After more than a decade of searching inside and out, I found that my work, on social and environmental justice issues, the experiences from it and the ideology behind it gave me my identity and a sense of self and purpose in life. I also identify myself as a woman – a feminist. These multiple and converging identities gave meaning to my life, they drove me and defined many of the choices I had made in my personal life. It has been no cake-walk but rather a struggle to keep up with the demands that this imposed on me – but the struggle, so far, has been worthwhile, despite the failures and falterings or rather, i should say, because of them.
My journey towards Motherhood was not going to be different, i told myself (much before I found out that I was pregnant). It would be a part and parcel of my belief system that had evolved and is still evolving as a part of my life and work experiences . I wanted birth and mothering to be as natural as possible, as free of the medical market contraptions and systems and as empowering as the other journeys of life this far. It couldnt be anything else. Or so I believed.
Finding a sensitive health care provider
The fight started from day one. All I wanted to know was that I was indeed carrying a baby, that I had concieved and that I was ok. And so I looked for the 'right' health care provider to help me with the same. (Four and a half months after having my baby I still havent found one). Instead, what I got was either a private nursing home offering me the latest ultra sound technology, another with an extremely cryptic and pre-occupied gynaecologist unwilling to answer questions and then a civil hospital with missing doctors. I live in a small town (in Himachal Pradesh), i thought to myself. But then if it could have an ICICI ATM, i could surely find decent health care service. Turns out that the deifinition of decent is one that can offer you, if you throw some money at it, a range of options in medical care – but all which treat the pregnant woman as a 'patient'.
My general allergic reactions to doctors and hospitals apart, I was not going to be treated as if I was sick or ill when I was actually having a baby – that women have been having since time immemorial, way before the ultra sound came about. Dont get me wrong, am not throwing the baby out with the bath water (no pun intended!) - it is ultimately the medical technology that came to my aid when things went wrong. But I was driven to the 'wrong' place by the way the system works. The attitude of the doctors and the intense medicalisation of pregnancy made me averse to seeking the service and change doctors frequently.
Some of the choices I made against the doctors' orders: choosing to have fewer ultra sound scans (I had 3 ultimately but if I went the doctor's way it wouldve been 5 or 6), avoiding medications that were unnecessary (I was reccomended eco-asprin to facilitate fetal brain growth. A bit of research indicated that perhaps using a blood thinning medicine was not really needed). I skipped the amneocentecis, a test to indicate if there was risk of fetal anomalies, especially down's syndrome. Again this invasive technique puts the fetus at risk of injury and I was not about to let a needle into my womb. The one that I could not escape was the tripple marker blood test – a really expensive blood test to test abnormalities in the fetus. It was only after I got the results that I found out that all it does is tell you the chances of the risk. This the doctors will forget to tell you and so will they that the chances of a false positives are extremely high in both amneocentesis and the tripple marker test. They will ofcourse not forget to tell you how desperately you need these tests because you are an 'elderly preemie' – the term used to describe you if you are 35 or above and pregnant. Disempowering to say the least – this reminds you your age and its limitations and grills in the notion that your body is no longer 'fit' to be nurturing the fetus, it needs all the help and external assistance and you must act like a 'patient'. Am not sure if the constant reminder of being an 'elderly preemie' helps exercise more caution but it does undermine confidence.
My dream of having a natural birth was going to fail. This was the message that every health care provider and statistics in mainstream medical literature tried to drive home. What it actually attempts to do is prepare you or rather brain wash you into believing that you are incapable of pushing your baby out and that you must be ready to go in for interventions ranging from induction of labour to a cesarean section. I was not ready to go under the knife to bring my child into this world. After much searching I found Asha didi. She was a midwife in the village I lived in and I was thrilled to hear from others in the neighbourhood and her that birthing at home was doable for me. She was casual about many of the things that the doctors were always on tenterhooks about. I instantly decided that I would give the home birth with Asha didi a full shot. She was trained – though in 1980s. She wasnt recognised by the health care system because she was not even 8th pass. So naturally she had no equipment and was unaware of the latest in midwifery. She was just a traditional dai who believed that there was little requirement for any kind of invasive method even during birth (she did not even support episiotomy).
As the due date came closer I became more convinced that Asha didi was the way to go. But in the meanwhile i continued my prenatal check ups at the civil hospital and once in a way visited the private doctor. “What if there is an emergency?” was always a question that i faced from family and friends and one that I myself posed to the dai. She said she would be able to identify the emergency well in advance for a hospital transfer. Only thing I knew was that I wasnt going to find a doctor who would be pleased if I walked into the hospital in that state. I kept trying to work out possibilities. I read like mad about home birth experiences of mothers accross the world and slowly I prepared myself, family and friends that I could do it. Am not sure whether it was my persistance or for the fear of saying 'no' to me (who isnt scared of the family rebel) that everyone decided to flow along – yet again I was grateful that when the system was failing there was community and family support. So there I was – all of 90 kilos and waiting for the day when I would go through a process, the feeling of which I was not even able to imagine. It just had to be felt, i guess.
