Ensuring Safe Delivery: The Role of Intra Natal Care

Childbirth is one of the most defining moments in a woman’s life, but it is also one of the most medically critical. The hours of labour and delivery decide whether both mother and baby walk away healthy, or whether avoidable complications turn into tragedies. This is exactly where Intra Natal Care (INC) steps in. INC refers to the care given to a pregnant woman from the onset of labour until the delivery of the placenta, along with the immediate care of the newborn. With over 80% of maternal deaths considered preventable through skilled care, INC sits at the very heart of safe motherhood programmes.

What exactly is intra natal care? 🔗

Intra natal care covers all four stages of labour: the dilation of the cervix, the actual birth of the baby, the delivery of the placenta, and the first hour after delivery. The care provided during this window aims to ensure a clean, safe delivery while staying alert for complications that can escalate within minutes. According to community medicine research published in the International Journal of Community Medicine and Public Health, intranatal care given throughout these stages is essential for both maternal and newborn survival.

Broadly, INC is delivered in two settings. Institutional delivery happens at a hospital, primary health centre, community health centre, or accredited private facility. Domiciliary or home delivery happens at the woman’s home, ideally assisted by a trained health worker. While institutional delivery is the recommended standard, ground realities in many rural and tribal pockets still make home births a reality, which is why both pathways need robust planning.

Objectives of intra natal care 🔗

The goals of INC are sharply focused and clinically driven. Each objective addresses a known cause of maternal or newborn death.

Ensuring a clean and aseptic delivery 🔗

Sepsis, infection following childbirth, remains one of the leading causes of maternal death. Clean hands, sterilised instruments, a clean delivery surface, clean cutting and care of the umbilical cord, and avoiding harmful traditional practices on the birth canal are non-negotiable. The “5 Cleans” approach, clean hands, clean surface, clean blade, clean cord tie, and clean cord stump, is drilled into every health worker for this reason.

Minimising injury to mother and baby 🔗

Proper monitoring during labour helps prevent obstetric injuries such as perineal tears, uterine rupture, birth asphyxia in the newborn, and shoulder dystocia. A trained attendant uses a partogram, a graphical record of labour progress, to detect any deviation from normal labour patterns early and act before things spiral.

Readiness to manage complications 🔗

Roughly 15% of all pregnancies develop unforeseen complications such as postpartum haemorrhage, obstructed labour, eclampsia, or sepsis. INC ensures the attendant is prepared to manage these emergencies on the spot or refer the woman quickly to a higher facility with surgical and blood transfusion capacity.

Provision of essential newborn care 🔗

The first hour after birth, often called the “golden hour”, decides a baby’s chances of survival. The World Health Organization outlines essential newborn care as immediate care at birth, including delayed cord clamping, thorough drying, assessment of breathing, skin-to-skin contact, and early initiation of breastfeeding. Resuscitation must be available within seconds if the baby does not breathe spontaneously.

Emotional support and dignified care 🔗

Often overlooked, respectful maternity care is now an explicit objective. Women in labour need reassurance, privacy, the presence of a birth companion where possible, and freedom from verbal or physical mistreatment.

Facilitating safe delivery in health centres 🔗

The single most powerful shift in Indian maternal health over the last two decades has been the move from home to institutional delivery. According to the Maternal Health Division of the National Health Mission, the government develops and disseminates standard technical guidelines for intra-natal care from primary to tertiary level institutions, creating a uniform standard of safety regardless of where a woman delivers.

The tiered health system for delivery 🔗

Public health infrastructure for delivery is organised in three levels. Sub-centres and primary health centres (PHCs) handle normal, low-risk deliveries with the help of Auxiliary Nurse Midwives (ANMs) and staff nurses. Community health centres (CHCs) upgraded as 24×7 facilities offer Basic Emergency Obstetric Care. First Referral Units (FRUs) and District Hospitals provide Comprehensive Emergency Obstetric and Newborn Care, including caesarean sections, blood transfusion, and newborn intensive care.

Janani Suraksha Yojana: the cash-incentive push 🔗

Launched on 12 April 2005 under the National Rural Health Mission, the Janani Suraksha Yojana (JSY) is a conditional cash transfer scheme designed to reduce maternal and neonatal mortality by promoting institutional delivery among poor pregnant women. The scheme offers ₹1,400 to rural mothers and ₹1,000 to urban mothers in Low Performing States. ASHA workers receive an incentive for mobilising the woman and accompanying her to the facility. Studies have documented a sharp rise in institutional deliveries after JSY, with one observational study in Madhya Pradesh showing significant improvements in institutional delivery rates following implementation.

Janani Shishu Suraksha Karyakram: zero out-of-pocket cost 🔗

JSY answered the demand side, but families still incurred costs for medicines, diet, tests, and transport. To plug this, the Janani Shishu Suraksha Karyakram (JSSK) was launched in June 2011. It entitles every pregnant woman delivering in a public health institution to absolutely free delivery, including caesarean section, along with free transport, diagnostics, medicines, consumables, diet during her stay, and blood if required. Sick newborns up to 30 days are also entitled to the same free package.

