Doulas in Jeddah

We’ve all probably heard of Midwives and know what their function is, but have you ever heard of “Doulas?” I recently learned about Doulas from Alicia Ali and Dayle Valenzuela, two young women who provide Doula services in Jeddah. They were kind enough to answer my questions.

Susie: Exactly what is a Doula and what does a Doula do?

Dayle: A Doula is a trained child birth professional. She is usally a mother herself, and offers her services to help aid women before, during, and after childbirth. A Doula is there to offer information to the mother prenatally, and help her figure out what kind of birth she wants. The Doula usually assists the mother at the onset of labor, and accompanies her wherever she chooses to birth. Doulas are trained in recognizing the needs of a laboring woman, and provide emotional and physical support to her.

Alicia: Most often the word Doula is referring to the birth Doula, or labor support companion, but there is also the antepartum Doula and the postpartum Doula. Most Doula and client relationships begin a few months before the baby is due. During this time, they establish a relationship that gives the mother complete freedom to ask questions, express fears and concerns, and take an active role in creating a birth plan. Most Doulas make themselves available to the mother by phone to answer questions or explain any developments that may arise in pregnancy.

Doulas do not provide any type of medical care. However, they are knowledgeable in the medical aspect of labor and delivery so they can help their clients get a better understanding of procedures and complications that may arise in late pregnancy or during delivery. During delivery, Doulas are in constant, close proximity to the mother at all times. They can provide comfort with pain relief techniques, such as breathing, relaxing, massage and laboring positions. Doulas also encourage participation from the partner and offer reassurance. A Doula acts as an advocate for the mother, encouraging her in her desires for her birth. The goal of a Doula is to help the mother have a positive and safe birth experience, whether the mother wants an un-medicated birth or is having a planned cesarean birth.

Susie: Are there different kinds of Doulas?

Dayle: Yes. The two main types of Doulas are birth and postpartum Doulas. A birth Doula attends the mother during her labor, whereas a post partum Doula assists the mother after childbirth.

Alicia: Antepartum Doulas provide help and support to a mom who has been put on bed rest or is experiencing a high risk-pregnancy.
Postpartum Doulas are there to support you in your first weeks of being a mom. They provide informational support about feeding and caring for the baby. They provide physical support by cleaning, cooking meals and filling in when mom needs a break, and they provide emotional support by encouraging a mom during those times when she feels overwhelmed.
Labour Doulas are trained women who will stay with you throughout labor and birth.
A Doula also provides emotional support, physical comfort measures, an objective viewpoint and assistance in getting the information she needs to help the mother make empowered decisions throughout her pregnancy.



Susie: How long have you been a Doula and what interested you in becoming one?

Alicia: I have been practising as a Doula for 10 years, including 7 years of post training and 3 years of pre-training. My interest began after my second child. I was fortunate to have a Doula for all three of my children, yet after delivering my second child, I was asked by my brother to ‘be there for support’ for his first baby. At that time, I had just delivered 3weeks prior and could not refuse. It was a success and the couple highly valued my presence. This triggered my personal interest to take professional doula training. Finally during my third pregnancy when I was 7 months pregnant, an opportunity came up for training in Canada.

Dayle: I've been a Doula for over a year and half now. The main reason I chose to become a Doula is due to my own childbirth experiences. I experienced a very difficult labor and delivery with my first child. The type of birth I got was not at all what I was planning, and I greatly regretted not choosing to hire a Doula. I was determined after that to help other mothers avoid some of the things that made my birth and pospartum experience difficult. With my second pregnancy I hired a Doula, and it made a huge difference! I had completely natural birth, and it was honestly the best day of my life.


Susie: What type of training does a Doula have?

Dayle: A Doula is usually trained by an overseeing organization. I was trained in Phoenix, AZ, by a Midwife to be a Birth Trust Doula. There are several organizations that a Doula can choose from.

Alicia: Workshops are mainly conducted by Doula Trainers. Workshops styles vary; some can be done over a couple of days. CAPPA and DONA are popular Doula certifying bodies. Each organization has their own minimal requirements as far as training is concerned. This may be found on their respective websites.

Susie: What are some of the benefits of hiring a Doula?

Dayle: Studies have shown time and again that Doula-attended births have lower incidence of harmful interventions such as episiotomies, vacuum extractions, c-sections, forceps delivery, and the list goes on. Mothers who chose to hire a Doula have also reported increased satisfaction in their childbirth experience.

