Traditional Care in Pregnancy

 Motherhood is what every woman dream about. Given birth to a child is the greatest gift we could ever imagine. Traditionally, across time and cultures, pregnant women have been surrounded by knowledgeable women, family, and close friends, who supported the transition to motherhood with affirmation and great excitement. Pregnant women were treated differently, given the best food, and protected as much as possible from stress and overly hard physical work. The woman knew she was pregnant when she noticed physical changes: a missed period, sore breasts, darkened areola, nausea, aversion to certain foods, and fatigue.

A woman's due date was determined by noting the start of those signs and, then, the timing of first movements of her baby. She got to know her baby through his movements. The pregnant woman was considered the expert in her pregnancy. She was encouraged to pay careful attention to her changing body, heart, and mind, and to her growing baby. Family rituals insured support during pregnancy and labor and the postpartum period. Pregnancy and birth were family events, and the care and support the pregnant woman received were from people she knew and who knew her well. Although pregnancy and birth carried more risks than today, women developed strong attachments to their unborn babies and worked with family, friends, and caregivers to insure safe passage of their babies. Life was different, healthy and free of tegnology.

Today, pregnancy and childbirth are treated as medical events rather than as normal life events. Women are treated like it is a business. It has become a money making business but at the same time a big cost to healthcare budgets.  Most women take commercial some kind of home pregnancy kits doing their own test to find out if they are pregnant or not and, then, anxiously visit their healthcare provider to confirm the fact of the pregnancy. As we know right from the start, the pregnant woman affirms that the obstetrician is the expert who must be consulted to find out every detail of how things are going.

Obstetricians are the main experts and women around the globe are bragging about their OB/GYN. Because of this, women typically worry from one prenatal visit to the next that everything is going well. “Expecting trouble” has become the trait of contemporary prenatal care. The experts GYN/OB exaggerate the risks of pregnancy and birth and increase women's fears for themselves and their babies. “Expecting trouble” has resulted in an exaggerated concern for safety, “intervention-intensive” pregnancy as well as labour and birth, and, not surprisingly, an escalating caesarean rate around the globe. Having a caesarian section has become the norm.

The days are gone of just a simple routine care and antenatal visit to the midwife. OB/GYN is doing routine sonograms, sometimes done at every prenatal visit in some countries because an increasing number of routine screening tests are considered standard antenatal care today.  Mostly, pregnant women panic if their OB/GYN did not perform such a tests. Strangely, all these tests lead to large numbers of “positive” results. In most cases, a positive screening result does not mean that there is a problem; in fact, there probably isn't one. The way to find out is, of course, to do more tests, and these further tests become increasingly invasive and risky. Most women feel pressured, once on the merry-go-round, to keep going. Women find themselves having to make decisions they never expected or wanted to be in a position to consider.

I think most women don’t realize that birth can be natural and feel that hospital birth is the normal. Most women don’t realize that even homebirth is a legitimate option because their overwhelming fears of birth and of what they hear from their healthcare provider. Most women probably found labour scary because they didn’t have the assistance of a doula, or midwife, didn’t have an undisturbed birth didn’t work through their fears in advance…nine out of then these couples were on their own, left to stumble through it alone. Now this is scary. I pray that most women become educated in childbirth. I hope women find self confidence to trust their bodies and birth and not believe in the fear by the whole “what if something goes wrong” argument. For me as a midwife, it is beautiful to watch labour progress undisturbed…labour is a challenge…

State of the World's Midwifery Report

The 2011 International Confederation of Midwives (ICM) conference was held in Durban, South Africa from June 19-23, 2011. The conference was attended by more than 3000 midwives from all over the world and was the first time for the continent of Africa. The five day conference was packed full with workshops plenary sessions, symposiums and many presentations. In addition the conference also attracted the submission of posters from local and international participants. The conference is a triennial celebration and the next location will be Prague, Czech Republic 2014. Prague has been a political, cultural and economic centre of Europe during its 1,100 year existence.

