Profiles and Perceptions of Traditional Midwives in Informal Urban Settlements of

Mumbai

To document life stories of Mid-wives residing in informal urban settlements of Mumbai

To document cultural practices & indigenous knowledge related to the process of birthing that are traditionally passed from one generation to the next.

To highlight maternal health related belief systems, indigenous to each community covered under the study

To document the contribution that dais make to the maternal health of their communities

Analyzing the impact of State health care policies on the traditional practices of midwives

N ward:10 InterviewsChirag Nagar, Kirol Village, Vikhroli Parksite, Varsha Nagar

F/N ward:3 Interviews

G/N ward:3 Interviews

H/E ward:3 Interviews

K/W ward: 3 Interviews

M/E ward:3 Interviews

P/N ward:3 Interviews

Methodology: Semi-structured interviewsTotal of 28 interviews were

conducted

Profile MAIN RESEARCH QUESTION:

What are the factors that contributed to women becoming dais?

Profile Age: Between 40 - 70 years

Caste: Chambar, Chavan, Maratha, Jadhav,

Sheikh, Khan

Religion: Muslim, Christian, Hindu,

Maharashtrian

Regional State prior to migration: U.P.,

Bihar, Maharashtra

Current location: Owned/rented room in a

basti in N-ward

Educational status: Never been to school,

studied up to standard 5, studied up to

standard 8, doesn't know to read/write

Profile Economic status: Orange ration card holder, no direct water source, toilet access

Marital status: Married, Widowed, Divorced

Status in the community: Respected for her profession, age, experience, approached by all castes

Title: Referred to as Dai (general), Suien (Marathi), Chamaiyan (North Indian)

“ Someone came to me and said please help me, I have this problem, so I went and she had a normal delivery through my hands. God took care of everything.… 

I’ve been delivering for about 15 – 17 years I’ve done about 150 deliveries till date.

Small, small babies who are now big and going to school…”

- Anwari Banu Mohammed KhanVikhroli, Parkside

Age 45 

“ I delivered my own children all along on my own.

I learned this from my father’s sister.

I used to go along with her to help her in deliveries.”

- Chachi Vikhroli, Parkside

Age 65 

“ I didn’t become a dai, actually our basti is on a hill and people here don’t know when they are about to deliver.

The situation can be very dangerous.They come to call me in the night, but who will climb this hill in the night?

My mister says don’t go, what if you fall then.... but if it is an emergency I always go.

I have to save women’s lives.

I’ve lived in this basti for 40 years and the babies I’ve delivered have had babies of their own now. ”

- AshaVikhroli, Parkside

Age 55 

“ In village I used to listen to the older women talking. They used to do these things in the house nah and I watched and remembered. They knew.

See, doctors have such a big name. I am simply an illiterate doctor. Right or no? Theirs is ‘degree ka kaam’ mine is ‘dimaag ka kaam’

Now, around 20 – 25 years have passed. The children that I’ve delivered have become big now.

In this chawl only, in every house, 2 – 3 children that I’ve delivered live.

You ask them”.   

- Koushlya Namdev BavskarChirag Nagar

Age 46

“ Actually, it (becoming a Dai) was unplanned I was sitting at a neighbours home, in my village (UP) and she started to go into labour. There was no one else around so she instructed me to sit close to her and catch the baby. I was very scared at the time, but she kept telling me what to do and I delivered the baby.

Then people in the village started saying that I have the hands for this work and every time there was a delivery, they used to call me. I've delivered countless (over 100). No one taught me, I used my own logic.”

- Parvati Mannu Chauhan

VarshanagarAge 46

“ This woman who lives next door…..in the night, one day, unexpectedly, it was her time to deliver. She called me in the nightthis happened around 13 – 14 years ago.

So I went to her. I said, I've never done anything like this, so how will I deliver, to told her this she said, you are like my mother, you are my everything , please do it. So then I helped her push and after sometime the baby came out.This is how her delivery happened. So I’ve delivered two babies like this within that family only. ”

- Deepa BavanaVarshanagar

Age 48

“ No one taught me this work. My mother-in-law used to do this and I saw her, learned and I also started doing this work.

Watching her I learned.

I used to go along with her. She used to massage the baby and I used to wash the clothes. So I learned like this.

My attention used to be there nah, so that’s how Ii learned. I started doing this work when I was 3 months pregnant. Since 1982.

I’ve massaged for about 28 years, around 10 babies daily a month. … so in total I've done this (maalish) for over 150 children in this area.”

- Kalpana Suresh JadhavKirol Village

Age 46

Family's attitudeI lie to my husband. I say that I want to go to the bathroom and I come out to see the lady. I like it….