Newer quality and assurance initiatives 🔗

Recent additions strengthen the safety net further. LaQshya (Labour Room Quality Improvement Initiative) targets quality of care in the labour room and maternity operation theatres. SUMAN (Surakshit Matritva Ashwasan) guarantees assured, dignified, respectful and quality healthcare at no cost, with zero tolerance for denial of services. Dakshata trains providers in skills for managing the intra and immediate post-partum period. Birth Waiting Homes in remote and tribal areas allow women from far-flung villages to stay close to a facility as their due date approaches.

The role of trained birth attendants 🔗

A facility is only as safe as the hands that catch the baby. The concept of the Skilled Birth Attendant (SBA) sits at the heart of every modern maternal health strategy. An SBA is defined as an accredited health professional such as a midwife, doctor, or nurse who has been educated and trained to proficiency in managing normal pregnancies, childbirth, and the immediate postnatal period, and in identifying, managing, or referring complications in women and newborns.

Who counts as an SBA in India? 🔗

The Indian SBA cadre includes obstetricians, medical officers, staff nurses, Auxiliary Nurse Midwives (ANMs), and Lady Health Visitors. To bridge skill gaps, the Government of India launched the SBA Training Programme in 2005, which equips ANMs, staff nurses, and LHVs with the practical competencies needed for clean, safe delivery and emergency management. Basic Emergency Obstetric Care (BEmOC) training is given to medical officers at 24×7 PHCs and CHCs, while EmOC and Life Saving Anaesthetic Skills (LSAS) are provided to MBBS doctors posted at FRUs where specialists are not available.

The ASHA: a community link, not a birth attendant 🔗

The Accredited Social Health Activist (ASHA) is often misunderstood as a delivery attendant. Her role is different but equally crucial. She identifies pregnant women in her village, ensures antenatal registration, prepares a micro-birth plan, counsels the family, arranges transport when labour begins, accompanies the woman to the facility, and follows up with home visits for the mother and newborn. Under Home Based Newborn Care (HBNC), ASHAs make scheduled visits to detect danger signs in newborns and refer them promptly.

When home births still happen: the role of trained attendants 🔗

Despite the institutional delivery push, home births continue in remote areas, among tribal communities, and where cultural preferences run strong. For these women, a trained birth attendant can make the difference between life and death. Research using the National Family Health Survey shows that although utilization of skilled birth attendance during home delivery has increased significantly in recent times, the rate is still low in several regions across India, underlining the need for continued outreach.

Earlier, the government also ran a Dai (Traditional Birth Attendant) training programme that taught local midwives clean delivery practices, use of disposable delivery kits, recognition of danger signs, and timely referral. While the focus has shifted firmly to skilled professional attendants, dais continue to play a culturally accepted role in some communities, and bringing them into the referral network rather than excluding them is increasingly seen as practical.

Essential newborn care by the attendant 🔗

Whether at a hospital or at home, the attendant must execute a tight checklist of essential newborn actions in the first minutes. Early Essential Newborn Care, which the WHO promotes through its “First Embrace” initiative, includes immediate skin-to-skin contact between mother and baby, which transfers warmth, placental blood, and protective bacteria, while reducing the mother’s risk of haemorrhage. Other steps include thorough drying, delayed cord clamping, initiation of breastfeeding within the first hour, weighing the baby, administering vitamin K, and watching for danger signs such as poor breathing, lethargy, or hypothermia. Babies born at home in high neonatal-mortality settings are now also recommended chlorhexidine application to the cord stump to prevent infection.

Why intra natal care matters for India’s MMR and IMR 🔗

India has made dramatic progress in maternal survival. According to research published in Scientific Reports analysing contributing factors for reduction in MMR, India’s Maternal Mortality Ratio has fallen substantially, driven by rising institutional deliveries, expanded SBA coverage, and conditional cash transfers. The country is now working towards the Sustainable Development Goal target of bringing MMR below 70 per 100,000 live births by 2030.

Yet inequalities persist. Tribal districts, hilly terrains, urban slums, and the empowered action group states still report below-average institutional delivery rates and higher maternal deaths. The unfinished agenda for INC therefore is less about new schemes and more about quality, respectful care, prompt referral chains, functional blood storage units, round-the-clock skilled staff at PHCs, and a reduction in the gap between rich and poor districts.

What do you think? If a woman in a remote village is more comfortable delivering at home with a familiar dai, should the system focus on convincing her to come to a facility, or on training and equipping that dai with skilled-attendant competencies? And how do we balance the push for institutional delivery with the equally urgent need to make those institutions actually respectful and high-quality?

References

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC3763618/
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3. https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/newborn-health/essential-newborn-care
4. https://nhm.gov.in/index1.php?lang=1&level=2&lid=218&sublinkid=822
5. https://nhm.gov.in/index1.php?lang=1&level=3&lid=309&sublinkid=841
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC3902985/
7. https://www.sciencedirect.com/science/article/abs/pii/S0266613822002650
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9. https://www.who.int/westernpacific/activities/scaling-up-early-essential-newborn-care
10. https://www.nature.com/articles/s41598-024-65009-0