The conference got off to a rousing start at the opening ceremony with lively Zulu dancing welcoming the gusts with several guest speakers such as the First Lady of Malawi. The main focus was on ICM president Bridget Lynch. Our ICM conferences are always memorable events.

The State of the Worlds Midwifery Report was lunch. The release of the long awaited State of the World’s Midwifery Report and the powerful, poignant Stories of Midwives provides new information and data gathered from 58 countries in all regions of the world to:Thousands of midwives nurses physicians and doulas travelled from all over the globe to address the challenges faced by midwives today. I met amazing people who are dedicating their lives and careers to this important cause. I was very touched by the energy and commitment as evident as this conference. I knew I was with passionate people from all over the world. I learned a lot from the midwives from Prague. I was so excited with when they introduced Prague to the world. Also at my hotel was delegation from Trinidad and Tobago India and Indonesia.

• examine the number and distribution of health prfessionals involved in the delivery of midwifey services;
• explore emerging issues related to education, regulation, professional associations, policies and external aid;
• analyse globloal issues regarding health personnel with idwifery skills, most of whom are woen, and the constraints and challenges that they face in their lives and work, and
• call for acceleating investments for scaling up midwifery services, as well as "skiling up" the respective providers.

The report includes statistical tables and applicable global standards, collating relavantmidwifery informations into one reference document. Behind The State of the World's Midwifery 2011 stand 26 international partners involved in materal and reproductive health, with s a specific focus on midwifery, including ICM and PMNCH, and led by the UN Population Fund (UNFPA).

http://www.unfpa.org/sowmy/resources/en/main.htm

I was with a passionate group of people after a full agenda of activities the dinner conversations were filled with the day’s event and mostly sharing of ideas and future contacts. I met a midwife from every African country and it helps broaden my knowledge of their day to day work. Underneath the different accents and perspectives there was seething more. Yes there was a common sentiment that much more needs to be done to improve the ives of mothers and babies. We as midwives are 100% committed to the cause. We are here in Africa to make a difference. And we will I know I will. The time is now…I am ready...we are ready. Africa is ready.

International Confederation of Midwives in Durban 2011

The biggest event in maternal and child care will be coming to Africa. South Africa will host the International Confederation of Midwifery Conference on June 19-23, 2011 in Durban. Midwives from allover the globe will be attending. South Africa is well-known for its big 5 in the world of nature and wildlife preservation, and so it is to be the theme of the conference in Durban. The theme of the ICM 2011 congress is “midwives tackling the “Big 5” globally. The ICM congress has turned to underline the Five Big Challenges facing Midwives Globally which are the leading causes of maternal death and morbidity in the world.

The expert advice is clear and that is that maternal mortality in Africa is facing a crisis. Maternal mortality ratio in Africa is the highest in the world. Sub-Saharan Africa suffers from the highest Maternal morality rates such as about 640 maternald deaths per 100,000 live births. Maternal mortality is a major problem in South Africa. South African rates are unacceptably high and far above comparable international norms and is totally preventable. It lacks political will.

The major organizations will be there such as the World Health Organization (WHO), United Nations Population Fund (UNFPA) United Nations Children’s Fund (UNICEFF) and the Bill and Melinda Gates Foundation, just to mention a few. These major organizations of the UN system are all relevant stakeholders whose emblems I expect to see on the conference website, though there are also the major pharmaceutical company’s competing for a place in Durban. They will all have an opportunity to view the conditions prevailing in Africa, my continent.

The countries of Africa will all come together to celebrate birth. Regrettably the numbers of midwives will be few because the majority of needed midwives will not be able to make this journey. The cost is very high. Most midwives in Africa don’t earn the kind of money required to afford the trip.. If they can’t come to an event like this it means they will never get the valuable information that will be presented at the conference. These midwives are the frontline workers, they do the dirty work while the other’s drinking the wine and enjoying the cheese; the sweet life.

I am fortunate to be able to attend these conferences. As a matter of fact I have been attending international conferences for the last 10 years. Many times I am the only person from Africa. Why; because many can't afford the high cost, hotel, airplanes, not to mention visas.

