Call the midwife!

To say that Sharon Marsay, veteran midwife and chair of the Private Practising Midwives Association, is passionate about the power of childbirth is an understatement. She tells Margot Bertelsmann about her near-30-year career and reflects on current trends in birth and parenting

WHERE DID YOU GROW UP?

I was born in Scotland and moved to South Africa as a child.

WHERE DID YOU QUALIFY?

I studied nursing in South Africa. I started as an oncology nurse, but I soon realised that I preferred helping people into this world than out of it. I went to the UK specifically to study midwifery. I then went on to do a BSc in midwifery in Scotland.

YOU RETURNED TO SA IN 1996…

Yes, after democracy we felt ready to return.

YOU BELIEVE THAT A WOMAN’S OWN EXPERIENCE OF BEING MOTHERED INFLUENCES HER BIRTH CHOICES. CAN YOU TELL US ABOUT YOUR OWN MOTHER, AND HOW SHE SHAPED YOUR VIEWS?

My mother had seven children, and I am the sixth. Her first- and lastborn were hospital births; the rest of us she had at home. This was the norm at the time. I grew up with my mother’s stories of being in labour at home while cooking, baking a cake or looking after children. Eventually, the village midwife would be called – and in the days before cellphones or even pagers, this meant that we spent time tracking the midwife’s whereabouts in the last weeks of her pregnancies. Sort of a “last seen at…” broken-telephone system of communication ensured we knew where to find her when we needed her. I grew up with an image of a midwife as a superhero – a caped crusader of sorts, who would swoop down on her bicycle, dressed in her cloak, ready to save the day. That was inspirational to me. I decided I wanted to be that.

CAN YOU TELL US A LITTLE ABOUT THE PRIVATE PRACTISING MIDWIVES ASSOCIATION?

We are an association of 25 independent midwives in Gauteng. Marilyn Sher founded the group about 10 years ago, and I have eventually become chair. There is a similar number in Cape Town, and a sprinkling of independent midwives in the rest of the country. We work at a few hospitals and in partnership with specialist obstetricians and gynaecologists, and we also do home births. Private Practicing Midwives are also there to mentor any midwife wishing to know more about practising in her own right

and giving service to her community the best way she can. You can find us through Genesis Clinic’s web page.

HOW HAVE YOUR CLIENTS’ ATTITUDES CHANGED OVER THE YEARS?

When I was working in the UK, we were near the Greenham Common women. [The world-famous feminist Greenham Common Peace Camp started as a group of women camped out at a nuclear weapons military site. The camp remained populated for 19 years, with some women living and birthing at the camp.] Some of them became pregnant, and they were politically conscientised and assertive. They would arrive and set the agenda for their births: “I have a birth plan”; “I will eat in labour”; “You will not shave me.” Those early clients developed my way of thinking. I feel in some ways that we are going back from that situation nowadays. I don’t get so many empowered, demanding clients anymore. Women back then wanted books – I have a huge library of books that I lend out to pregnant women. Then they wanted articles. Now they want one paragraph. That can’t be enough information to make an informed choice! Pregnant women who are from Generation Z or Millennials have more access to information than ever before, yet they know the least and are undermined by friends and family who direct them into births similar to ones they fell into themselves.

TELL US ABOUT YOUR PERSPECTIVE ON BIRTH?

The first thing to know is that when you are pregnant, you are not sick. In other first-world countries with excellent maternal mortality and infant survival rates, you automatically see a midwife first when you become pregnant. If you get sick during your pregnancy, then you go to a specialist in diseases of pregnancy – and that is an obstetrician. In South Africa, there is an impression that you need to be under the care of a gynaecologist from the start. But think about your own mother and grandmother. Your mother may have given birth in a hospital, likely under very constrained conditions such as being forced to have an enema, be shaved, and lie down on a bed with her feet in stirrups – but the norm would have been a vaginal delivery. But your grandmother would have given birth at home – and so did every woman before her, from your grandmother back through the generations and millennia all the way back to Eve!

