Dr. R. Kishore Kumar A Pillar of Maternal & Neonatal care Innovation in India’s Healthcare Sector

1. Dr. R. Kishore Kumar A Pillar of Maternal & Neonatal care Innovation in India’s Healthcare Sector Dr. R. Kishore Kumar Harvard Graduate in Healthcare Delivery, MBBS, DCH(Mys), MD(Paed), FIAP (India), DCH(London), MRCP(Paed), FRCPCH(UK) FRCPI, FRACP (Australia), FNNF(India), MHCD(Harvard USA), Chief Neonatologist, Founder, Chairman & Director Cloudnine Group of Hospitals Dr. R. Kishore Kumar Pioneering Pediatrician and Advocate for Child Healthcare www.insightscare.in

2. “ “ Maternal care is the foundation of life, nurturing not just the body but the soul of a child.

4. Editor’s Note

5. Guiding the First Breath ood healthcare saves lives. Great healthcare G approaches care. Dr. R. Kishore Kumar is one such changemaker. In this special edition of Insights Care India, we’re proud to feature Dr. R. Kishore Kumar: A Pillar of Maternal & Neonatal Care Innovation in India’s Healthcare Sector. It’s a look into the story of a leader who didn’t wait for change—he created it. changes them. And sometimes, it takes just one person’s vision to shift how an entire nation For decades, maternal and neonatal care in India has been riddled with challenges—delayed access, low survival rates, and outdated systems. But Dr. Kumar saw more than problems. He saw potential. And he acted on it. We hope this piece reminds you that healthcare is not just about systems and science. It’s about people. And it’s about those rare leaders who bring together purpose, passion, and progress to make a real difference. From founding Cloudnine to introducing global best practices in neonatal care, his work has directly impacted thousands of families. The numbers are impressive—among the lowest maternal mortality rates, world-class newborn survival rates—but what stands out more is the heart behind it. His belief that mothers deserve safety, babies deserve a fighting chance, and every patient deserves respect has shaped everything he’s built. Happy Reading Ahead! Pooja Shah Pooja Shah - Pooja Shah

6. Contents Featuring Dr. R. Kishore Kumar Pioneering Pediatrician and Advocate for Child Healthcare 06 Articles Ethical Considera?ons of Using AI in Neonatal Care Prac?ces 18 Sustainable Birth Care Solu?ons for Promo?ng Safe Home Births in Rural Areas 24

7. Editor-in-Chief Pooja M. Bansal Pooja Shah Nisha Mehra Managing Editor Assis?ng Writer Visualiser Sandeep Tikode Art & Design Head Art & Picture Editor Deepanjali Jena Suhani Gaikwad Vice President Swapnali Vasaikar Asst. Vice President Ashwini Thakare Business Development Manager Sr. Sales Execu?ve Ninad Wankhede Dhanashree Technical Head Technical Specialist Technical Consultant Prachi Mokashi Prashanth Hiremath Rajeshwari Avhad Sagar Lahigade Bharat Pa?l Digital Marke?ng Manager Assistant Digital Marke?ng Manager Circula?on Manager Tanaji Fartade sales@insightscare.in April 2025 Corporate Offices: Insights Success Media and Technology Pvt. Ltd. Survey No.133/134, Brand Square, Office No. 512,Kunjir Chowk, Pimple Saudagar, Pune, Maharashtra 411027. Phone - India: 7410033802, 8956487823 Email: info@insightscare.in For Subscription: www.insightscare.in Follow us on : www.facebook.com/InsightsCare/ https://twitter.com/Insightscare We are also available on : Copyright © 2025 Insights Success Media and Technology Pvt. Ltd., All rights reserved. The content and images used in this magazine should not be reproduced or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from Insights success. Reprint rights remain solely with Insights Success Media and Technology Pvt. Ltd. Insights Care is powered by Insights Success Media and Technology Pvt. Ltd.

8. Dr. R. Kishore Kumar Pioneering Pediatrician and Advocate for Child Healthcare The core principle he follows in life is the idea of performing one’s duties without expecting rewards. He believes that rewards naturally come when you do your job with dedication, and he views them not as personal accolades but as recognition for the service he provides, helping others learn about the work being done.

