Wednesday, January 15, 2014

Pregnancy and midwifery: Between modernity and indigenous knowledge

After a long hiatus of starting a new job and growing a human being (both equally hard work), I'm back and feeling more eager to write, especially since I have more free time now (yay for maternity leave).

The Malays have a saying, setiap anak ada rezekinya (lit. each child brings its own provisions). Needless to say, that these provisions come from God. I always thought this was an excuse for couples to not space their births and have as many children as biologically possible, ruining their health and finances.

That is, until the Dutchman and I decided to have a child. It was May of last year, and I was still freelancing and looking for a permanent job (in the bleak economy of the NL). I had always planned to have a kid right after I signed a nice contract with decent health benefits. Seeing how companies are not likely to hire a (visibly) pregnant woman, I figured that if I was going to be pregnant, I'd rather be paid for it.

In the end, the job front seemed to be going nowhere so I figured that there are just some things we can plan for, and some things that we cannot. And lo and behold, a month after I got pregnant, I also got a full-time job that I can work at from home, where I can write and edit -- pretty much the perfect job ever :) So I've definitely rethought setiap anak ada rezekinya since then.

In preparation for what will happen in the next few weeks, I've been reading a bunch of really interesting books, and I feel really lucky to have stumbled upon the natural birth movement, by chance. Like many others, my idea of labour and birth came from television -- a highly medicalised, interventionist and masculinist version. That these human processes are inherently dangerous and require active management by obstetricians and machines. God forbid one hired midwives (possibly the oldest profession ever): those nasty, dirty, uneducated and foolish women.

Even as a feminist, I never gave a second thought to this. Medical and technological advancement is good, right? Women should not have to go through the pain of childbirth (which are variously framed as a punishment for Eve eating the apple, or as a potential channel for martyrdom) so go ahead and use all these forms of pain relief available today!

Until my mother told me two stories: one about how my siblings and I were born by Caesarian section, and another about a midwife named Fatimah who worked in the kampung, or village, where she grew up.

Our births

Due to concerns about her high blood pressure, all three of us were born by C-section around 37 or 38 weeks (that's why I know I'm probably not going to give birth at this time because she didn't go into spontaneous labour yet). No one else was allowed into the operating theatre, and my mother underwent general anesthesia. She remembers only being dropped off at the hospital by my father, who came back the next day when she woke up.

Although the hospital was pro-breasfeeding in theory (evidenced by their constant screening of films to new mothers), things were different in practice. My mother recalls the social pressure to choose the kind of formula milk to feed us with (Australian milk powder being viewed as more superior than Malaysian milk powder).

At night, babies were sent to the nursery instead of being roomed in with her. Because babies definitely needed night feeds, they were probably being fed formula milk in the nursery -- something my mother was not even aware of. Not being able to nurse regularly, she had problems with demand and supply, causing her a lot of pain from engorgement a few days after birth with one of us.

Three C-sections was the limit in those days (circa 80s), because of the risks of such major abdominal surgery.

Bidan Fatimah

She was about 40 years old, and she was a midwife for the area of Kampung Melayu (area from the borders of Geylang to Jalan Eunos). My mother recalls that she was friendlier and more pleasant than another older midwife who also worked in the area at that time. She was medically trained and carried about a bag with all her equipment, during her prenatal visits (of which women had only 1 or 2 during their entire pregnancy).

Before urbanisation and the migration of most of Singapore's population into high-rise apartments built by the HDB (Housing Development Board) in the 70s and 80s (great read about that phenomenon here: Part I and Part II), my mother lived in a wooden kampung house in Jalan Ubi (now Eunos Crescent). Her mother gave birth to 11 children (9 survived) in that home, with the help of a midwife). My mother recalls that her eldest sister also gave birth to 3 of her 4 children in that same home, in the 70s.





Kampong houses were made of wood, and had metal grills on the windows. A favoured position for birth was to kneel on a mat and hold on to the grills. This way the birthing woman could stay upright, helping her baby descend and still support herself.

I loved hearing these stories from my mother. In part, they helped me to cement my decision to give birth at home. Not a popular decision, surprisingly even here, where I thought that a third of women gave birth at home (according to my midwife, the figure is more around 5-10% today). We've had to deal with well-meaning family members suggesting, hinting and asking why we don't want to birth in the hospital (Dutch directness seems to fly out the window in this case, I wonder why).

I think it's safe to birth at home in NL, by the way (duh, why would I do it if I didn't think so). All pregnant women on basic insurance automatically get midwifery care (and I've met the nicest Dutch people -- who knew they were all working as midwives!) and only get transferred to an ob/gyn at the hospital if there are medical complications. A friend in such a situation told me that she longs to go back to the care of midwives, because the level and quality of care in a hospital just doesn't match the one-on-one attention at a midwife clinic.

When we decided to birth at home, one of the midwives from the clinic came to inspect our house and make sure that it's suitable. Since we live on the first floor, with one staircase leading to our house, it's considered convenient enough in the case of a hospital transfer (we also have to ensure that the hallway is clear). Home birth is also only possible if one lives within 15 minutes of a hospital -- and we live 5 minutes away. To me, it makes total sense to stay as long as possible in a comfortable and familiar place (also where one is immune to germs!).

As a feminist I support women to make their own choices about where and how they want to birth. It's a human right, according to this film, although enforceable only in the EU. My own principles lead me to favour less intervention by the dominant modern science of obstetrics, and more empowerment to exercise what the indigenous knowledge of my own culture and that of others'.

More on indigenous knowledge for pregnancy diets, supplements, and birth stages in upcoming posts!

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