Pursuing Active Birth in Jordan

Author: Suzanne Mohammad*

After my mother underwent several days of an agonizing induction in King Hussein Medical City, the most advanced military hospital in Jordan, my father made his way to the blood bank, as my mother was prepared for an emergency cesarean section. I would later be told by my father repeatedly, who panics at the mere sight of blood, that I was the only one of his children for whom he was forced to sacrifice his own blood and how much I torment(ed) my own mother. Before she was transported to the operation room, I was born vaginally without instrumentation or episiotomy. I believe that this ordeal, filled with drama, danger and fear, established a fragile relationship founded in perceived antagonism and obstinacy. Despite being more than a week late, I believe I would have left my first home and entered the next at the right time on my own terms had I been allowed to do so. To make it worse, our truck was stolen that night and I was born on Friday the 13th.

Birth matters. Birth, in its intensity, can make or break homes, empower or disempower families and individuals. Birth is the foundation of a mother’s bond with her child, as opposed to an assembly line of extracting live babies and delivering them to live mothers.

Halfway through my bachelor’s in nursing program at Jordanian University of Science and Technology I met, fell in love with and married my husband on May 25, Jordan’s National Independence Day. For better or for worse, there is tremendous social pressure in Jordanian society to conceive immediately. Fertility is under speculation and ever subject to gossip. Since I had planned to postpone childbearing after graduation, the constant questioning and campaign against contraceptives for newlyweds felt more like interrogation and psychological warfare. Nevertheless, I was pregnant three months later. I can still remember the look of contentment, excitement and admiration on my husband’s face when I greeted him that day from work to give him the glad tidings of a child in my womb.

Our ecstasy was short-lived as we entered the health care system. I foolishly believed the University Health Clinic to be the best place to go for checkups and King Abdullah University Hospital the best place to have my baby. I had assumed that affiliation with an academic institution would translate into more evidence-based practice. I later read that in 2004, the cesarean rate at that particular hospital was 36.6% compared to 20% in the public hospital of the same region and a 16% national average (Hatamleh et al. 2008). Our options now were private clinics, an over-crowded military hospital or indifferent public hospitals. We started antenatal care in the first sector, continued in the second and eventually gave birth in the last.

During the first visit, the private doctor only confirmed the pregnancy, asked questions and took notes. His accent was that of the village-folk from the district, which I couldn’t understand well at that point in my life, not that he spoke much to me anyway. During the second visit he used the ultrasound probe to stimulate the baby. Tears came to my eyes as I watched her somersault before me.

On the third and final visit, we were still arguing about dates. He accused me of misdating my own period, dismissing the fact that my cycle is 39 days on average instead of 28 days. I would either have to pretend he knew my menstruation better than I did or go by my own date and be condemned 11 days overdue at the exact 40-week mark. He looked over my belly hurriedly, declaring the gender unclear and announced the end of the visit. Supposedly this doctor would only tell the gender if he was sure it was a boy; otherwise, he would claim it was unclear at that time. Sure I was curious about the gender, but establishing such wasn’t the only purpose of the visit! After the first pressure to conceive, the second pressure is to conceive a boy.

This is when my disillusionment with the health care professionals began. I realized the lack of services, information and psychological support from the medical community meant I would have to work harder and take more responsibility. I downloaded a pregnancy application from BabyCentre which gave me the updates of our development, pictures and practical advice I yearned for as a first-time mom. I also utilized the university resources to seek out truth, only to be deeply disturbed and devastated by the disparity between the research and the reality of maternity health care. I also enjoyed watching birth videos and documentaries and found Pregnant in America directed by Steve Buonaugurio to be particularly insightful and inspiring.

Realizing there are basically three types of births—medical, homebirth and unassisted childbirth—I mentioned causally to my husband and in-laws that I would be birthing at home. I had expected to find total support and encouragement for my decision given the fact that 9 out of 13 of my mother-in-law’s children, including my husband, were born in a home-setting, with the other 4 being referred to hospital by a community midwife. To my surprise, everyone either covertly or overtly opposed, opting for the progress and development of modern science. Sadly, science has little to do with modern obstetrics.

