Rebecca Howarth*, a Dubai-based mum of two, would love to have more babies. But in her words, “It’s simply not going to happen.” Her reluctance to add to her family is not a financial decision, nor is it because she would find it difficult physically to have more children. It’s because of the trauma she suffered during the delivery of her younger daughter.
Now a trained doula and a founding member of Out of the Blues, a postnatal-illness support group for women in the UAE, she says, “I’d love to have another baby, but just the thought of giving birth is so frightening for me personally, that I’m adamant I’ll never go through it again.”
After a trouble-free, midwife-only assisted birth in the UK with her first baby, who weighed over 4kg, Rebecca was confident that her second birth here in Dubai would be a breeze. “I’d had a lovely pregnancy and everything was fine until I got to the 38th week,” she says. “I discussed my preferences with my doctor, stating that, if possible, I wanted an intervention-free labour and a water birth. She turned on me and said that just because I’d risked the life of my first baby, didn’t mean I could do that again – and that I would deliver my second baby the way she wanted me to. This upset me greatly, so I changed doctors and the second one I saw seemed much more sympathetic.”
Unfortunately, when Rebecca went into natural labour on her due date, and arrived at the hospital at 9cm dilated, the trouble began.
She recalls, “I’m one of those lucky women who doesn’t suffer much pain in labour, so I was able to stay at home as long as possible. As we pulled up to the hospital, my waters broke and the amniotic fluid was clear. By the time we got into the reception, my daughter’s head was crowning – it was all happening so fast.”
Instead of calmly assessing the situation, the midwives panicked and tried to force Rebecca into a wheelchair – telling her she had to stop giving birth. “I was so far along that if I’d sat as they were insisting, it would have been on my daughter’s head,” she explains.
With no available bed, even though Rebecca was booked in, she was forced to give birth in a glass-walled observation room in full view of everyone. “The midwives kept shouting at me not to push because the doctor hadn’t arrived. It was horrendous and so stressful that my anxiety put the baby into distress. She then ended up aspirating meconium and had to spend eight days in the ICU. She was taken from us immediately after birth, and for eight hours, nobody told us anything. We didn’t know if she was alive or dead – or even if she was a boy or a girl.”
The total mismanagement of the situation, and a refusal to acknowledge Rebecca’s delivery preferences, led to her suffering from post-traumatic stress disorder (PTS) and postnatal depression, which lasted for two years.
Worryingly, while we may shake our heads at her misfortune and peg Rebecca’s experience as an extreme and rare case, apparently it isn’t. She says that through her work with Out of the Blues and as a doula, she’s come to realise that incidences like hers happen far more often than you’d think.
“My desire to have an intervention-free delivery was the real issue,” she says. “The hospital staff weren’t used to dealing with childbirth as a natural, straightforward procedure where mothers’ wishes should be respected.”
Statistics on the rates of C-sections in the UAE are scarce, but a study in 2011 showed that at least 30 per cent of babies are delivered here via surgical means – and that number is rising. While some of these are obviously due to high-risk situations, a sizeable percentage could probably have been avoided too.
Dawn Jackson, a senior midwife at Health Bay Polyclinic (www.healthbayclinic.com), says that while women need to be realistic about the nature of birth, knowing how they’d like things to proceed can make the process far less daunting.
“You may have heard of the term ‘birth plan’,” she says. “We try to avoid the use of this, as a ‘plan’ tends to be inflexible. Childbirth is a very unpredictable process and therefore parents need to be flexible in their ideas. This flexibility will allow your birth preferences to be reviewed and revised during your labour and will hopefully result in a fulfilling birth, where you don’t feel you have failed because the delivery didn’t reflect your original birth preferences.”
She explains, “Events during childbirth may occur which are out of your control. There might be a need for your doctor to help you give birth by using either a ventouse, forceps or a caesarian section.” Dawn adds that communication prior to birth is key, and that doctors should discuss the reasons why one method is favourable to another, and that mothers should always feel able to state, and change, their preferences.
Dr Ibrahim Abdelrehman, a consultant obstetrician and gynaecologist at Mediclinic City Hospital (www.mediclinic.ae), is a firm advocate of making sure mothers’ wishes are adhered to as much as possible during birth. He says it can be helpful for all concerned. “The birth plan gives the couple the opportunity, in advance and during the labour, to be part of the decision-making and treatment of both mum and newborn baby,” he explains. “But it is essential to be realistic and always have an action plan in place in case of emergencies. Every pregnancy and labour is unique, and the mother’s needs may change many times during the labour process. If for any reason we have to exit the birth plan, the couple should always feel that they succeeded where possible, and that their wishes were considered.”
Expect the unexpected
Even though mothers-to-be face enormous pressure to have a natural delivery, surgical intervention isn’t a tragedy – if your labour needs surgical intervention, it does not mean your birth experience will be a disappointment... especially if you have a sympathetic practitioner. Claire Flude, mum to Max, aged one, says that while she was deeply disappointed that her planned natural birth resulted in an emergency caesarian, her doctor could not have been more helpful. “I had the natural birth experience for four hours, until I was 9.5cm dilated... I did the whole pushing thing and everything. But his head got stuck because it was tilted to the side. My doctor used the suction cup but then eventually said, ‘Sorry, too long being stuck now, got to airlift him out!’”
Claire was so close to her natural delivery that Max’s head was even visible. She says, “I did feel robbed of the actual birthing experience, yes. But for safety reasons I had no choice. My doctor knew I wanted a natural birth so she tried for as long as she thought it was safe. I did cry when she called it, and she apologised so many times as she knew how upset I was. But she couldn’t risk it any longer. At the end of the day, we all just want a healthy baby, right?”
Information and communication
Ultimately, how well your delivery unfolds depends as much on the attitude of your doctor as it does on anything else, according to Rebecca. She says, “The most important thing mums can do is educate themselves and communicate their wishes clearly. While every birth is different, and labour is unpredictable, there are certain preferences that can usually be met, like immediate skin-to-skin contact, breastfeeding and avoiding unnecessary drugs. I would advise pregnant women to take antenatal classes at independent clinics because the midwives there can advise you on what facilities and practices are common at all the different hospitals. They have a broader knowledge and an uncompromised perspective.”
She continues, “Meet more than one doctor and make sure the one you choose supports your choices and understands your rights. Ask what her C-section and assisted delivery rate is. When you tour the hospital, ask the midwives about those rates again to corroborate the facts. Basically, arm yourself with as much knowledge as possible so that you can make an informed decision. And don’t forget that you are a customer here as much as you are a patient. You are paying for your delivery, so you have the right to state your preferences and take your business elsewhere if necessary.”
State your case
While you can never be certain that your delivery will go to plan, stating your case from the outset will help make sure some of your requirements are met. Here are a few elements that you can ensure on your delivery date.
Attendants State who you’d like to be present in the delivery suite – your spouse, a good friend, a doula, or even your kids.
Amenities Feeling ‘at home’ in hospital can help you relax and improve the odds of a smoother birth. If you want to have dimmed lights, lavender essential oil, zen music, or you’d like to wear your own clothes during delivery, then say so.
Once you’re admitted This is where you need to make sure your spouse, or birthing partner, is aware of your preferences in terms of the attendants and amenities mentioned above, and other factors like staying hydrated through drinking fluids rather than being attached to an IV and pain relief options. Additionally, you can ask for intermittent rather than continuous electronic fetal monitoring; to be allowed to progress free of stringent time limits; and to have your labour augmented only if necessary.
For more information on Out of the Blues post-natal depression support group, email firstname.lastname@example.org, or find it on Facebook: Out of the Blues.