Giving birth can be a daunting prospect. With more than 140 hospitals across the seven emirates, the majority of which are private, social media is the go-to resource women use to garner information and advice from other mothers. Which doctor would they recommend? Which hospitals offer the best prenatal or postnatal care? What hospital or doctor will cater to more natural birth preferences?
American resident Samantha Warrayat has lived in the UAE since 2008. The mother of two became a doula after she had her first child.
"In 2015, when I had my eldest daughter, the only hospital claiming to allow water birth was in Al Ain and I could not find a doula, showing their undersupply then. I gave birth at Al Zahra Hospital with the support of Dr Anni Engberg, and although I was permitted to labour in the tub, unfortunately I was asked to get out of the water for the birth. Less than a month later, the first water birth happened at the same hospital. It's incredibly positive to see that."
Warrayat believes that the UAE is more advanced than the US when it comes to hospital deliveries. "Hospitals here are implementing evidence-based policies around breastfeeding and delayed cord clamping, whereas the US falls behind in these areas," she says. "But birthing at home or at a birth centre is still not an option, and these are areas for growth." In the UAE, midwives are not permitted to work outside hospitals, so home births are legally not allowed, nor are there birthing centres, which are an alternative to hospitals for low-risk deliveries. Water births are facilitated by a growing number of hospitals, however, and hypnobirthing is more common.
Salma Ballal from HealthBay Polyclinic in Dubai says birthing options are progressing steadily in the UAE. Originally from the UK, where home births are common, Dr Ballal, a consultant obstetrician and gynaecologist, says this won't be an option unless the law changes to allow midwives to deliver outside hospitals. The law also states that a physician must be present at a birth.
"It's more of a stigma than a fact," Ballal says of the perceived high rate of Caesarean sections in the UAE. She says the private healthcare system does, for the most part, respect birth preferences. "There are fantastic doctors in the UAE and C-sections are only performed if they are required as it is major surgery … doctors often take a conservative option if problems arise during labour for fear of litigation action should something go wrong."
The rate of C-section deliveries here isn't as high as in some other countries such as Italy, Brazil and Egypt, she continues, and data varies from one hospital to the next, as there is no auditing system in the UAE, so it's difficult to quantify.
Of private healthcare, she says it's been wonderful to have the opportunity to develop relationships with families, from their first child through to their third in some cases. "This wouldn't happen in the UK, where the public healthcare system means as a doctor, you may never see the same family again."
For mothers considering a water birth, Clare Evans couldn't recommend it more. The mother of two from the UK had a water birth at Al Zahra hospital in 2017. Evans laboured in water in a dedicated hypnobirthing room with dim lighting, music and candles. She had the support of her husband and a midwife. Her doctor came and went. Evans chose to have capsules made from her placenta. She said she couldn't fault her UAE birthing experience even though she would have opted for a home birth or birthing centre if she had been at home in the UK.
Another consequence of the private healthcare system is the cost of health insurance. Giving birth in the UAE without insurance cover can incur a hefty bill. Private maternity packages in the UAE cover the basics, but if an emergency arises, or a C-section is necessary, hidden labour costs can escalate rapidly.
C-section birth rates are rising in almost every country in the world and it's an expensive procedure in the UAE, costing up to Dh30,000, with most insurers only covering up to Dh15,000 to Dh20,000. Hospitals often demand a deposit. It's important to read the small print as some insurance providers are affiliated to certain hospitals and not others. Svetlana Svetova from Russia researched heavily before choosing a hospital in the UAE as she favoured a natural birth without medical intervention. Then she faced another difficult decision a few months into her pregnancy: should she change doctor and stay with the same hospital – she had chosen Al Zahra – or follow her doctor who was moving to Saudi German Hospital.
She said would have preferred to deliver in a birth centre as her pregnancy was low-risk: in her home country of Russia, homebirthing is not an option either but birth centres are. Svetova found that few hospitals in the UAE ticked all the boxes: there were no midwife-led birthing options, water birth was rare, some allowed doulas for the birth and others didn't, and standards of neonatal intensive care unit units varied greatly in her opinion.
She would advise expectant mothers to do plenty of research and to double check postnatal policies as she believes in the importance of this crucial transitional area.
This is where doulas come in. Residents far from home or anxious about a first baby will often hire a doula for support. What's the cost? The aforementioned doula, Warrayat, charges Dh975 for a post-partum 12-hour package, to be used three hours at a time, or Dh3,000 for the full package.
Doula Nicky Langley, also a hypnobirthing teacher and breastfeeding counsellor, will charge Dh4,500 outright and make herself available whenever she's needed. Langley, who is British, is available through the Hippo Birthing Programme.
She sees her work as filling the role of an absent sister or mother and says she has seen considerable progress in 15 years of living in Dubai – eight as a doula. "Water birth is now an option, which is fantastic," she says. "There are many passionate OBs and midwives who want to offer pregnant couples more choices in this area."