My pregnancy was a battle to find truth myself, to be allowed to follow it and to find someone to help me reach it. Passively accepting to be violated, humiliated and abused again, along with my baby, was a cruel, ruthless request from those around me. Having refused to flow into the system trustingly and naively, my desperate search for alternative options began.

More than 98% of births in Jordan take place in hospital. Through a referral I found a midwife in Amman who attends homebirths. However, she wasn’t willing to drive to my city and would charge JD 300, about a month’s paycheck. We were barely getting by as it was. She wouldn’t budge on the price and I didn’t know her well enough to trust she would actually respect my desires for a hands-off birth.

Then in Ramtha, near my university, I found another woman who is the head matron of the Ramtha Public Hospital and who delivers in her home, charging only JD 90. I hoped it was the light at the end of the tunnel and called to make an appointment to meet, establish a relationship and discuss my preferences. She yelled at me and accused me of being a reporter, not a woman soon to give birth. She scolded me for knowing nothing about how birth “actually” is and exclaimed she would never consult a woman about anything in her practice, as she knows more/most/best and will do as she wants (including routine episiotomy). I could do nothing but laugh at the ridiculousness of our conversation and pray for Allah to place compassion into her heart for the women she is entrusted to serve.

I spent the second half of my pregnancy taking clinical courses and therefore spending time in labor and delivery wards. My experiences confirmed my suspicions as I watched and discussed the practices with the obstetricians. When I brought forth the research and evidence against routine episiotomy to one OB, his only argument was that it is his preference. The laboring women were all strapped to beds on monitors, denied the freedom to move, eat and drink and any support person was looked at as a trespasser. This is ironically the highest charging private hospital of the Northern region.

By the end of my pregnancy, I was still determined to avoid the trauma of technocratic birth. My husband, whether in exasperated surrender or genuine conviction, was finally willing to support my desires, but we had not found a health care professional who we trusted would protect our true interests. I had read, researched, studied and observed enough to confidently decide to be midwife to myself and I took some supplies from the ward that would have been used for me: a sterile razor, a cord clamp and some urine strips. The official deal between my husband and me was to labor at home for as long as possible. I prayed to God in helplessness and humility to decree the best for me and my family.

May was the month expected for me to have my baby, take my final exams for the semester and move into our new home. I had wanted not to interfere, letting my daughter begin her journey on her own terms, but I realized with my first final on the May 16, I needed time to rest.

I took half a bottle of castor oil in the early afternoon on May 6. My husband and I were on the roof, in the cool night breeze, when he noted how blissfully calm I was, like I was “basking in orgasm.” I could feel myself turn inwards as my Braxton-Hick’s became more vigorous. I began holding on to what I was ready to be the last day of my pregnancy. How much I had grown! How much I had faced and conquered inside and outside of myself! How much I had struggled for the knowledge my baby and I both needed for the birth. I couldn’t know for sure, but I felt this would be show time.

The next morning, fate would have it that my husband would need to start work at 6 am and be there indefinitely. I made us a pot of milk, kissed him goodbye and went back to bed. I had asked my mom how I could differentiate between labor contractions and the practice Braxton-Hick’s ones. She laughed and said I’d know once I had the real thing. At 7:30 am I was awoken, knowing for sure our long-awaited dance had begun.

I got my laptop out and decided to study for a final exam while laboring. Between 7:30 and 11:30 am, I responded to the surges leaning—more like dramatically throwing myself—against the wall, the arm of the chair and to the floor praying to God for my baby to be pious, righteous, kind, gracious, merciful and all else I wished for her. I was timing contractions on a handy Android application. They were already up to a minute long and less than 10 minutes apart. I felt awkward and uncertain of what to do, but just focused on getting through one surge at a time and distracting myself in between to pass the time.

