Lakshmana Venkat Kuchi
This week I intend to write about a not so often talked about subject–of midwifery–that perhaps India needs the most to help in natural child births and save pregnant women from losing lives during birthing due to complications.
True India has made tremendous progress in terms of medical education, quality and standards of hospitals and health care, but there are areas that still need our focus and immediate attention–as India is only second to Nigeria in terms of numbers of deaths during pregnancy, many of which are preventable if only India once again returned and encouraged midwifery as a profession to raise an army of highly trained midwives, who can offer the healthcare, empathy, sympathy and respect to the pregnant mothers.
Now, if there is any State in India that has recognized the importance of midwifery as an instrument of delivering superior care to the pregnant mothers, it is the newly carved out State of Telangana in South India, where the Government has stepped in to provide global-level training to midwives.
In fact, such has been the success of its pilot project it carried out with the help of a private hospital run by Fernandez Foundation, that even the Central Government has plans to take it up at the National level. The Telangana experiment and its results, thanks to the few committed doctors, hospital authorities and more importantly to the State administrators, can be replicated in rest of the country. And fortunately, the State and Central Governments have stepped in, and one hopes that in the overall interests of the mother and child, they step up the training and deployment of midwives as part of a separate cadre in healthcare sector.
What has been already observed in Telangana is that Midwifery has led to improvement in the key health indicators maternal and child health in the State and resulting in decreasing the dependence on unnecessary interventions, including cesarean operations.
There is no debate or question about the efficacy and life-saving capabilities of this intervention, but several factors have led to the predominance of C-Section for birthing of a child, which at times can lead to severe complications that could cause deaths of mothers, and child.
In fact, not so long ago, in 2015 it was observed that Telangana had the highest C-section deliveries at a stunningly high 60.7 percent of all deliveries in the State. Of these, 41 percent are in Government run hospitals and a whopping 75 percent in the private sector hospitals.
Another worrying statistic is that Maternal Mortality Ratio (MMR) remains 63 for one lakh births and an infant mortality rate of 26.4 per 100 live births.
These figures are also reflective of the situation in the country with the phenomenon of unnecessary C sector interventions being the rule rather than the exception–for a variety of reasons. The preference and even craze for a good Muhurtham (auspicious time) for the childbirth so that the newborn has a good future is one of the reasons why young couples insist on C-section delivery even though the pregnant mother is healthy, able, and even willing to undergo the natural delivery process. But this urge for medical intervention in childbirth poses a health risk both to the mother and the child.
About 60 percent of deliveries in India are in the private sector. The midwives there can play an important role in such hospitals and the doctors can concentrate on high-risk and complicated cases, as against the present heavy workload in the absence of such a cadre in health services.
Telangana Government recognized the need for improving pregnancy care and the impact of unnecessary C-sections on maternal and infant deaths and decided to step up midwifery care as the potential solution for the State. And it has partnered with Fernandez Foundation and UNICEF to propagate the idea of midwifery – and has come out with a concrete plan to train and employ midwives at Government hospitals across the State. The Foundation ran an exclusive two-year in-house course on Professional Midwifery Education and Training Programme, which began in 2011.
Meital Rusdia, Chief Field Office, UNICEF field office for Andhra Pradesh Karnataka and Telangana believes that this initiative can be the game changer and a sustainable solution to the health personnel gap in the country. She says, “Midwifery is a proven, globally acclaimed intervention that can prevent as many as 83 percent of all maternal and newborn deaths. With this in view, UNICEF has partnered with the Government of Telangana and Fernandez Foundation to launch the Midwifery Initiative in the State. The initiative has promoted respectful maternal care and ‘natural births’, thereby also bringing down the C-sections. Telangana has been a pioneer on this front and learnings from the State initiative have fed into the National Midwifery initiative.”
It was in the year 2017 that the Fernandez Foundation, which is also one of the Nationally recognized Midwives Training Institutes, undertook a pilot project in association with the Telangana Government by training 30 midwives. These thirty students were shortlisted by the State Government from the nursing staff of the different Government hospitals.
It is an 18-month certificate training programme in midwifery and the first cohort were trained in 2017 and since then two more cohorts have taken place and eventually the Government has plans to increase the number of trained midwives and post them at district level hospitals and even down the ladder in the Government run hospitals, and most importantly, at primary health centres that are the most easily accessible to the women in rural and remote areas.
The midwives play a crucial role in ensuring that pregnant women undergo safe and healthy pregnancy with dignity and care. Midwives not just help in natural birthing process but also help in providing mental support that a mother requires during pregnancy and delivery. These are trained to identify low-risk pregnant women and to take a call when any complication develops.
Central Government noted that 85 percent of pregnancies and births do not require specialized obstetric intervention. Midwifery led care can play a crucial role in promoting physiological births and reducing over medicalization. Which is why, the Centre has stepped in with support to the midwifery and has come out with guidelines for starting midwifery services, as a separate cadre, across India. Convinced at the conceptual level, one hopes that the midwifery services as a separate cadre gets implemented at the earliest. The Telangana Government has, at its level, already put in place a midwives training programme and has even appointed those who completed training in Government jobs.
While this presents a job and livelihood option for girls across India, the response of different states to the programme and the Union Government has encouraged all those committed to and engaged in propagating midwifery. They are happy that more States – Andhra Pradesh, Uttar Pradesh, Odisha, Karnataka, and Maharashtra have evinced keen interest in taking up the project and have also sent trainees for the midwives training programme.
It sure is a long journey, but one on which India has only embarked recently. But one is happy that it is in the right direction.
The WHO is of the opinion that 70-80 percent of all births could potentially be normal births, but in India and many countries, the C section rates increased that pose a health risk also in few cases as unwanted interventions can pose risk to the lives of mother and child.
The WHO has noted with concern that maternal and perinatal deaths following C-sections are disproportionately high in low-income and middle-income countries.
Lakshmana Venkat Kuchi is a senior journalist tracking social, economic, and political changes across the country. He was associated with the Press Trust of India, The Hindu, Sunday Observer and Hindustan Times. He can be reached on [email protected]
and Twitter handle @kvlakshman