Mail & Guardian
‘Radical birth keeper’ involved in
The alleged negligence of self-proclaimed midwife Caitlyn Collins could have caused the death of twins, but she is still advertising her services, despite lacking professional registration
It was past midnight when a 25-year-old mother-to-be could not take the pain any longer. Her husband tried for the second time that night to wake the “midwife” who had fallen asleep during labour. When the “midwife” realised it was a breech pregnancy, she dropped them off at a day clinic.
Ernie Chirwa’s twin boy and girl were stillborn because the so-called midwife was allegedly negligent. There are allegedly two other mothers that were under Caitlyn Collins’s care when their babies died.
Collins has, for years, called herself a midwife. She is not registered with any professional body. Collins, 39, was in June last year told to stop operating as a midwife by the Western Cape health department and to address her non-registered status. She did not, and instead allegedly misled parents into believing she was a registered practitioner.
The Mail & Guardian has been able to track down at least three cases in which babies have died under her watch. Only one of the families could speak about the ordeal.
Chirwa and her 29-year-old partner Chifundo Bingala claim that they are the third couple to lose a child while under the care of Collins.
“[A]ll those people [whose] babies had died, they’re just too quiet. So we just want to help other people,” a visibly distressed Bingala told the M&G.
Bingala is a fashion designer and tailor in Cape Town. Chirwa works at a childhood development centre.
After visiting a Masiphumelelebased GP last June, the couple did not visit the doctor again as they were soon after introduced to Collins by a close friend and colleague of Bingala, Cyan Khoury. Collins said she would gladly act as their midwife.
The first-time parents were told by Collins the estimated due date was 20 January.
Khoury had attended a friend’s successful home birth in 2020, at which she acted as a doula alongside Collins, who acted as midwife. All three were under the impression that Collins was a midwife.
By the end of January, when the baby had not arrived, Collins assured the couple this was normal, that no caesarean section was needed and allegedly dismissed queries from Bingala about going to a doctor.
On 14 February, Chirwa went into labour. The couple alleges that they alerted Collins at 6pm, but that she arrived only after midnight after a call from a distressed Bingala.
According to Chirwa, Collins did not check her blood pressure or dilation. Instead, she switched off the lights, saying the dark would induce relaxation during labour. Collins then fell asleep on a sleeper couch. Surrounded by darkness, Chirwa was supported by her husband and a friend. In the early hours of 15 February, Chirwa, who had been vomiting since going into labour the previous day, continued vomiting and experiencing contractions.
A worried Bingala woke Collins up, asking her to check on his wife. Collins found that Chirwa’s amniotic sac was showing, but that it had not ruptured. After briefly checking
Chirwa, Collins went back to sleep, this time on the couple’s bed.
“She said we should wait a little bit longer for the sac to fully expel. While waiting, she fell asleep again. At that time, dawn was approaching. I was still in agony from the pain: it lasted up to 5am. That’s when Caitlyn woke up and checked on me. Again, the sac was still stuck and that’s when she realised that the baby’s foot was inside the sac, keeping [the child] from coming out. That’s when she concluded it was a breech and that she couldn’t handle it,” said Chirwa.
Collins then dropped Bingala and Chirwa at the Retreat Clinic, an 18-minute drive from their home and, allegedly without any further offers of assistance, drove off.
But before leaving the bewildered parents, Collins instructed them “to not mention having a home birth with her as our nurse”, according to Bingala.
The parents also never opened a birth folder, which would contain vital test results and contact information, as Collins did not encourage them to do so. Collins had allegedly told them in the car that, if asked why they had not done so, they should say they were “afraid”. Bingala says he is not afraid to open a birth folder for his babies, saying he and his wife have legal work permits.
According to Bingala, the only tests Collins did were taking the babies’ heartbeats. But she “struggled to hear the heartbeats”, claims Bingala, adding that the midwife maintained it was a single baby.
A distressed Bingala and his wife, who had been in labour from 6pm the previous evening, were left at a day hospital, which had to call an ambulance to fetch the mother in labour. They had to wait four hours before arriving at the Mowbray Maternity Hospital. Here the doctors discovered that Chirwa was carrying twins, both of whom — Kweli and Kwesi — were stillborn.
The stillborn postnatal form from the hospital, which the M&G has seen, suggests negligence from Collins, and that she misled Bingala
and Chirwa into believing that she was a registered midwife.
The form states: “Cause of death: A couple followed up regularly with [a] ‘radical birth keeper’, believing that she was a qualified midwife. Spontaneous labour only at 43 weeks. Initially at home almost 24 hours after care of ‘radical birth keeper’.”
Regarding complications during labour, the form states an eventual “foot prolapse” and notes that when the parents were dropped off by Collins at the Retreat Clinic, a “cord prolapse” had already occurred. The mother had delivered a “fresh stillborn baby” at Mowbray Maternity Hospital, according to the form.
According to Bingala, the doctor who treated Chirwa at Mowbray Maternity Hospital told the couple that this was not the first time the hospital had received a patient from Collins. The M&G reached out to the attending doctor, but was referred by the doctor to the hospital’s chief executive.
