Happy birthing day
The fear of unnecessary cuts and the desire to have a natural and private delivery are prompting women to have their babies at home. Not surprisingly, this has led to a demand for trained midwives, says Sonia Sarkar
Three years ago, when 30-year-old Bincy Shibu Thomas of Cochin went into labour at 2am, she was not rushed to the hospital. Instead, she called a midwife home. The midwife delivered her second child, a baby girl, in the comfort of her own bedroom, with her husband and two-year-old daughter by her side.
"It was a happy and intimate experience," says Thomas, a homemaker married to a software engineer. "It was so smooth that none in my building got to know that a child was born in my house," she adds. Thomas opted for a midwifery-assisted birth again for her third child last year.
Kundo Yumnam, a 32-year-old Imphal-based entrepreneur, gave birth to a baby boy last December at home. "Lots of people had been scared of what was going on in the bedroom, not realising it was how birth happens naturally. Some still think I was crazy to have had my home birth without medical interventions, while others have changed their opinion and said that it was brave of me," she says.
More and more women from middle- and upper-middle class families across India are reaching out to midwives because they say they want the process of childbirth to be natural and safe, and only midwives can ensure that.
"In a month, at least 10 women ask about midwifery-assisted home birth. Four years ago, there were just one or two inquiries," says Manjari Kawde, a Mumbai-based gynaecologist and obstetrician who runs Beams Hospital.
Independent studies on childbirth second this. In her paper, Childbirth Narratives: Voices of Educated Urban Women, Subarna Ghosh, a researcher with Mumbai's SNDT Women's University, says five out of the nine women she interviewed for her paper had a midwifery-assisted birth. "Affluent women are engaging midwives who are trained abroad or have come from the West. They keep doctors only as a back-up option," Ghosh says.
The demand for midwives is also linked to the fact that hospital births are seen as impersonal. "Midwives do their work with love and care. Women need that most when they are birthing," says Hyderabad-based practising midwife Vijaya Krishnan, a graduate of New Mexico's National College of Midwifery. Krishnan's role typically starts around the 12th week of a pregnancy and continues for six weeks after the birth. Charges vary between Rs 45,000 and Rs 1.5 lakh, depending on the city.
Many women prefer having their babies at home because hospitals are too public. "In the hospital everyone is watching me writhe in pain. At home, it was my own space. I felt safe, comfortable, not agonised," says Mumbai-based reiki healer Kanika Aswani, who gave birth to a baby girl two years ago.
Couples also appreciate the fact that husbands have a more active role to play in midwifery-assisted births. "They massage and encourage their wives. They are aware of all their choices, pros and cons of any intervention, and can make effective decisions without getting into a flap," says Thomas's midwife Priyanka Idicula, a certified midwife and director of Birthvillage Natural Birthing Center, Cochin.
But in a country where babies were once mostly delivered by midwives, only a handful of them are trained and registered. The World Health Organization (WHO) states that the density of nurses and midwives in India is 17 per 10,000 population, which is low compared to Finland's 108 and Britain's 88. The midwives available in large numbers are either traditional birth attendants (such as a dai) or those who have completed a two-year auxillary nurse and midwifery programme. They, however, are not equipped to play an active role in birthing and merely assist doctors.
Childbirth with the help of midwives has been popular among poorer people, but of late the government has been promoting institutional deliveries among them to check maternal mortality rates.
The ones in demand are those who have received advanced training. "Only some of us, who are adequately trained in midwifery, can handle cases holistically like our counterparts in countries such as Britain, New Zealand and the Netherlands which promote midwifery-assisted home birth," says Lina Duncan, who runs Mumbai Midwife, a private midwifery practice.
These trained midwives, equipped to deal with issues such as vaginal bleeding, irregular movements of the baby, emotional disturbances and mental trauma of the mother during pregnancy, can administer emergency medication during birthing. They also provide check-ups, nutrition counselling and baby-care training later. Some provide services at home and a few run their own centres. There are also foreign nationals, trained as midwives, who deliver the services and often tie up with obstetricians, who support home births.
Another oft-quoted advantage of midwifery-assisted home birth is that midwives are on call 24x7, unlike doctors. Medically too, the benefits of midwifery assisted home birth are plenty. "Post-natal depression is lower among women who opt for home birth. Risk of infection among babies is lower too," says Ruth Malik, founder of Birth India, a Mumbai-based NGO to promote safe childbirth practices.
One reason why pregnant women are opting for midwives is the increase in Caesarean (C-section) deliveries. Often, hard pressed doctors find it easier to deliver a C-section baby than wait for a natural birth to occur. Delhi-based Divya Deswal, who runs Birth Bonds, an NGO that provides childbirth support, believes that doctors also instil a sense of fear among expectant mothers.
"In most cases, mothers have been told there are problems with normal delivery, so they are forced to go for a Caesarean or an induced birth," says Deswal, a doula and hypnobirth practitioner. Doula is the term for a birth companion and post-birth supporter, while hypnobirthing is a childbirth process that uses a combination of techniques - breathing methods, positive thoughts/language, deep relaxation and visualisation - to remove fear. A lot of women also opt for midwifery-assisted birth for their second child, because they want to forget their previous traumatic experience.
Thomas recalls how the doctor induced labour during her first pregnancy. She had to lie down for 12 hours before her child was born. "Before the delivery, an episiotomy (surgical cut at the opening of the vagina) was made. It was painful and the doctor never took our permission," she says.
According to WHO guidelines, only 10-15 per cent of births in India require surgical intervention. Another WHO study that reviewed 1,10,000 births from nine countries in Asia, including India, in 2010 revealed that in hospitals where Caesarean births took place, more than 60 per cent was done for financial gains and not because surgery was required.
"Women being led to agree to Caesarean surgery on the basis of false information, like C-section is safer than vaginal birth or telling them their baby might die without the surgery when the baby is absolutely fine, is a violation of the human right to autonomy," says Hermine Hayes-Klein, executive director, Hague-based Human Rights in Childbirth, an international NGO.
Gynaecologists, however, are not convinced that midwifery-assisted home birth is a feasible option in India. Renu Misra, a senior consultant at the Delhi-based Sitaram Bhartia Institute of Science & Research, says such births are feasible in countries which have a community health service integrated with higher centres. "There, a woman can be transported to a hospital in no time if she develops a complication," she says.
But women like Thomas are happy with their midwives. For them, the transition to motherhood is less scary and painful.