Are we ready to go back to homebirths?

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The fuel crisis prevailing for months now is taking a toll on almost all sectors in the country and the health sector, despite being most crucial, is not spared. Ceylon Today in its last Sunday edition’s (19 June) lead story reported how functions  at Maharagama Apeksha Hospital dedicated to treating cancer patients – including life deciding surgeries –  is faced with the threat of coming to a standstill with doctors, surgeons and other health staff finding it difficult to report to work as they are stuck in fuel queues.

It is in this midst, reports started circulating that midwives around the country have been advised to be prepared to carry out homebirths. Those reports suggested that these directives were issued taking transportation issues into consideration.

Was there really a directive from the authorities for midwives? What should be done when a pregnant woman in labour finds it difficult to reach hospital? Is it advisable to carry out homebirths by midwives?

Sri Lanka once regarded as one of the best healthcare services in the world is now in a crisis as the socio-economic turmoil deepens day-by-day. According to the records of World Health Organisation (WHO), Sri Lanka has high life expectancy and lower maternal and infant mortality rates than other countries in the region.

Reports show that the maternal mortality rate in Sri Lanka is 36 deaths per 100,000 live births while the infant mortality rate as 6.1 deaths per 1,000 live births. The Sri Lankan Midwifery Service is considered as one of the best healthcare services in the region.

Hospital deliveries are advisable

When Ceylon Today inquired about these issues, President of the Government Midwives’ Association, Devika Kodituwakku said that pregnant woman must always go to a hospital for the delivery process unquestionably. However, if at some point a pregnant woman cannot reach a hospital in time a well-trained midwife should intervene for the delivery, she said.

“All the women with conditions that require special attention should give birth in a hospital where there are obstetricians and gynaecologists (VOGs)”.

She said that a midwife knows how to help a pregnant woman give birth while she is being taken to hospital.

“Although there is a fuel crisis and midwives are affected by the crisis, their services are provided with no doubt. Family health care is provided to a pregnant woman at all times. In such cases it is important to identify those who need special attention and those who are in a normal condition to deliver the baby. All women are advised that their childbirth should take place in a hospital definitely,” she emphasised.

When a woman joins a family healthcare she is advised by the midwife as to how she should get ready for her pregnancy. Women are even advised as to how they should prepare for the delivery, Kodituwakku explained.

She claimed, women are given an estimated date for the delivery; they are even told to admit to a hospital before the given due date. In some cases, mothers might be hospitalised exactly on the due date. “We cannot say when childbirth will take place. Labour pains can come to any mother at any time,” she said.

When labour pains start, the midwife should be always alerted and no matter what the situation is the midwife would always get to the pregnant woman. A midwife would always assist the woman into the hospital and if in any case it is too difficult for the woman to tolerate the pain, the midwife would do the delivery. Even in the case a midwife helped with the delivery, the mother and child should be admitted to a hospital immediately, she said.

“No matter how hard life gets in this country due to many crises, midwives would always take care of the pregnant woman and newborns. The midwife is obligated to report to the service when required by a woman who has given birth or who expects to give birth. Sometimes the place of birth is not actually relevant, the midwife is bound to do what is required even it means home birth,” she further said.

Not encouraged

Meanwhile, Dr. Sankalpa Marasinghe, the Deputy Secretary of Government Medical Professionals Association said that they do not encourage home births even though the Public Health Midwives and others are trained to perform child births at home.

When Ceylon Today inquired about the child birth in the prevailing fuel crisis he said at the very first moment the women feel labour pain or any other signs of labour, they should be taken somehow to the nearest hospital rather than keeping them at homes.

“After a couple gets married, they are given necessary advice by the Public Health Midwife in their area. The midwives gather information on newly pregnant women and take action to register them early providing necessary antenatal care. The Medical Officer of Health (MOH) office monitors every expectant woman since they get pregnant and gets records through midwives. Then midwives refer those expectant mothers to a nearby hospital,” he said.

He also said that even amidst the crisis, family members of pregnant women have responsibilities to take care of them.

Addressing the question whether child deliveries can be performed at home with the help of midwives, he commented as follows:

“Pregnant women should attend medical clinics continuously. As there is a huge crisis in the country doctors and midwives cannot ask them to do this and that. Most of the midwives can perform a childbirth delivery at home but as doctors we do not encourage it. The risk level is very high. Therefore, we recommend going to a hospital as the best solution,” he commented.

He further said that a shortage of vaccines used to treat pregnant women has not been reported.

“Because of this crisis sometimes the beloveds cannot often visit pregnant women in hospitals and that can affect her emotionally. We must not forget that there is an emotional aspect of everything,” he added.

Risks

The delivery must be done in the presence of a VOG if there are complications. In case of an emergency, medical advice may not be forthcoming. Medical intervention might not be available when it comes to homebirth or any other place except a hospital.

“There are medical kits that are needed during childbirth. We used to be given those kits but now we do not receive them because there is no such need since the times have changed. A midwife should have the equipment needed for childbirth. The older group of midwives may have delivery kits although the newcomers might not have them. If the necessary equipment has been provided by now, it will be easier in the future. As this fuel problem increases, it is imperative to work until the mother and baby are born healthy and taken to a hospital. You need to be prepared in advance if you are going to have a delivery before you are taken to the hospital in case of emergencies,” Devika Kodithuwakku said.

In situations where more attention needs to be paid to the mother, childbirth is not even done in a normal hospital. The delivery is done in a hospital where there is an obstetrician and gynaecologist (VOG). A pregnant mother must go to a hospital for her delivery, she further said.

By Aloka Kasturiarachchi and Sahan Tennekoon