Babies are born every day but birthing is no everyday affair for a mum. In the rush to follow routine, this fact may be often overlooked.
Thankfully, the emergence of birthing centres in India could be a reason for mums to hope that their search for equality, respect and a sacred space to have a unique birth experience may be over at last…
Words Subarna Ghosh
Visual Akshay Kulkarni
What’s a birthing centre?
When mums go to the hospital to deliver a baby, they know what to expect from a medical facility. Starched uniforms, aprons, disposable gloves, a monitoring machine, the intravenous drip bottle hanger and smell of the disinfectant spirit welcomes her to labour. But the recent launch of natural birth centres aimed at reducing medical interventions and checking the C-section rates in India, has seen a slight change in this scenario. Imagine a mum-to-be and her partner walking into a homely bedroom with a sprawling double bed, bright curtains, a soothing vaporiser wafting a pleasant fragrance and soft music playing in the background. For company, they have a friendly midwife along with a doula or a Hypnobirthing expert ready to lend support so that birthing remains a gentle, natural and unique experience.
M&B expert and childbirth educator Sonali Shivlani defines a birthing centre more specifically when she says, “A birthing centre is a place where the woman births with the help of midwives. The ob/gyn is a backup option and is ideally called into the room only if the need arises. The labour team consists of trained midwives and doulas and the family as the support system.”
Kochi’s Birth Village
In the small town of Kochi, childbirth educator Priyanka Idicula’s efforts have resulted in the setting up of the second free-standing birth centre of India, the first being the Birthing Centre in Assagao, Goa, run by German midwife Corrina and her husband. Named as ‘Birth Village’, the Kochi centre is well-known for the Lamaze-classes which have been conducted here since long. But being a part of the team that made Kerala’s first water birth possible gave Priyanka the final impetus to start a full-fledged birthing centre with the help of like-minded friends. Priyanka, who is training to become a midwife, says, “Birth Village truly follows the midwifery model of care, provides women with an option to choose how she wants to birth her baby and ensures that this choice is respected. It is possible that a day or two after the water bag breaks, the woman chooses to wait for her baby to arrive naturally as she is fully aware and capable of taking decisions. In the midwifery model of care, the responsibility is shared equally by the midwife and the mum so no one can take a decision on the mother’s behalf. However, the midwife is qualified to make recommendations and guide her. Birth cannot be a planned event so we must let the woman’s body find its own rhythm.”
Priyanka believes that a birthing centre is built on the foundation of the relationship between the mum-to-be and her midwife which in turn is based on the principles of ‘equality, respect and sacred space’. But practical requirements also need to be looked into. For example, it is important that a hospital or medical centre is in the vicinity, easily reachable in about three minutes. In the Indian backdrop, it may be wise to register with a regular gynaecologist in advance, recommends Priyanka, so that in the case of an emergency, the doctor will not refuse care.
The birthing centres in Goa as well as Kochi are ideally located in beautiful, private bungalows that are surrounded by greenery. But such a space and setting often proves to be an unaffordable luxury when it comes to the big cities. Yet, the launch of Mumbai’s first birthing centre reinforces the belief that progressive change never fails to pave its way through the clutter of everyday routine. Daimaa’s Natural Birth & Wellness Centre is located in a 1,500-square-foot residential apartment in a busy suburban market area of Mumbai, a far cry from the serene setting that is ideal for housing a birthing centre. But what makes this a landmark are the founders, one of whom is a gynaecologist and obstetrician herself. Dr Veda and her husband Pravin Simons have handled resistance and ridicule, even from friends in the medical fraternity, in order to bring natural birth within the reach of the common Mumbaikar. The premises also house a medical facility, Dr Sherekar’s Hospital, that was established by Dr Veda’s mother, also a gynaecologist. Dr Veda and Pravin aimed to cut-down on travel time during emergencies when they decided to launch the birthing centre as a separate wing of the hospital. He explains, “We took utmost care so that the Operation Theatre would not be visible from the birthing rooms and tried to create a relaxing environment by doing up the interiors in a natural green colour scheme, using cheerful prints on the blinds, displaying wall art and equipping the rooms with a television, music, wardrobe and an extra pull-out bed.” Their efforts are visible, though the constraint of space is also an undeniable reality at this birthing centre that aims to resurrect the lost tradition of the Indian dai by providing necessary midwifery training to young women. Lamenting the poor quality of education and training given to nurses who specialise as midwives, this founder duo says that the natural birth movement cannot succeed until India starts producing competent midwives who will have the expertise to support a woman in labour with responsibility.
Dr Veda recalls that even before ‘Birth India’ – the network supporting natural birth in India – was formed, she found a new direction during a meeting with a Scottish midwife. “The righteousness of natural birth held great appeal and inspiration for me. I started asking questions to my own fraternity. The C-section rate of Dr Sherekar’s Hospital has always been very low. Only three to five out of 30 mums delivered through a C-section every month, so the idea of a birth centre was not really a very different reality for me,” she avers.
