http://www.midwives-exclusive.co.za
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Heather Pieterse
Midwife, Founder, and Manager
38 Belrene St, Pretoria, South Africa
Midwives Exclusive is a family centred practice aimed at assisting women to have an empowered, safe, and positive experience of childbirth and early parenting. We are fierce advocates of the right of women to birth safely and with respect. We are also tireless advocates of midwives, providing an environment where they can practice safely and look forward to longevity of their profession.
In South Africa we have a diverse population. The rate of cesarean section is 75-80% amongst the high income population with medical insurance. Meanwhile, the low income population without medical insurance endures long queue’s and free care of questionable quality. There is a lack of facilities, chronic understaffing, and an absence of compassionate care due to work fatigue. Fear is a part of both spheres. Our midwife practice fits neatly in the middle, accommodating woman who are low risk and desire a natural, supported birth experience.
Midwives Exclusive focuses on low risk, healthy women. We use a private hospital facility and the state hospital system to refer women who fall outside this status. We serve a diverse socio-economic and cultural clientele. Those who want a natural birth seek us out knowing their best chance is with a midwife in South Africa. Our target population is pretty much anyone who wants information and honesty in order to make critical decisions as to their birth choices. Our clients include young unmarried mom’s with unplanned pregnancies, date rape victims, women who just want a fair chance of natural birth, fanatical birth advocates, adoption cases, and diplomats living in South Africa (being the capital, Pretoria has many embassies).
We practice at several locations. The hub of Midwives Exclusive is a free standing birth centre, known affectionately as the ‘birth house’. Midwives Exclusive also manages a midwifery unit in a private hospital in Pretoria. We also do home visits. Births are offered at the venue that the patient chooses: free standing birth house, hospital birth unit, or home. Our care remains the same regardless.
Midwives exclusive is not a charity organisation. However, the fees charged for our services are considered a good monetary value. Our fees are less expensive than most private care in South Africa and are affordable to most who cannot afford private hospital care. If a woman is a suitable candidate for our care but cannot afford the fees, we offer a greatly discounted rate or free care. This occurs for about 20% of our clients. We can sometimes offer a sponsorship through the generosity of previous clients.
Our goal is safety with compassion. More than 22 years of outcome data show that Midwives Exclusive is a safe and affordable alternative for healthy mothers who desire a natural birth.
Services
- Birth option workshops
- Birth trauma release for those with additional trauma’s to help clear the path for a positive birth experience
- Antenatal care
- Trauma counseling
- Sonars
- Childbirth prep workshops, natural birth workshops, antenatal classes
- Birth, including water birth
- Post-birth care – home visits
- Post birth trauma relief/debriefing to help start the healing process
- Breastfeeding support
- Well woman’s clinic support and newborn vaccinations
- Newborn hearing screening
- Mom and baby Yoga
- Various post birth workshops
- Pelvic floor health with a physiotherapist (pre and post birth)
- Pregnancy massage
- Infant massage
- Infant CPR, choking response training, and first aid for parents and other providing infant care
- Community/eco friendly initiatives
Other features of our practice:
We feel strongly and actively encourage the growth of young midwives through apprentice opportunities and job shadowing. We encourage midwives in training to work alongside us and we hope to help them launch into independent practice. Whilst we offer one on one care within our practice, we are closely followed by a back up team approach. This also means that our midwives have time to take care of themselves. Our patients are assured of midwife support from a rested and equally passionate midwife at all times, even if it can’t be with their primary midwife at all times.
We are a breastmilk reserve bank and collect donor milk for South Africa Breastmilk Reserve (SABR), a non profit, human milk banking organisation.
We collect 2nd hand baby and maternity items for distribution to homes for unmarried mom’s and places of safety.
As an environmental project, we gift a Spekboom tree (Portulacaria afra) to our newborns. These small succulent trees are known for their ability to effectively absorbs CO2. We hope to encourage our parents to raise their children with environmental awareness. So far we have adopted more than 350 little Spekboom trees to our newborns. We grow these trees from leaf and plant them for gifting in used cardboard take-away coffee cups we collect.
Outcome Data
In the past year (2021), 334 women initiated prenatal care at the center and 135 births were completed at center. There were 77 transfers for care elsewhere, including 19 mothers in labor, 4 postpartum mothers, and 3 newborns.
