The Return Of The Midwife

Horror stories surrounding childbirth in hospitals are forcing some affluent urban women to opt for village-style natural births, reports HEMANGINI GUPTA

Pleased, naturally Vinita and Fayyaz Contractor with son Sohm, who had a natural birth

EARLY LAST April, in a nursing home in Mumbai, windows were darkened, incense sticks lit, and the soothing music of Deva Premal turned on: Vinita Contractor was having her second baby. With her midwife, Caroline, on hand, and her husband by her side, she knew exactly what she wanted: a natural birth. A sharp difference from the birth of Contractor’s first baby, during which: “tablets were shoved in, Pitocin used to accelerate labour, water bag ruptured, epidural injected, nurses held my legs and screamed at me, and finally I was given a cut and fundal pressure exerted. When I planned a second baby, I wanted it to be different”.

She had earlier met members of Birth India, a nine-month old group promoting the benefits and best practices of natural childbirth at a ‘birthing’ seminar. The group is asking some uncomfortable questions about hospital birthing practices, and using phrases rarely heard before, like ‘birth rape’. “This is a serious feminist issue,” says Ruth Malik, co-founder of Birth India. “Inserting objects into a woman’s vagina without her consent and being rude and abusive to women in labour violates women’s and children’s rights. Women are going through it without questioning it. This shocks me.”

In the US, caesarean-section (C-Section) childbirths have risen to approximately one in three, double the number recommended by the World Health Organisation (WHO), which states that “there is no justification in any specific geographic region to have more than 10- 15 percent caesarean section births”. According to Malik, “In India the figure could be as high as 75 percent caesarean births in a private urban hospital. Natural birth doesn’t suit the hospital setup since on an average it could take twelve hours. Doctors are trained for medical birth: to start labour, do a C-Section, to speed it up. Very few have even seen a natural birth.”

A pilot study on childbirth conducted by New Delhi’s Sitaram Bhartia Institute of Science and Research also suggests excessive use of ultrasound investigations and the routine use of procedures such as enema, shaving and episiotomy (a surgical incision through the perineum made to enlarge the vagina and assist childbirth) that are not supported by evidence. What the figures don’t reveal though, are the stories of the women behind them.

SHILPA PARALKAR had heard the stories. Too many of them. “Not many mothers had pleasant memories to share about their hospital births,” she says. “While a few had opted for caesareans, most had been induced, had their membranes ruptured, undergone cervical stripping, a routine episiotomy and a regional anaesthesia thrown in. All under the guise of a ‘normal delivery’.” She conceived at 37 and, after an Internet search, discovered India’s only home birthing centre, in Assagao, Goa. She read testimonials of women who had given birth there: “they wrote of ‘bliss’ and ‘powerful emotions’ and the ‘beauty of staring into their newborn’s eyes as they suckled’. The women around me shuddered and spoke of ‘hellish, torturous labour pains’ and ‘the agony of cracked, painful nipples’. It appeared to me there were two distinctly different planets for giving birth. By the fourth month of my pregnancy, I knew which planet I didn’t want to be on.”

Paralkar and her husband Haridas took time off work, packed their bags and moved to Goa to give birth naturally to Maya; assisted by two midwives. She says that natural birth completely changes the way you look at your baby. The Goa birthing centre is run by the German couple Corrinna and Peter Stahlofen, operating on the premise that “you’re not sick if you’re pregnant”. Babies are born in a home environment, sometimes under water, with family close at hand.

A trickle of highly-trained foreign midwives and doulas (labour care provider) are arriving in India and are working with independent clients and in hospitals. In the last six months, birthing groups such as Birth India (in Mumbai, New Delhi, Shimla, Kolkata and Chennai) and city-based birth networks such as the Bangalore Birth Network and the New Delhi Birth Network have been formed to help people make informed decisions about safe and supported birth.

Sometimes it might seem like the advocacy is premature. Paige Trabulsi, a doula in Bangalore and co-founder of the Bangalore Birth Network says, “what’s frustrating is that we try to make women understand that they have a voice and have choices but... do they really have choices? Which women have choices and what are those choices? Doctors are not willing to answer questions, being really paternalistic; the “I’ll take care of you” attitude is really prevalent”. Last month when she assisted a woman in labour in a room filled with doctors and nurses, cell phones went off and staff chatted loudly. “This is the most pain the woman will ever be in, and she really needs to be concentrating,” says Trabulsi, who politely asked for some quiet. In a huff, the entire team stormed out, she says, leaving her, “shocked. There is no acknowledgment of birth as an emotionally meaningful experience. It’s no wonder that women want alternatives.”

But the alternatives aren't coming easily, and it is harder for women in cities that don't have birthing networks or support groups. In Lucknow, six months pregnant with her first child, clinical psychologist Prachi Umesh knew she wanted her birth to be different from the "horror stories" she had heard, but grew increasingly upset at not finding a doctor who knew how to assist a natural birth, until she finally found Birth India online.

IN INDIA, 60 percent of women still have home births, but most of these are in rural India. In affluent south Mumbai, finding a midwife took Rita Theobald across town to a slum under a Thane bridge, looking for “Sitabai” which is all the information she had about this 75-year-old midwife. “We finally found her at a godown, sorting out potatoes and onions — that’s how undervalued her skills were”. After a ten hour labour, just as Rita was being persuaded to move to the hospitalagainst the midwife’s advise — the baby arrived.

But of course, a natural birth is not an option for everyone. “If you’re following up a woman who has done 40 weeks, if she wants to deliver at home, there’s no reason why she cant,” says neo-natalogist Dr Kumar, who started birthing facility The Cradle in Bangalore. “But if she has obstetric complications or headaches, it would be foolish to deliver at home; traditional midwives don’t have the ability to assist and guide women through these risks. Overall, the more midwives work in conjunction with obstetricians, the better. When women are at risk, you can then transfer them at the appropriate time”.

If experienced midwives are integrated into mainstream healthcare as countries like Canada have demonstrated, maybe more women can choose to draw the blinds shut, play their favourite music and have their midwife and family help them deliver naturally: knowing that should anything go wrong, help is right at hand.