A google search on “Bhanumati Gheewala” will flood you with news coverage featuring the rockstar midwife. Hailing from Vadodara – Gujarat, the Nurse Practitioner Midwife at Sir Sayajirao General (SSG) Hospital has a story worth sharing. No wonder the media houses were flocking around her as she proudly received the Florence Nightingale award in 2020.

Without taking a single day off during the early months of the pandemic, Bhanumati was the first midwife to help a Covid positive mother birth. She continued to support the mother and her newborn after they were separated in isolation. Whenever she went to tend to the mother, she saw her pining for her baby. The mother did not own a smartphone, so Bhanumati used her own to connect them over video calls. As the days progressed, she unfailingly helped birth many babies. But this was not the first time she managed to maintain a steadfast enthusiasm amid the mayhem.

In 2019, during Vadodara’s floods, the area surrounding SSG Hospital was waterlogged. Bhanumati was far from being disheartened. She was glad that the soon-to-be mothers were making it to the hospital walking through neck deep waters. For her, they had already won half the battle. It was up to her to help them win it all. No holidays and relentless work ensured that all births were handled with undivided attention. “Missing your days off is the least you can do for mothers in need,” she adds.

The Florence Nightingale award was a culmination of a journey that started in 1988 when Bhanumati was a trainee in nursing in gynaecology at Chandigarh. In 2010, she completed her Nurse Practitioner Midwifery (NPM) training in Gujarat. President Ramnath Kovind conferred the prestigious award for her exceptional courage and devotion – virtues that the award recognises.

“Why are we forcing the mothers to lie down and birth against gravity?” asks Bhanumati as she explains different birth positions. For over two decades of her nursing career, she had dealt with pregnant women in a very conventional way. “It was the usual story, day in and day out. My NPM training brought in the revolution. The change!” Midwifery opened the doors to a whole new avenue of respectful care.

She thanks her family as well as the doctors and support staff at SSG for supporting her. She says that it is impossible for a midwife to work without pouring her heart and soul into the job. All midwives are heroes. All of them are extremely devoted. There is no other way to do the job.

“Before getting trained as a Midwifery educator, the scenario was different. I always used to give commands to the mothers. But after the training, I understood one important thing: her birth, her body, and her choices. We must help mothers create a positive birthing experience and make them feel happy.” Mallika, a midwifery educator, believes in creating beautiful birthing experiences and giving preferences to mothers’ choices.

Mallika is a midwifery educator at State Midwifery Training Institute, Guntur, Andhra Pradesh. In 2010, she completed her MSc in Community Health Nursing from Narayana College of Nursing, Nellore. Since then, she has worked as a staff nurse in public health institutes until she came across an opportunity to train as a midwifery educator. She was happy to know that NMTI, Fernandez Foundation was offering such training with the association of the Government of India and the World Health Organization. It was a big thing because very few institutions offer such opportunities.

“My mother was a nurse, and I always used to go with her to the hospital. Since then, I dreamt of becoming a nurse. I always enjoyed being in the labour room, watching babies, and helping new mothers”. Mallika narrates one of her recent experiences as a midwife when she felt so happy and satisfied. “On a recent morning when I went to the hospital, I saw that one young pregnant lady in extreme labour pain. The thing that touched me was that she was alone, and nobody from her family accompanied her. More than the physical pain, she was going through emotional pain.” She added, “we took care of her. All the midwife trainees were always there with her throughout. And after she gave birth to a beautiful baby girl, she felt so happy and pleased.” When pregnant mothers visit hospitals, they feel so much more vulnerable. This is because midwives are the ones who always accompany and help mothers. This makes mothers feel confident, respected, and powerful.
Mallika recalls her early days of working in Guntur. “Initially, nurses working in the hospital found our birthing practices incorrect. However, we shared our experiences and knowledge of skin-to-skin contact, different birthing positions, and delayed cord clamping. After that, they started incorporating these methods.”

“Every day was an experience during our training at NMTI, Fernandez School of Nursing. The amount of respect given to us was heart-warming. Even today, whenever we feel stuck at work and need suggestions, they always extend their support,” adds Mallika. She believes Midwifery Training Programmes are essential to understand the essence of midwifery. Therefore, aspiring midwives should grab this opportunity for a beautiful learning experience.

