Month eight
How to have a successful government birth
PRIVATE AND GOVERNMENT hospitals in South Africa are worlds apart. Where private hospitals are serene places with shiny linoleum floors, state hospitals are busy places with zero luxuries. Both however have the same objectives, and that’s to have healthy mothers and healthy babies. Most South African women will give birth at government hospitals. Some of the challenges facing these hospitals include the HIV/Aids crisis (patient overload), huge numbers of teenage pregnancies (many of whom have had no antenatal care), unbooked patients (often foreigners who don’t understand the language or instructions) and undiagnosed complications. When this happens, tragedies that could have been avoided can occur and government hospitals stand accused.
ADVANTAGES OF A GOVERNMENT BIRTH
Every South African woman or foreigner with asylum or refugee status is entitled to go to a government clinic or hospital to have her baby – free of charge. Many of South Africa’s prized obstetrical specialists work and teach in government academic hospitals. Pregnant women with complications are referred from outlying clinics and midwives obstetric units (MOUs) to these hospitals for further investigations, where she is treated by a team of specialists. Government hospitals are also staffed by doctors, nurses and midwives who are young, ambitious and dedicated to their careers in medicine. Because of the shortage of doctors, antenatal clinics and local hospitals, government hospitals are midwifedriven. This means that not only do midwives monitor the women during pregnancy, they ‘progress’ her throughout labour and deliver her baby (providing there are no complications). Midwives are less likely to interfere with the normal progress of labour by encouraging women to eat and drink during labour (rather than putting up a drip), to walk about during contractions and to bear-down during the delivery stage in a more comfortable position for as long as it’s safe to do so. Indirectly, midwife-driven units can help a woman to feel more in control. There are educational charts on the walls and free literature is available. Many hospitals also give educational talks in the clinic waiting area. Clinics also provide free nutritional supplements, calcium and vitamin A. The antenatal clinic appointment card can be used anywhere in South Africa. This card records your medical history, tests and investigations during the pregnancy, records the birth and everything after the birth so that your card can be used at the postnatal and family planning clinic. It also lists what you need to take with you to the hospital. Western Cape Government Health communications officer Ethne Julius says that because of the huge number of patients using government hospitals, women are encouraged to book at the hospital or MOU in areas where they live. “If there are any complications, she will be referred to a hospital that offers the next required level of care,” he says. Julius adds that women are encouraged to book their bed as soon as their pregnancy has been confirmed.
TAKE NOTE OF THESE TIPS
1 Get used to waiting in queues, anticipate problems before they happen and be friendly at all times. These are the three golden rules when going to a government facility. On clinic days, get there early and come prepared with food, beverages and something to do while waiting. 2 If you can afford to hire a trained doula to help you during labour and birth, even better. Otherwise bring your partner or a friend with you to all your hospital visits. 3 Buy a flip-file with plastic sleeves to keep all-important documents in one place. Photocopy any forms or referral letters before you hand them in – just in case they get lost. These include forms for blood tests, urine and other tests and procedures. Don’t lose your script for the pharmacy. You will also need your hospital card and ID book every time you go to the hospital or if you are referred to other departments in the hospital. For your first booking, you must bring a proof of address along with ID. Foreigners need to bring their proof of asylum seeker or refugee status.
PREPARING FOR THE BIRTH
Women attending a government hospital quickly learn to take responsibility for their health. Don’t miss appointments or tests. Take the medicines prescribed and go to the pharmacy regularly – don’t wait until you have run out of tablets. If you’re referred to another hospital, it’s your responsibility to go there. If you’re advised to go to hospital on a booked
date before labour begins, it’s important that you do so. Besides packing your regular hospital bag, take your own pillows, blankets, towels and pyjamas. For your hospital stay you will also need essentials like pads, nappies and even food (it’s provided, but very bland). Take extras like beverages, toiletries (even toilet paper and towelling), energy bars and snacks. Bring your own baby clothes, wrapping blankets and toiletries. Pack these into a convenient backpack so that your arms are free to carry your baby out of the hospital or clinic. Women who deliver without any complications at a MOU may be sent home as early as four hours or 24 hours at the most after the birth. Uncomplicated hospital births are also sent home very soon after the birth – depending on the time of giving birth. Arrange for somebody to take you to the hospital and bring you home – don’t rely on public transport or an ambulance.
PATIENT RIGHTS
Health Minister Dr Aaron Motsoaledi admits that there are aspects in public healthcare that need urgent attention, including the need to improve cleanliness and patient safety in government hospitals. He’s also concerned that pregnant women aren’t using primary healthcare facilities and only going to the hospitals – contributing to patient overload. One billion rand has been allocated to pilot the National Health Insurance (NHI) over the next 14 years. The Better Births Initiative (BBI) was introduced to South Africa by Professor Justus Hofmeyr, the director of the Effective Care Research Unit run by a research unit at the Wits Faculty of Health Sciences. The objectives of BBI are to ensure that procedures used during labour are updated and effective, and that all women are treated with dignity. This includes: Humanity – being treated with respect. Benefit – care that is provided based on the best evidence. Commitment – health professionals are committed to improving care. Action – effective strategies are put into place to change outdated practices.
IF YOU WANT TO HAVE A VAGINAL BIRTH, CONSIDER THAT GOVERNMENT HOSPITALS ARE LESS INCLINED TO INTERVENE, UNLESS AN EMERGENCY C-SECTION IS MEDICALLY NEEDED