A View of HypnoBirthing from Dr. Tan in Singapore!

Dr Tan took HypnoBirthing in Singapore a year ago and has incorporated it into her practice.  She summarizes her results in this lovely story of gentle births with fewer interventions.   
Shared by Di Bustamante, HBCE and Faculty, USA

My First Year with HypnoBirthing
I took up HypnoBirthing out of curiosity. I had one mom that birthed via HypnoBirthing in 2013; and she really amazed me, smiling and saying ‘no pain’ up to the very end. I also attended a talk by Bee Ting and that made me more curious.
I went for the Practitioner course in February last year in Singapore. I wasn’t so sure how it works at first. I started introducing it at one of my antenatal talks in March 2014 and immediate a few mothers signed up. Yati just taught the lessons as we were instructed but the first few mothers were not so successful. It took me and Yati at least 5 to 10 moms to realize how it actually works.
I think one of your (Di’s) moms who birthed at Tung Shin asked me why is it that most doctors do not accept HypnoBirthing while I support it. I gave a thought and I think that it was because, firstly, I have a low Caesarean rate to start off with. I support vaginal births all along, and my total Caesarean rate for the years prior to HypnoBirthing was lingering between 10 to 15 % (both planned and unplanned). The other reason was I saw how much easier breastfeeding was with HypnoBirthing mothers, and I have always been a strong advocate of breastfeeding. So it just sticks to me, and I am loving HypnoBirthing more and more.
HypnoBirthing has actually changed my whole perception of birth. We were always told that pain from childbirth is the most painful thing a woman can ever experience. Now I realised that childbirth is not that painful at all. With the right mindset and support from the entire team, all women can endure the pain of childbirth. Childbirth was not supposed to be a painful experience. My mothers have never stopped amazing me. Mothers sleeping, eating or taking baths at 8 or 10 cm. I just had one mom last week who slept for 4 hours at 10 cm dilation until the membranes released.
All along we were told that first time mothers need to be taught to push. Nowadays, I tell mothers that if I leave you alone like the cat, you would birth anyway. Animals do not need to be taught how to push. Why should humans! And because the baby would come out slower, there is less tearing. Birth was not supposed to leave any tear. Vaginas are supposed to expand slowly to accommodate the baby.
Conventionally, we were taught that during the second stage, women need to hold their breath to push. With the birth breathing, it works as well, and even better. Women do not need to hold their breath at all.
In the past, I have never heard of delayed cord-clamping. We have always known that breastfed babies are anemic but formula fed are not because of the fortified iron in formula milk. Now I realized that it was not meant to be like this. Babies were not supposed to have the cord clamped too early so that the baby has enough iron stores for the next 6 to 12 months. And this is important for the development of the baby.
Controlled Cord Traction for the placenta has always been a routine practice. In fact, I have never learned about natural third stage. In the past, I had cases of retained small pieces of placenta that came back a few weeks later with bleeding as well as infection. To cope with that, I routinely scanned all uteri after delivery. With that, the cases reduced but I still got it occasionally. Nowadays, I routinely wait for all my placentas, irrespective of whether HypnoBirthing or not. No more cases of retained pieces of placenta so far. And I no longer scan the uterus.
Episiotomies have never been a routine practice in the past, so that did not change. But my practice of suturing the wound has changed. The first few cases that refused suturing came back with perfectly healed wounds with no traces of a tear at all. I would say that the wound healed better without suturing. Nowadays, I give the option to all skin nicks and first degree tear of not suturing as long as no active bleeding and no zigzag tears or multiple pieces.
Breastfeeding was a miracle. I have always struggled whenever there were flat nipples, inverted nipples. With HypnoBirthing mothers, the babies latched on so naturally after birth. It does not matter whether flat nipples, inverted nipples, or no nipples! They would just latch the moment they are on the breast. It made me realize that all babies were meant to have no problem with breastfeeding. It was the sedative pain killers that sedate the baby and made the baby lose the natural ability to breastfeed.
Breastfeeding has always been a struggle during the first week due to poor supply. I have always asked my mothers to persist for one week, and the supply would be abundant. I now realize that it was not supposed to be like that. The reason why the supply was low was because babies were sedated during the first few days of life. Sedative pain killers remain in the babies’ bodies for 72 hours. They feed less because they are sleepy all the time. By day 4, they would be alert and very hungry and mother’s supply still low because hardly breastfed during the first 3 days. With HypnoBirthing, babies are very alert during the first 6 hours and would suck and suck non-stop. This stimulation would encourage early initiation of established milk supply.
How has HypnoBirthing changed my practice? Without realizing it, my Caesarean section rate was only 6% last year (for both planned and unplanned). Lowest ever. Why? I don’t think I have reduced my threshold of Caesarean in general. I think I just had more and more moms who really want natural or vaginal birth. And with their mindset for a natural birth, my Caesarean rate goes down naturally.
Irrespective of whether HypnoBirthing or not, I have changed certain practices. I allow more ambulation and intermittent CTG. I allow different birth positions even if they had Pethidine or Entonox as long as they don’t look overly sedated. Delayed Cord Clamping for all. Skin-to-skin for all. Bonding and breastfeeding for 1 to 2 hours for all. Options to suture for all. Natural third stage for all.
I have changed my way of induction too. I know that some of you are against induction. But in certain special circumstances, it may be necessary. I routinely use the Foley’s balloon for all. There are 2 ways. I can insert the Foley’s balloon and allow them home. Most moms would admit in the next one week in labour and give birth naturally. Or, I may admit them for Foley’s and proceed with further induction. Moms love the Foleys because it’s totally pain-free.
What are my future plans? I have started giving skin to skin and initiate breastfeeding in the Operating Room. Lots of resistance from the Paediatricians. I usually quietly do it. I have the support from the Medical Board Chairman who actually asked me to do it for all, but the Paediatricians still never say yes. I am trying to slowly convince them to allow.
Rooming-in was never allowed. Now they allow it for single rooms only. I am planning to make it available for all in this coming meeting with the Paediatricians because it’s actually one criteria set by Ministry of Health for hospital licensing.
I am now discussing with the CEO of another hospital, Pantai Ampang, to start this mother-friendly care services. Our plan is to create a 2-room delivery suite where one room is for all other family members. Husband, parents, the elder child can all accompany the mom during the whole hospital stay. I will soon be giving training to the staff on HypnoBirthing and WaterBirth. The only problem I face is that all the Paediatricians in Pantai Ampang collectively do not want to accept WaterBirth cases. Luckily, my hubby has agreed to receive all those cases that the other Paediatricians do not accept. But still pending approval from the hospital side. They have never allowed spouses that work as a team to protect the other doctors. But, I hope that this can be an exception.
My next target would be Sunway Hospital at Sunway Velocity. Hah! Still waiting for Nadine to come up with the proposal. They plan to build another hospital at Sunway Velocity. I am going to propose to them to have some delivery suite like the ones at Pantai Bangsar. Hopefully I have less trouble with the Paediatricians.
It has been a busy year, and I foresee a busier year ahead. I have a total of 386 births last year. Busiest ever, compared to 376 in 2012 (Lots of Dragon babies). March 2015 marks the busiest month with 52 deliveries. Thanks to all of you for your support. I am sure that the birth rates went up so markedly due to your support and spread of news via your groups and friends. I will try my very best to further promote HypnoBirthing. A very big THANK You to all of you.
“Towards a Gentle Birth For ALL”
Dr Tan EE Ping
Malaysia
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