BUT NATURALLY
Hyderabad’s Fernandez chain of hospitals uses trained midwives to facilitate natural childbirths and reduce the number of caesarean section deliveries, writes Anjuli Bhargava
‘CREATING MIDWIFERY AS A UNIQUE CADRE HAS BEEN SUCCESSFUL IN REDUCING THE NUMBER OF CAESAREAN DELIVERIES’ EVITA FERNANDEZ Managing director, Fernandez Hospital
Evita Fernandez ,65, who runs Hyderabad’ s Fernandez chain of hospitals, has an answer to the growing number of ca es are an section childbirths in the country. She wants to setup a School for Midwifery that will train its students to bring about natural births form others-to-be. Her 70- year old hospital chain, which was founded by her parents, is also working with the government to develop a four-year professional midwifery programme like that in the UK and Europe.
For the last decade or so, there has been an explosion of ca es are an section deliveries in
India. So much so that many doctors and healthcare professionals now call it“an epidemic”. Till2010, Indiahada C-section delivery rate of 8.5 percent, which was well below the WHO-recommended level of 10-15 percent. However, in2014-15, then umber of C-sections shot up to 15 percent of all deliveries countrywide, with some states reporting that the surgical procedure accounted for half their child births.
Mid wives could reverse the trend, says Fernandez .“A traumatic child birth can be quite a terrible experience and women often feel strongly enough afterwards to try and prevent other women from suffering similarly. You would be surprised by the number of women who take up the midwifery course for mainly altruistic reasons ,” says Fernandez. The compassion and commitment these women bring to the job is unparalleled, she adds.
Although in India, people generally associate mid wives with rural areas, Fernandez Hospital employ sand uses the services of midwives— it has 30 at present— to ensure that its incidence of C-sections is kept in check. Their ca es are an deliveries are at 8.1 percent of the total number of child births whereas at its highest risk hospital with very complicated cases, the rate is 22 percent. But at many other hospitals, this rate is as high as 75 percent. Fernandez Hospital’ s mid wives are now training women in midwifery at a district hospital that handles 700 deliveries amonth.
Right now there is no special is ed training for mid wives in India. A nurse who under goes a three-year diploma course is considered both a general nurse and amid wife. Legally, she can pr ac ti se midwifery as well.
But Fernandez argues that a general course does not equip nurses with the skills and training required to be a professional midwife .“Amid wife needs to be highly skilled, competent and accountable as she is dealing with two live sat the same time ,” she explains. She says that child birth is meant to be a natural process and a woman can give birth on her own. The midwife’s job is to facilitate vaginal births, but she must also be able to discern if there is some complication and decide if a doctor needs to be brought onboard. The midwife is also responsible for them other’ s well-being for six weeks after delivery.
The mid wives at Fernandez Hospital do a focused, in-house training in midwifery for 18-24 months after completing their three-year diploma in nursing. They get a starting salary of about ~25,000. The hospital has brought in mid wives from the UK to train the nurses .“I am convinced that to make child births less medical is ed and more human is ed, this is the only way forward,” says Fernandez.
Fernandez asserts that her mid wives have contributed dramatically to reducing the C-section rates for their chain. In fact, countries that have created midwifery asa unique cad re have been very successful in bringing down the number of ca es are an deliveries, she adds.
At the Fernandez birthing centres everything is designed to encourage natural child births. There are designated and well-defined protocols that are strictly adhered to and 25 senior consultants are responsible for ensuring that the protocols are followed.
For instance, if an expecting mother walk sin with very high blood pressure, there isa certain protocol to be followed. If for some reason it is not, the consultant should be able to explain why. This helps them understand why aC-section or some other procedure was carried out in a particular situation .“If despite everything a ca es are an is performed, there would be a very valid reason for it ,” says Fernandez.
Also, the hospital does not blind ly adopt the practices advised by Western experts. It relies on its own data, evidence and documentation, all of which help it take informed decisions, including those that involve deviations from the protocols.
RatanJalan, former CEO of Apollo Hospital, and who now runs a boutique healthcare consulting firm in Hyderabad, says that the Fernandez chain isa class apart owing to its transparent practices and systems, which has been responsible for its growth from a single facility to five at present .“The hospital holds everyone accountable and that is its single biggest strength ,” he says.
There are no random prescriptions or lab tests and doctors are not required to meet any targets. Even if a protein supplement is prescribed to someone, there isa reason and explanation for that, J alan adds. He says that the focus is always on charging patients fairly. If any patient is charged extra by mistake, the hospital reimburses the amount immediately.
Fernandez, too, says that she tries to build the trust of her staff by keeping the finance soft he company entirely transparent. A private limited company with no investors, no shares, no equity funding, no partners and no dividends, the earnings are all ploughed back into the business. Fernandez herself draws a salary like any other employee.
Almost 80 percent of Fernandez Hospital’ s 1,400member staff are women and, until recently, the hospital gave them four months’ paid maternity leave( instead of the customary three months) and a further two months of unpaid leave—a rare privilege in the industry. After the recent change in law, six months’ paid maternity leave is given now .“The idea is to walk the talk. If we want them other to be respected and cherished, there is no better place to start ,” Fernandez concludes.