What are the birth options for South African women?
Unlike some Western nations, South Africa has a very specific segregation between those who can afford private medical care and those who cannot. There are no laws that protect patients who arrive at a private hospital, and they are often barred from entering if they do not have a cash deposit on hand. Instead, people without medical aid are referred to the many public hospitals or public clinics. While there are many of these, without exception they are overcrowded, understaffed, undersupplied and overburdened. Many are old, dilapidated, dirty or simply so full that patients may wait over 12 hours to see a physician. Oftentimes, the smaller clinics are unable to treat the severity of an illness and patients are then told to wait for an ambulance transfer to one of the bigger hospitals. Even for emergencies, this can take over four hours.
In short, the public system is a far cry from the clean, sanitized, well staffed and overly helpful private hospitals. Every year, 1 million South African women give birth in public hospitals, and 3,000 deaths result. (Source)
In short, the public system is a far cry from the clean, sanitized, well staffed and overly helpful private hospitals. Every year, 1 million South African women give birth in public hospitals, and 3,000 deaths result. (Source)
What is giving birth in the provincial system really like?
According to a research study conducted by the independent Expert Review Group (iERG) entitled "Information and Accountability for Women and Children's Health", in 2013, South Africa's Maternal Mortality rate is 300 deaths for every 100,000 pregnancies (Source). It is now predicted that South Africa will miss their 2015 Millennium Development Goals target for a reduction in this number, a reflection of the day to day negligence, malpractice and otherwise inhumane treatment that has become commonplace in many public maternity wards. In fact, there is evidence that maternal mortality has quadrupled between 1998 and 2007, a startling and rather unsettling statistic to consider (Source).
In order to more accurately explain the dire situation, it's best to look to the innumerable news articles that appear nearly daily on the incredible injustices patients experience under public care, specifically those in the maternity ward. Here are several examples;
While these cases are absolutely appalling, they are only a few examples of stories that made it to national media. There are many more women who's stories will never be heard. Ms. Delivery is working to provide an alternative to hospital birth and to help stem the tide of such heart wrenching accounts of needless loss and injury.
In order to more accurately explain the dire situation, it's best to look to the innumerable news articles that appear nearly daily on the incredible injustices patients experience under public care, specifically those in the maternity ward. Here are several examples;
- In 2007, South African health researchers concluded "that the high rates of direct obstetric causes of death in HIV positive women could be attributed to the level and quality of care given to HIV positive women by health care workers. Part of this was the perception that there is nothing more that could be done to help these women." (Source)
- Laboring woman "falls out of the back of an ambulance" as drivers leave her unattended with the door open as they drive away. After a passing motorist picks her up and takes her to hospital, she gives birth to a stillborn child. (Source)
- Neglect to a laboring mother directly contributed to her daughter being born blind and with a seizure disorder. In this rare case, the woman was compensated by the state, though many are not as lucky. (Source)
- A woman is horribly disfigured during a botched C-section with unsterilized tools, during which they left the umbilical cord inside of her abdominal cavity, and after which she develops a life-threatening systemic infection. (Source)
- A woman is left in such poor care at the hospital, that she must do an internet search on her phone to discern how to give birth, since the student midwife she was left with is incompetent and abusive. She then is left to clean the afterbirth herself. Her son is discharged without ever seeing the pediatrician who discharged him. (Source)
- Gross negligence and malpractice, including horrific treatment of laboring mothers, cause a string of infant deaths. The majority of staff are on holiday leave. (Source)
- The vast majority of medical malpractice claims in Gauteng this past year have been for children who are born with brain damage due to negligent nurses. (Source)
- An overview of the gross neglect suffered by several women in Mpumalanga and the budget-conscious tactics that ignore patient care in public hospitals. (Source)
While these cases are absolutely appalling, they are only a few examples of stories that made it to national media. There are many more women who's stories will never be heard. Ms. Delivery is working to provide an alternative to hospital birth and to help stem the tide of such heart wrenching accounts of needless loss and injury.
Why is home birth and midwifery important? Why not support private hospital birth?
"Abuse of maternity patients in health facilities can have indelible psychological effect, and drive women away from seeking care, leading to delayed diagnosis and treatment, and increased morbidity and mortality. Indeed, South Africa’s maternal mortality ratio (MMR) has more than quadrupled in the last decade, leaping from 150 to 625 deaths per 100,000 live births between 1998 and 2007, according to government data. Data on maternal mortality is notoriously difficult to gather and evaluate, and the increase is probably due to an increase in both reporting and in actual deaths (especially among women living with HIV). But even without decisive data, public health experts agree that South Africa has a major problem on its hands: thousands of women still die needlessly each year, and maternal mortality is apparently increasing, even as the number of deliveries in facilities rises...
The government has made a genuine commitment to address these problems. Since the end of apartheid in 1994, for example, South Africa has passed important sexual and reproductive health-related laws and policies, and a constitutional guarantee of the right to health. Acknowledging that maternal deaths are unacceptably high, the government has identified reducing maternal mortality as a national priority, and stated that decreasing maternal and child mortality is one of four “strategic outputs” that the health sector must achieve by 2014. (Source)
It is obvious that even with an increase in government involvement and international attention, South Africa's maternity care system has not improved enough for celebration. While the problems that plague the public system center on quality of care and the rampant mistakes that cost many women their lives, the private system suffers from an entirely different illness, on the opposite end of the spectrum. In many of South Africa's private maternity wards, the cesarian section rate hovers at around 80%. (Source) In some cases, even higher. This needless and reckless reliance on major abdominal surgery robs the woman of her birth experience as well as puts her at a serious disadvantage in caring for her newborn. Not only is recovery from such an operation painful and debilitating, the necessary hormone cascade that occurs during birth is completely circumvented. The massive release of oxytocin that bonds the woman to her child for life is avoided, the natural introduction of microbiota to the digestive tract of the infant is prevented, and several key epigenetic changes have a profound effect on the health and well being of that individual, with lifelong repercussions that have only recently come to light (Cite study).
