Water Births in Bengaluru

Dr Janhavi Nilekani, a development economist with a PhD from Harvard University, was pregnant during her doctoral research. She often flew between Cambridge, Massachusetts, in the USA and Bengaluru, and was struck by the difference in the quality of maternal healthcare. “The lack of protocol-based medicine came as a shock,” she tells Luru. “About 32 per cent of births in the US are c-sections; in Scandinavian countries, this is about 20 per cent. But in Bengaluru’s private hospitals, it’s maybe 70 per cent c-sections.” Indian private healthcare sees high usage of diagnostics and surgery, often amounting to over-intervention. In addition, says Nilekani, women are frequently disempowered, and the perspectives of expecting mothers are sidelined. According to a 2022 analytical paper by the United Nations Population Fund (UNFPA), even in urban India—where women are more likely to be educated and to experience greater levels of autonomy than their rural counterparts—just three-quarters of women seem to make decisions about their reproductive and sexual health.

During her pregnancy, Nilekani observed that most doctors did not follow evidence-based practices. For instance, an episiotomy—a surgical cut made between the vagina and anus to widen the vaginal canal for childbirth—is still a routine procedure in most Indian hospitals despite evidence that routine usage causes harm. “There is a cultural attitude that accepts the need to cut mothers open,” says Nilekani. With a determination to have agency in her birthing experience, and with no desire to be unnecessarily “cut open,” she refused to settle for invasive birthing methods. Nilekani gave birth with the assistance of a US-trained midwife in Hyderabad and returned to Cambridge to finish her PhD. She already knew that she wanted to work in maternal healthcare, and in 2019, she launched Aastrika Foundation with the mission to “increase access to high-quality, respectful maternity care for 25 million women annually by 2030.” The Foundation runs Aastrika Sphere, a capacity-building programme addressing skills gaps in healthcare, and supports the Government of India’s Nurse Practitioners in Midwifery (NPM) programme at Vanivilas Hospital, training midwives as well as midwifery educators. Nilekani tells us that although they have introduced water birthing at Vanivilas, it cannot be incorporated into public healthcare at scale, given its high costs. However, at Aastrika Midwifery Centre (AMC)—a sister organisation of Aastrika Foundation—water birthing is a regular practice.

A mother-first approach

“Water birthing can reduce the mother’s pain and anxiety,” Dr Vinutha KV, consultant OBGYN at AMC, tells Luru. “And the mother’s confidence is a reassurance for all.” Her remark points to the undeniable stresses around pregnancy and childbirth—and the need to centre the mother. While pregnancy announcements, baby showers, and the selection of everything from names to cribs may be exciting, expectant mothers often experience immense anxiety: after all, they are the ones whose bodies—and lives—will change most. They are frequently hit by a deluge of information from parents, in-laws, relatives, friends, and social media.  

“Even young, educated people were telling me what to do and what not to do,” says Hamsini Murali, a Bengaluru-based architect, who had a water birth at AMC in 2024. “But I found the voice to push back against all these voices.” Murali wasn’t initially looking to have a water birth, but she was intrigued when she heard about it here.

“I’d only heard horror stories about birthing,” she says. “But Janhavi ran us through the pros and cons of water birth and pain management. Now I’m Aastrika’s biggest cheerleader.” Murali went from dreading the pain of childbirth to choosing a water birth without narcotics or laughing gas, both pain management methods offered at AMC. No epidural, no episiotomy—she simply worked with her body to ease through the process. She speaks fondly of Salomi Thomas, the midwife under whose care she gave birth.

“I’m not a very intuitive person, but with Salomi Chechi’s guidance, I was able to read signs from my body,” Murali says. “I could dictate the positions I took—I was on my back for just two minutes.” This contrasts with media images of childbirth, which frequently show women lying on their backs, screaming in excruciating pain as doctors and nurses chorus, “Push, push, push.”

“It’s not about ‘push, push, push.’ You breathe the baby out,” says Murali. “Of course there was pain, and it wasn’t easy,” she clarifies, “but there was no suffering.” She recalls how she sat in a water bath—which is routinely set to the mother’s body temperature—for about half an hour during active labour but stepped out of it when she began shivering. She entered it again for another half-hour until it was time for the final act.

“But it’s not like you have to follow a clock,” she says. Her experience suggests that mothers can go at their own pace, listening to their bodies rather than a strict hospital schedule.

“Studies show that calm, comforting environments help,” says Nilekani. “We have a sensory birthing suite to calm the mother.” This suite is nothing like the typical maternity ward; although medically equipped and sterilised, it is far from impersonal. Its programmable lights, surround-sound system, and ceiling-to-floor screens allow mothers to create the ambience of their choice, choosing music and visuals that put them at ease. In addition to the birthing pool, it also offers mothers a birth ball, a peanut ball, and a birthing rope—tools that they can use while preparing themselves for the embodied experience of a lifetime. The best part: their loved ones can be present throughout. A peculiar feature of pain is that rather than just a physiological response to a stimulus, it is also a perception of the stimulus. “Each person’s pain threshold is different,” says Dr Dhwany Maharshi Munshi, another consultant OBGYN. “But the body naturally releases endorphins during childbirth.” Pain perception is managed through a supportive and immersive birthing atmosphere, the reassurances of a partner, and the care of midwives and doctors, and the water bath reduces tearing and eases the pain of contractions. While medical pain management methods are available, mothers may choose which ones to use or forgo them entirely.

Evidence-based practice

Some studies show that the use of epidural anaesthetics is associated with lower levels of endorphins and oxytocin, which means that mothers might experience dips in mood. Does this mean water births can prevent depression? “We can’t rule out postpartum depression,” says Nilekani. “But there are anecdotes of mothers feeling more positive and recovering better.” Rather than favouring one plan or method, AMC’s thorough, evidence-based approach to maternity care considers all angles based on scientific research. “There is a birth plan and set protocol, but these can change based on the needs of the mother,” says Dr Vinutha. If the mother has a fever or an infection, a water birth is best avoided.

“The difference is in the experience of pain and the mother’s freedom of movement,” says Salomi Thomas. “The baby even comes out with a smile.” In a world where women’s sexual and reproductive rights are still contested, the availability of choice is precious.  

The details: Learn more about water birthing practices & Aastrika Midwifery Centre (AMC) here.

This is an excerpt of a non-fiction feature from issue #2 of Luru. Get your copy here.