Are We Creating an Epidemic of High-Risk Women?
Two weeks ago I wrote about the first unnecessary caesar I attended. It was the first but it was also not the last. It did prompt me to do my homework and to really make sure that the women I was attending as a doula were well informed. One of the things I did was call up all the maternity wards of all the private hospitals here in Cape Town and ask them directly what their their caesarean section rates were. I knew from discussions with other doulas and midwives that many caesars were taking place but I did not have clear numbers. The conversations went something like this: “Hi…I am a doula supporting mothers wanting to birth vaginally in private hospitals here in Cape Town and I would just like to know what your caesarean rates are so that they can make an informed decision about where the best possible place to birth is.” Or something along those lines. Responses were everything from helpful and obliging to irritated, rude and irate: “Oh one doctor here has about a 60% caesar rate…he really tries, but the others are definitely around 80 – 90%” “About 65% but I think it is the private midwives that do deliveries here that bring the rates down…the doctors have much higher rates than that.” “Between 60 and 90%.” “I don’t see why we should divulge this sort of information, I don’t see how a high caesarean rate can make a difference to a woman’s chances to birth naturally!” “It is definitely upward of 80% but I am not telling you how much higher – I don’t think it is any of your business!” So in private hospitals in Cape Town, we are looking at a caesarean rate of 60 – 90%. And from my experience in two of the major government hospitals in Cape Town, it seems to be around 50% in the public sector. The World Health Organisation recommended a caesar rate of between 10 – 15% as being healthy, so WHY is our caesarean section rate so high? And why is it not my business to find out the caesarean rate of a hospital that is often promising to be supportive of women’s wishes to birth as they wished? And why is it suddenly okay to slice open perfectly healthy women and change their obstetric history forever? (I need to stress that I am not anti caesarean. I am eternally grateful for the operation that saves the lives of mothers and babies. I am not putting down this very necessary intervention and the skilled people who can perform it.) Since then I have worked within home birth midwifery practices and met midwives from all over the world who maintain a caesarean rate of between 2 and 20 %. Why do they get it right and the hospitals do not? I think the saddest and hardest thing for me is meeting the women who have undergone these unnecessary caesars. Who come with their stories. And who really want to give birth vaginally this time around, sometimes after one, sometimes after two, sometimes after more caesareans… I was induced at 38 weeks and didn’t progress so I had to have a caesar. The doctor said my baby was getting to big and I would never be able to birth her – but then she was an average size! I had a supportive doctor but she was on holiday when I went into labour and I got the doctor with the highest caesar rate in the hospital. The environment was too clinical for me, the beeping machines,...
Read MoreBirth : A Poem
Birth: What is birth? Birth is the emergence of a new individual from the body of it’s mother. The emergence of that new individual, is the emergence of a new life. Birth is completely normal yet unbelievably profound. As that baby emerges, everyone holds their breath….. Where do we give birth? We choose to have our babies in various settings: At home In hospital In a theatre And sometimes these are not choices but necessities. Sometimes we plan to give birth in one way but then something completely different may happen. Sometimes babies are born in trees, or on trains or by the roadside. Sometimes babies choose for themselves where they want to be born. Where and how we give birth affects who we are. It affects how we are as parents. We need to feel safe. We need to feel confident. And we need to feel in control, so that later we can lose control. If a woman feels cared for and nurtured, she is more likely to love and care for her baby. When we feel safe where we give birth, we give birth more easily. If we feel frightened or vulnerable, we may feel traumatised and incapable of loving our babies. If we are made to believe that we are incapable, we may hand over the power to someone else. There is a hidden secret in our culture: ‘It is not that birth is painful It is that women are...
