OPINION: Why India Needs to Improve Its Maternity Care Model
By Reba Daniel
“Why do doctors treat pregnant women who express any of their feelings or preferences while they are giving birth as if they are patients from the psych ward?”
These words burst out of my friend Arpita’s mouth and I was completely taken aback. Because she is a quiet, pint-sized, peaceful looking, non-invasive person usually, but she was a different person as she narrated the story of her first birthing experience – she was emotional, angry, confused and vulnerable as she recounted it. She spoke of having her wishes and requests completely disregarded by the hospital and the doctor, and following that how she spiraled into postpartum depression and struggled to find her sanity, and how she worked towards becoming a normal mom to the two daughters she has now.
After this experience, Arpita did intensive research to figure out the details of what happened to her. She knows now that the act of the doctor to burst her water physically (even though the labor was progressing smoothly) was totally unnecessary, and was the starting point of her birth trauma and post-birth experience spiraling out of her control. This understanding comes as no salve on any part of her physical or emotional memories.
At the Human Rights in Childbirth Conference (HRIC) to be held in Mumbai from February 2-5, these areas and many more essential questions pertaining to our existing maternity care model are going to be explored. Are the basic rights of women acknowledged and respected while they go through this very intense experience called childbirth? Are they completely at the mercy of their healthcare providers or are they entitled to certain rights even in this space? Are all the procedures they go through really necessary? The event is being held in partnership with Birth India, a Mumbai-based organisation, which works to support women through informed conception, pregnancy, birth and breastfeeding.
There are two very important areas to be addressed in maternity care as it exists in India.
1. Are the protocols that are currently followed evidence-based?
2. Is the system based on the mother and child, or on the business of birthing?
Addressing the first issue – the question of existing maternity care and the protocols that we currently follow being evidence-based. Our medical systems are popularly acknowledged to be ruled by evidence. So when is it going to be the right time for India as a nation to bring more evidence-based practices to its women?
Here are some routine practices that are done everywhere, which are not based on evidence – meaning there is no evidence to back up “why” these are in use now: surgical birth (C-section), artificial induction of labor, artificial acceleration of labor by using Pitocin, artificial breaking of water (the action that started Arpita’s bad trip when all was going fine till then), routine IV fluids, routine of not being allowed to eat or drink, routine of not being allowed to get off the bed, forced to lie on the back during pushing/birthing, routine episiotomy, etc.
Some of these are practices may be necessary in a small number of cases where medical intervention is needed. All of these, however, are practices that are coming into the picture when the model of maternity care is within the model of ‘business’ – where there is a push to optimize time, infrastructure and professional expertise, pharmaceuticals, and also when births are used to meet targets, albeit within the time frame of convenience for the practitioner.
This is the sad truth that exists. What we need to explore is – how can this existing paradigm be changed to ensure optimal outcome for mother and child, while sustaining the system for the greater good of all? The answer could lie in a reboot – bringing an evidence-based change to the protocols and practices within maternity care – to highlight issues, follow evidence, re-train healthcare providers and help the Indian model of maternity care to evolve to a far better version than what exists now.
The areas to be discussed at HRIC India, with research data shared by international specialists, are – Organising Healthcare for Improving Quality and Respect (treat a woman who is giving birth with respect and help her to have an empowering experience); Supporting Healthy Birth (what are the evidence-based practices that give a healthy birth outcome – how can they be incorporated optimally into the system); Accountability and Change (what are the recourses and how should the legal framework be formulated to address cases that go against human rights in childbirth?), and much more.
A few years ago, I met a woman in Trivandrum who had a hysterectomy done on her when her last baby was delivered through a C-section, despite her specifically telling her OB/GYN that she did not want a hysterectomy. Her anguish and anger are beyond description here. But it brings us to the following questions. Why do we not have informed consent? Who regulates? Who decides? What is the decision based on? What recourse does a wronged woman have?
In India, as we struggle with issues of women’s respect and safety in public spaces, ensuring the safety, dignity, and basic human rights of women who are birthing is crucial in making every woman feel safe and respected during an experience where she is most vulnerable. And undoubtedly, how the mother feels, affects the baby and our future.