9. Dr. R. Kishore Kumar Harvard Graduate in Healthcare Delivery, MBBS, DCH(Mys), MD(Paed), FIAP (India), DCH(London), MRCP(Paed), FRCPCH(UK) FRCPI, FRACP (Australia), FNNF(India), MHCD(Harvard USA), Chief Neonatologist, Founder, Chairman & Director Cloudnine Group of Hospitals

10. Dr. R. Kishore Kumar: A Pillar of Maternal & Neonatal care Innovation in India’s Healthcare Sector I n the face of life’s most heart-wrenching moments, there’s nothing more painful than saying goodbye to a loved one. For families clinging to hope during critical times, every second matters, and every action can mean the difference between despair and a miracle. He believes that rewards naturally come when you do your job with dedication, and he views them not as personal accolades but as recognition for the service he provides, helping others learn about the work being done. Dr. Kumar’s personal philosophy revolves around the idea of selfless service. He emphasizes that rewards are not for self-glory, but rather to make others aware of the work being done. As his professor Dr. Nirmala Kesaree from Davanagere used to say, rewards are not given because one deserves them, but to acknowledge the value of the work being carried out. At the heart of these stories of hope is Dr. R. Kishore Kumar, a beacon of compassion and innovation in healthcare. With an undying commitment to saving lives, he has dedicated his career to transforming outcomes for patients and families alike. From pioneering neonatal care to creating holistic healthcare systems, his work goes beyond the confines of traditional medicine, offering not just treatments but renewed chances at life. Transforming Maternal and Neonatal Care Through his visionary leadership, countless lives have been saved, and families spared the unbearable pain of farewell. Dr. Kumar’s mission is not merely about addressing illness but about restoring hope, ensuring that goodbye is not the end of the story, but the beginning of healing and resilience. His journey to revolutionize maternal and neonatal care in India was driven by a profound realization: childbirth, a natural and joyous event, often turned tragic due to preventable maternal deaths. His belief that pregnancy represents wellness—where healthy women embark on the journey to build families—fueled his vision to eliminate maternal mortality and improve neonatal outcomes in India. Let’s dive into Dr. Kumar’s inspiring story of pioneering neonatal care and delivering unparalleled outcomes for mothers and babies! Having witnessed the stark contrast in maternal care between India and the West, where maternal deaths during childbirth were virtually unheard of, Dr. Kumar envisioned a specialized mother-and-baby hospital offering world-class care. In 2006, he turned this vision into reality with the launch of Cloudnine’s flagship center in Jayanagar, Bangalore. The hospital quickly became synonymous with excellence, gaining recognition for its high-quality care and innovative practices. Within three years, hospital’s success became a case study at the Indian Institute of Management, Bangalore, and the Cleveland University of Ohio in the USA. A Life of Selfless Service and Dedication Dr. Kumar grew up in a small town called Kollegal, located about 100 kilometers from Bangalore. He had a fulfilling childhood, with his parents and grandparents instilling in him the value of service to humanity. After moving to Bangalore, he studied for two years at Ramkrishna Vidyarthi Mandiram, where he was deeply influenced by the teachings of Swami Vivekananda and the Bhagavad Gita. The core principle he follows in life is the idea of performing one’s duties without expecting rewards. Having witnessed the stark contrast in maternal care between India and the West, where maternal deaths during childbirth were virtually unheard of, Dr. Kumar envisioned a specialized mother-and-baby hospital o?ering world-class care.

12. Neonatology, though not ?nancially rewarding compared to ?elds like neurosurgery or cardiology, o?ers immense emotional satisfaction. Treating children, seeing them smile, and saving babies brings profound gratitude from families, making it incredibly ful?lling.

13. However, establishing Cloudnine was not without challenges. Financial hurdles loomed large, as building a world-class facility required ₹20 crores, far beyond the ₹3 crores Dr. Kumar could raise personally. With the support of angel investors, family, and friends, the first unit was established. Beyond finances, upgrading the standard of medical and nursing care posed significant difficulties. While nurses adapted to rigorous on-site training within three months, reorienting obstetricians to embrace data- driven, patient-centric practices required nearly nine months of persistent efforts. Weekly review meetings, aimed at improving outcomes without assigning blame, gradually built a culture of continuous improvement. Cloudnine also sought to address issues that were often overlooked. For instance, 25% of women experienced pelvic floor damage during childbirth—a statistic previously unacknowledged in India. Many women silently endured incontinence and other complications due to social stigma. Similarly, low breastfeeding success rates, with only 45–55% of mothers nursing successfully, highlighted the need for better support systems. Dr. Kumar’s team focused on empowering women by providing education and accessible support, ensuring no mother suffered in silence. Today, Cloudnine stands as a testament to his determination, offering international standards of care across 37 branches in 13 cities. It has redefined maternal and neonatal care in India, proving that compassionate, high-quality healthcare can transform lives and set new global benchmarks. Global Excellence in Maternal Care Dr. Kumar’s journey in medicine began in 1989 when he qualified as a pediatrician in India, driven by an unwavering passion for saving newborns. Early in his career, he worked at the mission hospital in Mysore, where he successfully saved a premature baby weighing just 780 grams—a record at the time. The case made national headlines, yet Dr. Kumar remained humble, questioning whether the baby’s survival was due to his efforts or other factors. This introspection fueled his desire to specialize further in neonatology, a nascent field in India at the time. To pursue this goal, Dr. Kumar went to the UK, where he trained extensively for four years, mastering the intricacies of neonatal care. His journey continued to Australia in the early 1995, where hospitals were already saving babies born as early as 24 to 28 weeks. At institutions like Monash Medical Center and Royal Children’s Hospital in