I do this work because it makes me happy. My family members tell me not to go, but if I know a woman is delivering somewhere, I have to go. I cannot just sit at home. I have to go….

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Acquisition of SkillsMAIN RESEARCH QUESTION:

How do daies receive their training or information in delivery practices and pass these on to the next generation?

From whom

Her role at the time

What motivated her to get into the profession

Perception of her own skills

How did she learn

Her age at the time of her first delivery

Transfer of skills

Acquisition of Skills

How did she learn?Doing.... doing we learned. They told us to observe, pay attention and remember what to do. The doctor showed me how to wrap the baby, give it to the mother for milk. Doing it repeatedly I learned. I’m not educated, but I do things from memory.

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How did she learn?In the village, the women come to deliver. I used to see this. My children also were delivered normally. 5 – 6 children i had in the village, normally. Looking at others one learns. No one taught me this or wrote instructions down. In the village we never even went to school.

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How did she learn?Whatever came to my mind I did that, in my mother’s house, I used to see my neighbours delivering.   My mother used to go to delivery babies . Now she’s in the village, she has become old. So I used to watch her when I was a child and learned how to deliver. 

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Perception of her skillsNo …. no I am not a Dai, just if someone is delivering a baby in the area, I go to help them.

In my childhood, I used to see my mother doing these things and I learned a little bit and I help women in emergencies ”

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Perception of her own skills

See this [being a dai] in not my work. Only if there is an emergency, if someone is in pain, then they call us.

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What motivated her to get into the profession?

I didn’t know at that time that I would start delivering at home…

Then I felt ok someone’s life can be saved through my hands, without operation etc, someone’s delivery will happen because of me, so I felt happy ..

You know if people don’t get operated, wont require stitches because of me, then I feel happy .  

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Assistance

See, whichever woman is there in the house, I tell them to sit at the side, give her support, then they (the woman) won’t shout …

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I haven’t taught anyone. Is this something to teach? This is dangerous work – its not meant to teach – whoever’s hands are good they should only do this work – god gives this to some people.

Transfer of skills

No one has ever asked me to teach them …

No one in my family wants to learn these things, they all run to the hospital…

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Cultural Practices & Indigenous Knowledge

MAIN RESEARCH QUESTION:

What are the specific community based maternal health related belief systems, cultural practices and indigenous knowledge of birthing?

Inducing contractions

Removing the placenta

Massaging a baby

Breast-feeding

Determining the baby's gender

Cultural Practices & Indigenous Knowledge

Inducing contractionsI give them black tea with garlic, kali meeri- some drink it, some vomit and when they vomit the baby comes out.

A woman had gone to Ramabhai hospital but after checking her they said that she has no blood in her body and they referred her to Rajawadi Hospital. There they said the delivery was too complicated and referred her to Sion hospital. But instead of going to Sion, she and her husband came home, they were very scared.

They called me.

I boiled some back tea with Kalimiri (no milk) and kept giving the mother. This increases the pain and the delivery happens. Then around evening time, she delivered normally.

I did nothing but give her this black tea.

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Removing the placenta

I put pressure on the woman’s bellybutton and ask her to push...

Like she pushes in the toilet… to push with lots of pressure.

Then I hold the placenta from one end and pull it.

It comes out…

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Delivering stillbornsIn the olden days, they used to put the hair of the woman in her mouth, to drop the placenta. (Narrates an incident of how her mother delivered a still born) When we were in Ramnagar, there was a woman there who’s baby had died in her stomach – she had gone to all the hospitals – Rajawadi – but it wasn’t coming out…..

Then my mother went to see her – she took all her hair and put it inside her mouth – then when her mouth was full her placenta droppedThis is how my mother removed the still born baby…

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Turing the baby

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Sometimes when one is working the baby moves to the side, or up, then the mother experiences difficulty. So i massage and move the baby. I did the same for my daughter. This sometimes in the 8th – 9th month. The baby becomes straight.

Massaging a babyThere was a woman, they told her at the hospital that she would not deliver a normal delivery, she would have to have a caesarean. But with me she delivered normally. Then the baby was not urinating. They took it to the hospital, and kept it there for 3 days. The doctor said that they would have to operate. They brought the baby to me and I massaged it with oil, as I massaged it a long spray of urine shot out (points to the opposite wall indicating how far the urine went). See these doctors for this reason they were saying to operate.  

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Massaging a baby

If a baby doesn’t pass a stool for 5 -6 days , people in the house get so scared. They take the baby to the hospital. What you have to do is bathe the baby with water and soap – then you have to massage the baby’s stomach, especially the belly button and the stool comes out.

