Islamic Birthing (1): Understanding Intervention | Janet Kozak

ISLAMIC BIRTH, A form of “natural birth,” is a way of approaching the experience of conception, pregnancy, labor and delivery as an Islamic ¢ibada (worship) and personal responsibility. It entails making the most of the whole experience—using it to boost spirituality and connection to Allah—but also considering the amana (trust) that Allah has given us with regards to our unborn child. Islamic birth means to prepare for and birth our children in the best way possible—and give them the best possible start in the world. This includes everything from maintaining proper diet and exercise to eschewing needless interventions in labor and delivery that are potentially detrimental to both mother and child.

Staying in tune with the fira (innate nature) of both woman and child, trusting our bodies, and understanding Allah’s plan and design for the natural birth process, is easier done when we study both how natural birth works and the steps we can take to achieve it. Islamic birth is also made easier by providing ourselves with best practices information, surrounding ourselves with knowledgeable birth attendants, and carefully choosing our birth environment. Guided by spiritual teachings from the Quran and the Sunnah, we can learn the best practices in birth that allow us to trust Allah, while we tie up our camel (Tirmidhi), resulting in the best possible outcome for both baby and mother!

Muslim Women as Mothers

In the spiritual teachings of Islam—from the Quran and from the sayings, practices, and ways of Prophet Muhammad œ—we find that the role and status of women in Islam is one of reverence and respect. Our prophet stresses that daughters are a special blessing, that we must honor and respect the mothers of the earth by treating women well, and that no less than jannah (heaven) itself is “at the feet of mothers.”

Mothers are afforded such reverence and respect in part, due to the hardships, trials, and tests that they’re put through as they take on the primary responsibility for gestating, birthing, and raising their children. This traditional role is a great responsibility but also a source of great joy to mothers. Mothers spend the majority of time with their children while their husbands are away from the house most of the day or even for months at a time. Women carry their babies in their wombs, birth the children, and are usually the primary caregivers as well. The husbands are usually out participating in the marketplace, conducting business deals that allow them to financially maintain the household, or engaging in da¢wah or jihad.

Child bearing and delivery is a natural process that nearly 90% of women experience at some point in their lives. These same women can be involved in making choices about the type of birth experience they have, a fact that gets lost at times in a world of guilt-trips, body-shaming, unflinching reverence of doctors, for-profit private hospitals, and expensive medical interventions.

When a woman becomes pregnant, the single most important thing she can do for herself and her child is to start reading and learning as much as she can about the natural processes of pregnancy and labor.

Armed with knowledge and understanding, women are then better able to communicate with all of their health-care professionals.  Informed of appropriate facts, they can also make well-thought out choices about who they want to let into their space while pregnant and laboring and what they need throughout the process. When women are well-informed about what happens throughout labor and delivery, they can make powerful and educated decisions about their care and have safer and healthier outcomes for both themselves and their babies. There are clues and recommendations for healthy pregnancy, labor, delivery, and childrearing to be found in the Quran, which I discuss in Part 2.

History of Birth and Modern Cultural Influences

Up until the early 20th century, nearly all women labored at home. This gave younger women an opportunity to see natural births first hand. With the move to hospitals, young women, girls, and small children lost many of those opportunities to see, hear, and fully experience natural birth. As these young women grew up, their concept of birth was instead unduly influenced by popular culture and hearsay.

With the advent of film and television, the visual narratives and portrayals of birth were made to seem excruciatingly painful and scary, like unnatural emergencies that needed to be medically treated. Few and far between are the depictions of the transformative natural process that mother and baby have to go through in order for baby to make her appearance. Examples of over-the-top birth scenes that come to mind can be found in the movies “Knocked Up” and “Baby Mama.”

Historical Birth Practices

In some cultures women still go off alone into the woods to birth their babies and come back with a baby victorious! Can you imagine? Unfortunately, in most cultures today, a women wanting to be alone in birth is seen as dangerous, selfish, and risky. Women who give birth alone in forests are seen as “lucky” to have survived the ordeal. The common thought is, “How can she do it without a trained obstetrician by her side, ‘helping’ her along?”

What many people don’t know is that the very word “obstetrician” (and the similarly named medical field of “obstetrics”) literally means “one who watches and observes” originally from the French word observant. When did this field of obstetrics move from being a field of patient observation to one of hands-on intervention? When did this perception of a doctor’s role change? When were doctors introduced into the management of routine and uncomplicated births?

Change of Labor and Birthing Position

In the article Position during labor and delivery: History and perspective by Yuen Chou Liu, the reason for this change to intervention becomes clear:

History and custom have decreed a choice of child birth position assumed during labor and delivery. The most common position throughout the centuries has been some form of the upright position, until the mid-seventeenth century when the obstetrician decided that the recumbent [lying down] position was easier for forceps deliveries. In the nineteenth century, ether was used as an anesthetic by inhalation. The parturient [woman about to give birth] turned on her side to aid the conduct of labor and delivery under anesthesia. From that time on, the birth positions which more easily lent themselves to the convenience of the accoucheur [male midwife/doctor] became the choice of childbirth position, and this practice spread throughout most of Western Europe and America.1

Before the 17th century the upright birthing position was common in western countries.2 Intervention-laden births only developed out of a desire to put women  on their backs (the supine position) for labor and birth so as to make the process more convenient for the physician–rather than to find the most comfortable and safe birthing position for mother and child.

