Midwives key to cut down C-section deliveries, believe medical experts

Professional midwives can improve the quality of maternal healthcare in India, experts said at an event organised by Aastrika Foundation in the city on Saturday.

While the health system suffers from inadequate staffing, infrastructure, below-par care and a weak referral system, normal pregnancies are being over-medicalised, with the inappropriate use of episiotomies, C-sections and inductions.

NFHS-5 (National Family Health Survey) said that there are 52.5% of C-section deliveries in Karnataka's private facilities, while in states like Telangana and West Bengal the number is over 80% against the global rate of 10-15%.

Dr Janhavi Nilekani, founder-chairman, Aastrika Foundation, said the solution is to have a cadre of midwives to facilitate easy births. "Professional midwives are not the same as traditional birth attendants. They are nurses who undertake a 1.5-year postgraduate NPM (Nurse Practitioners in Midwifery) course,” she said.

Dr Pallavi Chandra, the obstetrician at Fernandez Foundation in Hyderabad, said their hospital has been able to reduce interventions after inducting midwives about a decade ago.

IAS officer Dr Jayanti S Ravi explained how Gujarat rolled out the NPM course in 2009 and scaled it. "So far, 560 midwives have graduated, and a state-level resource pool of 52 master trainers have been created. Now, 14 facilities in Gujarat have midwife-led delivery units."

Economist Dr Nachiket Mor said obstetricians' discomfort with vaginal deliveries is the primary reason for C-section deliveries.

The number of C-sections can be regulated in different ways, said Dr Mor. "More number of births can be ensured in larger facilities with more staff. Clear protocols can be laid out for C-sections, and insurance companies can decline to cover procedures that aren't done as per protocol."