Sensitive Midwifery - Issue 44 - October 2019

Birth media has opened up the space for a new type of community support in the form of online groups. ‘Natural Birthing South Africa’ (www.facebook. com/groups/naturalbirthingsa) is one such group. Midwives, doulas, and thousands of other members (many of whom have had successful normal births and/or VBACs) communicate, post their questions and concerns, and receive helpful, evidence-based information. Johannesburg-based mother and birth photographer Vanessa Venter started this group in June 2015, after she embarked on her own VBAC journey and noticed that there’s so much regret for unnecessary and unwanted C-sections, and that natural birth isn't as it’s often portrayed, and isn’t as risky as women are often led to believe. While Vanessa cautions that members approach their care providers with any concerns about their or their babies’ health, she notes that the group aims to provide a platform for members to research their options further: ‘Armed with more information and support, women aren't as scared to speak up about their desires for birth, and to ask their care providers questions they wouldn't have thought to ask in the first place. Women are looking to be heard and have their choices respected without doctors resorting to fear-mongering.’ Vanessa sees many posts about concerns women’s doctors have raised, like 'big baby' or 'small pelvis', how they can induce labour naturally because their doctors have put time constraints on them, as well as questions regarding which medical aids cover natural birth options the best and which pay for midwives. As women become educated about their birth options and rights, they are seeking support for physiological birth - and this is where midwifery is flourishing. Though some segments of South African society are still incredibly patriarchal and the medical system itself still tends to be hierarchical, what women want (more specifically, what they demand) will surely continue to drive the birthing culture in this country. Women want trusting relationships with their caregivers, and to know that they and their babies are safe. In the past, there may have been the perception that the medical model of birth equated to safety, but this mask is now slowly (and surely) slipping. Of course, midwives know (and the evidence reflects) that what makes birth safe is not unnecessary intervention, but rather, respecting women, letting birth unfold, and knowing what to watch out for. Beating the system Midwives have a long history of finding ways around the system, as Sister Lilian explains: ‘That’s why some moved to private practice; some forged relationships with other midwives, doulas and supportive doctors; some negotiated with hospitals for admission rights and others started birth homes; and some lobby the authorities to be recognised as an independent and equal profession. It’s what led us to start educational and support initiatives like the Sister Lilian Centre and Sensitive Midwifery. Midwives, for all the balls we may have dropped, have never allowed birth to be completely stolen from women!’ Back to birth basics We’ve seen a rise in natural birthing options, such as maternity clinics, active birthing units and birth homes, in the past couple of decades, and yet, more recently, we have also seen how some of these are not managing to keep their doors open – one example being Origin Family-centred Maternity Hospital, the first privately owned natural birth and women’s wellness centre in the Western Cape. In 2015, Henny de Beer left her private midwifery practice in Johannesburg to help set up Origin. However, in December 2018, Origin closed its doors after 34 months. Henny explains: ‘Origin was a stand-alone unit. There wasn’t a hospital a ffi liated with us, and as a luxury unit, the overhead costs were too large.’ It was di ffi cult to find investors, especially as ‘it is hard to make money out of normal births: the pay-outs that medical doctors and midwives get from medical funders is low; a hospital makes its money out of theatres and ICUs’ and when it came to a clinic like Origin, potential investors were looking for quick returns. ‘It needed more time but the overheads were too high to keep it going,’ says Henny. Henny also explains how Cape Town doesn’t have the pool of private midwives that Johannesburg has, and that private midwifery practices in Cape Town are very regional. Securing back-up doctors in Cape Town was a concern too: Continued on page 23 22 eSensitive Midwifery Magazine Issue 44