By Prof. Hassan Hathout When Sir James Young Simpson, the famous Scottish obstetrician, used ether about the middle of the nineteenth century to alleviate the pain of childbirth, the church reacted violently against him. It was believed that the pain of childbirth was God's prescribed punishment for Eve (and every Eve) because of her alleged role in tempting Adam to disobey the Lord by eating the fruit of the forbidden tree. A campaign was launched against Simpson for his interference with the will of God, and the attack stopped only when Queen Victoria invited Simpson to conduct her delivery under his pain-releaving technique. The concept of God's punishment to Eve through the pain of childbirth does not exist in Islam, nor is she held responsible for Adam's sin. As mentioned earlier in this book, both succumbed to the temptation by the devil, both repented and both were granted God's forgiveness before Man started his career on earth as Vice Gerent ofGod, endowed with the concept of good and evil, the mind to discriminate between them and the freedom to make a choice. This is the only feasible basis for the accountability of Man. If Man (every man) was not free to choose, then responsibility would cease as also if someone else would have paid the price of human sins and accountability was priorly waived. The issue of alleviating pain is nowadays beyond debate neither the church nor anyone else in our times are against pain relief. In Islam, pain should not be invited, and indeed every measure should be taken to prevent its occurrance and to suppress it if it occurs. The concept of spiritual purification by humiliating the body through pain, uncleanliness or neglect of physical well being is alien to Islam. Indeed the prophet peace be upon him teaches: "Verily your body has a right upon you. " But if pain is inevitable, then it is a charity in Islam to endure it in grace. Patience is a value in itself, and holds a very high position at that Whereas the prophet says: "Seek a treatment (for your illness)", he also says: "By Him who holds my soul: never did the faithful suffer pain or illness, but God puts away his sins as a tree sheds its leaves." (Bukhari) It is not only physical pain that is encountered in the practice of obstetrics & gynaecology but psychologic pain as well. A baby born dead or malformed or dying in the early neonatal period is a crisis the obstetrician is often called upon to handle. According to medical literature, the mother's response to these situations typically goes through the classical phases of initial shock, denial and refusing to believe that it happened to her, extreme depression and hostility or anger towards the doctor, the person who brought the sad news, the team who managed the delivery or neonatal care or even the whole world. She might even entertain feelings of guilt for something she commited or omitted during the pregnancy, and some of them take it as a punishment from God for something she did in the past (induced abortion is frequently quoted). It will be a variable time until the stage of acceptance and later adaptation are reached. In practice, we have seen this stereotyped course appreciably and sometimes radically modified by mobilizing the protective power of faith, either autonomously by the patient herself, or therapeutically by her doctor if he (or she) is well equipped for the role. In a western environment this role of the doctor is almost unexistant nowadays and mostly unthinkable. Faith is not written in medical books and to delve into it would be trespassing outside the sacred 'boundaries of proper practice. Patient management has become increasingly fragmented, and the case might be handled in the fashion of a production line by the obstetrician, the ultrasonographist, the fetal echocardiologist, the genetic counsellor, the laboratory, the neonatologist, the psychologist (for the stressed), the priest (in situations of death and dying) and quite frequently the attorney for the malpractice suit. The pattern aims of course at providing top expertise all the way, and yet the area of faith remains notoriously empty. This pattern is no surprise in communities where the impact of religion on every day life has faded. When faith is alive, it is the primary and richest resource to be tapped in the face of adversity and it can offer instant support and immunity. '"You have given and You have taken and You are testing me. What you will I accept without a grudge and I thank You for inspiring me patience and giving me the strength to overcome. I am grateful all the way and I hope to be to the satisfaction of Your expectations." This prayer and its likes represent and foster an attitude that minimizes the effects of the traumatic experience and reduce it to an easily manageable scale. The prophet teaches that lost children are a credit to the believer in the hereafter and a security from the horrors of the day of judgement. The Quran says : "Be sure we shall test you with something of fear and hunger, some loss in goods or lives or fruits (of your toil), but give glad tidings to those who patiently persevere, who say-when afflicted with calamity: To God we belong, and to Him is our return. They are those on whom (descend) blessings from God and mercy, and they are the ones that receive guidance." (2: 155-177) In itself patience is a "value", and individuals or societies who cannot see it as such might be in grave jeopardy when confronting stress. 'Patience' was mentioned in the Quran on one hundred and three occasions and is highly esteemed. But the principal source of patience is faith, and if this exists it is the retreat to fall back to. Even when clouded by grief, faith can be addressed by the. counsellor who can attune to it, and it will work wonders. A case I always quote is that of a lady doctor who gave birth to a congenitally abnormal daughter the care for which really taxed her endurance. For two years she lived in bitterness and resentment, over-whelmed by the unanswerable questions of "why?" and "why me?" Although the defect was not mendelian and the prospects for another pregnancy were good, she refrained from pregnancy in view of her psychological condition, that occasionally became really bad. One day a gynaecological condition brought her to visit a gynaecologist who had not been so far aware of her story. Listening to her history, he asked whether she was an atheist or a believer so as to tailor his talk accordingly and she said she was a believer. "'Patience per se is a great thing in human life, and for its own sake God wants to enrich the human soul with this ingredient. To exercise patience in grace and acceptance is in the long run a valuable endowment of human life, as well as a great charity with a generous reward. Because of this, you must not consider that the effort you give your child is a purposeless waste. It might in fact be the principal role you are assigned to play through your life according to God's plan for you. And as you believe in the hereafter, just imagine that people there look at hell with great horror and clumber at the gates of heaven, to which none had access but those who had their keys to open and enter. Did it ever occur to you that in the awe of that situation your key might just be your daughter?" With this brief conversation she promptly changed. Her receiving apparatus had been there but just waiting for the proper message at the matching wave length. She left the clinic a different person. She became very fond of her child and her outlook to life enormously brightened. Her radiant smile and glittering eyes were a happy surprise to her relatives and friends. She stopped contraception, got pregnant and gave birth to a lovely normal girl, and looked a model of happiness. She again became pregnant, and this time the ultrasonographist suspected some degree of microencephaly later in pregnancy. She was of course worried but well contained, announcing she would accept whatever came. Fortunately the baby turned out to be normal, another beautiful little girl. In other cultures such an approach would be taboo. Its feasibility depends on the faith-index of the community as well as the individual doctor, individual patient and the integrity and scope of the doctor-patient relationship: which in certain contemporary advanced communities has been largely transformed into a medico-legal relationship. In the "Islamic Code of Medical Ethics (Islamic Organization of Medical Sciences, Kuwait), the following phrase is worth quoting (Chapter 11, p 190): "Faith is remedial, a healer, conqueror of stress and procurer of cure. The training of the doctor should prepare him (or her) to bolster faith and avail the patient of its unlimited blessings."