Aside from the heavy reliance on cesarean delivery, the private system also hinges on induced births and an over-medicalization of what is intended to be a natural process. Much of the knowledge that is passed during the apprenticeship of a midwife in her training has been handed down for generations from woman to woman, and was largely disregarded and labeled unscientific by the male-dominated world of obstetrics, as well as the medical system as a whole. Midwives draw on a vast knowledge of both highly specific anatomical and physiological training in conjunction with holistic approaches. They are well versed in herbal remedies or lifestyle changes to alleviate various ailments, for which many OB/GYNs simply prescribe medication (along with its side effects), or recommend a birth plan that may include induction or a c-section, where it may be completely unnecessary.
It is the modern OB/GYNs that have put women on their backs and immobilized them during labour (simply for their convenience, though making it more painful for the woman). It's the modern medical system that promotes c-sections for the great insurance payout and high salaries they receive, even when the woman can solve her 'medical emergency' by simply drinking more water (as in ogliohydraminos - a lack of amniotic fluid). It is not to say that there is not a time and a place where birth becomes an emergency, certainly there are definite cases when a woman should be in a hospital while she delivers, or perhaps needs a cesarean, but this should not be the norm.
Women have been delivering children for thousands of years without forceps, synthetic hormones and pain blockers, and we have been built over these thousands of years to rise to the occasion. Birth should be an overwhelmingly emotional, empowering, bonding experience that links one human being who has spent nine months creating, cultivating, readying an entire human being inside of her. It is the culmination of all of her hidden work, and a moment to be celebrated, reveled in, embraced, for all of the work that she has put in to this tiny individual. It is the task of the midwife to oversee this transformation, this great welcoming into a new world. They focus on the power of the bond that has formed in utero and carrying that bond into the postpartum realm. They are the stepping stone to forming a family, and thus forming a community.
The government has made a genuine commitment to address these problems. Since the end of apartheid in 1994, for example, South Africa has passed important sexual and reproductive health-related laws and policies, and a constitutional guarantee of the right to health. Acknowledging that maternal deaths are unacceptably high, the government has identified reducing maternal mortality as a national priority, and stated that decreasing maternal and child mortality is one of four “strategic outputs” that the health sector must achieve by 2014. (Source)
It is obvious that even with an increase in government involvement and international attention, South Africa's maternity care system has not improved enough for celebration. While the problems that plague the public system center on quality of care and the rampant mistakes that cost many women their lives, the private system suffers from an entirely different illness, on the opposite end of the spectrum. In many of South Africa's private maternity wards, the cesarian section rate hovers at around 80%. (Source) In some cases, even higher. This needless and reckless reliance on major abdominal surgery robs the woman of her birth experience as well as puts her at a serious disadvantage in caring for her newborn. Not only is recovery from such an operation painful and debilitating, the necessary hormone cascade that occurs during birth is completely circumvented. The massive release of oxytocin that bonds the woman to her child for life is avoided, the natural introduction of microbiota to the digestive tract of the infant is prevented, and several key epigenetic changes have a profound effect on the health and well being of that individual, with lifelong repercussions that have only recently come to light (Cite study).
Aside from the heavy reliance on cesarean delivery, the private system also hinges on induced births and an over-medicalization of what is intended to be a natural process. Much of the knowledge that is passed during the apprenticeship of a midwife in her training has been handed down for generations from woman to woman, and was largely disregarded and labeled unscientific by the male-dominated world of obstetrics, as well as the medical system as a whole. Midwives draw on a vast knowledge of both highly specific anatomical and physiological training in conjunction with holistic approaches. They are well versed in herbal remedies or lifestyle changes to alleviate various ailments, for which many OB/GYNs simply prescribe medication (along with its side effects), or recommend a birth plan that may include induction or a c-section, where it may be completely unnecessary.
It is the modern OB/GYNs that have put women on their backs and immobilized them during labour (simply for their convenience, though making it more painful for the woman). It's the modern medical system that promotes c-sections for the great insurance payout and high salaries they receive, even when the woman can solve her 'medical emergency' by simply drinking more water (as in ogliohydraminos - a lack of amniotic fluid). It is not to say that there is not a time and a place where birth becomes an emergency, certainly there are definite cases when a woman should be in a hospital while she delivers, or perhaps needs a cesarean, but this should not be the norm.
Women have been delivering children for thousands of years without forceps, synthetic hormones and pain blockers, and we have been built over these thousands of years to rise to the occasion. Birth should be an overwhelmingly emotional, empowering, bonding experience that links one human being who has spent nine months creating, cultivating, readying an entire human being inside of her. It is the culmination of all of her hidden work, and a moment to be celebrated, reveled in, embraced, for all of the work that she has put in to this tiny individual. It is the task of the midwife to oversee this transformation, this great welcoming into a new world. They focus on the power of the bond that has formed in utero and carrying that bond into the postpartum realm. They are the stepping stone to forming a family, and thus forming a community.
For more information about the home birth movement, Certified Professional Midwives (CPMs), Waterbirth and Placental Encapsulation, please feel free to peruse the following links:
- Waterbirth:
Waterbirth.org
Evidencedbasedbirth.com
- Placental Encapsulation:
Placentawise.com
Placentabenefits.info
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