Birth on the Threshold. Cecilia Van Hollen
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for most of his life. He told me about changes in childbirth practices which he had witnessed during his lifetime.
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When Murugesan himself was born, a maruttuvacci (midwife) from the nearby village of Navallur assisted with his mother’s delivery and continued to come to their house to help his mother for fifteen days following the delivery. Murugesan explained that the maruttuvaccis in those days were very knowledgeable about children’s diseases like māntam (infant indigestion) and i
Murugesan himself had had nine children, of which only three had survived. His first wife had had two children but only one survived, and that wife died in childbirth. The second wife, who was his first wife’s younger sister, had had seven children and only two of those children survived. All of the children had died before they reached the age of three, and most died within one year. The first child of the first wife was born at home with a maruttuvacci and died after 28 days. The second baby was also born at home and six days later his wife got janni (fits with a fever; in childbirth this often refers to tetanus). The people in the community thought that she was possessed by some spirits and they called the maruttuvacci to provide a cure. The maruttuvacci gave his wife a janni tablet along with cukku (dried ginger). But this did not cure his wife and her condition was deteriorating rapidly. It was decided that since the situation was so dire it was necessary to take his wife to Kasthurba Gandhi Hospital in Madras.
There was no main road to Madras in those days and therefore no buses. The journey was long and arduous so people did not consider going to the Madras hospitals when a woman’s labor began. Only if an emergency arose would they make the voyage as they did with Murugesan’s wife. It was 9 P.M. when they strapped her onto a board and transported her by bullock-cart to the canal. It was December and the night was cold. At the canal they boarded a small sailboat and sailed to Thiruvanmiyur. It took seven hours to reach Thiruvanmiyur from Kaanathur. From Thiruvanmiyur they went by horse-cart to Adyar. And from Adyar they could take a bus to Kasthurba Gandhi Hospital. They reached the hospital at 7:30 A.M. There was a doctor there who attended to them. The baby survived but his wife died in the hospital two days later. That was in 1952. It had taken them ten and a half hours to reach Kasthurba Gandhi Hospital from Kaanathur. In 1995 they could travel that distance within an hour.
His second wife’s first child was born in the Andhra Sabha Hospital near the Adyar bridge in Madras. They had gone to the hospital in advance to avoid the complications which his first wife faced. That baby died from diarrhea after ten days at home where they were treating him with nā
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Murugesan and others of his generation all told me that before the bus route had been established in the 1960s almost all deliveries in the area took place in the home and were assisted by a maruttuvacci. Only in extreme emergencies were women, like Murugesan’s first wife, transported to Madras for hospital attention. It was because of the death of his first wife and the deaths of so many of his children born by his second wife that they had taken the trouble to have three of her deliveries in the hospital in Madras. Murugesan came from one of the wealthier families in Reddikuppam and had received more education than others in the community at the time. He said that his wives’ visits to the hospitals in Madras were unusual within the community, where most could not afford the time and money required for these trips.
Everyone told me that since the road had been laid and the buses had begun to ply this route, women were all “running to the hospital for deliveries.” In fact this was not quite true. What was no doubt true was that there had been a marked increase in the number of women traveling to hospitals for deliveries. But many women I met in 1995 had had their deliveries at home. I decided to gather some statistics on the delivery sites for women in this area during the time of my research.
Based on the records of the Kaanathur Voluntary Health Services mini-health-center and the ICDS balwadis in both Kaanathur and Reddikuppam for the period from November 1994 to November 1995, I found that the total number of deliveries during this time period for the whole Kaanathur-Reddikuppam area (including Bilal Nagar) was sixty-one. Of these, twenty-nine were home deliveries, thirty-one were hospital deliveries, and one was unknown. As these records indicate, slightly less than 50 percent of the deliveries took place at home, and slightly more than 50 percent occurred in a hospital. These numbers clearly represent a region going through a transition with regard to maternal health care. In Nochikuppam, Madras, on the other hand, there were no home deliveries at all during 1995.
These two communities—Nochikuppam and Kaanathur-Reddikuppam—are similar and different in ways that are important for understanding women’s experiences during childbirth. Both were, for the most part, poor communities which relied heavily on government-subsidized support for many aspects of life, including maternal and child health care. Both also received NGO support for MCH services. Both were comprised primarily of a combination of Hindu Pattinavars engaged in fishing and “scheduled caste” Hindus engaged in wage labor in the informal sector.
The major differences between these two communities as far as this study is concerned was that Nochikuppam was located right in the city of Madras and women had had easy access to government-subsidized MCH care in the city for a few generations. Furthermore, the government had been actively working to prevent home births from occurring in urban centers. For women in Kaanathur-Reddikuppam, however, this access had been greatly restricted until the 1960s, and there had not been such an active effort on the part of the government to prevent home births in the rural regions.
Because of their similar class and caste backgrounds, women from both these communities faced many of the same difficulties and forms of discrimination in government maternity wards during childbirth, which will be discussed. The women from Nochikuppam had few means of circumventing this discrimination, since home birth was no longer considered a viable option. Women in Kaanathur-Reddikuppam, however, sometimes chose to remain home for their deliveries to avoid the discrimination they faced in the government maternity wards. But they were demanding new birth practices in their homes which incorporated those elements of allopathic MCH care which they considered to be beneficial.
FIELDWORK, FRIENDS, AND FAMILY
My research consisted primarily of structured and unstructured interviews with over seventy pregnant and postpartum women and their families in their homes and in public maternity wards. Most of these interviews were tape-recorded, transcribed, and translated with the help of research assistants. Those interviews that were not tape-recorded were recorded with notes on-site. I also interviewed a range of medical practitioners, including doctors, nurses, hospital ayahs,63 both governmental and nongovernmental female multipurpose health workers (MPHWs),64 and local midwives. And I observed interactions between these workers and their patients in hospitals and homes. (See Appendix I for samples of the questionnaires used for these interviews.) In addition to observing medical procedures in hospitals and discussing childbirth in homes and hospitals, I also had the opportunity to observe, and in some cases videotape, pregnancy and postpartum