Providing for the Need: Childbirth Education for Mothers in India
Living in India is quite possibly as different from living in America as you can get. There are extreme differences in dress, food, language, customs and religion. But there are certain human experiences that rise above all of the differences--for me, it is the experience of being a mother. Over the past several weeks, I have interviewed women, young and old, about their lives as mothers in the urban slums of Delhi, overcrowded migrant communities, and the concrete flats that lie beneath Gurgaon’s modern skyline. As often as opportunity allowed, I asked them if I could hear about their childbirth experiences. All agreed, though some were more reluctant than others.
Most of the women share their experiences with downcast eyes, heads lowered and voices just above a whisper. I originally attributed their timidity to the fact that my questions were on a topic few had shared with a foreigner. I discovered, though, that their reserved demeanor was not simply because they were talking about an intimate subject with a woman they did not know, but that the majority of these women had never shared their birth experiences with anyone, ever. A question that I had not planned to ask has now become a routine inquiry during my interviews is: “Have you ever told anyone the story of your birth(s)?” Without hesitation, nearly every woman answers “Nahi” (No). I was simultaneously astonished and privileged to be present while these women offered the details and emotions associated with their pregnancies and births for the first time.
If interviewed one-on-one, the women were prone to answer only what was asked. However, each time I interviewed more than one at a time, the atmosphere changed. Women laughed, asked questions, expressed shock (“Husbands in America are present at the birth!”) and exchanged knowing glances and comments with one another. Older women were often more open with their stories than those who were younger. Age, it seems, released them from social inhibitions that allowed them to share without reservation. The presence of a man, even outside of earshot, stopped conversation altogether. Veils that had been lifted were again lowered to cover their faces in accordance with a tradition of respect.
Each woman I spoke to offered a different perspective and each story had unique elements. There was, however, one constant theme. It did not matter the age of the interview participant. Delivery by village dai (midwife) or hospital was not a factor. Nor did rural or urban setting or natural or surgical delivery make a difference. Consistently, women acknowledged that they had no education about pregnancy or childbirth prior to delivering. Village dais, I was told, do not offer prenatal care, they only come when the laboring mother is nearing delivery. Women who choose to go to the hospital also said they lacked any prenatal care or education going into childbirth. This sad reality was testified to by a young mother of two who said she had no idea how her first baby would even come out of her body. “Women in India don’t know what is going to happen to them until after it happens,” she stated. All the women in the room nodded their heads in agreement.
Childbirth education takes many forms. By conservative estimate, there are hundreds of books that chronicle every possible sign, symptom or benchmark of pregnancy. Pregnancy-related websites address everything from digital renderings of the growing baby to pain relief techniques in labor. Women in the West are educated in the pros and cons of water births, VBACs, induction, and epidurals. They are privy to every possible media medium associated with childbirth. This is not the case for the women of India’s poor population. There is no access to relevant information, no trained childbirth educators, no available resources for the women I interviewed.
Our organization's maternal health workers are taking the information I am gleaning from these interviews and preparing a culturally-relevant curriculum, informed by the experiences and concerns of these women. In the U.S., teaching on prenatal nutrition is an easy topic to cover. In India we must consider if her family has access to a diverse diet, or how she could possibly get it. In the U.S., we are certain that a doctor or midwife has an environment fit to accommodate a mother immediately following birth--we don’t need to prepare for it. In India the likelihood of suffering from infection or hemorrhage, due to environment, immediately following birth is just as certain.
Imagine the difference when a woman is informed and educated on her body’s innate ability to give birth, feed her babies, and raise them well. A woman is empowered to have a healthy mindset about birth and mothering so she can enter into the newness of such a season with more faith and less fear. When we educate families, we are gifting them with sight to healthfully face birth. In doing this we assist them in their invaluable transformation into parents.
With the availability of childbirth education, the day of “Women in India don’t know what is going to happen to them until after it happens” is ending.