14. Journey to Hyper Wellness Melbourne, he honed his expertise in caring for premature infants. He further enriched his experience by working in the U.S. and dedicating 14 years to neonatal care in Australia. From its inception, Cloudnine sought to redefine maternal and neonatal care, going beyond traditional approaches to ensure a comprehensive and supportive experience for mothers. One of the key innovations was the integration of physiotherapy and lactation consultants from day one. These specialists played a critical role in antenatal education, preparing mothers for pregnancy and childbirth, and offering postnatal care to address recovery and breastfeeding challenges. Despite his success abroad, Dr. Kumar was deeply inspired by the pressing need to improve maternal and neonatal care in India. In 2006, he founded transform outcomes for mothers and newborns. At the time, India faced staggering statistics—97 maternal deaths per 100,000 deliveries and limited survival rates for babies born before 28 weeks. He envisioned a healthcare system that could reduce maternal mortality and save premature infants with the same precision as the best hospitals in the West. Cloudnine Cloudnine with a mission to This holistic approach yielded remarkable results: no recorded cases of pelvic floor damage among Cloudnine mothers over 17 years and an impressive 95% breastfeeding success rate. However, achieving these milestones required overcoming skepticism. Initially, insurance agencies and patients viewed these services as unnecessary expenses. Persistent advocacy and data-backed outcomes eventually convinced stakeholders of their immense value, making these practices a cornerstone of Cloudnine’s care model. Under his leadership as a Chairman & Director (though initially he dorned the caps of CEO, MD & Neonatologist too), Cloudnine has achieved remarkable milestones over the past 17 years. With over 250,000 deliveries to date, the hospital chain boasts a maternal mortality rate of just four deaths per 100,000 deliveries, among the lowest globally—even outperforming Western nations. Additionally, Cloudnine has become a leader in neonatal care, offering survival rates for babies born under 28 weeks that rival the top hospitals worldwide. Another transformative practice was encouraging early mobilization. Traditionally, women stayed bedridden for days after delivery, increasing the risk of complications. Cloudnine introduced early movement—within four hours of delivery, whether via normal delivery or C- section—helping mothers recover faster. This change allowed patients to be discharged within 48 hours, a practice now seen as a benchmark in maternity care. The hospital is also the only healthcare chain in Asia affiliated with the prestigious Vermont Oxford Network, an international organization that benchmarks neonatal care outcomes. By voluntarily participating in this database, Cloudnine has consistently demonstrated outcomes superior to many European countries, cementing its position as a global leader in maternal and neonatal healthcare. Cloudnine also prioritized infrastructure tailored to maternal wellness. Recognizing the unique challenges faced by pregnant women, the hospital introduced motorized outpatient beds, ensuring comfort and safety for expectant mothers. Innovations extended to room designs, Dr. Kumar’s visionary leadership has not only redefined maternal and neonatal care in India but also set new global benchmarks, ensuring that countless lives are saved and transformed. AI has been integrated into Cloudnine’s electronic database, predicting the risk of premature labor in pregnant women with up to 80% accuracy, a signi?cant improvement over the traditional 20% estimate.

16. From early mobilization post-delivery to introducing physiotherapy and lactation consultants, our approach ensures no mother su?ers in silence, and every mother’s journey is safe, comfortable, and ful?lling.

