Sunday, 4 December 2011

Rural birth for rural women

South Africa is a middle-income country and the richest in sub-Saharan Africa. It spends more on health per person than any other on the continent, and it provides this healthcare free, including services for pregnant mothers.. Despite these facts, according to the recent Human Rights Watch Report, our maternal mortality has more than quadrupled over the past decade (from 150-625 deaths per 100 000 women).

Rural women bear the brunt of these statistics due to lack of transport and inaccessible facilities.

I recently attended a conference at which, "how women access care" was being discussed. A recurrent issue identified, was that care was often inaccessible to women. The dialogue that followed focussed on how better roads were required, how more infrastructure was required to enable women to access care, and how this was very costly.

For a long time, this problem has been looked at from this perspective. Perhaps it is time to look at it from a different angle.

Instead of building better roads at great expense, maybe it is time to take the midwife back to the women.

Think of it this way. Think of yourself going into labour at night or maybe on the weekend. Think that your family has no vehicle. In fact there are very few vehicles in your village. Think that the at your last checkup the midwife had talked about how important it was to take your antiretrovirals through your pregnancy, and that in labour she would give you some medicine to stop the HIV being transmitted to the baby. Think of the nearest hopsital being 60km away and having no way to get there at night. Think of phoning the ambulance, but then remember how long you waited for them in your first labour. Remember the many stories of other women from the village, who have waited many hours for an ambulance, and who have given birth before the ambulance came. Think of the many women who have lost babies. Think of maybe walking the 15 minutes to the police station in labour, some women say that ambulance might come sooner if the police call the ambulance. That is if the police are there.

Then think about the little blue house next to the park. Think of the warm, friendly Thursday mornings, when all the women come for their checkups. Think of the comfortable double bed, the quietness of the birth house. Maybe you should phone Nomzamo and tell her that you think the pains have started.  It is 2am but the pains feel strong, you do not want to walk in the rain to the police station. You remember the way you were treated at the hospital when you gave birth to your first child, how impatient and harsh the nurses were. How will they be this time? Maybe you will call Nomzamo, she will know what to do. She told you you could call at any time, she will not be angry and she will fetch you in her car and take you to the birth house. There is a shower and toilet there, and you will be able to labour with privacy and Nomvula will look after you with Nomzamo. Yes, perhaps you will call.

When you think of it this way, although we do need roads, they suddenly do not feel as important as taking the midwife to the women.

Thursday, 20 October 2011

Maternal health in South Africa: Delivering Women's Human Rights

Over seventy students, lawyers, nurses, midwives, NGO staff from across Africa and other interested individuals packed a lecture hall on Wednesday 19 October for a panel discussion on maternal health in South Africa presented by the Centre for Human Rights. As the rate of maternal mortality more than quadrupled in South Africa in the last decade, the need to examine the related issues, challenges and opportunities is critical.

 To see photos and read the write up of the event please click here






Wednesday, 31 August 2011

Our first "Girl Talk"

In July, Unathi and I decided that we wanted to start to nurture the young girls in our community. There are many young girls and we felt that it would be good to provide a platform from which we could get to know the young girls in Hamburg and surrounding villages and to trickle the message to them that they are special.

Instead of telling them off, off instructing them not to fall in love, as the school system teaches, in order to avoid early pregnancies and HIV.  We thought a more effective route would be to encourage the young girls to start to see value in themselves. To realize that they are special and that they need to safe guard this specialness. That their lives have value and that they are each unique. We decided to have a Girl Talk day to open dialogue between the women and the young girls and to start to create a network of support fro the girls. The event was hosted at Vulendlela thanks to the generosity of Collette, and with the help of Andisiwe, Manjezi and Tiia. various individuals of the community of Hamburg contributed generously towards the day with money and food items, we really appreciated this assistance which made the day possible and affordable.

Around 50 girls attended, which was a lot of girls for the first of these days, advertised mostly by word of mouth. The day started with a welcome and then we all did some flower drawings to ease us into the day. When paints and papers were put away, Unathi had arranged guest speakers Ati bravely spoke first about her life story and choices she had made and that she might have made differently had she known the route her life would take. And then Sibongile Kumalo who spoke about choosing a career by doing a few fun group work exercises with the girls looking at personality types and ethical scenarios. We had a tasty lunch (curtesy of Unathi and family) where the young women served the girls and had planned to end the day with a movie but due to a technical difficulty had to cancel this.

