To-be-moms mull options

The culture of midwives is coming back. Birthing centres in Bengaluru are attempting to add the convenience of home to hospital-style maternity care

Many new mothers are opting for home births or birthing centres, and giving hospitals a go by.

The rising costs of institutionalised delivery, the health risks associated with C-sections, and the less-than-polite treatment meted out to expectant mothers is making home birthing an option.

“I have heard horror stories from my friends about hospitals,” says a 29-year-old woman, five months pregnant now. She is considering a home birth because her friends’ accounts suggest the hospital process is “cold and mechanical and robs us of the happiness of becoming mothers.”

A traumatic first experience prompts many to try natural and home births.

“Many Bengaluru women travel all the way to Hyderabad or Kochi to their birthing centres. These provide them with ‘respectful birthing’ where women are seen as more than their uteruses,” says Meghana Naidu, co-founder of The Birth Home, a midwifery-led birth centre that opened in Bengaluru recently.

The centre, she says, attempts to create a system where primary care is offered by midwives and doctors, and hospitals come into the picture only if complications arise.

“To call yourself a certified midwife, you need to have completed a certain number of births in a hospital setting, birth centre setting, home setting and so on,” Meghana says.

A midwife does not need supervision from a doctor to attend births, but is not allowed to perform surgeries.

Doulas (a non-medical companion who supports a birthing woman by providing care before, during, and after childbirth in the form of information and physical and emotional support), childbirth educators, prenatal fitness experts, women’s health physiotherapists, lactation consultants, postpartum doulas and mental health professionals are pressed into service at birthing centres.

However, if the midwives feel a woman needs hospital care, she is sent there immediately.

The Birth Home doesn’t yet offer home births in Bengaluru.

“The landscape to support it is simply not there. As part of the Bangalore Birth Network, when women want natural births, we ask them to talk to others who have done it before,” she says.

What to look out for

Dr Savitha Shetty, consultant obstetrics and gynaecology, Apollo Hospitals, Seshadripuram, offers a word of caution.

She recommends, as a first step, reading up about the process.

Her advice: “In case of birthing centres, opt for one where an obstetrician is available round the clock. Some obstetricians shuttle between two or three birthing centres and can’t provide individual, personalised care. Also make sure there is a blood bank.”

A good birthing centre is one with the facilities to deal with complications. “Straightforward cases with low risk are okay at birthing centres. Complicated pregnancies need multi-disciplinary inputs, available only in hospitals,” she says.

Since women are marrying late, many pregnancies are complicated and can’t be managed at birthing centres. It is difficult to predict when a low risk pregnancy turns into a high-risk one, say doctors attached to hospitals.

“Chances are low but it can happen. That centre should have adequate facilities to deal with that complication,” says Dr Savitha.

Can women choose natural births in a hospital?

“Women can have birthing plans and we assess and adhere to them. Unless it’s absolutely necessary, we don’t recommend C-sections,” says Dr Savitha.

If a woman is against C-section, she can give it in writing that the hospital is not responsible if anything goes wrong, she says.

Not all private hospitals force women to have C-section deliveries, she avers.

“There are times when women request Caesarean deliveries and we turn them down, explaining the risks,” she says.

Role of midwife

A midwife is a medically-trained birth professional; someone who goes through rigorous education and apprenticeship, and can help women deliver in all kinds of settings.

Increase in Caesareans

The National Family and Health Survey has found a significant increase in Caesarean births in India: 17.2 per cent of all births in the country from January 2015 to December 2016 were Caesarean.

The WHO says 10-15 per cent is to be expected. The Indian C-section rate is higher than that in rich countries such as the Netherlands and Finland. If the trend continues, India could soon have the largest number of C-section births in the world, the report warns.

What is wrong with C-sections?

Studies, research and reports from women say the following consequences of Caesarean births are common.

- Longer recovery periods

- Increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth.

- Babies have increased chances of allergy, asthma, diabetes and obesity.

- Higher risk of post-partum depression and lower breastfeeding rate.

Higher in private sector

The number of C-sections is higher in private hospitals, and among the affluent, two studies have found. An online petition to regulate C-sections at private hospitals prompted the health ministry to order them to disclose their data on C-sections.