The due date, 11th February, came and nothing happened. No contractions... just a few false ones here and there but no real stuff. I went to the private doctor as the civil hospital doctor I was seeing was on leave. The minute she saw my face she, virtually ordered me to “get ready to be induced since you are past your due date”. My heart sank. I wasnt even a day late. Why wont she give it 24 hours even? I mustered up the courage and told her I wanted to wait for the labour to arrive naturally and all I wanted to know was whether the baby was ok. She refused to do a physical exam and threw me out of the clinic saying that she was “not going to let me have my way and that she was not free on the next two days if I came back to her for my birth”. (The next two days were a weekend) Whatever happened to the Hippocratic Oath? Anyway, it was too much of an insult for me and my baby – so I walked out of the clinic with damp eyes but my (hot) head held high. Obviously I could not go back to her if there was an emergency.
Being over due was normal and I was going to wait it out. On the night of the 13th I started experiencing some pain. By early morning the contractions were more frequent. Till then I had the plan in place. My friend Nidhi's car was ready at the road head and Asha didi had been informed that the labour had started. If Asha didi gives up and so do I, we would sit in the car and go to the government hospital at Kangra (about a 45 minute ride). The only problem was that I dint discuss the plan with others. All of us assumed that there would be no problem and the baby would come at home with Asha di's help. By 11 am next morning, a good 10 hours since the initial contractions started, I was getting anxious. But the contractions were not as intense for another three hours. I do not remember how and why my memory of the labour phases (that I read about so many times) failed me but I just know that when Asha didi asked me to start pushing I was not really ready. She assumed I was after she felt the baby's head. But still it was clear that I wasnt dilated enough and yet I kept pushing (in between short naps) I did this for the next 12 hours.... At 2 in the morning, on 15th Februrary I started getting the intense contractions. In my head I knew that active labour had just begun and that what I had gone through for the last 24 hours was just the initial phase. For some reason I was not able to communicate this. This analysis is more in retrospect and the memories are vivid. It was pouring outside and there was a power cut. 7 women – friends and family, the midwife and her friend Kamla (assistant) were continuing to encourage me to push. By 4 in the morning the intense pain was coming at 2 minutes. I was probably just beginning to dilate more – it was going to be a long haul, my instinct told me. But by then the early and needless pushing had exhausted me, the look of distress on the faces of those around (especially in candle light) made me worried and I kept looking at Asha di for encouragement and found little. She had a responsibility on her shoulders and though she knew of labours that went on for 3 days even, she suggested that we should go to the hospital. That is when I realised that we were not going to head far in this situation. I was not panicking about the baby – perhaps because my water had not broken yet. There was no time to go to Kangra and we went to the nearest private nursing home with an emergency section. I picked up myself and did not wait till the umbrella or torch was handed to me. I dragged my exasperated myself with support from a friend on the undulated stony path to reach the car in less than 10 minutes. I had two contractions on the way and the crazy feeling that I may have the baby then and there but thankfully nothing happened.
The birth of Abir
What transpired at the nursing home then was more devastating for me. As long as I was in the comfort of my home, I went through the labour with much support, constantly being fed hot drinks and soup, hugged and held. The minute we reached the hospital, at the first instance I was separated from the family. I later realised that it helps in successfully carrying out prisoner's dilemma so that decisions are not taken by the 'patient' in consultation with the family members .After a good 15 minutes the young gyneacologist walked in. She did not have any conversation with me, nor asked me any questions even as I yelled in pain. Finally she took me for an ultrasound. She told me that the baby's heartbeat was fine and asked me why i waited so long into the labour – I chose to remain silent on the 'home birth' for the fear of being kicked out. I made up some story and then I remember her asking for the 'husband' to be called. I was promptly taken away. I wanted to be a part of the discussion but had no energy to ask any questions as the contractions were killing me by now. I just remember lying on a cold metal stretcher with legs up on stirrups. I just hoped that the doctor would help me get the baby out now. The doctor walked in after a while and asked for 'the truth'. I knew that Prakash (my partner) had told her everything (which was a wise thing to do). I later found out that unlike me he was told that the baby's life was in danger. I let the cat out of the bag and asked her to get on with whatever she had to do. They said that a normal birth was 'risky' as my pelvis was small and there was meconium in the discharge. They had to cut me up. It was clear that she had shifted her position from attempting to give me a normal birth to going for an emergency c-section. Whether the c-section was really required still remains in the grey area for me – I havent made my peace with it but then, at that time I said to the doctor “please do as required”. I was conscious through the operation but my eyes had been covered. Within a few minutes after I lay down I heard the whimper and a loud cry from the baby. I wanted to howl, hold the baby and wanted to know if it was okay. I was asked to be still and not talk. I drifted into deep sleep. They woke me once I was stitched up with a loud “Congratulations, You had a baby boy!”. I was relieved. But still couldnt see him. They said the baby was taken to the family. My stretcher was rushed into the room as I just saw a glimpse of the family but couldnt see the baby yet. I still had no clue of how traumatised the family was but i apologised to all for putting them through a tough time and thanked my stars that the baby was alright. He was the most alert newborn I had seen and so red faced that we went on to name him 'Abir' which also means 'gulaal'. He certainly would bring much colour into our lives and I could not wait to hold him.