“Midwifery is not just a profession. It’s becoming part of a woman’s life before, during and beyond her birthing journey. The crying newborn, the mother’s tired yet happy face and the family’s sigh of relief are all that keep me going”. Prasuna N, a midwifery educator, working in the state of Andhra Pradesh strongly believes that midwives are no less than superwomen and that midwifery is the only way to ensure mothers and their babies are safe.

Prasuna is a Midwifery Educator at State Midwifery Training Institute (SMTI), Tirupati. In her 23-year-long career, she has been a nurse, midwife and midwifery educator. She was awarded a PhD for her study on comparative study on osteoporosis among working and non-working Women. Throughout her career, she had some incredible experiences that she defines as unrealistic but simultaneously made her proud.

At the age of 22, when she just completed her graduation from Nizam’s Institute of Medical Sciences, she worked at a district hospital for her training. She narrates one of her early experiences in the labour room, “during the early days of training, suddenly one day the head nurse called me to the Intrapartum Room for support since the other staff was on leave. I was nervous but my previous experience of being in the labour room during my nursing education gave me a bit of confidence.” She further added “it was shocking for me to know that only staff nurses were there to support the mothers and not any doctors. The rampant use of Oxytocin was being used without any accountability.”

Oxytocin is a hormone used to induce labour, control bleeding after childbirth, and strengthen labour contractions. It is not used until it is clinically indicated. When Prasuna saw that oxytocin was being used without any accountability, she understood that these practices don’t change on their own, they need to be changed. When Prasuna got placed in the hospital, she kept the first thing she was to keep Oxytocin in a cupboard. Another crucial part of being a midwife is to educate people about the dos and don’ts during and after the pregnancy. She recounts another instance where she had to unravel some myths. “During Intrapartum care, many tribal people come with strange taboos and beliefs. Many leave the hospital immediately after giving birth, along with the placenta. So, it also becomes important for us to educate them about healthy practices, hygiene and their well-being”.

Prasuna explains how the role of a midwife is more beautiful and brings positivity to her life. A midwife deals with the natural birthing process and sees a new life coming into the world more closely than other professionals. She calls out other young people to choose midwifery as a profession since it gives them autonomy and power to help others. Moreover, Midwifery is now a recognised profession in India that provides you with a license to practice. It empowers you, gives you scope to prove yourself, and, more importantly, equips you with ways to give compassionate and women-centric care for mothers from all walks of life.

Midwifery mentor Nangunoori Thirumala has had seven years of nursing experience. But she remembers nothing from her nursing days to equate to the searing passion her career found on the path of midwifery. Today, Vanasthalipuram’s Area Hospital is proud to have her as a midwifery mentor.
She recalls her response to the government notification calling her to be a midwife in 2017. The extensive selection process involved:

• The first interview
• A theory exam for those who cleared the first interview
• The second interview for those who cleared the theory exam
• Shortlisting of 30 trainees
• A final interview with the 30 trainees to gauge their sincerity

After all of this, she came onboard for her 18-month midwifery training. This rigorously filtered selection process clarifies that Fernandez Hospital, and the Government of Telangana are highly committed to midwifery care. Thirumala says, “It is the only way we can make sure that genuine women are selected to be midwives in India. I am very hopeful for a future where India will be an excellent example for providing the best standards of maternal care.”

When she was a nurse, Thirumala was heartbroken to see the absence of respectful maternity care in government setups. Obstetricians multitasked and most of the times, only nurses worked with mothers. When a mother is in labour it is essential to track the progress of her contractions. A midwife can gauge almost everything that the mother is feeling. But can we expect that kind of support, time, and care from a hospital environment that is understaffed? Thirumala denies it vehemently. Which is why she insists that government hospitals in India need midwives desperately.

The Area Hospital in Vanasthalipuram has come a considerable way forward now. New ideas like birthing positions, including birthing tools, allowing the partner to be a part of the birthing process, etc. are all part of birthing at this unit. These changes came in after midwives began working at the hospital. To care for the wellbeing of pregnant women and their unborn children, the hospital is also running antenatal clinics and childbirth classes. It would be fair to say that the road leading to this change was highly challenging. Thirumala had to urge the government to provide special rooms for privacy while birthing. The facility is now a flourishing hub of midwifery-led care. Initially, no one in the government sector was aware of midwifery. She educated the doctors and obstetricians about midwifery. When she demonstrated how midwifery care could help women, they started believing in midwives and were more than willing to treat them as equals.

