I went to speak to a pakistani gynecologist named Shamma, who lives and works in the city of Mandi Bahauddin, in Punjab, Pakistan.

Her husband and herself made the project of a private hospital which was built in 2016.

I went to visit her while she was working, and she gave me some information about how the private system works and showed me around the hospital regarding pregnancy.

Pregnant women in their 1st trimester are given folic acid, then from 3 months onwards calcium and iron as she said food quality is not very good here and pregnant women need to increment their diet.

In the last months of the pregnancy it is important for the woman to take iron.

Pregnant women, I've been told, have no time for themselves, so they do not exercise, they carry on with their lives as they did till now, the only difference, and I would say big difference, is the baby they carry and the belly getting bigger and bigger, YES THEY ARE PREGNANT! If they can they will have someone to massage them weekly or as much as they can afford. One lady I know she would have massage every other day in the last months of her pregnancy, while instead I spoke to another lady whom I suggested to rest before giving birth and she told me she didn't have the time!

In Pakistani culture, generally, once a woman gets married, she goes to live with her husband's family, she leaves the house of her childhood and most of the time goes to a different village/city which could be from 10 minutes to several hours away, and that's the new house where she now belongs to; from time to time she will go back to the house where she lived before with her parents and stay there for sometime from a week till a month depending on how far her new house is and how long she's been away for (or other reasons)

In the new house the woman lives with her husband, her parents in law and her brothers in law with their wives. The responsibilities of the wives is to take care of the house, meaning cleaning, cooking, washing, preparing tea and food for guests at any time they might come, looking after children and their elder parents in law.

This is the most common situation as women stay home and rarely have a job outside the house which instead men have.

Women spend most of their time with women.

They are used to squat while cooking, emptying their bowel, cleaning the floor, washing the clothes, peeling vegetables and preparing bread and food. They sit sometimes on chairs. They like sitting on their typical bed called “char pai” with crossed legs, or squatting. 

When they go and visit relatives or friends they are invited to sit. (beja)

Then there are the women that work in the field all day long and take care of the animals like buffalos and cows, meaning walking and standing more.

Because of this hard work I've heard some women giving birth very quickly without much pain.

In the last generation women used to give birth at home with a “non qualified” but experienced midwife.

No man is involved in labour, or delivery, a part from driving the woman to hospital if she wishes to or the Gynecologist doctor in case!

Nowadays 60% of the women give birth in a hospital and many cases are caesarean.

Woman are getting more and more stressed about life and poor diet. They can experience  severe anxiety so pre eclampsia is very frequent and planned caesarean to avoid labour pain (although the recovery afterwards can really be tough for some!).

At the hospital there are no facilities such as birth centre or birth pools.

Women try to reach the hospital in the very late stage of labour, just for delivery, and spend most of the labour at home where they continue doing their usual work whether in the house or in the field

I've visited private and public hospitals and in both cases the gynecologist invites the woman to give birth on the bed therefor the labour room is simply a tiny walled room without windows with a chair, a bed for the pregnant woman, a char pai for another female only who is allowed to accompany the lady such as mother, or sister. 

In the private hospital there were 7 labour rooms on one floor and 2 delivery rooms on the same floor.

Before coming to Pakistan I imagined how women here could give birth, at home, in the “old style”, and some still do so, for example one of our neighbours who is 23 years old, gave birth 3 times in her house, and now she is already pregnant of her 4th baby and looks very fresh and energetic.

Other women are scared of delivery here as they have heard labour is very painful and stressful also they would rather go for a caeserean (not considering the pain afterwards of the stitches and the recovery time needed for mum and baby, although all births require recovery!). It looks like the majority of the deliveries are either natural at home or caeserean. 

Of course some women have labour at home and delivery at the hospital whether lying on a bed or sitting down if they are lucky to find a gynecologist to invite them to sit.

Labour here is a passage,it feels like it is something you have to tight your teeth and go on with it! Labour rooms are not inviting at all as I described and that puts down women when it comes to give birth!

The pregnancy length is considered of 40 weeks. At the end of these weeks the woman will start be induced through one pill and if nothing happens means no contractions, then a second pill will be given and labour will be strong intense and short.

After giving birth the woman will go home on the same day, depending on her condition of course, that is the case when everything is fine. 

Saira, a woman on my prenatal yoga course, after a caeserean stayed at the hospital for a few days. When I went to visit her and her baby there she was on a bed in a big room where also other women were after delivery and I asked her if she was given food by the hospital and she replied that only guests will, and then she explained she had to stay without eating for a week because of the operation and the catheter applied to her, she could only drink water or soup.

Once mother and baby go home after birth there is no midwife coming to them or appointment given but in most cases a lady will come to massage the mother especially on the legs.

I went to visit a mother and baby at their house in their village. It was around 11 in the morning and the baby was delivered at the hospital early morning and the mum was already home, they were fine. 

