Life is full of choices, and sometimes we make some of the most important ones without realising that we are doing so. This is the case when it comes to giving birth. While there are many birth options in South Africa, you should know that your whole birth plan is in the hands of your birth team. Women are vulnerable in labour, and those around them need to make decisions that protect their and their babies’ wants and needs.
Of course, it is true that life happens. Sometimes complications occur during pregnancy and birth that no one could have prevented. But you should also know that some of these complications are indirectly caused by how your birth team manages the process. And therefore, choosing your birth team and venue is far more important than deciding if you want a Caesarean section or a vaginal delivery.
Firstly, who are the healthcare professionals?
You may read about midwives and gynaecologists/obstetricians, but what does this mean and what do they have to do with birth options in South Africa?
A nursing sister that works with moms during pregnancy and birth is called a midwife. In South Africa midwifery is part of our 4 year nursing training, though the nursing council has for many years now been in the process of implementing midwifery as a direct entry programme. You should realise that midwives in different settings will have different roles. Midwives can work in hospitals (private or public), or in a private practice (which offers a completely separate birth option, but more on that below).
A doctor that specialises in women’s health is called a gynaecologist, and one that specialises in pregnancy an obstetrician. Most doctors practise these two together, so really either name fits. Some who experience pregnancy complications or have medical conditions that places them into a high-risk group in pregnancy should receive care under an obstetrician.
A doula is a non-medical person that offers support for women during labour. A doula is a wonderful add-on for your birth, if you can afford the extra cost. Research has shown many advantages to using a doula in labour. Note that a doula does not play a medical role. She also does not replace your partner in any way, but work on supporting both of you.
Government versus private sector birth options
The majority of women in South Africa will birth in a government facility. And if you do not have a medical aid and cannot afford to pay for a birth in private sector, this will be route to follow. It therefore is not really a choice one makes. But let us in any case explain how a birth in our government sector works, and how it fits into the South African birthing scene.
Women will receive antenatal care from a public or municipal clinic. This care is rendered by a nursing sister (midwife). Sonar’s are not routinely done in most facilities unless there is reason for concern. If you are low risk and your pregnancy remain complications free, you will be directed to go to a government hospital in your area for the delivery.
If any high risk factors emerge (for example high blood pressure), you will be referred to a higher-level facility where a doctor or an obstetrician will take over your care.
READ MORE: Managing expectations during pregnancy
Many developed countries like the United Kingdom uses this same model of care.
Many women fear delivering in government facilities, as one of course hears many stories of poor care and lack of resources. But know that very often women receive good care. Protocols and guidelines are often followed with more diligence than in private sector, especially in training hospitals where academic departments and students are involved.
One should think carefully before making debt and putting yourself under financial strain because of fear created by stories heard. Private sector has recently started services that attempt to solve this problem for pregnant couples, but more on that below.
Choosing a midwife in a private practise
Despite recent negative media coverage of a specific midwife, evidence shows that low risk women will have the best outcomes in this model of care.
A private midwife has her own practise and takes only a few clients in a month. She provides their antenatal care and is on stand-by for them 24/7. Sonars are done at certain visits. She will do their delivery, usually with a back-up midwife present. A gynaecologist will be on stand-by during the labour, should any complications occur, and a Caesarean section become necessary. If the mother does not have a medical aid she will be transferred to a public hospital if this becomes necessary. After the birth mothers are usually discharged after a few hours, and the midwife will continue to visit them at home.
With a private midwife you can birth in three facilities:
- Some private hospitals have active birthing units that allows midwives to work there. There are even a few facilities across the country that specialises only in natural birth, like Life Genesis Clinic in Johannesburg.
- Most midwives have private birth centres/houses. These are fully equipped for anything and everything relating to natural birth and its possible complications. But if a Caesarean section becomes necessary the mom would have to be transferred to a hospital.
