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BIHAR WORKSHOP 1 SYNOPTIC REPORT

Dates: 22-24, April 1997

Venue: Mahila Jagriti Kendra, Gomia, Bihar.

Participants: 28 dais (from Khamra Basti, Bela Tand, Kodva Tand, Bengali Tola, Lalpaniya, Karmathia Basti, Devipur and Hussirmian Bagh)

1 Family Planning worker
1 ANM
7 members of Mahila Jagriti Kendra and Mahila Samakhya
4 Matrika members
 

Activities

Sessions During Workshop:

Day 1 -- 22.8.97: Personal and group introductions by all participants
Role-plays on childbirth (small groups, sharing in large group)

Day 2 -- 23.4.97: Identification of Complications and Handling of Complications

Day 3 -- 24.4.97: Discussion on Rituals and Practices

  1. Knowledge, Skills and Practices Before Birth
    1. The dai comes whenever she is called -- be it day or night, has no fixed times (like nurse or doctor).
    2. When she arrives, she washes her hands.
    3. She feels the stomach, if it is hard there is still time for birth, if soft the baby is due soon.
    4. She sees how much the cervix has opened.
    5. sees whether or not the baby has moved down.
    6. Some dais tell the woman to have a bath, some do not. She washes the woman's hands and feet.
    7. If the baby is due soon the dai begins to massage the stomach with oil (sontna).
    8. She presses the hands and feet.
    9. The dai checks the position of the baby by pouring oil on the prasauti's navel. If it falls straight, the baby is straight, if it falls terha (crooked or transverse), the baby is terha.
    10. The dai keeps oil near the bed.
    11. If there is discharge of water and a little blood there is no cause for concern.
    12. If the bag of water bursts, but pains are not speeding up, the dai gives her milkless tea, or warm saline water, to drink.
    13. The dai gives hot fomentation, by placing heated coal below waist area, wrapped in cloth.
    14. Dai gives tea or kaarha to drink, and feeds the prasauti `hot' foods like khichri so she gets strength to push.
    15. Some dais said if the cervix is not dilated after 12 hours of labour, the jacha is taken to the doctor (however this seems to be true in theory more than practice, since a number of dais report never having sent a woman to the doctor). Other dais said that if labour is prolonged over five days, then there is cause for concern. The dais all are aware that the first child often takes a long time, but the next ones are born quicker.
    16. Dais facilitate birth by requesting that all knots, locks, boxes in the room are opened up.
    17. The dai may facilitate birth by calling in a relative who may have had some conflict with the birthing woman ("The dai asked me to come and sit in the room when my bhabi was giving birth, the birth was delayed but after I came in the baby came quickly... The dai said she must have been hiding something from me...": Saroja. Or, the saas’ toe is dipped in water and the prasauti has to drink that water....). [This may be interpreted as an `untying of knots' at an emotional/psychological level.]
    18. If labour is continuing for long, the dai or a family member draws water from the well with one hand, keeps it in a bowl (katori). The ojha -- medicine-man -- is called. First he sends water, often after drinking this the woman gets her labour pains. If not, he is sent for, he comes and blows a mantra meaning `go, go' to the evil spirit that is obstructing the birth. He mixes water, salt and mud with his left hand and gives the paste to the prasauti to drink. The nanad is made to knock at the door 5 times, and told to draw 5 parallel lines on the mud of the threshold; saas is told to put water and mud in water pot, dip her foot in this, and the prasauti has to drink it.
    19. Water may be poured over dehri (threshold) and collected. Saas dips her finger in it and prasauti drinks it.
    20. Latalatiya grass and other herbs may be put in her hair.
    21. Dai prays to the devi, to God, to Dharti Ma, Durga Ma: requesting their support at this time.
    22. The women of the house also do puja and pray.
    23. Some dais take the name of their own peehar (natal home).
    24. If evil eye (nazar) has been cast, they abuse the dayan so as to ward off the evil eye (abuses such as saali, haramzadi, randi).
    25. Parsad (sacred food offering) is offered.
    26. The dai deals lovingly with the prasauti ("She explains affectionately, tells us to take strength, to push only when she tells us...).
    27. The dai may put in her hand to feel the mouth of the womb, also the `balloon' (amniotic sac?), to determine whether it's time for delivery.

