IT is estimated that about five in 1,000 women in Malaysia give birth out of hospitals, either not making it to the hospital in time or opting for planned home birth with the presence of birth companions or ‘doulas’, The Star reported.

University Malaya Medical Centre’s Prof Dr Imelda Balchin said home births in Malaysia require enough midwives to go into the community and good transportation to transfer the labouring women to the hospital via ambulance in case of emergencies.

Midwives are registered nurses, licensed in midwifery and trained in all aspects of childbirth while a doula is a non-medical assistant during labour, the report stated.

“The doula’s purpose is to make the prenatal and postnatal process more comfortable for mothers. During active delivery, their role is on the side to offer physical and emotional support.

“They cannot take on the roles of doctors and midwives,” Dr Imelda of the Department of Obstetrics and Gynaecology was quoted as saying.

Her remarks came following the news on the death of a baby girl during a home birth in Johor Baru recently.

The Health Ministry confirmed that the death of the newborn on February 4 was due to shortness of breath (asphyxia) after the baby’s head was stuck in the mother’s perineum during a footling breech delivery at home.

Health director-general Dr Noor Hisham Abdullah said the birth of the baby was also supervised by an individual who was not a certified health personnel.

The case has gone viral on social media after the baby was said to have died of complications while under the alleged supervision of a doula.

Dr Imelda said the public needed to know the true purposes of doulas, who have no medical knowledge and are unqualified to provide medical advice like drawing up birth plans for mothers.

She also said that the rate for maternal death in Malaysia is about 30 out of 100,000 women.

Malaysian Medical Association (MMA) president Dr Ravindran R. Naidu meanwhile told The Star that home births in Malaysia are not supported by doctors, medical professional societies or the Health Ministry.

“If the delivery is conducted at home without trained midwives or doctors, the complications may be severe, irreversible and, on occasions, life threatening,” he said, adding that doulas cannot replace trained midwives or doctor in childbirths.

Severe bleeding, fits, ruptured uterus or infections are among the complications to the mother while babies may suffer brain damage, fits, physical or nervous system injuries, the report said.

“In serious cases, both mother or baby may die as in some instances in the past,” Dr Ravindran added.

In 2017, Johor recorded 58 cases of unsafe delivery, in which five cases were home births that were related to doulas and two were high-risk cases.

According to data from the Health Ministry’s Family Health Development Division, there were two maternal deaths in 2013 and an infant death in 2016 due to unsafe deliveries related to doulas, the report stated.

Federal Territories mufti Zulkifli Mohamad Al-Bakri was also reported as saying in a statement that the issue of aurat is not a valid reason for women to refuse to give birth at hospital, as one’s life takes precedence.

“After scrutinising the issue on top of seeking information from medical experts, we are of the opinion that engaging in the services of a doula is not allowed without the observation of a trained doctor or midwife,” he said. – February 13, 2018.