Instead of encouraging women to stay up, move around, and be active in labor, they were told that in order to make the birthing area more accessible, they needed to lie almost flat on their back or with legs in the air – usually in stirrups (lithotomy position). Of course this is completely unnatural and physiologically ridiculous. Have you ever seen an elephant or horse attempting to give birth on its back with legs in the air? To the contrary, gravity plays a significant role in labor and delivery as the baby moves and twists its way through the birth canal.

Forward to the Past?

Gravity—along with frequent position changes and other movements during contractions—aids the mother and child in the important dance of literally spinning through the birth canal. An upright position for delivery (standing, squatting, leaning or kneeling) also:

  • results in less need for instrumental deliveries
  • results in fewer episiotomies (an intervention in which an incision is made to enlarge the vaginal opening in the late stages of labor to prevent tearing and to facilitate the birth).
  • lessens cases of shoulder hang up in the birth canal (dystocia)

and results in generally better outcomes.3

  • shorter labor
  • less blood loss
  • lower risk for hemorrhage

When a mother is placed on her back for labor, it effectively closes her pelvic outlet by up to 30% as her tailbone compresses inwards.4 A smaller outlet for the baby to pass through translates into longer, more painful, and more difficult labors. Imagine trying to walk through a doorway that is all of a sudden 30% shorter and narrower!

The supine position creates more dangerous and prolonged labors, can cause painful and debilitating post-partum complications, and often necessitates the need for “emergency interventions,” many of which are actually iatrogenic emergencies. Iatrogenic is a fancy medical word for a “doctor-caused problem”: an illness caused by medical examination or treatment. Asking women to lie on their backs in labor for the ease of the attending birth professionals is in fact causing many of the problems from which doctors then “rescue” women-–all in the name of medical professional convenience.

As mothers and fathers begin to research all their options for birth, the results of their searches may be startling. They will learn that most births in developed countries with midwife-led models of care have fewer adverse outcomes. In developed countries where the educated midwife model is the standard of primary care, the physicians are freed up to handle the few truly high-risk pregnancies. In fact, in some countries a woman has to pay an additional fee to see a physician! This is the opposite of systems like that in the USA where it’s the lay-midwives who are seen as a luxury, and often not fully covered by health insurance.

The World Health Organization (WHO) has also found that “Midwife-led care leads to…:

  • fewer admissions to hospital during pregnancy
  • less use of analgesics during labor and childbirth
  • more spontaneous vaginal births.” 5

Modern Medicine and Labor Logic

It’s my observation from talking with and counseling pregnant women on a regular basis, that some parents have a fear of departing from “modern medicine.” They often place more trust in doctors and hospitals than they do in themselves, their own bodies, and the guidance of Allah in the Quran (see Part 2).

Taking full advantage of all that medical science has to offer is now seen as the “modern and civilized” way to birth our babies. In Brazil, for example, rates of cesarean births (surgical delivery of a baby by cutting through the mother’s abdomen and womb to manually remove the baby) in public hospitals are around 50%, and in private hospitals that rate can climb to 82% of all births!6  This is nearly six times the 15% cesarean rate that WHO recommends 7 –and 12 times what many natural health care providers would consider an optimal cesarean rate of 5-10% of all births-–inclusive of all the women who actually need the surgery.

With all these cesarean procedures come complications and deaths, both short- and long-term. What many women seem to fail to consider is that they are making unnecessary major surgeries part of their birthing routines. Ina May Gaskin’s Safe Motherhood Quilt Project – aims to shed light on the fallen victims of these dismally high intervention and death rates in the USA.

In contrast, in some countries, like Pakistan–where I’m now living, the cesarean rate is between 4-6%.8 However, this low rate is due mainly to untrained staff, poor infrastructure, and inaccessibility of medical services in general.

One has to wonder then, why so many women in developed nations around the world are asking for and allowing this major operation, its resultant complications–and other equally traumatic interventions–into their birth experiences? Why also are the well-trained doctors either unable (or unwilling) to practice in less developed countries? Why do some developing world doctors choose instead to practice abroad leaving behind women who actually need the operation without access to the surgery?

Fortunately, there are innovative programs, like doctHERS in Pakistan, bridging the gap between an abundance of educated non-practicing female doctors and the poor women who are in need of their expertise. Other facilities like Koohi Goth Hospital outside Karachi, offer free surgeries to repair the painful and stigmatizing obstetric fistulas of poor women.

Is there some way to get back to an international culture that revels in natural labour and birth, honors the transformative experience that birth is for a mother, while also still recognizing that emergencies can, and do, arise? Who can we look to for examples of more natural and practical birth experiences?

Alhamdulillah, as Muslims, we have a remarkable model for natural pregnancy and childbirth. It was sent to us in the form of the story of Maryam’s pregnancy, labor, and birth of her son, ‘Isa (Jesus).

… To the story of Maryam’s delivery of Prophet ¢Îsa, we turn, inshâ’Allah, in Part 2…

 

Written By

Janet Kozak, is an award-winning artist, designer, author, activist, and educator. Her articles, artwork, and interviews have been featured in The Huffington Post, Azizah Magazine, Aquila Style, SISTERS Magazine, Islamic Art & Architecture and more. She is currently working on collaborations with leading artists around the globe and a creating a series of collages addressing domestic violence in Muslim communities. Her lecture topic Financial Abuse: The Reason We Stay will was presented at the 2nd International Conference on Women Empowerment in Karachi, Pakistan. When not art-making or helping clients with content marketing, she can be found lending her talents to a variety of non-profit organizations.

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