DOES THIS NOT HAVE TO DO WITH THE ODDITIES OF BEING A COUNTRY WITH MASSIVELY HIGH INEQUALITY BETWEEN RICH AND POOR PEOPLE?

Yes, in South Africa you have more choice in selecting your medical care and medical professionals than anywhere else in the world, barring perhaps Brazil or other South American countries with similarly extreme rich/poor divides. Because the elite make use of private healthcare – and the NHI is trying to address this – in South Africa it is the norm if you can afford it to book yourself in to see a specialist. This does not happen in the UK! Here, you can decide right away to have an elective c-section. Some doctors don’t do anything but c-sections. They say it is safer, but research shows that it isn’t. Our c-section rate in the private healthcare sector is

80 to 90 percent; in the state sector, it’s 16 to 20 percent, which is comparable with the rest of the world.

DOCTORS ARE AT RISK OF BEING SUED.

Absolutely! We live in a litigious society, and the risk of litigation is a threat to obstetrics and midwifery. Lawyers are now setting up stations in postnatal clinics to solicit clients. Medical malpractice insurance contributions are now so high for obstetricians that some estimate that we have perhaps five years left of specialist obs/gynaes practising in the country.

WHAT WILL THAT MEAN?

Well, it’s a worry, but perhaps it will also mean that GPs will have to return to doing c-sections, or that more births will be midwife-assisted.

SO WHO ARE YOUR MOMS-TO-BE WHO ARE INTERESTED IN MIDWIFEASSISTED VAGINAL DELIVERIES?

My average first-time mom is a 38-yearold professional woman with a good relationship with her own mother.

THAT’S OLDER THAN MOST MILLENNIALS.

Yes, and that is what is so interesting to me. Millennials, we are told, are experienceseekers. They will go white-river rafting, launch themselves off bridges to bungee jump; they’ll climb mountains and swim with sharks. They run marathons. But they’re afraid of labour. Why? As a rite of passage, and a test of endurance, you can’t beat the life-defining process of labour, which is an unforgettable natural bodily process that releases more oxytocin – the feel-good hormone – than you will get from any other activity. But their peers and doctors frighten them to the point where they think, why bother? And they get a helicopter to drop them off at the top of the metaphorical mountain instead of climbing it.

SO HOW OLD WERE BOTH YOUR YOUNGEST AND OLDEST CLIENTS?

My oldest was 42, my youngest 17.

HOW DO YOU RUN YOUR PRACTICE?

I limit my clients, so I can be sure to be at every birth. I also first consult with the woman and her partner – because my job is to help them through the metamorphic process of pregnancy and labour that is going to change you into a mother or father. The first consultation is free, and we learn about each other. If we like each other, we enter into an agreement that I will support the mother before the birth and attend the birth. After the birth, I interact with the father, to help him into his new role. He has to monitor the baby’s weight, feeding, nappies, skin, as well as how his partner is coping – one in four women is expected to show some signs of postnatal depression, and we have to be alert to those signs. He has to check in with me via WhatsApp all the time. It’s the start of making a father. With our high rate of absent fathers, it is necessary to teach men how to be dads, just like women have to learn to be mothers. My work is about the whole family.

WHY CAN HOSPITAL BIRTHS BE SO STRESSFUL?

Well, because birth includes a process of warming up to it, which cannot be dictated by someone else’s schedule or convenience. Look carefully at the hidden messages our institutions give you about your labour: is the hospital tour at a time convenient for a working woman? Is it much more difficult to get medical aid authorisation and payment for a midwife-assisted birth than a c-section? In a perfect world, midwives should keep working with obstetricians in a mutually supportive way, and in many cases it does work that way. But interview your doctor and hospital. Every labour is unique, and your institution should be willing to be flexible around you, too. AND BIRTH CAN BE INCREDIBLY POWERFUL…

Yes! It’s a test of your limits – like holding a yoga pose past the point where you think you no longer can. Birth is a mystery and a miracle, and it’s totally worthwhile. That scared girl who comes into your rooms at first, she gives birth and comes out as a powerful mother – she knows, “I can birth this baby, I can feed this baby.” That is a powerful family.