Profile: Amna Saleem, AMANI Birth Certified Childbirth Educator and Birth Doula

One of Amna's clients relays her birth experience with Amna as her Doula:

"It was a journey that felt like it will never end.

It had been 37 weeks and I was exhausted, tired, and felt no sign of it ending any time soon. My nights felt longer and days felt shorter. Sitting down was uncomfortable and lying down was even more tedious. I would keep turning sides each time to find a comfortable position till the sun came out in the morning. Nights felt like scenes of horror movies - wherein the nights never end and the whole movie passes as if the day has never started - except that the monsters were my dreams that I had started having near the last few weeks. Midnight baby kicks, hiccups, nausea, and then nightmares. It was horrific. I would wish for the day to start earlier and last longer. I would hear the Athan and get up for prayer, then see the light of dawn and set out of the bedroom to start the day. I would wish each morning for it to end soon; I could take it no more. I started having nightmares lasting seconds, after which I would wake up at midnight. A slight voice or even a gush of wind would also feel too much to tolerate at that time. I had a bed specially made of a soft mattress with an even softer polystyrene fiber mattress on top of it for me to lay down but it all felt hard and uncomfortable even though it was as soft as a cloud. Nothing felt good, especially at night.

Then came an angel into my life.

I had been searching and studying the phases of pregnancy and delivery to understand this journey well when my old friend Amna came in as a helping hand. After a long time, our conversation started through a normal casual text message and then she shared her experience. Despite having other friends close to me who encouraged me and helped me out, with Amna it was different.... closer to heart. The way she explained things empathetically and helped me with anxiety is unforgettable. She became my go-to person. Someone I could trust and seek in a time of despair and confusion. Then came the last few days before my daughter came into this world. It felt too heavy to carry any further, and several nights, I would cry myself to sleep. Life felt too difficult to get through till the night of 2nd December 2020.

I was exhausted from being pregnant when on 3rd December at 10 am I felt as if I leaked!
This tingling feeling and then my pad got all wet... I felt as if I peed. I rushed to the washroom where I got confused and searched for any other signs which indicated anything clear about delivery.

I felt as if I am closer to delivery time. Then I messaged Amna, and she being in America where it was midnight several miles apart, told me to have dates, a healthy small snack before the baby kicks in, to conserve the energy. The words of affirmation, the encouragement that our bodies are made for this, the talk to anticipate the birth itself were worth it. She called me to tell me how it was going to be and how to stay strong through it. My labor pains had not started yet but the gynecologist suggested going to the hospital ASAP. I had read that it was not an emergency condition when the water breaks unless you are bleeding or have labor pains. So, I kept my cool, and composed myself. Set the hospital bag and was surprisingly energized at that time. Amna told me that she was going to offer prayer and will pray for me and offer nawafil (extra voluntary prayers) for me. It was at that point that I prayed with my whole heart for Amna’s continued health and happiness in life! I took time and prayed specifically for her and asked Allah to give her whatever she wishes for! It was a moment of gratitude for me to have someone do something so pure for me miles apart! She told me that she will try to stay in touch with me and guide me through it all. She asked to have a video or voice call in the labor room with her for support but in Pakistan, they don’t give any guarantee for items carried to the labor room. So, I had to leave my phone with my mum and told her that she will try to keep her updated if I couldn’t. Amna kept sending me voice notes for my ease.

Labor Room

As soon as I reached the hospital, they admitted me at 2 pm. The officer on duty, checked dilation and informed my gynecologist, who decided to induce me. I was injected oxytocin around 4 pm, I changed into hospital clothes. Another gynecologist who came to see her patient, passed by me and said that, “Pains start hogae?” (Did the pains start?). To which I replied, “Abhi tou thori thori hain” (They are less right now). She laughed and said, “Isne thori thori mein hi deliver kardena he, ye mazai ka case hoga” (She would deliver in these fewer pains, it would be a fun case). My condition got worst as soon as the labor pains started around 6:30 pm. My gynecologist also came on duty and visited me just to check how am I doing and how much am I dilated.