All in all, it was a fun day and much enjoyed by everyone. We plan to do similar Girl Talks 4 times a year with the changing seasons, the second one being planned for October.

As the poster suggests 'Notyatyambo Masinonelelane' -"They are flowers let us hold them carefully'

Saturday, 21 May 2011

Private Clients Make Busfare Babies Possible

Busfare Babies seems to be taking on a life of its own. The first half of this year has been so busy that I have not had time to do much more than midwife and mother. I am realising an increasing need for some one to help with the administrative side of things as I have not got enough time in the days to do this.

Having not really focussed on fundraising, we are still trying to finance the running costs ourselves. Thankfully birth works so well, and a baby slipping into the world is not generally very expensive, but having no funding has meant that I have needed to take on private clients in order to afford to run the centre.

These clients have been such wonderful births that despite having to travel long distances (sometimes up to 3 hours each way) to attend them they have been worth every kilometer of travel. Births in Hamburg I find so beautiful in their simplicity and in the way women are able to labour with such focus. In the private sector, I am amazed at the unflailing determination of women to claim birth back as their own despite a private medical system that believes that a 60-80% cesarean section rate is acceptable.

I am sure Carina will not mind me telling her story here. After 3 cesareans Carina was determined that she would not have another cesarean. She felt that cesareans had been damaging physically and emotionally. She had been obsessed with normal birth since her first child was born by cesarean 9 years ago. This cesarean she felt was unnecessary and she felt the same way about the next 2 cesareans, all of which plunged her into deep post natal depressions which she struggled to shake.
With her fourth pregnancy she carried beautifully. Carina is tall and slim, with hips that no obstetrician could believe could birth a baby naturally. Her belly grew rounder and rounder and her pregnancy lasted longer and longer. She struggled with her own fears and with the concerns of her family and friends and the idea that her notion to have a home birth after 3 cesareans was foolish and risky. Thomas stood by her solidly. In his role of protector, he weathered the wait with her, not bowing to the opinions or pressures, he was a solid, unwavering rock of support.

Eighteen days after the estimated due date, labour started. Labour was slow and steady and I went to her in the night as I had a few nights previously. We slept on and off until labour strengthened and sleep was no longer possible then with the waves of labour we paced stronger times with sleepy times. Children went off to stay with helpful grandparents and there was time to focus on the labour. By the afternoon, Carina was weary and feeling despondent, the place many labouring women must journey through. The terrible place of impossibility. Carina mustered her strength in this difficult place, laying down all her fears and wishes and surrendering to a process that was so much stronger than herself. With this frightful surrender, and Thomas beside through each contraction, her labour strengthened and following a final, intense phase, she birthed her baby. All 4.180kg of baby boy from her own womb, all by herself, despite all the prophets of doom and their predictions of impossibility.

What a healing moment. It was as if she had birthed her fourth baby to make up for all the other births of her babies that she was not able to experience. The delight was tangible. The relief enormous.

For the next few days Carina reveled in the elation that comes from giving birth to a baby. The tiredness came, but this time she had a wholeness that made the tiredness manageable. She felt complete, like she had done this herself and was able and strong to go forward as a mother with confidence. In one of her sms messages she summed it up: ' O Karen, I am wonderful! Rupa is awesome! What a glorious experience giving birth is."

As a midwife there is not much that compares with the satisfaction of attending women who realise what it is that they want and go forward towards that strongly and resolutely.
The satisfaction that these woman feels after giving birth against so many odds is so powerful and incomparable with anything else and it is such a privilege to be in attendance.

It is births like these that fuel my work as a midwife. And it is wonderful that births like these make Busfare Babies possible at the moment and allow the women in these villages around Hamburg and Bodium to have these same experiences which would otherwise be so unaffordable.

Thank you Carina and all the other women that trust me to attend them through their pregnancies and labours and as they give birth to their babies and who make Busfare Babies possible.