A job for midwives

Copyright: paffy / 123RF Stock Photo

HOMEBIRTHS may seem like the most natural way to bring a child into the world, but anything can happen during childbirth and you should always be prepared for the unexpected.

Midwife Ann Ibrahim, who has delivered hundreds of babies, says more people are asking for homebirths today and some are even going for unassisted births, perhaps not aware of the potential complications that may occur.

When having a homebirth, you should have an obstetrician or 2 midwives with you. According to Ann, the rule of thumb when there is no obstetrician, is to have two midwives present at the childbirth. However, in Malaysia, midwives are not yet able to offer homebirthing services as the government has not set up a midwives registry and they don’t have any licence to operate.

Without a licence, midwives can only work in a hospital environment with the doctors and medical staff.

“It takes at least 3-5 years of studies to become a midwife. Even though it looks like we’re doing nothing, we’re actually assessing all the time, every 10 minutes. We know what to look out for, how to stabilise the mother, how to transfer, what to do in an emergency, and things like that.

“Birth is not an illness and if everything goes well, then fine, but some things can happen, and they need to be prepared for that.

Ann Ibrahim: 'A lot of parents are just jumping on the bandwagon without having done their research.'
Ann Ibrahim: ‘A lot of parents are just jumping on the bandwagon without having done their research.’

“Some parents accept that and still want to go ahead with unassisted homebirths. A lot of parents are just jumping on the bandwagon without having done their research. That’s really where the danger is.

“They think that the bidan kampung (village midwife) used to do it, so what’s the harm of giving birth at home. They don’t realise that the bidan also has had years of experience and those homebirths were done in communities where everybody attended the births. So, they knew the processes and the differences between what’s normal and what’s not normal, and they studied how to do it, although it was passed from generation to generation and it was a different method of learning,” says Ann.

She advises those opting for homebirths to make sure they have with them people who know what cues to look out for and how to respond in the event of an emergency.

Although childbirth is a natural process, there could be unseen and unknown barriers to it. For example, some women may have emotional barriers.

She relates the story of a lady who was raped when she was young. At 42 weeks, the doctor decided she would need to be induced because she still had not dilated. But even after being induced, her cervix would not open and she had to go for an emergency Caesarean.

It turns out she was concerned about bringing her baby girl into this world. “If there had been some counselling prior to childbirth, then her body might have listened and then opened up and she would have had the birth she wanted. I am trying to address things like this through prenatal consultations, which may start before conception even,” says Ann.

Even though midwives in Malaysia can’t conduct deliveries on their own, they are still needed to bridge the gap between expectant parents and obstetricians.

At the moment, Ann conducts prenatal classes and consultation. The prenatal classes are often done only towards the end of the pregnancy.

“I look at it holistically. I look at barriers that might affect childbirth like previous births, their influences on how their birth was, and their experiences.

“I explain the nutritional aspect and help them prepare the birthing muscles because you have to learn to release as well as tighten up,” says Ann.

The prenatal consultations start with a booking visit when she assesses the couple and lets them know which areas they need to work on. She then prepares a care plan based on the individual. Even if the woman is a high-risk case, such as a more mature woman, there would still be areas that Ann can help her work on.

“I look at their diet and what they’re already doing and I try to work on that, rather than say you have to do this. It’s like a woman finding out that she has to be on a vegetarian diet when she doesn’t even eat vegetables; that doesn’t work.

“I’ve got a dietitian on board and I’ve got people in various disciplines that I refer to for advice to create the care plan,” explains Ann.

The hour-long visits would be every month and it’s more like just having a chat. While Ann is monitoring the couple’s progress and care, she also has other activities that the couple can attend at ILM Hub, her venue for parenting events. There is massage, pilates classes, and aqua natal classes.

She would also discuss the birth plan with the couple. If they see her early, she would go with them for two obstetrician visits. If they come in later in the pregnancy, she would only go with them for one doctor’s visit.

According to Ann, the obstetricians welcome her presence as they don’t always have the time to answer all the questions that a couple might have; this is a gap that she fills.

In addition, sometimes the expectant couple may want to do things differently. For example, standing up or squatting to give birth. They may sometimes find that the doctor is against their birth plan.

Ann explains that the doctor may have his reasons and this is where she steps in to help find a common ground and acceptable compromise.

“It might not be so straightforward. The doctor might be saying no because of hospital policy or because there is no insurance coverage if something goes wrong. It’s a lot more complicated than what the layman sees,” says Ann.

She believes that a lot of doctors do see the need for gentle births, but because of hospital or resource limitations, they may not be able to allow the couple to proceed with their birth plan.

Besides the prenatal consultation and classes, Ann also offers doula services and even accompanies the mother into the labour room, if the hospital allows it.

While she does not offer postnatal services, Ann does followup with her clients by seeing them after the baby is born, just to provide a bit of assistance in showing them how to breastfeed and bathe the baby.

So far, response has been good although she is starting slow.

Ann, 42, gained lots of experience delivering babies in Bristol, London and Oxford. She was straight out of university then and on some days, she would deliver up to six babies!

“I remember every birth and I still cry at every birth. What’s lovely is until now a lot of those families are still in touch with me and they update me on their children. I really feel like I’ve made a difference in their lives. Some of the kids are in their late teens now,” she shares, her face lighting up.

“Hopefully, when the midwifery board is set up by the government and I can be covered properly and there are other midwives to support me, I will be able to offer homebirths,” says Ann.

Besides her consultation services, Ann also conducts talks, workshops and classes for parents at ILM Hub.

She is also involved in building children’s outdoor spaces under the ILM Spaces marque to give children a chance to play outside while they learn. ILM Spaces is focused on getting knowledge from life for life.

Her soon-to-be-launched website will also have a directory of places and people that children can learn skills from. This will be helpful to parents who homeschool their children and are not sure who to go to if their child is keen to learn from an expert.

The mother of three advises first-time parents to be aware of where they’re getting their resources and information from.

“There’s a lot of information out there and it is a bit hard to filter. Sometimes the information is not from qualified people. Sometimes it’s quite anecdotal and based on their own experiences and sometimes they may not give the full story. They may have left out something really important, making it no longer relevant to the next person. So, it is important that you chat with somebody who is a professional before deciding on your birth plan,” stresses Ann.