The stay at the hospital was horrible. The baby monitor's sound felt horrific and depressing. I had the urge to pee every half hour or so. But every time I went to the washroom and sat on the toilet; I couldn’t get it out. I was sure that the baby’s head was blocking the passage. I would return to my bed disappointed but as soon as I laid down again, I would feel the same urge to pee again. For the first few times, I was able to get it out a little, drop by drop but by the 5th time, fewer drops fell. This time when I returned to my bed around 8 pm, the officer on duty asked the nurse to not let me go to the washroom. She came to me and without saying anything or asking for permission, checked dilation. My pains got intense by 9 pm and I was transferred to another bed near the observation desk for close monitoring. The gynecologist kept on checking dilation now and then. I couldn’t lay on my back and found it better to cope with pain while standing or walking though I couldn’t walk more as the baby monitor was attached. Ayas (nannies/nursemaids) and nurses were assigned for each task of patients. One of the aya (nanny/nursemaid) came to me for support while I stood against the wall. She told me to slant against the wall so that my weight is shifting towards the wall. Little tips like those helped a little but having no close person nearby felt as if I was left in a place of strangers who have an access to me in my vulnerable time and I’m at their mercy. As the intensity of pain increased so did my to and fro movements. It felt as if my internal nerves were aching. My whole body was in pain by now and I kept taking Allah’s name as Amna told me. I couldn’t think of anything else. Surprisingly at that moment I wanted to cry so bad but the pain was so intense that I couldn’t even cry. My tears dried up and my voice numbed down. I bottled it all up, trying to stay composed but it was my breaking point and I couldn’t take it anymore. It was around 11 pm and I had been standing for almost an hour with pains across my back and lower body. I had peed twice by now; the contractions were so intense that the pains felt like stabbing in the abdomen. My legs bore the load strongly and I could feel the trembling of my body as well as legs with each contraction. My body had started shivering as I leaned against the wall beside my bed. The gynaecologist checked dilation again and I asked her how much am I dilated to which she replied, "Almost 7 cm". After some more standing and pushing she checked again and I was still at around 7/8 cm. My mother came in to ask her if anything was required or blood was needed, to which she replied that all is going well and nothing is required so far; the baby will be delivered soon. Previously the doctor had said that there is no significant progression in dilation.

When mum came, I asked her out of despair, “How do you PUSH?!!!”. She told me just like you pass stool... with the flow of contractions. I said I’m already doing it. She said, “Beta insha’Allah hojaega (my child, it will happen God-willing), keep doing it”.

Soon enough the doctor checked the dilation again and then ordered the nurse to transfer me to the labor room as I’m not pushing well enough.

Delivery Room

I was transferred around 11:10 pm to the labor room and then I was instructed to push. This felt like the worst day of my life till now. The duty officer kept saying with a loud voice to push harder. I said I’m pushing. My gynecologist said she is not pushing, the baby is not moving forward, take out the vacuum. Then another officer, who was a comparatively new officer than the other one, kept checking for contraction and as soon as the contraction started, the Aya (nursemaid) started giving me fundal pressure, while on the other end, my gynecologist sucked the baby out with a vacuum. With every contraction the new officer, the duty officer would announce that a contraction has started: and Aya (nursemaid) would comply by exerting her full pressure from the top. The doctors acting like butchers would yell, "PUSH, PUSH, PUSSHH!" And my gynecologist would suck with a vacuum. This happened for quite some time and I was being given an IV of some medication. My doctor then said that she has made the way even wider now it should get easier. (This was probably the cut/episiotomy they gave to widen the path for the baby).

Another contraction, and again Aya (nursemaid) would exert her body weight, again the duty officer would yell. I was incredibly exhausted! It was torturous and traumatic with unbearable pain! My labor had stalled or the doctors were in a hurry to deliver the baby soon. Either way, it was unbearable! It went on for another half hour or so and I felt totally helpless in pain. My doctor said it’s almost there... “Bus thora sa aur thora sa aur” (just a bit more a bit more) and then it took another few minutes. Then suddenly the pains numbed down and I felt a warm mass above my abdomen and I looked down to see it...it was my BABY!

For the first time, I felt the warmth with a slight weight of my daughter above me and within a few seconds, she started crying. They said 12:10 am... the time of birth, and took her away for a shower and all the pain in my body suddenly decreased. I took a sigh of relief... the worst was over... in my head! But little did I know that there was more to come.