The Post birth period
The hospital staff did nothing to ensure that I had an interaction with my baby immediately post birth. The lower half of my body was numb, I had a drip on and I needed to rest and so I was not allowed to spend time with family nor have the baby lay next to me. In retrospect, after reading post birth experiences of other women who had had c-secs I realsied that a lot could have been done to ensure that I got to put the baby to the breast for a while atleast. Another fact that I am yet to make peace with. The resulting disconnect with the baby was overwhelming and still makes me feel guilty and angry. By the afternoon of the birth day I started getting anxiuos and I wanted to be with my baby who was put in another room with family. I was sharing the room with another mother to be and the only way I could get to Abir was if I climbed down to the basement where his room was. By evening I had decided I needed to be with my baby and prepared to get up and walk down. I sent out several messages to the staff who finally relented and helped me get there. I held my baby 12 hours after he was born and I could put him to the breast much later in the night.
“Ouch! That hurts”, was my reaction to Abir's first few minutes of suckling. The milk had not come in yet and I was assured that it would soon. While a few nurses came in occaisionally and pressed my nipples (hard) between their fingers to check if I had started lactating, none of them offered me much counselling on breast feeding. During the pregnancy I had read up all I could for upto the birth phase and so I had taken for granted the post birth part – of which breastfeeding was a central part. “Ofcourse, I will breast feed my baby – no dabbe ka doodh for my baby” I had thought confidently. It wasnt long before the confidence evaporated in thin air. Though the milk came in three days later and I kept putting Abir to the breast, I realised that this was going to be no mean feat. In the next three weeks Abir and I still struggled to establish a nursing relationship. It hurt me when he fed and so I would give him short feedings of 10 minutes on each side instead of the frequent feeding which is essential to establish a good milk supply in the first few weeks. I would avoid feeding him at night because I was exhausted when actually i shouldve been feeding him in the nights when the prolactin levels are better (to aid milk production).
I learnt these basics of breastfeeding only in the 4th week as Prakash, my partner and I began educating ourselves since Abir had not put on his birth weight and was looking rather skinny. Many of the other basic norms to facilitate breastfeeding had also been flouted. For instance, we top fed him with a bottle – leading to possible flow preference (the breast can never match the flow of a bottle nipple). Also, I switched breasts from one to another looking at the clock rather than the baby. Not letting the baby finish on one side and access the hind milk which is more fattier was also problematic. Once we understood the fundamentals of it at six weeks we got Abir off the bottle and any top feed (though it was minimal in quantity – about an ounce a day – in the first place). For the next few weeks Abir was on exclusive breastfeeding. Breastfeeding if going well can be an empowering experience – that my baby needed me to provide nutrition and I was able to give him what he needs made me feel good. The pressure to top feed continued from family and friends – clearly on the grounds that Abir's weight gain was still poor through out. But I kept trying to convince everybody that he was okay as long as he was pooping and peeing. If there was output it means there was something going in. But the fact that the amount consumed cannot be seen in case of breastfeeding was making everyone anxious, especially my mother.
Through long discussions with my mother I learnt that I was formula fed as well. This was in the 70s and formula feeding was just emerging as the trend in the west. I was born in Oman, a middle eastern country and this was the time when the exposure to the western markets had begun. An American doctor had given our family the advice that formula was 'good' for the baby. 'Cerelac', another gimmick from the western world, was also given to us as baby food. Other practices that came from the west and were adopted by the upper and middle class families initially in other parts of the world and later in India included - early weaning from breastfeeding because it was “inappropriate” to breastfeed a toddler. Or it was 'wrong' to breast feed in public – these ideas clearly came from the 'developed' world and have been adopted by urban Indian families. (On the other hand, Prakash my partner who was also born in the 70s in a village in Uttarakhand in the same decade as me breastfed for four years! A clear indicator that breastfeeding for as long as there was milk was a common trend across rural India and still is).