Many countries will come and present their papers. Some of them I have previously heard and listened to. They refer to us as the Third World. Third world is such a derogatory term, but it is the most used term in North America. In 2001 at the UN more then 189 countries agreed that the term third world will never be used again but unfortunately people in the developed world don’t seem to understand that. The term Third World is actually a Cold war nomenclature because at the time they did not know what to do with those countries that neither aligned with the Western World powers nor the Soviets. From day one the term started out to be some kind of a stereotype. 

I feel angry when they us that term. It feels as if they refer to me as nigger. It is so distasteful that I can't explain but many midwives continue to talk like that when writing in journals or presenting papers. In midwifery we do not need demeaning terms like that. I don' expect an organization like ICM will tolerate language like that. Most of the people that will speak at ICM are all graduates, PhDs, so I am sure they will respect us in this beautiful continent of us. I hope they will use “developing world” or “developing nations.”  The Third World Term is just a very very bad label! African nurses do not deserve that label.

World Health Organization and Agencies

The World Health organization recommends that a skilled attendant be present at every birth. The WHO recommends lots of things but in reality it is not possible. Yes, the WHO renamed  African midiwives to become "traditional birth attendants." I am ne of those attendants the WHO is taking about. WHO strongly advocates for “skilled care at every birth” to reduce the global burden of 536 000 maternal deaths, 3 million stillbirths and 3.7 million newborn deaths(3) each year.

The WHO recommends two midwives per mother in labour. According to the WHO skilled attendance at birth remains drastically low in sub-Saharan Africa; only about 42% of the childbirths are assisted by a skilled attendant in the Africa region, some countries registering as low as 5%. This is against the target of 80% of births being assisted by a skilled attendant by 2015 if the goal of reducing maternal mortality rate by three quarters (between 1990 and 2015), is to be achieved.

In 2000, the United Nations agreed to reduce the mortality rate for children younger than five with the implementation of the Millennium Development Goals (MDGs).  Achieving the health MDGs will be a major challenge but 2015 is around the corner.

The Safe Motherhood Initiative was launched at the Nairobi Safe Motherhood Conference in 1987. This is a global initiative to reduce maternal mortality in developing countries through a collaborative effort of international agencies, national governments, and nongovernmental organizations, but it is 20 years later and little progress has been made to reach that goal.  In some countries, the situation has actually worsened. So where do they go wrong? In 1999 with the WHO's guidance, many countries launched the " Making Pregnancy Safer" initiative, aimed to reducing te burden of maternal mortality.

Several Maternal health messages have focused largely on the size of the problem of maternal mortality and its human rights dimensions. But what is wrong with the mesage. What has been missing has been clarity about the interventions that work to reduce unsafe motherhood. Too many programmes try to do too much while simultaneously failing to focus on the interventions known to be effective. Most of these programmes have included major international conferences, women’s health advocates, uplifting of health care professionals with the help of  donor-funded support. Yet on the whole all these efforts have lacked conviction because there is no political will.

Political leaders are not involve or do not know what is going on, and generally not a priority either nationally or internationally. Everybody writes beautiful papers but nobody really put presure on governments to imporve education of midwves and improve access to health centres. here are very few roads in Africa and most women live in remote areas and walk for days to the nearest healthcare centre. Imagine if better training can be done for the African women by African women designed by African women. What if these traininees can be scattered around the continent to offering good antenatal care and clean safe deliveries with good access to healthcare centres.

Alliance of African Midwives

My organization is called the Alliance of African Midwives. The African Alliance of Midwives is a nonprofit organization whose purpose it is to improve the health of women and children in Africa. My mission for the African Alliance of Midwives is to provide comprehensive, quality care to women in pregnancy, childbirth, and the postpartum that is safe, holistic, loving, and that honours the divine in all people.  

