by Ambica Gulati

Motherhood. The only act that manifests in human form the cosmic wonder of creation. Imagine a life growing within you, nurtured with your lifeblood. And then the wonder of all, this vague motion within your womb turns into two tiny hands, reaching out for you. It's like a moment of epiphany—a sacred communion when you look within and discover the Godlike power of creation.

The story begins with a birth. And, like all beginnings, a positive childbirth is not only spiritually more fulfilling, but can also strengthen the mother-child bond.

"A baby is God's opinion that the world should go on. And the birth pangs are just that-old order giving way to the new. This is how nature creates a new mother," says first-time mother Deepali Kukreja who is planning to offer natural childbirth classes in New Delhi. Her guru was her prime guiding force during pregnancy, and the touch of the divine was apparent in Deepali's relationship with her yet-to-be-born child. "I used to visualize my baby as my personal angel, and this angel finally entered my life."

Motherhood brings an inner awareness. But it also comes with its own share of responsibilities and worries. From the moment of conception, your neatly patterned world teeters on the brink of chaos. Priorities change, you are forced to look at life from a different perspective and all that you had taken for granted seems like a thing of the past. At this moment, you need to organize sufficient resources - financial security, family support, safe environment, adequate food, rest and exercise, a skilled and wise practitioner, and, above all, confidence in your ability to give birth.

"Today, women are worried about the risks of childbirth. They have preset notions that it would be a painful process," says Delhi-based Poonam Nagpal, a spiritual healer and firm advocate of natural childbirth. "So they opt for the regular hospital procedure with its wide array of drugs, forgetting the spiritual dimensions of childbearing."

BIRTHING, NATURALLY

A natural process such as birth is best when it is natural. But what should natural childbirth be like?

Natural childbirth as a movement has already started in the West in reaction to the medicalization of birth. Natural childbirth practitioners—even hospitals—now advise a woman to give birth in a squatting position unlike the old order where a woman was expected to lie down during childbirth. Unfortunately, hospitals in countries like India continue to make a woman lie down.

And not just that, a hospital birth here means being herded into a birthing room, drugged and strapped to tables, and delivering the baby with legs in stirrups. Unnatural? Definitely.

Even bizarre, as this practice originated from the diktat of the French monarch Louis XIV, who wanted to see one of his mistresses deliver.

The grave error of this position was pointed out by Dr Michael Odent of France in the mid-1900s. When the legs are held in stirrups, a woman has to push her baby upward, against the force of gravity. This leads to stronger contractions, greater pain and extended labor. To make childbirth more natural, Dr Odent devised his own method based on traditional midwifery. According to him, women in labor return to a primitive biological state, functioning at a new level of animal awareness, losing inhibitions and following their basic instincts.

IN THE BEGINNING

Natural childbirth is a process of immense power and extraordinary significance. "I remember my baby's birth as having put life back into me," recalls Rashmi Palkhiwala, wife of Mumbai-based yoga instructor, Jehangir Palkhiwala. Her labor lasted merely three hours. She was standing under a warm shower and the baby popped out.

Vineeta Mansatta, publisher of Earthcare Books, says: "My first delivery was a caesarian. But I insisted on a natural birth for my second baby. " Although she did face difficulties getting a good midwife, "the support that I got from her was worth the effort. She pressed my back and the baby came out. I also got back on my feet faster than the first time".

For most, however, the process is not so easy. Especially when you are expecting your first child and are faced with often contradictory suggestions.

"While the elders in my family asked me to do things in a certain way, my obstetrician would say something quite different," says Sarita Dhawan, a housewife. She, however, refused to complicate the situation. "I decided to let nature take its

DOCTORS, DAIS & MIDWIVES

The options are limited. To help you in childbirth, you can choose from obstetricians, government-certified nurse-midwives and traditional dais or birth attendants. While nurse-midwives rely on diagnostic technology and defer to the obstetrician's authority, dais follow traditional methods.

In the tug-of-war between tradition and technology, the latter seems to be winning this time. Ask any urban expectant mother. Chances are, she would opt for an obstetrician. Or at least her family would-as happened with Deepali. "I was so well-prepared for my baby's arrival that I could have cheerfully let a dai handle the birth," she says. But finally, she went for a hospital birth. Many women would rather do away with dais altogether.

"Doctors are much more reliable. I wouldn't feel comfortable with a dai," says Shalini Duggal, manager in a Delhi-based multinational company.

The opposite holds true for rural areas. Here, the rustic mothers-to-be gladly hand over their responsibility to the time-tested attendants of birth. "In our village," says Phoolwati, a construction worker in Delhi, "dais and family women handle childbirth."

The questions are many. How do you figure out who to trust? Are dais and midwives really equipped to handle emergencies? At the threshold of the 21st century, is it sensible to go back to tradition? Especially when you have the latest in childbirth technologies at your beck and call? The tussle here is between man and machine. And man and man-between doctors, nurse-midwives and dais.

