Original Article “Midwives back: Women opt for intimate home settings to give birth”
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.
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Dr. Evita’s response on the article “Midwives back: Women opt for intimate home settings to give birth”:
In 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.
- To make pregnancy safe
- Humanize birthing
- Train a workforce
- 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.