Interview by Jessi Vining
Aisha Al Hajjar, BSM, MSM, LM, CPM, AMANI is a midwife and the founder of AMANI Birth, an organization which provides doula and childbirth educator training, publishes birth education resources, and educates medical providers around the world about physiologic birth. Aisha has eight children and works together with her husband, Mohammed Al Hajjar (co-founder of AMANI birth), to promote gentle childbirth and informed choices around the world.
Both AMANI Birth and Aisha’s midwifery practice are founded on Islamic principals, which include the belief that female bodies have been designed by Allah to conceive, carry, birth, and feed babies without the need for routine medical interference. AMANI Birth has doulas and childbirth educators located around the world in 26 different countries, and her curriculum has been translated into 4 different languages.
What made you want to become a midwife?
Aisha: The main reason I went into midwifery was to give women the respect and the space to have autonomy over their own bodies.
I have 8 children of my own, and with all of the first seven births I had to fight to some degree to have control over my own birth experiences. With the eighth birth I was tired of having people tell me to do things that weren’t evidence based, and that weren’t best for me and my baby. I didn’t want to have to fight for that control during birth again, and so I opted out of medical care completely and chose to have an unassisted birth at home. At the time, I was living in Saudi Arabia where it is much harder to fight for your birth than it is here in the States. Everything went well and it was a beautiful birth experience! My husband Mohammed actually caught our daughter and we named her Amani which means “wishes” in Arabic.
After my birth experience with Amani, I thought it was such a shame that to have the kind of birth I wanted, it felt like I had to stay away from medical providers. I think when you are more afraid of what they are going to do to you than you are of birth itself – there’s a problem. When there are no complications, why are we forcing interventions on people? Why are we forcing them into certain positions for no good reason? I knew after Amani’s birth that I needed to become a midwife so that I could give birth back to the mother.
How did you choose which midwifery pathway to pursue?
Aisha: I had thought about pursing midwifery years before, but I mistakenly thought that you had to become a nurse first, and I had no interest in jumping through all of the nursing school hoops just to be able to provide care at births. Sometime after Amani’s birth, I realized that you could go into midwifery directly and this was game changer. A friend of mine recommended Midwives College of Utah (MCU) to me, which is a MEAC accredited direct-entry midwifery program. I was attracted to the fact that I could get a bachelors and a masters degree in midwifery specifically and that the school provided a solid midwifery education!
Tell me a little bit about your training and education.
Aisha: When I started pursuing midwifery education with MCU, I was living in Saudi (where truly autonomous midwifery practice does not exist in the medical system) and I had no idea where I was going to get my clinical experience from. Even so, I realized that the time was going to pass no matter what, and so I thought I might as well just pursue the education and see what doors Allah would open for the clinical work.
As it turned out, Allah opened many doors for me and it has been amazing! I ended up doing some of my clinical training in a Saudi Arabian government hospital, some in a birth center in Indonesia, some in China, and some in the U.S.. During those early years I always took my baby Amani and one of my older children with me so they could help me watch her while I was doing births. Other midwives also helped me to take care of my children and made it possible for me to get the experience I needed. People often hesitate to jump into midwifery because they don’t know the path or where they will get all of their experience from, but Allah opens doors as you just take a leap of faith and start pursuing it.
What inspired you to start AMANI birth?
When I married Mohammed, I already had 5 kids. He is from Saudi, where birth is totally a “women’s thing” which was devastating to me as an American. At first, he had no interest in pregnancy or birth, and for the birth of our first two children he wasn’t present in the room. However, this changed during my last pregnancy with Amani. While I was pregnant, I trained to become a childbirth educator with the Bradley Method. Mohammed started learning more about birth and really began encouraging me to create an Islamic childbirth curriculum for our side of globe, since everything about childbirth education was coming from the West.
When I then had Amani at home, he actually caught her and got to experience the birth and bonding directly. He immediately went from being the guy who thought birth was a “woman’s thing” to being the guy who now teaches other men about childbirth and actively advocates for midwifery care. He is the one who started pushing me to do midwifery school so that I would have more knowledge in order to write a curriculum.
