Secrets from the Labor Room: Breathing, Pushing, Avoiding the Cut, & More

From the Author of AMANI Birth

Secrets from the Labor Room Breathing, Pushing, Avoiding the Cut, & More

Aisha Al Hajjar

©2021 Aisha Al Hajjar All Rights Reserved Published by AMANI Inc. Delaware, USA

From the Author of AMANI Birth

Secrets from the Labor Room Breathing, Pushing, Avoiding the Cut, & More

“Don’t go into the labor room without reading this!”

Aisha Al Hajjar

Aisha Al Hajjar

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DEDICATION

It is with all praises to Allah (SWT) that this work is dedicated for His sake to all Mothers, Fathers, and their children, whether born or unborn. We pray that Allah provides the best of it and protects from any harm in it. May your births be easy and your children healthy and pleasing to Him and their parents...AMEEN!

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TABLE OF CONTENTS Dedication Books Available Disclaimer Important Islamic Teachings Meet Aisha Al Hajjar Secret 1 – Childbirth Choices Secret 2 – Labor Pain is Bearable Secret 3 – Breathing Secret 4 – Avoiding the Cut Secret 5 – Birth Positions Secret 6 – Pushing Secret 7 – Birth is Inherently Safe Secret 8 – Support People Secret 9 – A Matter of Perspective Wrap Up – Take the Next Steps References

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www.amanibirth.com

amanibirth.online

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DISCLAIMER It is important to note that this is not intended to be a medical reference or to replace professional care during pregnancy, labor, or birth. Each family should consider their situation and medical history and work closely with their birth team to achieve the safest and best birth experience for mother and baby, wherever and with whomever it takes place.

Allah (SWT) has given us bodies to birth and medical interventions for rare complications that may arise. We pray that this book will be a source of confidence and encourage you to employ those interventions only when truly necessary.

We cannot stress enough the importance of good birth consumerism by families who are educated and empowered to keep control of their birth and make the best decisions for their particular situations. You have choices in birth; not making any choice is a choice that allows someone else full control over your experience and outcome.

Please note that the author is not an Islamic scholar and there is no intended or implied fatwa (ruling or opinion) in this material. Feedback and references are welcomed for revised editions.

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IMPORTANT ISLAMIC TEACHINGS One day the Prophet Mohammed (SAWS) noticed a Bedouin leaving his camel without tying it and he asked the Bedouin, “Why don’t you time down your camel?”

The Bedouin answered “I put my trust in Allah.” The Prophet then said, “Tie your camel first, then put your trust in Allah.” [At-Tirmidhi] “…Verily never will Allah change the condition of a people until they change themselves…” [Qur’an 13:11] This hadith, saying of the Prophet Mohammed (SAWS), and ayah (verse) teach us to prepare as much as we can while trusting the will of Allah (SWT). It is important that we do our part in preparation for birth, just as in all areas of our lives.

“Tie your camel” and put your trust in Allah (SWT): get educated and choose wisely and cautiously. Your baby, your recovery, your family, and our worldwide community depend on it!

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MEET AISHA AL HAJJAR Asalam aliakum! Welcome to the labor room! I am a midwife and the founder of AMANI Birth. My passion to teach others began with the birth of my eight children. As someone who has made the journey before you, I am responsible to share what I’ve learned.

Labor has become a mystery in modern times. New mothers hear horror stories of pain and procedures from behind ominous double doors that leave childbirth looking like an ugly cloud looming in their future. The truth is, birth doesn’t have to be this way. In fact, Allah (SWT) has built our bodies for this event, as we were created to birth our babies.

Let’s uncover Secrets from the Labor Room that minimize fear and empower mothers to make informed decisions about their choices. These simple truths become tips of evidence-based practices that make childbirth a gentle and safe event, bidnillah (God willing). Knowledge is power and preparation is key. May Allah (SWT) give you the best of these pages and protect you from any harm. Ameen.

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SECRET 1: CHILDBIRTH CHOICES The first thing to realize is that there are many choices that will be made in the labor room. Many of these choices are not a matter of necessity but rather a matter of preference. If a laboring mother has not made her own wishes known, or does not speak up about what she wants, someone else will make all the decisions for her—most likely her care providers.

The secret is that many decisions taken in the labor room are not made for the benefit of the mother and child.

Instead, they are made to facilitate hospital efficiency, saving time, regardless of the physical or emotional cost to mom and baby. Additional decision-making factors may include opportunities to increase revenue, such as introducing billable interventions or perhaps, in teaching hospitals, opportunities to perform procedures for the sake of teaching upcoming medical practitioners.

