Monday, February 10, 2014

Home birth

Assalamualaikum wbt

Long ago when i was in the primary school, my friends and i were used to look at each other's birth certificates as all of us need to bring a copy of it during our first day of school every year to hand it over to our class teacher. We usually talked about which hospital that we were born, what time, our birth date-whether easier to remember or not and etc. 
And the normal chit-chat would be-
'I was born in this hosp-very far from where i lived now-'
'I was born in that hosp-we didn't move anywhere since then-' OR
'I was born overseas-but i can't remember anything about being there-sadly'
Urm, nothing special. But suddenly all of them will give their weird look at me when i said:
"I was born at home". Hee.

Picture by alachamberlain from DeviantArt

All of my siblings except me were born in the hospital. My brother was quite sick at that time when my mom was due to deliver me. He needs ummi very very much and ummi couldn't leave him just like that-and there was where i came in. 

So it was an unplanned home birth. A midwife was called to attend the delivery. Ummi said she experienced an obstructed labour-she described it as my head was pulled back into the perineum (i imagined it as 'turtle sign' which classically referring to shoulder dystocia, where the anterior shoulder of the fetus become caught under the symphysis pubis) but my mother was told that it was umbilical cord strangulation that cause the obstruction.

The controversial part of the story was when the panicked midwife called a traditional midwife(bidan kampung) to help with the delivery(you see, this should be an emergency as i was stuck over there-and my mom was in severe pain-why didn't she call the hospital at the first place?). And yes the bidan managed to help me at the end. All praises to Allah for protecting my mom and me.

There was a lot of grey area in this story as I doubted the actual diagnosis and how did I manage to survive without any medical equipment to monitor me and my mother's condition. I wonder what could be my Apgar score at that time. Anyway here I am still surviving the world under Allah's mercy.

My actual point from this story is: anything can go wrong during the delivery. Even if you are at low-risk for complication, it's better to stay at the center where specialist help is there for you. 

I would like to share with you below an article written by Prof Madya Dr Rafidah Hanim Mokhtar, from Faculty of Medicine and Health Science, USIM. I copied the article from Dr. Zainurrashid's blog. You can find the link here.


"There is this wide misconception that natural means Islamic. Natural means leaving things in the hands of Allah SWT. Active interventions mean otherwise, that one is not having enough faith because one depends too much on another human, or on technologies.
This is wrong.
I have had the privilege to be an academician in medical faculties of 2 esteemed institutions, previously in IIUM and currently in USIM. Students in both institutions are taught that Islam covers a wide approach in investigation and treatment and that includes a holistic scope. Students are taught on the concept of maqasid al shariat, or purpose of law. 
There are 5 purposes of law (maqasid al shariat):
1. preservation of morals and religion (hifdh al diin)
2. protection and maintenance of human life (hifdh al nafs)
3. protection of the human intelect (hifdh al aql)
4. protection of progeny (hifdh al nasl)
5. protection of property rights (hifdh al maal)
In maqasid al shariat, there is no mention on the approach of how one achieves the protection. It is neither natural, nor modern intervention. If either one proves it is better than the other, say to protect one’s life, than we are to choose the better method. In preserving life, it is in fact WAJIB to choose a better method.
Obstetric discipline whether in Malaysia or abroad has gathered almost enough data on the risk of home deliveries, our grandmothers’ generations had endured.

There were post delivery bleeding because placenta would not come out which needs blood transfusion, there were cases of cord around neck that babies came out with breathing difficulty that he/she needed ventilator, there were cases that mothers endured prolonged labour that Caesarean section was inevitable. All these need hospital settings. 
Injecting certain medicine to make the uterus contract faster to avoid bleeding, as well as helping mother delivering the cord, a procedure called control cord traction (CCT) are procedures in the active management of third stage labour (AMTSL). Yes, these will definitely involve chemicals, help from others and machines. But as I said, the maqasid shariah dictates the importance of preserving life, not the method. 

This brings us to another concept which is the 5 principles of law (qawaid al shariat):
1. The principle of motives
2. The principle of certainty
3. The principle of injury
4. The principle of hardship
5. The principle of custom
In the principle of certainty (yaqeen), it is stated that a certainty cannot be voided, changed or modified by an uncertainty (al yaqeen la yazuulu bi al shakk). 
It stress that any change in treatment or human behaviour should not be based on the new evidence that is not at the level of certainty. The principle has graded the level of knowledge in decreasing order of certainty as below:
Yaqeen (certain)
Ghalabatul Dzon (predominant conjecture)
Dzon (conjencture)
Syakk (doubt)

In medicine, to be certain on important decision, one has to be on the ghalabatul dzon level based on the facts (from experimental, observation, literatures) that he/she has. A 50-50 chance is not enough.
This requires research and studies. Therefore, evidence based medicine with adequate research, is very much Islamic as it provides the objective measure of Qawaid Al Shariat. 
I therefore could not comprehend people who reject modern medicine on the grounds that it is less Islamic.
The case where the mother was reported to die because of retained placenta more than a few hours for waiting for it to be expulse naturally, is very much regretted. Studies have shown that AMTSL has reduced the risk bleeding or post partum haemorrhage by 60-70%. This is by comparing of only cases delivered in hospital with many other facilities available. AMTSL even in home birth, in my opinion is helpful. And if AMTSL, which has no contradiction in syariah, and proven in studies to have greater benefit, by the law of preserving life, should be a mother’s choice.
In summary, modern medicine is to reduce all these risks. It’s not intended to cause hardships to mother.
But mothers who nevertheless had to endure hardships because they delivered in hospitals, and they had to share facilities with other patients, knew very well that all those were for the sake of their babies. 
So when a mother would like to choose whether it’s a home or a hospital delivery, please weigh your option carefully. Giving birth to enjoy home atmosphere, as I read from the many reasons given by mothers over related blogs or forum, should be rethink by the question: Whose interest do you have in mind, yours….. or the baby’s ? 
As for this 2nd case of maternal death reported, al Fatihah. My condolences and may Allah grants great sabr to the family.
P/S: The above note was guided by a module called Medicine and Health : An Islamic Perspective by Prof Omar Hassan Kasule, part of the postgraduate curriculum in IIUM Faculty of Medicine, that integrates aqli and naqli."
Prof Madya Dr Rafidah Hanim Mokhtar
Deputy Dean Academic and Research, Faculty of Medicine and Health Science, USIM
Chief Information, Biro Wanita ISMA
Vice President II, I-Medik