Services and costs
Keeping in mind the importance of environment during birthing and the need to keep all medical interventions away, she decided to redesign and renovate the premises available so that the mum could have a gentle birth experience. It has only been two months since its launch and the first mum has already delivered through Hypnobirthing. Dr Veda reveals that the dearth of qualified Indian midwives mean that skilled foreigners have to step in to fill the gap. She says, “Though I am a doctor and am always present during the natural births, I am happy to have midwives and doulas to support the mum. Since we now house a birthing centre, we plan to close other gynaecological procedures and concentrate on safe births. We also have a neonatologist on stand-by during births.” The Mumbai-based birthing centre offers midwifery services that include services of an internationally-qualified midwife including antenatal home visits every month for up to six months, fortnightly till the eighth month and every week during the ninth month. The mum is checked by a gynaecologist if any parameters that may hinder the birth are noticed. Postnatal visits are also included.
Expenses incurred to have a baby in a birthing centre will obviously vary according to the city and the package that one opts for. In Kochi, Birth Village offers the mum Lamaze classes during the antenatal period and the package of Rs 35,000 includes the birth as well as these classes. If you skip the Lamaze classes, then you have to pay Rs 7,500 less. The service of an in-house midwife and a doula is included and so are the postnatal visits, lactation counselling and stay until you feel fit to go home. The set-up for a comfortable water birth is also available but Priyanka prefers not to design specific ‘packages’ for birthing as she feels that every woman has a unique experience and this cannot be slotted. In case, you want to birth at home, Priyanka is also willing to provide all facilities in the comfort of your own home. More aware of the importance of marketing, the Mumbai-based Daimaa’s presents an exhaustive list of services that include natural birthing, water birthing, hynobirthing, orgasmic birthing, Lamaze classes, yoga classes, nutritional guidance and mother and baby merchandise. It even has an ISO certification. Pravin, the CEO and MD informs that the package offered here costs Rs 65,000 and includes antenatal and postnatal care, lactation counselling, services of a paediatrician and nutritionist during stay, initial vaccination of the child and three to five days stay, including home-cooked food. In the case of an emergency where medical intervention is unavoidable, there will be OT charges and surgeon charges extra.
The whole spectrum
The principle of demand and supply works in the sphere of birth as well, we discovered. The awareness about the adverse effects of medicines used during hospital procedures like epidural or induction has created the demand for a more natural approach to birthing. Also the freedom to exercise one’s choice – the choice to wait, the choice of birthing position, the choice to eat or drink during labour, the choice of people as labour support – is denied to women in most traditional hospital set-ups. But mums want their choice to be respected and are willing to challenge the existence of institutions where there is no equality between the service providers like midwives or doctors and the receivers or mums-to-be.
Realising this change in the attitude of young parents-to-be, industry biggies like Apollo and Fortis have plunged into a new exercise in brand-building. They are offering expensive, five-star maternity centres called ‘birthing boutiques’. Dr Shaveta Sethi, Medical Superintendent at The Cradle, Gurgaon, says that they provide “a homelike facility, existing within a healthcare system with a programme of care designed in the wellness model of pregnancy and birth”. The Fortis Le Femme in Delhi is equipped with a luxury spa, a Swiss chocolate shop as well as diaper stations! They claim to be “driven by a core belief that a woman is a very special person, in body and mind, and that the best healthcare for her emerges from a deep understanding of her physiology, emotions, aspirations and anxieties”. While the concept of pampering mums sound great, none of them clearly reveal their C-section rates or talk about reducing medical intervention or promoting natural birthing.
The picture at the other end of the spectrum looks too bleak. Dr Veda reveals, “In municipal hospitals where we have trained as doctors, we saw how horribly women are treated during labour. They are verbally abused if they express discomfort and sometimes even physically forced to follow instructions given by the attending nurses. Nothing is a matter of choice for these mums.” Though upscale facilities are more pampering, the relationship between a doctor and ‘patient’ or mum-to-be still remains one where the doctor is in authority. In a birthing centre set-up, the idea is to empower the woman in labour.
Anita Shetty, the first mum who delivered her baby at the Daimaa’s Natural Birth Centre through hypnobirthing, says that it was a very satisfying experience. She believed in birthing naturally and changed her doctor in the ninth month in order to be able to deliver in the newly-launched birthing centre. Priyanka Idicula says, “We may feel that natural birth is only for urban, upper class women. But this is a myth. The first mum who opted for my birthing centre was not a city girl. She had grown up in the hinterland. She is hardly fashionable and only wears a traditional Kerala saree but her roots are very strong. She believes in the natural way of living and could easily relate to what we are trying to achieve here.”
If the numbers of birthing centres grow, mums will finally be able to move beyond choosing between a restrictive hospital birth and a relatively unprepared home birth. Speaking of trends, Sonali reveals, “At present, none of my clients have opted for a home birth. In fact, very few have even opted for a doula, in spite of the fact that we actively provide the information about these optional supports available to mums.” She believes that birthing centres are definitely a viable option and some of the maternity nursing homes could function as birthing centres. But unfortunately, bringing the midwifery model of care back in a major hospital (as they have in the UK) seems like a distant future. Sonali hopes, “There is a good working relationship between the doctor, midwife and the doula with lines of communication running parallel. The ultimate objective of each of these services is to provide good service to the parents and ensuring the well-being of mother and baby. There is no place for ego in this equation, so they need to share parallel status.” M&B