This is not to say that doctors or hospitals are preying on patients, they truly believe in the work that they do. However, make no mistake about it, birth is a business and you are a consumer in the industry of birth care. Doctors are not gods and do not have all the answers. In fact, the American College

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of Obstetrics and Gynecology (2016) acknowledges that medical prognosis (predictions of outcome) are uncertain and not predictable. In fact, medical knowledge has its limitations and the evidence, data, and technology used in medical care is imperfect. Thus, medical advice is imperfect and therefore, outcomes are not predictable either. Mind you, this statement come from the leaders of the obstetrics and gynecology society in the United States. They know that they are not perfect and urge doctors to respect mothers birth plans.

Keeping that in mind, it is imperative that parents get educated and speak up for their rights to current evidencebased practices. Remember, there are choices in childbirth and not doing your own research or having intelligent conversations with care providers leaves a mother and baby vulnerable to the routine practices that are often times not in their own best interests.

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SECRET 2: LABOR PAIN IS BEARABLE Every probably woman has probably spent time worrying about the pain of childbirth. Perhaps we should consider that it is not the pain itself, but rather the fear of whether or not she can bear that pain that is the real issue.

Women in developed countries expect pain medications, as if there were no other option for labor. Pair this with care providers who are trained to mitigate pain with drugs, many of whom truly believing that birth is not bearable without them. It is no wonder that nearly 98% of births in developed countries and in the city hospitals of lower income countries today involve some sort of pharmaceutical intervention.

The secret is that Allah will not put on us more than we can bear. In fact, childbirth pain is bearable, if we take the time to learn natural coping techniques taught in childbirth education courses, such as AMANI Birth. “…God does not burden any soul with more than [s]he is well able to bear…” [Qur’an 2:286] “… We do not burden any soul with more than [s]he is well able to bear…” [Qur’an 6:152] “…We do not burden any soul with more than [s]he is well able to bear…” [Qur’an 7:42] “…God does not burden any human being with more than He has given him [her]-[and it may well be that] God will grant, after hardship, ease. [Qur’an 65:7]

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SECRET 3: BREATHING Many women approach me for tips or lessons about breathing techniques in labor and birth. This is not surprising, considering that outdated childbirth education classes focused on learning the “right way to breath.” Perhaps this has been perpetuated by media depictions of women huffing and panting in, what seems to be, a patterned, non-normal way.

The secret is that you already know how to breath. You do not need lessons on breathing. Your body will automatically adapt your breathing as your labor gets more intense. What you may need is a reminder to “tummy breath,” as some women may panic and begin chest breathing. Chest breathing or panting can result in a dangerous cycle that leads to lack of oxygenation and fetal distress, a common reason for cesarean delivery. Deep relaxing breaths is what you need for labor.

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SECRET 4: AVOIDING THE CUT Episiotomy is a surgical incision in the women’s perineum (smooth tissues between the vagina and anus).

Many doctors perform this procedure as a matter of routine on every mother, especially first-time mothers. Their reasons for cutting vary but most of them are outdated and not evidencebased.

The secret is that the majority of women do not need to be cut and this procedure causes more harm than good. In fact, the major players in maternal and child health all around the world have recommendations to restrict the use of this barbaric intervention.

As a woman, you have a right to refuse this outdated practice. If your doctor prefers to cut as a matter of routine, he or she may try to scare you with threating prognosis about increased risks of tearing versus cutting. Remember, from the first secret, that medical prognosis is not predictable and that your body was designed to do this…including stretching to accommodate passage of your baby.

Many doctors will tell you, “If I don’t cut you, you may tear.” That is true, considering that 50% of first-time mothers

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will tear. But realize that this also means that 50% will not!

Additionally, statistics show that the majority of tears will be to first degree, meaning tears in the skin only. Considering that a doctor’s cut is a second-degree injury, meaning injury into the muscle layer, or worse, leaves us realizing that letting things happen naturally stacks the odds of no, or minimal, damage in our favor. Of course, you could tear to third- or fourth-degree, however, the stats show that the majority of third- and fourth-degree tears are actually an extension of a doctor’s episiotomy, as once they snip, the area becomes weakened and is more likely to extend to further degrees of damage with the pressure from the passage of the baby’s head.

This is not to say that there is never a time or place for episiotomy. There are valid medical reasons for cutting and the World Health Organizations states that about 10% of mothers may need this procedure for best clinical outcomes.

Just realize that the majority of moms do not need this intervention and finding a doctor who does not cut as a matter of routine in the number one factor in avoiding this unnecessary damage to your vaginal area.

