Medicalization of Birth in Africa

Childbirth was always a women business. Women assisted other women during birth as well as bearing children for thousands of years. Before colonization of Africa, birth happened at home. Midwives have helped women deliver babies since the begining of history. Women were surrounded by female relatives and friends and under the care of a midwife. Men had little knowledge of the birth process or of the female anatonomy. These women were called  midwives, and they were in charge of the birth of a baby. The midwife would care for the pregnant women, deliver the baby and provide essential postnatal care for the woman until she is back on her feet to care for herself.

Medicalization of childbirth in the African continent is a crisis that had affect mother babies and midwives. As the western world invaded Africa, things have changed regarding midwives in the African continent. A more technological approach to childcare gained momentum and men were the focus. In the United States around 1939 was the time when more babies were born in hospitals, and this is still rising. While midwives dealt with straighfoward births male doctors were called to intervene, and they used forceps to assists obstructive births. Unfortunately, it is during this time that physicians began to define what normal standards should be for childbirth.

This standards for birth was not because medical science was particularly good at childbearing but because male domination at the time took over the childbirth. Physicians went on a massive advertising campaign, aimed at telling women that other women were not as good at delivering babies as they were. They used the Emmanual Friedman (Friendman's curve) graphic presentation of a normal labour. One of the most common reasons for cesarean today is due to a failure to progress during labour. Unfortunately midwives were not strong enough to stand up against the mighty machine. The number of doctors specialized in obstetrics increased and at the time all were men. Technology such as cardiotograph machine were introduced and as such the caesarian rate has gone up. More money are spend around the world to perform unnecessary caesarian sections whereas the funds could have been used to improve birthing practices and education of pregnant women. Because of the medicalization of birth in the western world, this practice was forced onto African people.

Today the role of the midwife had changed dramatically in Africa. Midwives in Africa is a dying breed. The working environment of midwives had changed and most midwives worked in hospitals. They carry out most of the deliveries and refer complicated cases to the physcian. Unfortunately these midwives have to be a nurse first and then follow with a one year midwifery diploma. The training of midwives to go to school to learn midwifery is gone and to be able to work as a midwife in most countries, most women must learn nursing first, and then transfer to midwifery. This is so medical and controlled. Hospital midwives do not spend so much time with their patients because of the shortage of staff.

In most of Africa, the majority of births occur at home under the care of a midwife just like centuries ago. The difference is these midwives are no called Traditional Birth Attendants (TBA). This derogatory term is given to my grandmother and many other women who work in rural villages and win the confidence of birthing women for their skills and understanding. With the current shortages of midwives in Africa, more attention should be on the need of the African woman.

Despite all the money spent in African on hospitals, the World Health Organization and various other organizations involve in birthing have not managed to alter this mind set. The main reason for this apparent impasse is that those in the west do not understand the African culture. Birth practices are implemented in Africa by people who do not understand the African culture at all. How on earth can a woman be expected to find her way to a hospital if there are no roads or transport.  Nevermind the fact that she might be alone with no labour support or back up. Many of the clinics are far away and lack staff, equipment and drugs. If there are staff at the clinics, their numbers are normally insuficient to meet the needs or demand of the labouring woman.

Why should women subject themselves to the extra burden of a long journey, alone and in pain and at the end of the journey she might be placed in a tiny bed with tens of other women, away from family and friends. It is far better that women birth at home amongst family and friends in the care of a midwife who are able to lend support and give comfort during the long hours of labour. The question begs to ask, why not train women in the African villages as to what the inside of a hut looks like and not that of a hospital room. There is a  very big learning curve to be addressed when it comes to birth in Africa.

My Grandmother-The Traditional Midwife

I grew up with two very strong women in my life: my mother and my grandmother. They both had a profound and lasting effect on my life, providing me, through their example and guidance, the foundations for what I am today. Whilst my mother was the closest person to me in my life, my grandmother provided the role model for my vocation in midwifery. My grandmother was a strong, tough but caring and compassionate woman and despite the formidable personality that she presented to the world, I have fond memories of her.

She raised her own seven children and took care of anyone else's children that needed a helping hand. This particularly so after the early death of my father, grandma stood in the breach and was a pillar of strength in those dark days. I attach myself to her and my grandfather like a muscle on a rock. She educated me by example and I am forever grateful for the inner strength she passed on to me. She was the sweetest grandmother imaginable, very special to me, and the best anybody could wish for. Her love was palpable, but tempered with a touch call as if it was made of steel.

