The 40 days… Nifaaz or Baqwaas?

Where does the ’40 Days’ superstitions originate from? 

The blood that passes from a woman’s vagina after giving birth to a baby is called Nifaas (Postnatal bleeding).

The maximum period for this bleeding is 40 days.

What is the longest that nifaas (post-partum bleeding) can last?

Praise be to Allaah.

There is a difference of opinion among the scholars concerning that.

1 – Most of the scholars said that the longest that nifaas can last is 40 days; if the bleeding lasts longer than that then it is istihaadah (irregular vaginal bleeding) unless it coincides with her regular period. This is the view of Abu Haneefah and Ahmad, according to one report, and is the well known view of his madhhab. This was also the ruling given by al-Tirmidhi in his Jaami’, narrating from Sufyaan, Ibn Mubaarak, Ishaaq and most of the scholars.

2 – Maalik, al-Shaafa’i and Ahmad, according to one report, said that the longest it may last is 60 days.

3 – al-Hasan al-Basri said that it may last between forty to fifty days; if it lasts longer than that then it is istihaadah.

4 – There are other opinions but these are cases of ijtihaad for which there is no saheeh evidence apart from the first view. It was proven that Ibn ‘Abbaas (may Allaah be pleased with them both) said: “The woman in nifaas should wait for approximately forty days.” (Narrated by Ibn al-Jaarood in al-Muntaqa).

Ahmad, Abu Dawood, al-Tirmidhi and Ibn Maajah narrated via Massah al-Azdiyyah that Umm Salamah said: “At the time of the Messenger of Allaah (peace and blessings of Allaah be upon him), the woman in nifaas would wait for forty days…”

There is some dispute concerning this isnaad. Ibn Qattaan classed it as da’eef (weak) in Bayaan al-Wahm wa’l-Ayhaam, as did Ibn Hazm. Al-Haakim classed it as saheeh and al-Nawawi and others classed it as hasan.

Ibn ‘Abd al-Barr (may Allaah have mercy on him) said in al-Istidhkaar, with regard to the maximum period of nifaas there is no opinion to be followed except the opinion of those who say that it is forty days. This is the view the companions of the Messenger of Allaah (peace and blessings of Allaah be upon him), and there was no dispute among them concerning this matter. All other opinions are those of people other than the Sahaabah, and in our view no other opinion can be counted because the consensus of the Sahaabah is evidence for those who came after them. Usually everyone feels comfortable with their opinion; how could anyone hold a different view with no evidence from the Sunnah? This view is the correct one, and that is for a number of reasons:

1- It is the view of the Sahaabah and no one has the right to go against them.

2- It is essential in this case to define a number of days during which a woman may remain in nifaas; it is not permissible to ignore the view of the Sahaabah and accept someone else’s view.

3- This is the view of doctors who are specialized in knowledge of this bleeding. Their view coincides with that of Ibn ‘Abbaas and of most of the scholars.

With regard to the minimum length of nifaas, most of the scholars have not set any limit for that. If the woman sees that she is pure (taahir) – which is when the bleeding stops – then she should do ghusl and start praying.

Imaam Abu ‘Eesa al-Tirmidhi (may Allaah have mercy on him) said in al-Jaami’ that the view of the scholars among the Sahaabah, Taabi’een and those who came after them was that the woman in nifaas should not pray for forty days unless she sees that she is pure before that, in which case she should do ghusl and start praying.

Shaykh Sulaymaan ibn Naasir al-‘Alwaan 

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Hospital Birth vs. Home Birth…part 4

When my wife and I chose to have our second child be born at home (our first child was born in a community hospital, not Brigham & Women’s or Mass General, with the assistance of a certified nurse midwife), we reflected upon the safety issues, both among ourselves and with our midwife. Had there been any indication that something was out of the ordinary with the pregnancy, long before my wife went into labor, we understood that our midwife would transfer care to an OB in a premier hospital so that our child would be well-attended. Had there been a hint of a problem at any point in labor, our midwife would have packed us up and gone to the nearest appropriate facility. We weighed the likelihood of the need for a Cesarean section, or other interventive care, with the psychological and physical benefits of my wife being able to labor at home, and came to the personal conclusion that the benefits of staying home far outweighed the risks, particularly given the skill and experience of our midwife.