- Lastly, private midwives can do a birth at the mom’s own home. It is wonderful to witness how different a woman’s body reacts when she is in her own environment. This option may sound way-out, but it really is not. It is how women have been giving birth for millions of years, but with a trained and experienced professional present. And nothing beats getting in your own shower and back in the peacefulness of your own bed with your new baby after all is done!
Birth with a private midwife typically involves the following:
- A personal relationship with your caregiver; she gives attention during your pregnancy to birth preparation and to your birth plan, and advocates to make this possible for you during labour.
- Natural pain relief methods like using water, massage, reflexology, or aromatherapy.
- A calm and peaceful birth environment, using simple tools such as music and candles to create a birth space.
- The mom has freedom to move around in labour and can birth in any position she chooses.
- Freedom to have more than one person present for support, should you wish to do so.
- Medical interventions are only used when needed, and not routinely (for example breaking your water during the labour or putting in an intravenous line).
- Gentle care of baby after birth, including skin-to-skin and delayed cord clamping.
- Continuous care after the birth, with special attention to establishing breastfeeding.
Although midwifery births typically cost less than birth with an obstetrician, the medical aids unfortunately does not always cover it fully, which may mean some extra expenses from your pocket. Most women feel that this cost is worth it.
It is important to note that you should be a low-risk client in order to birth with a midwife. If any complications occur, she would have to hand-over care to your obstetrician.
Birthing with an obstetrician
This is the best option for women with high-risk factors in pregnancy. But in South Africa most low-risk mothers who birth in private hospitals will also birth with an obstetrician.
If you choose this birthing option your doctor will provide your antenatal care, and sonars are usually done at each visit. With a gynae you can choose between a vaginal delivery or a Caesarean section. Delivery is amost always done in a private hospital.
During labour you will receive care from the midwives on duty in the labour ward, and they will call the doctor to come and do the delivery when the birth is close. If there are any complications during the labour, your dr may choose to do an unplanned (emergency) Caesarean section.
Elective Caesarean section
This may be done either by choice or for medical reasons. You will receive a date and time in advance and will be admitted to the hospital for the procedure.
After the birth you will be admitted to the postnatal ward, where you will remain for two nights after a vaginal birth and three nights after a Caesarean section. The midwives working there will assist with breastfeeding and baby care.
How labour is managed will be different for each specific gynae. It is worthwhile to read up on birth plans and to think about what you want from your birth. You can discuss this with your doctor to hear if he/she is willing to support you. It is important to find someone that you feel comfortable with and that takes time to discuss your birth with you and to answer your questions.
You should know though that birth in a hospital setting will typically involve more interventions. These may include the following (also good starter points to ask the obstetrician about):
- Mostly women are only allowed one support person.
- Putting up an intravenous line (drip).
- Pain relief injections or epidural anaesthesia is used in most deliveries.
- Many doctors choose to routinely break the mom’s water during the labour.
- Most doctors prefer doing the delivery with a mom lying in bed (as opposed to for example kneeling or squatting).
The facility’s protocol
Your doctor plays a key role, but most of the care will be given by the midwives on duty. It may be valuable to also visit the labour ward during a hospital tour, so that you can get an idea of the look and feel. You can then ask questions on what to expect from your visit.
Birthing with a private hospital birthing team
This is a fairly new option in South Africa, in response to an increasing need. Many women do not have medical aid, but they may have some funds available for the birth, even if it is not enough to pay for a full hospital delivery with an obstetrician.
A few hospitals across the country has rolled out programs where moms can birth with the labour ward midwives, while a gynae is on stand-by. They usually birth at a reduced rate, with some aspects of care not included (for example if baby needs to be admitted to NICU, in which case they may still need to be transferred to a government hospital).
How birth is managed and the protocols of care will depend on each facility.
It is important to know that there is not one option that suits everybody. So do some research, make the effort to look at a few options, and in the end listen to your gut feeling on what would be the best option for you as an individual.