At 11:30 am, I put away all my distractions, deciding I needed all my energy and focus. I took a shower, but it didn’t relieve, and maybe increased, the surges. I tried to do an internal exam the medically proper way, but had no idea what I was feeling. I threw up twice, needed to defecate every half hour and felt the need to urinate with every surge. I was all over the house, making so much noise and using any position my instinct told me to. I spent quite a bit of time running from the rooms of the house to the bathroom and going down on my arms and legs over the Arab toilet, afraid to vomit or urinate on the carpets. When I wanted quiet and dim lighting, I sought refuge in the bedroom, throwing myself on the carpet, on the bed and writhing, wishing I could just take an hour break to replenish my energy and resume.

At this point, my psyche had reached the greatest vulnerability known to mankind. I was no longer concerned with my baby as I had been praying vehemently before. I only prayed for myself, my safety and for this all to end! It was so exhausting physically, mentally (debating with myself about calling it quits, calling my husband to take me to hospital and getting an epidural or at least Pethidine [Demerol] intramuscularly to put me out of my agony) and emotionally (being completely alone except for the occasional company of some cows grazing behind the house and under the windows). I yearned for my husband’s presence and called out to him inside myself. My intuition, or perhaps purely fear, was that because this was his first child and despite our deal, he wouldn’t handle seeing me like this and would rush me to hospital, to which I couldn’t resist at this point. I can’t be certain: was I protecting him or myself from his intervention? Due to lack of preparation on his part and lack of a kind midwife to support him in supporting me, he would most likely hinder the labor process. So I left him uninformed as he continued about his work day.

At about 5 pm, I felt the inspiration that my water needed to break; it had to if I was going to get any relief. The pressure on my bag of waters was so immense—the intensity tempted me to break it manually. I shook that medical thinking off and prayed for God to make it facilitated. Then instinct told me I had to push and I had to do it on all fours. I remember the conversation in my head, “I don’t care if I’m not fully dilated or if I’ll bruise my cervix or get it swollen. I need to push!” This wasn’t an urge to birth my baby; it was an urge to break my waters. So push I did and at about 5:30 fluid filled my flowery, green capris trickling down my right leg.

Instinctively I put my right middle finger up my vagina and found myself 6 cm dilated. My psyche shifted again to being in control, like a lioness, with the mission to birth my baby and keep her safe, willing to devour any predator and defy any danger, person or thing that got in my way. With the rejuvenation of my waters having broken, the sense of progress and the guidance of my instincts, I kept pushing and pushing on all fours. The neighbors probably assumed we were making intense love all morning with my uncensored vocalizations. I was having so much fun at this point having finally let myself go like a wild animal.

The doorbell rang and I prepared for surrender, assuming my husband had finally returned from work. To my surprise it was my mother-in-law! I was only willing to go to hospital with my husband and if she knew I was in labor, there would be no delay in sending me. My contractions ceased, as I now felt unsafe to labor. This is a biological defense mechanism to ensure the continuation of the species, hence labor should be delayed until the danger resolves. Today, if a woman does not have a doula or other support person, anxiety, fear and other psychological barriers may very likely slow dilation rate. Rather than help the woman through this time, to explore herself and overcome the barriers, she is deemed in a medical model needing an emergency cesarean for dystocia (also known as failure to progress and dysfunctional labor). In essence, she and her labor are declared a failure; she shouldn’t have wasted her time and effort or theirs. The cruelty of it all makes me shudder.

My mother-in-law didn’t suspect a thing despite my lower half being soaked in amniotic fluid and my own urine. I sounded a bit tired or under the weather, but surely not in transition! We spoke, walked into the kitchen and I poured her a glass of water. As she walked out the door I called my husband to convey a message from his mother. Hearing my husband’s voice, I began to feel safe again and felt a surge begin. I didn’t want him to discover my state over the phone. As fate and good fortune would have it, the conversation was brief. I threw down my cell phone and gave into another surge, feeling like I had transformed into a wolf under a full moon. Within an hour I was fully dilated and having the time of my life.