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Other things you have control over include keeping a healthy diet, exercising (including squats which stretch the area and Kegels which tighten and strengthen it), doing perineal massage, and making your preferences to avoid episiotomy known on your birth plan and verbally in the birth room. Your partner or doula can also be a great support by keeping a watchful eye and speaking up if the doctor goes for the scissors. Your birth position can also make a huge difference and will be discussed the next section.

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SECRET 5: BIRTH POSITIONS Most of us have been influenced by media, which depicts birth in a laid-back position on the bed, to believe that laying down for birth is normal. In fact, if you’ve ever attended a birth, or given birth, you are statistically most likely to have seen birth as a laid-back event, or been placed on your back yourself.

The secret is that it is neither normal nor beneficial for the laboring mother, nor her baby, to lay on her back during labor or birth. This may be a convenient position for a care provider who performs routine interventions, but this position is far from the physiologic norm and is an outdated intervention in and of itself, not to mention that the routine interventions it facilitates are not evidence-based either (such as episiotomy, discussed in the last section, and others).

From the beginning of recorded time, birth has been depicted as an upright position. Consider the Egyptian hieroglyph, shown at right. Like all other ancient artifacts, birth was always shown in some upright position. In fact, consider that birth was described in Qur’an,

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Egyptian Hieroglyph for Birth

revealed over 1400 years ago, with instructions to “shake the trunk of a palm tree,” we can infer that Allah (SWT) was describing a woman who was upright and active during childbirth. “…and shake the trunk of the palm-tree towards thee…” [Qur’an 19:25] Following the example of the only birth detailed in Qur’an, we can easily see that an upright position has long been the standard, normal way to birth.

In recent years, ACOG (2017), has also encouraged freedom of positions, “For most women, no one position needs to be mandated nor prescribed,” (p. 1). This means that if your doctor insists on a laid-back position, he or she is insisting on outdated practices that may even be harmful to mother and child, as the laid-back position can reduce blood flow and result in fetal distress, not to mention that it is physiologically more difficult to push a baby out whilst laying on the back.

Having said that, mothers have a responsibility to prepare for their birth in order to have the strength and stamina for upright labor. Staying off epidural and other debilitating drugs is the number one key to physically being able to choose the best position for birth. Carefully selecting your birthplace and attendant is the second key factor to maintaining freedom of your choice of position during birth.

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SECRET 6: PUSHING “PUSH! HOLD YOUR BREATH AND PUSH! ONE, TWO, THREE, FOUR, FIVE, SIX, SEVEN, EIGHT, NINE, TEN. AGAIN!” These are commonly shouted instructions in many labor rooms across the world. In fact, many family members join in and add to the labor room chorus. The shouting can be confusing for the mother and turn her final moments of birth into something like a circus.

The secret is that these instructions are not only unnecessary, they are actually harmful and may cause damaging outcomes. Women do not need to be screamed at, nor told how hard to push, when birthing their babies. Just as she knows how to purge her bowels, she will instinctively know how to facilitate her own birth.

In fact, some women will choose not to push at all.

Although most will experience an undeniable and forceful urge to push, some will not. Either way is okay. The baby will come regardless of how much effort the mother puts in. That is to say that her uterus will do the job of expelling the baby with or without her added efforts. Of course, if she does

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choose to push it will speed up the process a bit and most women will choose to do some amount of pushing.

Having said that, our medical teams tend to rush the final moments of delivery, and shouting at the mother to PUSH is a part of the rush. Sadly, this practice is truly outdated and especially unneeded when a woman has not taken pain medications and can feel her own bodily urges. Then again, too few mothers get past the idea that labor pain is bearable and they opt for drugs during labor. In such cases, she may not feel her own body and perhaps the attendees are justified with their instructions. However, when a mother has stayed the course of normal physiology, she can feel her body’s cues and is able to tune in to her own instincts. In fact, with mother-led pushing, she will be far less likely to tear her vaginal tissues during the birth. A slow, controlled delivery of the baby’s head will result in the least amount of damage to the mother.

On the other hand, if she is forcefully pushing in response to shouted instructions she is more likely to push too hard and tear herself. Additionally, if she is holding her breath to push, she is not getting any oxygen and this means that her baby also is not getting any oxygen. In such a case,

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the baby’s heart rate will begin to dip and the doctor may respond with an episiotomy, which we already discussed is a rarely needed and outdated practice, to hasten the delivery.

