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Model for Safer Motherhood
by Tripat Kaur Bookmark and Share

India has a long and rich tradition of childbearing methods and practices. Ideally, the medical fraternity should make an effort to integrate these with the modern methods. Matrika, an NGO, aims to document the different methods used by dais or Indian midwives across the country. Matrika, an acronym for Motherhood and Traditional, Resources, Information, Knowledge and Action, is a unique project to explore the indigenous knowledge of dais. Matrika also means model in Hindi language.

Janet Chawla, founder of Matrika and a strong proponent of natural childbirth, says that Indian midwives are more equipped to understand the needs of a woman rather than the doctors. Chawla recently released a book, `Birth and Birthgivers: The Power Behind the Shame'. The book seeks to explore women's voices, agency and aesthetics in the traditional handling of childbearing.

"It (childbirth) is a natural process and it should be without the excessive use of technology. I have three children and out of them one daughter was born with
the help of midwives in San Francisco (US) and it was this experience which totally changed me. Most of the times, stitches are not required. Also, doctors make you believe that a pregnant woman should lie on her back while delivery, however, traditionally, the squatting position is advised, which my experience
tells me is better," says Chawla.

She has held exercise classes for pregnant women in San Francisco. After coming to India 25 years ago, she started teaching childbirth exercise classes to
pregnant women. "Gradually some doctors contacted me to hold childbirth exercise classes in their clinics."

"I think a pregnant woman should be aware of all the choices and insist on childbirth without any medication. Most of the time, they are not aware that they have the right to ask and insist on their choice. For instance, there was this extremely orthodox Roman Catholic woman who didn't want to use any medicines or surgery during delivery for religious reasons. The doctors finally helped her deliver the baby according to her wishes. So, it's very much possible to deliver babies naturally even in a modern hospital," says Nutan Pandit, who was one of the first to start childbirth exercise programs in Delhi.

Chawla believes that the dais are a reservoir of wisdom and knowledge. The importance of dais can be ascertained by the fact that two-thirds of births in India still occur at home and approximately a million Indian women work as
midwives. According to a study by the UN, skilled personnel attend only 42 per cent of deliveries in India. Only 34 per cent of deliveries take place in health

Around 1,30,000 women die due to pregnancy-related causes every year in India and the maternal mortality rate is higher in rural areas, 619 as compared to urban, which stands at 540.

Also, at a time when caesarean deliveries are increasing at an alarming rate in India, it is time an effort is made to integrate the natural birth techniques with the modern childbirth procedures for a safer motherhood. "We are in fact, loosing a whole tradition. The skill, knowledge and techniques used by dais should be utilized by the doctors," believes Chawla.

Matrika conducted a three-year research project on the knowledge, skills and practice of midwives. The research was carried out in Rajasthan, Punjab, South Bihar and the resettlement colonies of Delhi. The study was conducted in association with the NGOs, Ankur and Action India on `women's experience in childbearing'.

"The research was difficult since childbirth is spoken about in secretive tone. Initially, dais were very reluctant to talk about their work since they thought
we would train them in modern childbirth methods or try to change them," says Chawla. "Also, there is hardly any data available on them. Dai is also a very
loosely defined word: a woman who has helped in the birth of five children is also a dai and a woman who has helped in 1000 births is also a dai."

What is of special significance to Chawla is that dais don't separate rituals associated with the actual process of childbirth. It is more than a means of livelihood for them. For instance, a dai from the rural Punjab said, `Rab (God) is the doer, the hands are mine'. Being a woman and usually coming from the same culture milieu as the prospective mother, dais are better equipped to
understand the mother. They also have a collective way of doing things, which gives more power to the woman as a decision-maker.

Dais across the country employ different methods and Matrika has endeavored to record the techniques used by the dais. Many a times, the methods used by dais are linked to the climate of that place. For instance, in the desert state of western Rajasthan, they attend to births with the mother lying on a bed of warm sand, which foments her body and absorbs blood and other waste. The sand can then be disposed off safely.

Post the research project, Matrika plans to continue to disseminate its findings within India, work as advocates for indigenous midwives and network with
others promoting safe motherhood programs which are more grounded in local realities.

There is also a lot of bias against the dais. "They are believed to be unhygienic and responsible for the high child mortality rates. Some of their procedures might be unhygienic but some of the traditional ways of handling birth can make motherhood safer. Also, many a times, I feel that dais become scapegoats for deaths which might have happened anyway, especially due to the poor health status of most women in rural India," says Chawla.   

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