Now we were in second stage for the journey down the birth canal, beginning from full dilation and ending in the birth of the baby. It was two hours before my husband came home. It is normal for a first-time birther to take up to three hours in second stage, but I believe it was the uncertainty of whether I should continue my birth the way I dreamed, achieving this on my own, being midwife to myself, or compromise by accepting the victories I had achieved in having a safe, gentle labor, but giving in now to the normal hospitalized way of birth for the rest. It was not a matter of capability, as I am confident that I would have birthed my baby in a squat, scooped her up myself, covered us in a blanket and nursed her until the cord went limp and then casually birthed my placenta into the plastic container I had set aside for the occasion. Then I would clamp and cut the cord with my gathered supplies, leaving the cleanup for once she fell asleep, all the while monitoring and assessing for complications as I had done throughout labor. I had set up the supplies and a birthing mat in a special room and had rehearsed it over and over in my mind.

The barrier keeping me back was not inside me, it was on the outside: my husband, my in-laws, my own family and anyone who got whiff would all think I was crazy and irresponsible to be so bold as to go completely unassisted for our first birth. Considering the consequences, the heat, the turmoil and conflict which would result, I dreaded to admit that continuing on my own would bring more harm than good. It would be a step backwards in birth activism, as I would be the subject of social ridicule, prosecution and disdain. I left the decision to God.

The answer was my husband’s knock on the door, after 13 hours of unhindered laboring without any suspicion on his part. He had groceries in his hands. It took just one brief look at me for him to ask tenderly what was wrong. “Take me to the hospital.” I was bidding my glorious labor farewell and asking to be taken to the battlefield I wished not to enter. I had no other choice but to surrender. My husband would be overwhelmed with panic if his first child was born under his care and accountability without a professional to supervise and simultaneously allay his fears and anxieties. His worry vanished with my words as he knew his role was clear: to be chauffeur and temporary supporter. He walked me to the bedroom to get dressed and pack. A surge came and I enjoyed having him to lean on and hold my face in his hands. He smiled genuinely through his anxiety, whispering to me that I had to take this. His words comforted me, essentially telling me to give in, let go and be patient—to take and not resist it. His presence helped even more and the surges felt less and less like pain. It was good to have company between surges, someone simply watching, witnessing and perhaps lightly caressing me during contractions.

I had imagined it being just my husband and me, but seeing he hadn’t prepared himself during the pregnancy, he insisted on taking his expert mother along. I was laughing with him on the way to his mom’s house, asking for a kiss. We pulled into the driveway and one by one, each of his siblings came out to greet, congratulate and pray for us. I was smiling and cheering myself on. Then my mother-in-law hopped on board and I had to be serious—I didn’t want to blow my cover yet of how far along I was. My brother-in-law opened the hood of the car and began tinkering with the fan assuming we had time. Thoughtfully, he didn’t want our car to break down on the way, as it often does. To our surprise my other brother-in-law came to help him, and then my husband stepped out of the car to help, too! Then a surge came and I called out for my husband, holding on to the car door and moaning. None of the present individuals had ever witnessed labor, except my mother-in-law, birther of 13, all vaginally without episiotomy or instrumentation.

We drove off uncertain about which hospital to go to, eventually settling on the closest, which happened to be public. My mother-in-law was insisting my contractions were less than 5 minutes apart and she didn’t want to have the baby in the car! I entered the hospital, my spirits still high, with the soul of a warrior. I held my husband’s hand as we walked down the aisle, teasing him about how it feels to be a daddy. My mother-in-law took the stairs so we could have a moment alone in the elevator where I finally got my kiss.

We came up to the reception desk and were asked to take a seat and wait until the women before me had their turn at being seen. I was happy to stall my interactions with them, but couldn’t sit because my baby was only a few inches from crowning! Perhaps had I waited to be seen, I would have crowned and birthed in the hall without their routine episiotomy. My husband insisted I was having the baby soon which they didn’t really believe because I was happy, calm and coping well with the surges which had of course slowed down since we left the house.