He is also the one who said we should call the curriculum AMANI birth, because Amani’s pregnancy and birth had been so special for him. The phrase “Amani lil Welada Tabayiaya” means “wishes for natural birth” so the name worked well in Arabic, and then we started looking for an acronym so that it could also be meaningful in English. We decided on “Assisting Mothers for Active Natural Instinctive Birth.” It works perfectly, and I could not have chosen her name with the idea of creating a birth program if I had tried, and so I look back on all of it as Allah guiding us and really providing us with the name. Today, Mohammed often proudly wears a t-shirt that says “It takes a real man to live with a midwife!”
What is your birth philosophy?
Aisha: I really feel strongly about making informed decisions. I want moms to have knowledge and access to educated conversations about birth. I don’t care what anyone’s birth choices are –whether they choose candles and waterbirth or a cesarean – I just want people to have the opportunity to make informed decisions. Any birth can be empowering as long as people are a part of their own birth process. Mothers become traumatized when birth happens to them, or when interventions are done to them, and they don’t understand what is happening. I am all about helping people have the information and become informed enough to have intelligent conversations with their care providers. I think it’s really important for us to do everything in our power to try and keep birth as empowering as possible for people.
What does your midwifery and birth advocacy work look like right now?
Aisha: I have a midwifery partner who I work with in a homebirth practice in Delaware, and while I am in the States we do some births together so that I can stay active in my clinical skills. However most of what I do is the teaching of our AMANI Birth curriculum to train new doulas, childbirth educators and medical professionals around the world. I consider attending births as a midwife as my side work, and educating people in the community as my primary work. I primarily focus on equipping people to teach the AMANI curriculum, but I also travel to any hospital or ministry of health that will have me in order to educate their staff and care providers on physiologic birth and evidence based practices. Teaching is my main priority.
So what exactly is AMANI Birth, and what different trainings, classes and resources have you created?
Aisha: I wrote a book called AMANI Birth: Assisting Mothers for Active Natural Instinctive Birth, which is available on Amazon. AMANI Birth is also an organization that currently offers in-person doula and childbirth educator training. We are currently working to get our childbirth education classes online and available for parents to also take electronically. In addition, we offer a workshop called “Evidence-Based Practice: Supporting Normal Physiologic Birth,” which is a class for medical providers to educate them on caring for people who are giving birth naturally.
AMANI Birth now has doulas and childbirth educators located around the world in 26 different countries, including Egypt, Saudi Arabia, Malaysia, Indonesia, Jordan, Bahrain, the UAE, the UK, Singapore and America. Our curriculum is available in Arabic, German, Indonesian and English. This year, we are excited to be starting our first online birth webinars in April (insha’Allah), which will be for both parents and birth workers and available in English, Arabic, Indonesian, and Urdu.
What kind of feedback are you getting about how your curriculum is changing birth for people?
It is making real change in people’s lives! I mostly get feedback from doulas who have taken our training and people who have given birth after taking our classes – but occasionally I will hear from people who just found my book independently telling me how the book inspired them to have a VBAC, or a natural birth etc. Several of our AMANI moms have had vaginal twins (including one set of breech VBAC twins, which were number 18 and 19 for the mom!), and we also have an AMANI affiliate who gave birth to triplets vaginally not too long ago! One mom in the UAE told me, “it’s only because of AMANI Birth that I felt strong enough to stand up for my rights.”
Because AMANI is Islamic, some of the feedback that we get from our Muslim clients is that they have found their religion and the true meaning of their faith through the materials we teach and provide. So AMANI Birth is also bringing people back to their roots and to their faith, and the result is that people are having better birth experiences across the globe.
What do you think is especially unique about the AMANI birth material?
Aisha: Our organization and curriculum are rooted in Islam, and looking at birth from an Islamic perspective. The materials were written for the Muslim community especially, though we do have families and teachers who are not Muslim. It is very rooted in faith and looking at scripture and our religious practices in relationship to childbirth and how we can apply our faith to our childbirth experiences.
In my first marriage I used a method of childbirth education which was very focused on the husband’s involvement in birth. While this is great, I found that it wasn’t really helpful in the context of a culture or community where the partner can’t or won’t be present for the birth process. So while AMANI birth definitely has a place for honoring fathers and giving them education to support the mom if he can or wants be there, we focus more on helping moms learn how to cope on their own terms. For example, we still have lots of hospitals in the Middle East where dad can’t be present for the birth, and I want mothers to know they can do this with or without their husbands. We are very much about empowering the woman as the person birthing, and the support people as just additional support. We don’t need particular other people in order to birth, we have all the power. We don’t advocate for unassisted birth because sometimes complications do arise – but we definitely want people to feel confident in their own abilities in normal birth situations.