My mother tried to pass on some of her 'knowledge' even in the face of complete dismissal by me. While I had been rejecting a lot of the family norms for many years now, this time it was not easy – because there was a baby involved and I was up against my mother who had reared three children. It was most difficult to resist her ideas because she was otherwise a tremendous support at this hectic time of my life and I know I ended up hurting her everytime I refused to follow her advice.
This was the time that I got in touch with Yasmin, a La Leche League (LLL) leader. I found a mention of LLL (an international organisation that promotes breastfeeding) in almost every breastfeeding website and article I read and wondered if they had any lactation consultants in India. I was lucky to find Yasmin through this who from then on became my guide and confidant to deal with my breastfeeding challenges. She introduced me to many new ideas and with her help I was able redefine breastfeeding success when at 3 months Abir started getting extremely fussy and impatient during feeds. It was apparent that my milk was not sufficing and the flow was too slow for him. After much angst and three doctors diagnosing him with 'failure to thrive' I had to start supplementing with formula. With each bottle of formula my milk supply dwindled and so did my motivation. The only thing that was on the rise was anxiety becuase by 3.5 months Abir was feeding only once at night at the breast until one night he refused to breast feed even at night. He just wanted the bottle!
I chewed Yasmin's brains and read up all I could to figure out the problem that Abir and I were having. Why was the supply not building? There were too many possibilities – that our BF did not start off at the right note, that Abir had a upper lip tie which made latching on difficult, that I had hypoplastic breasts or Insufficient Glandular Tissue (which makes for low milk supply). My life was now revolving around Abir's weight gain and breastfeeding – perhaps to the point of obsession. I travelled across to Shimla and then to Delhi. I got the lip tie fixed and rented a hospital grade pump to increase my supply. I downed more than a kg of methi (fenugreek – a galactogogue) in the last few weeks.
Am not sure how I finally came to terms with the fact that after all this I still had to formula feed Abir. I think time handled some of it. But I have to give credit to Yasmin for introducing me to 'supplementing at the breast' (SNS or supplemental nursing system), which played a critical role in relaxing me and letting go of the high standards I set for myself. I remember I first read about it and laughed and said “These Americans will go to any length to feel good about themselves”. I guess it was reverse snobbery on my part! I was resistant to the idea at first - I mean why would I put my baby to the breast and then feed him formula/pumped milk with a tube? If the source is the bottle then let the baby have the bottle, no? I felt I was fooling myself and Abir. But that was on day one. I must credit Prakash who constantly urged me to use the SNS – he saw the practical aspects of it which I dint. He saw that Abir was back to the breast, his sucking had improved and believed that he was getting my milk even while I was using the feeding tube. I soon found that Prakash was right but my biggest realisation was that the closeness and bond I felt when Abir's tiny hands held on to me and he closed his eyes and sucked intently, was giving us both something emotionally and using the SNS had helped re-establish that relationship. Abir knew no other way of relating to me in the first three months and the bottle had temporarily interrupted that relating. I understood what Yasmin meant everytime she said “Breastfeeding is not just about the breastmilk”. By day 3 of trying the SNS I was feeding and supplementing Abir at the breast only. I got a hang of using the tube and I could insert it in my sleep even. Put together with the pumping this was our best shot at giving Abir the nourishment he deserved.
Up until Abir was 6 months old I was going strong with the use of SNS and the pump (with which I had a love hate relationship). But the day I started Abir on solid food he took to it like fish takes to water. Its been great offering him a variety of coarse cereals, vegetables and fruits and he is finally gaining weight. I still breastfeed him about 4 times a day though he's probably just getting enough to quench his thirst or provide him the much needed comfort after his hectic explorations. Am not sure till when I can sustain the breastfeeding relationship. I dream of it lasting till Abir expresses his need for it.... but am not placing a benchmark this time – so that letting go is easier.
The journey so far has taught me a lot. While Im proud of my perserverance I am also re-thinking on the ideals that I have formed, the pressure I put myself under (not to mention others) to live up to those and whether I can do the same now that I am responsible for another soul. 'Personal is political' is the principle that ought to be followed – but how does one deal with the emotional turmoil involved... how can I continue to follow this principle and find more creative ways of doing it? As I slowly get back to work and start seeing myself in the bigger picture, it comes to me... the merging of my multiple identities with a new identity – of being a Mother. An identity which has brought with it not just newer ideals but also newer ideas. There is another life to evolve and share these with and a fresh chance to grow up, once again.
Manshi Asher is a mother and an environmental activist. She lives in Palampur, a Himalayan town in India. She can be contacted on firstname.lastname@example.org