Your Pregnancy - - Bump Talk -

A smoother trans­fer of pa­tients be­tween spe­cial­ists and mid­wives could en­hance the health sys­tem in South Africa, im­prov­ing out­comes and mak­ing ma­ter­nity care more cost­ef­fec­tive. “Mothers and ba­bies could see bet­ter out­comes if our health­care sys­tem was struc­tured to give mid­wives a greater role in preg­nancy man­age­ment and birth,” says The Birthing Team’s Dr Howard Many­onga, an ob­ste­tri­cian and gy­nae­col­o­gist with a back­ground in health sys­tems man­age­ment. A new study in the United States, pub­lished in the sci­en­tific jour­nal PLOS One, has shown that states that give mid­wives hos­pi­tal ac­cess and pro­fes­sional de­ci­sion-mak­ing power per­form bet­ter on mea­sures of ma­ter­nal and neona­tal health. It echoes a review in Lancet, which con­cluded that in­te­grat­ing mid­wives into health­care sys­tems could pre­vent more than 80 per­cent of ma­ter­nal and new­born deaths world­wide. “Mak­ing mid­wives the pri­mary prac­ti­tion­ers in non-com­plex preg­nan­cies will in­crease ac­cess and make pri­vate care more af­ford­able for more women, in­clud­ing those not on med­i­cal schemes,” says Dr Many­onga. In most med­i­cal set­tings in South Africa, mid­wives and ob­ste­tri­cians are paid sep­a­rately and as a re­sult are often in di­rect com­pe­ti­tion for pa­tients. This means that if a com­pli­ca­tion presents dur­ing birth, there is a fi­nan­cial dis­in­cen­tive for mid­wives to re­fer the pa­tient on to a spe­cial­ist. “Typ­i­cally, mid­wives only re­fer pa­tients on to ob­ste­tri­cians if a se­ri­ous com­pli­ca­tion arises; some­times this hap­pens too late. As a re­sult, spe­cial­ists have gen­er­ally de­vel­oped a falsely neg­a­tive view of mid­wives’ skills and ap­ti­tude be­cause they only come in at a cri­sis point,” says Dr Many­onga. For ex­pec­tant mothers, such a re­fer­ral also en­tails high, un­ex­pected fees. Bet­ter in­te­gra­tion of mid­wives also in­cen­tivises pre­na­tal care by mak­ing it more af­ford­able. “Qual­ity pre­na­tal care is the best de­ter­mi­nant of a healthy de­liv­ery – with this in mind, at The Birthing Team, we cre­ated a set fee for com­plete care by a team of mid­wives and ob­ste­tri­cians, al­low­ing women to ac­cess all nec­es­sary pre­na­tal care at no risk of a co-pay­ment,” says Dr Many­onga. The Birthing Team pro­gramme is re­struc­tur­ing how South African mid­wives and ob­ste­tri­cians in­ter­act. It ap­plies an in­te­grated care model to ma­ter­nity care, which em­pha­sises col­lab­o­ra­tion, team fees, rig­or­ous pre­na­tal care and a com­mu­nity-based ap­proach. There is no ad­di­tional fee for the pa­tient if the ob­ste­tri­cian is con­sulted dur­ing an­te­na­tal care or called in for de­liv­ery, and the mid­wives who have over­seen the preg­nancy will still earn their fee. The Birthing Team is cur­rently op­er­a­tional in Berea, Jo­han­nes­burg, at the Net­care Rand Clinic and in Dur­ban at the JMH city hos­pi­tal. “Ob­ste­tri­cians train for years to be ex­perts on com­plex births – they should be freed up to fo­cus on these cases,” says Dr Many­onga.

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