Safe And Humane Birthing: Why India Needs Trained Midwives Again

India is a country where mothers are worshipped but maternal health is neglected. We have long grappled with unsafe births, abortion and maternal deaths due to factors like lack of sanitation, weak infrastructure in medical facilities and lack of doctors. However, off late a new worrisome trend seems to have developed, what many people are calling the “Caesarean Epidemic.”

A statement by the WHO in 2015 says that Caesarean births higher than 10 percent is not good news for maternal and newborn mortality. In India, however, our current C-sec rate is 10.6 percent. How she gives birth is purely a woman’s choice. However, a large section of healthcare professionals worry that women are not provided with the correct exhaustive information about birthing processes. These lead to many women having traumatic childbirth experiences.

Neha Misra Mutluru, a trained doula and founding member of the Delhi Birth Network, shares how doulas make childbirth safe, humane and comfortable, supporting mothers in their journey from pregnancy to postpartum care.

Here's an excerpt from a conversation with her:

Also read: Writing On Post-Partum Depression Was Like Therapy: Shubhrata Prakash

There are so many myths & misconceptions around the work Doulas do. Tell us more about Doulas, and why we need them in India more than ever.

Women have always been supported by other women while giving birth and caring for their young children. This role has traditionally been played by an elder female relative who understands and has been through this herself. Nowadays families have become more nuclear, and birth has become highly musicalized. This is where Doula’s role comes in; this supporting family member can be replaced by a professional Doula.

A professional Doula understands the physiologic birthing process and is trained to support women during labour and birth. She can offer physical, emotional and informational support as per the birthing woman’s needs so that she feels more safe and comfortable and can have a satisfying birth experience. Nowadays many women find the current medical system to be intimidating and impersonal. This causes undue fear and anxiety during this vulnerable time. That's why women are seeking the support of someone they trust, who listens to what they need, understands their feelings and can help them assimilate the right information. And mainly be by their side to encourage and support them during this journey.

Doulas and midwives have always been part of our history & heritage. Why are they suddenly not in the picture?

Ever since medicalization of birth, the focus is on mother-baby survival. Doctors are trained to save lives, and they do a great job of it. The culture around birth has become of fear and pain, fear of complications or unexpected outcomes. We don't trust our bodies anymore. We feel like it's not in our control. However, midwives and doulas look at birth differently. We see it as a normal physiological process of the body that is designed to work for a majority of women. We understand this and know how to support women having this experience. Gradually, this kind of care is coming back into the mainstream.

What has been your journey as a Doula? How has been your journey with the Birth Network?

I started this work after the birth of my kids as I felt the need to offer better information and started off as a Lamaze childbirth educator. I focussed on offering the best evidence-based information that could help couples make informed choices and be better prepared for their birth. In time, though, I realised that this is a highly vulnerable period for women during labour, birth, and soon after. There was a lack of continuous support from someone who trusted. As a Doula that's what I learnt to do. First is to listen to the women you are supporting - who is she, what’s her story, what does she fear, what works for her and what she needs and simply be that pillar of support. As a doula, we learn various skills and techniques, but only offer what that specific woman needs.

What have been some of your biggest learning about women's health, as a Doula?

The first thing I believe that the most important thing is body awareness. The understanding of your body and signals helps, you know exactly what your body needs in sickness and health. Secondly, there is a fascinating, almost magical design for health and healing in our bodies. We need to be sensitive to these natural healing capabilities. Thirdly, our state of mind and subconscious beliefs directly impact our body’s physical health and thus impact our hormonal health. Hormonal imbalance is the root cause of most ailments.

Also read: We Wanted To Change The Narrative Around Menstruation: Aditi Gupta

Ever since medicalization of birth, the focus is on mother-baby survival. Doctors are trained to save lives, and they do a great job of it. The culture around birth has become of fear-of pain, complications fear or unexpected outcomes.

What would be your advice to expectant mothers, about a healthy pregnancy?

The first one is to only plan to have a child when you feel is the right time. Not when you think you “know” because you will never know for sure. There external factors of societal pressure and age that put pressure on us women. But it is important to step away and think about whether you and your partner feel ready to enter this new phase of life. The second one is to choose your care providers, very nicely choose a doctor, hospital and birth support companions with much care.

They need to be with people who listen to you, to understand and acknowledge your journey so far, and give importance to what you wish for. If you are surrounded by a birth team that you trust, then that makes a huge difference in how your body works. Third, stay connected to and respond to your body. Your body always knows best. Your intuition always guides you to make the best choices for you and your baby.

 Swarnima is the Founder of TheaCare and the Curator of FemmeCon.