Alicia: In all the above studies, the Doulas used soothing words, touch and encouragement. They explained the procedures as they occurred and translated medical terms into laymen's terms. The results of the studies were as follows:
• Reduced the overall cesarean rate by 50%
• Reduced the length of labor by 25%
• Reduced oxytocin use by 40%
• Reduced the use of pain medication by 30%
• Reduced forceps deliveries by 40%
• Reduced requests for epidural pain medication by 60%
• Reduced incidences of maternal fever
• Reduced the number of days newborns spent in NICU (neo-natal infant care unit)
• Reduced the amount of septic workups performed on newborns
• Resulted in higher rates of breastfeeding
• Resulted in more positive maternal assessments of maternal confidence
• Resulted in more positive maternal assessments of maternal and newborn health
• Resulted in decreased rates of postpartum depression
Klaus and Kennel speculate that the mere presence of a Doula had a beneficial effect on the emotional state of the mother, resulting in a decrease in catecholamines (adrenaline). This relaxed state allows uterine contractions to be more effective and reduces the occurrence of compromised uterine blood flow.



Susie: How do Doulas differ from Midwives?

Alicia: Doulas are non-clinical whereas Midwives are clinically qualified.

Dayle: Often times Midwives are busy making notes on the mother’s chart, checking the mother for dilation, her blood pressure, listening to fetal heart tones, etc. Doulas are not involved in any of these tasks, which allows the Doula to only focus on the mothers needs. Having a Doula as part of your birth team ensures that no matter what takes place during labor and delivery the mother always has the emotional and physical support she needs to cope.


Susie: For what period of time are Doulas' services generally required?

Alicia: Prenatal period and Postnatal (a few weeks) are popular choices for mothers and families.

Dayle: I encourage mothers to contact me early in their pregnancies. This allows us to get to know each other, as birth is a very intimate experience. However most mothers do not begin looking for a Doula until they are in their third trimester, and that's fine too. Once the mother has chosen to hire me, I'm there for her until after she delivers. I usually have one follow up visit with the mother around 2 weeks postpartum to help answer any questions the mother may be having and to provide resources.


Susie: How do fathers generally feel about the presence of Doulas?

Dayle: Overall the response from fathers is overwhelmingly positive! For those fathers who choose to take an active role in helping his wife cope with labor, I usually take a back seat role, offering suggestions to the father on how he can support his wife, and giving him a break when needed. For those fathers who are squeamish about childbirth or do not wish to participate for cultural reasons, they are usually relieved to know that their wife is being well cared for and looked after.

Alicia: Doulas lessen the stress of fathers during birth. A big stress for many partners is feeling they need to support the mother during the birth and advocate for her, while at the same time, the father has as many emotional needs and worries as the mother has. Also, the hospital environment can be intimidating itself, with nurses walking in and out, and the doctor usually not being around to answer many questions. Fathers end up with a positive experience and a feeling of being there to support his wife during birth thus strengthening the bond between the couple. It is common for dads to ‘chicken out’ as they feel too much stress on them and the couple ends up opting for a mother or sister to be present during the mother’s delivery, thus leaving the father to be totally out of the picture.



Susie: What other services do you offer?

Alicia: A unique part of the services is I offer through Your True Nature is a Complete online Birth Education Course. This is an amazing and truly empowering self paced course with unique content ranging from natural birth techniques, breathing, natural healing, prenatal yoga, etc. In the Kingdom, we lack prenatal education options through hospitals, and have a shortage of trained instructors, thus, this is an ideal solution for many. This e-course is practical for internet savvy mothers who lack access to classes, support and information such as books or are living in remote areas. There are a total of 7 Modules. More information is available at: http://yourtruenature1.wordpress.com/courses-and-education/Doula-services/distance-support-Doula-service/

Dayle: I've just started a new Facebook group caled "Caring Moms of Saudi Arabia" for mothers who can network with one another to help each other through difficult times. The idea for this group came to me when I heard from a friend who had recently given birth and was struggling to care for her three small kids all by herself. She needs a caring Mom to come bring her a few meals and to help out with her kids so she can take a nap. Most expat mothers in KSA don't have their family close by to help out and are very isolated. This way we can be a support system for each other, both physically and emotionally and fill that void.

Susie: Where can women find out more information about your services and how can they contact you?

Dayle: My website is - http://jeddahdoula.webs.com/
And my Email is - dayle.valenzuela@yahoo.com

Alicia: Here’s my website - http://ytnature.com/
and here’s my Email - essentialfitra@yahoo.ca

Susie: Thank you both so much for taking the time to answer these questions. It’s been enlightening.

