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CAREGIVERS
Obstetricians / Gynaecologists (OB/gyn)
The field of gynaecology deals with women's' reproductive health.
The field of obstetrics deals with “abnormal” pregnancies and deliveries.
In S.A. most women who can afford it, opt to attend an OB/gyn for their pre-natal care.
On the day of your labour, the OB/gyn will most likely only attend to you in the labour ward once or twice and will join you once the baby's birth is imminent, to deliver it. The hospital midwife usually attends to you in the interim and informs your doctor if you require further attention.
OB/gyn's are able to provide expert care in high-risk deliveries for baby's that need instrumental delivering (using either forceps or ventouse) and where a caesarean section is needed to deliver the baby, in cases such as breech presentation, foetal distress and multiples.
Some OB/gyn's will also assist with specialised procedures such as trying to turn a breech baby (ECV-external cephalic version) for a mother wishing to attempt a vaginal delivery. And in some instances a skilled obstetrician can attempt delivering a breech presenting baby. However less and less doctors are being trained in these highly specialised deliveries, so finding an OB/gyn to do this for you might be hard work.
The OB/gyn will remain with the mother for a short while after the baby's been born to deliver the placenta, check postnatal bleeding & attend to any perineal grazing /tearing. They will check you the day after your baby's been born and then again at 6 wks.
Midwives:
In an ideal world, all women should be cared for by a midwife through their pregnancy and labour, as these “special” women are often experts in the art of child birth and view pregnancy and birth as a normal and natural physiological human occurrence.
In cases where the pregnancy is regarded as “high-risk” (eg. multiples, diabetes or hypertension) a midwife can still provide midwifery care along with the expertise of an obstetrician / gynaecologist. The midwife will work in consultation with the ob/gyn, to offer the best holistic support for the expectant mum.
In S.A there are 2 types of midwives:
Hospital midwives and independent midwives.
Hospital midwives are midwives who work exclusively in a hospital setting, either in the private or public sector.
Midwives in the public sector are able to provide holistic care to the mother and newborn by managing the prenatal care, delivering the baby, postnatal care for the mother as well as providing neonatal care to the newborn.
Midwives in the private sector do not provide any pre-natal care for the mother and generally do not “deliver” the baby. She does however assist the mother during her stay at the hospital and is responsible for vital monitoring of the mothers' medical observations, which she will report on, to the relevant obstetrician as well as assist the OB/gyn during the delivery of the baby. She also supports the mother in the postnatal period in the hospital with breastfeeding as well as monitoring her medically.
Independent midwives have no affiliation to a specific medical institution and are therefore “employed” by the expectant couple. She offers all the prenatal care for the duration of the pregnancy (bp, urine checks, blood works, foetal heart tones, etc.) all the while monitoring the pregnancy for any “abnormalities” that may arise. She will refer each mum for the relevant scans and also for obstetric support either in the private or public sector.
Independent midwives are able to assist mothers with home, water & hospital births. Independent midwives stay with the mother for the duration of the labour and remain to assist with the baby's first breastfeed Their care also extends to the postnatal period where she's able to do home visits to assist with the demands of a being a new mum and help with breastfeeding.
Independent midwives fees are partially covered by most medical aids.
All midwives are required to refer high-risk pregnancies to obstetricians for case management but as mentioned before, she can still provide other expertise unique to their profession.
Doula's (childbirth companion)
Doula's are non-medical labour support persons skilled in the role of supporting women and their partners through the transition from pregnancy-to-birth-to-parents.
A doula is able to assist you with the emotional & physical preparations for your baby's birth such as assisting you with drawing up a realistic birth plan and helping you execute it effectively. Selecting a doula is a deeply personal choice and you might have to interview many doulas to find someone that you feel confidant with and supported by. She is after all going to be sharing in something immensely intimate with you and your loved ones. Worldwide research has shown that doula supported women have shorter labours, less need for pharmacological pain relief and less incidence in the requests for epidurals and fewer c/section births.
As with independent midwives, doulas are not affiliated with any specific medical institution but are employed by the couple. Expect to pay R1000 for doula services which should include at least 1 pre and postnatal visit as well as support for the duration of your labour and at least an hour after the baby has been born. Costs for a doula are not covered by medical aids as yet.
A doula can be part of your support team whether you are having a home, water, hospital or v.b.a.c. (vaginal birth after a caesarean section) with either an obstetrician or independent midwife.
BIRTHING PLACES
Active birthing units (ABU)
ABU's have been established to fill the need of pregnant women, to have a comfortable, homely setting with the safety of a hospital environment at their disposal. Here women are also encouraged to labour actively and use natural methods of pain relief. She is often attended to by a midwife from the ABU or she may choose to bring in her own independent midwife for her labour & birth. ABU's are designed with the comfort of the mother and her partner in mind, so in most cases these rooms have a double bed, birthing bath, labour balls, cd player, etc. Rooming- in of the mother, father & baby is encouraged. In the event of any complications that could arise, obstetric assistance is available on the same premises.
Candidates for ABU's need to be low-risk pregnancies.
Private hospitals
Private hospitals accommodate women with low to high risk pregnancies. In this setting women can be attended to by their OB/gyn (who is licensed to practice at that specific hospital) or independent midwife (as long as the back-up OB/gyn practices from that facility as well) Second to the public sector, most women deliver their babies in private hospitals for various reasons ranging from the need for reassurance that they are in a facility that can offer immediate obstetric assistance in the event of an emergency, to the need for privacy and avoidance of being subjected to “staff-in-training” .
It should be noted that S.A's private sector has an alarmingly high caesarean section rate (btwn 70-90%) Whatever the reason for this imbalance, women should be made aware, that when choosing to deliver at a private hospital, they're more likely to have a medically managed birth.
Public maternity hospitals
Most government hospitals have implemented the “better birth initiative” whereby women are encouraged to bring along labour support persons, have an active birth (labouring and birthing in positions conducive to best health practices) and not be restricted to nourishment and so on.
Statistics also show that the caesarean section rate in the public sector is significantly lower than those in the private sector – 20% (state) vs. between 70-90% (private) as is the use of pharmacological pain relief.
Because of the large volumes of patients utilising the public sector, you can expect longer waiting times and in some instances less time being attended to by the relevant staff.
Home
A birth at home can be an immensely empowering experience and women who choose this option do so for reason varying from wanting to avoid a repeat of a previous bad hospital experience, wanting to have complete autonomy during labour and birth, the safe & familiar setting of home, to the feeling of being uninhibited and unrestricted.
There is still a lot of misconception regarding the safety of homebirths and which women are suitable candidates for homebirths. Worldwide research has shown that homebirths done by skilled practitioners with good obstetric backing on “low-risk” pregnant women, have as safe and in some cases, safer outcomes. You will need to find an independent midwife to offer you this service and she will help you arrange the services of a back-up obstetrician in either the public or private sector as a precautionary measure should any complications arise during your pregnancy or labour. High-risk pregnancies should not be attempted in a homebirth setting.
Lana is a qualified Doula at Lalilu Doula Care. She can be contacted on 021 703 4291 or 073 514 9754. She can be emailed at lalilu@sybaweb.co.za.