Another problem with holding the breath to push is the buildup of too much internal pressure. This can lead to a splitting headache for the mother or even busted blood vessels around the eyes, where she comes out of the labor room looking like she’s been in a fight!

A better alternative is open mouthed pushing. In fact, this is the instinctive way to push. Take a look at the photo of the laboring elephant below. Not only is she squatting to push, she is also keeping her mouth open. Subhan’Allah, there is a lot we could learn from the animals!

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SECRET 7: BIRTH is INHERINTLY SAFE The medical model of birth focuses on the many things that might go wrong in childbirth. After all, our doctors are trained and skilled surgeons who are prepared to jump in when complications arise, and for their skills and expertise we are grateful, if complications do arise.

The secret is that most mothers, especially if prepared mentally, physically, and emotionally for birth, will not have a complication at all. What’s even more shocking is that most doctors have never been truly trained on how to support birth as a normal physiologic process. Sadly, the only tools provided via medical training are typically ones that are pharmaceutical or invasive in nature. It is tragic that the very people who hold license and power over childbirth may not know much about the natural process at all. They are masters of delivery, but not so much about normal physiologic childbirth.

What most people, doctors included, perhaps, do not realize, is that the uncountable numbers of interventions that are performed on women, “just in case,” may actually increase risks and need for higher, more invasive

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interventions to follow. One intervention causes side effects that are then treated by the next intervention and so on. It truly is a case of the domino effect, where one thing leads to the next until a mother finds herself with the granddaddy of them all, cesarean section.

In fact, the World Health Organization acknowledges, "By medicalizing birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her, the woman's state of mind and body is so altered that her way of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result is that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what 'non-medicalized' birth is. The entire modern obstetric and neonatological literature is essentially based on observations of 'medicalized' birth.” (WHO, 1985)

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Realizing that Allah (SWT) has built a number of safety nets into the childbearing year and that birth is inherently safe is quite reassuring for most of mothers. Learning about these safety nets and what she can do to prepare and maximize them is a key part of the AMANI Birth childbirth education journey.

Knowledge is power and preparation is key.

amanibirth.online/blessedstart

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SECRET 8: SUPPORT PEOPLE Many families have been led to believe that doctors are the only experts on childbirth and that they cannot birth without them. In fact, I’ve heard from countless expectant fathers and well-intended grandmothers-to-be that childbirth education or doula services are unnecessary, because, after all, “Her doctor will handle everything.”

The secret is that doctors are not typically trained on normal physiology, as discussed in the previous section, and they won’t be with you throughout your labor and birth journey anyway. Most will pop in and out during your labor to check on you and then rush in at the last moment to “catch their paycheck.”

Laboring women are on a normal physiologic journey and simply need love, encouragement and confident reassurance. In fact, the World Health Organization (1996) states, “…normal birth, provided it is low-risk, only needs close observation by a trained and skilled birth attendant in order to detect early signs of complications. It needs no intervention but encouragement, support and a little tender loving care.”

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Who is with the mother during labor will make a world of difference in her experience of the birth and the overall outcome. She should choose her companions well, as the people who surround her can make or break her strength and confidence. A good support person will encourage her through, while a well-meaning one, who is not educated about how to support the normal process of birth, may undermine her and actually make the birth more difficult.

At AMANI Birth we encourage the mother to bring anyone she is considering to attend her birth to all of her AMANI Birth classes. We want all persons on her personal birth team to learn alongside her and understand why she makes the birth decisions she does. Someone who has the same knowledge as the mother will be much better equipped to support her choices on the big day.

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SECRET 9: A MATTER OF PERSPECTIVE As noted in the previous section, many people simply leave everything to the doctor to decide. Doctors are an important part of the birth team. However, as you read earlier, most are not likely focused on supporting normal physiology, but on performing interventions instead.

The secret is that being overly dependent on someone else to make all decisions is a decision that often leads to medical dominance and maternal emotional trauma, if not physical harm.

You see, birth is a matter of perspective. Most doctors are taught to “deliver babies.” This means that from their perspective, the doctor is the star of the show. The labor room is their stage and the work being done is all about them. At AMANI Birth, our perspective is that birth is the work of the mother. She is the star of the labor room and everyone else should be there to support her. No

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one can birth for her. Of course, someone can deliver her with medical interventions, but there is a big difference between “delivery” and “birth” and our goal is for mothers to give birth, not be delivered—unless there is a medical complication to warrant that.

In fact, I recall one birth, where I was serving as a doula, and the doctor rushed in at the last moment to “catch her paycheck.” The mother was on her knees on the bed with her upper body resting on the head of the bed. The doctor freaked out, immediately screaming, “Flip her over, flip her over!”