Thanks also to my friend Kacy, who gave me permission to use these beautiful photos of her handsome baby boy Mazen for this special post.

Hospital Visitors

V
isiting the sick is a very important obligation that the Saudi culture follows and it is dictated by Islam. Not only is it good for the sick person in that it lifts his spirits, but it is also a virtuous act which will be rewarded for the Muslim person who visits someone who is sick. There are even guidelines in Islam about not staying too long, about visiting an unrelated person of the opposite sex, and specific prayers (du’a) that are said for the sick individual.

I hadn’t really had much exposure to this aspect of Islam until my husband spent ten days in the hospital recently and had open heart surgery. He had a steady stream of visitors during most of his time in the hospital. Usually family and friends started coming in the early afternoon, and sometimes the last visitor of the day came late, leaving when visiting hours ended at 11pm. I thought it was interesting that during Ramadan, the hospital visiting hours are changed to ending at 3 am (see photo below). I learned that my function was to act as hostess for the visitors, offering them small cups of the traditional Arabic coffee called Gahwa (here’s a simple but delicious recipe for Gahwa), which my sisters-in-law thoughtfully and thankfully brought to me every day in thermal pots, as well as dates or chocolates, which guests brought with them in abundance. The Gahwa is mainly cardamom with very little coffee in it - I still haven’t acquired a taste for it.


I managed not to cry at all the whole time Adnan was in the hospital – I felt that he needed me to be strong and positive, and I was! I have heard many times since moving here that Saudi women have a reputation for being very dramatic and emotional. Now I’m not saying that they are, just that I have heard it often enough. So I thought it was rather amusing when I was saying goodbye to Adnan right before they wheeled him into the operating room that a small group of women employees turned around to watch me, as if to see whether I was going to break down or not.


Adnan initially didn’t want his own mother even knowing about his surgery because she, for one, IS quite emotional, but it reached a point where that was just not practical. So she was finally told that he was having more than just tests and procedures done. She came to the hospital to see him a few days after the operation once he was out of ICU - and she cried the whole time, which I could see was tough for Adnan. But the funny thing is that when she was leaving, she got after me about what I was wearing – one of Adnan’s long loose shapeless thobes with elbow length sleeves and a huge billowing colorful scarf over my head (properly covering my hair) that hung loosely down past my wrists. But when I served coffee, she could see part of my forearms from underneath so she didn’t think I was dressed properly. She thought I should have worn a long sleeved dress, but I told her that I would be way too hot dressed that way and that I was comfortable in what I had on. She knows how I complain about being hot all the time. But she said, “Not hot.” It struck me as funny because here she was crying her eyes out because her son had just had heart surgery, but she was still worried that a man might have seen my sexy middle-aged forearms! I know she means well and it is actually a compliment that she cares. She is just from a different time and a different place…


The third day Adnan spent in the hospital, which was also the day before his surgery, was a Friday – the holy day in Islam when it is customary for men to go to the mosque to attend the Jumu’ah prayers, comparable to Christians attending church services on Sundays. After the prayers ended, men well-wishers dressed in their crisp white thobes and flowing headgear began appearing bearing huge floral arrangements (one was almost as tall as me!), plants, chocolates, or cologne and I finally abandoned my hostessing duties because there must have been 12-15 men in the room all at once. Many of them I had never seen before even though some were my husband's cousins - but because of the way the society restricts interaction between unrelated men and women, I had never had any opportunity to meet most of them before. I went out for a walk down in the beautiful park adjacent to the hospital, but it was a bit warm, so I wandered around the hospital for a bit before returning to the room.


Each day, except for the three days Adnan spent in ICU where limited visiting hours were strictly enforced, visiting guests streamed in and out of the room, some calling before coming, others showing up unannounced. When a couple of his previously-unknown-to-me cousins came calling, they were SOOOO incredibly handsome that I almost spilled the coffee on them! And after almost every visitor left, Adnan would tell me that the friend or family member who just left had offered to foot the entire hospital bill, and he would remark, “This system is so much better than insurance.” All in all, the total bill for everything came to about $18,500 US – for an angiogram, triple bypass open heart surgery, ten days in the hospital including three days in ICU, our meals, doctors’ charges, medications, etc. I have no idea what the same might cost in the States, but I’m pretty sure it would be considerably more.