I guess they soon knew from the start I wasn’t their everyday submissive patient. When asked to get undressed for the internal exam, I took off the modest prayer outfit I had commuted in, my flower Capris and underwear, to remain in the black and hot pink flowery lingerie top I had labored in. This was bizarre to them because all women came in old-granny nightgowns to labor and birth in. I wanted to feel comfortable, sexy and confident as I had throughout my labor, seeing no need to change this mindset to become an ill patient for the hospital staff. When they asked me to lie down for the exam, I protested that it was uncomfortable on my back, stalling for more time. They pointed out that the windows were open and I wouldn’t want anyone from the street to see me undressed, so wouldn’t I just cooperate? A nurse or midwife checked me rather roughly and confirmed what I already knew, that I was in fact fully dilated.

Then I was to go to the birthing room. I walked there in nothing but my lingerie top, after making sure there weren’t any men around. I desperately didn’t want to have my birth hijacked by a bunch of ill-informed, technocratic terrorists, having my birth reduced to an assembly-line processing. The attendant got her sterile kit ready for the ceremonial genital mutilation all new mothers must endure routinely in the name of “better” medical care.

An episiotomy is a surgical procedure in which the vaginal outlet is expanded by an incision in the perineum to aid the expulsion of the fetus, introduced into obstetrics on the basis of theoretical benefits of preventing severe or irregular tearing, improving neonatal status and sexual function, by supposedly keeping the vagina firm and preventing natural stretching. A brief review of the relevant literature clearly indicates that the benefits of episiotomy in normal labor and childbirth are minimal to none and should therefore be restricted to cases in which second stage labor must be hastened for the genuine wellbeing of the mother and/or baby, such as established fetal distress, presence of cardiac disease in the mother and malpresentations of the baby being delivered vaginally (brow, face, breech.) In fact research shows that in normal labor, episiotomy has no significant benefits regarding prevention of third- or fourth-degree tears, improvement of Apgar scores nor reduction of NICU admissions as was once widely believed. Sadly, routine episiotomy is still performed in the developing world.

In addition to lack of clinical benefit, research clearly captures the morbidity, adversity and suffering following childbirth of the mother receiving an episiotomy, including but not limited to: chronic pain, prolonged healing (4–6 months compared to 6–10 weeks for a naturally occurring second-degree tear), difficulty walking, sitting and changing position, as well as resuming sexual intercourse due to painful penetration. This has a devastating impact on the woman’s experience of motherhood, her ability to care for herself and baby, as well as plaguing her marital relationship with even more challenges than childbirth and childrearing has already imposed upon her.

If given a safe, sensitive, respectful environment, I know I would have birthed my baby easily with a few gentle pushes. I had dreamed of birthing my baby lovingly into my own hands in a squat. Instead I was being physically pushed, pulled and hit by health care professionals in an attempt to subdue me into accepting a routine episiotomy. I began discussing with them relevant evidence and research which fell on deaf ears. How could they have been doing it wrong for the past 20 years? That would too difficult to admit, so instead they ridiculed, insulted and humiliated me. They told me I would tear terribly and told my husband that I would suffocate the baby and we would both die—the most absurd thing I have heard. One nurse approached me with the scissors, as if beginning the procedure without preparing local anesthetic. It was another attempt to threaten and intimidate me, to which I responded by pushing her away with the force of my foot against her chest.

They shushed me as I moaned and bellowed, to which I responded that it made me manage the sensation and relax. Now I was being denied and discouraged from the two most powerful aids in my labor: movement and vocalization. I felt my daughter’s head crowning and felt for her in excitement. To this I was scolded for breaking sterility. Since when is my vagina sterile and my welcoming touch detrimental to my baby’s wellbeing? How could I birth in a surrounding of violence, manipulation and fabricated danger? They threatened to leave me alone; I said, “Please do.” They threatened to let me bear the consequences of my own misguidance in refusing episiotomy, including a dead baby, and throwing away the past 10 months; I told them I would sign the required papers. They threatened to get my husband involved, assuming I would get in trouble; I said, “Go ahead.” All of the staff came in and out completely puzzled, yelling in frustration and bewilderment.

