Your home-away-from-home birth

Private birth centres offering midwife-led births are springing up all over South Africa, ranging from luxury clinics to a simple room in a midwife’s own home; and more and more mothers are choosing birth centres over hospitals – or even home births – to welcome their babies into the world. So what can you expect from a birth centre birth, asks Camilla Rankin

TAKING BACK BIRTH FROM SOUTH AFRICA’S BIRTH CRISIS

With current numbers showing that about one in four – or 68 percent – of South African women in the private sector delivers their babies via c-section, far exceeding the World Health Organisation’s recommended 15 percent; with accusations flying about obstetricians bullying patients into c-sections, or inducing births according to their golf tee-off times; with the burnout rates of public sector nursing

and midwifery staff; the intense expectations and demands of fee-paying clients and with the crippling medico-legal insurance rates, it is no wonder that Dr Judith Carter, an obstetrician and gynaecologist at The Birthing Team, describes South African obstetrics as “in a state of crisis”. “Obstetrics is a dying discipline,” she says. “As a sole caregiver you carry a huge, stressful burden, and with malpractice and litigation rates skyrocketing, you are forced to take a defensive medical approach, often opting for the more controlled and predictable c-section.” Judith believes, that private birth centres, led by a team of experienced caregivers, are offering a safe, nurturing and viable solution to this crisis, that not only improves the experience and outcomes for the birthing mother, her baby and her family, but also for the professionals who are caring for them.

MOTHERS ARE DOING IT FOR THEMSELVES

The biggest drivers behind the rise in birth centres, however, are mothers themselves. Attitudes are shifting back towards pregnancy and birth being seen as a state of wellness, not illness, with women “starting to research more about birth, wanting to take an active role in their healthcare and wanting to be more in charge of their own bodies,” explains Ingeborg Sonnichsen of Genesis Maternity Clinic in Johannesburg. “Mothers are more confident these days,” agrees midwife and owner of Little Arrivals’ birth centre, Ntombi Mchunu. “They trust their bodies more, do a lot more research on the internet and talk to other mothers on forums, ask more questions and no longer just sit back and believe everything their doctors tell them.” And with this shift, more and more mothers are wanting to try for active, vaginal births away from a hospital environment: “When women are well-informed and know how their bodies work, then they look for a vaginal delivery – they look forward to it,” according to The Birthing Team. “And it’s about time,” says Sydney Grové of the Origin Family-Centred Maternity Hospital in Cape Town. “I’ve birthed more than 23 000 babies and I know what women’s bodies are capable of. Birth is a normal life event.”

WHAT CAN YOU EXPECT AT A BIRTH CENTRE?

The facilities offered at birth centres vary hugely – some are more like boutique hotels with fine dining, hot tub-like birthing pools and sophisticated medical equipment, while others are more basic, simply offering a comfortable room and area to freely move about in a private home. But at their core each birth centre offers passionate midwife-based care

with a focus on natural birthing led by the mother herself, in a relaxed, more home-like environment, as well as access to emergency care (either at the clinic itself or a short distance away) should the need arise. Some will have in-house theatres for emergency c-sections, while at others a maternity hospital is close by, so if a mother needs surgery, she can be quickly moved during labour. Regardless of the level of luxury of the birth centre, because the births are midwife-led, their actions are all guided by the Midwifery Model of Care. This means that every mother can expect one-on-one attention during birth from a private midwife, or team of midwives (depending on the centre), with highquality antenatal and postpartum care; for pregnancy and birth to be considered a natural and healthy process where women who require obstetrician intervention are identified and referred in good time; and are encouraged to take charge of her own healthcare and birth choices, with greater parental control, less intervention, freedom to eat and move during labour, to give birth in any position, and to be allowed to have family and friends attend the birth.

IS THERE A DOWNSIDE?

There are always pros and cons, and birth centres are no exception. There are often strict health screening criteria, and most birth centres only accept low-risk pregnancies, and what constitutes “low-risk” depends entirely on the birth centre. So, VBACs, over 35s, breech position, or any complications in previous pregnancies, for example, are often referred elsewhere; and should a complication arise during your pregnancy, you will also often be referred – but again this depends on the birth centre’s criteria and your specific midwife. Birth can be unpredictable, so another consideration is that, should the need arise, it can take time to gather a medical team together, or you may need to be moved to a hospital while in labour. The same applies if your baby needs medical attention. While some birth centres have paediatricians on call and the equipment needed to stabilise a baby in distress, at others your baby may need to be transported to the nearest hospital. Birth centres are quick to point out, though, that in a healthy, low-risk pregnancy, where the mother is active, feels safe and confident and is under the care of an experienced midwife, the chance of birth complications is lowered – and the academic research backs this up. Explains Ingeborg, “Women who use a midwife as their primary caregiver throughout pregnancy were found to be less likely to have unnecessary medical interventions.” “A birth centre offers parents a more personal, family-centred birth experience,” explains Ingeborg, and for many, a birth centre birth is a home birth for parents not comfortable with actually giving birth in their own homes. “It’s like going away on holiday to have a baby,” says Ntombi. “Because midwives are passionate about birth, they love it and want you to, too.”

IT’S LIKE GOING AWAY ON HOLIDAY TO HAVE A BABY