Full Interview with Angie Chang, Doula in Taipei

In its September issue, Centered on Taipei magazine ran an article I co-wrote with editor Kath Liu, about Taipei-based Canadian Doula Angie Chang.  Due to space restraints, much of my interview was not published.  With permission, I am printing the full interview here.  I trust it will be of some interest to families planning on having their babies here in Taiwan.

An Interview With A Doula : Birth in Taiwan

A wonderful part of being in the “Taipei Long-term Ex-pat with Family” community is mixing with dynamic, motivated women making their own way in a country that has become a second home. Canadian-born doula Angela Chang is one such woman. Curiosity got the better of me, and I begged her to let me interview her about her experiences in helping others start their own Taiwan-based families.

So, Angie, tell me about your early academic background.

I studied English literature in my home country of Canada, so I could earn enough money to get to Asia. I wanted to teach English for a year, travel for a year, and then go home.

Did you have any ambitions to be in the baby business when you were young?

No, not at all! Well, I wanted to be a mom and maybe open my own daycare, but I never imagined I would be helping moms give birth in Taiwan.

So, what happened? Did you get to travel?

No! I came to Taiwan, met my now-husband, and had three children. I didn't get to travel much at all, but I was happy.

Tell me about your experience having three children in Taiwan.

I had my first baby in hospital. I thought I knew what to expect, but actually knew nothing about giving birth in Taiwan, nor how to communicate with my caregiver. I fell into the hospital trap of having lots of “stuff” done without being able to speak up. I felt quite powerless during labor. As a result, I cried for a week after the birth. My son was in the Neo-natal unit and I was not able to be an advocate my for son or myself.

I felt so traumatized after my first birth, that I decided I would just stay home for my second birth. But, at the time there were no practicing midwives in North Taiwan, so I just stayed home as long as I could. I got to the hospital at 11:00 and had the baby at 11:10. In retrospect, this was a reaction to being traumatized during the first birth. I was like, “You can't do any interventions. Ha! Ha!” These interventions included being strapped to the bed, which I realized is not compulsory, but done as routine here in Taiwan.

For my third birth, we were lucky enough to find the natural birthing center in Shingjuang. I convinced my husband that it was safe, and then had a fabulous water birth where I felt like a Superwoman totally in control of my family.

What was your “A-ha! I need to become a doula” moment?

A friend of mine asked me to be her doula, because I seemed quite experienced at this birth thing. I looked up “doula” and said “A-ha!” I knew that this is what Taiwan needs. Families really need this emotional and educational support, including continuous support during labor. A lot of birth-related things are different in Taiwan compared to our own countries, and new parents really need this extra assistance.

Some readers are probably dying to ask, “What the heck the is a doula?” Can you give us a definition?

Basically, a doula provides emotional and educational support for parents. A doula stays for the entire duration of birth, giving continuous assistance in areas including suggesting different questions to ask to assist decision making, trying different birth positions, helping the partner support the mother, giving reassurance, and unique to Taiwan, helping with language and cultural differences. Most women appreciate a woman next to them who has experienced birth before, and who can empathize with their situation, particularly with birthing in Taiwan. It's not always practical for family to attend births and it can also provide relief to moms or aunties who can only arrive after the baby is actually born.

What are some myths about doulas you'd like to dispel?

A doula is not a midwife. Not all doulas are totally pro-natural, anti-intervention. Doulas don't make medical decisions. They provide information to help parents make informed decisions, and then support that decision. Doulas can attend c-sections, and support you during the experience. It's all about making informed choices.

What's the hardest thing about being a doula?

Being on-call is really tough. I can't plan any trips out of town or with my children during the 4 weeks around the client's due date. Births are unpredictable, so my husband may need to look after my children for two hours or two days. I have missed birthdays and children's milestones because I'm at a birth. I'm not complaining, it's just a part of the job that people don't really think about.

What's the best thing for you about your job?

Seeing the reaction of the parents when the baby is born. It brings me joy every time!

What changes have you seen in birthing procedures in Taiwan since you started working as a doula?

I've attended 75 births since becoming certified (through Childbirth International). I thought I'd be attending three births a year, but I am now attending two to three per month.

Compared to when I started this work, there is more immediate contact between mom and baby, and a lot more support with breastfeeding. There is more rooming-in, and less scheduled feeding. All hospitals try to get the baby breastfeeding within the first hour of birth. There are now “LDR”s (labor, delivery, recovery rooms) for women choosing natural birth. Hospitals also have equipment like birth-balls, but you still do have to specifically request them.

How have staff at hospitals reacted to you, a Canadian woman, coming in and working with them in Taiwan hospitals?

Honestly, every single hospital has been very welcoming. Nurses are thankful to have someone to communicate with in their native language, as well as someone experienced with Taiwan hospital procedure to give continuous support to the mother. OBYGNs have been happy to take on suggestions, and there has been no negativity at all.

Why do clients come to you?

Generally, they are looking for a natural birth advocate that can explain what is happening in the Taiwan system. Sometimes, the father is doesn't know how to support the mother and is looking for support in assisting most effectively.

What have your ex-pat clients been most surprised about when experiencing birth in Taiwan?

The first thing is how cheap it is! The second is probably the high level of medical care available, and the choices available if you know how to get them.

You do a bit of work with The Friendly Birthing Center. Can you tell me a bit about that?

Barbara Harper, world-renowned water-birth advocate, trained staff and help set up the water-birth clinic. The Friendly Birthing Center moved to a better, bigger location two years ago. They practice “Expectant Management” This means, they are ready to use interventions like giving an IV if necessary, as opposed to traditional ways of giving an IV to everyone whether they need it or not. At “The Center”, you don't need to lie on the bed all the time because they use a hand-held Doppler rather than a strap-on unit to monitor the baby. Mothers are encouraged to try different positions, whether in the water, squatting, or on their hands and knees.

The Friendly Birthing Center is run by OBGYNs, not midwives. C-sections can be performed if deemed necessary. Unlike some other hospitals, dad can attend the c-section, and breastfeeding is started as soon as possible.

What other interesting birth information do you have for expectant parents in Taiwan?

Well, home births are covered by NHI, and actually cheaper than going to the hospital. Your prenatal and postpartum visits can be done at home, too..Certified midwives do a four-year nursing degree and then a masters in Midwifery, so they are well-qualified.

There are some birth classes in Taiwan, but as they are usually in Chinese, and geared toward local parents, I run English-language classes throughout the year. It's a great way for parents to meet others in the same situation as themselves, and many parents end up forming baby playgroups after the classes. In Taiwan, you are sent home on the third day after the birth, and there is no home-support given. I give postpartum visits to help with the concerns clients have as new parents, whether it be childcare, breastfeeding, or mom's general wellbeing.

It's about time to wrap up the interview and let both of us pick up our children from school. Reflecting on my own birth experience and life with my kids in Taiwan, I realize how lucky we are to have ex-pats like Angie, working hard to make life easier for families like mine, in Angie's case right from before the child's first breath.

Angie's five questions for taking to a caregiver:

It's important to find out whether you on the same page as your doctor regarding birth. Here are five questions you can ask to check whether you are on the same page as your caregivers.

1. What positions do you encourage moms to use in labor?
2. What are your policies regarding induction?
3. In what ways is your hospital supportive of breastfeeding?
4. What is your procedure if a c-section becomes necessary?
5. How often do you attend natural births?

Angie is a certified doula and childbirth educator working in Northern Taiwan. You can find out more about her services at www.beautifulbeginnings.com.tw. She also has a community center for families in Neihu: www.parentsplace.com.tw.