Missing link in India’s natural-birth story: Midwives

Source: The post “Missing link in India’s natural-birth story: Midwives” has been created, based on “Missing link in India’s natural-birth story: Midwives” published in “Indian Express” on 08th April 2026.

UPSC Syllabus: GS Paper-2- Governance

Context: India has achieved significant progress in maternal healthcare as the Maternal Mortality Ratio declined from 130 per lakh live births in 2014–16 to 93 in 2019–21. However, the increasing rate of caesarean-section deliveries from 6.4% in 2008–09 to more than 27% in 2024–25 reflects a growing imbalance in childbirth practices. The World Health Organization recommends that caesarean-section rates should ideally remain between 10% and 15%, which indicates that India is witnessing excessive surgical intervention in childbirth.

Reasons for Rising Caesarean Deliveries in India

1. The rate of caesarean deliveries in private hospitals has reached nearly 47.4%, which indicates the increasing medicalisation of childbirth.
2. In states such as Telangana, the caesarean-section rate has reached over 60%, reflecting regional imbalances.
3. Financial incentives influence delivery practices because caesarean procedures cost significantly more than normal deliveries in private hospitals.
4. Deliveries contribute nearly 70–80% of the earnings of private gynaecologists, which may indirectly encourage surgical interventions.
5. Cultural preferences among families for selecting auspicious birth dates also contribute to unnecessary surgical deliveries.

Risks Associated with Unnecessary Caesarean Deliveries

1. Caesarean deliveries increase the risk of infection and haemorrhage in mothers.
2. Caesarean procedures may cause adhesions and complications in future pregnancies.
3. Caesarean deliveries may also lead to long-term complications such as scar endometriosis.
4. Children born through caesarean delivery are more likely to develop respiratory infections, asthma, and obesity.
5. Caesarean delivery can disrupt the newborn’s gut microbiota, although exclusive breastfeeding may help restore it partially.

Role of Professional Midwives in Strengthening Maternal Care

1. Professional midwives support natural childbirth by recognising labour as a physiological process rather than a medical emergency.
2. They provide continuous monitoring during labour and reduce unnecessary medical interventions.
3. They help identify complications early and ensure timely referral to obstetricians when required.
4. They also help reduce dependence on surgical deliveries by promoting safe normal deliveries.
5. They improve maternal care both in remote rural areas and urban institutional settings.

Government Initiative to Promote Midwifery in India

1. India launched the Nurse Practitioner in Midwifery programme in 2018 to strengthen the midwifery workforce.
2. Around 1,500 trained midwives have been produced under this programme so far.
3. However, India requires nearly 90,000 professional midwives to meet the needs of the public healthcare system.

Challenges in Strengthening Midwifery Services in India

1. India faces a shortage of trained professional midwives despite increasing institutional deliveries.
2. The healthcare system remains largely doctor-centric, which limits the role of midwives in childbirth services.
3. Private hospitals often prefer surgical deliveries due to financial incentives.
4. Social perceptions sometimes favour surgical delivery over natural childbirth.
5. There is inadequate integration of midwives into the public health system, especially in rural and tribal regions.

Way Forward

1. The government should expand midwifery training programmes across states.
2. Midwives should be integrated into primary healthcare institutions and maternity care systems.
3. Awareness should be created among families regarding the benefits of normal childbirth.
4. Regulation of unnecessary caesarean deliveries in private hospitals should be strengthened.
5. Strong referral linkages between midwives and obstetricians should be institutionalised.

Conclusion: India’s maternal healthcare progress must now focus on ensuring safe, appropriate, and evidence-based childbirth practices rather than only increasing institutional deliveries. Strengthening professional midwifery services can help reduce unnecessary caesarean deliveries and ensure equitable maternal care for women in both rural and urban areas.

Question: The rising rate of caesarean deliveries in India reflects both gaps in access to skilled birth attendants and over-medicalisation of childbirth. Discuss the role of midwives in ensuring safe and appropriate maternal care.

Source: Indian Express