  2. Knowledge, Skills and Practices During Birth
    1. Only when "the child is ready to come out", the dai tells her to push.
    2. Many dais put in hand to see when pains are pukka (hard contractions).
    3. The dai presses the amniotic sac, which doubles in size when the pains are faster, and bursts -- as the sac slips out, so does the baby.
    4. Some dais observe the woman begins to sweat, just before labour pains.
    5. When birth begins the dai uses her hands -- to put oil, water, massage the perineum.
    6. She tells her to sit, one person holds her from the back, dai supports from front. The woman is asked to lie down only if there is a lot of difficulty.
    7. If the woman is made to lie down, it is in a direction along the direction of the beam of the house, lengthwise.
    8. The dai sometimes pushes alongwith the prasauti.
    9. "The main word used by the dais is dhire, dhire, dhire, dhire..." (Andrienne, a Matrika member).
    10. Dais are conscious that during delivery their nails should not touch the prasauti's body.
    11. They see to it that coal is not burnt near the woman, because it is believed that if she sees smoke from burning coal during her delivery, the child would develop epilepsy.
    12. The dai salutes (does pranam to) Dharti Ma, for it is believed that it is the earth that is giving birth to the child. The saas too will pray. ("Dharti Ma is like a mother. Like a mother gives birth, the Earth also gives birth. We pray to Dharti Ma by touching the Earth with our hands, and do puja and keep her in our minds.
    13. If the prasauti screams, the dai tells her not to, because everyone will hear, including sasur (father-in-law) and neighbours. The saas may even slap the prasauti. Both dai and saas explain to her that she should use her strength and it is good she is at home ("at home no one will see, if you had been in hospital the doctor would hang up your legs and hands and see everything.")
    14. If the woman is not pushing the dai speaks to her, coaxes, even threatens and scares her, gives her a drink.
    15. The dai may do maalish, press her feet against the prasauti's buttocks and ask her to push, saying "It will get born, use your strength...".
    16. The baby's head moves down, and birth takes place.
    17. If the baby is not moving down, the dai may pull with her hand. However, most dais said they do not use their hands to pull, rather they let the baby come out on its own.
    18. There are reports of women birthing on their own, without a dai even. (Lisa's experience of being present when a woman gave birth in a railway compartment, and Lisa had to help by cutting the cord....Another woman said, "My mami has her children all by herself.").

  3. Knowledge, Skills and Practices After Birth
    1. After birth of the baby the placenta is to be delivered. The dai keeps the stomach pressed to prevent placenta from moving up.
    2. To facilitate delivery of the placenta, the dai does massage, and may get the woman to gag (with hair in her mouth). She may even put in her hand and pull it out. [This was criticised by the NGO worker as often the placenta is pulled too hard. Similarly, massage is sometimes too hard.]
    3. If the baby is not active or does not cry then the dai rubs the cord, placing a coin or rice grain underneath it. By rubbing, heat passes to the baby. The baby often revives. This resuscitation may also be done by rubbing the navel, and burning the placenta in a fire.
    4. The cord is cut only after placenta delivery, and after the child cries. If cord is cut before placenta is out it is harmful for the prasauti, because the placenta (phool) may go up and affect the liver.
    5. Nowadays dais use a new sterilised blade to cut the cord, while earlier they used an iron knife heated over fire.
    6. The dai makes the prasauti stand against a wall with her arms stretched upwards, then the dai puts her head hard against the prasauti's stomach, to help all the blood come out.
    7. The child is shown to the father. He gives rasm (ritual gift/money) to the dai.
    8. The baby is cleaned, bathed (or water sprinkled on), wrapped up, baby's tongue is pressed so that he will talk, then fed milk with deer-antler powder rubbed in it; or goat's milk administered with a cloth; or garlic.
    9. The mother is cleaned up, her blood-stained clothes changed, her hands and face washed, given hot fomentation by placing a kulhar on a leaf, on the stomach. She is then allowed to sleep. Her back is pressed with feet. The baby may be given in her lap.
    10. The mother is fed after a few hours --tea or milk, with bread. She is given food in a leaf-plate for the first few days, from far. The dai is the only one who can touch her, until Chhati.
    11. The baby is put to the breast after 5 or 6 hours of birth. The dai teaches her how to breastfeed if she doesn't already know.
    12. Meanwhile the dai buries the cord and placenta, in cowdung or in the ground. If the cord is buried deep, the next child will be born after a long gap.
    13. If the dai were to give some blood from placenta to a barren woman, that woman will conceive a child, but the first woman will never have another child.
    14. The dai applies oil for six days, feeds the woman, gives her ajwain water, foments with arandi leaves, and ties waist with a cloth.
    15. The dai gives ghunti ( a nourishing drink) to the child every week.
    16. The dai looks after mother and child intensively for about six days. Then, Chhati is performed.
    17. If the placenta did not fall out spontaneously, the dai looks after the mother for nine days, not six.
    18. A woman should rest for several days after delivery but the exact period she is made to lie down differs depending on her state of health and the requirements of her household.
    19. On the third day after delivery, halwa is distributed in the village.
    20. The dai goes to her own home soon after the delivery, but comes regularly everyday for the next few days.
    21. On Chhati, the mother and child's bedding is picked up, the dai is given neg (gift/money), and there is samdhi milan. [See Bihar Workshop 2 report for details].

