Changing Childbirth in India

Changing Childbirth in India (CCI) is a small charity (or NGO) based in the United Kingdom (Registered charity number 1148209) which supports the improvement of maternal health in India and the reduction of India's large inequalities in maternal health:
*by raising funds in the UK to support the development of a new profession of woman-centred Professional Midwives in India
*by providing skilled midwifery guidance and a bank of volunteer UK midwives to mentor and teach the trainee Professional Midwives
*through the work of the School of Public Maternal Health. The School provides pro bono research, assessment and advice to promote a multi-sector Public Maternal Health strategy for India.
Background
CCI was set up in 2012 by a UK ex-Director of Public Health who had helped develop a pilot of UK-style midwifery in a large urban maternity hospital in Hyderabad, India, and by a senior UK midwife, who mentored the first trainee midwives in the pilot.. The initial outcomes of the Indian trainee midwives' work had been impressive (100% of women attended by the trainee midwives breastfed their babies within the first hour of birth; 98% had skin-to-skin contact with the baby immediately after the birth; 100% had been offered choices about their labour and the position in which tbey wanted to give birth).
Those initial results contrasted with the institution-centred service in many Indian maternity hospitals, where research showed care to be often devoid of choice, dignity or privacy. India does not appear to have a profession of midwives trained to practice woman-centred care, nor expected to manage the maternity care of women with low-risk pregnancy. Maternity care in India is highly doctor-centered, and antenatal, intrapartum and postnatal care is normally conducted by doctors (which has promoted the 'medicalization' of childbirth in India.
The results of the pilot strongly suggested that it would be possible and very desirable to discover whether a new profession of midwives could be educated and trained so that they could safely manage the maternity care of women with low-risk pregnancy (thus releasing doctors to concentrate on the care of women with high-risk pregnancy).
This pilot of midwifery in India was founded by a leading Indian obstetrician who is also the Managing Director of the hospital. She had a strong concern about India's huge burden of maternal morbidity - mostly falling on the more disadvantaged women,- and about rising rates of - often unnecessary and harmful - interventions in labour and childbirth among Indian women with normal or 'low risk' pregnancies. She aimed to see whether UK-style midwifery - in which a highly skilled cadre of midwives trained in evidence-based care, and promoting natural birth could make labour and childbirth safer in India. Professional Midwifery was designed within a Public Health approach. In other words, to create a profession specifically to make labour and pregnancy safer among more disadvantaged women in India so as to reduce inequalities. To succeed, Professional Midwifery will need to be part of wider strategic initiatives in India to address maternal health - namely including maternity care alongside improved gender equality, education and income. CCI's School of Public Maternal Health aims to promote this.
The Professional Midwifery Education & Training (PMET) programme was launched on India's Independence Day 2011. The curriculum underpinning the programme was designed to meet all the competencies of the International Confederation of Midwives. It also incorporated the principles of 'woman-centred maternity care', 'promoting natural birth', 'sensitive midwifery' and 'humanizing childbirth'. The first group of eight trainee Professional Midwives were mentored by the senior UK midwife who had previous led the Albany Centre maternity service in South London. The PMET programme is now in its fourth year and by August 2014, 35 trainees and (now qualified) professional Midwives were managing the maternity care of more than 40% of the women with low-risk pregnancies attending the hospital. Among 2300 women attending there were no maternal deaths, and the rates of interventions such as induction of labour, epidural anaesthetia, and episiotomy were substantially lower than had been the case when junior doctors provided the care. Satisfaction rates among women attended by the Professional Midwives were very high, women especially appreciating being offered choice about walking about during labour, and choice about what position to give birth in.
The work of Changing Childbirth in India
CCI was set up to support the improvement of maternal health and reduction of inequalities in maternal health in India, and the charity has - encouraged by the results of the pilot of Professional Midwifery - agreed to focus funds and efforts in the short term on supporting the development of the PMET programme by providing volunteer midwives to mentor and teach in India. The charity will also support the piloting of the Professional Midwives to provide maternity care in community health settings. Although it was important to have the original pilot within a very high quality hospital setting, CCI intends to support the provision of safe maternity care closer to women's homes, and also to specifically provide antenatal care in India's urban slums.

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