17. with toilets at floor level to ease mobility post-delivery. The hospital ambiance was intentionally designed to resemble a welcoming hotel lobby rather than a clinical setting, eliminating the traditional “hospital feel” and reinforcing the concept of pregnancy as a state of wellness. Dr. Kumar emphasizes that these “minute details” have made a significant impact, transforming maternity care in India. Cloudnine’s patient-centered approach, supported by modern infrastructure and evidence-based practices, has not only elevated standards locally but also contributed globally by setting new benchmarks in maternal and neonatal care. “Hyper wellness” remains at the core of this revolutionary model, ensuring every mother’s journey is as safe, comfortable, and fulfilling as possible. Transforming Neonatal Care It’s truly remarkable how Cloudnine has evolved over the years, focusing on providing comprehensive, patient-centric care. From the integration of physiotherapy and lactation consultation to the innovative steps in newborn care like the mandatory screening, every change has been made with a focus on improving maternal and neonatal health. Introducing newborn screening from the very start was a significant advancement. By detecting metabolic disorders and hypothyroidism early, Cloudnine has saved countless lives, preventing severe developmental issues and even death. The challenge of convincing both parents and medical professionals about the importance of these screenings was difficult initially, but Cloudnine’s persistence and educational efforts made a significant impact. The patient-centric approach has also changed the perception of maternal care in India, where it’s become more than just about luxury but about providing essential, scientifically backed care. As you mentioned, early mobilization and creating a welcoming environment in the hospitals reflect the commitment to improving the patient experience at every level. Moreover, Cloudnine’s implementation of technology in neonatal care, such as newborn hearing screening, has been groundbreaking. Being one of the first hospitals in India to offer this service shows a clear commitment to identifying issues early, ensuring timely interventions that improve outcomes. The fact that one of the children diagnosed with hearing loss went on to become a professional singer highlights the transformative effect of this approach.

18. Pregnancy represents wellness—NOT AN ILLNESS—where healthy women embark on the journey to build families—fueled his vision to eliminate maternal mortality and improve neonatal outcomes in India. These changes weren’t easy and required significant investment and effort, but it’s clear that Cloudnine’s dedication to quality care and patient well-being has led to life-changing results for many families. pandemic, which created widespread fear among the predominantly interstate nursing staff, prompted Dr. Kumar and the hospital management to offer reassurance and medical support. His efforts led to reduced attrition rates, with the hospital’s nursing staff demonstrating exceptional loyalty. Additionally, Cloudnine introduced remote services like home vaccination, teleconsultations, and a phone triage system to continue offering care while minimizing risk. Compassion in Crisis Dr. Kumar has been deeply involved in several initiatives to improve pediatric healthcare, particularly in rural and underserved areas. Over the years, he has led efforts such as conducting antenatal classes for rural pregnant women, training nurses as lactation consultants in government hospitals, and working with NICUs in Tier 1 and Tier 2 cities to provide advanced care, including Tele-NICU facilities. He has also trained local pediatricians in these regions on the latest technological advancements and international standards in neonatal care. Dr. Kumar's Vision for Pediatric Healthcare Looking ahead, Dr. Kumar identifies emerging trends in pediatric healthcare, particularly in the areas of technology and artificial intelligence. He mentions the progression of newborn screening to genomic screening, which could soon become a routine test to identify genetic diseases at birth. He also highlights the importance of routine medical screenings, such as hearing and cardiac screening, in India’s healthcare system. Dr. Kumar emphasizes that neonatology, though not financially rewarding compared to fields like neurosurgery or cardiology, offers immense emotional satisfaction. Treating children, seeing them smile, and saving babies brings profound gratitude from families, making it incredibly fulfilling. He highlights the demanding nature of the profession, noting that it’s not for those who seek a typical work-life balance but for those committed to the 24/7 responsibility of caring for others. One of the key advancements Dr. Kumar is championing at Cloudnine is the use of artificial intelligence. The hospital has piloted AI in neonatal intensive care units (NICUs), allowing for the early identification of septic babies within 12 hours, a process that traditionally takes 72 hours with blood cultures. Additionally, AI has been integrated into hospital’s electronic database, predicting the risk of premature labor in pregnant women with up to 80% accuracy, a significant improvement over the traditional 20% estimate. He shares how his approach to work has been shaped by his wife’s compliments. Dr. Kumar balances his professional and personal life by working whenever possible and being available for his family when needed. He focuses on enjoying his work and the flexibility to relax when necessary, ensuring that tasks are completed efficiently without delay. Dr. Kumar’s work continues to focus on research and innovation, ensuring that Cloudnine remains at the forefront of revolutionizing maternal and pediatric care. During the COVID-19 pandemic, Dr. Kumar’s leadership at Cloudnine Hospital Group was critical in maintaining patient care while ensuring the safety of staff. The

