In a remarkable milestone for maternal healthcare, Telangana has emerged as the first state in India to successfully implement a midwifery program, setting a shining example for the rest of the country. The significance of this achievement was felt profoundly when a newborn took its first breath in the world. The midwife responsible for this natural delivery, Swaroopa Rani, breathed a sigh of relief. The labour room at District Hospital Khammam had been tense as the mother arrived in an emergency, but thanks to Swaroopa's training, a surgical intervention was averted.

Swaroopa is part of the inaugural group of midwives who received specialised training through the Fernandez Foundation's Nurse Practitioner Midwifery Programme (NPM), a collaboration between the Telangana government and UNICEF. This program aimed to tackle the high rate of unnecessary caesarean (C-section) deliveries in the state, which accounted for 60% of all births, as revealed by the National Family Health Survey (NFHS-5) data from 2019-20. Many of these C-sections were performed without medical necessity, often driven by superstitions about auspicious timing, cultural beliefs, and profit motives in private hospitals.

A Health Management Information System (HMIS) report from January indicated a decrease in C-section deliveries. However, the rate still remained high at 54.09% in 2021-22, more than double the national average of 23%. The World Health Organization recommends a rate of 10% to 15% for C-section deliveries, highlighting the vital role midwives play in reducing this prevalence.

Telangana's journey toward successful midwifery implementation offers valuable lessons for the nation. District Hospital Khammam boasts a team of seven midwives, ensuring at least one is available during each shift. These midwives go beyond delivering babies; they offer exercise classes for outpatients and promote natural birthing positions when possible. However, some facilities still face challenges, like space constraints and lack of necessary supplies.

While DH Khammam has separate labour rooms, other healthcare facilities like Nampally Area Hospital, Modern Government Maternity Hospital in Hyderabad, and the Community Health Center (CHC) in Khammam struggle with limited space and resources. Ideally, husbands should be allowed to accompany their wives during childbirth, as it can reduce the mother's pain. However, the setup in many places hinders this practice.

The CHC, serving coal mine workers and their families, employs only one gynaecologist. After the doctor's shift, midwives handle deliveries, often successfully converting cases that might have required C-sections into natural births. These midwives have even performed Vaginal Birth After Caesarean (VBAC) deliveries, a procedure considered risky and typically avoided by doctors.

However, VBAC cases often get transferred to doctors, depriving many women of the opportunity for natural deliveries. Telangana has seen a notable shift toward a more equitable balance between natural and C-section deliveries, but improvements are still needed, especially in smaller health centres.

Despite challenges, midwives like Swaroopa and her colleagues are making a significant impact on Telangana's maternal healthcare. They are bridging gaps in regions with a shortage of doctors and providing respectful maternity care, a stark contrast to past mistreatments in labour rooms.

In rural areas, midwives face additional challenges, such as dealing with complex home delivery cases and respecting tribal traditions. Their dedication to improving maternal and child health is undeniable, even in the face of limited infrastructure and resources.

As Telangana leads the way in midwifery, the rest of India has a lot to learn from their pioneering efforts. The success of this program offers hope for safer and more accessible childbirth experiences for women across the country. The opening of new healthcare centres and continued support for midwives are crucial steps in this journey towards better maternal healthcare for all