Copyright Christine Choong
When Christine Choong delivered her first two babies about 30 years ago, she was confined to hospital beds, each time with drips to induce and accelerate labour. The drips, she recalls, were very painful.
With her third baby, she went through most of the labour at home, which enabled her to remain upright, comfortable and relaxed. When she was admitted to hospital later, it was back onto a bed and more pain.
These very different labour experiences prompted Christine, a nurse and midwife, to set up Mamalink in Kuala Lumpur, which provides education and assistance to parents going through pregnancy, birth, early parenting and breastfeeding. Christine holds a graduate diploma in Childbirth Education and is an International Board Certified Lactation Consultant. She also teaches hypnobirthing and infant massage.
In this first of a two-part series, Christine talks about the advantages of birthing without intervention and why it is important to ensure that your doctor and hospital are on the same page with regard to your birthing plans.
What was the general feeling towards breastfeeding and natural birthing in the early 90s when you set up Mamalink? How has that changed today?
Labour ward practices tended to be fairly interventionist in the early 90s with quite a high incidence of managed labours. IVI syntocinon was commonly used to either induce or accelerate labour and most first time mothers were given episiotomies.
Women were expected to labour lying in bed, which happens to be the most painful position to be in during labour. Most babies were taken to the nursery after mom had seen and identified their sex. They were brought back to mom only after she was settled in the post-natal ward.
It was also common practice to give a pre-lacteal glucose feed to all babies before they were breastfed. Many babies were kept in the nursery overnight and given bottle feeds of formula milk.
My husband is an obstetrician and we had hoped that before we retired there would be a change in birthing practices, which would enable more women to experience a really natural birth. Well, nearly 20 years on there is actually little change.
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While women do have more freedom of choice to utilise self-help techniques, such as assuming comfortable positions, massage, relaxed breathing, use of heat and so on, it is only those who are aware of these options and who choose a doctor or hospital that are open to these preferences, who are able to take advantage of them.
Many women still spend their entire labour lying on the bed, often with continuous electronic monitoring restricting their movement. Induction rates are still high and caesarean rates are rising.
Change will occur only when women themselves request for it. For example, we had been trying for many years to introduce the use of immersion in water as a comfort measure in labour but with no success. Finally, after a group of mothers started to campaign a hospital in KL and wrote in over a hundred letters, the hospital agreed.
The approach to breastfeeding has changed significantly with the introduction in Malaysia in 1993 of the Baby-friendly Hospital Initiative. All the government hospitals and a few of the private ones have now been certified Baby-friendly but it is imperative that they maintain as well as improve their standards to continue the momentum towards breastfeeding.
Under Baby-friendly guidelines, all healthy babies should remain with their mothers for at least 30 minutes after birth and mothers should be encouraged to breastfeed. Babies should room-in with their mothers 24 hours a day and, unless medically indicated, should receive nothing but breast milk. If there is medical indication to supplement, then the milk should be given by cup and not by bottle.
While much of this is currently being practiced by the hospitals, some private hospitals certified as baby-friendly continue to take babies from their mothers for weighing and measuring before the first breastfeed. Many babies are also taken into the ward nursery for checking, bathing and phototherapy, if jaundiced.
Parents need to know that they have the right to keep a healthy newborn with them at all times and that, in fact, all hospitals certified Baby-friendly should not have nurseries in their postnatal wards.
Why is the act of birthing such an important one for both mother and baby?
A natural birth is very empowering for the parents, especially the mother. Any intervention or drugs used in labour impact the baby and, in many instances, affect early efforts to breastfeed and bond.
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Studies have shown that when babies are born, they are naturally very alert, very calm and they are able to breastfeed effectively. Most babies will lie on mom’s chest for about 30 minutes before starting to search for the nipple, crawling to the breast and attaching without assistance.
Few parents and babies are given the opportunity to do this; often, due to concerns that babies will lose heat. In fact mom’s body is the warmest place to be on and blankets placed over mom and baby keep both warm and cosy.
Following a drug free birth, mothers have very high endorphin levels and both mom and baby have high adrenaline levels making them alert and very responsive to each other.
Of course, there are instances where intervention may be necessary and in such cases, the main concern is that both mom and baby are healthy. Whenever possible mom and baby should be kept together without interruption, including after a caesarean birth if mom is using regional anaesthetic.
What can expectant parents do to ensure that their birth experience is a good one?
Firstly, they need to ensure that they choose a caregiver and place of birth where they will be given options to help them birth as naturally as possible.
Many parents choose their caregiver long before they actually think about the kind of birthing experience they are hoping for, or even before they have acquired knowledge of the benefits to mom and baby of a non-interventionist and drug free birth.
There is so much information on the internet nowadays, enabling parents to research all aspects of birth. It is also helpful to attend small group, independent pre-natal classes.
Most hospital classes consist of a series of lectures given by various members of the medical and nursing staff who provide the information that the hospital wants parents to know. These classes are useful for meeting other parents, visiting the labour wards and becoming familiar with the hospital staff.
However, there is rarely the opportunity to practice self-help techniques or for open discussion. Independent classes are able to furnish parents with evidence-based information on birthing, which does not always match caregivers’ preferred practices.
Copyright Christine Choong
Armed with information, parents should then discuss their birth preferences with their caregivers to ensure that they are in agreement. If parents are not happy with the responses they are given or if they are told that it is too soon to discuss these issues they should think seriously about changing their caregiver.
It is never too soon to discuss these issues and, if left too late, it will be harder to change caregiver/hospital. Once parents and caregiver have agreed on the preferences for birth, parents should write a birth plan detailing all that has been agreed and ask the doctor to sign a copy, which will be given to the midwife when they are admitted in labour.
This ensures that the midwife is aware of what the doctor has agreed to and should support the parents with their choices It is useful to ask the labour ward staff to encourage self-help techniques rather than offer pain medication. It is also helpful to ask the doctor to back up the decision not to remove baby from mom’s chest until after the first breast feed.
The key to natural birthing is the ability to relax. It is helpful to practice slow breathing and deep relaxation throughout pregnancy. During delivery, avoid bright lights in the birthing room, play the mother’s choice of music, adjust the temperature and minimise interruptions—these will assist a mother to relax and tune in to her birthing body.
Christine talks about breastfeeding in Part Two of this interview next week!
Our Interview series focuses on parents, teachers, role models and children with interesting tales to tell, lives to share and inspiration to give. If you have a suggestion for someone you’d like to see interviewed (including yourself, ahem!), drop us a note at parentingworks AT gmail DOT com to tell us why the person should be featured.
