Tribal women trained in safe home deliveries
In remote tribal areas where hospitals are hours away, women deliver their babies safely at home, thanks to traditional birth attendants trained in safe practices.
For the women in cities and towns childbirth means getting into a car and rushing to the hospital.
But there are many tribal areas so remote that the nearest hospital is miles and hours away, like where I work with Swasthya Swaraj, a non-profit organisation.
Though achieving 100% institutional delivery may not be practically possible, we try to ensure that every mother receives skilled care. The team strives to reduce maternal and neonatal mortality rates.
In fact the WHO’s key strategy to reduce mortality rates is to ensure that all births take place in health facilities, so that when complications arise they can be treated immediately.
The National Family Health Survey (NFHS) data shows that institutional delivery in India increased from 43% in 2004 to 83% in 2014. However the percentages remain low for rural areas in most states.
Distance, difficult terrain, unavailability of hospitals and financial constraints make it difficult for the tribal people in Kalahandi, Odisha to avail institutional delivery.
One of the strategies we follow is to leverage the experience and traditional knowledge of generations of traditional birth attendants (TBAs). Over the years, we have been able to identify TBAs in each of the villages where we work.
Role of traditional birth attendants
The TBAs are women who have been midwives for years. We train them in conducting safe and hygienic deliveries and in identifying signs that may turn risky. We collaborate with the TBAs to understand their methods and help them do what they do, a bit better.
Like Gurubari Parabhoi from Butriguda village in Thumul Rampur block of Kalahandi district – one of our rock stars who has assisted in 50+ deliveries.
She demonstrated how she assists the pregnant mother during a home delivery. As part of the preparation, she cuts her nails, washes her hands thoroughly and wears a pair of gloves as a precautionary measure.
Gurubari Parabhoi – whom we all affectionately and respectfully call Gurubari didi (older sister) – cleans the mother’s genitals with lukewarm water and sponge. Then she helps the mother push her baby out. She carefully massages the mother’s stomach and helps keep her calm.
She is proud of how calmly and carefully she pulls out the baby.
Once the baby is taken out, she wraps the baby in a clean cotton cloth and places the baby on the mother’s chest. She then proceeds to take the placenta out, which may take a few minutes to an hour.
Once the placenta is removed, Gurubari didi cuts the umbilical cord. Here, she demonstrates with ease, a complicated method called cord clamping. Then she cleans the baby’s eyes, nose and ears to ensure nothing is stuck. After carefully cleaning the baby, she wraps the baby in a clean cloth.
A follow-up care
Now that the active part of childbirth is over, Gurubari didi takes the help of a Swasthya Saathi (para-health worker) and a staff member to record the birth weight and height of the infant. She looks over the mother and child one more time to ensure she hasn’t missed any danger signs.
There have been instances when she has referred the mother and child to our clinic when any complications came up during one of her visits.
Gurubari didi tells me that her role does not end here. She visits the new mother frequently in the first few weeks to give advice on newborn care.
There have been instances when she has referred the mother and child to our clinic when any complications came up during one of her visits.
Training and integrating traditional midwives
From my conversations with TBAs in our villages, I understand that the role of TBAs like Gurubari didi should not be overlooked. They are accepted by the community, and are held with great respect and honour within their communities.
Swasthya Swaraj has worked with TBAs to make inroads into the communities and thereby, improve health and nutritional outcomes of mothers and newborn babies.
Integrating TBAs into our healthcare system and providing them the professional training and support required has been highly rewarding in the past seven years.
Perhaps a similar model can be scaled up at the national level to address the human resource gaps in the health sector and to reduce the maternal and infant mortality rates.
Training the TBAs, setting up a prompt referral system to the nearest health centre and integrating them to the formal healthcare system would be beneficial, especially in remote and inaccessible areas.
The lead image showing a young mother and her baby depicts the importance of safe deliveries (Photo courtesy Andrew Khaanh, Unsplash)
Rakshikha P is an India Fellow (2021) working at Swasthya Swaraj, closely with medical practitioners and social scientists to support the tribal health and nutrition programme.