"Hospitals are better equipped to handle emergencies," says Deepali. "Doctors monitor you and your baby throughout the pregnancy. You can watch your baby's growth through ultrasound machines."

SOUNDING OUT

Ultrasound checkups are routine nowadays. But what are their effects on the fetus? Dr Harmeet Malhotra, senior consultant of obstetrics and gynecology at Indraprastha Apollo Hospital in New Delhi would say none. "Ultrasound has been in use since 1960. There is no evidence of it hurting the baby," she explains. Poonam, however, disagrees: "Research shows that ultrasound produces a sound similar to that of a helicopter's blades. Now, if you, as an adult, cannot stand that unnerving drone, should you subject a baby to this torture?"

True. Especially if the same monitoring can be done in a much gentler way.

Devaki, a vegetable-seller-turned-midwife, says: "We monitor the baby's progress by moving our hands on the mother's stomach."

But does childbirth require hospitalization at all? "If all you are worried about is the unsterilized atmosphere, just consider the amount of bacteria and viruses in the air. If we were that susceptible to infections, we would be permanently sick," says Nutan Pandit, author of Pregnancy, an A-Z handbook on various aspects of childbirth. She also holds natural childbirth classes in New Delhi.

PRENATAL BONDING

The mother-child bonding starts a few months after conception. Which is why a would-be-mother is advised to listen to soothing music, relax and be in a positive frame of mind. "If the mother experiences feelings of self-worth, then she associates these with her newborn," says Kavita Mukhi, a Mumbai-based health food retailer. But these emotional aspects of childbirth, she feels, are often ignored by obstetricians. "When I had a baby, I was trapped by a huge nurse who didn't allow me to move," she adds.

For Jyoti Singh, a housewife, it was worse: "I was in immense pain after my caesarian section. I was so depressed that I could hardly relate to my baby."

Even the doctors are not spared. Dr Anjali Malpani, who runs Malpani Fertility Clinic in Mumbai, recounts: "Despite being a gynecologist, I felt out of control during my first delivery in a hospital." For her second delivery, she insisted on natural birth. "As soon as the baby is born, it should be handed over to the mother. Automatically, it begins to suckle. That is a beautiful moment. The baby should not be immediately separated from the mother, as is the norm in most Indian hospitals."

Dr Malhotra doesn't agree. "We need to supervise the baby for at least four to six hours. Unexpected complications can arise," she says. However, most obstetricians in the west would differ in opinion from her. It is more common to allow the mother and child to immediately bond after birth than not—only in the case of a C-section is the baby taken away for monitoring in most hospitals in the west.

Generalizations, however, never do justice. According to Dr Manju Khemani, obstetrician at Geetanjali Hospital, Delhi, doctors do understand a mother's needs. "But some women are unable to handle birth. Then intervention becomes necessary," she says. So you have unnatural birth positions and caesarian sections. But what about women who don't need technology?

RITES OF WOMANHOOD

"Birth is a renewal of life. Which is why a woman should be given full freedom to do what she chooses," says Saraswati Nagpal, student of a midwifery course in the USA. "We are taught to respect the mother and her natural body rhythms."

"When birth becomes a union, it creates a stronger spiritual bond," says Poonam. "Home birth also allows a woman to deliver with dignity."

Once again, this is particularly true of countries like India where most people cannot afford quality medicare. The less fortunate mothers are herded into one big room in public hospitals and placed on separate tables. "It's unavoidable," says Dr Malhotra. "Due to scarcity of space and time, we can't give a separate birthing room to each mother." So you have a room full of screaming mothers, rushing doctors, chaos, confusion—and amidst all this, a bonding of pain.

BIRTHING CENTERS

But technology need not always be at loggerheads with tradition-as is obvious from the new birthing centers in the western world where natural birthing is becoming increasingly popular.

"These centers," says Claire Bruce, an expectant mother from Scotland, "have comfortable rooms with soft lighting, homely atmosphere and complete freedom for a mother to decide how she wants to deliver." And all this with state-of-the-art standby equipment for emergencies.

Western countries, it would seem, are seriously thinking about the natural rite of passage. "Though even now at least 90 per cent Americans deliver in hospitals, the rest 10 per cent are becoming more confident about nature," says Saraswati.

Around the mid 1900s, France-based Dr Frederick Leboyer discovered that births in quiet, homely surroundings helped relax a child and that an underwater birth lessened the baby's pain.

Since then, many women have opted to deliver in a tub or immediately put the newborn in water.

"Since we spend the first nine months of our lives in water," writes Sarvananda Bluestone in Signs of Times, "it makes sense to put a newborn in warm water. Immersion in water has been a symbol of rebirth long before the time of John the Baptist."

