After having been married for eight years, I recently gave birth to a baby girl. I had a natural delivery, but it is only because my husband and I persisted against the odds to find a doctor who did not ask me to have a Caesarean section. I am not used to talking about private matters, or writing about the most private parts of my body, but for this I feel I must.
My husband and I did not try for a child in our early years of marriage. As an older couple, after more than two years of trying to get pregnant, we realised we needed medical help. These years were filled with anxiety, but with the help of medical technology I became pregnant. Days after fertilisation, I saw a dot on an ultrasound that was the potential child inside me, and that was a marvel.
After carrying our child safely in my womb for three months, my eyes stayed tracking the calendar, but I felt relieved. I thought I would spend the next six months moving step-by-step towards a natural birth, just as my mother had and her mother had, and so on. However, the closer we got to the delivery date, I became fearful that I would not have the option of having a natural birth.
The large number of C-sections conducted in India indicates that many of these procedures are unwarranted. The World Health Organisation has said that the recommended rate for C-sections is between 10% and 15% of deliveries. C-section rates in India are much higher and they are higher in the private healthcare sector compared to public health facilities. This year, a petition to regulate C-sections at private hospitals has led to the health ministry issuing an order for all private hospitals to disclose their data on C-sections and normal deliveries.
My story is not of anger against private hospitals; our daughter would not have been conceived without advanced private healthcare. But, as I went from hospital to hospital in Ahmedabad in the last days of my pregnancy, I was given the wrong impression that the only way I could deliver my child was to have a C-section.
The first private doctor we went to was a fertility expert who treated me with sensitivity. Whenever I had questions – and I had many – he would give me answers when we met, and even between visits on WhatsApp. While examining me, he would tell me in advance every time he touched and investigated my body. These were my most private parts but I felt respected, whether a probe was being inserted into my vagina or a sonography was being done. While deciding on a good date for conception, the doctor had to examine me when my period was in flow. He was professional, which meant that at a time when I am used to being most guarded, I was at ease. This was also a time when I was carefully guarding my hope.
After each visit to the doctor, I double-checked the prescribed medicines on the internet. Everything checked out and my confidence in the doctor grew.
Once the foetus reached three months we told our close friends the news. A number of friends recounted their bad experiences of having C-sections forced on them. They spoke of their difficulties making decisions when pressured with the safety of their unborn children. They gave me names of hospitals not to approach. I wrote down “delivery choice” in my list of questions for my next doctor’s appointment. The doctor told me that a natural birth was best, of course, and that he would support me in having one. He did mention that all his patients asked for C-sections to ensure their children was born on auspicious dates or to avoid long and distressful labours that can last 12 hours. A baby can be delivered in thirty minutes with the C-section procedure.
I was glad that the doctor was transparent about the common practice at his hospital, and that he was ready to give me a choice.
All seemed well until the foetus entered its ninth month. During a visit to the doctor, he told me my baby was getting overweight and that we should schedule a C-section. He wanted to perform the C-section at the earliest since he would be away for the Diwali vacation. A friend of mine had been given similar advice from a different doctor. She had gone on to deliver an underweight baby that went straight to the Intensive Care Unit.
I looked down at my round tummy and knew I was not yet looking to burst. I squirmed inside as I felt my choice for my body being taken away from me.
The hunt for a doctor
That day, my husband and I sent out SMS messages to friends, specifically asking for a doctor that insists on natural delivery. Through the responses we got, I met a very caring doctor. She completed scans and examined my pelvis. What I was not ready for was when she inserted her fingers into my vagina without warning me. My body jerked up and I bit my teeth together as she moved her fingers around. Afterwards I bled. The discomfort was on my mind long after I scrubbed the blood stains off my underwear.
This doctor told me that my baby was not yet big enough (as I had suspected), and that all health indications were good for a natural delivery. She recommended I have the delivery at another private hospital in Ahmedabad.
When we visited this hospital, my heart sank. I felt like I was in a factory and meant to efficiently deliver a product. Now, a doctor at this hospital asked us about our case and examined me with a sonography. Then she inserted her fingers into me to examine my cervix, without asking or warning me beforehand. The mix of pain and insult at not being asked before being entered burned inside me.
The doctor’s matter-of-fact manner continued. We were told multiple reasons why artificially inducing delivery would be necessary, and how a C-section would be safest. Reasons included that the baby may be ingesting its own faeces (though there was no way of telling of this was actually happening) and that the baby’s face was downward.
I did not feel good at this hospital. It stuck in my head that the doctor had asked for facts, given me only one option for childbirth, but did not ask me my name. As we walked to the car park my husband and I concluded that a natural delivery would not be possible here. We then phoned yet another private hospital and took an appointment for the same day. We travelled for the possibly the most urgent task of our lives, but at the slowest possible speed. In the ninth month of my pregnancy, each road bump would cause enough discomfort so as to crease my forehead.
On the way to the fourth hospital, I was uneasy at the thought of yet another pelvic examination that would leave me bleeding into my underwear. I knew that I should be calm, but I could not stop my tears, even as people watched me in the doctor’s waiting room. I was a few days away from giving birth but without the happiness of knowing that I would have our child in a way that I preferred.
The doctor at this hospital looked at my previous records from the other private hospitals. She conducted a light check, touching my abdomen to feel the baby’s position. I spread my knees and bit my teeth, but she told me that there was no need for a pelvic examination. Her manner was much different. She asked my name, where we both worked, and then told us a little about her own daughter. The conversation was not more than ten minutes long, but I felt a human again. She guided a mother, and did not instruct treatment for a patient. She insisted that I should only have a natural delivery. She told me that I should come to the hospital when my contractions started and that she would arrive a few hours after that to help with the delivery.
Two days after that day of searching for a hospital, my contractions began. At around 7 am my water broke and my husband began tracking, with the help of Google on his phone, how labour should progress. We reached the hospital where they quickly strapped a heart monitor to my stomach. I calmed down when I heard my baby’s heartbeat. Everything happened quickly. In less than thirty minutes our baby daughter was out of the safety of my womb.
My husband had been pacing outside the door, pleading to be allowed inside to hold my hand for the delivery. Both of us knew that if a doctor recommended a C-section, epidural anaesthesia, or other intervention to reduce risk for the baby or mother, then we would not be able to say no. Thankfully, the birth was completely natural. A sympathetic nurse let my husband come in after the delivery was complete.
We named our daughter Anaka, a Sanskrit word meaning without weakness.
The right to choose
It seems that the private maternity industry has been built around the preferences of the majority and most efficient option for hospitals. C-sections are quick and they can be scheduled. Moreover, hospitals can save resources by promoting more C-sections since they can avoid having obstetric staff on standby through all 24 hours of a day. Natural births, on the other hand, may start at any time and there is no way to estimate when it might end. Scheduling surgery allows hospitals to manage with small low-cost teams. High-cost specialists – anaesthetists and paediatricians – may be brought in for specific hours.
India needs good quality advanced maternity care where women are not scared into making medical choices that are convenient for hospitals. To get this proper care, we need to be better informed so that we can identify options and make decisions for our bodies and for the lives of our families. My story is not a call for more government regulation or to dispute medical practices. We need to start talking more to the medical experts we trust our body to and make them give us the best healthcare.
The writer is the director of Sajeevta Foundation, an NGO in Gandhinagar supporting children born in poverty to learn for success, and a delighted first-time mother.