A Cut above Modern Medicine

A coin, a blade, and in the balance, life. How dais can teach modern medicine a thing or two
Midwifery
A good dai can tell false labour pains from the real thing. She will help pace the woman through labour and ensure delivery of the placenta (Photo: SAHANA BHATTACHARYA)

In 2002, a pregnant Rita Theobald drove out to a slum on the outskirts of Mumbai. The car stopped outside a godown under the Thane/Vashi bridge, and Rita got out to speak to a woman sorting through a pile of onions. Without the help of an address or phone number, Rita had finally tracked down Sitabai, the traditional midwife, or dai, she wanted to help deliver her first child.

Rita was 38 and tired of being told she was too old. She was healthy, of that she was sure after years of living a vegan, holistic life. She’d been to three or four gynaecologists, wasn’t convinced by any of them, and was irritated that they kept harping on about calcium supplements.

Almost with her first words, Sitabai proved to be something entirely different. “She looked at me, and said, ‘No more tests.’ She also said it’d be a son.”

Nine years later, her boy grown, Rita laments the fact that Sitabai passed away without leaving her skills to anyone. Traditionally, mothers-in-law pass on their knowledge to their daughters-in-law, taking them along to attend deliveries and take care of pregnant and labouring women. Dais’ techniques of monitoring pregnancies and assisting deliveries include the use of massage and application of oil (the latter to determine the position of the foetus). A good dai can tell false labour pains from the real thing. She will help pace the woman through labour and ensure delivery of the placenta. She can tell if the after-birth is out or still in the womb—a potentially fatal development—and even help deal with a prolapsed uterus. Skilled in traditional knowledge, a dai is typically equipped with twine to tie the umbilical cord, a razor blade to cut the cord, and a coin on which to rest the cord as she cuts it once she is sure the newborn is out of danger.

It may well be that traditional midwives fall victim to modernisation, but ask mothers who have had the benefit of their gentle, non-invasive techniques, evolved over centuries, and they are clear that the world will be a poorer place if we lose their understanding of labour and childbirth. “The tradition is not passing,” worries Rita, who had kept in touch with Sitabai until she died nearly two years ago.  “It has to be appreciated and valued.”

Given that there aren’t enough modern doctors to attend to pregnant women throughout India, the dai is indeed valuable. A home birth attended by a dai is still a rarity in the metros. In the rest of India, it is common: 61 per cent of Indian women delivered at home and 36.5 per cent were assisted by dais and other women, according to data from the National Family Health Survey-III, 2005-06. In rural India, it is commoner still: 42 per cent of women delivered at home with assistance from a dai.

The tradition is especially valuable for the insights dais have that modern medicine has yet to acknowledge. Western science is just coming round to accepting the need to delay cutting a newborn’s umbilical cord, ideally until the cord has stopped pulsing. By contrast, dais have always understood the importance of the placenta, and can work miracles with the organ that modern doctors dutifully throw out with the baby’s bathwater. Stimulation of the placenta can revive a newborn that would otherwise seem stillborn, and most dais know this. A recent study of dais’ knowledge by Jeeva, a collective of healthcare professionals in the field of women’s health, documents quite decisively how indigenous midwifery offers two or three techniques by which the placenta—necessarily still attached to the newborn—can be warmed and heated in such a way to revive an unresponsive baby.

Yet, dais are often treated dismissively by the formal medical system, and Indian society at large. Astoundingly, given the sharp divide between outcaste dais and the high-caste traditions of Ayurveda, there are remarkable correlations with dais’ knowledge. “The dai’s low-status in every sense of the word—caste, poverty, literacy, and I would even say gender—compromises her ability to contribute her information and expertise in a referral situation,” says Janet Chawla, director of Matrika, an NGO to reclaim indigenous midwifery.

The prejudice persists, though the formal medical system has often been exposed to have monetary rather than maternal interests as its motivation. There was, for instance, a rash of Caesarean deliveries recently at a Kerala taluk hospital, enabling gynaecologists to enjoy their Easter weekend at the cost of expensive and invasive operations on expecting mothers. A number of obstetrical procedures, including routine enemas, pubic shaving and routine episiotomies, that are widely practised in hospitals around the country have been listed as harmful by the World Health Organization (WHO).

“We have a very traceable genealogy of bad-mouthing dais through colonial times,” says Chawla, tracing the bias from the Lady Dufferin Fund launched in 1885 to more recent attempts to bring dais up to date by formally training them to cut the umbilical cord immediately after birth. Reliable data is hard to come by, since government statistics count ‘dais and other women’ together, but rough estimates put the number of practising dais at around half a million in India. The State-pushed trend in favour of hospitals, however, means that their numbers are dropping, warns Chawla.

Yet, for most Indians, hospitals are out of reach. But dais offer services far beyond their call of delivery duty.

Fables of Birth, a documentary by Sahana Bhattacharya, who spent seven years in a remote part of Bengal with dais, shows the challenges they take on and the weighty role they play in rural society. “The dai is not only a midwife, she is also a psychologist and psychiatrist, an entire support system,” says Bhattacharya, explaining a section of the film that shows a mother who has delivered, much to the disgust of her husband’s family, a third girl-child. The exhausted mother reels when told the gender of her newborn, and not one member of the family offers to help her or even take the baby, until Manjura the midwife imperiously summons the baby’s grandmother to take the child.

Manjura is the film’s lead character, a feisty 60-odd-year-old who yells at and cajoles the labouring woman as well as her family, who smiles and washes newborns, be they unwanted girl babies or celebrated baby boys.

Along with four other midwives, Manjura covers as many as 37 villages in an 80 km radius by foot. After walking all day to check on some 15 women in four or five villages—a different set every day—she likes to come home and get drunk on her favourite tipple, mahua. “It’s a very difficult thing, what they are doing… living with birth and death,” says Bhattacharya.

The London-based Journeyman Pictures  has made the first few minutes of the 52-minute documentary, which was awarded a Brouillon D’Un Reve by Scam, France’s Civil Society of Multimedia Authors, available on YouTube. The documentary has received a rousing reception across the world, says Bhattacharya, most recently at Cannes. “Because the struggle for human existence is there,” says the filmmaker, “the struggle for life.”