POSITIVE state of mind

Giving birth in a government hospital? Read on.

Most of us 60 million ordinary South Africans use the government healthcare system. After all, only about 10 million South Africans belong to the medical-aid schemes that make private hospitals accessible to ordinary citizens. And this is not necessarily a bad thing.

There are pockets of excellence in the state system. The doctors and nurses you’ll see in the private sector are the same ones who once practised or still practise in the state (because all doctors are state-trained, and many remain there, at least part-time). It’s also only in the state healthcare system where you’ll see a team of specialists make peerreviewed, academically based decisions, which is ideal for complex cases.

HOW DOES IT ALL WORK?

Dr Salome Mokgohloe Tshabalala, a Johannesburg-based obstetrician who worked in the government sector recently, explains how the process works there. Most importantly, you don’t choose the hospital or clinic at which you’ll deliver your baby. “You begin at an MOU, which stands for a midwife obstetric unit. These are clinics with the capacity to deliver lowrisk patients,” Dr Tshabalala says. There are no doctors, theatre or neonatal ICU facilities at MOUs. This needn’t be cause for concern, and is the case in many countries worldwide.

“The midwives are trained to manage low-risk pregnancies, assess you for risk factors, and refer you to the appropriate level of care.”

If necessary, you’ll be referred for more complicated care.

“A level one hospital is staffed by a midwife and a medical officer, with limited access to specialist doctors, and has a caesarean-section theatre, but no neonatal ICU,” she explains.

”Level two hospitals have a midwife, medical officer and a specialist on the staff, as well as a caesar theatre, blood bank, a limited neonatal and maternal ICU, and basic radiology services. Level three and four hospitals have midwives, medical officers, registrars (specialists in training), specialists, subspecialists and, in terms of infrastructure, provide facilities for caesarean-section deliveries and hightech radiology, a blood bank, and maternal and neonatal ICU.”

WHAT PAPERWORK DO I NEED?

The department of health has standardised the care for pregnant women in SA, Dr Tshabalala says, by putting in place policies and guidelines.

Staff are obliged to adhere to those national guidelines and protocols.

For instance, according to our Constitution, every pregnant woman in SA, regardless of nationality or age, has the right to access health services.

Bring your ID document or passport as well as proof of address – if you have them – to your first clinic visit. These documents will also help you register the birth of your newborn later.

“The proof of address is to ensure that you’re in the correct area,” Dr Tshabalala explains. “For instance, if you live in the Johannesburg CBD, you must access health services at the Hillbrow clinic, which will then refer to the Charlotte Maxeke Academic Hospital should the need arise.” This does not mean refugees, foreign, homeless or undocumented women can be turned away for lack of paperwork, as the right to access to healthcare trumps the regulations determining which facilities to access.

Says Dr Tshabalala: “Undocumented women requiring medical assistance cannot be turned away. But the importance of proper documentation must be emphasised. It facilitates good recordkeeping, ease of birth registration of the newborn and accurate statistics, among other things.”

She adds that you should still go to the clinic in the area where you live, because this contributes, ultimately, to the responsible sharing of state resources. “For instance, if you have a heart condition, you can be at a level three hospital where you can be cared for by specialists, instead of not being attended to because the available beds have been occupied by low-risk patients who walked into a facility because they can,” she explains.

DON’T DELAY – GET IN THE SYSTEM SOON

Take responsibility for your own healthcare from early on in your pregnancy. This means opening a file at your nearest clinic early on, and getting to know the people and processes. This will make it easier to form relationships with the people who will care for you in labour.

The staff’s attitudes towards you are also likely to be more positive if you have a file and a record of your treatment at their facility, rather than arriving on your baby’s birth day as a stranger.

Seen from the nurses’ perspective in this instance, they will have no record of your baby’s growth, your HIV status and other health markers such as blood type and blood pressure and won’t be able to assess if you are a complicated case or not. This makes their jobs much harder. Norma Bustard, registered nurse/ midwife and nurse manager of the obstetric and gynae block at the Charlotte Maxeke Johannesburg Academic Hospital in Parktown, encourages you to take responsibility for your own health, especially when you’re pregnant.

“You should understand that if you’ve been referred to a specific hospital for follow-up, it’s your responsibility to do so,” she says.

“There have been unnecessary, tragic incidents when women did not fully understand the implications of their conditions and failed to follow through at an academic hospital until it was too late.”

IS IT CLEAN AND COMFORTABLE?

There may be differences in the “niceto-haves” between state and private facilities: the condition of the building, the plumbing, paintwork, the linen, the food, the levels of privacy or the noise levels. But these are things you can prepare for, so that you can have the most pleasant birth experience possible under the circumstances.

Check out your facility before, and bring food, linen savers and pads, or whatever is missing that you know will make you feel more comfortable, from home on your labour day.

Registered nurse and midwife Nomonde Makhudu reassures us that government hospitals do supply linen and feed their patients.

“Of course you may bring your own pyjamas or night gown, slippers and dressing gown, bath towels (if you prefer) and even your own pillows,” she says. “All patients are given a list of essentials that they must bring, and these include clothes for the baby, blankets to take your baby home in, disposable nappies, cotton wool and surgical spirits as well as your own sanitary pads.” If your birth went smoothly, you will have to look after your own baby (good preparation for going home) and be responsible for yourself. Your hospital stay may be as short as six to 24 hours or as long as weeks if there are complications. The standard of cleanliness and the atmosphere of each maternity unit depends on the unit manager. Even in circumstances of poverty, many of these units are clean and orderly, and there is a feeling of security and contentment among patients and staff alike.

In a “baby-friendly” environment, posters encourage breastfeeding, and midwives are helpful, offering support and breastfeeding advice. What the bathrooms lack in luxury is made up for in cleanliness and – most importantly – the nursery is spotless despite the lack of lace and frills. Where you are satisfied with the service and nursing care, take the trouble to thank the staff (a box of chocolates says it all!), and do tell hospital management in writing.

WHAT ABOUT PAIN RELIEF?

Although pain relief is given when necessary, alternatives such as heat, massage, water and movement will be offered first, before Entonox, pethidine and Atarax.

Epidurals should be discussed ahead of time because they are generally not standard and are limited to level three and four hospitals.

Whether your baby’s father will be allowed to be with you is another question, and can be facility-dependent. During the pandemic policies and protocols change, and it is likely that you will be alone.

Caesareans are done only when necessary. There is no need to document a “birth plan” because every midwife at a government hospital wants the best for you and your baby. Natural birth comes first.

WHERE DO I START?

Book your hospital bed early – preferably at about eight weeks into your pregnancy. Take your antenatal card (or referral letter from your doctor), ID, proof of residence, an employment certificate or other proof of income.

If you are not working, you need three consecutive current bank statements.

You will then receive a hospital appointment card along with your registration number and payment classification. Sister Bustard stresses the importance of giving correct details such as ID number, street address and family contacts.

“The clinic card is a legal document – these should not be changed or tampered with in any way,” she points out.

You are also encouraged to stay with one antenatal clinic and not “clinic-hop”, miss appointments, change or swap appointments because this complicates administration – particularly when there are long queues.

If you’re single, you’ll get some advice about organisations and support groups that can help. “We will help in any way we can,” Sister Bustard says. ”We can make arrangements to help you and Baby during your pregnancy.” ●