Breastfeeding in Macau: Current Status and Advice from an Expert

Recently I had the good fortune of being invited to attend an all-day seminar about breastfeeding, presented to the medical community of Macau.  Dr. Jack Newman, a world-renowned expert on breastfeeding presented four lectures throughout the day, which I will comment on in later posts.

The general theme of his advice to the Macau medical community was that, in order to improve breastfeeding outcomes here, a few things need to change from a government and hospital policy standpoint.  The WHO recommends children be breastfed to the exclusion of all other foods until approximately 6 months of age, and continue to breastfeed in conjunction with solid foods until at least 2 years of age.  I don’t have the current stats for Macau on hand, and I will research them and get back on this, but it is safe to say that from the social reaction of most mothers to this idea, it is not common that Macau babies are getting the full benefit of their mother’s milk.

Among Dr. Newman’s recommendations: extend maternity leave from employment.  Compared with Canada (52 weeks) and some European countries (3 years), Macau has mandated 8 weeks maternity leave.  This does not leave enough time for mothers to exclusively breastfeed their children until they are old enough to eat some solid foods while their mothers are away working.

In addition to the maternity leave, mothers and newborns will be able to eliminate certain breastfeeding challenges at the outset if they are able to room-in together at the hospital after birth.  Keeping newborns in separate rooms from their mothers disrupts bonding, and affects a baby’s ability to better handle early challenges of hypoglycemia and jaundice.  Babies and mothers belong together from minute one,  for a wide variety of reasons, not insignificantly because it helps them to establish their breastfeeding relationships. They learn how to communicate easily and effectively about feeding, and can feed on demand, rather than on a schedule or depend on another person to notify them when their baby is crying.

For more of his comments (and a brief soundbite from yours truly!) watch the segment on TDM English language news starting at 8:20 here.

Macau Birth Doula Plan of Action

So how DO we serve the underserved communities? I mentioned before changing from the inside out.

1. Education

What I plan to do here is to begin with English language childbirth education.  I am a certified HypnoBirthing® Practitioner and am beginning this comprehensive series this month.  I believe this will start to open people’s minds to the idea that birth does not mean submission to an authority figure.  A favourite Ina May Gaskin quote:

“Remember this, for it is as true as true gets: Your body is not a lemon. You are not a machine. The Creator is not a careless mechanic. Human female bodies have the same potential to give birth as well as aardvarks, lions, rhinoceri, elephants, moose, and water buffalo. Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.” 
― Ina May Gaskin, Ina May’s Guide to Childbirth

This pretty much sums up the aim of HypnoBirthing®: your body is designed to give birth, and your attitude towards your birthing body will shape your experience of your birth.

2.  Community

I plan to bring moms together in the expat community to get to know each other and me, by way of facilitating a breastfeeding support group and a ‘newly born and nearly born’ group. This will expose them to my radical uncommon-to-this-part-of-the-world ideas about gentle and family-centred birthing, as well as allow them to discuss these ideas amongst their peers.  I see this as a golden opportunity to provide support and education to those who are unable or uninterested in pursuing my client services.  Also, they will learn that doulas aren’t all as portrayed in the media and entertainment. Most of us are quite sensible, pragmatic, albeit passionate, feminists whose egos and personal preferences stay out of the doula-client relationship.

3. Lobbying/Shmoozing

If I intend to get into the hospitals (where labour companions are currently unwelcome), I need to get the hospital staff to know me and understand what I do and why I do it.  I will begin by requesting meetings with the prenatal care providers (who only provide care outside of the hospitals, not during birthing times), and woo them, shamelessly.  It has been noted by other doulas and birth professionals that delivering goodies, treats, coffee, what-have-you along with business cards will usually secure a meeting with the doctors. In the USA (perhaps in Canada too…) pharmaceutical reps do this all the time to get their product into doctors offices.  I have in mind a few clinics that seem like they are open to a more wholistic approach to prenatal care and I will start there first.  Knowing with confidence that they will love and appreciate the community’s need for the services I have to offer, I will promise to cross promote their clinic.  Once I have infiltrated this level of care, I will learn more about the hospital system of obstetrics and continue to look for an opening there.  If none arises, I have another trick up my sleeve that involves selling a product to the hospitals for use in their labour and delivery wards.  Basically, anything that gets my face and personality and confident manner into their minds will give credibility to the the term DOULA.

4. Professional Development Opportunities

In addition to attracting more passionate birth advocates and feminists to the work–two of whom I plan to hire to work with me before the end of the year–once my name and face are known in the hospitals, I will begin marketing labour support education classes to the hospitals.  Continuing education for their nurses and L&D staff, based on techniques that are not known over here, and backed by statistics that show that this won’t add to their work load, it will actually make it lighter by having fewer instances that require medical intervention. I can’t offer too many details here just yet, but stay tuned…

5.  Build a Self-Sustaining Company

This is my end game. Before I leave Macau (because to be honest, my family has desires to be elsewhere in the long term), I want to have a company that can operate in my absence, continuing to share my ideals and philosophies with the next generation of birthing families.  But this is the long-term goal, one step, month, year at a time!  What this will look like in the short term will be branding, fortified by community service among the underserved community (in this case, it will be folks who cannot access my English-language services, and young/unmarried mothers in crisis pregnancies).  The community service will eventually be set up as a foundation in conjunction with the for-profit company so that one can feed the other, and the community can access it while keeping the birth workers working for comfortable living wages, and attracting more birth workers from the underserved communities to work with their own peers.

Connecting my long-term vision to the present, I absolutely recognize the need and right of all women birthing in Macau to have options and choices and feel that they are confident in making these choices work for them.  Starting work with the ones who are accessible to me (the English speaking, therefore most likely expat women) I will plant the seeds of change by allowing these first women to demonstrate what informed consent looks like.

Birthing culture in Macau

I’m a doula who recently moved to Macau. For those who don’t know, it’s a former Portuguese colony that is now a region of China, although it retains some autonomy in its government.

The birth culture here is such that:

• As far as I know, I’m literally the only doula in town;
• Women birth on in communal wards managed by strict nurses who tell them to keep their screams quiet;
• Birth partners are not welcome in the wards, there are no waiting areas in the hospital, so they are told to go home and wait for a call to let them know their child has been born;
• The only other choice for prospective parents to take in managing their own births is to travel to Hong Kong to birth at a private hospital, which means a one hour ferry ride plus transit to the hospital from the ferry terminal.

Women that I have spoken to about their birth experiences have been traumatized–particularly first time mothers who don’t speak Chinese and cannot have procedures and protocols explained to them before they are subjected to them, i.e. the basis of informed consent.  No tours are given of the Labour and Delivery suites, no childbirth classes offered in any language other than Chinese. Despite the trauma that some experience, many women accept this standard as the status quo, and are resigned to have any subsequent children the same way saying “at least I know now what to expect.” It has been intimidating, to say the least, as a doula coming into this scene. I am not currently welcome to practice my work on the labour wards in this country. But rather than tuck my tail and run to get a job at Starbucks, I am inspired to endeavor to change the birthing culture here to one that is more family-centred and woman-supported.

Nonetheless, I have been welcomed with open arms by several expats and an occasional local and am greatly looking forward to sharing my knowledge and passion about gentle family-centred childbirth, informed consent and women’s rights.  The more I do it, the more I love my job, and I am very excited to meet the challenges that await me head on. Stay tuned for updates on my impressions of the birth culture here in Macau!