Tamil Nadu | Home births gaining ground despite govt's warning on perils

This despite the statistics being rather damning. Vaginal ('normal') deliveries, when done at home without institutional assistance, is proving to be a major contributor towards maternal and infant deaths.

What the numbers say

Public health activists and experts note that the maternal mortality rate in Tamil Nadu, which was 319 deaths per one lakh live births in the early 1980s, has decreased to 39 deaths per one lakh live births in 2024, largely due to institutional deliveries.

On the other hand, Tamil Nadu Health Department officials have recorded 25 maternal deaths over the past five years in connection with home birth incidents.

This has led the state government to call for a high-level meeting for steps to tackle maternal and infant deaths during home births.

Also read: Why women in Kerala are risking their lives with dangerous home births

Some women feel 'safe' at home

Women advocating home births say they prefer the comfort of their house over a hospital due to several reasons.

Many mothers, who recently attended a meeting in Chennai along with their children, all born at home, said that they chose home births to avoid 'unwanted' caesarean sections, vaccinations, and the 'mental stress' of a hospital environment.

The proponents of home birth have been organising campaigns and holding meetings with expectant mothers across the state to grow their community.

Aruliya Arul, a 41-year-old math graduate from Udumalpet village, 500 km from Chennai, delivered her first child in a hospital, but chose home birth for her second and third children. Reflecting on her experience, Aruliya told The Federal that the hospital environment was unpleasant, whereas home birth gave her the confidence to go for a third child.

A ‘traumatic experience’

Aruliya said the hospital’s atmosphere and the “rude” behaviour of the staff during her first delivery left her traumatised enough to opt out during her second delivery.

“Although I delivered my first child 'normally', the experience was very fearful. I couldn't accept strangers shouting at me and treating me like a patient when I was going through my first delivery. Instead of healing me, they scared me.

"When I delivered my second child at home, my husband and the women in my family were with me, and I felt much supported," she said.

Also read: In tribal Gujarat, childbirth journey in cloth stretchers is often a woman’s last

Aruliya further said that even though she underwent labour for two hours, it was pleasant and less painful. The home delivery also helped her greet her third child without stress or fear and in a happy environment.

‘Doctors tear the vagina'

When asked about emergency needs during delivery and sterilisation of the home environment, which only a hospital can provide, Aruliya said the house can be sterilised on par with hospitals.

“We keep our home clean and suitable for the child. A new mother won't face an emergency or risky situation when she is in a supportive environment," she said.

She also alleged that the blood loss during delivery – which leads to the death of many mothers – occurs because doctors try to tear the vagina instead of waiting for the child to come out naturally.

“I delivered my second child after two hours of labour pain, and the placenta came out two hours later. If this had been in a hospital, they would have pressured me, injected me with medicines, and not waited for two hours for the placenta to come out," she said.

Doctors disagree

However, several medical practitioners strongly caution that Aruliya’s experience should not be generalised for hundreds of mothers who need emergency care.

Gynaecologist and obstetrician Dr Shanthi Ravindranath told The Federal that many who opt for home births are confused about the role of midwives versus untrained birth assistants and fail to prevent mortalities despite having access to proper medical facilities nearby.

Also read: How lockdown spun medical nightmares for expectant mothers

“We are seeing some young couples preferring home births over hospital deliveries. They claim they follow traditional home birth methods used by their parents and ancestors," she said.

"But they are unaware that even three decades ago, when home births were more common, deliveries were handled by traditional dhais (experienced birth assistants), not by mothers, mothers-in-law, or relatives. These dhais are no longer available because home births had almost disappeared in Tamil Nadu. Reviving home births is worrisome and unnecessary," she added.

‘Couples should not fight science’

When asked about concerns raised by mothers about the alleged trend of hospitals of forcing them to go for caesarean sections, and the stress of a hospital atmosphere during childbirth, Ravindranath said these should not be reasons for couples to completely dismiss the efficacy of institutional help.

