Islam Promotes Safe Births
Childbirth is a process of giving birth to offspring. In medicine, doctors and nurses in the field of obstetrics and gynaecology are responsible in taking care of a pregnant mother until birth. Obstetrics is a field in medicine that focuses on pregnancy, childbirth and postpartum period, while gynaecology is a medical discipline that deals with the health of the female reproductive system.
Obstetrics and gynaecology are combined together in medical practice to ensure the health of the mother throughout pregnancy and the safety in delivering the baby. The practice of this specialised discipline is in line with the definition of safe birth by the World Health Organization (WHO) which clearly states that: “Safe birth is a delivery of baby conducted by a trained health professional.”
In the field of obstetrics and gynaecology, a lot of research has been carried out to improve healthcare services for pregnant women. Based on these research, medical professionals could identify risks related to pregnancy and delivery, and thus improve the monitoring plans throughout pregnancy.
Adequate check-ups on pregnant women are required to enable doctors and nurses to identify some pregnancies that need essential care in order to avoid or reduce serious complications in the future as well as determine the safest way to deliver the baby.
For example, in the case of a baby that does not settle into a position that allows for a headfirst delivery such as the breech position, a normal vaginal birth is no longer considered as safe. Doctors would then consider to facilitate the birth process through caesarean section to save the life of the baby as well as protecting the mother from serious complications.
The development in the field of obstetrics and gynaecology particularly in Malaysia has greatly benefitted society especially in reducing the rate of unsafe birth. The Director-General of Health, Datuk Dr. Noor Hisham Abdullah reported that the percentage of unsafe birth rate has declined from 24.8 per cent in 1990, to 1.7 percent in 2012, and further to 0.42 per cent in 2016. This is considered as a good achievement by the Ministry of Health Malaysia.
However, incidents involving unsafe birth that result in two deaths of mothers in 2013 and two deaths of babies in 2016 and 2018 highlight a worrying pattern in healthcare. This is mainly associated with advocacy of pro-natural birthing or gentle birthing influenced by a group of non-medical practitioners known as “doula”. Some of them are considered to be extreme in their approach when influencing pregnant women to give normal birth despite being diagnosed with high risk pregnancy. This results in some of them rejecting medically approved methods of delivery such as induction and the caesarean section.
In a recent incident in Johor Bahru, the parents insisted on normal vaginal birth despite the breech position the baby was in. It died due to shortness of breath after its head was stuck in the perineum of the mother during the breech delivery.
With such tragic incidents of unsafe birth that, by right, could have been avoided, is a matter of serious concern in Islam. Essentially, Islam prioritises safety in every single action, and rejects any that reciprocates harm. This is based on one of the Islamic legal maxims which states that “harm should not be inflicted nor reciprocated (la darara wa la dirar).”
The phenomenon of home birth without supervision of a qualified medical practitioner is closely related to the act of reciprocating harm especially when it concerns high risk pregnancy.
In cases of high risk pregnancies, the safe method of delivering the baby should be determined by qualified experts. Medical acts that are proven to be effective in saving the lives of the baby and mother should be given priority in order to eliminate the risks of serious complications.
It cannot be denied that most women prefer to give normal births. However, some of them would not be able to do so due to some medical reasons such as breech presentation of foetuses, multiple pregnancy, severe pre-eclampsia and many other complications. The caesarian section is perhaps the best and safest option available for childbirth in these situation. Therefore, women who undergo labour through caesarean section should not be stigmatised.
In fact, one of the classical Islamic Jurisprudence works, Qawa’id al-ahkam fi Masalih al-anam by Izz al-Din Ibn Abd al-Salam, states the permissibility of caesarean delivery. This is based on the argument that preserving the life of the infant is more beneficial than the harm of violating the mother’s sanctity.
Indeed, Islam emphasises the medical qualification of a person in a particular area in order to enable him/her to be a reliable medical practitioner. This is based on a hadith from Prophet Muhammad PBUH, “Anyone who practises medicine when he is not known as a practitioner will be held responsible.” (Abu Dawud, Hadith 4586).
In matters involving childbirth, these must be referred to doctors and nurses who are trained in the field of obstetrics and gynaecology for the safety of the baby and mother. People who are not medically trained in this area should not involve themselves in child birth process.
The phenomenon of unsafe birth must be dealt with from a multidisciplinary approach. Medical practitioners have put in a concerted effort in creating awareness among society pertaining to safe birth. Support from religious scholars is therefore valuable in continuously upholding such an effort.