Imagine, if you can, being in the worst pain you’ll probably ever experience in your life: that of an expectant mother delivering a child. Imagine, then, being utterly alone in this time of fear and pain, with no familiar faces beside you to provide comfort and solace. This is the current reality for most women delivering babies in government hospitals in Kerala, but if all goes to plan, this will change in the near future.
A “labour companionship” program is set to be rolled out in four additional major government hospitals in Kerala, including Kollam Victoria Hospital and Women and Children’s Hospital in Thycaud, Kottarakara and Palakkad, and other major government hospitals by the end of this year. As per the program, one family member of the expectant mother will be allowed in the labour room.
Why a labour companion
When asked why a labour companionship program is considered necessary, Dr Ushakumari, Additional Director of Health Services (ADHS) Family Welfare says, “One problem is staff shortage, nursing staff often have to attend to first aid and other patients, and so it will be easier if relatives are present in labour room with expectant mothers. If any complaints are being raised by the mother, it will be more comfortable for these ladies to have their own relatives with them, to tell in detail what their issues are to be communicated to the staff.”
She adds, “As part of LaQshya standards, we had started this labour companionship in certain taluk hospitals and WCD hospitals, like the Punalur Government Taluk Hospital. It will start in other major institutions this year itself.” The LaQshya program is a Union Health Ministry initiative aimed at improving quality of care in labour rooms and maternity operation theatres.
Dr Shahirsha, superintendent of Punalur Government Taluk Hospital, where the labour companionship program has already been in place for one year, tells us of another reason why such a program is necessary. “Usually, the labour room is a very strange area. The only person the female patient knows there is the doctor. Everyone else, the nurses, paramedical staff, nursing assistants…the labour room is full of people she is unfamiliar with, and women enter the labour room with a lot of fear. Even if there are relatives nearby inside the hospital, they feel very far away from their relatives, they can’t even call out to them. So combined with all the pain and fear, they are alone in an atmosphere that’s not very comfortable, which can lead to hysterical behaviour, postpartum psychosis and other problems.” This feeling of fear and alienation, and the psychological or behavioural problems that can ensue as a result, can be alleviated in some part by having the husband or a close female relative during delivery.
Infrastructure upgrade and an attitude change
When asked about what changes need to be put in place in order to roll out such a program in a hospital, Dr Ushakumari says, “The first thing is infrastructure changes. For birth companionship, they have to separate the first stage labour ward, and have separate enclosed areas for these patients who are about to go through delivery. Then only the bystander or companion can be near to these patients.”
Dr Shahirsha says Punalur hospital addresses the issue of privacy, which is often raised when discussing labour companionship, by having “a separate labour suite within the labour ward for deliveries. It is a private cubicle that looks and feels almost like a separate room. Inside that cubicle, there will only be the patient, her husband or companion, nursing staff and doctor. The partition gives privacy, and nobody else can see inside.”
Dr Ushakumari says that the costs for developing infrastructure to implement the labour companionship program is “included within the infrastructure, repair and maintenance allowance according to LaQshya standards. Some amount of money is needed for this additional maintenance, and creation of additional partitions and cubicle formations.”
Dr Shahirsha is heartened by the fact that other hospitals in Kerala will also be implementing such a program, and mentions what else needs to be done, aside from infrastructure development, in order for the program to be a success. “Firstly, and most importantly, there needs to be a change in attitude, of the medical and nursing staff.”
Dr Ushakumari says the government will address this too. “As part of LaQshya standards, we have monthly Maternal Mortality Reduction (MMR) meetings. During that meeting, all these things [including details are explained to gynaecologists and representatives from different hospitals. They will in turn will relay this information to the staff in their hospitals.”
Why the husband is the ideal labour companion
Punalur Hospital also provides counselling to the husband and wife before the delivery, where they can choose whether to have a labour companion or not. Dr Shahirsha says that patients can choose their labour companions themselves, be it the husband, mother-in-law, sister-in-law, or any other close female relative. “But mostly it is the husband who is chosen.”
He believes that the husband should be the ideal labour companion for a few reasons. “First of all, delivery is one of the most painful conditions of a woman's life. The husband should also see this and experience it first-hand. Secondly, as of now, all the responsibilities of family growth are on the female partner’s shoulders: from birth to birth planning, to birth spacing, to delivery to lactation. In the present situation, all this is the female’s responsibility, and the male has no role: he’s just a sexual partner in this equation. This needs to change, and having such a [labour companionship] program would help. It would be eye-opening for them.”
Dr Ushakumari agrees that having husbands involved in the delivery process will have a positive impact. “If the husband is willing to stay with the woman during delivery, it will definitely be very good and more comfortable,” she says.
As to how many women will actually opt for this new program, we’ll have to wait and see. Dr Shahirsha says that of 150 births in the Punalur hospital per month, around 10% choose the labour companionship program. When asked why such an apparently low number opt for the program, he clarifies that it is in fact a surprisingly high rate, “Actually, it’s a change in concept, and a total attitudinal shift. Initially, when we started the program one year back, on average only one or two patients would opt for the program in a month. Now, about 15 or 16 opt for it. Last month we had about 15 births with labour companions.”