In India, childbirth and motherhood are commonly projected as the most gratifying experience for a woman. At the other end of the spectrum is the scaremongering, tales of excruciating labour pains and births gone wrong, with a big share of the blame going to movies replete with scenes of ear-splitting screams, bleeding and semi-conscious mothers, and general mayhem. In a bid to gain greater agency over the birthing process, women from a certain demographic — literate, working, urban, middle class — are increasingly opting for natural, non-invasive, vaginal birthing. Arming themselves with information to make responsible choices in the labouring room, they want to reclaim a space usurped by doctors and old wives’ tales, and tweak gender expectations along the way.
Neha Chopra was elated when she became pregnant for the first time, but her joy turned to shock when she visited a Mumbai gynaecologist. “How did you allow her to get pregnant?” the doctor asked her husband. “The doctor’s reaction suggested that pregnancy was supposed to be undertaken with the man’s permission. If the woman happens to be overweight, there is a preconceived notion that the pregnancy would be risky, even though my parameters were fine. I felt guilt and shame, and that ruined the joy of being pregnant,” says the 32-year-old filmmaker.
Chopra gave birth to her daughter in 2013 in Ahmedabad, but her harrowing experience prompted her to delve deeper into the subject of birthing, alongside photographing it. She joined Birth India, an advocacy group.
Expectant mothers undergo regular medical check-ups to minimise surprises during birthing.
“Pregnancy means the health of both the mother and the child should be monitored on a regular basis, and proper antenatal care provided. Families that cannot afford treatment at well-known institutions, shun government hospitals for the smaller nursing homes in the hope of finding better facilities.
However, many of these centres do not have the necessary medical infrastructure, experienced doctors or a proper emergency response system,” says Dr Kiran Coelho, a Mumbai-based gynaecologist and obstetrician.
Lending a ear
Invasive medical processes often leave the pregnant woman feeling traumatised, as various instruments and even fingers are used to probe the vagina, that too without seeking her consent or attempting to make the person comfortable. “Check-ups are a very intimate process, and medical attendants can be cold and robotic at times. It becomes more of a violation than a check-up. Questions are not encouraged and the women are given an exaggerated account of the process, fanning fear. Rather than addressing the fears of the prospective mothers through discussions, they are merely given instructions to follow,” says Dr Veda Simons, birthing consultant and founder of the Mumbai-based Daimaas Natural Birth & Wellness Centre.
A gynaecologist and obstetrician, Simons found herself hitting saturation point after practising for 15 years. Around that time she came across the concept of non-invasive natural birthing, which was already growing in popularity in the West. Simons decided to set up a centre for such births in India.
She alleges that many doctors convince pregnant women to go under the knife, or undergo needless surgical procedures, all for an extra buck. Across the world, hospitals have recorded a spike in C-section deliveries, making it a hotly-debated topic. Typically, hospitals push for a C-section if labour has prolonged beyond a stipulated time; gynaecologists pass on C-section literature, often without discussing the alternatives. In Chopra’s case, a day after her due date, the gynaecologist suggested she choose a date and time for the surgery. Though she remained unsure, Chopra was cajoled to go for it — an action she deeply regrets now, amid swirling reports of the supposed ill-effects of C-section.
The clinical approach at hospitals is driving women to look for a more personalised and curated pre-natal care and childbirth, turning the focus on concepts of natural and even home births. Catering to this demand, several organisations have sprung up around the country, offering a holistic birthing experience that puts the mother’s needs at the centre while, at the same time, equipped to deal with any emergencies that may arise. Among the natural birthing techniques gaining popularity is water birth, now offered by many big hospitals in India.
This, in turn, has generated a demand for midwives who provide a comforting and calming guidance. However, these are trained midwives who are different from the traditional dai or daula who rely on traditional, and mostly anecdotal, knowledge. “Myths such as the need to consume more ghee for a smoother delivery are still prevalent,” says Simons. Traditional midwifery was considered high-risk, unhygienic and a cause for high mortality rates, which prompted governments to actively propagate institutionalised birthing to curtail the mortality rates across the country.
