DON'T JUST PUSH
Venessa Lee takes a look at other ways of giving birth to baby.
MS REGINA Lim gave birth to her daughter in circumstances starkly different from most other women's.
"Actually, childbirth is not painful," said the 34-year-old, referring to her pain-free labour with Hannah and contrasting it with her experience giving birth to her two older boys, where labour had been induced.
Describing her daughter's birth at Mount Alvernia Hospital on Feb 20, Ms Lim said: "It's almost like your body's trying to do a split for you. If you just relax, it will gradually, over four or five hours, get into the 'split' position." Labour had been "fun", added the property analyst.
Ms Lim had practised hypnobirthing - a technique she credited with helping ensure a pain-free birth - with the help of her doula, Ms Ginny Phang. In ancient Greek, the word "doula" meant a woman of service. Today, a doula is a professional who assists women during childbirth, providing practical and emotional support.
Actress Nicole Kidman was reported to have had a doula at the birth of her daughter Sunday Rose last year.
Dr T C Chang, a consultant obstetrician and gynaecologist at Thomson Medical Centre, told Weekend Today that hypnobirthing "can reduce the need for pain relief." "Some patients will tell you ... they didn't feel pain. Others will say the pain was reduced markedly", obviating the use of pain relief during labour, according to Dr Chang, who said that 15 to 20 per cent of his patients use doulas.
Hypnobirthing, which can comprise visual and auditory cues, is "a mind-body technique to teach women to relax during labour," said Ms Phang, who owns FourTrimesters, a firm that offers doula services.
According to another doula, Ms Kiki Porter Wolff, hypnobirthing "is mind over matter, the mind controls how the body reacts. It won't get rid of the pain per se but it reduces the pain to nothing but an irritability."
Said Dr Chang: "They don't even use the word 'pain' ... they refer to every contraction as a 'surge'."
Ms Lim was part of a small but growing group of women who employ doulas, who number fewer than 20 in Singapore.
Ms Di Bustamante, the director of ParentLink, a company whose services include doula and pregnancy-related services, said the firm provides doula services for eight to 10 births a month, compared with five or six such births per month, two years ago.
About half her clientele are expats and half are locals, she said.
The numbers involved are still tiny, however. Since 2007, for example, KK Women's and Children's Hospital "has received two requests for the assistance of a doula, during delivery", according to Ms Paulin Koh, deputy director, nursing, at the hospital's delivery suite.
Ms Lim said: "In previous births, I had difficulty in getting what I wanted because I was in labour and (not in a fit state to) argue with doctors and nurses, and I wanted an advocate."
Ms Lim said her "advocate", the doula, Ms Phang, advised on matters such as when to lie down and when to walk around, and when to go to the hospital when labour had advanced. "When you're pushing the baby out, someone will, invariably, in all the births, say something like 'Shut up and push!' I will usually tell the nurse, 'you shut up'. Now I have Ginny helping me to glare at her," she quipped.
Having the kind of birth they want - which often excludes pain relief - is important for clients of doulas. "
Some doctors don't even allow birth plans. We often have people switching to us because they can't have a birth plan," said Ms Wolff, who, besides being a doula, is also a trained nurse and midwife.
For Ms Lim, as with many people who opt for doulas, having a natural, drug-free birth was crucial, especially after her unhappiness over her second son, Rupert, having to be delivered via an emergency Caesarean section six years ago.
"I felt that birthing, like eating or sleeping ... or having sex, should be something that your body is designed to do. I wanted to have a natural birth. I felt that this is the normal way to give birth," she said, in contrast to "interventionist" societal norms regarding childbirth.
In opting to give birth without drugs, Ms Lim is in a distinct minority. With regard to the women who give birth at Singapore General Hospital (SGH), for example, "over 90 per cent opt for pain relief", according to Dr Tan Lay Kok, senior consultant at SGH's department of obstetrics and gynaecology. The three forms of pain medication commonly used are epidurals, pethidine injections and Entonox gas.
"In Singapore, all births are pretty much looked at as requiring medical attention ... a medical event, not a normal physiological event," said Ms Bustamante, a doula herself, stating views similar to other doulas'. Citing the use of painkiller drugs as an example of a medicalised approach, she added: "Some doctors want to release the membranes, break the waters routinely, halfway through labour."
Asked separately by Weekend Today whether obstetricians in Singapore were generally too interventionist in childbirth, Dr Tan of SGH said: "Obstetricians have their patients' and their babies' best interests at heart. It is in this context that any intervention is discussed with the patient, taking into account both maternal and fetal considerations, and assessing the pros and cons of the intervention."
Dr Tan added: "Labour is usually managed actively in hospitals, and if the progress of labour is slow, the obstetrician may suggest breaking the waters to help augment the uterine contractions."
Ms Bustamante also said: "Many doctors require that women give birth on the bed on her back. This position is not conducive to an easy birth. It fights gravity and can cause perineum tearing."
She added that "using a birth stool, squatting, (being on) all fours, even standing are much better positions as this allows the pelvis to open an additional 30 per cent".
Asked separately about which birthing position is best, Professor Chong Yap Seng of National University Hospital (NUH), said that would depend on the individual; it would be "the position that you feel most able to push when you're in the second stage of labour".
"The training all over the world is like this: Most doctors are trained with an active management mindset. Some of the policies may seem a bit too cautious to laymen," he said, in reference to queries about medical intervention in childbirth.
However, as doctors are privy to "very bad outcomes" that may occur even with normal pregnancies, "we actually like to err on the side of caution", said Prof Chong, senior consultant at NUH's department of obstetrics and gynaecology.
Whichever birthing method women choose, there is perhaps one universal constant in all new births. In 30 years of nursing, "I've seen thousands of deliveries", said Ms Wolff, "newborn babies always look like their fathers." She reckons it's a way for fathers to bond with their new babies, even though their children's features will soon shift and change.