“Both private and government hospitals allow a family member to be with the mother during delivery. Instead of fighting for their rights and addressing their fears, these couples are fighting against science.

"Hospitals provide emergency care and have the facilities to protect the lives of both the mother and the child. Several maternal and infant mortality cases that were once common have become rare, thanks to institutional deliveries," she observed.

Also read: Why pregnant tribal women of Gujarat are dying on way to hospitals

She noted that hundreds of infants born with low birth weight, such as 500 or 600 grams, are able to survive only because of institutional support.

Gaining traction?

R Sudhakar, who runs an NGO called ‘Nalam’ and campaigns for home births, has been facing legal challenges for his promotional activities.

Sudhakar, in collaboration with other advocates of home births, organises an annual conference where women who opted for home births are recognised for their choice. Aruliya was one of the new mothers to join Sudhakar’s Nalam.

Sudhakar believes home births are a part of women's rights and points out that fatal complications also occur during hospital deliveries.

“Our mothers delivered at home and enjoyed their motherhood. Institutional deliveries are often portrayed as safe, but many unwanted surgeries take place in these settings. We also know of cases where both mother and infant were forced to get vaccinated. Home birth is natural, and it was the original science. While home births are celebrated in Western countries, why should we distance ourselves from our traditional method?" he asked.

Big no to YouTube videos

He further claimed that pregnancy is now viewed as a disease due to the advent of technology, and women's knowledge of pregnancy and delivery is lost because of institutional deliveries.

When asked about the reduction of maternal deaths in the state due to institutional deliveries, Sudhakar countered it by pointing to a rise in C-sections.

Also read: Lower grey matter, increased white matter: What pregnancy does to the maternal brain

Dr Ravindranath, however, stressed that Sudhakar and other home birth advocates should be educated about the risks of morbidity, infections, and why tools like forceps are used during deliveries.

"We should not take home births for granted based on knowledge gained from YouTube videos. There have been many deaths — both maternal and infant — among families that opted for home births without proper knowledge. Factors such as lifestyle, food habits, the nature of the body, labour duration, and the baby's position and many others factors decide whether a woman will have a normal or C-section delivery," she argued.

Fatal complications

State Health Secretary Supriya Sahu listed several recent examples of fatal complications during home births to bring home the point on their risky nature. Twenty-five maternal deaths have been recorded in the past five years, all associated with home births, she said.

Also read: How Karnataka govt has woken up to address female foeticide issue

“Every year, Tamil Nadu records 8 to 9 lakh deliveries. The majority of mothers choose government hospitals with greater confidence because these facilities have emergency support systems and trained medical officers to handle any situation.

"While there are a few cases of home births, maternal and infant mortalities in such cases are something we want to prevent. Block medical officers file negligence cases against those involved," she told The Federal.

Shift towards institutional deliveries

When asked about the safety of home-based childbirth in countries like India compared to developed countries, Sahu said that even in the UK, where home births are carried out by trained midwives, there is a shift toward institutional deliveries due to their convenience and the availability of expert care during emergencies.

"The UK has long practiced home deliveries by trained midwives. These midwives provide antenatal care, assist during delivery, and offer post-delivery follow-up. However, even in the UK, there is a shift toward institutional deliveries because of the convenience and availability of expert care in emergencies," she said.

Why home births are riskier

Speaking about the complications associated with home births, Sahu said: “Prolonged labour can lead to obstructed labour, which, if not addressed promptly, can result in a ruptured uterus and even mortality.”

“Similarly, sepsis during delivery is more likely in home births, as neither the room nor the instruments used are properly sterilised. This can lead to puerperal sepsis, which, if untreated, can cause lifelong complications and even death. Post-delivery bleeding is another major cause of maternal death. An unqualified person may not be able to identify excessive bleeding and could mistakenly consider it as normal post-delivery blood loss," she added.