Europe leads the way in certified midwife-assisted birthing, and the United Nations has stressed on the need to further develop this segment. In India, Birth Village in Kerala and The Sanctum — Healthy Mother in Hyderabad are among the centres offering midwife-assisted birthing. Midwifery training in India forms only six months of nursing education, with hardly any sustained focus on the practice. Hence, foreign nationals with expertise have taken up this role in India.
“Foreign midwives work in many capacities in India. Most of the midwifery programmes in Europe and the US are well-structured. Most show a high degree of professionalism and work autonomously. Their licences may be equalised in India after applying through the designated councils and they take up teaching or clinical work, or work with an NGO. They can work with Indian organisations after securing an employment/volunteer visa, just like the Indian nurses who work in the Gulf countries,” says Priyanka Idicula, co-founder, Birth Village.
She stresses on the need to upgrade the teaching course for midwifery: “We need to rebrand our curricula with a strong bridge programme for existing nurses, for an 18-month specialisation in midwifery, and also have a separate three-year programme. Trained midwives will be an asset in rural areas, where they can provide culturally appropriate care in places where roads, leave alone doctors and nurses, do not go.”
A challenging option
Women who seek to give birth in a familiar environment are weighing the option of home births too. But it comes with a fair share of challenges and safety concerns. Ragavardhini Perumal, a pilot based in Bengaluru, had opted for water birth for her first daughter, but the experience was not as wholesome as she expected. “For my second delivery, I decided to go for home birth with minimum interference from doctors and also to involve my first daughter in the process,” Perumal says.
As a safety option, Perumal and her husband, Captain Parijat Narayan, zeroed in on a doctor who promised an assistant for post-delivery care, as well as a tie-up with a nearby hospital in case of an emergency. However, during the delivery, the doctor remained out of reach, claiming to have been in surgery, and missed the birth. As an experienced mother who had done her research, Perumal gave birth without assistance.
“Hospitals are now setting up a more personalised maternity unit with labour rooms, where family members can be present. For home births, it is essential to have a doctor on board, as well as an experienced midwife, to step in if something goes amiss. I don’t recommend home births because there may be unforeseen emergencies for which the mother has to be transported to a hospital. Such a situation can be a risk to life and also add to the financial burden,” says Coelho.
Centres such as the Birth Village serve women from diverse social and economic backgrounds. For young at-risk women/single mothers belonging to low-income groups, the centre offers free care through its NGO Birth for Change.
Another of its projects is called Tejus Home, started in 2012, which serves as a shelter for pregnant teens, most of whom are victims of sexual violence. “It is heart-wrenching as many of them do not have any parental support as they grapple with the judicial system owing to the rape cases, alongside the demands of their pregnancy. The youngest mother we have cared for was 12. We offer psychological support, prenatal care and, most importantly, childbirth education that is tailored for a child,” says Idicula.
The father’s role
Holistic birthing practices are breaking another barrier by assigning roles to the prospective fathers. A labour room has typically perpetuated watertight gender roles, with the male partner often spared the uglier and messier bits of childbirth. Today, although some couples are opting to be together during labour and birthing, the numbers are too few. “It is essential for a man to be a part of the process, not only during his wife’s pregnancy but also during the delivery, for him to realise the effort and pain, bond with the child, and connect at a more sensitive level with not only his partner but also other women,” says Simons.
Narayan supported his wife during the birthing. “He created the safe space for me, gave me food, put on calming music and was a source of support throughout the delivery,” says 36-year-old Perumal.
According to Simons, the fact that society absolves a man from witnessing the messy side of pregnancy sends the message that the man’s role is limited to sex and the economics of pregnancy. Exposure to the process of pregnancy and birthing can be liberating for both the man and the woman, she adds.
This article was published here by Hindu BusinessLine on Jun 1, 2018