1. Concern regarding low birth weight babies getting well
baby certificates: The Coimbatore Medical College
Hospital predominantly caters to people of low socioeconomic
status with inadequate maternal nutrition and therefore
quite a sizable proportion of the neonates born here are low
birthweight. But they are frequently small for date babies
(SFD) with no other significant neonatal problems and are
nursed by mother’s side with monitoring of blood sugar.
Babies more than 2 kg who are roomed in with the mother
usually have no other neonatal morbidities and hence receive
well baby certificates. Those less than 2 kg and who have
been discharged from neonatal intensive care unit to mothers
side also received well baby certificates if they are term
SFDs with birth weight >1.8 kg and have no other neonatal
problems (10 of the 17 babies weighing less than 2 kg in our
study). Near term neonates (35 or 36 weeks) with birth
weight less than 2 kg are discharged to mother’s side after
a brief stay in NICU if they are asymptomatic but they don’t
usually receive well baby certificate for immediate
puerperal sterilization.
2. Comments upon the requirement for
well-baby certificates: Getting pediatrician certificate
for neonatal well-being is an established age old practice
in Tamilnadu both in government and private sectors. It is
clearly mentioned in a recent WHO document that ‘Because
female sterilization is permanent careful counselling is
important to make sure that woman will not regret her
decision (to undergo puerperal sterilization)’ [1]. As
discussed in our paper and agreed in the comments on our
paper, infant death is the important cause for regret in
developing countries and so ensuring a well-baby certificate
for the neonate by the paediatrician is entirely in order.
Although this process is not explicitly mentioned in our
Ministry of Health reference cited in the commentary, in
page 11 of that reference it has been mentioned that ‘ A
delay of upto 7 days (for doing postpartum sterilization)
may be justified in situations which demand a more accurate
assessment of the baby’s chances of survival’ [2].
Pediatrician’s certificate of baby’s well-being is thus
included therein.
3. We fully agree with the authors’
comment that informed consent be taken mentioning the
drawbacks of one time physical examination and certification
process of neonatal well-being. Our one year observational
study was not designed for a further one year follow-up
because of logistic problems. Even during our study period,
two babies were brought back with ventricular septal defects
that became evident after the certification process. It has
to be noted that 65% of women using birth control measures
in 2007-2008 preferred female sterilization, and states like
Tamilnadu, Andhra Pradesh, Karnataka and Kerala have
achieved replacement fertility levels by offering minilap
tubectomy on a regular basis throughout the year [2].
