Fernandez Hospital uses trained midwives to facilitate natural childbirths

Evita Fernandez, 65, who runs Hyderabad’s Fernandez chain of hospitals, has an answer to the growing number of caesarean section childbirths in the country. She wants to set up a School for Midwifery that will train its students to bring about natural births for mothers-to-be. Her 70-year-old hospital chain, which was founded by her parents, is also working with the government to develop a four-year professional midwifery programme like that in the UK and Europe.

For the last decade or so, there has been an explosion of caesarean section deliveries in India. So much so that many doctors and healthcare professionals now call it “an epidemic”. Till 2010, India had a C-section delivery rate of 8.5 per cent, which was well below the WHO-recommended level of 10-15 per cent. However, in 2014-15, the number of C-sections shot up to 15 per cent of all deliveries countrywide, with some states reporting that the surgical procedure accounted for half their childbirths.

Midwives could reverse the trend, says Fernandez. “A traumatic childbirth can be quite a terrible experience and women often feel strongly enough afterwards to try and prevent other women from suffering similarly. You would be surprised by the number of women who take up the midwifery course for mainly altruistic reasons,” says Fernandez. The compassion and commitment these women bring to the job is unparalleled, she adds. 

Although in India, people generally associate midwives with rural areas, Fernandez Hospital employs and uses the services of midwives — it has 30 at present — to ensure that its incidence of C-sections is kept in check. Their caesarean deliveries are at 8-17 per cent of the total number of childbirths whereas at its highest risk hospital with very complicated cases, the rate is 22-35 per cent. But at many other hospitals, this rate is as high as 75 per cent. Fernandez Hospital’s midwives are now training women in midwifery at a district hospital that handles 700 deliveries a month.

Right now there is no specialised training for midwives in India. A nurse who undergoes a three-year diploma course is considered both a general nurse and a midwife. Legally, she can practise midwifery as well.

But Fernandez argues that a general course does not equip nurses with the skills and training required to be a professional midwife. “A midwife needs to be highly skilled, competent and accountable as she is dealing with two lives at the same time,” she explains. She says that childbirth is meant to be a natural process and a woman can give birth on her own. The midwife’s job is to facilitate vaginal births, but she must also be able to discern if there is some complication and decide if a doctor needs to be brought on board. The midwife is also responsible for the mother’s well-being for six weeks after delivery.  

The midwives at Fernandez Hospital do a focused, in-house training in midwifery for 18-24 months after completing their three-year diploma in nursing. They get a starting salary of about Rs 25,000. The hospital has brought in midwives from the UK to train the nurses. “I am convinced that to make childbirths less medicalised and more humanised, this is the only way forward,” says Fernandez.

Fernandez asserts that her midwives have contributed dramatically to reducing the C-section rates for their chain. In fact, countries that have created midwifery as a unique cadre have been very successful in bringing down the number of caesarean deliveries, she adds.

At the Fernandez birthing centres everything is designed to encourage natural childbirths. There are designated and well-defined protocols that are strictly adhered to and 25 senior consultants are responsible for ensuring that the protocols are followed.  

For instance, if an expecting mother walks in with very high blood pressure, there is a certain protocol to be followed. If for some reason it is not, the consultant should be able to explain why. This helps them understand why a C-section or some other procedure was carried out in a particular situation. “If despite everything a caesarean is performed, there would be a very valid reason for it,” says Fernandez. 
 

Also, the hospital does not blindly adopt the practices advised by Western experts. It relies on its own data, evidence and documentation, all of which help it take informed decisions, including those that involve deviations from the protocols.

Ratan Jalan, former CEO of Apollo Hospital, and who now runs a boutique healthcare consulting firm in Hyderabad, says that the Fernandez chain is a class apart owing to its transparent practices and systems, which has been responsible for its growth from a single facility to five at present. “The hospital holds everyone accountable and that is its single biggest strength,” he says. 
 

There are no random prescriptions or lab tests and doctors are not required to meet any targets. Even if a protein supplement is prescribed to someone, there is a reason and explanation for that, Jalan adds. He says that the focus is always on charging patients fairly. If any patient is charged extra by mistake, the hospital reimburses the amount immediately.

Fernandez,too, says that she tries to build the trust of her staff by keeping the finances of the company entirely transparent.A private limited company with no investors, no shares, no equity funding, no partners and no dividends, the earnings are all ploughed back into the business. Fernandez herself draws a salary like any other employee. 

Almost 80 per cent of Fernandez Hospital’s 1,400-member staff are women and, until recently, the hospital gave them four months’ paid maternity leave (instead of the customary three months) and a further two months of unpaid leave — a rare privilege in the industry. After the recent change in law, six months’ paid maternity leave is given now. “The idea is to walk the talk. If we want the mother to be respected and cherished, there is no better place to start,” Fernandez concludes.