19th December 2007
Talking about birth …
“ippuDu evvariki normal avaTamu lEdu.”
[No one has normal anymore.]
“noppulu rAkunDAnE tIsupOtunnAru.”
[they are taking them in even before contractions begin.]
“tommidi nellalu mUDu rOzulu avagAnE rammanTunnAru asupatriki”
[they are asking us to come in to the hospital by 9 months, 3 days]
Stirred by these anecdotes of rapid mass conversion from home birth to hospital birth in rural parts of Srikakulam district, I sought to talk in more detail with women about their birth experiences.
I met women in Tolapi and Appalagraharam villages, some of whom were receiving sOLLu pindi (ragi flour) in the AID India nutrition program. I said that child nutrition began before birth, even before pregnancy. A healthy woman would become a healthy mother and a healthy mother would be more likely to have a problem-free birth and be able to breastfeed easily. And so I asked them to share their usual dietary patterns, how these changed in pregancy and postpartum, and in this context asked them to share their birth experiences as well.
Those who had C sections, also known as “pedda operation [big operation]” said that they went to the hospital at the appointed time, often without any contractions at all. Generally people believed that once a Cesarean, subsequent births must be Cesarean and therefore the woman should not be kept at home waiting for contractions to begin but should just go to the hospital on the scheduled date. Other indicators for Cesarean, according to them were malpositioned baby or water breaking prior to onset of contractions. Apart from this since women were asked to come in at 9 months 3 days many went in prior to contractions anyway and for one reason or another had Cesareans. Many who went in after onset of contractions also reported that contractions slowed or stopped at the hospital and therefore they did have Cesareans.
In each village there were also home births and they described their birth experiences as well. I was mesmerised by the detail in which they could recall the progress of labor, indicating at what time contractions began, what they were doing at the time, whom they told (for some time they kept it to themselves so as not to interrupt what they were doing), right up to what time the baby was born.
One of the women who had a home birth reported that she did go into the hospital at 9 months 3 days as requested, and was asked to stay and wait for the baby to be born. However, her mother who went with her said that she was just fine and did not need to wait in the hospital and took her home. A few days later she delivered at home with only her mother to help her. Her mother was experienced in childbirth and was called by others as well. In another case the government nurse actually came home to deliver the baby for a woman.
There was also a case of a woman who delivered at home with a “mantrasani,” or traditional birth assistant, who lost the baby due to incompetent handling by the mantrasani. She reported that the mantrasani tried to pull the baby out by reaching in. The baby died. Another woman reported that because she had high BP the doctors told her that she could not deliver a breech baby and gave her injections to kill the baby. I asked why they did not do a Caserean delivery and she said that because of her high BP they could not do it. This happened in 1994. Since then she reports that she has fits and very poor memory.
After hearing all the stories I shared my birth experience as well. I also described what was happening during the “pains” which is the word used for contractions, and how this indicated that the body and baby were ready for the birth. 3 days past my due date my contractions began but occurred at 1 hour intervals. This continued for 7 days. I did not go to my midwife until the contractions came every 5 minutes. I told them that I was advised not to come in until contractions were 3-5 minutes apart, lasting 1 minute each and continuing at this rate for at least 1 hour. By waiting until this stage one could be relatively sure that the baby was ready to come and avoid unnecessary interventions. I emphasized that even if one had a Cesarean before one could possibly have a normal delivery next time. I asked them how long it took to reach the hospital and they said 30 minutes. This meant that they could definitely wait for labour to begin rather than going in advance “just to be safe.”
Some people asked how long you can wait – can you even wait till the 11th month?
Varalakshmi explained that we don’t always know the month that accurately, sometimes we may miss a period even before the pregnancy and think that we are farther along than we are. Also in case they are going by the lunar calendar, these months are 28 day months, which means that normal term is 10 full months. So entering the 11th month would be fairly common. Some people are counting in solar calendar months but then they should make sure they are not confusing the two.
We also talked about nutrition during pregnancy and postpartum. They reported that they were not getting the supplementary nutrition from the anganwadi as promised and for which their names were registered. We spoke with the anganwadi workers who reported that they were each responsible for 20-25 pregnant women but as their target was 8 women, they received supplies only for 8. Therefore they gave only to 8, sometimes by rotation so that they prengnant women would “adjust among themselves.”
Before coming to breastfeeding I also asked them about postpartum nutrition. I knew this would be an explosive topic. Postpartum dietary restrictions are quite tough on women. Many reported that they ate only one meal / day comprising dilute pappu (dal) or only charu with rice or chapati. Even those who raised a fuss (”goDava”) and ate 2 meals a day were very restricted in terms of what vegetables were allowed, and generally everyone reported feeling very weak and hungry during that time. Some took tonics from the doctor to help overcome this weakness and to produce milk. Some reported that they did not have milk and had to use cow’s milk or dabba (formula) milk. I emphasized that women should eat heartily during post partum without restricting any vegetable unless they personally had a problem with it, not because someone somewhere had a problem.
Some are even limited from eating their fill during pregnancy because they are afraid a big baby will be hard to deliver.
[I was in doubt about the whole peanut issue so I steered clear of it. Peanut was the only food I restricted during the first 2 years of breastfeeding, due to prevalence of peanut allergy in US. But the theory that allergies are likely to affect people in highly sanitary living conditions much more than those living with plenty of germs in the environment made me pause before casting aspersions on the peanut, which is a local crop, cheap and nutritious. ]
It seems that villagers think that rich people are healthier because they eat more expensive, i.e. packaged foods. So when they have a little spare money they try to buy packaged foods.
After learning more about their diets and diets of infants and children, we wanted to make a pamphlet on nutrition that would be locally relevant, written in colloquial language, focussing on the nutritional value of locally harvested food and how to incorporate more into the daily diet. We have made a rough draft and would appreicate help from anyone interested in nutrition and fluent in Telugu.