When the OB came in furious, I realized I had to put down my weapons and accept that I was in their hospital, a battlefield I could not win in. He got his equipment ready without a word or a look. I was already conquered, so why speak to me? I was reduced to below human, so why look at me? I asked meekly how many stitches he would do. He sneered it was none of my business how he worked. I shot back, “How is it none of my business? This is my body!” He looked me in the eye for the first time, stern, cold and with sheer contempt, commanding me not to speak a word or resist. I recalled my dance with my baby, unhindered. I smiled inside myself, bittersweet. I had done all I could to protect myself and my baby from harm and I did it from pregnancy and beyond, so utterly alone. I had battled my own fears, insecurities and pain of a lifetime while also fighting three fronts: one with my life partner whose support I yearned for the most, one with other family members and friends who shared or ridiculed my journey and the last with the medical system in a quest for alternative options. I had been victorious in ways by God’s good grace, but now I was asking God for forgiveness. I could no longer fight; I had to surrender and let my baby enter this world. We were relatively safe now—the battle was over. I let go and at that moment my baby girl Shems was born: the rise of the sun.

I sat up and reached arms outstretched to embrace and welcome my baby. I was on my oxytocin high and instinctively wanted to nurse my newborn skin-to-skin to release more love hormone and aid expulsion of the placenta. I was mocked for being in such a hurry. Her Apgar scores were 9 and 10 at 1 minute and 5 minutes, respectively, a perfectly, unhampered, unharmed result of natural childbirth. I watched as my baby was unnecessarily deep-suctioned by the OB. A neonatologist was called in for more dramatic effect. He took one look at her, played with her feet lovingly and pronounced her fine. Then she was dressed in the clothes I had brought for her, her vernix still intact. She received no vitamin K, no eye prophylaxis to blur her vision, no sticks or needles, no rectal thermometer. Furthermore, she was never separated from me for more than 10 minutes, as opposed to an average of 3–4 hours in private hospitals. Public hospital policy promotes breastfeeding in a baby-friendly environment. This was the main reason I opted for a public hospital—for the respectful motherbaby care after birth and so we would not be separated.

As my baby was being tended to by the OB, I was approached with a needle by an attendant. I would have preferred to gain acquaintance with my body, birthing the placenta with the aid of my baby’s suckling reflexes working on my bosom and using the medicine only if I genuinely needed it. I took comfort in the fact that my baby was safe and her oxytocin was not at all tampered with during our dance. My oxytocin rush was terminated prematurely. I asked if my placenta was intact, since I had sustained a hard fall in late pregnancy. She looked at me bewildered and pleaded, “Just let me do my work.” I had really wanted to hold it, explore and feel it with my hands, mush it into jelly. She then had more compassion, more humanity. “Your placenta is fine and you’re doing great.” As she stitched I inquired about her technique and we had a conversation like any two people in another setting.

I was in a hurry to get back to my baby and move on from the conflict. I told them, “No hard feelings. Let’s forgive each other.” I got dressed and proceeded to walk to my room, but the assistant insisted she wheel me. I gave one attempt to say it really wasn’t necessary before accepting her pampering of me. I beamed smiles to everyone in the hall, held myself strong and mighty and joked with sheer confidence and innocence. Everyone wanted to know who the commotion was all about and came to congratulate me. I wanted them to know birth is empowering, a miracle and a blessing to mighty women, not a passive, pitiful act we must endure.

My husband handed our baby to me and within a few minutes I had her to my breast. I was ready for a victory feast, having had only the milk with my husband that morning and copious amounts of water. I asked him to get me a roasted chicken or other meal, since I had missed the dinner meal provided by the hospital.