My gynecologist said that it’s all OK now and she was going to suture me up. Meanwhile, I started feeling slight pinches down there. Hardly in a few minutes, they brought back my baby and I saw her for the first time wrapped in a yellow towel. The sight of my little baby diverted my attention from the needle pains down there. A glance of about 5 seconds and the nurse said that she was going to take her, and they will be waiting outside. I said I was having pinching pain down there. I guess the anesthesia had now started to wear off, so I requested that the baby be kept close to me while the doctor was stitching me up, in hopes that my pain would feel less intense. But the nurse insisted on taking her away, to which I agreed. Shortly after that as I was feeling the needle going through my skin, a gush of blood flowed from there and my doctor quickly ordered the nurses to hand her gauze and needle and catgut. She tried to stitch up quickly but the blood didn’t stop flowing. It was uncontrollable. She asked the junior doctor to hold on to the other side. My doctor said, “bleeding itne horhe h mje nazar nhe arha k khoon nikal keha se raha hai, isko aese hi band karna prega” (Bleeding is happening so much that I can’t see where the blood is coming from, we will have to close it just like that). She asked the nurse to get more catgut from the emergency. The nurse went and came back and told her that they are not opening the door. She quickly asked the other one to give another dose of injection. And angrily headed herself towards the emergency operation room beside the labor room and banged the door. I could hear her shouting at them, then returned with more gauze and catgut. Asked the nurse to tell my guardians to arrange blood quickly. There was an emergency condition, things had turned terribly critical - the officer on duty said we should take her to the operation room but my doctor said we have no time, there will be too much blood loss before we shift her. At that point I started remembering Allah. They then called someone through my doctor's phone but the other person didn’t attend. The nurses brought more gauze and packs. She sealed everything down there. Then more stitching. I could feel every movement of the needle going in and coming out of my skin and I told them that I am feeling the needle pain! My doctor said to bear the pain as there is no time and even if she will insert the local anesthesia, I would still have to bear the needle pain of anesthesia. Then she said, “itne himmat se jaha itna dard bardasht kia hai, waha ye bhi karlo” (you have borne so much pain with so much courage, just bear this too).

All of it was traumatic, to say the least. At that time, the pain was at such an extreme level that I couldn’t even cry it out! I kept myself pushing further by not even taking out a cry. It was like a miracle for me to go through all this and bear another trauma after birth.

She stitched up everything. My vitals were being monitored. My pulse wasn’t stabilizing. My blood pressure was shooting and my pulse was high. I was given a blood transfusion (which was arranged in emergency and could have been arranged as a backup before when mum asked her earlier). She asked the nurse, “Ye inke bhai ka hai?” (is it her brother’s?). She told yes and then she said, “Ye bhai ka h islye me sara he lagadeti hu” (since it’s her brother’s, I’ll put/use all of it). I was given a whole pint of blood. It was almost half an hour later that I started feeling a dip in my heart. Then I said that I’m fainting. She said it’s all OK. I again said that I’m fainting and she didn’t take it seriously. She was still sitting there in the corner telling me that all is OK, we have given you a sedative. Then at that point, I said assertively that I know the difference between drowsiness and fainting and I AM FAINTING BECAUSE I CAN FEEL MY HEART DROWNING! I was in bradycardia.

At that point, she quickly got up and gave me another injection. Checked the monitor, stood there watching the monitor beep.  She stayed there till 1:30 am and kept monitoring me - it started stabilizing a bit.

After half an hour almost, I said I’m not able to breathe properly. The Dr. said, “theek hojaega” (it will be okay), “Ap sonaiki koshish kren” (you try sleeping). I closed my eyes to try and fall asleep but my heart was throbbing. I was a little drowsy by now and they thought that I couldn’t hear or understand them talking. I tried to calm down myself with eyes shut. My gynecologist turned to nurse and said that, “Mujhe ye case pehle e corona ka lgrha tha, mene sae btaya tha na” (I was already feeling that this is a Corona case, I said it correct, right), and the nurse agreed with her! A few moments later I tried to adjust the pillow but due to the IV lines and drips attached to my both arms, I couldn’t move my arm up. My head was tilted downwards slightly blocking my airway. I asked her to move the pillow below my neck to lift my face and then I was able to breath properly as my neck straightened up. Now I felt a bit relaxed lying straight on labor bed still under observation.