I believe that pregnancy and birth are normal states of being and normal life processes.  I believe all women should have access to care. Most pregnancies and births are normal, and the greatest safeguards in keeping them that way are education and non-intervention.   I believe that spending quality time with women in pregnancy in regular prenatal appointments and giving loving, thorough care are essential to positive birth outcomes in today’s society.  I truly trust birth and do not intervene in the birth process unless necessary, as experience has taught me that most births unfold beautifully without outside interventions.  

My vision for the world community is that women in the continent of Africa will have access to safe and loving midwifery care.  I want all women to believe in themselves and in their bodies.  I want women everywhere to know themselves intimately: spiritually, emotionally, and physically.  I want for women to rejoice in femininity, in pregnancy, in the miracle that we can create and give life!  I want for women everywhere to be self-confident and to get what they want for their births.  I want for all normal births to stay that way, to be free from intervention.  And I want for women who experience complications to receive loving and safe care that they understand.  I want for midwives to be educated and to provide safe and available care to all women who seek for us.

I believe that birth has real power to change the Africa and the world.  I believe that the world can change one birth, one mother, one baby, one family at a time.  I will do my part by striving to constantly walk with all midwives and organizations in this continent of mine to make it happen.

Midwifery Education in South Africa

Midwifery education in South Africa goes back to the early 1960's. During that period in order to become a midwife a person first had to qualify as a nurse and then subject themselves to a period of training as a midwife.There was a three year nursing diploma course offered followed by a one year course in midwifery.This format was the norm for many years. Young women were first trained as nurses and it was compulsory at the time to complete midwifery traiing even if your willl never work as in a midwife setting.

Midwiffery clearly was seen as second to nursing with the doctors being the mainstay of birthing, the control over what we do and cannot do.The nurses ran the antenatal clinics, dispensing medication and doing basic medical procedures normal deliveries.This freed the doctors up to attend to the more lucrative issues. Doctors were called for complicated or surgical intervention. The nurses were left overworked and underpaid for many years.

The above picture in South Africa is the norm, tired and overworked nurses and clinics that are too small and overcrowded, and severely understaffed. Sometimes there is just a screen between women giving birth. Every person can hear every coversation which is suppose to be private and confidentail but it is not. It a wonder that African women prefer to give birth at home with midwives and avoid the clinics and hospitals completely. In private hospitals, babies are generally delivered by doctors, not nurses,


The  nursing curriculim was changed in 1986 when the four-year course was implemented. So, since then the most prestigious route to become a nurse in South Africa is a four-year degree, offered by several universities and universities of technology and regulated by the Department of Higher Education.

The four year degree course was implemented in the United States because nurses are the only healthcare professional without a degree. The decision was made that all new nurse entries should be a degree. At the time 15 countries signed up. South Africa tried to be on board as well but unfortunately, our nurses graduate with a four year Diploma in general nursing, community health, psychiatry and midwife. The four-year degree courses (BCur, BA Cur, BSc Cur) are offered at most university in South Africa


The degree nurses do the same course at university level and both degree en diploma nurses are callled profesional nurses whereas everywhere in the world nurses are called registered nurses (RN).  Forty years ago the American Nurses Association (ANA) issued it's position paper making the bachelors degree in nursing (BSN) mandatory for entry into the profession. This is happening slowly allover the globe. All new nurses in England starting from 2013 will have to be degree educated. Diploma courses will be fased out slowly. Countries like Canada, Australia require a degree entry for all new nurse applicants.

The South African system of training has to be upgraded since the current training system and curriculum is inadequate.The results can be seen in the high HIV rates, maternal and infant death statistics.The way the training of nurses in the US is structured is completely different and geared to cope with the problems we encounter in todays world. South Africa needs to upgrade the criteria in it's nursing education. The nurse-midwives of South Africa especialy those in the public health system are overworked and understaffed. Nuses are the largest category of healthcare professionals. The training of nurses has been neglected and need change.

Since the Direct Entry Midwifery Course was stopped in South Africa in 1981, we now are all nurses first. Some academics argue and brag that the Advance Midwifery Course is the way so if it is the way why not making it a direct entry course. Mothers should be attended by midwives not nurses who know little about childbirth support apart from technology. If this is not the case why are so many women giving birth in hospital alone, and why are there so many private hospitals controlled by men.

