CHENNAI: The way you made your baby is how you should deliver your baby — "with love." While this may seem like a line out of a cheery ‘what to expect when you’re expecting’ movie, it was all the persuasion that Sruti Nakul needed to choose a natural, water birth for her pregnancy. This, after hearing the line from her doctor-to-be — cofounder and director of The Sanctum, Natural Birth Center — in their first consultation that lasted 45 minutes.
A few weeks, and several Lamaze lessons and aerobic classes later, Sruti gave birth to her baby girl in a process that had her have her husband by her side, accounted for all her needs and likes, and was devoid of the usual trauma that marks many a woman’s delivery. It’s for these reasons that more urban women seem to be considering home births or places that offer natural birth services.
The shift has been on the rise since the start of this decade. Kochi got its midwifeled birthing centre, Birth Village, in 2010. Hyderabad’s The Sanctum came a year later. Birth India network, a nonprofit organisation that helps families get access to skilled, respectful caregivers (midwives, doulas and birth educators), was started in 2011.
These organisations came about as a way to address the huge gap in the country’s evolving healthcare system when it comes to pregnancy and childbirth; a system that has been accused of denying the expectant women their autonomy, resorting to medical/surgical intervention as the norm and treating the mother as the patient and the baby as a disease that has to be attended to.
Tenets of delivery
At a hospital that Sruti visited during the early stages of her pregnancy, the doctor suggested that she would probably be delivering the baby via C-section based on the scans from her 25th week that showed the baby was in the breech position (the baby’s head is up). “At that point, I didn’t know that it was only by 35 weeks or so that most babies change positions. I’m not against C-section; it is definitely a boon. What I don’t like is pushing everybody to surgery because they don’t have the time. For me, after my water broke, it took me nearly 16 hours to deliver the baby.
And it happened only in the 40th week. Here, a C-section is encouraged if you cross 37 weeks and your water does not break,” she points out. Contrary to this range of care, what she got at the birth centre was a personal midwife who was also a trained lactation consultant and nurses who could step in and offer help when needed. Birth Village, founded by a certified midwife and childbirth educator, Priyanka Idicula, works the same way. She suggests that some of the gaps in the system are so, simply because we don’t listen to the women. “Across whatever profession, the woman has to scream ten times more to make sure her point is heard.
Another important factor is that we are looking at the ‘healthy mother, healthy baby’ model. But that’s not enough. We should be looking at how respectfully the mother and baby are treated; whether this mother was listened to, if she has been given full respect, if she was informed about any intervention. That’s very important, whether she is an industrialist’s daughter or a farmer’s,” she offers. With these basic tenets and the midwifery model of care that’s proven to involve lesser intervention and thereby, increased vaginal birth rate, the Birth Village manages a 91.4 per cent natural birth rate (2010-2019), the highest in the country. It may also serve to note that they specialise in healthy pregnancies, where the women do not have diabetes or hypertension, etc.
And they ensure that the women stay healthy during the pregnancy, covering diet, exercise and much more. “If you go 79-80 years back, we lived healthier and ate healthier. For various reasons, we are probably not able to do that now. But, with a lot of modification in exercise and diet, we can have that birth rate outcome because 80 per cent of the population is healthy; 20 per cent will have issues, no doubt. Yet, if a woman is in the 80 per cent bracket, we need to have a really good try for a healthy birth. And the midwifery model will have an answer to that,” she suggests.
No choice left
While the urban population is able to choose such centres or take the help of a trained midwife to assist in childbirth, we are far from ensuring access to even the most basic healthcare further down the economic scale, where women often end up giving birth at home, the worksite or en route to the hospital. There are a number of reasons — from the distance to the nearest hospital, being stuck in bonded labour to a general mistrust in the institution — why this continues to happen in a place that’s trying to achieve 100 per cent institutionalised birth.
While the policy does little to accommodate the women who choose home births, it is not able to cover the women who are pushed into it either. It results from the focus on reducing maternal mortality rate, says Dr Thendral K, senior consultant-Obstetrics, Gynaecology and Laparoscopic Surgery, BirthRight at Rainbow Children’s Hospital. “Right now, the maternal mortality rate is 113 per one lakh live births. Our goal is to bring it down to less than 70 by 2030.
So we promote institutional deliveries because we do not have a system like the NHS (National Health Service) in the United Kingdom. They promote home deliveries for low-risk antenatal mothers. They have a systematic network of midwives and a referral system. Since we don’t have such a system, in places like Tamil Nadu, we have achieved near-100 per cent institutionalised births. Yet, there are places — say, rural areas — where home deliveries are prevalent. For this, there is training happening for the dais, who can help them with home births; provided that it’s a lowrisk pregnancy.
But, there should be a referral system for when there are complications, and we don’t have this yet in India,” she explains. KR Renuka, director of Centre for Women’s Development and Research, suggests that this gap can be bridged by equipping primary health centres to handle childbirths. “Right now, we have a lot of facilities at hand for those who can afford it. For those who can’t, ‘home birth’ should be a viable option. We talk about health and hygiene but how many government hospitals are able to ensure that? The government should turn PHCs into places that are ideal for childbirth.
We should make sure that these centres have gynaecologists and nurses round the clock, and local people trained in midwifery. If we are able to address this, India can easily become the best places for pregnancy and childbirth. We have the infrastructure; it’s the mindset that needs to be changed,” she suggests. Seconding this suggestion, Priyanka says that we have to make midwifery available at all levels — be it hospital-based or communi ty-based. “The midwife should be advocating for the women. That is where we have to change the education for it readies us only for the system.
Midwifery is something that can develop well to address women at the village-level also, provided they are from the local community,” she offers. There’s also need to focus on the proper training of midwives. The six-month course that’s currently being offered along with nursing programme does little to help, says Priyanka.
“We need a midwifery programme that is an 18-month add-on course to nursing or direct- entry midwifery programmes that allows someone to join the three-year course right after school. We have not introduced it yet but we are hopeful for the future,” she adds. Beyond all this, treating people with kindness and compassion should be included in the training. And these things would go a long way in making the hospital a more welcoming place for expectant women, she suggests. Isn’t that the hope?