  4. Complications Before, During and After Birth
    1. If a child is transverse usually the dai may say the woman should be taken to the doctor. However, one dai said she is able to turn a terha baby to the correct position.
    2. If the baby is ulta (breech) the dai turns it around to seedha position. By the fifth or sixth month a dai knows the baby's position, and is able to turn it by massaging (sontna).
    3. If a woman is so weak she cannot push she may be directed to a doctor. However, this does not seem to have happened much. The compounder or nurse may be called in to give injection -- this too does not seem to have happened much.
    4. If labour pains do not start, although the baby has moved down, the nurse may be called to give injection.
    5. However, typically the dai performs a number of facilitation techniques (described in 1 above), which are supportive of the mother and usually prove sufficient to induce the labour pains.
    6. The dai acquaints herself with any specific causes that the woman is "not opening up" -- it may be that it is an illegitimate child; a dai describes that once the woman had eloped against her parent's wishes, and it was only after the father came to the house and met her, that she was able to deliver her baby.
    7. If the mother's cervix is too small, it is potentially dangerous for both mother and child, the child may die during labour and the mother may become listless. The dai feeds the mother, then rubs her cervix with mustard oil or ghee, massaging until its size increases. This is more likely to happen with a younger woman.
    8. A dry labour can be difficult. Putting specific herbs under her pillow helps.
    9. During labour, if the head is big the neck may get stuck, the dai pulls it out with her hand.
    10. If the baby is not moving around when in the womb, help may be required. However dais report having themselves delivered already-dead babies.
    11. If the cord is around the baby's neck during delivery, a dai will hold it with her hand, a little away from the neck, and gradually loosen it as the head emerges.
    12. Dais are confident about delivering twins, and most have done so.
    13. A number of dais have handled delivery of a handicapped child.
    14. If the baby, once born, is not active, the placenta may be heated as a resuscitation device.
    15. If the baby is breathing but not crying, it is put into lukewarm water: it sneezes, then breathes.
    16. If a baby is premature, it is well looked after immediately after delivery and over the next few days/weeks. It is wrapped up in cotton or woollen clothes and never exposed to wind. It is massaged several times a day. It is kept near a fire to warm it. The mother takes out breastmilk and gives it to the child in a spoon.
    17. If water is coming out of the baby's nose, the doctor may be called and tetanus injection given.
    18. If the placenta delivery is obstructed, the dai may decide, after attempting milder methods, to put in her hand and pull it out. Daisi who have done this report no incidence of broken cord, or haemorrhage.
    19. Dais are confident that they can handle extremely complicated and difficult deliveries ("..no child has died in my hands"...).
    20. In situations of complication and delay, often a dai may call in one other dai for assistance and support in handling the case.
    21. In situations of complication and delay, the dai relies on her own experience, the grace of the devi, and the strength of the prasauti -- Said one, "There is no other way one can see. We have gone to earn, and now, here it is a matter of life and death that we are faced with...."