You state the following: “I do not feel people choose to home deliver out of ignorance or stupidity. In fact, such persons usually are more thoughtful and knowledgable of the whole process than your average hospital delivery parents.” You have the opportunity to reach, through both your book and your work online, people who are thoughtful and knowledgeable enough to be presented with the facts about home birth, rather than the fear that is so evident in your new book. Please take advantage of that opportunity. Contrary to what you might think, I do not consider myself an advocate solely of home birth, but of making that option truly available to parents around the country through accurate information about midwifery care. If a mother, having been given full and fair information, feels that she will be most comfortable and safer by laboring and birthing in a hospital, then that is where she should be. The worst thing one could do is to have a mother labor and birth in place in which she does not feel safe and comfortable; I believe that anxiety is probably the most prominent “risk” facing any mother.

As I hope you can see, I am far more interested in intelligent discourse than calling you names.

Dr. DiLeo’s Response
Certainly those who choose home birth are more passionate about their decision, for the typical hospital birth woman is merely going with the flow. Therefore I expect many more letters in support of home birth than hospital birth. It is tempting to interpret the number of responses each way as a vote of sorts, but that would be unfair to this discussion. I would like to think of this as a qualitative discussion, not a quantitative one. That being said, there are some initial comments I’d like to make.

First of all, that birth is a natural event is not the argument here. What has been gained in modern obstetrics is a reduction in neonatal mortality and maternal mortality. Also, comfort in the way of pain relief for those who choose to bypass discomfort. But what has been lost in modern obstetrics is the fact that it’s not just a baby being born, but a family being born. This is the whole point of home birth, it is a “back to the hearth” event of significant importance as a family event. In my book, The Anxious Parent’s Guide to Pregnancy, this is one of the points I emphasize the birth of the family as the highest pinnacle of mammalian evolution. It is for this reason that I can easily see the value of home birth from a romantic, caring, humanistic, and loving point of view. But this doesn’t mean that I accept it as just as safe as a hospital birth.

One of the misconceptions is that doctors who are anti-home birth are anti-midwife. I can’t answer for all obstetricians, but I will say that I have absolutely no problem with midwifery. In fact, I respect the profession greatly. It was a midwife who trained me in the very first delivery I attended. I think that I still use her mindset and technique for deliveries today. Midwives are not saddled with competing responsibilities of post-operative patient care, waiting surgeries, and the myriad other things that obstetricians multitask while patients are in labor. This means midwives can be dedicated to a full labor participation. They are wizards at playing gravity to advantage, sensing the nuances of positioning so as to effect more efficient labor. I wish there were a midwife in every hospital OB delivery area, supervising the goings-on there.

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Hospital Birth vs. Home Birth.. part 3

The ACOG position on home birth, while possibly well-meaning, is an unsupported, self-serving statement. I could just as easily state that the drive to and from the hospital “clearly presents potential hazards” to the mother, father, and baby, yet not even I would argue that that is reason enough not to go to the hospital. ACOG has a vested economic interest in making sure that mothers keep coming to hospitals to birth their babies, so a blanket statement such as the one you cite simply cannot be read by a reasonable person outside of this context.

This statement does not mention that, during labor and delivery in a hospital, mother and child will be exposed to “germs” and other pathogens that are not present in the home (even if they are, the mother and child have already been exposed to them during the pregnancy). In the end, ACOG makes assertions, which you mirror in your book, that only serve to frighten those who might be considering, in good conscience, the option to birth outside the hospital. ACOG does not provide scientific support for its statement; if that is the basis of the reflection in your book, I again challenge you to provide that support.

You say that “the current thinking” is that neonatal mortality is three times as high in the home as in the hospital (even though it is low in the home). First, what is the basis of this “current thinking”? I can think of a lot of things regarding the law, but that doesn’t make them right. The Ninth Circuit Court of Appeals recently stated that “under God” in the Pledge of Allegiance was unconstitutional, but I dare say that most Americans think quite to the contrary. In the end, the Supreme Court will have the final say. Your reference to “current thinking,” in order to convince me, needs to be supported. If the risk is indeed that great, then show me that this is the case and I will pass that onto my colleagues.

Second, statistics themselves can be manipulated. (I’m sure you’ve heard the old saying, “There are lies, damned lies, and statistics.”) What is the context for the statistics to which you refer? Are the home births planned or accidental? Are the mothers healthy, the babies full term? Has there been consistent prenatal care? These are questions that must be answered in order to put these statistics in the correct context. Even if you are right that the mortality risk is three time as high in the home, if that means that three out of 1,000,000 cases, compared with one out of 1,000,000, then it is simply irresponsible to use that statistic to discredit all practitioners who serve persons who birth outside the hospital.

Third, you mention that “Certainly the risk is low when you take the whole population into account, but on an individual basis, the statistics aren’t reassuring if you’re that one person out of hundreds or thousands that it happens to.” Yet, this approach to life would have us lock up our kids in our home for fear that some stranger might come in contact with them. Or even stay at home because babies die at the hospital, too. The studies to which I refer support the argument that home birth is as safe as (if not safer than) birth in the hospital, even when you consider the additional “risks” associated with not being in the hospital. To be fair and true to the science, your writings in print and online should reflect this, not the fear or anxiety that you profess that expectant parents should have.