I responded, “She is fine the way she is.”

The doctor shot back, “I can’t deliver a baby this way!”

To which I replied, “Sweetie, you’re not delivering this one, she’s giving birth. All you need to do is catch!” You see, it all came down to a matter of perspective.

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WRAP UP: TAKE THE NEXT STEPS

In this book we have uncovered several secrets of the labor room. These translate into tips for laboring women and the people who support them. In order to put them to best use it is recommended that you consider a childbirth education class to really dig deeply into these and other topics that will get you best prepared for the big day.

You can look for AMANI Birth teachers in your community at www.amanibirth.com on the [Find Teachers and Doulas] page. Or you could sign up for immediate access

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to the Blessed Start Course, an on-demand, online versions of AMANI Birth classes at amanibirth.online/blessedstart/.

The journey to childbirth is just too important to leave to chance, especially when the chances are that you will not simply fall into the hands of providers who support normal physiology as a matter of routine practice. Searching for a care provider you trust takes time, but is well worth the effort.

Having said that, you first need to have the knowledge of your choices and the preparation to back them up. This will allow you more leeway with your care provider and ensures that you have intelligent and respectful conversations that lead to shared decision making for your childbearing journey.

Please also check out our other publications at www.amanibirth.com on our [Products] page. Here you will find online versions of the original AMANI Birth book, which will give you a more in-depth perspective on childbirth and the AMANI Quick Guide for Fathers, which is a quick read to help husbands get prepared to support their wives through the journey. You will also find our books on Amazon and Kindle.

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Remember that knowledge is power and the first aya revealed in Qur’an was a command, “IQRA,” Read! As Muslims we are commanded to read and learn what we knew not before. Apply this in your childbearing year just as in all other areas of your life.

May Allah bless you with an easy birth and may your children be granted with good health and maturity of years and may they all be counted amongst those who are pleasing to Allah and their parents…Ameen.

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REFERENCES Al Hajjar, A. (2020). AMANI Birth. Wilmington, DE: AMANI Inc. Al Hajjar, A. (2014). Evidence-based use of episiotomy: Implication for practice in Eastern Arab countries.

(Unpublished literature review). Midwives College of Utah, Salt Lake City, UT. ACOG. (2016). Refusal of medically recommended treatment during pregnancy. Committee Opinion No. 644.

American College of Obstetricians and Gynecologists.

Obstet Gynecol 2016;127:e175–82.

Cohain, J. S. (2007). Management or care: Different outcomes. Midwifery Today. pp.

19-21. Eugene, OR, USA Davis-Floyd, R. (2001). The technocratic, humanistic, and holistic paradigms of childbirth. International Journal of Gynecology and Obstetrics. Vol. 75, (Supplement No. 1) pp. S5-S23.

Austin, TX, USA

International MotherBaby Childbirth Organization (2008). The International MotherBaby Childbirth 23

Initiative (IMBCI): 10 steps to optimal MotherBaby* maternity services. Retrieved from http://imbco.weebly.com/uploads/8/0/2/6/802617 8/imbci_english_final_04-05-08.pdf Lake, R. (Producer), & Epstein, A. (Director). (2008). The business of being born. (DVD).

USA: Red Envelope Entertainment Levy, M. (2005). Intuition, women and birth. Midwifery Today. pp. 30-32. Eugene, OR, USA Morning Star Women's Health and Birth Center. (2011).

Midwife model vs. medical model of care. St. Louis Park, MN, USA. Retrieved on September 18, 2011 at: http://www.morningstarbirth.com/index.cfm?event=page view&contentPieceID=3225 World Health Organization. (WHO, 1996). Care in normal birth: A practical guide. Retrieved from http://whqlibdoc.who.int/hq/1996/WHO_FRH_MSM _96.24.pdf World Health Organization. (WHO, 1986). Having a baby in Europe. Report on a Study (Public Health in Europe).

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The Author of AMANI Birth

Would you like to meet the author?

Aisha Al Hajjar, first and foremost, is your sister in Islam. She is a mother, a midwife, and an advocate for all families to experience empowering, safe, gentle, respectful birth experiences. With this in mind, she has dedicated her life to raising awareness about evidence-based birth practices with a foundation in Islam.

Aisha trains people around the world to teach AMANI Birth childbirth education courses and to serve in their own communities as labor and birth support doulas. She believes that every woman and baby, regardless of where they live, deserve a blessed start in life.

Register for a chance to meet Aisha in a live online workshop at: http://bit.ly/MeetAisha I hope to see you there!