Delivering choice

A birthing centre in Bengaluru is helping women make informed decisions about their pregnancy, right down to choosing how they have their baby, writes Sweta Daga

Over the last few years, the world has witnessed a more honest conversation around feminism, sex, consent and a woman’s choice in matters related to her body. While the Metoo movement foregrounded the idea of consent in the United States, the birthplace of the movement, women’s right to choose has, however, been severely undermined: as many as 11 US states have made abortion illegal.

While abortion remains legal in India, the way a woman goes through her pregnancy — and delivery — is increasingly slipping out of her control. Several studies point to an increase in the number of Caesarean- section deliveries in India when they might not be required as a lifesaving measure.

The 2015-16 National Family Health Survey ( NFHS), conducted under t he Ministry of Health and Family Welfare, indicated that many C-sections are decided before there is a medical need. “A caesarean section without a medical need can put a woman at risk of short- and long-term health problems,” the NFHS stated.

With the idea of helping women make informed decisions about their pregnancy and the birthing process, Bengaluru’s first midwife -based birth centre, The Birth Home, organised an open house in midAugust where it invited women to come and learn about the choices available to them. The Birth Home offers childbirth and breastfeeding education, prenatal fitness and physiotherapy, postpartum support and care, one-on-one counselling, and so on. What’s unique about it is that unlike hospitals that offer similar services led by doctors, The Birth Home is a midwife-led centre. It works on a model where the midwife, a medically trained and skilled birth professional, handholds the expecting mother, caring for and assisting her before, during and after the childbirth.

The Birth Home follows a collaborative model: while it has tied up with doctors and hospitals, families that choose to birth here will be attended to and cared for by midwives. The centre is currently accepting women who are in their first and second trimester, and who can choose to have deliveries assisted by certified, professional midwives.

To ensure that the journey is smooth and safe, the expecting mother will be screened to begin with. Only if she is found to be healthy and low risk will she be considered for a midwife -assisted deliver y. Besides being qualified to conduct deliveries, the midwives are trained in cardiopulmonary resuscitation, or CPR, and neonatal resuscitation, among other emergencies. At the time of the deliver y, if it is felt that the mother needs an emergency C-section, she will be transferred via ambulance to a partner hospital.

The Birth Home’s philosophy is that birth is a normal, physiological function of the human body and while medical interventions have their role and place, these are not needed routinely.

The centre was co -founded by five women: Asha Kilaru, a public health researcher focused on maternal and child health; Chetana Kulkarni, a lactation and childbirth educator; Meghana Naidu, a business development and birth advocate; Nora Kropp, a midwife and public health researcher; and Sneha Shah, a labour doula, childbirth educator, pregnancy fitness expert and physiotherapist.

“From the time we realise we are pregnant, we are told to give birth in a certain way,” says Kulkarni, a mother of two. “Doctors and the advancements of medicine in gynaecology and obstetrics have their place and need. They are indeed life-saving and we are not against C-sections. But routine use of highly medicalised procedures in a low-risk, normal pregnancy and birth often translate to higher health costs and postpartum complications for both the mother and the baby. These may even have lifelong physical and psychological consequences.”

The NFHS data shows that over the years India’s use of C-sections has witnessed a significant increase, especially in the southern states. According to the paper “Increasing Trend of Caesarean Rates in India: Evidence from NFHS-4” in the

Journal of Medical Science and Clinical Research, “At all-india level, the CS (C-section) rate has increased from 2.9 per cent of the childbirth in 1992

93 to 7.1 per cent in 1998-99 and… to 17.2 per cent in 2015-16. According to the recent NFHS 4, the average rate of Csection in India is 17.2 per cent ranging from 5.8 per cent in Nagaland to 58 per cent in Telangana. The difference in C-section delivery from NFHS-1 to NFHS-4 shows that seven states have CS rate that is more than 30 per cent, eight states have CS rate in between 10 per cent and 20 per cent and nine states less than 10 per cent.”

Nivetha Krishnamoorthy, 33, and her husband, Srinivas Adiga, have come to The Birth Home with their son. “I am part of the Bangalore Birth Network (BBN), and I want to be able to support more women through this process,” says Krishnamoorthy. A registered society, BBN is a network of parents, parents-tobe, doctors and birth workers (doulas, childbirth educators, lactation specialists, counsellors, physiotherapists, psychologists, midwives, and so on). “When I gave birth to my son, I did as much research as I could. I read books and spoke to friends who had had babies, but had I got the right support, like what is offered here, I would have made different choices,” Krishnamoorthy says.

What she is referring to is access to the right kind of information during pregnancy, at the time of birth and postpartum. Many birthing persons are not aware that they have the right to be informed about everything that involves their body — from procedures or interventions to internal examinations, ultrasounds, pregnancy tests, monitoring of contractions, and so on.

Informed consent needs to be taken from the pregnant person. Options, alternatives and risks need to be spelt out to both the expecting mother and her family so that they can make a decision based on their unique situation. Support suggests not just the right kind of care but also compassionate care, which plays a critical role during this entire process — and has long-term implications on the mental and physical health of the birthing person and the baby.

WHILE IT HAS TIED UP WITH DOCTORS AND HOSPITALS, FAMILIES THAT CHOOSE TO BIRTH HERE WILL BE ATTENDED TO BY MIDWIVES