The death of a 36-year-old woman and her unborn child at Karakkamandapam in Thiruvananthapuram, following attempted child birth at home, has suddenly focussed all attention on the small proportion of home births happening across Kerala, which mar the impeccable record that the State has maintained in maternal and child health.
The State takes much pride in having achieved near 100% institutional deliveries. The proportion of institutional deliveries in the State has been consistently above 99.5% since 2005. During the National Family Health Survey-4 (NFHS, 2015-16) and NFHS-5 (2019-20), it was 99.8 %.
Kerala’s low maternal mortality ratio (19 as per the last SRS data, but the Health department reckons that it is 26, per one lakh live births) was achieved through consistent efforts at developing safe delivery care services and implementing quality improvement standards in obstetric practices across the State, to identify and address all probable causes of maternal mortality.
Yet, a minuscule percentage of deliveries — approximately less than 1,000 every year — continue to stay under the radar of the State’s health system and occur outside health-care institutions.
Some are cases of “precipitous labour” (labour which is quick and short, following rapid cervical dilation and descent of the foetus to the birth canal), which may result in sudden or unavoidable home births. Child births which happen enroute hospitals are also recorded as home births by the health system. In some tribal belts, home births are considered a tradition
A new fad
But religious considerations, people’s mistrust of all medical interventions and, of late, some new fads such as “birth villages” which glorify the “all natural, holistic childbirth experience”, often promoted by social media influencers, have been persuading more people to experiment with home births. “It is a concern for us that this segment has been growing and surprisingly, some sections of the well-heeled are willing to fall for this. There are previous instances in Ernakulam district itself, of such “beautiful child birth experiences’‘ going wrong and mothers having to be pulled back from the brink of death,” says V.P. Paily, a senior obstetrics and gynaecology consultant who has led the State’s efforts to reduce maternal mortality.
“There are way too many unpredictables in obstetrics and even a very “normal” pregnancy can throw up unexpected and life-threatening complications during delivery. Uncontrolled post-partum haemorrhage and sudden cardiac arrest are problems that can turn a so-called “normal” pregnancy into a nightmare. In the U.K., home births are popular but these are handled by trained midwives who can immediately identify obstetric emergencies and arrange the woman to be transferred to a hospital. The National Health Service also has a well organised system for handling such emergencies,” points out Smithy Sanel George, a Kochi-based senior obstetrics and gynaecology consultant.
It is also important that obstetric emergencies are handled at the right time, by an experienced team of doctors so that mothers do not end up with serious long-term morbidities that may affect their health and quality of life, she points out.
It is not necessary that all deliveries are conducted in a tertiary care centre but safe motherhood is not something to be taken for granted too. Given the steeply falling birth rate in Kerala, every pregnancy should be considered precious and all efforts should be taken to ensure the safety of the mother and child, Health officials said.
