Sensitive Midwifery - Issue 43 - July2019

Soothe , Heal & Protect Manufactured for and on behalf of House of Zinplex (Pty) Ltd. t: 086 111 9462 | f: 012 803 9283 w: www.zinplex.co.za | e: info@zinplex.co.za The Zinplex Junior animal family has your baby covered! Birth Continued on page 14 where the obstetric doctor took charge, was a trend that emerged in many developed and developing countries. By the 1960s, most South African women gave birth in hospitals (according to the history books anyway), as this was viewed by the medical world as the safest place for birth. Since independent midwives were not permitted to practise in either the private or public sector hospitals, midwives in hospitals were soon regarded as obstetric nurses who worked under the obstetricians. Home and hospital births during apartheid By the 1970s, South Africa’s racial segregation and escalating economic stratification continued to influence health care, extending to care providers’ approach towards natural birth. Interestingly, it was the white population who seem to have been at a natural birth disadvantage as the business and medical models increasingly took over in predominantly white-used private hospitals; whereas in the state hospitals (increasingly patronised by all other racial groups), midwives played a more prominent role, ensuring that more vaginal births took place. Home birth was also still common in townships. Mona McAlpine, a midwife who lived and worked in South Africa for 50 years, remembers her early experiences of natural birth in the country, having arrived from the UK in 1969. Less than a month after she arrived, she was employed at Noordgesig Clinic, a coloured clinic on the border of Soweto. For women in the townships, most births happened at home with very little need for intervention, says Mona. Mona was on maternity leave after having her own baby when the Soweto Uprisings took place in 1976, and in 1977, she began working at the Marymount – a private ‘white’ hospital. Mona, having witnessed births in Soweto, where the majority were natural, was shocked – the difference between the two settings was stark. At the Marymount, she says, a truly natural birth was rare: ‘If a normal, natural birth did take place, it was because the mom couldn't hold back the urge to push her baby out.’ Economic birth disempowerment ‘Inductions were the order of the day. I remember one Saturday having 11 women sitting in the waiting room of the labour ward, all with Syntocinon drips … To be fair, some women did need induction, but many inductions were done for the doctor’s convenience. Then, of course, many of these inductions did not do the trick because the cervix was not ready, or they were done far too early – sometimes routinely at 38 weeks – and a premature baby would be delivered, or the failed induction would end up as a caesarean section,’ shares Mona. Other, often unnecessary or otherwise harmful interventions were common too: ‘Shaving of the vulva, enema and episiotomy were routine procedures. IM pethidine was the preferred pain relief in labour. Mothers were delivered on their backs, often with their legs in stirrups.’ She notes that ‘the Marymount was no different from the rest of the private maternity sector in South Africa’. For private patients, it was ‘the doctor’s responsibility to deliver the baby. Doctors were fed up if we called them too soon or too late,’ says Mona. This was very different to state hospitals where, as midwife Marilyn Sher remembers, ‘midwives did all the births’. Now an independent midwife with her own practice, Marilyn qualified in 1973 and worked in the state hospitals during her early days of midwifery. Here, ‘mothers were given one-on-one care by midwives’, who only called a doctor if there were problems. Vaginal birth without intervention was still considered normal in state hospitals and Midwife Obstetric Units (MOUs), and tearing seldom happened as ‘midwives were trained on how to guard the perineum and allow slow delivery of baby’. Still, Marilyn recalls that ‘mothers were not allowed to get off the bed and move around’ and ‘were always on their backs’. 13