There is no nursery to separate mothers and babies in public hospitals; rather a crib is provided for each baby to stay with mother. I kept her in my bed most of the night, feeling it wrong to put her any farther than what she had known to be home for the past nine months. No escorts were allowed to sleep over in vaginal deliveries. I was relieved to be alone with my baby, unless of course it was my husband to stay with me. A woman had delivered by cesarean for a facial presentation and had her mother stay with her, who in turn mothered me and the third woman in the room. The third woman was now a mother of eight. I was pleased to hear that the staff instructed her to walk up and down the stairs to speed up her labor, as opposed to starting her on an oxytocin drip.

In the morning the birth attendants came to tell me they would never forgive me for the hassle I caused them. The physician came to check on me for discharge and demanded to know why I was so incompliant. I tried to block out, ignore and move past the fact that they had traumatized me and not the opposite.

I returned home to find the whole house cleaned, the laundry done and a meal made. As is custom, my family-in-law were dutifully ready to care for me, my home and the cooking for my 40-day recuperation period. Soups are also made daily to boost the milk supply. I was very grateful for their practical support, especially when the stitches began to bring me down in spirit and body. I felt violated; perhaps I had given in too early or easily. Why didn’t my husband do anything to protect me? I couldn’t get comfortable sitting, walking or changing position. What good was I to myself and to my family? It took a while to forgive my husband for letting me down. New fathers need to be supported if they are to support their partners. I didn’t accept the assumption of the sick role, staying in bed for at least the first two weeks, as is custom. Physically and mentally this was against my own wellbeing, so once again I was defying tradition by wearing a dress and make-up by day two and moving about within reasonable activity levels, promoting my circulation, energy and restoration.

From her first hours, Shems, Arabic for “sun,” was different. The other babies lay lifeless and listless only to barely latch on and then return to their slumber. All the other babies were drugged along with their mothers in states of altered consciousness, soon to go home to a process of drug-withdrawal, apathy and irritability. My baby was alert all night struggling to get the hang of breastfeeding, observing the surroundings and discovering her hands. She was, and God-willing will continue to be, a happy baby. At the age of two months and one week, she said her first word: seha, the Arabic word for “health and wellness.” It is custom to say seha to another after they cough and, in a baby’s case, burp. This time she repeated it after me.

I wrote this to share my experience with the intention of shedding light on birth in my country, providing insight to other women searching for truth and for birth activists bringing the struggles of mothers to life with a name and a story. Birth in Jordan must become evidence-based, humane and under the prerogative of women and their families. I am passionate about reviving respectful, sensitive birth practices as a rite of passage and empowering feat of womankind. I have contacted an MD and senior advisor in the Royal Medical Services, regarding the implementation status of the universal recommendations of selective, rather than routine, episiotomy in Jordanian hospitals (Ayyad 2011). He avowed he would contact US AID in Jordan and get the process going. I ask God to make us all keys to open doors of good and lock the doors of evil.

I know the bond between me and my daughter has healed me from not only the negative aspects of my birth (indeed my labor was incredible in many ways), but also from the trauma, betrayal and pain of a lifetime. In giving birth, I was reborn. I laugh from my heart and smile with my soul again. The love between us gives me hope, her innocence gives me faith, her trust gives me courage and her smile wipes the wounds clean. No wounds can exist in the face of her contentment, joy and satisfaction. Thus is the power of love, the power of motherhood and the power of birth.

Suzanne Mohammad* is currently living in rural Jordan with her husband and daughter, Shems. She is a registered nurse and mental health case manager with the International Medical Corps, implementing the WHO’s Mental Health Gap program in primary health care. She is passionate about the psychology of motherhood, the interactions of mental health and family wellbeing, and the empowerment of women, parents and families. She welcomes emails at suzannemd@windowslive.com.


Ayyad, I. 2011. “Selective or Routine Episiotomy?” Middle East Journal of Internal Medicine 4 (4): 35.

Hatamleh, R, et al. 2008. “Technological Childbirth in Northern Jordan: Descriptive Findings from a Prospective Cohort Study.” Evidence Based Midwifery 6 (4): 130–35.

*Name has been changed to protect privacy.