Looking into midwifery as a profession and reassessing its importance in our society shows that most Indians possess little knowledge of traditional midwifery. In India, the word “doctor” still invokes ultimate authority, security and is placed at the top of the hierarchy. Expectant parents can be a medium of changing birthing practices by asking, questioning and expecting better experiences.
Through the writings of ancient Indian physicians, Charaka and Sushruta, it was discovered that midwives were a part of privileged families and were established as wet nurses. Soma Mukhopadhyay’s research on traditional midwifery in India suggests the loss of their social statues and their undesirability was a result of imperial policy and its decision to terminate traditional practices of childbirth in order to spread the Western system of delivering babies. Thus, the “dais”, experienced professionals who were familiar with the process of delivery and practitioners of folk medicine, were replaced with “functional” midwives, who were trained as support professionals and ultimately served the urban elite. In 1946, the Bhore committee laid out the foundation for public health planning and highlighted the need for qualified midwives and health visitors, and in 1947, the INC combined the Nursing and Midwifery courses into a singular course structure.
The place of birth can make the difference between who lives or dies. In India, economic disparities, class discrimination and access to medical facilities strand countless newborn babies without the professional care that is taken for granted in the privileged sector. For women who cannot afford to have an institutionalized birth or do not have access to a medical facility, a home birth becomes the only mode of delivery.
In rural spaces therefore, the pregnant women of the community depend on the elder women of the village and the ones who have successfully given birth in similar conditions. They create a birth community around them, building a system of care that delivers successfully. These women also chose to make a career out of midwifery. Statistics suggest 16.2% women in rural India initiate home births.
India accounts for 17% of all maternal deaths globally. Our maternal mortality rate is 167 per 100,000 live births, and the infant mortality rate is approximately at 43 per 1,000 live births. Among the causes of these numbers, insufficient medical care during pregnancy and childbirth, and malnourishment takes precedence. There are approximately 444 million children in India. The National Family Health Survey indicates that only 54% of the infants are fully immunized and that more than half the births take place at home.
National statistics show that due to the various state initiatives, awareness about cesarean births and medical advancement, 90% of child-births are conducted in medical institutions. And yet, there’s an emerging class of women who are consciously deciding to move away from these institutions, hiring midwives or other qualified birthing professionals, to deliver their babies at home. Pregnant women usually consult an OB-GYN during the course of their pregnancy and are required to come to the hospital for regular check-ups, ultrasounds, and in case of other complications. The women who appoint midwives erase the dominating medical ideology that turns birthing into a procedure, and get qualified pre-natal care that leads to a normal delivery. In urban India, 10.8% of women gave birth at home. One in four births are attended by “untrained officers”, fluctuating from 53.3% in Jharkhand to 5.3% in Delhi and 0.2% in Kerala.
The common denominator for this shift was the elimination of strangers delivering babies in strange rooms and the post-delivery care that is lacking in most cases. Economic disparities also plays a huge role in determining the type of birth. In Delhi, 55% delivered in government hospitals while 23% were admitted to a private hospital and 17% of births were carried out by home birth professionals. Some women believe that in a hospital, especially in public hospitals, the back-log and increasing demand reduces any chance of post-pregnancy care unless its a critical case. The staff treats the pregnant woman like a patient, medicalizing the process, and her pregnancy as a disease that needs to be cured. In the case of caesarean births, the scare of being anaesthetised, looking at the statistics of survival and op complications (during and post-op), turns the birthing process into a medical procedure where the survival of both the mother and baby is jeopardised. There are also police reports of mental and physical abuse during deliveries where the rights of women during the birthing process were compromised. These are the main reasons for women to consult a health care provider, get check-ups and their medical sonography, but switch to a midwife during the last trimester and deliver at home.
According to the World Health Organization, midwives “who are educated and regulated to international standards” can provide 87% of the essential pregnancy care for women, and post-op care for newborns. In India, 255 die out of 10,000 medical institute births, and 198 out of every 10,000 home births. Midwifery provides comfort and undivided care during the pregnancy, bypassing the need to make an appointment and travelling to the clinic for the most basic things. However, for rural India and the urban poor, the prospect of a home birth still suggests desperation and lack of resources, there is a need for intervention and provision of quality hospitality, training programmes, awareness about sanitation and post-natal care and local health care services.