MIDWIVES MAKE FOR BETTER HEALTH OUTCOMES
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.