Fascinating as it sounds, underwater birth is still an unexplored territory for most. When Saraswati told me that she was carrying videotapes of some deliveries, I couldn't resist having a look.

There were these women sitting in large tubs filled with lukewarm water as tiny, scrawny babies emerged from their wombs. "The midwives are trained to hold the baby while it is being born," explains Saraswati. "Here, you have less pain and smooth contractions since there is no fight with gravity."

WORKING WITH MIDWIVES

But homebirths, like all else, have their limits. "When babies are lying in an oblique position in the womb," says Devaki. "You have to go for a caesarian section. But if the baby is in a breech position, that is, feet downward, then we massage the stomach so as to turn the baby," says Devaki.

Which, according to Dr Khemani, is what hospitals also do. "We try to change the baby's position the same way. Caesarian is the last option," she says. Then why is there a sudden rise in caesarian? Is the urban woman incapable of coping with labor? Or is something else involved?

COPING WITH PAIN

Birth is invariably related to pain . But if you prepare your body, you can alleviate it. Deepali, who did regular yoga during her pregnancy, vouches for its efficacy. "I programmed myself for labor and I coped well," she says. Dr Khemani, however, dismisses these as myths: "The exercises merely shift the mother's attention." If you want to escape pain, the answer, according to most doctors, lies in epidurals (anesthetics that numb the area below the waist) and analgesics.

"I have seen women being rendered unconscious with pain. The only option in such a situation is to give epidurals so that the labor continues without pain," says Dr Khemani. However, in Pregnancy, Nutan writes that medication at this stage is best avoided as it can slow down the birth process.

There's also another side to it. After analyzing about 53,000 births, researchers at the National Institutes of Health and the University of Florida found that many children suffered from noticeable negative effects of these drugs. "Obstetric drugs lower the oxygen supply to the unborn babies' brain and can result in brain damage," says a researcher. Agrees Dr Khemani: "At times, epidurals can result in lifelong back pain for the mother. Sometimes it can also result in total respiratory failure."

But why does the human species alone have to face such trauma during childbirth when cats, dogs and cattle do it rather well on their own? God's punishment to Eve for eating the forbidden fruit? Or the price of surging ahead in the evolutionary race? Desmond Morris, in his book The Naked Ape, says that standing erect has its disadvantages since it narrows the uterine passage and makes birth difficult. Some would even blame those Victorian waists that were squeezed into unimaginable proportions by corsets, ruining their backs and ribcages for good.

Interestingly, rural women deliver with greater ease. Is it because their lifestyle keeps them closer to their primal nature? Janet explains: "Rural women work long hours. Squatting or sitting on floors is natural to them. That is why they have more control over their muscles and have easier childbirth." The question, once again, boils down to exercise.

The arguments are many. Even if you decide to put up with labor pain, it doesn't stop there. You still have to cope with physical wear and tear. "The baby comes out of the vagina. Sometimes the area between the vaginal opening and the anus tears badly, resulting in permanent damage to the rectum," explains Dr Khemani. "To prevent this, we resort to episiotomy—a planned diagonal incision."

Midwives, however, score when it comes to the aftereffects of birth: in traditional India, they massage the vaginal opening with ghee (clarified butter) to facilitate birth. "Even if a tear occurs, it is minimum," explains Devaki. A method most doctors would call crude. "This traditional ghee-massage expands the vagina," says Dr Khemani. "Sometimes it does not return to its original shape and results in loss of sexual pleasure." Then there is the umbilical cord. Should it be cut immediately or after the placenta comes out and stops pulsating?

"The baby comes out with the umbilical cord and the placenta follows later," explains Dr Malhotra. "That can take five to 45 minutes." Even Nutan agrees. She explains that after the birth, the umbilical cord continues to pulsate and supply the baby with oxygen through the placenta, while the baby tries to breathe. In natural childbirth, midwives gently rub the stomach to facilitate the placenta's exit. But here again, Dr Khemani objects. "Massage can damage the uterus. It can pop out."

It would, however, be wrong to say that doctors are against natural childbirth. "I believe in letting the mother take her own time to deliver the baby. Caesarian sections are only eight to 10 per cent of the total number of deliveries," says Dr Khemani.

Another stark difference in the birthing process between the west and India is that in the latter country, fathers are rarely allowed in the delivery rooms. Though, of late, this trend is changing and many private hospitals do allow fathers and other support persons to be part of the experience.

Lontars says, "the husband must try to be with the birthing woman, to double her strength". Being present during labor also creates a stronger father-child bond, since the father is an active participant in the birth process.

It is a moment of realization, a chance to go back to your roots and seek the inner self. It is also a moment of special bonding between the couple.

During birth, a child is suddenly pulled out of its comfortable cocoon and forced to face the light. It can either be a difficult transition or a moment of immense beauty—depending on how you perceive the situation. Then isn't it time you gave your unborn child a second thought?

- With inputs from Suma Varughese