Ankita Chakrabarty/ Zee Research Group/ Delhi
Pregnancy is considered as nothing short of divine experience and is the first step towards becoming mother in every woman’s life. But, the joy of motherhood comes along with labour pain which every pregnant woman has to undergo. It is at this difficult time, a woman requires a sister companion other than the concerned medical practitioner with whom she is comfortable and also who is an expert in child delivery, the ‘midwife’ (commonly referred in India as ‘Dai’).
However, India falls woefully short in the availability of skilled health personnel especially midwives. Only 47 percent births are attended by skilled health personnel’s according to the ‘State of the Midwifery 2011’ report. The rural populace of India makes up 70 percent of the total count. Against this, the total number of midwifery workforce in India stands at 3, 24, 624 only which is very low than the requirement needed to meet the maternity services of the rural India.
In India, 10,976 obstetric and newborn complications occur per day and the figure for rural areas stands at 7,683 respectively. The density of midwives, nurses and doctors per 1,000 populations is recorded at 1.9. This is when every year globally approximately 350,000 women die while pregnant or giving birth, up to two million newborns die within the first 24 hours of life, and there are 2.6 million still births.
What’s intriguing, while India suffers from the lack of skilled medical workforce for maternity, there has been steady rise in pregnancy delivery through the C-section in recent years. In 2010, nine percent of all births in India were by caesarian section, the figure has gone up by five per cent between 2005 and 2010 raising doubts, according to the World Health Statistics 2012.
Expressing deep concern over the issue, Dr. Manisha Gogri, medical doctor and child birth educator, says, “In urban areas most of the women are ready to go under the knife deliberately, so the figure of normal delivery is going down naturally, as a result the mid wives in urban areas are not very much in fashion.”
Mid wives in India have a lot of emotional connect especially in the rural areas. In an era when gynecologists were not much in fashion, babies were delivered with the help of midwives who were expert in conducting normal deliveries. As time flew and medical science advanced, trained and professionally qualified gynecologists started to replace mid wives and were seen conducting delivery.
Detesting the perception that midwives are now totally lost in oblivion, Dr. Sadhana Kala, consultant gynecology at Moolchand Women’s Hospital, Delhi, instead suggests that they are increasingly being integrated into the health system with modern training. “In remote areas where there are not enough doctors to carry out delivery, the midwives are still helping in the process and they are also getting educated through awareness drive to handle complicated cases,” Kala explains.
In fact, the concept of medically trained midwives is actually a western practice. Lending her support to the practice, Anika Puri, maternity head at Fortis La Femme, Delhi reiterates, “The concept of birth without a doctor is almost out of fashion nowadays. Professional midwives do not actually exist in India, it is a concept of the west and those who exist are mostly outsiders and practice in key metros.”
Apart from medically trained midwives, what’s coming into vogue nowadays are accredited and certified doulas (child birth assistant). Explaining the concept, Puri at Fortis said, “Doula services are becoming very popular these days which are helping women right from the time of conceiving till lactation.”
The Maternal Mortality Rate (MMR) of India stands at 212 per 1, 00,000 live births according to the latest Sample Registration Survey (SRS 2007-09). The target for India is to achieve the Maternal Mortality Ratio of 109 by 2015. The still birth rate of India is recorded at 22 per 1,000 births.