Nagaland
Dr. Y. Simpson
Department of Developmental Paediatrics, Christian Institute of Health Sciences and Research
Nunpuia (Name changed) is 8-year-old boy who was second born among two children in the family. He was brought with the complaints of poor speech and language development, poor attention and concentration and less stability in walking. He was assessed and diagnosed to have severe level of developmental disability, seizure disorder and residual cerebral palsy. He was delivered at home under the supervision of a midwife. His birth history revealed that his disability was caused by birth hypoxia due to breach presentation and prolonged labour. Family members were shocked to hear about the permanentandsevere level of disability that will persist for the rest of his life. It was too late for them to realize that his brain damage could have been averted if he was delivered in a hospital with emergency care.
Child birth is a unique and memorable experience for all women. It is life’s most wondrous moments. The mother as well as the family members encounter new symptoms of physical and emotional experiences. The umbilical cord is cut and clamped soon after the baby is delivered. This makes the baby independent of oxygen and nutrition supply from the mother.
Majority of rural mothers deliver their babies at home. Of those who deliver in institutions may be in rural clinics, Government sub centers, Community Health Centers, Primary Health centers, district Government Hospitals or in the Private Hospitals. Antenatal care is not accessible most often to the rural mothers.
The Government shows lots of effort to offer free maternal services in India. Yet, many mothers in rural areas deliver their babies at home. Factors such as long distance from home to the nearest health facility, lack of transportation, poor road conditions, poor economic factors, cultural factors, lack of knowledge about obstetrics care,inadequate knowledge on pregnancy related problems, lack of antenatal care, low level of maternal education, as well as demand from obstetricians to go for caesarean section are few of the common reasons why pregnant women prefers home delivery.
Although mothers have the right to choose where they want to deliver the baby, it is important to consider the potential dangers of delivering babies at home. Many infants die due to maternal causes amongst mothers who deliver at home. The causes for infant deaths(mortality) or other infant related complications are often due to breach presentation, premature delivery, birth hypoxia, infections, birth injuries and other related conditions.
One of the unpredictable complications that can result from birth hypoxia is meconium aspiration. This is suspected when there is meconium stain amniotic fluid at the time of delivery (Amniotic fluid is the clear fluid which comes out along with the baby during delivery- also called birth water). During hypoxic conditions. the baby experiences bowel movement inside the mother’s womb and the contents of the bowels is expelled out into the amniotic sac. These contents mixes with the amniotic fluid and there is a chance for the baby to inhale it. Once the baby is delivered, the baby has to breath by himself. But if the baby has inhaled the meconium, the baby’s breathing will be blocked (birth hypoxia) by the meconiumresulting in brain damage to the baby.
Another condition that can arise during delivery is placental abruptioni.e. separation of the placenta from the mother’s womb before the baby is born. This is dangerous because the baby’s sole supply of oxygen is through the blood flow from the placentavia the blood vessels in the umbilical cord from the mother. This will lead to disruption of blood supply to the baby and this in turn will cause breathing difficulty in the baby due to lack of blood supply. This can cause damage to the brain cells and the baby may be affected with physical or intellectual disability. Cigarette smoking, hypertension in mother and multiple pregnancies are some of the causes for placental abruption. If it is not recognized quickly, it can result in the death of the mother or baby too.
One more condition that occurs during child birth is the umbilical cord prolapse. The umbilical cord slips in to the birth canal before the baby is delivered.The pressure exerted by the baby during delivery compresses the umbilical cord which in turn will prevent oxygen supply to the baby resulting in brain damage.
Another rare condition is umbilical cord knots or cord around the neck. These conditions are equally dangerous for the baby.Breech position of the baby is another condition in which the baby who face the wrong way in the womb. This also can lead on to oxygen starvation to the baby. Babies born after the due dates (post term delivery-born after 41 weeks) are also prone to birth hypoxia.A similar kind of danger a baby faces is premature birth (Born before 37 weeks)and is at the risk of many complications besides what has been stated already.
Though most home births are safe, not all births are uneventful and the risk of long-term disability has not been adequately addressedby medical professionals in our country. All mothers have the right to choose the place of delivery, but it is very important to be aware of the potential dangers and risks to the baby delivered at home. When complications such as above conditions occur, the home conditions will not be suitable to manage any emergencies.
Birth hypoxia can cause problems such as seizures, cerebral palsy, Intellectual Disability and various other conditions that may cause lifelong problem in the child. When the baby is delivered in the hospital, supplemental oxygen may be beneficial to save the baby from neurological problems, seizures and other permanent disabilities.
Following is the data from Christian Institute of Health Sciences and Research about children who were assessed with different forms of Intellectual and Developmental Disabilities (IDD) for the period from June 2014 to February 2018:
The above data shows that about 33.24% of the babies had birth hypoxia and 23.05% with seizure disorder and 20.38 % of them with Cerebral Palsy. According to the National Family Health Survey of 2015-16, about 99 percentage of children from Kerala, Pondicherry and Tamil Nadu are delivered in hospital while only 32.8 percentage in Nagaland which is last among whole of other 28 states in India. When a baby is born with hypoxic brain injury, immediate treatment from a hospital is crucial to save the babies brain from neurological deficits.Most maternal and neonatal dangers could be prevented if all women delivered their babies in settings where emergency obstetric care to both mothers and babies is available in case of complications.
Seventy percent of birth defects are preventable through appropriate antenatal care and obstetric care from hospital. India being the second most populous country with a large number infant born annually with birth defects, should focus its attention on strategies for control of preventable birth defects.