Change occurs when outdated practices are scrutinized and replaced. As redundant birthing methods get examined, maternal healthcare is witnessing improvements, thanks to the midwifery model of care. Many midwives support humanized birthing practices very strongly. One of them is Ruth Joshila Philip, who works as a faculty member at the Government College of Nursing, Hyderabad.

Ruth completed her graduation in nursing and got the opportunity to work in the government sector before she pursued her master’s. By 2019, Ruth was teaching for 15 years when she heard that the first batch of Midwifery Educators from Fernandez Hospital were about to take up the National Midwifery Training Program. She instantly signed up for it!
Today, Ruth is a firm believer in the power of midwifery. She says, “Sometimes, you go beyond the call of duty. It is not just a job. It is a personal commitment to a mother.” She finds midwifery immensely fulfilling on a professional as well as personal front. Her recently submitted PhD thesis on birth preparedness programmes for maternal and feotal outcomes is based on the midwifery model of care.

She says, “While it is a common belief that only the poor opt for midwives in government hospitals, this notion is in for a sea of change. Today, government hospitals see plenty of educated and financially stable women opting for midwifery care. It proves the trust and confidence they have in midwives and in the government.”

Before she started walking on the midwifery path, Ruth came across mothers who were rushed to the hospital and were assessed inappropriately due to a shortage of staff. Only a midwife can ensure that no mother goes through such lack of attention. A midwife must be with the mother and give her all the emotional support and care that she needs.

A second-time mother was about to have a baby after a long gap since her first child. It made the mother very anxious. Ruth shared her own story of having a huge age gap between both her kids and assured her that it would be okay. She addressed the mother’s doubts and inhibitions. Thanks to Ruth, the mother had a natural birth and a positive birth experience. She went back home relaxed and confident.

Midwives bring in a lot of difference with the work they do. They are in a position where they can influence women and empower them. Conveying her message to obstetricians, she says, “We are here to ‘complement’ your services, not to ‘compete’ with your profession. Together, we can do wonders.”

Gajwel is a small town in the Siddipet district of Telangana with a population of about 70,000 people. The Area Hospital at the centre of Gajwel caters to the healthcare needs of people living in the town and those living in nearby villages. The hospital website claims that it offers a range of healthcare services, but the ‘midwife-led normal birthing’ is what makes it famous.

Srilatha Kandukuri is a midwife at the Area Hospital at Gajwel. Srilatha’s journey into midwifery began in 2017 when she qualified to be a professional midwife. Midwives are health professionals trained to support and care for women during pregnancy, labour, and birth. Midwives work with low-risk mothers to help them have normal physiological births. The Fernandez Foundation offered rigorous training as per international standards in partnership with UNICEF and the Government of Telangana.

Srilatha experienced a paradigm shift in how she thinks about women and birthing now. She says, “Training at Fernandez was not just about midwifery care but really about respectful midwifery care. We learned how to respect women’s choices which is unheard of in any public health facility. We learned how to empower women with the right knowledge about birthing and reproductive rights. This training also ensured that we have the right skills to manage obstetrics emergencies like breech births or shoulder dystocia.”

After the course, Srilatha began working in Gajwel. Ever since Srilatha and her fellow midwives started working with pregnant women in the Area Hospital, the hospital became known for letting women have births of their choice. “Only a 1000 mothers per month would come to the hospital before the midwifery model of care was introduced. Now, close to 3000 women birth here,” says Srilatha. Once Srilatha started working with pregnant women, the word began to spread that midwives respect women’s choices and help them birth normally.

“We gather a group of pregnant women who visit the hospital for antenatal check-ups and explain to them about the advantages of normal birthing. At each visit, we share all the knowledge they need to make informed decisions about birthing,” she adds. These antenatal classes include information about different birthing positions, nutritious diets, and the advantages and disadvantages of normal births v/s c-sections. Antenatal classes plus the time and attention midwives give to mothers make a real difference in ensuring birthing remains a positive experience for mothers.

Srilatha recalls one incident when a mother birthed a baby weighing 4.2 kgs. “Even though the baby was big, I was prepared to support the mother birth normally. I knew this birth would take time, and the mother may not have the energy and patience to give birth. I was there to cheer and encourage her. She had a beautiful experience. Along with her family, the mother blessed me for helping her have that experience. What else can I ask for!” says Srilatha.

“I am grateful to the Fernandez Foundation, Government of Telangana, and my family for their support in allowing me to be a midwife,” adds Srilatha. She believes that all women deserve a midwifery model of care, irrespective of which strata of society they come from.