Labour rooms in govt hospitals set for a fancy makeover
Health experts, while welcoming the initiative to introduce midwife-led units to manage patients in crowded gynaecology and obstetrics departments, still have their doubts about adding the extra frills.
With birthing balls, suspension straps, grass mats and other tools and props that help manage labour pain, the Union health ministry is seeking to revamp delivery rooms in government hospitals to make natural childbirth a stress-free and calm experience for women.
Earlier this month, the health ministry began an 18-month course to train nurses in midwifery to run midwife-led units that the ministry plans to attach to the gynaecology and obstetrics departments in medical colleges and district hospitals with high case load, to improve the experience of care for women having non-surgical deliveries.
The initiative is a part of the ministry’s Respectful Maternity Care (RMC) programme that aims to provide a better environment for women coming to deliver babies in government hospitals.
Health experts, while welcoming the initiative to introduce midwife-led units to manage patients in crowded gynaecology and obstetrics departments, still have their doubts about adding the extra frills, given the state of most government hospitals that lack even basic amenities such as clean water and sanitation facilities.
“We should be rational in our approach; these things are good but secondary, as the focus should be on providing a sterilised environment, and all the necessary instruments first,” says Dr Alka Kriplani, former head of the gynaecology and obstetrics department at the All India Institute of Medical Sciences (AIIMS) in New Delhi.
Dr Dileep Mavlankar, director of Indian Institute of Public Health in Gandhinagar, says, “This is required; women need nice places to deliver, privacy, someone to talk to but it shouldn’t distract from making basics available in the labour rooms. As you have the basics of safety-related things in place, then you should improve on other things.”
Health ministry officials say it is an effort towards improving facilities for child delivery and also the care offered to women in government hospitals.
“There are issues, and that’s exactly what the government is trying to address. These labour rooms will be a part of midwife-led units that are being set up in government hospitals to deal with all low-risk patients. Dividing the load will help manage the services better, and there will be a dedicated staff to run these units who’d be responsible for their upkeep,” said a senior health ministry official, requesting anonymity.
According to health ministry estimates, about 80% of childbirths in India, are non-surgical.
“The idea is to provide empathetic care; as in most government hospitals where case load is high, the gynaecologist may not be able to provide one-on-one care. It can get chaotic so this cadre of midwives that’s being generated through special training will help make the environment pleasant for women with low-risk pregnancies,” said Vandana Gurnani, additional secretary at the health ministry.
“This is a large number and the aim is to humanise the entire experience for these women. It will also promote practices that are beneficial for the mother and her newborn such as encouraging breast-feeding immediately after birth, etc,” she added.
Midwife-led labour units are the norm in western countries, especially in the United Kingdom, where such units are operated as stand-alone facilities.
The first batch of six nurses is undergoing training in Telangana’s Fernandez Hospital, in a programme that began on November 6. International experts are being enlisted to train this initial batch of candidates as also trainers, to enable them to, in turn, coach their peers.
Five other institutions have been identified in Maharashtra, Andhra Pradesh, Karnataka, Uttar Pradesh and Odisha where a batch of 30 nurses each will be trained later. The budget for the programme is being allocated from the National Health Mission (NHM),and ~22 crore has already been assigned.
“It will be done in a phased manner to see how well the project works and money from the programme will be taken from our NHM budget as per the need,” the official added.
Experts say it may work well, provided people handling these units are well-trained.
“Any idea is worth giving a try. There’s no harm if the patient load is segregated, it may ease pressure and there’ll be better monitoring of high-risk cases. With the high load of low-risk patients that we get, the attention that high-risk patients need sometimes gets divided in the department,” says Dr Puneeta Mahajan, senior gynaecologist at the Delhi government-run Dr Baba Sahib Ambedkar Medical College and Hospital.
“One must, however, keep in mind that a low-risk patient at any stage can turn high-risk, so the person managing the case must be well-trained to identify signs early. Also, it can’t be a stand-alone facility as patient transfer has to be immediate,” she adds.
Health ministry shows India has a birth cohort of 27 million, out of which 52% deliveries take place in government hospitals. Medical colleges in states handle about 30% of the delivery load.
“This is a biopsychosocial model that looks at the interconnection between biology, psychology, and socio-environmental factors in service delivery. We are at a stage when feedback from patients is given significant weightage to improve facilities in a hospital. It matters how their experience was while visiting a health facility; so it’s not just about care but also about the experience of care that we want to improve,” said a health ministry official, who didn’t wish to be identified.
During their antenatal check-ups, these women will be taught breathing exercises and various birthing positions to help make childbirth a relatively easy experience.
“If the atmosphere is stress-free for women, then the delivery is also likely to be drug-free as in stressful situations the body doesn’t adequately release oxytocin (a hormone necessary for contraction of the womb during childbirth). In whatever way our system permits, the labour room facilities will be upgraded,” the official said.
Even though there are also stand-alone midwife-led units operating in the west, the health ministry intends to establish these within a hospital, preferably next to the obstetric units, so that any emergencies are quickly dealt with without time being wasted in transportation.
“Labour room revamp and introducing midwife-led units is a good plan that the ministry has been toying with for some time now, and is finally materialising. It may take time but is doable. There surely are infrastructural and other issues in government hospitals but there’s no harm in at least making an attempt to improve quality of care,” says Sohini Paul, senior programme officer at the Population Council, specialising in maternal, newborn and child health.
A special focus will be on introducing these units in empowered action group states with bad maternal and infant mortality rate indicators such as Bihar, Uttar Pradesh, Jharkhand, Chhattisgarh and Assam.
“It is a start; and will be scaled up depending on the feedback,” said the first official cited above.