Wednesday, April 25, 2012

Home Vs Institutional Delivery


Home Vs Institutional Delivery
- Jagannath Chatterjee

In the year 2009 I was in Pastapur village in Zahirabad Mandal of Medak district of Andhra Pradesh. I had gone there to interact with a community of village women who have led many initiatives that have brought them international fame. I had finished my work (which was in fact learning from them their techniques for interacting with communities and gathering vital information about traditional knowledge on agriculture and millets cultivation) but still had three days of time in my hand.

I decided to put it to good use and got involved with a group of female health workers who told me how difficult it was for them to get women in the district to go to hospitals for childbirth. They were frustrated because their income levels were not going up due to this resistance. I then took a vehicle with a driver from an NGO and toured the neighbouring hospitals and villages, both the rural and the urban hospitals of Zahirabad and a nearby town.

In the rural health units the doctors told me that the health workers were in fact bringing pregnant women to their units. These women delivered the babies naturally and were instantly eager to get back to their homes. But they were requested to wait for at least an hour. The doctors felt that these women were better off delivering in their own homes and it was a risk to make them travel to the health units in their pregnant state. The doctors were instructing the health workers to only bring a certain risk group based on age and physical health, for example teenage girls and those who were thin in built.

In Zahirabad district headquarters and the nearby town the situation was different. A vast majority of those who were visiting the government hospitals were being advised to deliver in the private clinics being attended to by the doctors employed in these government hospitals. They were being subjected to cesarean childbirth. I do not know if these women were being given any amount, maybe the papers were being manipulated. But of course the net result had to be a monetary outflow with attendant risks and additional stay in the clinics and the consequent use of unnecessary medication and risks of hospital infection.

I will not draw any conclusions here but leave it to the readers to decide which method should be adopted.

And yes, I found that the villages had traditional dais who knew how to conduct births. They said they used massaging techniques using oil or without to induce births, knew herbs to check bleeding and after birth pains, and knew the use of new blades, hot water and clean clothes. They also advised special diets both during pregnancy and after birth i.e during the breastfeeding period (millets cultivation is very popular in these parts due to the great efforts of an NGO operating in the area). In the many villages I managed to cover, I found only eight instances in the memory of the villagers, also senior women, of any birth complications/deaths during home birthing. The senior women told me that in their times they considered birth as a part of their daily routine and were back at work usually a day after delivery.

Unfortunately these districts have a high coverage of administering the UIP vaccines. It would have been so wonderful to have natural children after natural childbirth but then we live in a highly complex world.

Educated parents in developed countries are moving towards home birthing and natural children who are not vaccinated or drugged mostly aided by yoga instructors, chiropactors, naturopaths and homeopaths and also doctors opposing vaccinations.

I had written a piece about Home Delivery Vs Institutional Delivery yesterday arguing that women are better off giving birth at home. This was after I was investigating the phenomenon in a part of Andhra Pradesh. Today I decided to look at what is happening in the USA. What I found is presented here.

The USA spends more than any other country on health care, and more on maternal health than any other type of hospital care. Despite this, women in the USA have a higher risk of dying of pregnancy-related complications than those in 49 other countries, including Kuwait, Bulgaria, and South Korea.

Maternal deaths are only the tip of the iceberg. During 2004 and 2005, more than 68,000 women nearly died in childbirth in the USA. Each year, 1.7 million women in the USA suffer a complication that has an adverse effect on their health. According to Amnesty International’s 2010 report, Deadly Delivery: The Maternal Health Care Crisis in the USA, 99 percent of births in America occur in hospitals.

Although homebirths are gradually rising, the 4 million babies born each year generate approximately $100 billion for the medical industry. Health complications during childbirth, involving mothers and their newborns, are the most common and most expensive causes of hospitalization across the board. 

An article published July 2011 in  The Seattle Times revealed that homebirths increased by 20 percent in the U.S., accounting for nearly 30,000 of 4.2 million births annually, according to a study conducted by the U.S. Center for Disease Control and Prevention (CDC).

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