OBSTETRICS and gynaecology are combined in medical practice to ensure the health of the mother during pregnancy and childbirth.
A lot of research has been carried out in this field to improve healthcare services for pregnant women.
Based on the research, medical professionals could identify risks related to pregnancy and delivery, and thus improve the monitoring throughout pregnancy.
Regular check-ups for pregnant women enable doctors and nurses to identify 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, when a baby does not settle into a position that allows for a headfirst delivery – such as when it is in the breech position – a normal vaginal birth is no longer considered safe. Doctors would then consider a caesarean section.
Advances in the field of obstetrics and gynaecology has greatly benefited society, especially in reducing the rate of unsafe births.
This includes Malaysia. According to a Feb 12 statement by Health director-general Datuk Dr Noor Hisham Abdullah, the country’s percentage of unsafe deliveries has declined from 24.8% in 1990 to 1.7% in 2012 and 0.42% in 2016.
This is based on the World Health Organisation’s classification of a safe delivery as one attended by skilled health personnel.
However, childbirth incidents that resulted in the deaths of two mothers in 2013 and two babies in 2016 and 2018, have highlighted a worrying trend.
This is mainly associated with the advocacy of natural births or gentle births, influenced by non-medical personnel known as doulas or birth companions.
Some doulas are considered to be extreme in their approach, sometimes persuading pregnant women to opt for normal childbirth despite their high-risk pregnancies.
These mothers then reject medically approved methods of delivery such as induction and caesarean section.
In a recent incident in Johor Baru, the parents insisted on a normal vaginal birth despite the baby being in the breech position.
The Health Ministry said the baby died due to asphyxia after its head was stuck in the perineum of the mother during the breech delivery.
Such tragic incidents that could have been avoided is a matter of serious concern in Islam.
Essentially, Islam prioritises safety in every single action and rejects any action that brings harm.
This is based on an Islamic legal maxim: “Harm should not be inflicted nor reciprocated.”
A home birth without the supervision of a qualified medical professional is closely related to the act of reciprocating harm, especially with a high-risk pregnancy.
For high-risk pregnancies, the safest method of delivering the baby should be determined by qualified experts.
Medical options that are proven to be effective in saving the lives of the baby and mother should be given priority in order to eliminate or minimise the risks of serious complications.
Most women prefer to give birth normally but some of them cannot to do so due to reasons such as breech presentation of the foetus, multiple pregnancy, severe pre-eclampsia or other complications.
The caesarian section is perhaps the best and safest option available in these situations. Therefore, women who choose to deliver 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.
Islam emphasises the medical qualifications of a person in a particular area in order to enable him to be a reliable medical professional.
This is based on a hadith from Prophet Muhammad: “Anyone who practises medicine when he is not known as a practitioner will be held responsible.” (Abu Dawud, Hadith 4586).
For the safety of the baby and mother, matters involving childbirth must be referred to doctors and nurses who are trained in the field of obstetrics and gynaecology.
Unsafe births must be dealt with through a multidisciplinary approach. Medical professionals have put in the effort to create awareness of safe births.
Support from religious scholars is therefore valuable to make the effort more effective.
Mohammad Mustaqim Malek is a research officer with the Centre for Science and Environment Studies, Institute of Islamic Understanding Malaysia (Ikim). The views expressed here are entirely the writer’s own.
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