwait looking for a doctor who will respect and support their birth to you! The work that I do as a doula helping mothers have a healthy and positive birth experience would not be possible without doctors like you!

(See the mother's birth story below)

Joy and relief after a long labor, supported by her doula and doctor.


My name is Addie and my son, Maxence, was born on January 4th, 2013 at the Royale Hyatt Hospital in Kuwait.  He was delivered naturally without the use of any drugs.  The greatest reward of having an all-natural birth was seeing my son enter this world calm, peaceful, and alert.  

The decision to move to Kuwait during my pregnancy was somewhat reassuring for me because I had previously lived 2 years in this country and was familiar with the private hospital services offered here.  I knew that we would have luxury, comfort, and professionalism when it came to delivering at the Royale Hyatt Hospital, however my biggest concern was whether or not I’d have a positive birthing experience.  I felt very strongly about having an all-natural birth and the idea of delivering without an epidural or C-section seems to be a foreign concept here.  The last thing I wanted was to be in the labor room, fighting with the nurses and doctor, being pressured into doing things that I don’t agree with. 
Fortunately, I came across Sarah Paksima’s blog, “Engaging Birth” and discovered that she offers doula services, right here in Kuwait!  My spirits immediately elevated and a sense of relief came over me as I was overjoyed at the possibility of having a doula present during my delivery.  I emailed her expressing my interest and after speaking with her, I knew there was no other option.  
Having a doula (Sarah) was by far the best decision in making my natural birth a reality.  I was in labor for over 24 hours and spent nearly the entire time in the comfort of my own home.  It was only the last hour that I spent pushing at the hospital before my son was born.  Staying at home for most of the labor not only created a relaxing and peaceful  environment, but I was able to have the freedom to move around, try different positions, and spend a considerable amount of time in the bath tub, while avoiding any pressure from doctors about how far I’m dilated.  I cannot express how essential it was to have Sarah by my side during this time.  She kept me grounded and focused during every contraction, reminding me that with each contraction, my baby was moving lower and preparing to make his entrance into this world.  
Sarah’s knowledge about different positions and the birthing process kept me reassured, confident, and hopeful that I could continue on with a natural delivery.  ( Deeper into the labor, the thought of an epidural crossed my mind on several occasions, but having Sarah by my side swiftly pushed those thoughts away) She provided words of encouragement,  kept me hydrated (avoiding an IV at the hospital), and kept me breathing  which provided crucial oxygen to my baby, all the while Sarah remained calm and collective.  It was also great having her present because she was able to direct my husband so he could be involved with the labor.  As a typical male, my husband really had no idea what to do during these moments, however Sarah simply indicated tasks for him like rubbing my back while I was in the bathtub.  This was a wonderful way for him to be a part of the experience and feel of use.   Overall, I can honestly say I don’t think I could have successfully performed an all-natural birth without the support, guidance, and compassion of a doula. 
I am beyond thankful that Sarah has so passionately offered her knowledge, services, and teachings to Kuwait.  Having a doula (Sarah) made my birthing experience the most positive and memorable experience of my life!   



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