If you’re a mom wanting to give birth naturally in South Africa, you might find yourself facing some opposition, and not just from women around you. JUDE POLACK, director of active birth hospital, Genesis Clinic, gives advice on dealing with ‘medical bullies’.
Standing up for yourself can be hard at the best of times. Doing it when you’re pregnant and have the life of your unborn child to consider, is particularly daunting, especially when you’re up against a doctor or caregiver who’s intent on changing your mind.
That’s because in South Africa’s private healthcare arena, the decision to ‘go natural’ is often one that moms have to rigorously defend. Based on the experiences of moms who come to us at Genesis Clinic after being discouraged by their doctor against natural birth, there are three clues to alert you to the fact that you’re dealing with potential medical bullies.
The first is a doctor who warns you that your baby is too big or that you’re too small to deliver naturally. They’ll start hinting about this early on, preparing moms for a change of game plan. “Just start getting your mind around the possibility that you might need a Caesarean,” they’ll say. But the doctor who tells you early in your pregnancy that your baby is going to get stuck is flat-out lying to you.
There is no way to tell, even from an x-ray, that a woman’s pelvis won’t distend and disengage sufficiently for her baby, and ultrasounds can be off by as much as 400 grams. In my practice, I’ve seen tiny women giving birth without trouble to babies over 3.5 kg, while bigger moms needed help delivering babies just over two kilos.
Another common sign of medical bullying happens quite late in the pregnancy, at about 36 weeks. The doctor will start priming you that your baby hasn’t engaged or dropped down, which will unfortunately necessitate a Caesarean. A large percentage of babies however, will only engage once labour starts, particularly in second pregnancies; in fact, most second or third babies will only engage the day before or even once labour has started.
The third clue you have a medical bully on your hands is when your doctor tells you halfway through your pregnancy that your amniotic fluid is drying up or calcifying; this typically only starts to happen though, once mom is two to three weeks overdue.
WE’RE BEING DECEIVED
To put it bluntly, women in South Africa are being deceived. They’re being given one-sided information aimed at pushing them into making decisions that suit the medical fraternity, which, in the case of private healthcare in South Africa, is significantly skewed towards performing C-sections.
The World Health Organisation says that a Caesarean rate above 15% is unjustifiable, yet private hospitals in South Africa have rates as high as 68% (National Perinatal Mortality and Morbidity Committee Triennial Report, 2008-2010).
Disregarding elective C-sections, why is the rate so high? People joke and say that doctors in South Africa do Caesareans so that they’re not interrupted on the golf course. Convenience does, of course, come into it, but it’s more complex than that.
Did you know that gynaes and obstetricians pay upwards of R40 000 a month on medical insurance, a premium that goes up significantly should insurance have to pay out for malpractice.
It’s understandable therefore, why some doctors would rather do a hundred unnecessary Caesareans than risk losing one baby or mom in a real emergency. For these doctors, C-sections seem like the safest obstetric procedure from a legal standpoint.
Currently, government is working on capping medical malpractice payouts, which might well have a significant impact on the number of C-sections pushed onto unwilling women in years to come. Until then though, what can moms do to get the best chance of having the safe, natural birth they want, without the bullying?
GETTING THE BIRTH YOU WANT
If you want to give birth naturally, the most important thing you can do is start off with the right caregiver. From the very beginning, have an in-depth discussion with your doctor. Find out what his or her C-section rate is, and what his or her philosophy about natural birth is. Arm yourself with information about the pros and cons of both routes; don’t just rely on what you’re told.
If your doctor is clearly not on the same page as you, then you should consider finding a new caregiver. I’m always amazed how moms will swop hairdressers and nail technicians and insurance companies if they’re not getting the service they want, but they’re terrified of changing doctors.
This is a very special time in your life; it’s your right to find a caregiver who will help you to enter motherhood in the way you choose, while safeguarding both your and your baby’s life.
You should also consider finding a midwife or doula, even if you are planning to give birth in a hospital. They will come to your appointments with you, support you and stand up for you, while ensuring you get a safe experience.
Currently, private hospitals don’t allow midwives to come into the labour room with moms, and only a handful allow doulas; with consistent pressure from moms however, this will change. Women need to put pressure on hospitals and doctors to start offering them the birthing experience they want. There is no reason why all hospitals shouldn’t have active birthing units, giving moms the beautiful experience they so want, with the safety net for the 10-15% of moms who’ll experience complications.
I always remind women that this isn’t just the day that a baby will be born … it’s also the day that a mom is born. This is a huge rite of passage for a woman; she should be allowed to make this journey in the way she chooses, and with a caregiver who is mindful not only of mom’s and baby’s safety, but also of her hopes for how she wants to bring her child into the world.