Read MoreMy First Unnecesarean
When I first became a doula I was quite naive. Yes, I had been given all the information and statistics during my training but there was a part of me that smugly believed I could ‘save’ any birthing situation with good intentions, homeopathic remedies and aromatherapy oils. *humble blush* I attended my first unnecesarean very soon after becoming a doula. I met with a young couple who were keen on a natural birth but in hospital. She had originally wanted a home water birth with midwives but he did not trust midwives and therefore they had chosen a female doctor who seemed to resonate with the young woman’s wish to birth physiologically. They had chosen (or rather, their medical aid had chosen) a hospital which was nicknamed Caesar’s Palace due to its alarmingly high c-section rate (anywhere between 80 – 100%). We went through their birthing plan, which was beautiful, and it was decided that I would join them at home in labour and that we would go through to the hospital once labour was strong and well established. They felt optimistic that with the birth preparation they had done attending an antenatal class and with the support of their doctor and myself, their birth plan would be successful. Simple right? They called me one early morning to tell me that her waters had broken and that the doctor had told them to come in to hospital as she needed monitoring. They would keep in touch with me. Luckily for her, her contractions started soon after her waters had broken and when I arrived at the hospital, she was already contracting regularly. I was taken aback by what I saw though, she was in a hospital gown (her birthing plan had explicitly expressed that she labour in her own clothes) and she was attached to a drip which was administering antibiotics (to ward off infection now that the waters have broken, I was told). Despite these obvious discomforts, this young woman used the breathing techniques she had learned and practiced in her antenatal classes and walked about the room, pushing the drip stand around as she laboured. At least she was not continuously strapped to a foetal heart monitor, but she did have to lie down every hour for twenty minutes or so to be monitored which was extremely uncomfortable for her. At one point a doctor came in to examine her. It was not the doctor she had built a relationship with, her doctor was unavailable and this new doctor (all in black and wearing a pearl necklace) would be taking care of her. My client tried to hide her disappointment and muttered that at least the new doctor was female. The new doctor examined her patient and declared that my client was already 4cm. The doctor congratulated my client on her progress and said she would be back in a few hours to check on my client again. We were pleased and for the next four hours, as the contractions grew stronger, the young woman continued to use her breathing techniques, and walked about the room listening to the music she had so carefully chosen for this special event. I rubbed her back and chatted to her husband who was sweetly supportive. A nurse came in every half hour or so and monitored the baby’s heart rate, checked her blood pressure and took her temperature and pulse. Labour seemed to be progressing, we were feeling positive. At one point I excused myself and went to the en suite loo. I heard the doctor coming in and when I came out of the bathroom...
Read MoreWho Cares for the Midwives?
Midwifery can be very lonely. Midwifery is very much a calling and something that those who choose to walk this path, do because they want to ensure a safe and holy passage for mother and baby. Midwives believe in the sanctity of birth and know that protecting the mother during pregnancy and through the birthing process will ensure that the mother bonds with her baby and will make her a better mother. Midwives believe in women’s ability to birth and it is the midwife that is that solid rock during labour when the mother feels she can no longer do it. Midwives encourage. Midwives listen. Midwives trust. Midwives are there for the mother. Midwives are there for the father. Midwives are there for the baby. But who is there for the midwife? Who cares for the midwife? Who can she turn to when she has had a scary experience? Who rallies around her? Midwifery can be very lonely. When a midwife is called out to a birth at three in the morning and cold rain is ripping at the windscreen of her car, it can be very lonely. As the clock ticks and the world is asleep and no one else is awake, it can be very lonely. When a midwife writes up her notes and heads home to her bed it can be very lonely. When a midwife has to deal with an emergency, she has to think quickly on her feet and act to save a life, or two, it can be very lonely. When a midwife has to transfer to hospital and stay strong for the mother, all the while feeling worried herself, it can be lonely. So why do midwives do it? Why do they keep doing it? What drives them? Because it is a calling. There is a pull, something unstoppable. Because it is beautiful. The soft sigh of a woman finding her rhythm as she labours. The gentle splash as she moves about the birth pool. Because it is awe inspiring. To be a witness, a guardian, of the birth of a new life. Not only the birth of the baby, but also the birth of a mother. Because it is empowering. There is something incredible about a woman in labour tapping into her own innate instincts. Because it is...