Collins did not respond to emailed questions from the M&G, and instead said: “Due to the sensitive nature of
this story, I am unable to comment at this time.”
But she did confirm the following in a brief conversation: “I’m not a midwife, and I don’t work as a midwife in this country.”
Instead, she claims she is a “traditional birth attendant” or “birth keeper”.
The M&G confirmed with the South African Nursing Council (Sanc) that Collins is not registered as a midwife. The Nursing Act is clear that no person may practise as or use the title of midwife unless they are registered with the council.
The M&G also received confirmation from the department of health in the Western Cape that it had informed Collins to stop operating as a midwife and to “address” her nonregistered status in June 2021. This followed a complaint from a doctor about Collins and her colleague, Ruth Ehrhardt, who refused to respond to numerous requests for comment.
Both were allegedly involved in two previous cases in which mothers lost their babies.
The department became aware that Collins’s practices were not “aligned to the department’s clinical guidelines for patient safety,” according to Mark van der Heever, deputy director of communications at the department of health in the province.
Asked why the department did not take the matter further, Van der Heever said that because the women did not belong to any professional body, it could not report them to such. It did, however, advise that the Mowbray Maternity Hospital obtain legal opinion on which potential laws had been broken.
“Thereafter, the hospital has the option to make a criminal case, explaining exactly which laws were contravened,” he said. He also advised anyone who had made use of the services of Collins or her colleague and had suffered a loss to contact the police.
Colonel Andrè Traut, spokesperson for South African Police Service in the province, said that a case docket could be opened “for a contravention of section 31(1) and (4) read with section 31(11) of the Nursing Act, 33 of 2005 for practising as a midwife without the proper registration and making use of the title of midwife without the proper registration”.
Last year in June, after being informed by the department of health that she must stop practising as a midwife, Collins adopted the teachings of an international group calling themselves the “Radical Birth Keepers”.
An interview between Collins and the Free Birth Society through the Radical Birth Keepers School, confirms her unregistered status as a midwife.
Collins and her colleague, Ehrhardt, completed an online course at the North American Registry of Midwives called the Certified Professional Midwife (CPM). This credential is not recognised by Sanc.
“When I did pass my CPM and because it is a US credential, but still nothing in South Africa, my really close, beautiful friend and companion found this loophole that in South Africa there is the Traditional Healers Association … and in that space, they call [it] the traditional birth keepers,” Collins said.
After writing to the association,
“the chief read our letters and proclaimed that we were traditional birth attendants”.
Asked by the interviewer whether this offered them any protection, assumed to be legal, Collins responds: “None, essentially”.
The South African Traditional Healers Association Collins referred to could not be reached. The numbers advertised for it does not exist or is not available.
A director at the African National Healers Association, Willem Badenhorst, told the M&G he had never before heard of the association Collins claimed to be part of, but said there were more than 200 different traditional health groups in the country.
Traditional health practitioners were still awaiting a permanent council that would serve as an umbrella body, he said.
In the interview, Collins says of the loophole: “At the time, it was a loophole that felt good. And so I guess I felt like myself and a couple of others were being those unicorn midwives, bringing undisturbed sort of physiological birth to Cape Town.
“I’m really amazed that I managed to navigate that kind of playing the game but not playing the game for as long as I did.”
From what the M&G could gather, Chirwa’s stillborn twins was not the first but the third incident in which infants had allegedly died under the care of Collins acting as a midwife.
Collins allegedly admitted to Bingala after the deaths of the twins that another incident took place about two years ago with an “Afrikaans woman” from Woodstock. Although the Mowbray Maternity Hospital has knowledge of this family, it is legally unable to disclose any information.
The M&G confirmed the existence of the third family through another registered midwife, who will not be named to protect the identity of the parents. However, the parents decided not to speak to the M&G, because it might be “much too triggering” for them.
Angela Wakeford has been a midwife for 30 years, 15 of which were spent in the UK. She currently practises in Cape Town and is Sanc registered.
According to data Wakeford has been capturing over the past seven years, the group of midwives who formed part of the Birth Options Midwife Team — who are all registered at Sanc — and who had conducted more than 160 home births between 2014 and 2018, had not recorded one death.
Collins had recorded four deaths over a period of 18 months, of which the twins’ deaths “could have been prevented”, believes Wakeford.
When Collins was asked by the Free Birth Society if she would practise again after the warning from the department of health, she answered: “I will, I will”.
And she does. After taking down their former website, Collins and her colleague now operate under two new domains, Birth Into Essence and True Midwifery, respectively.
Meanwhile, Khoury, who has been emotionally devastated by suggesting Collins to Bingala and Chirwa, is working tirelessly to obtain justice for the twins, Kweli and Kwesi.
On 12 April, Khoury accompanied Bingala and Chirwa to the Women’s Legal Centre in Cape Town to obtain legal advice to help them consider whether they want to pursue a civil suit or criminal case. According to Khoury, the parents are considering the latter, because they want Collins to stop acting as a midwife.
Speaking to a grief-stricken Bingala, he says: “Every time we [expect] them to be with us. But everything ended up in this kind of tragedy because we trusted a midwife.”
He maintains that if he knew Collins was not a midwife, but a “radical birth keeper”, he would not have engaged her services.