You cannot compare home and hospital birth statistics without looking at the morbidity (and, yes, mortality) caused by interventions routinely practiced in hospitals. Home birth outcomes are better partly because the mothers are arguably healthier and more engaged than your average hospital patient (as you appear to indicate); they also have better outcomes because it would be unethical to practice many standard hospital interventions at home. Therefore, even accounting for transports, there are lower Cesarean rates, lower numbers of forceps deliveries, and fewer mothers requiring induction or anesthesia among mothers who planned to birth their babies at home. Although each intervention was created for good reason, with each one offered, the morbidity and mortality rates can rise.

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Don’t give birth in a hospital-birth at home.

Home Births with Midwife Safe As Hospital for Babies, Fewer Infections and Less Bleeding for Moms

by S. L. Baker, features writer

(NaturalNews) The American College of Obstetricians and Gynecologists (ACOG) has a long-standing opposition to home births. In fact, their official statement released last year actually accuses women who want a home birth of placing “the process of giving birth over the goal of having a healthy baby”. The statement goes on to say “ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex…”

While ACOG may “believe” whatever that organization wants to, it would be more professional for them to base their policy on science-based facts. New research shows planned home births attended by registered midwives is every bit as safe as a hospital birth for babies. What’s more, it appears to be a whole lot safer for moms.

A study just published in CMAJ (Canadian Medical Association Journal) looked at 2889 home births attended by regulated midwives in British Columbia, Canada, and 4752 planned hospital births attended by the same cohort of midwives. Then Dr. Patricia Janssen from the University of British Columbia and her research colleagues compared the outcomes with 5331 physician-attended births in hospital.

The results? Newborns born at home where the home birth was planned and a registered midwife was on hand were at similar or reduced risk of death than babies born in a hospital. And the moms who gave birth at home had a significantly lower risk of obstetric interventions and adverse outcomes, including induced labor, electronic fetal monitoring, epidural analgesia, assisted vaginal delivery, cesarean section, infections and bleeding.

“Women planning birth at home experienced reduced risk for all obstetric interventions measured, and similar or reduced risk for adverse maternal outcomes,” Dr. Patricia Janssen wrote in the CMAJ article.

The authors of the study pointed out there may be factors in the home environment that decrease risks to moms and babies but these factors are not yet well-understood. For example, it could be that women with healthy, natural lifestyles may be the ones who most likely choose home births — and may be most likely to have safe home births.

“We do not underestimate the degree of self-selection that takes place in a population of women choosing home birth. This self-selection may be an important component of risk management for home birth,” the researchers stated. They also wrote in their research article that the fact registered midwives screen women who want to have home births to make sure it is the appropriate decision could contribute to the safety of home births.

It’s not only America’s ACOG that opposes home births. The Australian and New Zealand Colleges of Obstetricians and Gynecologists also are against babies being born at home. However, the United Kingdom’s Royal College of Obstetrics and Gynecology and the Royal College of Midwives are supportive, and so are midwife organizations in Canada, Australia and New Zealand. Canada’s Society of Obstetricians and Gynecologists has encouraged research into the safety of home birth, and the new study is part of that directive.

“Our population rate of less than one perinatal death per 1000 births may serve as a benchmark to other jurisdictions as they evaluate their home birth programs,” the authors concluded.

For more information:

http://www.cmaj.ca/press/cmaj081869.pdf

http://www.acog.org/from_home/publications/press_releases/nr02-06-08-…

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Placenta Previa

Placenta Previa Symptoms and Treatment

What is placenta previa? If you’ve heard the word, you have probably figured out just from the word alone that it has something to do with the placenta. You are exactly right. Placenta previa occurs when the placenta attaches in the lower portion of the uterus instead of in the normal position in the upper more muscular portion of the uterus. Placenta previa is a frequent cause of bleeding during the second and third trimester of pregnancy

What are the different types of placenta previa?
Complete previa – The placenta completely covers the cervix.

Partial previa – The placenta covers a portion of the cervix, but does not completely cover the cervix.

Marginal previa – The placenta extends to the edge of the cervix but does not cover it. This can also be called low placental implantation.

What is the cause of placenta previa?
The cause of placenta previa is unknown.

