Waking up to the need to provide privacy and dignity to women during delivery, the Ministry of Health and Family Welfare has drafted protocols on improving the condition of labour rooms in public-funded hospitals.
In India, haemorrhage, sepsis, obstructed labour and unsafe abortions remain the biggest direct preventable medical causes for maternal deaths. But, the underlying factors, or indirect causes or ‘delays’, in accessing healthcare during pregnancy and childbirth cause many of the maternal and neonatal deaths. Most often these deaths are a result of the inability to recognise danger signs and deciding to seek appropriate medical help for an obstetric emergency, reaching an appropriate obstetric facility and receiving adequate quality of care in such a place.
While the first two delays are related directly to the access of care, including transportation, the third ‘delay’ occurs due to the lack of quality care in the health facility. It is crucial to address the third ‘delay’ first as it would be useless to facilitate access to a health facility if quality healthcare services are not available there.
“Labour rooms have never been created through a proper thought process,” Anuradha Gupta, Additional Secretary (Health and Family Welfare) told The Hindu . The third ‘delay’, she said, could be addressed only by making available basic and emergency obstetric and neonatal services of good quality. “All facilities providing maternal and neonatal health services should have a mother-and-newborn-friendly environment. Dignity and safety of patients should be ensured.”
In a toolkit prepared for programme officers, hospital administrators and stakeholders, the Ministry has drawn on various existing guidelines to provide information on how to set up state-of-the-art maternal and child health wings, including labour rooms, wards, and operation theatres, complete with standard technical protocols.
The toolkit emphasises on respecting the right of every mother and baby to stay safe, and with dignity, in the facility, designing the infrastructure for easy mobility and comfortable stay, and providing integrated maternal newborn and child health services in accordance with protocols with required competency.
“Not only are we designing labour rooms to provide privacy and dignity to women in labour but we are making place for a companion during delivery, if the woman so desires,” Himanshu Bhushan, Deputy Commissioner (Maternal Health) said, adding the emphasis was on building “woman-friendly set-up.”
Recommending that a nodal officer be designated at every institution for assuring quality service, there is also a provision for a robust grievance redress system.
The designs proposed by the Ministry for labours in hospitals with a large patient-load includes ensuring brightness, separate toilets with latches, running water and even music (wherever possible). Even the staff should be trained and posted based on their performance instead of those trained for dealing with general patients.
When the designs are put in place, more than one woman sharing a bed before or after delivery would be a thing of the past. Any hospital where the bed occupancy is more than 70 per cent, can apply for additional bed strength and approval would come on a priority basis.
The Ministry said health facilities could be classified as Basic Emergency Obstetric Care and Comprehensive Emergency Obstetric Care, based on the level of services provided. Health facilities have been classified into three categories depending on the number of deliveries. There will be an outline for planning infrastructure, equipment, drugs and supplies, record keeping, reporting and monitoring.