As a midwife who trains doulas, what is your perspective on the role of the doula at birth as compared to that of the midwife?
Aisha: I am both a doula and a midwife, and I work to support women in both roles. When I am a midwife, I can use some doula skills to support people. However, I cannot totally be a doula when I am worried about clinical tasks like fetal heart tones, blood loss, charting etc. You can’t fully give yourself to be a doula when you are doing the role of midwife. In fact, if you were to ask me which of those roles I prefer – it’s actually the role of the doula, because I can really connect and work with a mom on a more emotional level when I am not preoccupied with clinical tasks. I find this type of emotional support to be far more rewarding, and I think that the role of a doula allows you to be much more a part of the birth process.
What are some of the gaps in client care or birth education that you see many midwives making?
Aisha: As a childbirth educator I spend 21 hours with people specifically preparing them for labor and birth. I think many midwives don’t realize how much gets missed in prenatal care. Even though we spend more time with our clients than OBs might, we really aren’t spending concentrated time teaching people how to cope with contractions, or about how labor might unfold. I sometimes see that midwives make an assumption that just because a person is choosing to birth naturally, that they must already be educated and prepared – and this just isn’t the case. Parents still often need someone to walk them through what to expect.
Since my main focus is on working with other Muslims I often see the spiritual component missing from people’s care. When I talk with moms prenatally they are scared and anxious every time – it doesn’t matter if it is their first or twelfth time giving birth. They don’t know what to expect this time. When you are a midwife who shares their faith it allows you to encourage them on a deeper spiritual level and ease their fears. Allah tells us he will not give us more than we can bear, and so I help them to look at birth from our religious perspective: this is the natural way that Allah has created, let’s trust the process. When we look at the stories of Eve and Mary, they gave birth in what we today would consider unassisted childbirth and Allah gave them everything they needed. We also see this reflected in the animals giving birth naturally all around us, do we think that Allah would give more care for the animals then for us? Of course not!
If we look at birth from an Islamic perspective we can trust that Allah has our back and that he will help us do this. This is something I can offer my Muslim clients, since I am a Muslim midwife. If you aren’t Muslim it is going to take more effort on your part to learn and appreciate your client’s faith, in order to truly support her emotional and spiritual needs through birth and this is a part of what AMANI training offers to the non Muslim birth worker—the pieces to help you connect with your clients of deep faith and that applies across all faiths.
Have you experienced discrimination or prejudice from within the midwifery or birth community due to being Muslim?
Aisha: I practice in a small midwifery community in Delaware, and we all know each other. So in our community we have a Catholic, a Jew and a Muslim midwife all happily working together. The Islamic midwifery community here is the States is pretty small and diffuse, with individual Muslim midwives practicing in different areas around the U.S., and it can be somewhat isolating.
I have found in attending midwifery education and networking events that there is also deep segregation in the U.S. between white midwives and midwives of color. As a white midwife who is also Muslim and a member of a religious minority in the States, it has been challenging to find a place of welcome within the midwifery community since I carry elements of both racial privilege and also religious oppression. Just because I could take my niqaab off if I chose and go back to looking like every other white person, doesn’t mean that I automatically fit into white midwifery culture as a Muslim. So I have sometimes left midwifery events feeling more alone as a midwife, with no close community to fit into.
If you could change one thing about the midwifery and birth community what would it be?
Aisha: From a global perspective: the one thing I would change is to increase more respectful and evidence-based care from medical care providers. For example, I am still teaching workshops to care providers telling them about the evidence against the use of routine episiotomy, which is still really common in many countries. We are really behind the times and frequently doing routine interventions that are unnecessary and harmful.
For the American midwifery community: we need to get our act together and increase our sense of community and kinship! There is too much division and petty behavior. This is one thing that sets the OB model apart from us, and has helped them to be much stronger than we are as a group: they stick together and protect their own. We as midwives are not watching out for each other are often fighting over really surface-level stuff. We should be more focused on supporting one another as midwives, not competing against one another or battling each other.
Want to know more about the AMANI Birth Curriculum developed by Aisha Al Hajjar? You can find a review of it here!