  5. Understanding of the Body, Health and Disease [see Bihar workshop - 2].

  6. Health Delivery and Referral Networks
    1. In Gomia, the dais are Harijans and even the Santhali women call them for deliveries.
    2. There are a few doctors, ANMs and compounder in Gomia, a Mission Hospital run by the Mahila Jagriti Kendra, and a hospital attached to the Indian Explosives Limited (for its employees). The hospital at Hazaribagh is supposed to be good.
    3. According to an MJS worker who has had 5 deliveries in the IEL hospital, she goes to hospital only because her husband, being an employee of IEL, has access to free delivery for her, and this leaves him `free' from responsibility; she herself would prefer home delivery, because i) the hospital bed is very narrow and I can't push there; ii) the mother is neglected after birth, only the baby is looked after, while at home a dai looks after both mother and baby; iii) in the hospital the doctors and nurses do not wait, like a dai does; iv) in hospital a cut is made (episiotomy); v) injections are given in hospital; vi) the nurses abuse verbally -- neither nurse nor doctor has a humane attitude, treat the women like animals...;vii) the nurse doesn't come even when called.
    4. Another MJS worker reported that during her childbirth in a private nursing home in Gomia, "the nurse tied my hands and feet to bed with my sari pallu, then said, Push!...How could I push?!"
    5. Dais noted that they have never faced death due to a complication they could not handle. Rather, they exercise their judgement and, if they see a complication they cannot handle, they advise the family to take her to a doctor. If there has been a delay in this, it is on the part of the family, not on their part.
    6. Harijan dais are called in by the Santhalis too. Among the middle and higher castes, the jajmani system prevails whereby each dai has her fixed jajmans, she may have about 10 villages which are `hers'.
    7. [More on this category in Bihar workshop 2].

  7. Identity and Status of Dais
    1. Midwives in the area are uniformly low-caste (Chamarin or Chamain).
    2. They are uniformly poor. Rather than buy the bus tickets for the workshop, for instance, they walked sometimes ten miles. They were (initially and misguidedly) hoping for `jobs' as an outcome for the workshop.
    3. They are pursuing this as a caste-based hereditary occupation. It is learned from older women of the family -- sometimes dadi or mother, more often saas or gotni (elder sister-in-law).
    4. The occupation is regarded as low-status. Educated young women would rather not be associated with it. In the workshop, a striking example was presented by Saroja Das, a `Sahayogini' (Mahila Samakhya worker), who had been working with the Mahila Jagriti/ Mahila Samakhya set for several years, yet had never before revealed her caste-name (Das), or the fact that her own mother and dadi (paternal grandmother) are dais. [It is at the same time interesting that a woman's group should not have accessed such basic information about their own member].
    5. Although people come from far to call her for a delivery, yet a dai is looked down upon, doesn't have izzat (honour). As Saroja put it, the work of the dai interests her, but others do not treat that work with respect and therefore she chooses not to do it.
    6. Some dais are keen to teach their daughters or daughters-in-law, but lament that the younger women do not want to learn the work.
    7. Dais earn very little, and want their children to do better.
    8. Dais are feeling some competition from modern medicine and the modern system, and are keen to upgrade their own skills and knowledge. However, they have very few avenues for this in their present situation.
    9. Yet dais are respected for their knowledge and skills. As one sahayogini put it -- the dai uses her hands during delivery -- that is good." Women report feeling safe with and trusting the dai.
    10. Since a dai here attends a number of deliveries, as apprentice and helper, before beginning to handle the work independently, she builds up a stock of experience and skills which stands her in good stead over the next many years.
    11. People respect the goodness and wisdom of the dai, and know that although she herself is poor, yet she takes no money for deliveries in the home of the very poor.
    12. Many dais say they do the work out of sheer necessity. In the beginning, some report feeling fear and repulsion, while others report a growing confidence born of close observation of a number of deliveries.
    13. For her own delivery, the neighbouring dai is called, rather than one's own mother-in-law, due to sharam.
    14. The bond with the dai does not end with delivery, rather it continues over the years. Women come to her for a host of other ailments as well.
    15. Yet, because she uses her hands for this `dirty work', the dai herself is considered unclean.
    16. During delivery, she cannot go anywhere else in the house or touch anything else. After delivery, for the next few days, she is the only one who can touch the new mother, but she cannot touch anyone else or anything in the rest of the house. The cord-cutting is considered the dirtiest of the work, and this is something that is absolutely taboo for anyone else to do.
    17. [More on all this in Bihar workshop -2]


  8. Stories, Songs, Beliefs
    1. The dais sang Sohars -- birth-songs, associated largely with the birth of Krishna; and Jhoomars -- wedding-songs.
    2. There is a belief in dayans and the story goes that on Amavasya (no-moon) night all the dayans get together and dance -- feet backwards. One has left her baby and gone for this dance. Her husband asks the ojha to call her back. For this, he says, the ojha should hit her on her feet. He warned that if the ojha leaves his stick behind then he will come under the influence of the dayan. ...The ojha did as the man requested....
    3. "In Government Colony there is a dayan, local people harass her. People from the families of pregnant women come out an abuse her....
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