August 2014

Managing the Miracle of Birth, Naturally

Dr Vijaya Krishnan,

Dr Vijaya Krishnan, Certified Professional Midwife (CPM), USA, co-founder and Director of Healthy Mother Wellness & Care and Healthy Mother Sanctum, Hyderabad, Indias first Natural Birth Centre based on Scientific Midwifery Model of Care, in conversation with Shahid Akhter, ENN advocates the need and practice of natural birthing

Healthy Mother is known for Scientific Midwifery. Can you please elaborate more on this model of care?

The core tenet of Scientific Midwifery is that midwifery is woman-centered. Scientific Midwifery encompasses the full range of primary healthcare services for women from adolescence to beyond menopause, with emphasis on a womans child-bearing period. The word Midwife means With Woman. The midwifery model of care considers pregnancy and childbirth as normal life events, and encourages mothers to trust their bodies unique wisdom to go through labour and birth their babies under the personalized, continuous and unlimited care from their midwives. Midwives are experts at normal birth “ their education, clinical and hands-on training make them the best source of physical and emotional support for expecting mothers who are healthy and are at low risks “ in effect for the vast majority of women around the world.

You believe in empowering women but decision making should be in the doctors domain?

The midwifery model of care is very different from the hospital and doctor-centric medical model of care practiced in almost 99 percent of In- dian hospitals. We believe in giving the factual, unbiased and evidencebased information and knowledge to mothers, their husbands and family who are the best people to make the right decision. Todays progressive, confident, independent women are yearning for alternatives to the kind of maternity care practiced in Indian hospitals which consider them as diseased patients to be subjected to numerous, often unnecessary tests and procedures. We are bringing informed decision making back to where it should be “ in the hands of expecting mothers, their husbands and their family.

How do you handle emergency or situations where caesarean may be the only solution?

Part of the training for midwives is to recognize when there is a need for medical intervention like Induction, Assisted Birth or C-Section. We have pioneered a unique collaborative model where we follow the scientific midwifery model for most normal birth situations, but bring the emergency care expertise of the medical model in case there is a true emergency. This means having in-house Operation Theatre, SICU, NICU, emergency medical personnels and equipments available 24 hours

Modern life and lifestyle seems to prompt and promote the new caesarean as the way forward. How do you uate its impact and outcome?

Yes, we agree that some modern lifestyles introduce stress in our lives as couples juggle multiple roles and responsibilities in their daily lives. This stress and the accompanying health implications can cause problems in reproductive health too. However, we do not agree that this is the cause of increased caesarean sections in the country. There is a lack of true, evidence-based information about the physiology of pregnancy and birth among couples. This lack of information feeds on the natural apprehension among expecting parents for the health of their baby, creating a panic-like situation for them, and forces them to agree to often unnecessary procedures like C-sections at the urging of their hospitals. This is a worrisome trend, and society will be in danger of giving rise to a generation of women who dont know what it is to give birth naturally.

Caesareans come under fire for being too quick and too clinical but dont you think it is essential and life saving at times?

There is absolutely no doubt that caesarean operations can be life savers for mothers and babies. In fact, at our Natural Birth Centre, The SanctumTM, we have had to perform C-sections on a few mothers where the health of babies or mothers was looking to be compromised. However, what our midwifery model of care does is not judgemental “ mothers who have had to undergo C-sections received the same level of physical and emotional care and support as those who give birth naturally. In fact, in line with WHO recommended guidelines on breastfeeding, even while a mother is being sutured after undergoing a C-section, we put her baby on skin to skin contact with her body, and initiate breastfeeding within the first hour of birth.

Are you apprehensive about the sudden spurt of the IVF industry?

No, there is place for IVF wherever it is truly required. We are concerned at the intense marketing to snare customers by employing gimmicks. We often see full page Ads from various IVF clinics offering goodies and discounts to couples to get the treatment. Because wanting a baby is a highly emotional and aspirational feeling, many couples are taken advantage of by some unqualified people who play on their minds. We also wish that the cost comes down so that good IVF care can be more affordable to a larger cross section of people.

“We are bringing Informed Decision Making back to where it should be “ in the hands of expecting mothers, their husbands and their family”

When do you suggest one should opt for IVF treatment?

This is left to experts to answer, but in our opinion, we believe the choice for IVF should come after all other infertility treatments are exhausted.

What makes Sweden the second-best country in the world to become a mother?

As they say, In Sweden it is the mother and not medicine who reigns supreme. Most attribute this to the healthcare system where midwives are entrusted with care for the expecting mother and her baby. Midwives care for the mother and her unborn baby all throughout her pregnancy, and the doctor while being available, stays in the background, and only comes into the picture when there is a medical problem or when the mother has to or opts for epidural.

What is the success rate at Health Mother and your road ahead?

We have had high success rate of natural births at Healthy Mother. In 2013, our natural birth rates were 92 percent. We routinely help women who have had a previous C-section, try for a full trial of labour and give birth naturally. Our VBAC rates in 2013 were 86 percent. Because of the personalized, continuous and unlimited care, our midwives give to mothers during labour, we have been able to help mothers with so-called highrisk conditions such as Gestational Diabetes or Pregnancy Induced Hypertension and many others, have an empowered natural birth. 99 percent of our mothers and their husbands are young, professionals and want an alternative to the hospital and doctorcentric model in maternity and infant care. We are getting increasing word- of-mouth referrals and other customers enthusiastically refer their friends and relatives to us for their maternal and infant care. We have plans to open similar centres in other metros and later in Tier II cities as well.

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