Read MoreCarol Catches Twins
My mother, Carol, was a ‘lay’ midwife (ie she never received any formal training as a midwife) but accidentally ‘fell’ into the catching of the babies on our farm Droëland. This is the story of the birth of the first set of twins she attended. They were undiagnosed twins (i.e unexpected): Willie and Sannie had been on Droëland for about a month when Sannie went into labour. They arrived one Sunday morning on foot with their two children, a boy and a girl, and settled into the labourer’s cottage next door to Dappie and Marie up at the Barracks (this was what the labourer’s cottages were unofficially called). Sannie was heavily pregnant at the time and my mother joked that Sannie was carrying a rugbyspan (a rugby team). Two weeks after Sannie and Willie’s arrival, the farm labourers were being driven into Ceres for their bi-weekly shopping trip on nat naweek. (Literal translation of ‘nat naweek’: ‘wet weekend.’ This refers to the weekends when the farm labourers were paid. They were paid every other Saturday. Unpaid weekends were referred to as ‘droë naweek’, ie. ‘dry weekend.’ ‘Nat naweek’ also refers to the fact that most of the farm labourer’s wages were spent on wine.) Two vehicles, the truck and the bakkie (pick up truck), drove the 60km dirt road in convoy into town. It was about eight in the morning on a beautiful spring day in October. At the turn at Witklippies (one of the neighbouring farms), the truck overtook the bakkie. Willie was sitting in the back of the bakkie and eager to get to the bottle store before anyone else, decided to jump from the bakkie on to the back of the truck. He missed and landed on his head. He was never quite the same again after that. Smell the freshness of the air. The farm only smells like this in spring. Fresh and warm. My mother was in the kitchen with my younger sister Gypsy. “Mami! Mami!” Jasmin (my younger sister)’s voice called from outside. Jasmin had been up at the Barracks and had heard Sannie screaming from the labourer’s cottage. Jasmin had nervously poked her head around the corner of Sannie’s bedroom and seen Sannie crouched on a thin sponge mattress on the cold cement floor in strong labour; the usually shy and quiet woman behaving like an enraged wild animal. Births on the farm had by now become routine for our mother. She now had a well stocked birthing kit. Our mother took her time in getting ready (much to the irritation of my two youngest sisters). She chopped some wood and washed the dishes and put some food on to cook on the wood burning cast iron Defy Dover stove, before heading up to the young woman in labour. Our mother walked up to the Barracks with Gypsy and Jasmin, who rushed ahead burning with curiosity. My sisters ran up and down, rushing our mother along but our mother refused to be rushed and ambled slowly up to the Barracks. Our mother was ushered into the bedroom by An’ Ragel and An’ Christine. Gypsy and Jasmin joined the other curious bystanders in the kitchen (mostly children). Jasmin had been instructed to boil a pot of water with some cotton yarn (to tie off the umbilical cord) and a pair of little scissors. Jasmin did this, feeling useful and proud at having been given this job. The labour went quickly and smoothly and soon a little boy slid out of his mother. Our mother wrapped him in a towel she had brought with her (there was absolutely nothing in the house for a baby). The new mother pressed her breast to the baby’s little face and he began to eagerly suckle it....
Read MoreThis is a Baby of Rape
I live in the seaside village of Scarborough, near Cape Town, at the tip of Africa. It is rather idyllic; small, safe and beautiful. I live in a simple wooden shack near the beach. Life is simple but good. This morning I went to see a pregnant client at her home in Glencairn. It is about a ten minute drive. It was overcast and drizzling but warm. We sat at her table, sipping rooibos chai and chatting while her nearly two year old daughter played around us. I left after an hour or so. All was well with mother and baby. We hugged and said our goodbyes. I drove back to Scarborough and at the bottom of Red Hill, a young mother from the settlement was hitch hiking with her baby on her hip. I stopped and with relief she hopped into the back of the car and told me she was travelling to Ocean View to the clinic there. Her baby had a rash and she needed to have it checked out. I apologised that I was only going to Scarborough ( I had another pregnant client to see there) but could at least take her that far. She said she was happy with that. I asked her how old her baby was and where she had given birth to her. “She is seven months…I gave birth to her in the Eastern Cape,” she said. I asked her if this was her first child. No, she replied, this was her second. Her eldest child was already eight years old. “This is a baby of rape,” she said matter of factly. I was not sure what to say. I turned around and looked her in her eyes and said, “I am sorry.” I am still not sure if that was the right thing to say. But what do you say? I then turned back again and looked at the baby. So sweet and innocent and beautiful, sitting in her mother’s lap. “Your daughter is beautiful.” I said. She laughed and agreed. When she got out of my car I asked her what her daughter’s name was. She told me. I repeated it back. “What does it mean?” I asked. ” It means, ‘We are Friends’…” Then hoisting her daughter onto her back, she slammed the car door, smiled, waved, and walked...
Read More