3 years

Midwifery

The Foreign Hand

Page 1 of 1
As home births come into vogue, pregnant Indians get a helping hand from overseas women who know just how it is done

Nora Kropp was in graduate school when she met her Indian husband. Five years ago, they decided Bangalore had better job prospects, and they could live close to his ageing parents as a bonus. Trained as a professional midwife, Kropp, an American, did not advertise her services when she moved. She merely updated her details on the International Midwifery Directory.

She could scarcely believe the response. More and more well-to-do Indian mothers-to-be wanted to avoid the rigmarole of a hospital-and-gown delivery in favour of the romance of having a ‘natural’ baby born at home.

“Mainly people found me through that (the directory). They’d have to look pretty hard,” she says wryly. “People would approach me, ‘Can you do my delivery?’… I became overwhelmed. Even in the States, where it’s very dire, there’s always another midwife. Here I felt I was calling out in the forest and there was no one.”

Nora, however, doesn’t have a monopoly on the practice. Natural home childbirth has been a rage in the West at least since the 1960s, and India is now home to many expat professional midwives—wise women, as the French call them. Drawn to India for a variety of reasons, women from Canada, Germany, Poland, America and other unlikely countries share a firmly-held but quietly-stated belief—against the advice of most doctors—
that pregnancy and birthing are natural processes for which a woman’s body has evolved perfectly.

In 2007, Kropp helped set up Bangalore Birth Network, and the NGO Birth India were born, marking a steady increase in public knowledge on home delivery and the help at hand to see it happen. There are other such networks in India, though not as extensive as those of the midwives and doulas of North America, who have multiple pathways to choose from in taking up midwifery—there are conferences, advocacy work, accreditation committees and even lobbyists. Still, while Kropp offers her own midwifery consultation (she has both expats and Indians as clients), the Bangalore Birth Network helps women with such things as lactation and identifying doctors ‘who are much more willing to let nature take its course’.

It helps that India has always been on the world map as a centre for all things natural. “I came to India for its soul,” says Kasia Wierzbicka, a model and yoga teacher who came five years ago from Poland. All she carried was a backpack with some photos from her modelling portfolio, just in case. The pictures came in handy in Mumbai. She stayed on, attracted by her love for the country, its people and culture, and married an Indian.

Deeply influenced by Russia’s Conscious Birth movement of the 1980s that popularised water births and other natural ways for parents to explore the ‘spiritual’ aspects of childbirth, Kasia has been training to become a doula. Unlike a midwife, who is trained specifically to help deliver the baby and take functional charge in case of an obstetric emergency, a doula’s role involves acting as an emotional support and a birth companion.

Foreign midwives have been working in India for decades. In stark contrast to countries such as Sweden or Sri Lanka, where maternal mortality has decreased as their public health systems have incorporated trained midwives, midwifery is not recognised as a separate profession in India. Nurses in India get some training in delivering babies, but not the kind of specialised focus that Sweden’s two-year midwife training provides.

Statistically, most births in India (60 per cent) still take place at home, especially in rural areas, with a traditional dai in attendance. It is in the affluent urban areas where hospitals have taken over, supplanting the dai who is typically lower caste and considered ritually ‘polluted’ by the orthodox. Many urban families happily shell out the Rs 1 lakh or more it takes to give birth at a fancy hospital, under the assumption that science provides the safest space for an otherwise risky act.

As a result, many urban Indian women endure labour in which medical intervention is rife. Enemas and episiotomies are routine—even surgical incisions to expand the vaginal aperture for delivery, despite mounting evidence that the cut does not serve its claimed purpose. Medications to initiate and speed up labour, and epidural injections to contain pain, are also part of the standard operating procedure at Indian hospitals. “They give you very little time to labour your baby,” observes a midwife originally from Peru with a practice record of ten years and experience with reputed networks like Doctors Without Borders, “It’s a very Indian thing, because in Europe and other countries, women are able to procreate, feed the baby. It’s biological nature to do the job… But a lot of hospitals are not very flexible. Like, an episiotomy is a must. Then you have 15-20 minutes to push out the baby, otherwise they intervene with drugs.” Or scalpels. Estimates suggest that more than two-thirds of the deliveries at five-star hospitals in Delhi or Mumbai end up as Caesarean sections—scandalously higher than the 5-15 per cent that the World Health Organization (WHO) considers normal.

So entrenched is the idea of a hospital birth in urban India now, that, “We don’t have any Indian midwife in [Mumbai],” reckons Kasia, “In the West, we already went through this cycle 100 years ago, and then we realised something was amiss.” Back in 1861, Sweden’s maternal mortality ratio, an indication of the riskiness of pregnancy, was at 400 per 100,000 live births—only a little less than India’s 450 deaths per 100,000 live births in 2005 (the latest WTO figure available). However, by 1894, by when trained midwives were delivering 70 per cent of Swedish babies (up from 30 per cent in 1861), maternal mortality had declined to 100 deaths for every 100,000 live births. By 2005, Sweden’s ratio was down to 3 per 100,000 live births.

No wonder, then, that a Swedish midwife would react to her stint as a volunteer at a hospital in Dehradun with horror and a bugle call to her sisterhood of wise women. ‘What I am seeing here,’ she wrote to the International Alliance of Midwives, ‘is the worst thing I have ever seen. There is no respect for normal birth at all.’

Closer home, Sri Lanka has seen a twenty-fold increase in the number of trained midwives from 1941 to 2000. India, on the other hand, has no network of professional midwives, and there are signs that traditional dais are fast dwindling in number, relegated tragically to the margins of society (many live in urban slums).

This, despite the horror of India’s maternal mortality rate being seven times that of Sri Lanka, ten times that of China and four times that of Brazil. Oddly enough, Indian mothers-to-be and their families are undaunted by any of this. Perhaps they assume that so long as they can pay for the fanciest modern equipment and care that money can buy, there is little else to think about. Now, however, word of natural childbirth is getting around, and while a foreign midwife or doula is not exactly cheap—she could charge Rs 40,000 to Rs 50,000 for a package of pre- and post-natal care—the option is striking many families as one worth considering.

For the time being, the Peruvian woman is not looking at running a business; she wants to help, one woman at a time. So too, the others in the network. Progress is satisfying, if slow. “Even though I know we’re right, we’re in the strange state of being on the margins,” sighs Kropp.