ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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The Baby Arrived at a Natural Birth Centre

Natural birth centres promise comfortable and respectful pregnancy and childbirth services to well-to-do women who have suffered trauma, discomfort, and humiliation in hospitals.

“I didn’t want to have another caesarean section (C-section) unless absolutely necessary,” Neethu explained when I asked why she chose to give birth to her second child in a natural birth centre. As a major surgical procedure, the C-section carries the risk of intraoperative problems (such as anaesthesia, uterocervical, and bladder lacerations) and postoperative complications (such as pelvic infections, sepsis, and urinary infections).

I had met Neethu during my PhD fieldwork at one of the three birth centres where I conducted ethnographic data collection. Like most of my respondents, Neethu had had a vaginal birth after C-section (VBAC) at a natural birth centre in Hyderabad. The birth centre, one of the very few in India, is notable for its collaborative care approach to childbirth where, in case of an emergency, obstetric care is provided. A birth at a natural birth centre, relatively uncommon and recent phenomenon in India, and only a handful of births take place in such centres. In India, the norm for childbirth is in an institutionalised hospital-based birth under the care of an obstetrician. The government supports and encourages hospital-based births because of reduced risks. But pregnant women like Neethu choose the natural birth centre to try for a “normal” delivery after a C-section, as there is a common belief that “once a C-section, always a C-section.” Some upper-class, well-to-do women prefer to give birth at a natural birth centre to escape the negative experiences they have had giving birth in hospitals. These experiences vary from not having their questions answered, to labour inductions being performed without their consent, and unjustifiable and unnecessary C-section deliveries. The increasing number of C-section deliveries in India is adequate evidence of this.

During her first pregnancy, Neethu was induced. Recalling the experience, she said, “When I was induced, the pain was intense and continuous. But in the natural birth, it was like one-minute contraction, one-minute pain, then a three-minute gap. If induced, there is no rest.” Neethu had travelled from Chennai with her daughter and parents. She had rented a studio apartment nearby. Neethu explained that she had a tough experience with the first birth, “They gave me a lot of antibiotics and pain killers which I ended up being allergic to. Also, the pain from the surgery stayed for very long. I was not able to get up and feed my baby. So much so that my mom or someone had to lift me up. It was very kashtam [difficult]. I had back pain for three months because of the C-section.”

Natural birth centres in India are usually owned and run by certified professional midwives who have been trained abroad. “This place [birth centre] doesn’t feel or smell like a hospital,” a few of my respondents commented. The birth centre’s corridor was tastefully decorated—the floor was covered with mats with symmetrically placed flowers, the walls were painted brilliant yellow, and lights that looked like old lanterns hung from the walls.

The morning of the birth, I could hear Neethu scream and groan in discomfort. Suniti, the nurse-midwife, returned to the birthing room, papers in hand. Neethu’s cervix had dilated six centimetres. There was mucus flow, but her water did not break. One of the midwives recommended taking her to the water tub—water helps in pain management and progressing the labour. I entered the birthing room to find Neethu lying down on the bed and her first child, a daughter, sitting by her side. The room had a big bed; there was a tub in one corner of the room for water births, a couch-like chair, gentle lighting, and an attached private shower. Neethu’s next contraction began, coming in much stronger than the previous one. She cried out in pain. After a slow minute, the contraction faded. Drenched in sweat, she rested her head on the pillow waiting for the next one. The professional midwife Divya came into the room to check on Neethu and discussed her concerns. Neethu experienced a few more contractions as she spoke. Divya held her hand and stroked her head.

Neethu’s baby was born later that day. She had given birth to her son in a squatting position. As I entered Neethu’s birthing room, I saw her holding the baby as he calmly suckled. Seeing me, she said, “I feel very good now. The pain brought me my baby. The pain was very intense. After more than 10 hours of being in labour, the baby came out. Pushing was easier for me than the pain.” 

Chaitra, another pregnant woman mentioned that the people of the birth centre were like her friends, with whom she discus­sed how most of her family is sceptical of her giving birth at a birth centre. She chose the birth centre as she could do prenatal aerobics, attend childbirth education classes, and get most of her doubts clarified. Divya, the midwife, says that the objective of midwifery-led care is to provide birthing women with respectful maternity care where the women themselves are able to make choices about their pregnancy and labour. Recognising the importance of respectful maternity care, the Ministry of Health and Family Welfare’s Midwifery Guidelines, released in 2018, introduced the Nurse Practitioner Midwifery (NPM) course in the maternal health delivery service structure.

Although midwives have assisted in births for thousands of years, pregnancy began to be treated as a medical condition with the medicalisation of childbirth. Birthing women were left with no choice but to give birth in a hospital with the assistance of obstetricians—no choice in the care provider or the type of care they want. In India, birth centres are independent birthing facilities only accessible to women from an upper socio-economic class owing to the high prices and most women’s limited awareness about midwifery-led care. But pregnancy and childbirth are expensive, as it is, across socio-economic backgrounds. While obstetrician-led deliveries in hospitals have their advantages, many women undergo ill-treatment during pregnancy and delivery at hospitals, including vaginal examination without the woman’s consent, inducing labour, and administering epidural anaesthesia. These are issues that all women face whether in a public or private hospital and irrespective of their social background. Women who chose to give birth in a natural birth centre mention that in regular hospitals, they were not given enough time or information, their doubts aren’t clarified, and their husbands are not allowed to be present during the birth.

These practices have become normalised over time, making them appear as an urgent medical requirement with no opportunity for consideration or consent—especially for women from a lower socio-economic background. Of course, this undermining of women’s consent is an extension of the position that women occupy in the household, within the family and across classes, where their agency is curtailed, and their views and concerns (even regarding their own bodies) are neither sought nor respected. Therefore, at both societal and policy levels, it is important to recognise that the birthing woman has the right to choose how she wants to give birth and have the healthcare system support her on her journey.

[Note: All the names of the respondents have been changed.]

 

 

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Updated On : 31st May, 2022
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