The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.
OVERVIEW
A midwife is a nurse who specialises in the care of support of women and their babies, throughout pregnancy, birth and infancy. The term comes from Middle English and means “with woman”. It points to the core role of a midwife – to be at your side during your pregnancy, labour, and first few months with your new baby.
Midwives are usually not doctors. They work alongside obstetricians and gynaecologists to ensure you have access to any care you need. A midwife is recommended when your pregnancy is low-risk or if you have only mild complications.
Midwives provide a range of services:
- full antenatal care, including parenting classes, clinical examinations and screening
- identify high-risk pregnancies, and refer these to obstetricians where necessary
- monitor women and support them during labour and the birthing process
- teach new and expectant mothers how to feed, care for and bathe their babies
Midwives play a vital part in the healthcare system. They help women understand the emotional, physical and psychological processes of pregnancy and birth. When pregnancies do not go to plan, midwives can support and advise on stillbirth, miscarriage, termination, neonatal death and neonatal abnormalities.
According to the World Health Organisation (WHO): “Midwifery, where care includes proven interventions for maternal and newborn health as well as for family planning, could avert over 80% of all maternal deaths, stillbirths and neonatal deaths.”
MIDWIFERY IN SOUTH AFRICA
The majority of pregnant women in South Africa use the public healthcare system, and most of this care is provided by midwives. Our midwifery profession is regulated by the South African Nursing Council (SANC). Training includes aspects of midwifery, general nursing, community nursing and psychiatry, and can be achieved as either a four-year degree or a four-year diploma.
Midwives are not allowed to prescribe medication. Should you experience pregnancy complications, your midwife will refer you to a doctor for the necessary medical treatment.
Unfortunately, there has long been a shortage of midwives in South Africa, particular in the private sector. This is thought to be one of the reasons for the high rate of caesarean sections in private hospitals. It is also one of the reasons for widespread use of traditional midwives.
Traditional midwives, often referred to as an ababelithisi, have played an integral role in African medicine for centuries. Ababelithisi usually have no formal education but do have children of their own and decades of experience, and are highly regarded in their communities for their obstetric and ritual expertise. They provide all the care and advice that formal midwives do and are often the only resource available to expectant mothers in our underserviced rural areas.
THE DIFFERENCE BETWEEN A MIDWIFE AND A DOULA
The word doula means “female helper” in Greek. A birth doula is not a medical practitioner; they have no medical training, although they may have received training in the physical and emotional support of women during childbirth.
MoreHOW DO I DECIDE IF I SHOULD HAVE A MIDWIFE?
Working with a midwife is a personal preference. Some people prefer midwives, and others prefer obstetricians. A midwife might be for you if you have a low-risk, routine pregnancy and if you desire a more personalised relationship with the professional helping you with your pregnancy and delivery.
Statistics show that the more comfortable a woman is with her care-giver in pregnancy and birth, the better the outcome. Some advantages of using a midwife are:
- Less chance of induction or assisted delivery
- Less chance of caesarean birth
- Reduced use of epidurals or medication
- Less risk of third and fourth-degree perineal tears
- More flexibility for home births
- You have greater control over your care
- 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 wellbeing of both mother and baby
However, if you have a health condition that could complicate your pregnancy or delivery, close collaboration between your midwife and obstetrician is necessary.
Some of these conditions include:
THE DIFFERENT TYPES OF MIDWIVES
In South Africa, a midwife is generally defined as a Registered Nurse with a minimum of 4 years of training. However, there are different levels of midwives, including those with additional training or certifications, such as Certified Nurse-Midwives (CNMs). Lay midwives and traditional birth attendants also exist, though their practice may not be formally regulated.
- Registered Midwives (Registered Nurses with Midwifery Specialisation):
These midwives are registered nurses who have completed specialised midwifery training, typically 4 years of training. They work in various settings, including hospitals, clinics, and private practices, providing antenatal, intrapartum, and postpartum care.
- Certified Nurse-Midwives (CNMs):
CNMs are registered nurses with additional midwifery education and certification. They can practice in all birth settings, providing a full range of midwifery services, including prenatal, intrapartum, and postpartum care, and well-women care.
- Hospital employed midwives:
These midwives work in labour wards, antenatal clinics, caesarian section theatres and postnatal wards. They are required to follow the protocols and guidelines of the doctors and hospitals they work for.
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 practicing midwives:
Private practicing midwives work independently of hospitals, although their 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 Practicing Midwives Alliance in SA.
These midwives are on call 24/7 and make themselves available for any given time when labour begins.
HOW DO I CHOOSE A MIDWIFE?
Important considerations for choosing a midwife:
- Ensure the midwife you choose is registered with the South African Nursing Council. You need someone with a recognised medical qualification to give you the best advice on childbirth options. For example, did you know that water births are NOT recommended as they can cause flooding of your newborn baby’s lungs which are just starting to fill with air?
- Educate yourself during pregnancy as to your choices, options and rights. Choose a midwife who can support you should you be interested in a home birth, hospital birth, or a combination of the two.
- Discuss their availability and fees – each midwife practice has their own pricing structure.
Some questions you should consider before choosing a midwife are:
- Where will I deliver my baby?
- What kind of training do you have?
- How long have you been a midwife?
- How many births have you attended?
- What are your philosophies or values when it comes to childbirth?
- What kind of tests or screenings do you perform during pregnancy?
- Does medical aid cover any of your costs?
- Do you work with any local gynaecologist / obstetrician?
WHERE CAN I FIND A MIDWIFE?
As well as referrals from friends, family, or your doctor, you can also find links to independent midwives near you online. There are also websites that provide a registry of available midwives, like:
FURTHER READING
Visit these sites to learn more: