Innovation in Maternal Healthcare – Starts with a Chair in Bangladesh

Ishrat Jahan

Through a midwifery led center in Mirpur, the Developing Midwives Project is trying to change how women can experience childbirth – and it begins with a chair. 

Inside the winding pathways of Darrusalam, Dhaka, BRAC, among its various maternal and child healthcare interventions, has been operating a maternity center since the late 90s. For over a decade the center had become a part of the community, offering significant services to pregnant women, mothers and infants. Recently, the center has been reformed into the BRAC Midwifery Led Care (MLC) Centre by the Developing Midwives Project (DMP), in an effort to provide quality midwifery services at a low cost. The ethos behind the center was to expand the possibility of respectful maternal care within these community-based health delivery services, and to give women the knowledge and understanding that childbirth need not necessarily be traumatic and that the presence of their choice and agency in their own deliveries is important.

The MLC centre implements midwifery practices that focus on creating a holistic environment for childbirth, which currently include expanding their options of exercising and birthing positions during delivery by introducing the birthing ball and birthing chair.

The birthing chair

Within the maternity centre at Mirpur, the delivery room is a quaint space whose walls are covered with posters for rules of normal delivery, breastfeeding and proper midwife behavior during labour.  A quarter of the floor is taken up by a bed, where patients are usually lied down for examinations and deliveries, equipment are stored in autoclaved drums around room and the birthing chair, the room’s newest addition, is set up in the middle. The chair was introduced to the Mirpur maternity clinic in February 2018, and the midwives were trained on its facilitation. As of September 2018, the chair has been used to facilitate 130 deliveries in the upright birthing position, which is 40% of the total normal deliveries that has happened in the centre.

This chair, in midwifery’s terms, is recognized as a device that is shaped to assist a woman to give birth in an upright position. It is intended to provide balance and support and its current style supports the bottom of the women in labor and has a slender, sloped back for comfort and to allow midwives, who are positioned in front of the mother in labor, to support her. Often the arms of the chair have hand holds or arm rests for the mother to grip, to provide extra leverage.

The use of the birthing chair or similar devices has been seen around the globe, not isolated to a particular region. But even with its old albeit historical origins, the birthing chair and the upright position of birthing are much used and present model in childbirth. The benefits of giving birth upright has long since been recognized and incorporated into current childbirth practices in developed countries. Although many of the cited advantages are physical and physiological, increased comfort and increased responsiveness to the infant also have been reported in several studies from the North, where the chair had been ‘reintroduced’ in medical spaces around 1980s.  Case–control studies have found that their use may reduce the pain of childbirth, diminish perineal trauma, decrease the need for episiotomies, and increase the mother’s satisfaction with her birthing experience.

Why do we need a chair in maternal healthcare?

While birthing positions are contextual and varied if looked at with a more critical lens, the dominant narrative has increasingly been shaped within the medical space – hospitals and clinics. The established narrative of childbirth or delivery is pictured as: a woman within a medical space, laid down on her back being treated by doctors and nurses during her delivery and postpartum period. While it is a legitimate and common method for delivery, its greater adaption has increasingly sidelined alternative methods of childbirth, the recognition of a woman’s own participation in her childbirth and a shift from the preference of natural birth. Hospitals and clinics, over the years, have become the authoritative knowledge holder on childbirth and delivery practices.

But the use of the chair, at the MLC centre in Mirpur has challenged this notion. In introducing an alternate birthing positions, its impact has rippled beyond the clinic grounds into the community. The chair is an innovation in the context of Bangladesh. The institutionalized practice of putting women on their backs during delivery has, in one way or the other, been challenged by the DMP’s initiative to introduce alternate birthing positions. DMP’s efforts to introduce the birthing chair, as part of midwifery practices, within this specific community of women reflect a growing recognition of the relationship between the physiology of birthing and its social-interactional context. A recognition that is crucial when interventions seek to dig deeper and address the growing challenges in maternal health. These efforts grow a more holistic approach to childbirth that recognizes the notion that women’s own health, her ideas and decisions about her childbirth experiences have a stronghold within the medical space.

The combination of the clinic’s natural birthing practices (which includes respectful care and management) and the advent of the birthing chair, has introduced the women in Mirpur and its surrounding areas to a different concept of childbirth and experience of delivery. For these women, introduction to the birthing chair at the centre could mean an introduction to more choice, knowledge and agency regarding their own experiences of childbirth than medical spaces had previously offered them.

The concept of alternate birth positions has only just made a small step in the wide landscape of maternal health, in the form of the birthing chair in Bangladesh. Present interventions that aim to create safe spaces for maternal health and wellbeing should take alternatives, such as the birthing chair into consideration. Giving birth on a bed, though it is the modern norm, is neither the only viable birthing option nor always the best one, and the expansion of birthing options would benefit women’s overall state of health and childbirth experiences.

This blog is written by Ishrat Jahan, research assistant at the CGSRHR, BRAC JPG. Special mention goes to the Developing Midwives Project team.

The blog is derived from an ongoing JPGSPH short study on women’s experiences of childbirth on the birthing chair at the Midwife Led Care Centre by the Developing Midwives Project.