Why India Needs Midwives by Dr. Aparajita Gogoi, WRAI - National Coordinator

Why India Needs Midwives by Dr Aparajita Gogoi WRAI National Coordinator amp Executive Director Centre for Catalyzing ChangeldquoNow a woman has become a support system for another woman at the time of pregnancy labour and birthrdquo 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 ldquoI did not come to know about the work of a midwife until I was pregnant myselfThe sentiment Koechlin expressed had been both moving and essential ndash not only making her one of the first Indian public figures to openly talk about her experience with midwiferyled 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 Lancetrsquos 2014 Midwifery Series points out midwifery is more than just assisting childbirth it is ldquoskilled knowledgeable and compassionate care for childbearing women newborn infants and families across the continuum throughout prepregnancy pregnancy birth post partum and the early weeks of liferdquo Midwiferyled care is often communitydriven 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 overuse 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 wellbeing on their need to pay for ongoing health care costs and on the ability of their families to escape poverty ndash 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 4637 of maternal deaths and 4037 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 costeffective 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 nonjudgemental and can personalize the care to meet the womanrsquos needs to combine both clinical and interpersonal approaches And this is where midwives come inldquoMy midwife had patiently explained the childbirth process to me well in advance so on the day of the delivery I was less nervousrdquo says Susheela Devi a 32 yearold resident of Bharatpur district Rajasthan ldquoShe 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 historyrdquo Another mother who was cared by a midwife recounted ndash ldquoMy midwife was very empathetic and ensured my delivery was normal I might not have had a normal delivery elsewhererdquoThese accounts are just few among many who have benefitted from the presence of a midwife during childbirth A Cochrane Review on ldquoMidwifeled continuity models vs other models of care for childbearing womenrdquo 2016 found that midwifeled continuity of care can result in a 2437 reduction in preterm births a significant reduction in episiotomy surgical births or use of pain relief while increasing psychological support for women Midwiferyled care is womencentric care administered by women to women found to improve longterm healthrelated 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 midwiferyled 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 toThe 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 lsquomidwiferyled care unitsrsquo to integrate midwiferyled 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 Csections 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 highquality care to women and newbornsWhile 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 ldquoNo matter how much you read up prepare or ask your doctor there are challenges in childbirth that one can only know from experience and practicerdquo 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 headon At a time when COVID19 is posing a grave challenge to the health and wellbeing of mothers it is crucial that we renew and strengthen our commitment and investment to midwiferyled care