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Massaging a babySometimes what happens, the baby has difficulty breathing, the nalli gets stuffed/clogged and the baby cannot breathe properly.

What happens nah, when a baby is small the nose cavity is small, over time it gets bigger. But people don’t know this and they get scared.

So I tell them not to worry, it time it will happen, only they have to make the baby cry a little bit – if the baby cries it nalli opens a little bit

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Facilitating Breast-feeding(baby)

After delivery I give the baby to the mother for breastfeeding, it helps to put little milk on a cotton and give it to the baby, so that it feels like drinking…

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Facilitating Breast-feeding

(mother)If a woman cannot breastfeed after delivery i tell her to take coconut, lasson, ajma, cooked in ghee, with gourd, eaten one bowl hot, hot in the morning. With this the mother will get lots of very nice milk. even those who don’t get milk will get after this

Now if someone doesn’t get milk with this, then I tell her to take (bajri) atta that is cooked in milk not water, she should take this every morning for 6 days. Within 6 days she will get milk. ”

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Contribution to Women’s HealthMAIN RESEARCH QUESTION:

What is the contribution that daies make to the maternal health of their communities?

Contribution to Women’s Health

Emergency Delivery Measures: Neo-natal health

Maternal health

Emergency Delivery Measures

That case was so dangerous, when she delivered her placenta along with her uterus came out. They had left her in that condition for 2 hours, while they were looking for a dai. They never got one, then they came to me. By that time the baby had gone completely dry. I put 25p. plastic bags on my hands and pushed her uterus back with my hands and told her to get a tetanus injection the next day. Now she is compeletely fine and had another baby also after that.  ”

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Referring women to Hospitals

I know like this, see (showing with her hands), if the cervix opens by one inch, or two inch or three inches, then by the 4th inch she will be ready to deliver “her time has come”. And through checking if I feel the baby’s head/hair, then I send them to the hospital. And if someone is close to delivering, then they take a rickshaw and go fast. Like this.  

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Referring women to Hospitals

In one instance, a woman came to me in pain. It was her 6th month . I checked her and found that her cervix was opening and I told her to go to the hospital and get checked. They gave her some medicine and she became alright.  

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Family planning“

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I tell women to use a tambi (copper T). I don’t encourage taking tablets because it effects the quality of milk the mother produces.

In this area the men don’t use condoms, they say why should we use, if the women get affected let it be, we will not use anything. They don't’ like to use anything while having sex. I would say 75% don’t use anything.

That’s why I tell women tambi is the best. I used it myself for 9 years. I give them my own example. That I used it and I didn’t have any problem at all. In my time there was the ‘loop’ that used to give so many problems, now with the tambi there is no problem. But women do nakra, they say it causes bleeding,

Contribution to Women’s Health

Registration of the baby

Role in promoting child immunization

Assisting women acrosscommunities

Everyone. In this matter why would you consider whether she is a Muslim or a Hindu. If they are in pain then we go.

Now see these women [gesturing to Muslim ladies]. I helped them also.Here I look after every woman even if she’s Muslim or Hindu because it’s related to life.

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Changes in her Profession over timeMAIN RESEARCH QUESTION:

What has been the impact of State health care policies on midwives from these communities?

Changes in her Profession over timeFrequency of home births

Changes in women

Cultural practices

New practices

Frequency of home births

Before in this area every month there were 10 – 15 home deliveries, people used to not go to the hospital – not even take the name of hospital. Now it has become very less.

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Frequency of home birthsNow I’ve left this work.

Doctors told me to stop this, no delivering at homes, so now I send them to the hospital. They shout at the women and scare them that this will happen and that will happen so they run to the hospital.

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Frequency of home births

Before people used to deliver at home, I’ve see so many home deliveries in this area. But now the doctors have stopped home deliveries. If a woman delivers at home, then they don’t take her only into the hospital.

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Changes in women

In the village what happens – the women do a lot of work, so the deliveries happen very fast, their bodies are very supple because of their work. Those who sit and do work, they most have caesareans, problems, the baby doesn’t move etc. If you’ve active nah, the baby also likes it, you eat better so the baby gets more nourishment etc.

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Changes in women

Yes, women have changed. Before women used to be stronger, their bodies more supple. Because they used to work hard. So the deliveries used to happen immediately, after the water broke. Nowadays, women are sitting all the time. They don’t do much hard work. So deliveries take longer. Their bodies aren’t as strong.

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Changes in women

Before women used to deliver 7 -8 children. How were the women? They were strong.

Nowadays, with one child women a woman is finished.

When my daughter went to deliver I saw other women delivering. My god, they were experiencing so many difficulties. In my time it was not like this.

