Posted by Purnima Sah
Trigger Warning: This story contains first-person accounts of childbirth, stillbirth, in fact death and traumatic maternal healthcare experiences, which some readers may find triggering. Reader discretion is advised
As the COVID-19 pandemic raged, expectant mothers in rural Maharashtra were hesitant to visit healthcare centers. Many risked their lives by avoiding routine prenatal health check-ups as they were fearful of contracting the virus. A ground survey report by Aroehan, a non-profit organisation that works on education, health and nutrition of tribal and rural communities of Maharashtra, from twenty such villages that come under Mokhada Taluka in Maharashtra cites 69 home births between March 2020 to June 2021. Most of these women were attended to by traditional midwives or family members who allegedly used blades or scissors to cut the umbilical cord.
“So far, there have been no reported cases of infections related to such home births, but the after-effects may appear in the coming days. We recorded four stillbirths during this pandemic. The number of home births could be much more than we have been able to record through our field visits, as many families get it done quietly, due to the fear of the virus,” said Kaustubh Gharat, Project Manager (Community Development) from Aroehan.
Distressing accounts of traumatic births
It was Sabita Deepak Pagi’s third pregnancy. 25-year-old Pagi said her village Dhamani is 45 kilometers away from Mokhada Primary Health Centre (PHC), but that did not matter because her family had already decided not to let her visit the hospital. In February 2021, in her third trimester, she developed labour pains at 4 am. Instead of rushing to the hospital, her family kept her homebound until 10 am, reassuring her that she would be fine. Her mother-in-law then helped deliver the baby, but she could not remove the placenta. Further panicking, she was also unable to cut the umbilical cord.
Wracked by severe pain and physical exhaustion for over six hours, Pagi slipped into a coma. Only then did her in-laws decide to take her to Mokhada hospital, where the staff cut the umbilical cord and referred her to the Nashik government hospital. There the placenta was finally removed. It took a month for her to recover from the trauma. “We are terrified of the virus, and we did not want to risk our daughter-in-law’s life by sending her to the hospital. Unfortunately, everything went downhill, but we are thankful that she is well and alive today,” said Pagi’s mother-in-law (name withheld upon request).
Gulab Badu Bhombay, a 22-year-old mother from Dandwal village said that it was her second pregnancy and a difficult one considering the COVID-19 lockdown. “I delivered my child in August 2020 in the worst possible situation. We were experiencing heavy rains for weeks in the hilly hamlet where we live. All means of transport were inaccessible,” recalled Bhombay, who had delivered her child at home with the help of a dai (traditional midwife).
Bhombay’s family had dialed the 108 ambulance service, but they did not turn up. After the birth, an Anganwadi worker from the rural child care centre visited the mother and child and weighed the baby. But she was hesitant to get her newborn a more thorough checkup and vaccinations. “The ANM sister comes in contact with multiple people. What if my baby catches the virus through her? I do not want to risk it. Immunity boosters and other vaccinations can wait,” she stressed.
Midwives assist births, with varying degrees of success
In Bhombay’s village, she said two dais have been helping expectant mothers deliver during the ongoing pandemic. The villagers have immense faith in them. Dai Thakubai Devram Vargharay, in her 70s, has been delivering babies long before their village even had concrete roads to walk on.
The knowledge was passed on to Vargharay from her mother as a family tradition. “I do not have a fixed fee. I accept whatever people give me; after all, only a woman can understand another woman’s pain. When a mother is in labour, all I do is place my palms on the woman’s womb; it gives me an idea of the baby’s position,” said Vargharay, who uses a new blade each time to cut the umbilical cord. “After cutting the cord, I wash the baby with hot water, wrap it in a cloth and give it to the mother. Sometimes when the baby does not cry immediately after birth, we have to rush to the hospital.” Though she does not have an exact count of the number of babies she has helped deliver, she added, “This year, in May, I helped three mothers from our village through their home births.”
One of the dais from the village had attended a home birth where the baby was in breech position. The dai continued to pull the baby’s legs but to no avail. She then had to reach inside the womb and pull the baby out, but the baby had already died from asphyxiation. The ambulance reached much later, shared the dai (name withheld upon request).
Fear keeps them away
Unprecedented apprehension because of the virus’s rapid spread might have resulted in hospital-wary behaviour among pregnant women, say experts from Lancet Global Health. A retrospective analysis of pregnant women by Lancet Global Health during the ten weeks after lockdown (March 25–June 2, 2020) compares the findings with a control period of the ten weeks before lockdown (January 15–March 24, 2020).
“The initial analysis of women admitted during the lockdown period revealed a 43·2 per cent reduction in hospitalisation compared with the control period and a 49·8 per cent reduction compared with the same calendar period from the previous year. Referred obstetric emergencies also decreased by 66·4 per cent. This result was contrary to an expected increase in referred cases because of interrupted antenatal care among patients with high-risk pregnancies and the unavailability of emergency care at healthcare facilities; since most of these facilities were either leased by the government for patients with COVID-19 or the facilities themselves refused to cater to such referred patients given the shortage of paramedical staff and intensive care unit beds,” states the report.
Denial and delusion
Dr Sanjay Lohar, Taluka Health Officer, Mokhada, presented a different version and said only five registered home births took place from March 2020 till July 2021. “The dais who helped these women deliver at home have been medically trained just like ASHA workers. We conduct dai baithak (meeting) four times a year in which we teach them safe practices. We also instruct them to inform the department about expectant mothers from their respective villages. These dais only take charge when there is no connectivity and in case of emergencies. ASHA workers and trained dais expertly handled the five home births. I am afraid I have to disagree that more home births and unsafe deliveries have happened,” said Dr Lohar to 101Reporters.
Purnima Sah is a multimedia journalist with over seven years of experience. Before becoming a full-time freelance journalist in 2020, she was with Times of India and Deccan Chronicle Holdings Ltd. She is passionate about women’s issues, human rights, gender, environment and rural India
This story was published by 101 Reporters and has been re-published here with consent
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