My mum was called in around 3 am. I asked her to bring water as I had had nothing for almost 9 hours. I was thirsty and exhausted. As mama came with water and helped me take small sips, she asked the Dr. why was I being kept in observation and not being shifted to the room to which she replied that “She is all OK, we are just checking her for some time; she gets anxiety due to which her heart beat is not stabilizing.” I told mama that now I was breathing better because Dr. had changed pillow position properly (to make sure that they don’t make it a corona case as obviously, it was not one). Mama was then asked to leave as talking was making my heartbeat faster. My doctor said that it was the most difficult case she had in the last 10 years of her career. An operation would have been easier than this. Then she left shortly after that leaving a nurse behind to monitor me. I dozed off for some time but stayed awake for most of the time till 7 am when I was brought back to the delivery room from the labor room. I had been awake the whole night, I needed rest. In the morning after being shifted back to the delivery room, I slept for a full hour till I was woken up by the noise around. The Dr. who had said yesterday that I’ll do fine, crossed my bed and asked happily how was I doing, “Apka tou asani se hogya hoga” (you would have delivered easily). Nurse came to tell her, “Inka 3rd-degree tear h with hemorrhage & Shoulder dystocia” (she had a 3rd-degree tear with hemorrhage and shoulder dystocia), “Blood loss hoa h, blood b lga hai” (Blood loss happened, received blood as well). To this she replied, "Sadly that’s a nightmare, it turned into a critical case then".

6 hours of labor and 14 hours of stay at the hospital felt like forever. I couldn’t remember the day or date in the morning. I was under observation for the next day till 4 pm. In the morning, my husband came to ask me for breakfast then he brought cornflakes. Mama kept coming off and on as needed. She gave each one staff member Rs 500/- tip who was there with the Dr. during delivery. Later those staff members nurses and Aya (nursemaid) asked him for a tip also. At 12 pm, my doctor came and checked me. I was again shifted to the labor room. My doctor said, “ab koi dard nae hoga, tumne jitne dardaen lene thein wo khatam hogaen, mene bus pack remove karna hai aur condition dekhne hai” (There will be no more pain now, whatever pains you took, they are over now, I just have to remove the pack and see the condition). She removed a large piece of gauze full of blood from down there.  It felt as if a large cloth was used to block the bleeding and seal it off right there. Then I was shifted back to the delivery room. Later, my gynecologist brought the anesthesiologist with her (whom she had been calling last night at the time of emergency), he checked my BP and heart rate. He was the senior Doctor. He apologized that he couldn’t take the call in time and that he had just returned home from duty. She told him that she had called him due to this emergency in tachycardia and she wanted to ask the medicine to be injected. They both discussed and decided that I’ll be given Inderal for a few days and discontinue it as I feel better.

I was still being kept under observation till 4 pm on 4th December. My vitals were being monitored. My newborn was brought in the morning, I saw her for the second time. Then after 7 am, I slept for some time. Around 9 am, I got up and asked mama to give me my phone. I saw messages from Amna and informed her of the situation.

I felt like she had been there with me throughout this time. I can now say that distance doesn’t matter if your intentions are pure. Someone so far away can be so close to you. Her guidance and the way she boosted me, is remarkable. I really appreciate the way she helped me throughout the confusion. Being a mom is tough and a lot of hard work but she took the time out for me at the moment where I needed an experienced person the most.

To my virtual doula Amna: your virtual presence made all the difference. Your advice for dates and nuts before going into labor, your guidance to keep remembering Allah even though I was in pain... and most of all the new researches, the knowledge you shared - and still sharing - is a beautiful way of expressing that you go out of your way to provide the best care, all the while staying connected. The affirmations you gave to boost my morale, that I can do it and my body is made for it, that I needed to just breathe and take a pause then breath again, your tips and guidance all paved the way to make my experience less difficult. The best thing which I like the most is that you share research-based knowledge which is evidence-based with good scientific reasoning. Many people just follow trends or believe things without knowing the logic behind them. But you share things that are logical, as well as scientifically true. I am in love with the way you deliver knowledge... effortlessly beautiful. May Allah bless you even more. Ameen!"