Why India Needs Midwives by Dr. Aparajita Gogoi, WRAI - National Coordinator & Executive Director, C3

Dr. Aparajita Gogoi

Why India Needs Midwives by Dr. Aparajita Gogoi, WRAI - National Coordinator & Executive Director, Centre for Catalyzing Change

"Now, a woman has become a support system for another woman at the time of pregnancy, labour, and birth," actor Kalki Koechlin had written in an Instagram post in 2019, where she had thanked her midwife after the safe delivery of her newborn daughter, "I did not come to know about the work of a midwife until I was pregnant myself."

The sentiment Koechlin expressed had been both moving and essential - not only making her one of the first Indian public figures to openly talk about her experience with midwifery-led care, but shedding light on the tremendous difference a midwife can make in the life of a pregnant woman, helping her through a safer, smoother, and more respectful birth. As Lancet's 2014 Midwifery Series points out, midwifery is more than just assisting childbirth, it is "skilled, knowledgeable, and compassionate care for childbearing women, newborn infants, and families across the continuum throughout pre-pregnancy, pregnancy, birth, post- partum, and the early weeks of life". Midwifery-led care is often community-driven, intimately understanding and prioritizing the needs of women and families rather than taking an overly medicalized approach that is often common in health institutions.

. Global evidence shows that the over-use of treatments and medical procedures during pregnancy that were originally designed to manage complications, often adversely affects many healthy women and newborns. It has a lasting impact on their physical and psychosocial health and well-being, on their need to pay for ongoing health care costs, and on the ability of their families to escape poverty - which further leads to intergenerational inequalities in health. And as per the Lancet Newborn series 2014, the time around labour and childbirth accounts for almost 46% of maternal deaths and 40% of stillbirth and neonatal deaths. All of this ties back to the quality of care mothers and newborns receive during this period, and how, when it comes to maternal healthcare, it is essential to enable women to build their own strengths, capacities and knowledge around their health, so that they are able to make informed choices, are able to access services in a timely and cost-effective way, and most importantly, are able to receive the dignity and respect they deserve during the period of pregnancy and birth. We need care providers that are empathetic, non-judgemental and can personalize the care to meet the woman's needs, to combine both clinical and interpersonal approaches. And this is where midwives come in.

"My midwife had patiently explained the childbirth process to me well in advance, so on the day of the delivery, I was less nervous," says Susheela Devi', a 32 year-old resident of Bharatpur district, Rajasthan, "She was there with me throughout my labour and held my hand and gently guided me and made the experience of holding my newborn baby for the first time extremely special. She understood that I am allergic to certain medication and made sure that everything that was prescribed to me was in accordance with my medical history." Another mother who was cared by a midwife recounted - "My midwife was very empathetic and ensured my delivery was normal. I might not have had a normal delivery elsewhere".

These accounts are just few among many who have benefitted from the presence of a midwife during childbirth. A Cochrane Review on "Midwife-led continuity models vs other models of care for childbearing women" (2016) found that midwife-led continuity of care can result in a 24% reduction in pre-term births; a significant reduction in episiotomy, surgical births or use of pain relief; while increasing psychological support for women. Midwifery-led care is women-centric care, administered by women ,to women, found to improve long-term health-related outcomes among women, ranging from promoting breastfeeding to preventing cancer, cardio metabolic diseases, improving sexual and reproductive health, as well as the early childhood development of newborns. In fact, quality midwifery-led care is fundamental to achieving universal healthcare, because it paves the way for every woman from every social background receiving the respectful maternal care they have a fundamental right to.

The thrust towards scaling up and standardizing midwifery lead care in India is the aim the landmark 2018 Midwifery Initiative of Ministry of Health and Family Welfare, India. . The initiative seeks to invest in the education, training, regulation and licensure of midwives in line with international standards of competencies, to introduce dedicated ‘midwifery-led care units', to integrate midwifery-led care into the public health system, and to establish midwives as a specialized cadre. This will encourage the shifting of tasks and the care burden from doctors to midwives when it comes to normal deliveries, and reduce unnecessary medical interventions (including C-sections), leading to reduced health complications through a referral based collaborative care model. These trained midwives will be able to promote safe birthing processes, and contribute to the larger goal of improving maternal and newborn health outcomes. They can act as advocates and champions of maternal and newborn rights and priorities and deliver evidence based, high-quality care to women and new-borns.

While the process of training and integrating midwives into the public health system continues, this International Day of the Midwife, we must remember how much of an impact midwives can have on the lives of pregnant women and newborns. "No matter how much you read up, prepare or ask your doctor, there are challenges in childbirth that one can only know from experience and practice," Kalki Koechlin had written in her post, and it is often the support and constant dedication of a midwife that helps a woman meet the challenges of childbirth head-on. At a time when COVID-19 is posing a grave challenge to the health and well-being of mothers, it is crucial that we renew and strengthen our commitment and investment to midwifery-led care.