Am I at risk for placenta previa?
Placenta previa occurs in about 1 in 200 births. Risk factors include:

previous history of placenta previa
multiple births
having given birth before (second or greater pregnancy)
smoking
over the age of 35
surgery of the uterus
prior delivery of a baby via cesarean section
history of uterine abnormalities
Symptoms of placenta previa
Vaginal bleeding after 20 weeks of pregnancy is the primary symptom of placenta previa. Bleeding during pregnancy may have another cause, however, it is important to call your doctor if you experience bleeding.

The placenta normally attaches to the upper portion of the uterus which is more muscular and stronger to support the placenta. However, in placenta previa the placenta attaches to the lower portion of the uterus which is weaker, thinner, and more vascular. As you enter your second and third trimester, the cervix begins to thin and stretch in preparation for labor. As this area stretches it can cause the villi (blood vessels) to break therefore causing bleeding. Placenta previa can lead to complications for both mother and baby. Complications that may arise include placenta abruption, hemorrhaging, preterm labor, anemia for either mother or baby.

Treatment of placenta previa
Placenta previa will often correct itself during pregnancy. In more than 90 percent of women diagnosed with placenta previa in the second trimester, the placenta will correct itself by the end of the pregnancy. The placenta itself doesn’t actually move, but as the uterus stretches it is not as close to the cervix as it was earlier in pregnancy. Think of it this way, imagine taking a balloon and drawing a circle on it at the lower end of the balloon. Then blow up your balloon. The circle doesn’t actually move, but it may not still be at the lower end once it has completed stretching. So for the majority of women, placenta previa will correct itself.

If placenta previa, however, does not correct itself there are several things that can be done to manage it. Placenta previa will usually require bedrest and frequent visits to your doctor or hospital. Vaginal exams are not recommended for the pregnant woman with placenta previa. You may be given steroid shots to mature your baby’s lungs because you at risk for delivering early. Treatment will vary depending on how far along you are in your pregnancy and whether you have complete, partial, or marginal placenta previa. If you start bleeding or having contractions, you will be hospitalized. Your doctor will want to monitor you baby’s heart rate and monitor your vital signs as well. If bleeding stops, your doctor may send you home on bedrest. If bleeding cannot be controlled an immediate cesarean section is given regardless of length of gestation. If bleeding is controlled your doctor will discuss scheduling a cesarean section with you. In most cases of placenta previa that does not correct itself, a cesarean section is necessary due to the location of the placenta.

Complications after delivery

Because the risk of hemorrhaging is higher for women with placenta previa, mothers will be monitored for signs of hemorrhaging. She may be given medications to control bleeding such as pitocin and a transfusion may sometimes be necessary. Anemia may occur in mother or baby therefore hemoglobin levels will be monitored and iron supplements may be given.

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HAIDH AND NIFAAS

HAIDH AND NIFAAS

1) If, from the beginning of the monthly haidh (menses) period, the flow of blood continues more than ten days and the woman cannot remember the number of days of her haidh of the previous month, then the principle of Taharri should be adopted to determine haidh and istihaadhah.
Taharri means to reflect, to ponder, to think.
The woman should accept as her haidh period the number of days indicated by her Taharri. If she is inclined to regard any particular number of days as being her haidh period, then this result of her reflection will be valid. For example, if her Taharri leads her to conclude that her haidh in the previous month was seven days, then she should regard seven days as being haidh and the rest as istihaadha. She should then make qadha of the Salaat of the 8th, 9th and 10th days.
2) If her Taharri results in a stalemate, in other words, she is unable to determine any number between two numbers, then she should act on Ihtiyaat, i.e. precaution. She should adopt the safest option. Example: A woman in this situation (i.e. where the flow is more than 10 days) feels equally disposed to two numbers, viz. that her previous haidh could have been six days or eight days. She is unable to decide which of these two numbers was actually her haidh period.
In this case the Ihtiyaat is to regard the lesser number (i.e. 6 days) as the haidh period. She should make qadha of the Salaat of the 7th, 8th, 9th and 10th days.
The number of days thus determined, i.e. either by Taharri or Ihtiyaat, should be considered as the haidh period for future as well, provided that the flow continues more than ten days.
If, however, the flow terminates on the tenth day or before, then this number of days (i.e. when the blood-flow ended) will be her actual haidh period henceforth. Thus, in future, when the number of days accepted as haidh, has ended, she should take ghusl and proceed with Salaat.
3) If a woman mostly experiences the flow to end before three days, then she should not desist from Salaat and Saum (fasting during Ramadhaan). Since this is a usual occurrence with her, she should consider the flow to be istihaadhah and continue with her Salaat and Saum.
If, however, the flow continues for more than three days (i.e. 72 hours), then only will it transpire that it was haidh. The fasts which she had kept on the first three days will have to be made qadha.

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