Several couples, disgruntled with the way the hospital machinery functions, are looking at other (happier) ways of bringing their babies into this world. Birthing centres that are run by midwives offer services that take care of the physical, psychological, and social well-being of the mother during her childbearing cycle, helping her with labour, delivery and post-partum support. Midwifery still remains an occupation without a professional identity in India. The only recognised body is the International Confederation of Midwives (ICM), founded in 1919. This represents a federation of midwifery associations from 75 nations of the world.
Priyanka Idicula is an internationally certified midwife at Birth Village, The Natural Birthing Centre, Kochi. She represented India at the ICM conference in Toronto in 2017 and is also the Co-Founder and Director of Birth Village. Here, she tells us a little more about the practice in India.
Why do you think India is lagging behind in midwifery?
To provide optimal maternity care and to reach our millennium development goals, we need more certified independent midwives that can care for women, and the hallmark of midwifery is one-on-one care. We need changes at the policy level, a separate body altogether for midwifery regulation. We also need to introduce a proper three-year midwifery programme; currently, midwifery is intertwined with nursing, which comprises just six months. The International Confederation of Midwives is quite clear that a midwifery programme must be of at least 18 months, with clear emphasis on didactic and clinical training. There must be a strong focus on compassionate care with the woman and her unborn as the focus. We have to be willing to let go of our hierarchical struggles within our maternity-care system for the betterment of our women and subsequently the nation.
Tell us about the Birth Village.
Birth Village, The Natural Birthing Centre, is India’s free-standing established birth centre. We offer childbirth and water birth at our facility; professional antenatal, postnatal, well woman and well baby care with a holistic approach in a warm and supportive setting. We follow the 10 steps of the Mother-Friendly Childbirth Initiative, from the Coalition for Improving Maternity Services. Our current natural birth rate in the centre is 96 %, one of the best in the country. Our centre is run by midwives and we follow the Midwives Model of Care. The transfer rate for C-section is currently below 4%, which is in line with what the WHO has standardised for any geographic region. We do transfer care to the tertiary hospital if required, and if instrumental or C-sections are needed. The postpartum care schedule includes monitoring of vitals of the mother and baby and ensures that breastfeeding is established. Clients usually leave the centre around three hours after birth, with full instructions.
What drew you to midwifery?
Midwifery chose me. The birth of my son drew me to maternity care. I realised the lack of childbirth education. It was pretty clear to me how women were unaware of what their bodies were capable of and what evidence-based care was, for which I had to travel overseas on a scholarship programme. When I came back, I was one of the first certified Lamaze educators in India. I slowly built my practice, attending births as a labour support professional, and then finally reaching midwifery.
No one wants to take a risk when it comes to their baby, especially a wait-and-watch approach in this model...
It requires a lot of commitment and prenatal education on the part of any pregnant woman and her husband to navigate through the labour of her choice. We must be able to move from the culture of fear that has very strongly taken root and progress from defensive practice to offering evidence-based options, so that choices strongly rest with the mother.
Tell us a little about the women who come to your centre.
All our clients are independent women/men who would like to birth with choice, with information and on their terms. They come from varied backgrounds, from farmers and business leaders to teachers and IT professionals.
Your comment on the role of social media?
There is a strong sense of community that one can feel amongst like-minded people. On the flip side, we are going overboard when women start posting about their labour status on FB and WhatsApp groups. Putting the unborn in the spotlight isn’t fair and it will only add more pressure and anxiety. There is also value in meeting your care provider in person and knowing what care is best for you. That cannot be determined over the web.
How to pick a midwife
You can choose to employ a midwife even if you opt for a hospital delivery. As per the international confederation of midwives, the person should have successfully completed a midwifery education programme that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education.
The midwife should be competent in health counselling, antenatal education, and have the qualification to prepare the woman and the extended family for parenthood. She should be well-versed in matters relating to women’s health, reproductive health and child care.