The problem is that nowadays home births in South Africa are not catered for by the state health service. The only registered professional service that offers this option is that of the Professional Midwives, registered by SANC and a Facebook page for students studying direct-entry midwifery in Johannesburg from other countries, these student practice on our women and return to their countries with degrees. Our women and resources were use to help foreigners advance but our own student and people do not get the opportunity to enrol in a direct entry midwifery program. We have to start the long road of becoming a nurse. It is a frightening thought!

Abortions in South Africa and midwives

I am a midwife. Midwives bring life into this world. They are doing great work and I am honoured to know many wonderful compassionate and caring midwives. Midwives provide care across the spectrum of a woman’s reproductive life–from well-woman care, to pap smears and yearly exams, to prenatal care, and the birthing process.

Abortions are a very sensitive issue in South Africa. It is angers people. For many years abortions were illegal and were only done in certain cases. With the change in Government abortions were legalized, as in terms of the new constitution they were deemed a right. Abortion was made legal in South Africa with the implementation of the Choice on Termination of Pregnancy Act of 1996. The Choice of Termination Act stipulated that registered midwives can perform abortions for women and immediately a program was initiated to train midwives around the country to provide abortion services. How disgusting! Prior to the Abortion law, abortion was understood to be a common crime. The law was after the person who performed the abortion not the pregnant woman.

Many religious groupings were against the legalization of abortion and many protest marches took place to the countries parliament. The government however resisted, and the law legalizing abortion was duly promulgated and passed. To add insult to injury midwives were forced against their will and their religious convictions to partake in abortions. South Africa is the only country in the world where midwives are expected to perform abortions. They trained these saviours of life to perform abortions; what a contradiction! Abortion is a gruesome business. From 6 weeks gestation after conception the foetus is clearly human. At 8 weeks, the foetus is 3 cm long and has limbs and facial features.

South Africa hospitals perform two types of abortions, surgical and medical abortions. In surgical abortions the vacuum extraction or dilatation and curettage (D & C) technique is used. The abortionist use sometimes a handheld specially designed syringed or hollow tube connected to an electrical pump to apply suction inside the cervix, removing the unborn foetus in the process, all in pieces. So it is understandable why nurses and doctors are revolting. Doctors and nurses see the pieces of the dismembered foetus as they come out. Worse of all, the nurses must scrap all the pieces together of the dismembered foetus to prevent infection and to make sure nothing is left behind. As a midwife for 25 yrs I am appalled that any health professional would want to be part of this "campaign of abortion."

In medical abortions the patient is given pills orally or vaginally to induce labour. Sometimes when the foetus is over 20 weeks, the baby is still alive and lives for a few hours. Nurses have to stand and watch a baby die and do nothing while the pregnant woman goes back to her normal life of promiscuity. No wonder so many of us want nothing to do with abortions. The ANC government did not take into account the feeling of the medical profession when they debated on this law.

Resultant from this particular law many midwives left the country; nurses found this law very contrary to their training and belief; anathema. Were the fact of the matter that a woman had a miscarriage or self induced abortion this would have been a different matter; to force nurses to abort women is enough to blow even the broadest of minds. There of course were numerous arguments in defense of the abortion act; the foremost being that it would help reduces maternal deaths. As it turned out it was the exact opposite, but rather an increase in the maternal death rate, coupled with severe trauma and depression. In a report published in the Pretoria News in 2004 it was estimated that 500 women died each year from legal abortions in South Africa compare with just 32 backstreet abortions. The Pretoria News surveyed 18 hospitals and each one admitted that pregnant women had died from legal abortions.

The law in question should definitely be revised since it is subject to abuse, being used as a contraceptive when it is in fact the ending of an innocent life. I don’t think we will have a change in the abortion law unless we have a change in government. The constitutional court has eight members and they are all pro-choice, all appointed by the present government.