[GUEST BLOG] The Ins and Outs of Midwifery

*Originally published in October 2020.

The culture of birth in South Africa (indeed, globally) has been changing, particularly as more women are encouraged and empowered by information available to them online – from beautiful birth stories to evidence-based research – and specifically seek out birth practitioners who support and trust their innate ability to birth.

Many expectant couples have questions about the birth options out there and which choice would be the best for them. This will depend on your pregnancy, how labour unfolds, the health of mom and baby, where you live, and what birth facilities are available in your area.

Your main birth options include:

Homebirth
Active birth in hospital or birth unit
Vaginal delivery in a maternity facility in hospital
Caesarean birth in hospital

While normal vaginal deliveries and C-section births in hospital are the right choice for some women, many women with low-risk pregnancies prefer a non-medicalised approach to birth. As women become educated about their birth options and rights, they are seeking support for physiological birth – and this is where midwifery is flourishing.

Worldwide, there is a movement to choose a midwife-led birth as this offers a woman-centred and natural approach to pregnancy and birth. Importantly, research has shown that this approach to birth actually yields better birth outcomes as well as a better experience for women and babies.

What is homebirth?

Homebirth simply means giving birth at home with the help of a private midwife:

Homebirth is only recommended for uncomplicated pregnancies.
The relaxed atmosphere and familiarity of the environment often make labour progress more easily.
Family and friends can be involved.
An experienced midwife can take care of the first stage of labour and deliver the baby.
Midwives have an obstetrician who is called on if any complications or risks arise.
Natural pain relief options are encouraged (although you’ll have to move to the hospital for medical intervention and procedures).

A homebirth follows the age-old, traditional way of birthing a baby: taking place in your home, assisted by a competent and caring midwife.

Many women choose a homebirth simply because they want to bring their baby into the world in the most relaxed, natural way possible.

What is a birth in an Active Birth Unit like?

An Active Birth Unit is a pleasant, home-like suite where a private midwife (or occasionally, hospital midwife) will deliver your baby:

Being next to or in a hospital means that any emergencies can be treated promptly.
Like homebirth, an active birth is a form of vaginal birth with more empowering options that support the physiological process, like giving birth in an upright position (kneeling or squatting), water birth, moving around during the first stage of labour, and not having a episiotomy (a surgical incision to widen the vaginal opening).
Like homebirth, the emphasis is on the fact that this is your birth and you are helped to make it as special as possible.

How safe is birth in an Active Birth Unit or at home?

Birth is not an illness or a medical condition. Rather, it is a natural, well-designed process that very rarely needs medical intervention.

If done properly, research has shown that birth in an Active Birth Unit or at home can be as safe as a hospital birth. Midwives work within a certain scope of practice and do not take on high-risk pregnancies – like preeclampsia or twins.

Throughout the birth, the midwife will monitor the baby’s heart rate and progress, as well as the mom’s pulse, temperature, blood pressure, and cervical dilation. Midwives are trained to detect any complications early and to refer moms to the back-up obstetrician and hospital should medical intervention be necessary.

As experts in natural birth, midwives are qualified and equipped to deal with birth concerns such as:

The baby not breathing
The mom bleeding heavily after birth
The umbilical cord wrapped around the baby’s neck
The baby not descending
Episiotomies or tearing

Is there pain relief?

Midwives use natural pain relief methods. Stronger pain relief is possible at home, but you’ll need a doctor’s prescription ahead of time – plus an antidote in case the medication affects the baby. However, pain is related to stress as anxiety tells the body to slow the labour, but the body is already telling the uterus to push – this clash is painful! Because homebirths aim to be more relaxed, there is usually less fear and anxiety, and therefore less pain.

Midwives will use effective methods like massage and natural remedies to help you. Most importantly, a midwife encourages and supports you throughout your labour, which is essential to a good delivery.

What are the benefits?

The relaxed atmosphere helps labour to progress easier.
Parents get to establish a relationship with the midwife before the birth, and get daily check-ups (usually in your own home) afterwards.
Midwifery-led care focuses on the mother’s needs and preferences.
Moms feel empowered; they decide what position to deliver in, when to eat, and whether to walk around – and this facilitates physiological birth.
There is freedom and privacy. Moms walk around in the garden, bake a cake during labour, wear whatever is comfortable, or even birth naked if they like.
The familiar environment is comforting and afterwards the mom can relax in her own environment and bed.
Both mother and baby are never separated.
Visitors and family members are allowed even for the birth itself, if preferred.

How do I choose a good midwife?

The bottom line is that an experienced midwife in private practice is most likely to give you a happy, safe and empowering birth experience based on dedicated professional care and easy access to information supplied by a knowledgeable person.

A registered midwife is not only fully trained to handle normal deliveries and offer personalised support for the mom-to-be, but can also recognise when medical intervention is necessary.

When considering using a midwife, ensure that your chosen midwife:

Has a good rapport with you, and makes you feel confident
Is registered with the South African Nursing Council
Has 3–5 years postgraduate experience, including homebirth
Has a maximum workload of 10 deliveries per month
Has a working relationship with a back-up doctor and another midwife
Brings the necessary equipment for any interventions that may be needed like oxygen, suction, intubation equipment, intravenous access, post-birth bleeding medication, catheters, and suture materials