Childbirth: The natural order of things

“When I moved to India and was planning to start a family, I was alarmed by the high rates of Caesarean section births and interventions during delivery such as inductions and epidurals,” says Nora Kropp, a Certified Professional Midwife trained in the USA, from where she moved to India in 2005 with her Indian husband. Kropp, along with Paige Trabulsi, a trained doula (a professional birth companion; see box), started the Bangalore Birth Network, an online and offline community of women who provide childbirth support to each other through mother-to-mother meetings, pre-natal classes, lactation support and help in finding doctors who are more likely to hold out for a normal delivery.

Community effort
Soon, Kropp was also part of the Birth India community (http://www.birthindia.org), a growing group of professionals who work to promote natural childbirth and provide help and guidance to pregnant women by holding their hands through pregnancy and labour, sometimes literally. Birth India has an online directory that connects women to midwives, childbirth educators, doulas and lactation consultants in many cities.

An increasing number of women are turning to such help, frustrated by the medical fraternity’s clinical approach to childbirth and the same high intervention rates that drove women to seek out Kropp through an obscure midwifery directory, where she had posted her details on moving to Bangalore. Although Kropp has not assisted in any home-births yet — largely because she has been kept busy by her own pregnancies and two young children — she advises women from her home on the myths surrounding natural childbirth and guides them through their pregnancies, helping them trust their own bodies to do what they are naturally programmed to do. “There is a certain level of acceptance of C-sections and high interventions. People have bought into all the hype about risk without making themselves aware,” says Kropp, who is dismissive about ‘birthing suites’ in hospitals that are supposed to simulate a more natural environment during labour and delivery. “Believe me, it’s all just cosmetic. C-sec and induction (inducing labour through medication) rates in these kind of facilities are just as high,” says Kropp.

At home in the world
All this led Kropp to seek a home-birth at what was India’s only home-birth facility in Goa at that time for delivering her two daughters. The simply named ‘Birthing Center’ in Assagao, Goa, is run by professional German midwife Corinna Stahlhofen and was set up in 2002. “Midwifery is not an accepted profession in India; you just have untrained midwives in rural parts of the country whose safety and hygiene standards you cannot trust. In the West, being a midwife is an accepted career option today with increasing number of home-births,” says Stahlhofen.

“Home-birthing in the hands of a trained midwife is absolutely safe if the mother is healthy and there are no major complications,” she asserts, and testimonies written by mothers on her website bear this out, speaking as they do of a relaxing, comforting atmosphere divested of all the stress-inducing hustle-bustle of a hospital and with one’s family near at hand. For emergencies, Stahlhofen has arrangements with a hospital close by where the mother can be transferred at short notice, but she’s rarely had to use this, she claims.

Knowledge is power?
Across India, women — many of them specially trained in techniques such as Lamaze, hypnobirth, water birth and doula services — are setting up consultancies or centres to help those seeking active participation in the way they give birth. In Delhi, Divya Deswal runs Birth Bonds, which provides childbirth support. Deswal is a doula and hypnobirth practitioner who is strongly against the practice of ‘inducing’ labour as a matter of course after 40 weeks in a pregnancy. “All pregnancy manuals say 40 plus or minus two weeks. But most doctors don’t wait because they need to move on to the next patient, while ignoring natural methods of induction such as acupressure, hot showers and intercourse,” says Deswal. “As a doula, it is my job to inform parents of their rights, to tell them that it is ok to ask questions and help them reach the right decision. There is a lot of advice out there, but most of it is conflicting and confusing to parents. Sometimes you need a caring but objective professional.”

Mumbai-based Sonali Shivlani, co-founder of the Birth India community, endorses this. Shivlani carries a childbirth and lactation educator certification from Childbirth and Postpartum Professional Association (CAPPA), USA and is the executive director of CAPPA India. “I wish more women would come forward to become professionals in childbirth. The awareness that such programmes are available in the country is growing, and if there are more doulas and childbirth educators, we could get better cooperation from the medical fraternity,” says Shivlani.

The other view
Her views are echoed by Dr Leela Bhagavan, consultant, The Cradle, who specialises in high-risk pregnancies. “I would definitely say that there is a need for more trained midwives, birth educators and doulas, who can provide women with unmatched support in the labour room, where a woman in labour needs to see a familiar face,” she says.

According to Dr Bhagavan, the higher rates of intervention are a direct fallout of more complications resulting from women waiting till later in life to have babies and sedentary, unhealthy lifestyles. “Because we have better diagnostic tools, we are able to identify risk factors and once we are aware of them, we naturally try to bypass them. After all, it’s our responsibility to deliver healthy babies. Knowing the risks, we can’t very well go ahead and endanger lives, can we,” asks the doctor, providing an alternative perspective.