We would also like to re-print here a historical review of Midwives Exclusive outcome data for the years 2012 to 2019, compiled by Sr Christel Jordaan:
From the beginning of 2012 to the end of 2019 Midwives Exclusive assisted with an average of 233.5 births per year. This is a total of 1868 births over a period of 8 years. There have always been 4 full- time midwives and a few visiting or part-time midwives assisting with births. The policy of Midwives Exclusive is to care for women with low risk pregnancies. Women are referred to the public or private maternity care sector if complications arise. The statistics described below are only related to outcomes during labour and after birth. Women referred during pregnancy for medical conditions or other complications are not included in these statistics.
The preference of birth venue differed from year to year. In 2014 70.1% of births occurred in a birth unit attached to a maternity hospital. This percentage was 55.5% in 2019 with 32.8% of women preferring to birth at the practice’s birth home and 8.9% of women birthing in their own homes. Necessary transfer and handover to the public sector due to complications during labour fluctuated. Only 3 women (1.3%) were transferred during 2016 whereas 11 (4.5%) were transferred to the public sector during 2017. During 2019 9 women (3.8%) needed transfer. Women with medical aid cover or the financial means to pay for private hospital care are transferred to a private healthcare facility.
Normal vaginal birth rates were the lowest during 2014 when 71.7% of women had normal births. The assisted birth rate was 10.2% during that year whilst the caesarean section rate was 18%. These statistics have improved. In 2019 80.9% of Midwives Exclusive clients had normal vaginal births; 5.5% had instrument assisted vaginal births and 13.6% had caesarean sections.
Water births have gained popularity. During 2014 46% of women had water births compared with 69% in 2018 and 59.5% in 2019.
Intervention rates have consistently been low. In 2017 induction of labour occurred in 5.3% of all cases (excluding planned caesarean section) and 3.8% in 2019. Augmentation of labour was used in 9.9% of labouring women during 2019. Midwives became less inclined to perform artificial rupture of membranes (AROM) between 2012 and 2019. AROM was perform in 35.4% of cases in 2012 and 2013 and 27.6% of cases during 2019. The use of epidural analgesia has fluctuated between 0.8 and 1.2% except for 2018 in which 2.5% of women used epidural analgesia. This was influenced by anaesthetist availability and backup obstetrician preference. Cases of post-partum haemorrhage (PPH) are reported when blood-loss is estimated at more than 500ml during a normal birth and more than 1000ml during a caesarean. Over the past two years PPH was reported after 22 out of 278 births (7.9%) in 2018 and 17 out of 235 (7.2%) in 2019. In 2018 three women were admitted in high care as a result of the haemorrhage and in 2019 no women needed admission to high care. Midwives Exclusive had no maternal deaths between 2012 and 2019. No maternal deaths have occurred in the history of the practice.
The status of the perineum is reported after each natural or assisted birth. Midwives Exclusive midwives performed between 5 and 11 episiotomies per year which is usually between 2.3 and 3.2%. In 2016 and 2019 there were no reported 3rd or 4th degree tears needing repair in theatre. There were no more than three such significant tears in any other year. ‘Intact perineum’ was reported in 33 – 42.2% of women between 2012 and 209.
With regards to neonatal outcomes the practice reports the number of neonatal intensive care (NICU) admissions; Apgar scores of equal to or below 7 at 5 minutes and overall stillbirth rate and infant loss. NICU admissions are dependent on numerous factors including varying criteria used by paediatricians in the private sector. Admissions occurred in 4.3% in 2012 and 2013; peaked at 6.5% in 2017 and went down to 1.4% in 2018. There were 4.3% admissions in 2019. Reasons for admission have included jaundice, infection, Rh incompatibility, prematurity, congenital heart defects, problems related to complicated births and short-term respiratory distress. Between 2012 and 2019 Midwives Exclusive’s midwives were involved in the births of 3 women who experience intra-uterine foetal demise during the third trimester. There have been no occurrences of foetal demise during the process of labour. One case of early neonatal death occurred which was declared an ‘idiopathic unexplained new-born death’. The combined rate of overall foetal loss and neonatal death after 24 weeks was thus 4/1868 (0.2%).