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21. Ethical Considerations of Using AI in NEONATAL CAREPractices T he use of artificial intelligence (AI) in medicine is transforming patient care throughout the entire lifecycle—but nowhere are the stakes higher than in neonatal medicine. Newborn babies, especially premature babies and those with complicated medical conditions, must be cared for with an extraordinary degree of gentleness and precision. AI holds the potential to transform neonatal medicine by making possible early diagnosis, monitoring, and individualized treatment regimens. But where there is great promise, there is a multitude of ethics to navigate. The Promise of AI in Neonatal Care AI systems are already demonstrating their value in neonatal intensive care units (NICUs). Machine learning algorithms can comb haystacks of data from vital sign monitors to detect patterns of distress hours before they would be obvious to human clinicians. AI can even diagnose congenital disease, predict outcomes from genetic and clinical data, and even optimize the utilization of life- support devices. For instance, computer programs can read electroencephalograms (EEGs) to diagnose seizures in newborns—exactly the sort of subtle pattern that would be simple for human observers to overlook. Once more, AI can help with decisions about respiratory therapy, choosing the optimal method of ventilation and reducing the risk of long- term lung injury. Even these advantages, nevertheless, have raised pressing ethical issues about the application of AI in neonatal care. www.insightscare.in April 2025 19

22. Informed Consent and Parental Autonomy procedure that results in harm, who is at fault—the doctor, the computer programmer, the hospital? Infants are not able to give consent to treatment, and parents are put in the surrogate decision-maker role at a time of crisis. Where AI systems are used to propose or recommend treatment, parents need to be in a situation to comprehend what these systems are, their role, and their limitations. In neonatal care, where life-or-death decisions are made and outcomes can be life-changing, responsibility is particularly problematic. Ethically, there would have to be extremely clear guidelines as to who has ultimate responsibility for clinical judgment. AI must augment, not replace, human judgment, and physicians must be accountable for treatment delivered. But AI is also a "black box," and even physicians may not know why an algorithm has made a specific recommendation. That kind of transparency hinders informed consent. Parents can be confused, skeptical, or overly reliant on AI recommendations without necessarily knowing the underlying reason. The hospitals and governing bodies also have to play their role by ensuring that the AI technology is accompanied by strict standards of safety and ethics before being implemented in hospitals. The Human Element in Care Healthcare providers have an ethical responsibility to ensure parents' autonomy is preserved. This not only means informing parents that AI is being utilized but also presenting information in a way that is understandable and permits informed choices. And then finally, there's perhaps the most subtle but fundamental ethical issue, which is the possibility of dehumanizing care. Neonatal care is not only clinical outcome by itself; it's also about providing comfort, compassion, and humanity during one of the most vulnerable moments in the course of a family's life. Bias and Equitability in AI Algorithms AI systems are only as good as what they have learned from. If training data is biased—under-represents racial or socioeconomic groups, for example—then the algorithm may produce imbalanced or even dangerous recommendations. In neonatal care, this can lead to unfairness in the way care is being provided or in the outcome being predicted for various groups. While AI can take away from the accuracy of care, it can never take the place of empathy and intuition in an experienced caregiver. As great as this technology is, we need to be careful that we implement AI to enhance and not replace the human touch of neonatal practice. Ethical practice demands that we utilize AI as a tool to support and not replace caregivers and to enhance them to work even better and streamline their care. For example, a model learned from data mostly from a single population will not generalize well to infants from another group, and this will lead to false negatives or misdiagnosis, or the provision of inappropriate treatment. This has extremely serious ethical considerations of fairness, justice, and the possibility of increasing healthcare disparities. Conclusion AI in neonatal care promises exciting prospects of better outcomes and lives saved. However, with great power comes tremendous responsibility. Ethical issues—from informed consent and bias to responsibility and respect for human dignity—must take top priority in the midst of this tide of technology. Repairing such an issue requires deliberate effort in constructing fair datasets and frequent testing of AI programs for bias and unexpected impacts. Developers, in collaboration with clinicians, can render equity a default assumption in building and implementing AI. Ultimately, the goal must be to use AI in a way that enhances the science and humanity of neonatal care such that the patients receive not only the best care but also the compassion and humanity they deserve. Responsibility and Accountability When AI is used to advise or decide medically, questions of responsibility are raised. When an AI program suggests a - Nisha Mehra www.insightscare.in April 2025 20

