Labour & Delivery

Doulas and 4 Other Alternative Birthing Options in Malaysia

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If lying on your back in a stark, sterile hospital doesn’t sound like your ideal birth plan, never fear – as it turns out, there are lots of options available in Malaysia, from hypnobirthing to home births, for mums who would prefer a different kind of delivery experience. Please note that some of these options can be mixed and matched – for example, you could be attended by a doula while at your water birth at home.

1. Doulas

For the uninitiated, a doula is a woman who gives support, help, and advice to women during pregnancy, childbirth and throughout the postnatal period. Based purely on that definition, your doula could be anyone – a relative or best friend, for example – but increasingly these days, professional doulas are available for hire. If you’re springing for a pro, you can expect a childbirth educator, lactation counsellor, and in some cases, even a postpartum expert emphasising postnatal and newborn care, all in one.

In short, according to certified Malaysian doula Hayati Muzaffar, “We are the shoulder that mothers hang on to, the arms that hug them in warm embrace, the voice that soothes and reassures them that they are making progress, we are their eyes and ears. We provide mothers with what they need to get the job done.”

And they seem to be doing a fine job – statistics show that women who deliver with continuous support from doulas experience:

  • 31% decrease in the use of Pitocin
  • 28% decrease in the risk of C-section
  • 12% increase in the likelihood of a spontaneous vaginal birth
  • 9% decrease in the use of any medications for pain relief
  • 14% decrease in the risk of newborns being admitted to a special care nursery
  • 34% decrease in the risk of being dissatisfied with the birth experience

Here’s what doulas can do for you: “We help the mom to relax and maintain her calm, hold her space that makes her feel confident, we use massage and encourage the mum using positive affirmations, assist her physically with flexible labour and birth positions like supported squat, provide the basic needs of the mom like fluid and food, just responding to their cues,” says Hayati.

Here’s what a doula cannot and should not do for you: As doulas are usually not medically trained, they cannot provide medical advice or perform medical procedures; a doula isn’t the same as a midwife and shouldn’t be mistaken as such. “A doula also cannot advocate for or on behalf of the couple in the hospital,” says Hayati, “But she can remind the couple of their birth plan and suggest options and alternatives to the interventions proposed.”

2. Hypnobirth

Hypnobirthing is the practice of using hypnotherapy during birth to allow the process to become a more natural, comfortable and easy one. It’s based on the theory that the fear-tension-pain cycle during the birthing process often results in a painful labour and interventions for birth. Mothers in labour train themselves to focus on positive thinking, relaxation, breathing and visualisation exercises in order to have a calm, relaxed delivery, free of resistance.

After a painful first birth experience with epidural and vacuum, Joanne Ho was more than willing to try hypnobirthing for her second child. “During my first birth, the effect of epidural was long lasting and I couldn’t feel my legs for six hours afterwards,” she says. “I tried hypnobirthing for my second baby after doing plenty of research – and I had an easy labour and birth with no pain, within an hour of arriving at the hospital. My third baby was the same – I had my baby easily and went home seven hours after the birth!”

Hypobirthing techniques, she says, are what made this possible. “I didn’t have any worries or anxieties, and I fully trusted my body and the birthing process.”

3. Home Birth

Ayuni Zainuddin knew as soon as she was pregnant that she had no intention of giving birth in a hospital. “I had just heard too many horror stories about childbirth in hospitals. My mother had given birth to me and my sister at home, so why not?”

Unfortunately, even after experiencing it herself, Ayuni’s mother wasn’t particularly supportive. “Everybody said it was just because people do it at the hospital these days. But pregnant mothers are not sick, though they may be in pain during labour. I just didn’t see the reason for me to go to the hospital.”

Of course, the idea of giving birth in the comfort of one’s own home can appeal to many. But it’s important to understand exactly what you’re getting yourself into. “In Malaysia, we do it unassisted, which means no medical professionals are present during the birth,” explains Ayuni. She and her husband felt comfortable with their choice given Ayuni’s low risk pregnancy, although they prepared transport to the hospital in case of any emergencies and kept their doctor updated throughout the process.

The best part about her home birth? “The freedom to move around, eat, drink, make out with my husband to release oxytocin that diverts pain, nobody rushing you, no strict monitoring, and nobody telling you what to do!”

Having said all that, Ayuni advises much research and soul searching before deciding on giving birth at home. “It’s also very important to note that, in the case of unassisted childbirth, the responsibility of any outcome is solely on the decision-makers, the parents,” she says. “You should know the differences in their certification and what sort of support they are able to provide. Keep reading, keep questioning not just hospital procedures but also home birth practices, do some soul-searching. If you feel that you can accept whatever outcome, go for it. Otherwise, best if you leave it to those who are certified to manage it.”

4. Water Birth

When a pregnant Sara Sheldon moved to Malaysia from the UK, she was on a mission: find out as much as she could about different birth methods available to her here. “I felt as though it would be silly not to explore all of the options that were available to me,” she says. Through various local Facebook groups, she made contact with a lady who talked her through her own water birth (and later became one of her closest friends!).

Water birth is basically exactly what it sounds like: childbirth that occurs in water. Proponents of the method say that water results in a more relaxed, calm birth, with reduced chances of mothers needing epidurals or experiencing tears during the process. “I think this choice gave me a great deal of control as I wasn’t relying on lots of pain relief and so looked more to breathing methods to help me through the process,” says Sara. “My daughter was also very calm and alert when she came out and I felt that this could be attributed to the water.”

No method of delivery comes without its own risks, and water birth is no exception. Critics point to a risk of mother and child infections or instances of infant drowning as arguments against it. However, these risks are lessened by having medical professionals on scene, as Sara did at Pantai Hospital. The hospital is the first to offer the service locally, allowing mothers to experience all the benefits of traditional water birth while still having medical personnel on hand in case of emergencies.

“I think the biggest misconception about water birth is that it is an ‘alternative’ method for people who see themselves as hippies or earth mothers!” says Sara. “I’d like to see it as a genuine option for all mums-to-be, particularly having seen the calming effect on the baby as it entered the world.”

5. Active Birth

Can’t stomach the idea of laying down on your back to give birth? As the term implies, during active birth, mothers are encouraged to walk around, remain upright (where possible), choose positions for labour and birth freely, find ways to relax in upright positions – basically doing what feels right for you.

Mangai Balasegaram may have given birth in a hospital, but was blessed with a doctor who encouraged her to be in whatever position she chose. “I was standing, leaning, lying, squatting… whatever felt comfortable,” she says. “This may not sound unusual, but in fact, few hospitals and doctors here allow you to do this, even though it’s the most natural thing to do.”

In the end, both of Mangai’s birth experiences were natural and drug-free – exactly the way she wanted it. “It was worth doing it without drugs,” she says. “When my son came out, he recognised my husband’s voice immediately; he stopped crying at birth and turned to look at my husband. He was very, very alert.” The second time around was even easier. “I was very prepared this time, and somehow it was just not so painful. A very old senior nurse who told me what position to get into when I was in transition. She told me to move this way and that, and pop, (literally!) the baby came out. My daughter was born within a few hours of labour. It was amazing.”

“Truly, it felt like a great experience. I felt so powerful afterwards. I felt like that if I had survived two births with no drugs, I could move a mountain.”

After seven years in journalism and communications, Hanna Alkaf recently became a freelance writer and work-at-home mum so that she could be with her son Malik (before you ask, it was totally worth it).

Image Credit: Essential Baby