Adnan continues to improve a little bit every day. He’s still in some pain, has good days and bad days, and is a tad impatient to feel better sooner, but overall he’s doing very well. The doctors are pleased with his progress and the long incision down his chest looks good. We still have a way to go, and both Adnan and I are looking ahead to the day when this will all be behind us. Many Thanks to all of you who sent your well wishes and prayers – I could see that Adnan was quite touched as I read them to him. Thank you all from the bottom of my heart.

Triple Bypass

When I wrote my last post about the doctor who made a tasteless joke about my husband taking a second wife in my presence, little did I know what would happen in our lives in the coming days. When Adnan complained to me that he had been having difficulty breathing at the slightest physical exertion, like climbing a flight of stairs, I insisted that he go in to a doctor to have it checked out. The news wasn’t good. We got two opinions, both of whom recommended an angiogram. This came as quite a surprise to both my husband and me - Adnan has always been very health conscious about eating and isn't overweight.

Adnan applied for approval to have the procedure done at a government hospital, where it would have been done for free. We personally don’t have health insurance here (like many people here), but there are government hospitals that offer free quality care as well as private pay hospitals. But after about a week, Adnan finally decided to go in and paid to see a heart specialist, who was so concerned at what he saw that he insisted that Adnan be at the hospital the following morning for an angiogram and a likely angioplasty.

The doctor wanted to put in 4 stents, however the blockages were so extensive that he was unable to complete the procedure and couldn’t even put in the first stent in the largest vein. Adnan was kept in the hospital for observation until open heart surgery – a triple bypass - could be performed a few days later. The operation was successful.

I spent the entire ten days at the hospital in his room on the surgical floor, even while he spent three days down in ICU after his operation. If it hadn’t been for the circumstances, I would have felt like we were staying in a lovely hotel. I have never felt more comfortable in a hospital before, but of course, I wasn’t a patient either. There was a small fold out couch that opened up into a very comfortable single bed that I slept on. As my husband’s guest, I was also provided with three nourishing and delicious meals a day.

The room we stayed in is called an Executive Suite. It’s made to accommodate two patients, but there was just one hospital bed and where the second patient bed would have been was a large comfortable sitting area. When you first enter the room, there was also a smaller separate sitting area, where visiting women could sit when there were other men visiting. Our son was also able to stay with us for part of the time, although it wasn’t really that comfortable to sleep in either of the sitting areas, unless you were maybe the size of a little person like in the Wizard of Oz. There were two large windows that looked out over a beautiful park which many people utilize towards late afternoon.

International Medical Center (IMC), an affiliate of the world renowned Cleveland Clinic, was many years in the making from the idea for its original conception back in 1993, through its design and construction until its opening in Jeddah, Saudi Arabia, in late 2005. IMC is a gorgeous 300-bed facility, utilizing different shades of marble in its main lobby and other common areas and highlights distinct Middle Eastern and Islamic design elements throughout the entire building, inside and out. The building was designed by famed local architect Dr. Sami Angawi, one of the most well known Islamic architects in the region and whose unique modern but traditional home I have had the pleasure of visiting.

There was a beautifully landscaped inner courtyard, as well as an enormous park adjacent to the facility, where people by the dozens gathered at dusk to just sit and enjoy the spring air or to walk the track around its perimeter. At one end of the park was a field of palm trees with paths and benches interspersed among the trees, and at the other end was a large open grassy area where children played or families picnicked. It was a wonderful layout and we had a fantastic view of it from our fifth floor room. It was really nice to see so many people enjoying the outdoors here because in the part of Jeddah where we live, there’s nothing like it and I just don’t get to see people outside at leisure that much.

My husband’s doctors were top notch and professional and were from Saudi Arabia and the Sudan – I had complete faith in their expertise and recommendations, and I knew Adnan was in the best and most capable hands. The staff, comprised of about 80% Filipino and the rest mostly from Middle Eastern countries, was amazingly helpful and genuinely concerned in making our stay there as pleasant and comfortable as possible - from the nurses to the kitchen staff to the cleaning crew to the guards.

I got the feeling that my husband and I were somewhat of a unique and curious attraction during our stay, since I was not Saudi; but I cannot say enough nice things about the hospital and its wonderful staff for making our entire experience while we were there a pleasant one. I am truly grateful for their kindness and professionalism in creating such a nurturing environment for its patients.

Adnan and I have been home now for three days and already I can see a little progress and less pain for him every day. He's also starting to get back his sense of humor a bit too, which is a great sign. I hope to share more about some of my particular experiences, impressions and adventures I had at IMC – so stay tuned.