BY Heather Pieterse, Midwife in Private Practice

The term midwife is derived from Middle English: mid = “with” and Old English: wif = “woman”. A midwife is a health care professional who, in partnership with the woman provides care, education and support during pregnancy, birth and postnatal period, thus facilitating parenting. The World Health Organisation states that “…midwives are the most appropriate primary health care providers to be assigned to the care of normal birth”. In South Africa a midwife is a Registered Nurse with minimum of 4 years training.

Midwifery qualifications are part of the overall Registered Nurse training programme. The qualification can be obtained either as a diploma (at a University) or a degree (at a nursing college). Midwives work in different settings, determining their roles:

Hospital employed midwives:

  • These midwives chose to work in a hospital environment and are employed by an institution
  • They work shifts and are allocated to care for specific patients whilst on duty.
  • These hospital midwives are required to follow the protocols and guidelines of the doctors and hospitals they work for.
  • You will find these midwives in labour wards, antenatal clinics, c/section theatres and postnatal wards.
  • In public sector hospitals, midwives conduct all the low-risk normal deliveries, only calling in a doctor or gynaecologist should certain complications arise.
  • In private sector hospitals, the midwives in the unit will care for women throughout labour, but will call the gynaecologist when the patient is close to giving birth so that he/she can conduct the delivery.

Private practising midwives:

  • Private Practising Midwives have chosen their career path in Private Practice rather than working for a hospital. The training and qualifications are the same.
  • They work for the individual families who employ them to care for them during their pregnancies and births.They follow specific protocols and guidelines set out by the Private Practising Midwives Alliance in SA.
  • These midwives have a rare quality about them as they are passionate and truly believe in natural birth.
  • They commit themselves to the care of these families being on call 24/7 and making themselves available for any given time when labour begins.

Midwifery – With Women

Midwifery is traditionally holistic, combining an understanding of the social, psychological, spiritual and physical aspects of a woman’s reproductive experience. Midwives promote wellness in women, babies and families, both in their own right and in collaboration with other health care professionals. Most midwives are in no way opposed to medical intervention, but rather believe that most women with low risk pregnancies can safely give birth naturally with little or no intervention unless medically necessary.

Although midwifery is one of the oldest professions, the medicalization of childbirth in the last century has suppressed the midwifery model of care as well as women’s right to make decisions about their bodies and their births. This is changing, though. Midwifery has been reborn once again and is increasingly developing and growing a voice, both in South Africa and internationally. Women are progressively taking back control over their birth choices. Each woman should be able to choose what type of birth she would ideally want and have a right to the care that will safely facilitate this passage. In today’s world it is unacceptable to be pushed into a direction without having any choice in it especially when it comes to something as sacred as the birth of your baby.

Women deserve safe options in childbirth. They have the right to make educated, informed decisions about their health care including the choices they have for maternity care providers and birth locations. All women need to be treated with dignity and respect. Birth is an event whereby a woman’s life is inevitably transformed. It is a powerful and sacred process and women have a right to a model of care that will safely facilitate this passage with patience, intuition, skill and compassion. An empowering birth experience sets the stage for infant-mother and family bonding, the effects of which last a lifetime. These statements encompass the heart of a midwife.

Some advantages of midwife-led care include:

  • Statistics show that the more comfortable a woman is with her care-giver in pregnancy and birth, the better the outcome. You will form a close bond with your midwife during your prenatal care.
  • A midwife stays with her patient throughout labour and birth. The support of a familiar and trusted figure is tremendously reassuring to the mother and can help to minimise unnecessary medical interventions.
  • Midwives will promote early bonding between mother and child, which contributes to higher rates of successful breastfeeding.
  • A midwife will conduct home visits during the days after the birth to check up on the well being of both mother and baby.
  • A midwife will respect the preferences of her patient, but will not hesitate to refer either mother or baby to another professional if she judges this to be in their best interests.
  • The midwife practice has specific protocols and guidelines based on Evidence based care and ACOG.

Midwifery is a partnership, based on mutual respect, between the midwife, her patient (and family) and other medical professionals (obstetrician, paediatrician and dietitian). It also includes other professionals like the reflexologist, the chiropractor, the osteopath and the homeopath.

To practice as a Midwife in SA you need to be registered:

  • SA Nursing Council (SANC) – stipulates the scope of practice of a midwife and gives us our guidelines for practising.
  • Board of Health Fund (BHF) – issues practice numbers for private midwifery practices, BHF is the body that is associated with the medical aids and sets the practice codes for claiming of fees
  • It is a highly recommended that independent midwives are linked with various associations to ensure accountability and up to date practice amongst their contemporaries:
    • The Private Practising Midwives Alliance (PPMA)
    • Society of Midwives, South Africa (SOMSA)
    • Society of Private Nurse Practitioners (SPNP)

Midwives LOVE their calling. It’s hard to imagine doing anything more rewarding than being present at a birth, making a lifelong difference in people’s lives!