My grandmother was a traditional midwife in an age when midwifery was more appreciated and much less complicated than is today. She became the rural community midwife because of her experience; her services were constantly in demand, and she was happy and proud to fulfill the duties and obligations that her calling presented.

My mother was born on a farm situated outside a small town called Beaufort West, situated in mid South Africa. She became in time the midwife for all the farms in the region, which went by names such as, La Rochelle, Leeukuil, Soutrivier, and Tweeling. The nearest of these farms is situated approximately 25 km from the nearest town. Those years in South Africa, gradnmother made her midwiery rounds on a donkey-cart.

I am pleased to say that we as a family were fortunate that my grandmother was the midwife in of me, and all my siblings. However, grandmother was not the only member of my family with caring skills, my ancestry was enriched by a long line of midwives and healers, including my grandfather, who was a firm believer in the benefits of natural healing long before it was fashionable. This may have been a consequence of the circumstances of his life, or, as I like to think, he was perceptive enough to have seen the effects of natural healing. My grandfather taught us that the best way to take care of our bodies was to eat garden fresh foods and to use herbal medicine. Grandfather had his own herb garden and we were treated with herbs when we were sick; he and grandmother worked together on the garden most every day.

I have vivid memories of seeing my grandmother massaging women on her many antenatal visits. She used massage as a comfort method and for pain control. I remember how she massaged us as children when we did not feel well. She told us the massage would rid us of the sickness that made our bodies unwell.

I remember how my grandmother visited women after birth and in my mind; I can still see her bathing the babies. I see her preparing food too because she told us that a pregnant woman must eat well. Nutrition was an important issue for her; she believed that breastfeeding must be encouraged so that babies can have good nourishment. It was very important to her that those in her care maintained good nutrition and hygiene. However, I remember most vividly her most important advice, which she often repeated: that the entire family must be prepared for the new baby. That is how she guided the community in all aspects of their social and psychological welfare.

Birth in the Karoo

Beaufort West is the gateaway between Cape Town and Johannesburg. It is also the gateway to holiday resorts in the Western, Eastern and Southern Cape. I am a Beaufort Wester. Heart transplant pioneer Professor Chris Barnard, is the the town's most famous son. Yes, Chris grew up in the dusty and small town we love. The people of my dusty home town are strong and know how to survive. I learned about enduring hardship in this small town.The life lessons of Beaufort West have enabled me to survive many obstacles. I have lived in many countries and feel that I can survive anywhere. Many people in Beaufort West feel that way and do well anywhere they go.

The karoo district which includes towns like Beaufort West, Laingsburg, Murraysburg and Merweville are experiencing an intense drought and all water supplies are currently running low. These towns are known for their climate; droughts are common place and endless. Beaufort really needs rain. Having no water is no joke.

I think South Africa could face a water crisis in the near future and therefore the leaders should start to take action now. We need good water management for growth and development otherwise water demand will outstrip supply. Our government leaders have to take the lead and take this issue seriously. South Africa is known as the 30 driest country.

Beaufort West is small town with lots of unemployment and poverty. The town is riddled with chronic diseases due to poverty. All of this is preventable. People are used to hardship, yet they know how to survive and do quite well. The people of Beaufort West are goodhearted, genuine and warm. They take care of each other even though they struggle themselves. Everybody knows each other. Beaufort West is the best town, and a great place, but it is sad about the drought.
　
Beaufort was known for its long history of midwives. Chris Barnard was born at home. There are no private midwives in Beaufort West; everybody gives birth in the hospital or clinic where midwives take care of them. Somtimes it is very busy and sometimes not. Beaufort West has one hospital and seven clinics. The hospital, located next to the N1 freeway in Beaufort West, services a vast geographical area that serves as home to thousands of residents. The 57-bed hospital admits patients from far-flung Karoo locations. It also serves as a national health asset caring for thousands of travellers passing through the town. There is a small maternity unit. Women endure labour and give birth to their babies without any drugs.

The midwives of this town do not just deliver babies in the town but also on the nearby farms. My grandmother was a midwife in this mould. She went from farm to farm to deliver babies. She looked after women, cared for them, making food and basically taking care of all their needs.