26. I n the majority of rural communities worldwide, maternity care provided by hospitals is inaccessible because of geographical unreachability, poor infrastructure, and a lack of professional health personnel. Home birth is not an option for the majority of women awaiting birth, particularly in low- and middle-income countries. Home birth is safe only with the availability of favorable conditions, and security can only be facilitated by accessible, community-based birth care interventions. Promoting safe rural home births is more than emergency measures. It is creating sustained, culturally sensitive systems that involve families, educate local birth attendants, and reestablish the link between communities and formal health networks. Understanding Rural Home Birth Challenges Before they can construct long-term solutions, it is important to understand the underlying challenges: Sustainable Birth Care Solutions for Promoting Safe Home Births in Rural Areas • Distance and infrastructure: Poor roads, absence of transportation, and distance to the closest health facility might deter or hinder access to emergency services. Insufficient skilled attendants: The majority of rural births are attended by traditional birth attendants (TBAs) who are not necessarily medically qualified. Limited medical supplies and sanitation: In the absence of sanitary conditions and limited medical equipment, infection and complication are more probable. Cultural beliefs and trust barriers: Suspicion of modern medicine or cultural practice can discourage facility births or external intervention in some cultures. • • • These issues are only resolvable sustainably by a multi- faceted, grassroots approach. Training and Integrating Community Birth Attendants Probably one of the safest methods of endorsing safe home birth is training and integrating traditional birth attendants into the health care system of the country. TBAs tend to be liked by people since they have years of experience working as baby attendants, despite not being licensed. Educative interventions for giving systematic training in the essential obstetric care, hygiene, infant resuscitation, and referral to clinics are found to be useful. Such programs need to offer respect-based, respectful care and also empower the TBAs through the provision of equipment www.insightscare.in April 2025 24

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28. such as clean birth kits, emergency contact phones, and follow-up visitations by the midwives or nurses. themselves in the planning and implementation of care interventions. Bangladesh and Ethiopia are some of the countries where effective midwife-TBA partnership model implementations, where trained midwives train local TBAs and provide maternal care in pairs in remote areas, have been realized. Local stakeholders co-designed interventions will be more likely to be successful and sustained in the longer term. This may include changing traditional birth procedures so that they meet safe medical standards, the preservation of local herbs or rituals in a safe and approved manner, or involving family members in care and education sessions. Empowering Midwives through Mobile Health (mHealth) Technologies Strengthening Health Systems Through Community Collaboration mHealth technologies can offer a cost-effective, sustainable road toward better maternal health in rural settings. Mobile phones and SMS can be employed to send prenatal care reminders, education, and emergency alerts to expectant mothers and birth attendants. Finally, home birth procedures must be safely combined. Partnership between the institutional health system and the community-based care providers ensures enhanced maternal outcomes. Also, mHealth platforms may facilitate linking TBAs and midwives with experts in health to provide access to real- time counsel during labor or emergency transport access. Sophisticated telemedicine becomes increasingly feasible with growing rural internet penetration and can be harnessed for teleconsulting complex cases. Referral chains, mobile clinics, and frequent visits by trained midwives or nurses to the rural facilities need to be made accessible to provide continuity of care. Additionally, investments in the rural healthcare infrastructure, including building the maternal waiting houses near the facilities for pregnant women who are in advanced pregnancy, need to be made by the governments and NGOs. These interventions need to be designed in a way with user facilitation and local language assistance in consideration so that they are inclusive and effective. Conclusion Planning Birth Preparedness and Emergency Planning Rural home births are not only feasible—and, in most of the planet, a necessity. But they will have to be undergirded by sustainable, locally based solutions that strengthen local caregivers, integrate advanced healthcare technology, and mediate the space between tradition and evidence-based practice. Comprehensive birth preparedness training also falls under safe home births. Pregnant women and their relatives need to be taught about danger signs, importance of antenatal check-ups, and planning an emergency transport system. Investment in education, infrastructure, and care models which reach all sectors of society enables us to ensure that rural mothers not only have the right but also the facility to give birth where they perceive themselves to be safest, together with the services they require in order to deliver safely. This is not replacing home with hospital—it's giving good quality care to every home, regardless of how remote. Community health workers may take part in the facilitation of birth preparedness training and other home visits. In situations where funds exist, communities may utilize local emergency transport funds or make arrangements to work with local drivers so they can arrange for speedy and safe transport during complications. Sustainable systems anticipate and prepare families with the information and resources required to respond swiftly when complications do occur. - Nisha Mehra Culturally Respectful and Locally Led Solutions Sustainability is culture-sensitive. Trying to enhance home birth safety must consider community practice and provide a place for community leaders, elders, and women www.insightscare.in April 2025 26

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