Jyothi Raepelli, a nurse-midwife serving women in Fernandez Hospital in Hyderabad, reflects on what she learned during her training transforming her from a nurse to a professional nurse-midwife. But what’s one important thing she has learned? India needs midwives. Read more to learn about her journey and how she supports women to have normal births.
From surgeries to normal birth
I began my career as a registered staff nurse, at Fernandez Hospital, in Hyderabad. Initially, I worked in the Intensive Care Unit (ICU) where I cared for postnatal mothers following cesarean surgeries. As a staff nurse, I followed orders and immersed myself in routine work.
In 2011, I was given the opportunity to join a professional midwifery education and training program launched by the hospital. This was a pilot project and seven of us who joined did so with mixed feelings ranging from excitement to apprehension.
However, today as a qualified midwife with five years of experience, I readily admit I have no regrets. It has been an enriching journey that reshaped my understanding of birth and the care for mothers and babies.
What made this difference?
The two-year study program taught me to look at pregnancy and birthing in a new light. For the first time, I began to truly understand woman-centered care. I learnt to be sensitive to a woman’s social, physical, spiritual and cultural needs. As a professional midwife, I realized I have to approach a woman in a holistic manner, rather than just get my routine assessments done.
While an obstetrician focuses on complications of pregnancy and birth, as a I midwife I have learned to focus on the normality of the process. But, I have enjoyed working along with our knowledgeable obstetricians in the antenatal clinics. However, most of my training was under the guidance of experienced midwives. We had the luxury of senior midwives from the UK who taught and trained us. Presently we have Ms. Indie Kaur, a consultant midwife from London, to mentor us and help train us for water births.
Today, because of the knowledge and clinical experience I gained, I am able to counsel and help not just the woman in labour, but her entire family.
More than routine care- trust, support and evidence-based practices
I learned to communicate with women in labour and help them cope with pain without drugs. I have learnt to discuss with women about the various natural methods of pain relief like movement and hydrotherapy. In the antenatal clinic I also talk about the importance of a healthy diet and the need for exercise with emphasis on certain exercises to help them enjoy a normal birth.
The importance of continuity of support was reinforced over and over again during my training. I discovered that my support really helped a mother reduce her fears and boosted her confidence.
During labour, I know what helps women is to remain mobile rather than being confined to the bed. This is why I encourage the mother to find positions she finds most comfortable. I have seen women birthing in the squatting position, lateral and recently on all fours. The knee-chest (mother’s bum in air) position amazed me as I found there was no need to offer perineal support and the woman was most comfortable as she gently breathed her baby out. Her perineum was intact!
With regard to immediate practices after the birth, I have learnt the importance of delayed cord clamping and the joy a mother and baby experiences with skin-to-skin contact while she is holding her newborn baby across her chest. Research tells us that this will have a positive impact on both the mother and the baby especially with regard to lactation and maternal-infant bonding. When one sees this in front of them, it’s easy to understand why. It’s clearly how mother and baby need to be.
Stepping up and into the unknown
A few weeks ago I had I faced a new challenge. One of our mothers asked for a lotus birth when we discussed her birth preferences in the antenatal clinic. I had no idea what this was all about. Ms. Kaur encouraged me to do a Google search and to educate myself on the subject. On her next visit we were able to form a birth plan with regard to the placenta and how it would be retained in a bag while the umbilical cord remained attached to the baby. This mother also wanted a water birth, which gave me a wonderful opportunity to appreciate the importance of a birthing environment. The room was quiet and calm, except for the gentle chanting by the birthing woman. It was an awesome experience.
I have been given the opportunity to become a trainer and teach on the various hands-on workshops Fernandez Hospital has been conducting over the last two years. It gave me a lot of satisfaction to work with obstetricians and other midwives to help train colleagues working in smaller hospitals in rural India. The positive feedback from the participants of these workshops was encouraging and motivated me to improve my skills.
As a professional midwife I now realize the vital role we play in a woman’s journey into motherhood. Because of our training and the midwifery approach to birthing women I know we make that vital difference to a woman in labour.
I believe India needs professional midwives. In order to preserve the normality of birth, we need more midwives attending births who have good relationships with obstetricians who can counsel or take over if it’s required. Midwives make birth safer for mothers and babies.
I wish to thank my colleagues and the team of obstetricians at Fernandez Hospital for supporting us and accepting us as professional colleagues. I wish to thank Dr Evita, Dr Rajitha and Ms Indie Kaur (Consultant midwife from UK) for their encouragement. This program gave me a wonderful opportunity to grow into a responsible, confident, competent and sensitive professional. I am indeed proud to be a professional midwife.
I also want to take this opportunity to wish midwives all over the world a Happy Month of the Midwife!