Dr. Evita’s response on the article “Midwives back: Women opt for intimate home settings to give birth”

Original Article “Midwives back: Women opt for intimate home settings to give birth” 

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Kolkata: When Meenakshi sensed the hormonal orchestra of labour inside her, she ambled into the kitchen, brought out her baking trays and started whipping up carrot muffins. As the surge arrived in waves she walked over to the windowsill, crouched on the bed and eventually leaned back against her midwife inside an inflatable wading pool in the living room until her baby floated out.

Read complete article at :  

http://timesofindia.indiatimes.com/city/kolkata/Midwives-back-Women-opt-for-intimate-home-settings-to-give-birth/articleshow/53250264.cms 

Dr. Evita’s response on the article “Midwives back: Women opt for intimate home settings to give birth”: 

Dr.Evita.jpgIn response to this article I agree that women should be given the opportunity to choose and have control in their birth journeys. There are several studies supporting continuity of care by midwives, which result in better outcomes for both mother and her newborn.

While home births offer women the much-wanted privacy, intimacy and comfort of personalized care, I strongly support the collaborative hospital model (especially for India) where midwives and obstetricians work together as a team – respecting each other’s roles. C Section if required can be performed without wasting time driving the laboring mother through narrow roads and horrendous traffic.

I am convinced of the vital role professional midwives play in a woman’s journey through pregnancy, labour, birthing of her baby and in the care of her newborn. It is time India promotes and supports Professional Midwifery.

All pregnant women who do not have medical/obstetric complications (otherwise termed as low risk) should be offered midwifery care. The midwife is trained for normality and works within a strict safety framework of rules. Stand alone birthing units in the UK is a good example where clear guidelines and defined protocols exist for midwifery led units. It is important that we in India focus on the quality of training to help produce a cadre of competent and confident midwives. It is equally important to define her role and responsibilities. Most importantly, is the attitude of the obstetric community – to accept, understand, respect and take delight in working with midwives as professional colleagues.

My own epiphany happened only a few years ago. Today as an enlightened obstetrician, I champion the cause of Professional Midwifery.

I am convinced that we obstetricians need to step back and stop interfering. We have medicalized and dehumanized birth. Our training focuses on making pregnancy a journey of complications and emergencies. Our own fears are often transferred to the woman. Most of us have a very poor understanding of “natural” birth and unfortunately an even poorer understanding of a woman’s needs during her labour and birth of her baby. We obstetricians need to get involved only when there is a medical or an obstetric complication, which demands our expertise.

At Fernandez Hospital we launched a two year in-house Professional Midwifery Education and Training Programme in August 2011. More than 4000 mothers have been supported through their labours and have enjoyed our professional midwives assisting them with their births. This journey has changed our own understanding of birthing issues and woman centered care. Our team of 40 ObsGyn doctors has had to unlearn a lot while simultaneously opening our minds to new thinking. It has been an enriching learning experience. PROMISE (Professional Midwifery Services) is the campaign we launched – out of conviction and belief that professional midwives are urgently needed. The campaign has four objectives.

  1. To make pregnancy safe
  2. Humanize birthing
  3. Train a workforce
  4. Promote midwifery by raising awareness among women and obstetricians

In India, where role models for professional midwifery exist, it is even more important that we encourage professional midwives (ensuring they are certified and have impeccable credentials) from countries that produce them i.e. UK, Australia, Sweden, Netherlands to register with the Indian Nursing Council. This will give them the license and medico legal protection to offer their services without fear. Besides, they could also partner with local hospitals/state Government in teaching and training a similar workforce for our country. The Indian Government and the Indian Nursing Council should open its doors to such well trained and competent professionals from other countries.

So while I STRONGLY support woman centered care, work towards reducing our interventions, help train a professional midwifery workforce, I do not (presently) support home births especially in a climate where there is no medico-legal protection for the professional midwife and with the Indian Government mandating institutional births.

I reiterate the fact that Professional Midwifery is the most urgent need of the hour. ALL laboring women MUST be offered midwifery support and care.

 

Human Rights in Childbirth – A Global Movement A word from Dr. Evita Fernandez

 

why-human-rights-in-childbirth-matter-cover-pageOver the past seven years, my views on childbirth practices have taken a 180 degree turn. Today, I am convinced we obstetricians in India need to UNLEARN a lot of what we have been taught, and we need to LISTEN more to the women we are privileged to serve.

I realized, to my horror and shame, that we have indeed been violating a woman’s human right with regard to childbirth. Every time we fail to share/offer honest evidence based information, fail to give her the freedom to make a choice, prevent her from having a birth companion, refuse to let her birth in the position she finds most comfortable, we are violating her rights.

With a birth rate of 22 million a year, India has an overwhelming volume of laboring mothers, in overcrowded, poorly staffed hospitals. With institutional deliveries being made mandatory, the majority of our women are subjected to “obstetric violence,” which translates into physical and verbal abuse by healthcare workers, who are ignorant and insensitive to woman-centered care. I admit to being that myself (ignorant and insensitive) particularly in my early years of training and as a young obstetrician. Compounding all of this is the utter lack of privacy, loss of dignity and respect. Our women, especially the voiceless poor, birth in appalling environments.

Human rights in childbirth has today become a global movement which is gaining strength, and rightly so. Women, doctors, lawyers, midwives and activists are coming together to offer solutions to help protect the basic human rights of birthing women. We in India need to wake up. All levels of health care workers involved in maternity services, need to wake up. We need to reflect, rethink, and change our attitude and understanding of childbirth practices.

Rebecca Schiller in her well researched and well written book “Why Human Rights in Childbirth Matter” says “Looking at how a society approaches childbirth, how it constructs a system around it, the rituals, the rites and the way it treats the key protagonist – the birthing woman – is akin to taking the temperature of that society. Nothing says more about the communities we live in than how they treat their most vulnerable at this extraordinary time.” – Rebecca Schiller, Why Human Rights in Childbirth Matter (Pinter & Martin Why It Matters 9)

India is hosting the International Human Rights in Childbirth Conference in February (2 – 5th) in Mumbai. I hope, it will help bring about the much needed change in attitude, practices, and more importantly, help build a network of support for women birthing in our country.

For more details about the Conference, please visit : http://www.humanrightsinchildbirth.org/event/india-2017/

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