How safe are Institutional Births? (Photo Credit: Baneen Karachiwala)

As I entered the Eclampsia labor ward of Bangalore’s biggest public tertiary care facility and put on my disposable shoe covers, the shrill cries of a particular woman got my attention. I needed to go about doing my routine observations for the day but instead my feet trailed the dividers of the ward, following her voice, only to find her gasping for breath, possibly her life. Seeing her lay on the cold steel bed, her eyes fixed towards the ceiling, I knew something had transpired which was definitely not routine, not normal.

I wanted the whole story.
 R.E.W.I.N.D.
 Another observer who was not associated with the hospital but was stationed there to do some of her own independent research, did not have any qualms in sharing with me the intricate details of the episode that had just gone on a few minutes ago. “Spirit” was poured down the woman’s throat, she said. No, don’t go back to check if you read the word correctly. You did, you definitely did.

The woman in labor was thirsty from pushing, she asked for some water. Across from the delivery table, was a mineral water bottle and the reflex of the Aayamma (helper) was to pick it up and just hand it over for the woman’s consumption. The minute the bottle had been shoved into the woman’s mouth, the intern nurse realized what it was. But, it was too late. The fumes from the spirit had stirred the medical providers olfactory senses leaving them speechless for a second. The woman had coughed up the spirit and was screaming about wanting to throw up. Another nurse had immediately realized they had been using that spirit to clean instruments all morning so that the health inspection due the next day would run smoothly. She also realized she had forgotten to move the bottle.

Now that I had been brought up to speed with what had happened, I was curious to find out how the next few minutes would play out. However, I had a thousand questions running through my mind both from a researcher’s perspective as well as situational. Does free/ subsidized care come with the risk of being exposed to occurrences like these? Are incidents like this reported and what are the penalties? What is the quality of medical education and training today, that allow providers to be so lax? Are there any protocols for safety in a hospital ward where they treat complications and if so are they adhered to? Can this carelessness and indifference be attributed to the fact that women’s lives don’t matter? Or is it because they come from that section of the population that cannot afford, avail and access good quality care?

Detach and observe is what I had to do for the next few minutes until the baby was born. So, I started tuning back into the present of the conversations being had between the different providers standing around the woman in labor. The duty doctor and the senior nurse were feeling a bit relieved because the woman’s cries had died down. However, that relief had quickly turned into a sort of silliness where they made jokes about what effect the consumption of spirit might have on the baby. Some of the remarks they made were (I quote verbatim):

“The baby will be drunk when s/he is born”

“The baby will be sanitized”

Did they even realize this woman was listening to what they had to say? That she was not just an object but a real person with feelings and emotions. What I felt that day, I will never forget. That moment of absolute disregard for what the woman may have gone through made me understand there was no such thing as “respectful care” in the four walls of a big hospital where you are at the mercy of providers who don’t really understand or care for you.

This was not all. The baby was still to be delivered and it was apparent from standing 2 feet from the woman, that she was extremely tired and unable to push. Some encouragement from the doctor would have helped her at this point but instead there was another taunt thrown her way. The duty doctor said, “If you don’t push, then we will make you sign a form that says you are responsible for any negative birth outcome”. I thought to myself, how might I have reacted if I were told these very words. I could not think of a thing. When you put your life into the hands of someone you hopefully trust to experience one of the most precious and valuable moments of your life, do you anticipate situations like this? By this time the Aayamma had climbed onto the table and was pressing the woman’s abdomen down and the duty doctor was screaming at the woman to push harder. In a few minutes, a live baby boy was born and his cry was the only voice she wanted to hear. Lights out.