Biriyani and Birthing

by Subha Srinivasan                                                        

There is a rising healthcare crisis among the women of middle class, urban India and no one is doing anything about it yet. A lot of young women in Bengaluru are giving birth by Caesarean section at premier, private hospitals and this number exceeds the WHO recommendations by around one hundred percent. Almost every other woman I spoke to in my family and social circles has had a Caesarean section. These are well-educated, upwardly mobile, mostly healthy young women who are having surgeries with alarming regularity.

While I was pregnant with my second son, talk in social circles inevitably veered toward pregnancy and birth stories. The majority of women I talked to had had “emergency” C-sections. I wasn’t sure if I was shocked by the numbers or the fact that it was so commonplace that women brushed it aside as just another thing in a day’s work.

“The baby was too big.”

“My pelvis was not roomy enough for the baby to pass through”

“Baby didn’t descend after three hours of labor.”

“Labour didn’t progress enough after eight hours. We thought it better to cut short the agony for both of us,” laughed one woman and dismissed the whole topic.

I heard other stories where women opted for a C-section because they had already had a very difficult pregnancy. Who wanted to go through the uncertainty of labour? Why bother with the pain when you might have an emergency C-section anyway for other reasons? In some cases, when the women opted for C-section, families decided to time the birth of the child on an auspicious day. Since when did major abdominal surgery become such a trivial event?

With my firstborn, in the US, I had opted for a doula and a certified nurse midwife. When I asked about a certified nurse midwife in Bengaluru, I was met with puzzled stares. Google didn’t yield much and none in my social circles had even heard of any other option other than an OB-GYN. So, for my second pregnancy, left with minimal choices, I began my quest for a doctor who had low C-section rates. It was a frustrating search not least because the OB-GYNs were not used to patients questioning them on aspects of their practice. I was mostly met with barely-repressed irritation and condescension.

“You want to know my birthing philosophy? Girl, I can lecture you for hours on birthing and fill entire tomes on the topic. I surely can’t be expected to explain it to you now,” quipped one senior doctor.

One doctor said she didn’t allow husbands in birthing rooms because “women tended to be more dramatic” with husbands around. Another told me that she didn’t tolerate screaming during labour. Another said she didn’t like her patients asking too many medical questions because they never understood the full implications anyway.

Seven doctors, three hospitals, two clinics and several appointments later, I finally found a reputed doctor with a low C-section rate. I was comfortable with her. Until I showed her my birth plan, that is. I had put together a list of birthing preferences from pain medication to labouring positions to medical interventions. Labeled a “Birth plan”, this is fairly common in western countries. The birth plan helps the pregnant woman and the doctor to agree on the set of procedures that will be followed during childbirth. From the patient’s perspective, it helps her understand what to expect from her caregivers during labour.

“First off, India doesn’t have the concept of formal birth plans. So we’ll just discuss your preferences. Yeah?” she quipped.

That was fine by me. But as we talked, it became increasingly clear that she was not going to be around for 99% of my labour. Everything would happen with assistant doctors on telephone with her. I wasn’t going to be able to talk to her personally during labour. I got the impression that I’d be lucky if she showed up when the baby arrived.

I grew increasingly nervous as the conversation went on. She wanted all the medical interventions possible during labour. I was to go through a battery of blood tests – most of which I believed were useless – every week. I was exasperated but based on my experience so far, I didn’t think other doctors would be any different. I’d tried three major hospitals, two clinics and nothing had worked out. So with a sense of helplessness, I stuck with her and went through the tests.

The last straw, ironically, came because of another set of medical tests that her assistant ordered. At 38 weeks pregnant, feeling like a beached whale, the last thing I wanted to do is sit through a few more hours of scans and blood tests. So, I did the only thing I could do: I walked out.

We’d pre-booked a birthing room at the hospital and we informed the administrator that we wished to cancel our booking. He pulled up our “booking” and looked through.

“Why are you cancelling, madam?”

“We are not happy with this hospital.”

He was visibly taken aback and started listing the numerous advantages of the hospital which included air-conditioned rooms, colour TVs and bathrooms with modern amenities. It went on for about five minutes before he took a breather.

“That might be so. But I am concerned about medical interventions and C-section rates.”

He was baffled. Clearly, not many had expressed concern about medical interventions.

I just shook my head.

“Madam, this is one of the best places to give birth in Bengaluru. We serve biriyani to the new mom! ” he protested. “We have an in-house chef who prepares the biriyani fresh and we send it over as soon as you’ve delivered. Everything is included in this deal.”

He was nodding and smiling enthusiastically now. Biriyani for surgery seemed like a good deal to him, I suppose.

“Are essential post-natal and baby supplies included in the package?”

“Like what, madam?”

“Like napkins for the mom, baby diapers for immediate use after birth, nasal aspirators?”

“No. But we have a wonderful shop in the first floor that you can buy these things from.”

He was positively beaming.

“Cool but I still want my refund. I don’t want a C-section and I don’t want A/C rooms or colour television or baby shops.”

He drew in a sharp breath.

Finally, he sighed heavily and exclaimed, almost pleadingly:

“But, madam, we have biriyani!!”

Biriyani didn’t seem worth running the risk of surgery.  So I did walk out. Don’t get me wrong, I am all for hospitals and medical care. Maternal and child mortality rates are down because of advances in medicine and access to proper medical care. Childbirth is not the same scary, life-or-death event it used to be a century ago.

But I do think it is time for Indian women to start participating more in the pregnancy care process. Blindly following doctor’s orders won’t cut it anymore because, let’s face it, doctors are affiliated to hospitals whose only goal is to make money. No one is in the hospital business for altruism. Women need to ask about medical procedures and make educated choices about whether a particular procedure is absolutely required or can be skipped.

We live in an age where institutional care has become the norm especially in cities and changing this mindset towards home births, midwives, etc. will take immense policy changes, training, education and time. But in the meantime, having an entire generation of women going through avoidable surgery is a healthcare crisis for the whole nation. Childbirth is not rocket science and we shouldn’t try to make it so.

As for me, I gave birth at a small clinic. I had an intervention-free, normal delivery. The point is: it shouldn’t be this hard for everyone to do the same.

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