Despite my misgivings about midwifery in Thailand, there is one place where you can have a natural birth within a midwifery model of care.
The Samitivej Hospital is a large private hospital in Bangkok, and it contains the only Birth centre in Thailand. Over 20 years ago, Melanie and Dr Tanit Habanananda set about creating a special birth place that would be open to all the active birth concepts they believed were best for women and babies. With the support of the Hospital, they redecorated and refurbished some birth rooms, installing baths, low beds, soft lighting and a collection of simple birth aids (stools, mats, hot packs, bean bags, birth balls etc). Dr Tanit led the way, offering water births and births off the bed, often in squatting or kneeling positions. His success (his personal caesarean rate has been around 3%) encouraged others and several colleagues began offering similar care.
About 3 years ago the Birth Centre was relocated, providing an opportunity for expanded space and new decoration. There are four birth rooms - two with fully adjustable beds and access to more traditional equipment in case of obstetric need and two delightful natural birth rooms, complete with large tubs, regular beds, wooden support frames and discreet lighting. The walls are covered with a collection of lotus flower prints, reminding women of their sacred flower as they labour and give birth.
Even though this may be the most beautiful birth centre in the region, it is the quality of the care that is important. The midwives who work here are a dedicated group, skilfully supporting women through the labour without the use of drugs. The obstetricians who use the centre are open to water births and “alternative approaches”. Their results are excellent and the unit is very popular with the expat women in Bangkok, who are used to midwifery care in their own home countries and appreciate the rare chance to have a similar experience in Thailand.
The Hospital tends to be more modest about its achievements with the Birth Centre than it need be. A facility like this should be trumpeted as world class and promoted as the only place where the routines of shave, enema, lithotomy and episiotomy ( the standard fare in other hospitals) will not even be suggested. Thai women need to learn of the availability of this service - foreigners usually manage to find out about it through their support networks.
Doctors, especially those who are keen to develop a thriving practice, could see the advantages of such a set up. In this unit, women will be able to labour with much less involvement of the doctor, who needs only stay in the background to improve his statistics (reduced caesareans, forceps, vacuum etc) while producing satisfied clients (and collecting his fee!).
Women need more choice when it comes to giving birth in Thailand. This unit is a shining example of how it can be done, with little cost, better outcomes for mothers and babies and increased job satisfaction for staff. The Samitivej is to be congratulated on its forward thinking approach to providing such options.