The mother was lying on the bed and the grandmother took the new born baby outside in the courtyard. I heard him crying and thought maybe he was hungry and I went out and saw the grandmother had just washed him with water and soap all over his body and hair and she put new clean clothes on him, and I remember commenting "baby just born needs their mother and warmth". I didn't expect the baby to be washed so soon, although that's what they did, it looked to me like a new second birth for the baby!

Mothers here know the importance of breastfeeding although they are not told anything from gynecologists who think their mother will tell or presume they have seen someone from their family doing so and maybe that was the case in the past, but things are changing with the new generation and some women give formula milk or buffalo's milk to their new born. 

In these villages there are no classes nor meetings for pregnant women. During pregnancy a woman who chooses to visit a gynecologist will have 3 scans one each trimester. 

One gynecologyst told me women nowadays want to have a scan every month during their monthly check up. The scan is never shown to the pregnant lady unless she asks for it so the monitor will be shown to her. Maria, one of the ladies who was in my  weekly group course, told me she never saw the monitor and do not wishes to, as they believe it is a "Hidden special baby", who God decided to be so!

During these anti natal appointments blood pressure and weight of the woman is measured. Some medicines in case are prescribed by the doctor.

Every check is very fast and brief.

Pregnancy is very medicalised and pregnant women in hospitals are considered a patient.

There is a very big belief in medicines and people simply trust doctors and gynecologist and will most of the cases do anything they say without questioning. Sometimes because they don't have the knowledge, also they feel there's no other option to it or time for natural relief or homeopathy.

Here in Pakistan, or at least in the villages and surrounding where I am in Punjab, there is not postnatal care for the woman and baby. Sometimes babies cannot survive the cold of winter, as most of the people live in open houses with no heating system or they cannot provide appropriate health/clothes for their little children which is very sad.

I would like to write some words remembering an event that happened in the neighbourhood here in the village Dogal which made me meditate and reflect and ponder how delicate, fragile and precious a baby's life is and how important postnatal care and check up can be if done appropriately and accordingly.

Today 6th January a little boy of 7 months passed away.

I used to pass smaller clothes from my daughter to his dad knowing they are a poor family in need with other children. I knew 2 of his sons died when they were in very tender age but the mother got pregnant again and gave birth around 7 months ago!

As soon as I heard the news I felt num, I wasn't expecting this, when my husband was telling me I thought he was going to say about this poor man, I could not believe it , I didn’t want to accept it. But it was true and it felt real just later on...when I wanted to go and see the family. We went to his village next to ours where we sometimes like to walk there with our children in the buggy. We asked people where his house was because we had never been before. After asking a few people, someone (who later I found out was the man's older son) confirmed the house was over there. We stopped the motorbike and I got off and picked through the entrance door: I saw many women on char pai, looking sad, and then I saw a big blanket on another char pai, I didn’t know who was underneath there!

My husband told me to go in and say “Salam”, but I felt embarrassed saying I don’t know anyone there, and my husband replied the same to me, so I asked me to come with me and the children.

He encouraged me to go there, over there...meaning next to that person underneath the big blanket. For a moment I thought maybe the little boy was there but in myself I knew that person looked too big to be a baby and also my husband told me on the way there that the little was boy already been buried. 

Then my husband repeated again, Go there, that's the mother!

I went to her. She sat down and looked at me. I said Salam. Some women invited me to sit next to her, others to sit near that char pai and so I did. I initially decided to sit slightly away from her because I had my daughter in the carrier bag who was sleeping and didn’t want to wake her up.

I asked her what happened and when is the boy and what was his name. The boy was called Abdullah and his funeral had been just an hour before.

Shortly after, I mean a couple of minutes, my husband said now we can go, so I stood up, but something in me told me it was too rushed to go just like that with only having said salam. So I said to him “ Let me hug her first” I went to sit next to her and hugged her and she hugged me and started crying, we were both crying but mine was silent instead hers was with words, she was saying ...Abdullah, calling her son, and I could feel her pain, I felt like I was taking some of her pain away, we were one thing together in that moment, sadness, but also we were so close I felt she was my sister or even myself. I dried her tears and I was wondering what to give her, in that moment I couldn’t give anything rather than me, my human heart. Our hearts were connected and after a while she stopped crying and I looked at her, I held her hand and then kissed her on the cheek.

I said “khuda haffiz” ( God be with you), and we left.

I would like to thank all the pregnant women that I met here in Pakistan and their babies, for giving me the opportunity to share with them these moments of life.

Thank you for allowing me to get some informations and to the gynecologists who showed me around hospitals.

And thanks to my family and children who lived this time here with me.

This of pregnancy and postnatal care is a big theme and definitely in Pakistan they could improve, although there is a lot we can learn from it!

My wish is that women keep supporting each other during pregnancy and postnatally so that desired home birth or natural birth will increase again in the light that every woman can live this experience fully and without fear, letting herself be.