Malaysia has a rich tradition of maternal care, where midwives, known as bidans, have played a vital role in ensuring the well-being of mothers and newborns for centuries. Although modern medicine and hospital-based maternity care have become the norm, bidans continue to serve an essential function, particularly in rural communities and among women who prefer traditional methods of prenatal and postnatal care.
The role of a bidan has evolved significantly over the years, blending traditional knowledge with modern medical practices. Today, trained bidans not only assist in childbirth but also provide holistic prenatal care, health education, and postnatal recovery services. The shift toward medical professionalization has also ensured that bidans receive proper training and certification, making them a recognized part of the maternal healthcare system in Malaysia.
1. Historical Background of Bidans in Malaysia
1.1 Traditional Practices and Early Midwifery
Before the introduction of modern healthcare, bidans were the primary caregivers for expectant mothers, offering home-based pregnancy care, labor assistance, and postnatal recovery services. They relied on a wealth of herbal medicine, massage therapy, and spiritual rituals to ensure a smooth pregnancy and safe delivery. These women were highly respected figures within their communities, often considered not just healthcare providers but also guardians of cultural traditions and wisdom.
1.2 Influence of Colonial and Modern Healthcare
With the arrival of Western medicine during the British colonial era, formal hospitals and maternity clinics were established, leading to a decline in home births and the informal role of bidans. However, many families, particularly in rural areas, continued to rely on bidans due to their affordability, accessibility, and culturally aligned care practices. The Malaysian Ministry of Health later introduced midwifery training programs, requiring bidans to undergo formal education and certification to practice professionally.
2. The Modern Role of Bidans in Malaysia
2.1 Prenatal Care (Antenatal)
Bidans today play an essential role in monitoring and supporting pregnant women throughout their journey. They conduct regular check-ups to track the progress of the pregnancy, ensuring that both the mother and baby remain healthy. By offering nutritional advice, bidans help expectant mothers balance traditional food beliefs with scientifically backed dietary recommendations. Furthermore, education on prenatal exercises, emotional well-being, and childbirth preparation allows mothers to feel more confident and prepared for labor.
2.2 Labor and Delivery
During childbirth, bidans assist with natural labor techniques, ensuring that mothers are comfortable and supported throughout the process. Many bidans specialize in non-invasive pain management, using breathing exercises, massage therapy, and herbal compresses to help ease labor pains. They also provide emotional and spiritual support, reassuring mothers during contractions and labor progression. In cases where complications arise, trained bidans are equipped to recognize warning signs and promptly refer patients to medical facilities to prevent risks.
2.3 Postnatal and Confinement Care
The postnatal period, or pantang, is a significant phase in Malay culture, where new mothers undergo a structured confinement period lasting between 30 to 44 days. Bidans play a crucial role in ensuring proper postpartum recovery by offering:
- Postnatal massage (urut bidan) to help with blood circulation, body healing, and relaxation.
- Abdominal wrapping (bengkung) to support the uterus and encourage post-birth body shaping.
- Herbal baths and steams (mandi herba) to help relieve body aches, enhance circulation, and promote healing.
- Dietary counseling, focusing on traditional “heaty” foods believed to replenish energy.
Bidans also support breastfeeding guidance, helping new mothers improve milk flow, correct latching techniques, and resolve common issues like engorgement and mastitis.
3. Integration of Traditional and Modern Practices
3.1 Bidan Training and Certification
Today, bidans are encouraged to obtain formal training through recognized midwifery programs in Malaysia. These programs blend traditional techniques with scientifically backed obstetric knowledge, equipping bidans with essential skills in:
- Fetal monitoring
- Recognizing high-risk pregnancies
- Basic emergency response techniques
- Sterile delivery practices
By obtaining certification from health authorities, bidans ensure that they meet national healthcare standards while preserving their cultural role.
3.2 Traditional Medicine and Scientific Validation
In recent years, scientific interest in traditional Malay medicine has increased. Research institutions are studying the efficacy of herbal remedies, postnatal massage, and traditional confinement care to determine their medical benefits. Some bidans collaborate with naturopaths and modern healthcare professionals to integrate herbal supplements, traditional healing, and modern nutrition into maternal care practices.
4. Challenges Faced by Bidans Today
4.1 Competition from Modern Healthcare
With the expansion of hospitals and maternity clinics, many women now opt for hospital births over home births assisted by bidans. This shift has reduced the demand for traditional midwives, particularly in urban areas where medical facilities are more accessible.
4.2 Legal and Regulatory Issues
While some bidans practice with official certifications, others continue to operate informally, raising concerns about safety, accountability, and medical oversight. The lack of clear legal frameworks for traditional bidans makes it difficult for many to secure recognition within Malaysia’s formal healthcare system.
4.3 Financial Challenges
Many bidans operate independently without government funding, making it difficult to sustain their services. Additionally, the lack of insurance coverage for bidan-led home births and prenatal care means that many women opt for government-subsidized hospital births instead.
5. The Future of Bidan Services in Malaysia
5.1 Government Support and Policy Development
There is a growing need for better policy support and funding to sustain bidan services. The Malaysian government can:
- Provide grants and subsidies for certified bidans.
- Encourage collaborations between hospitals and bidans to create a hybrid care model.
- Establish standardized training programs to ensure uniform safety and medical standards.
5.2 Digital and Technological Integration
Some bidans are now leveraging digital tools and telemedicine to reach a broader audience:
- Telemedicine consultations for pregnant mothers in remote areas help bidans provide real-time guidance, fetal monitoring advice, and pregnancy education via video calls.
- Mobile applications for maternal health tracking allow bidans to remotely monitor pregnancy progress, send reminders for check-ups, and provide dietary guidance.
- Online courses and digital workshops help bidans educate mothers on self-care, childbirth preparation, and postpartum recovery.
5.3 Revitalizing Traditional Knowledge
Efforts are being made to document and preserve bidan practices, ensuring that future generations can benefit from their expertise. Universities and research centers are now studying traditional midwifery, helping to bridge the gap between folk wisdom and scientific validation.
Conclusion
The bidan profession in Malaysia remains an invaluable part of maternal and infant healthcare, balancing tradition with modern medical advancements. While hospitals have become the norm for childbirth, bidans continue to offer personalized, culturally relevant care that many women seek, particularly for pre- and postnatal support.
To ensure the survival and sustainability of bidan services, more effort is needed to integrate them into the modern healthcare system, offer financial and policy support, and recognize their expertise in both traditional and modern maternal care.
By blending ancient wisdom with contemporary knowledge, bidans will continue to serve as guardians of maternal well-being in Malaysia for generations to come.