So many women were experiencing so much pain. In my time, when the delivery happened, we ourselves used to not know, it used to happen so fast. And after delivery we used to come home and work.

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Cultural practices

In the village, they don’t throw the chord, they put it in the earth, here they throw it, dogs, cats eat it. In the village they burry I for a good reason. The significance of it that no animal eats it. Here they throw it, dogs cats eat it – so its not good. There is also life in the chord no, that’s why.

In Mumbai the custom is different.

Where is the space here to do these things ?

In the village the custom is very nice.

So that no bad ‘nazar’ falls on the baby they burry it.

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Cultural practices

Before after cutting the chord we used to burry it, but now people don’t allow anyone to dig. There is place nearby in my area, but they don’t allow digging.

Those who live on top of the hill, they still burry the chord. So that animals don’t eat it. There is ‘life’ in it.

But nowadays everyone throws it in the garbage bin.

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New practices

Before, in our time,  we used to throw the first of a mother’s milk out, our daadis used to do it so we did it. 

Now we know that this is a wrong practice. 

Science had gone very far. 

First we give this milk. It has a lot of strength.

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* Vulnerability of pregnant women in slums covered under the study* Reluctance to access formal healthcare systems* Dais constitute a direct point of access to vulnerable women* Contribution of Dais to maternal and newborn health* Incorrect practices that can be rectified through training/certification* Role that Dais can play in the promotion of child immunizations, reproductive health, pre-natal and post-natal care* Loss of traditional knowledge and cultural practices related to maternal health and neo-natal health

Conclusions

Vulnerability of pregnant women in slums covered under the study

Here what happens, the hospital is not close by, there are no rickshaws available in the night, doctors are not available after 10pm. This is the problem in this area, there aren’t any rickshaws in the area. They only go from that corner.

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Vulnerability of pregnant women in slums covered under the study

How will a woman ready to deliver come down from this hill? In the monsoon, it is worse. The road gets spoiled and you cannot walk properly.

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Vulnerability of pregnant women in slums covered under the studySometimes what happens nah, women go to the

hospital for delivering and there they tell them to go back home, there is still time for delivering. This is what they tell them. So they go home. Then suddenly, they start to deliver. This also happens. At the hospital they say, no you have lots of time. Now a days doctors are also a little ‘like this’, they tell women they have time and to go home. By the time the women get home, its evening and in the night they deliver. You can never predict when she will deliver, sometimes its in the morning, sometimes in the night

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Reluctance to access formal healthcare systems

So many times her husband picked up the hospital papers, but she said no I won’t go, even if I die here, I wont’go!The problem in hospitals is there is such a long line. That day my daughter-in-law went for a check up and there was such a long line, waiting, waiting she feel sick. It starts at 2 – 3 in the afternoon but you won’t get home till about 7 – 8 at night.   

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That’s why women get scared (to deliver in a hospital) – they say “over there they do like this and that (caesarean) – so out of fear they don’t go. So like this they decide to deliver at home. Then afterwards they call me and take me along.

Reluctance to access formal healthcare systems

If they had gone to the hospital, they would have been cut open (caesarean) without operation, they don’t remove the baby in such cases. So if you go to the hospital operation is bound to happen.   

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Before delivery she had gone on her own to the doctor – there is one nearby … the doctor told her there is time for the deliver.

She had put her name in Rajawadi for delivery, so I told her to go there then since she had put her name. But she said no, they will get angry with me, verbally abuse me, she got scared.  

Attitude of healthcare providers

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When women go to Rajawadi, they send them to Sion hospital, then they send them somewhere else..

People have to spend so much money in the process

So that’s why they get fed up to go to hospitals

How much money will people carry at the time of delivery? They don’t have money to eat over here. People here are very poor. If they eat today, they have nothing for tomorrow. So how will they afford hospitals?

Attitude of healthcare providers

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* Vulnerability of pregnant women in slums covered under the study* Reluctance to access formal healthcare systems* Dais constitute a direct point of access to vulnerable women* Contribution of Dais to maternal and newborn health* Incorrect practices that can be rectified through training/certification* Role that Dais can play in the promotion of child immunizations, reproductive health, pre-natal and post-natal care* Loss of traditional knowledge and cultural practices related to maternal health and neo-natal health

Conclusions

Hospital staff don’t treat the patients well. They talk to them very rudely and shout “Hey, for what have you come?”

That’s why people don’t like to go to hospitals.

This is the wrong attitude nah? People are in need that’s why they come.

They should understand this and talk to them with respect.

I want to bring about this change in the attitude of hospital staff…

Attitude of healthcare providers

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