We are there to hear their cries. The moans of their frail mother, Shanti Lata Sahu, as she whines weakly through 17 hours of labour. Her shrill screams as she writhes in the delivery room. Her helpless shrieks as the pain tears through her. We hear the doctors who doubt whether both the twins will live. The nurses who cluck in worry each time the stethoscope prods Shanti’s bloated stomach, striving to pick up the heartbeat of either foetus: "The babies are small, the mother’s weak. Undernourished anaemic mothers giving birth to dead or dying babies is common here..."
Here, in Orissa. Where the infant mortality rate has been the highest in India for over two decades, where nine out of every 100 children still die during or within 12 months of birth according to the latest Sample Registration System statistics. Dirt, disease, deprivation, botched-up deliveries devour babies routinely. And much more voraciously so in the backward, southwestern belt of Orissa, in districts like Ganjam. Where 22-year-old Shanti Lata Sahu, wife of driver Babu Sahu, lies in Behrampur’s Christian Hospital, in labour that could well be fruitless.
Stained sheets, creaky beds, walls with peeling paint, squalid floors, crowded wards...Christian Hospital hardly seems a safe haven for newborns, but its large force of doctors instils confidence. Matter-of-fact, the medics bustle about their business, shouting down a screaming mother in labour, shooing away sweaty relatives from the labour ward, delivering babies round the clock. But Shanti has already borne a dead child just a year ago. Only to find herself burdened with another pregnancy—her second in under three years of marriage. A pregnancy that stuck unhealthily on to her emaciated frame like a malnourished child’s swollen stomach. And now, in its last stage, a pregnancy that has bred more fears in her than hope. She groans out the fears all during labour: "All this pain for nothing. I’ve been through this before, nothing comes of it."
On his rounds in the labour ward, Dr M.K. Nanda, medical superintendent at the hospital, would like to assure Shanti of the safe birth of her twins with more conviction than he does. Instead, cursory words of comfort over, he rushes out of Shanti’s earshot to list out the problems with her pregnancy: "Bad obstetric history, no pre-natal check-ups, chronic weakness and anaemia because of her bad dietary habits, extremely underweight babies. The probabilities of still-birth, or the infants being born with abnormalities are high." There are many more cases like Shanti’s in the hospital. "So many women who’ve come to deliver their babies at the hospital have done so only after they’ve had one or more infants dying at birth."
Myths midwifed by ignorance keep families away from accessing medical help. Jacob Thundyil, president of Behrampur-based People’s Rural Education Movement, explains: "For instance, elders don’t allow expectant mothers to take iron and vitamin supplements prescribed by doctors during pregnancy. They believe that medicines make babies grow big in the womb and therefore difficult to deliver." Dr John Cherian Oomen, who works in Bissamcuttak in Orissa’s Rayagada district, has even more unbelievably archaic stories of birthing practices to tell the 21st century. In the tribal Kuvi Kondh families of Rayagada, he narrates, women continue to deliver babies in their damp, muddy, dirty backyards where goats are usually tied: "And once the mother’s membrane ruptures, she’s considered unclean, and has to self-deliver her child, including cutting the umbilical cord herself with a knife or a piece of pottery. Then, relatives count the number of spots in the baby’s oral cavity to give it a bath as many times every day, often killing the baby of hypothermia or pneumonia. Also, if a baby doesn’t cry or breathe at birth, it is laid aside as probably dead, resuscitation is not attempted traditionally."
Shanti then has already given her babies a better chance at living by insisting she would deliver in a hospital. "She wouldn’t hear of giving birth without doctors around," recalls husband Babu Sahu, nervously awaiting the birth of his babies outside the labour room. If the delivery is successful this time, if his children live through their birth, "even if they are both girls", Sahu swears he’ll get a vasectomy done: "I just want two children, I want them to be healthy and alive."
Inside the sparse delivery room, meanwhile, the battle for life has just begun. Lying on a very basic, very hard delivery table, her legs buckled to two iron rods on both sides of the table, Shanti looks like she’s in a horizontal squat. Weakened by her protracted labour, she seems to have exhausted all energy to push her babies out into the world. In excruciating pain, pale and panic-stricken, she shouts and shouts that they’ll die. Like her first-born.
Till a life force larger than Shanti’s fatigue and her fears takes over. And riding on it, a tiny little head bobs out: Shanti’s daughter. Just a little over 1,800 grams, pink and wrinkled, alive and kicking. Bringing with her a trace of smile on her mother’s face. Till the next wave of pain rises, and rises again, and again. And on its crest, it brings a boy tinier than Shanti’s daughter: Shanti’s son. Barely 1,400 grams, crumpled skin, little bones, and sheer resilience.
And as their mother’s body coughs up the placentas that have been their home for nine months, the twins ready themselves to meet up with her. They howl, are cleaned, oiled, wrapped, and brought to Shanti. "Very small," she whimpers. "Very small."
The next day, they seem even smaller in the neo-natal nursery. But stronger, even more determined to take on life. "No complications," says the paediatrician. "Now one just has to hope that once at home turmeric water, bitter gourd juice, goat’s milk and suchlike aren’t shoved down their throats." It is seen fit for Shanti to be wheeled in to breastfeed her daughter; her son though is still too small, too weak yet to suck. "But they’ll grow," Shanti consoles her anxious mother, "Don’t worry, they’ll be well." And thrive. For these babies have survived birth in a nation where so many children don’t. They must live.
